Gene polymorphisms of insulin secretion signaling pathway associated with clopidogrel resistance in Han Chinese population

BackgroundDue to the loss of responsiveness to insulin, diabetes mellitus (DM) patients develop increased platelet reactivity and reduced response to antiplatelet agents. Nevertheless, the relationship between the single‐nucleotide polymorphisms (SNP) of the signal pathway gene of insulin secretion and the effect of clopidogrel is elusive.MethodsBlood samples were collected from patients administered with dual‐antiplatelet therapy (clopidogrel, 75 mg, once daily and aspirin, 100 mg, once daily) after 5 days and completed test within 4 h. The VerifyNow P2Y12 assay was used to measure the platelet functions, and the results were expressed as a P2Y12 reaction unit (PRU). Notably, the selected SNPs were analyzed to demonstrate the functionality of genetic variants.ResultsAnalysis of the study population showed that old age, lower plasma albumin (ALB) level, higher creatinine (CREA) level, higher uric acid (UA) level, lower platelet (PLT) count, and lower plateletcrit (PCT) potentially increased the risk of clopidogrel resistance. In a single‐nucleotide polymorphism rs6056209 of the PCLB1 gene, the AG genotype was a risk factor for clopidogrel resistance (p < 0.05, OR = 1.574). Similarly, the CC and AG genotype in GNAS rs7121 and CCKAR rs1800857 were protective factors (p < 0.05, OR = 0.094; p <0.05, OR = 0.491). TT was a protective factor in rs10814274 of the CREB3 gene (p < 0.05, OR = 0.444). In the RAPGEF4 gene polymorphism rs17746510, TG was the protective genotype, and the TT genotype was a risk factor for clopidogrel resistance. GCG rs5645 was confirmed; there was a relationship between genotypes containing A or G and clopidogrel resistance.ConclusionSingle‐nucleotide polymorphisms of insulin secretion signaling pathway genes trigger clopidogrel resistance.     

丙戊酸钠单药治疗儿童癫痫对血脂水平影响的Meta分析

目的:系统评价丙戊酸钠单药治疗儿童癫痫对血脂水平的影响。方法:系统检索中国知网、万方数据库、PubMed、the Cochrane Library、Embase数据库中的病例对照研究、队列研究及横断面研究,由2名研究人员独立按照纳入标准及排除标准筛选文献,提取资料和评价文献质量后,应用RevMan 5.3软件进行Meta分析。结果:20篇文献纳入Meta分析,均为病例对照研究,累计病例组586例,对照组1155例。Meta分析结果显示,两组总胆固醇[SMD=0.24,95%CI(-0.11,0.58)]、甘油三酯[SMD=0.28,95%CI(-0.06,0.62)]、高密度脂蛋白[SMD=0.12,95%CI(-0.16,0.39)]、低密度脂蛋白[SMD=0,95%CI(-0.31,0.32)]比较,差异均无统计学意义(P均>0.05)。结论:基于目前的证据可认为,丙戊酸钠单药治疗对癫痫患儿的血脂水平无影响,但鉴于纳入文献质量较低及样本量较少的问题,本研究结果仍需大样本、高质量文献进一步验证。     

腹腔镜手术器械绝缘性能故障检测相关性研究

目的对腹腔镜手术器械绝缘性能故障进行统计分析,并提出应对措施,以保障患者和操作者安全。方法采用目测法和仪器检测法分别对399件腹腔镜手术器械进行绝缘性能检测,比较两种方法检测腹腔镜手术器械绝缘性能的差别,分析绝缘故障的原因;并通过问卷调查的方法,了解腹腔镜手术器械绝缘性能临床现状。结果目测法和仪器检测法检出腹腔镜手术器械绝缘层故障率分别为38.6%和44.86%,绝缘层故障可发生于器械前端、中部、末端、手持部等任何部位。两种方法检出器械绝缘故障的种类、位置存在显著性差异(P<0.05)。结论腹腔镜手术器械存在较普遍的绝缘层故障,通过目测法和仪器检测法相结合的方法可提高器械绝缘层故障检出率,保障患者和医务人员安全。     

