癌基因c-fos、c-jun蛋白在鳞状细胞癌皮损中的表达及意义

目的　探讨癌基因c fos、c jun的表达与皮肤鳞癌发生和发展的关系。　方法　采用免疫组化法对 6 0例皮肤鳞癌的c fos、c jun的表达情况进行检测 ,并与正常皮肤组织进行对照。　结果　c fos、c jun在正常皮肤组织不表达 ,在皮肤鳞癌中的表达阳性率分别为 6 1.7%和 4 8.3% ,其表达水平与癌组织的分化程度有关 (P <0 .0 5 ) ,肿瘤的分化程度越高其表达水平越高。　结论　c fos、c jun的表达水平可作为判定皮肤鳞癌分化的指标。     

儿童下呼吸道博卡病毒混合感染的临床分析

目的 研究博卡病毒混合感染对儿童急性下呼吸道感染临床特征的影响,分析其高危因素。方法 收集2017年11月-2019年10月苏州大学附属儿童医院呼吸科因急性下呼吸道感染住院儿童的鼻咽分泌物标本3 350例,进行呼吸道多病原学检测。结果 3 350例标本中博卡病毒(hBoV)阳性167例(5.0%),其中hBoV单纯感染102例(61.1%),混合感染65例(38.9%),混合感染主要病原有病毒26例(15.6%)、肺炎支原体16例(9.6%)、细菌11例(6.6%)、混合2种以上病原12例(7.2%)。hBoV单纯感染、hBoV混合病毒、hBoV混合支原体、hBoV混合细菌和hBoV混合2种以上病原各组在咳嗽、喘息、发热、呼吸困难、肺部啰音、住院时间等方面比较,差异均无统计学意义(P＞0.05)。hBoV混合细菌感染组发生重症肺炎的比例高于hBoV混合病毒及hBoV混合支原体感染组(χ²=15.648, P＜0.05)。Logistic回归分析显示入院前病程＞7 d是混合感染的独立危险因素(OR=1.040, 95%CI:1.002~1.079)。结论 hBoV有较高的混合感染率。hBoV混合细菌感染可能会加重病情。入院前病程＞7 d的患儿应警惕hBOV混合感染。     

Improving trauma care in exsanguinating patients with CHOP (critical haemorrhage to operating-room patient) resuscitation protocol—A cumulative summation (CUSUM) analysis

IntroductionThe standard protocol for exsanguinating trauma patients involves initial evaluation and resuscitation in the emergency department which then sets the stage for subsequent definitive care and disposition. This involves major coordination and mobilisation of resources which may cause a delay in intervention especially when most of these cases present after office hours. Our centre has employed a second-tier activation system (CHOP protocol) that immediately mobilises all respective trauma specialists including interventional radiologists and allows rapid access to the operating room.ObjectiveWe hypothesised that exsanguinating patients managed by CHOP protocol have better overall outcome and survival.MethodsWe identified trauma patients that fulfilled CHOP criteria from 2016 to 2019 and divided them into two groups: preCHOP (standard protocol) and CHOP. Data was extracted from a prospectively maintained trauma registry. Demographics, injury pattern and in-hospital data were analysed. The key outcome studied was the impact of CHOP protocol on the mortality rate. Success and failure of the two groups were analysed using CUSUM methodology.ResultsThirty-seven patients were managed by CHOP protocol since its introduction in March 2018 compared to 36 patients who underwent standard protocol. Majority of the cases were blunt trauma (89% CHOP vs 92% preCHOP). The mean Injury Severity Score was 37 for CHOP group and 39 for preCHOP group. We observed a significant improvement in time to intervention in CHOP patients (78 min vs 113 min), both during and after office hours. CHOP patients had lower mortality compared to preCHOP group (11% vs 31%) and the effectiveness of the protocol was seen in achieving significantly lower mortality compared to the predicted model. CHOP protocol was able to produce a consistent trend of desired outcomes leading to the CUSUM curve exhibiting a sustained downward slope.ConclusionThe CHOP protocol, a relatively novel system in the local context, was able to achieve sustained improved outcomes compared to standard protocol. The CUSUM analysis concurred that implementation of CHOP protocol has helped to achieve consistent desired outcomes. It also suggested that the uptake and use of this protocol has integrated well into the existing workflow.     

昆山郑氏妇科二十九代世医考

江苏昆山郑氏妇科世医、代代相传二十九世,历经宋,元、明、清、民国、迄今已有近８００年历史,堪与江南何氏二十九代世医媲美,成为中外医学史上罕见的奇迹。整理其家谱、墓志,方志,文稿,医著等传世文献资料,地郑氏二十九代妇科的世系,医家传略,医术,著述等进行了较详细的考证和整理,并编绘了世系图。     

替勃龙联合更安宁对雌性去势大鼠血管内皮细胞的保护作用

目的:观察替勃龙联合补肾中药(更安宁)在雌性去势大鼠加高脂饮食状态下,对血管内皮细胞的保护作用。方法:9月龄雌性Sprague-Dawley大鼠50只,随机分为假手术组(SHAM)、卵巢切除组(OVX)、卵巢切除后药物联合治疗组(OVX+E)、高脂血症组(OVX+HC)、高脂血症药物联合治疗组(OVX+HC+E)。在卵巢切除术后14d起,OVX组、OVX+HC组给予生理盐水灌胃,OVX+E组、OVX+HC+E组予替勃龙+补肾中药更安宁溶液灌胃,OVX+HC组、OVX+HC+E组同时喂饲高脂饮食。12周后处死大鼠,测定血浆雌二醇(E2)、高密度脂蛋白(HDL-c)、低密度脂蛋白(LDL-c)、胆固醇(Tch)、甘油三脂(TG)、一氧化氮(NO)、血管性假性血友病因子(vWF),在光镜及电镜下观察主动脉管壁结构的改变。结果:OVX+E组与OVX组相比,OVX+HC+E组与OVX+HC组相比,均表现Tch、LDL-c明显降低,HDL-c明显升高,血浆NO含量增加;OVX组存在轻度动脉粥样硬化坏死,OVX+HC组动脉管壁损伤严重,伴随vWF明显升高;OVX+E组与OVX+HC+E组动脉管壁结构正常。结论:替勃龙联合补肾中药更安宁治疗能保护血管内皮细胞,对抗高脂血症对动脉管壁的损伤。     

昆山市糕点类食品检测结果分析

目的：了解昆山地区食品生产企业所生产的糕点类食品卫生指标现状,为卫生监督人员在卫生监督执法和卫生评价时提供科学依据.方法：抽检昆山地区20家食品生产单位172份糕点类食品样本进行卫生细菌、致病菌、酸价、过氧化值、总砷、铅等检测.结果：共检测糕点类食品标本172份,其中165份样本卫生指标符合国家标准,合格率为95.93%,不合格样本主要是微生物超过国家标准,该类产品均为小作坊类单位所生产.结论：应加强对食品生产企业特别是小作坊类单位的卫生监督监测和卫生知识宣传.     

1例重症嗜肺军团菌肺炎患者的抗感染治疗分析

目的:探究重症嗜肺军团菌肺炎患者的抗感染治疗方案.方法:临床药师参与1例经第2代测序技术(next-generation sequencing,NGS)检测为嗜肺军团菌感染患者的抗感染治疗过程,协助医师调整抗感染治疗方案,识别药品不良反应.结果:经治疗患者感染症状得到控制,病情好转出院.结论:临床药师参与重症嗜肺军团菌...     

陈红风治疗乳腺癌中的扶正观

介绍陈红风教授治疗乳腺癌的临床经验。认为乳腺癌的发病与气血亏虚,肝、脾、肾及冲任二脉功能失调有关;治疗时重视通过调摄冲任以扶正、调理脏腑以祛邪。并附病例1则。     

针刺、拔罐、神灯照射配合穴位敷贴治疗周围性面瘫30例

[目的]观察针刺、拔罐、神灯照射配合穴位敷贴治疗周围性面瘫疗效。[方法]对30例门诊患者,使用针刺、拔罐、神灯照射配合穴位敷贴治疗。连续治疗20d为1疗程。连续治疗1疗程,随访30d例,判定疗效。[结果]痊愈27例,显效3例,总有效率100%。[结论]针刺、拔罐、神灯照射配合穴位敷贴治疗周围性面瘫可缩短治疗时间,提高治疗效果。