不同囊袋处理方法在永久性心脏起搏器更换术中的应用

目的：探讨不同囊袋处理方法在永久性心脏起搏器更换术中的临床应用。方法96例永久性起搏器更换患者,50例[年龄（72±177;6.2）岁,起搏器植入时间（8.3±177;2.6）年]在原囊袋中植入新起搏器（传统囊袋组）,46例[年龄（71±177;10.4）岁,起搏器植入时间（8.7±177;2.2）年]切除原囊袋,充分止血后在新囊袋中植入新起搏器（新囊袋组）。观察术中两组的起搏囊袋处理时间,术后随访6个月,比较两组血肿发生率,囊袋感染率,并对患者行舒适度评估。结果传统囊袋组囊袋处理时间（2.6±177;1.6）min,血肿发生率12.0%（6/50）,囊袋感染率4.0%（2/50）,体温增高发生比例20.0%（10/50）,患者满意度72.0%（36/50）。新囊袋组囊袋处理时间（3.4±177;1.3）min,血肿发生率6.5%（3/50）,囊袋感染率0,体温增高发生率8.7%（4/46）,患者满意度93.5%（43/46）。血肿发生率、囊袋感染率、体温增高发生率、患者满意度新囊袋组优于传统囊袋组（均P＜0.05）。结论起搏器更换术中,常规切除原起搏器囊袋有利于降低血肿及囊袋感染发生率,提高患者满意度。     

Association between smoking during pregnancy and breastfeeding at about 2 weeks of age.

Maternal smoking during pregnancy may decrease breastfeeding, in part perhaps by decreasing milk supply; furthermore, prenatal smoking is a predictor of postpartum smoking. In this study, birth certificate data, including maternal smoking, for 1998 Oregon resident live births were linked to newborn screening data obtained from Oregon's Newborn Screening Program (NSP), allowing study of risk factors for failure to breastfeed. NSP collects information on infant feeding before newborn discharge and again at about 2 weeks postpartum. Feeding data and risk factor data were available after a probability match of the newborn screening and birth certificate data sets, respectively, for 36,324 (80.3%) of the 45,228 resident live births. Prenatal maternal tobacco use was significantly associated with failure to exclusively breastfeed at about 2 weeks of age (adjusted odds ratio = 2.08, 95% confidence interval = 1.94, 2.21). Women who smoked during pregnancy were less likely to breastfeed than women who did not smoke during pregnancy.     

对129位乡镇卫生院院长的调查报告

乡镇卫生院及其院长在我国农村卫生的改革与发展中起着举足轻重的作用。通过对129位乡镇卫生院院长的调查，结果表明：当前乡镇卫生院院长素质偏低；现有院长3任用渠道单一化；院长对当前乡镇卫生院处于困境的原因看法有失偏颇；“等、要、靠“思想严重等，已成为制约乡镇卫生院改革与发展的瓶颈。只有针对性地解决这些问题，乡镇卫生院乃至整个农村卫生才能健、持续发展。     

把脉湖南乡镇卫生院的改革与发展

乡镇卫生院能否以及多大程度上得到发展，直接关系整个农村卫生改革与发展的成效。业已存在的“体制不顺、投入不足、布局不合理、认知偏差、设备陈旧、人员素质偏低、外环境紧”等，使湖南乃至全国的乡镇卫生院内外交困。只有理顺体制、搞活机制、明晰功能、严格管理、整治好环境，湖南乃到全国的乡镇卫生院才能走出困境，持续发展。     

运动行为改变评定量表的汉化及其在我国高血压患者中应用的信度效度检验

目的:翻译运动行为改变评定量表(Measuring Change in Physical Activity Questionnaire,MCPAQ)并验证其在我国高血压人群中应用的信度和效度.方法:对MCPAQ进行汉化及跨文化调试.采用便利抽样法,于2020年11月至2021年1月对长沙市2个主城区4家社区卫生服务中心...     

肝动脉药盒灌注氟脲苷联合全身化疗治疗不可切除老年结直肠癌肝转移

目的 探讨经肝动脉药盒灌注（HAI）氟脲苷（FUDR）联合全身化疗治疗不可切除老年结直肠癌肝转移患者的疗效及安全性.方法 对18例不可手术切除的老年结直肠癌肝转移回顾性分析.所有患者采用一种改进的介入方法植入肝动脉药盒,术后第2天开始接受HAI FUDR联合全身化疗.对治疗疗效、毒副反应及随访结果进行分析.结果 18例患者的总有效率为94.4%,其中完全缓解1例（5.6%）,部分缓解16例（88.9%）,疾病进展1例（5.6%）.8例患者转化为可手术切除,转化率为44.4%.中位无进展生存时间为26.0个月,中位总生存时间为30.2个月.结论 HAI FUDR联合全身化疗是治疗不可切除老年结直肠癌肝转移的一种安全有效的方法,可获得较高的手术切除率.