8年间剖宫产率及指证变化的临床分析

近年来，我国各地的剖宫产率均呈明显的上升趋势，部分地区的剖宫产率甚至高达60％。居高不下的剖宫产率已引起了广大产科工作者和全社会的广泛关注。对我院近8年来剖宫产病例的临床资料进行回顾性分析，以寻求剖宫产率逐年上升的原因及探讨降低剖宫产率的途径与方法。     

CT影像学评分预测急性胰腺炎病情及转归的研究

目的 探讨CT影像学评分对急性胰腺炎病情和转归的预测价值。方法 回顾性分析入院后经CT检查的急性胰腺炎46例，按一定的规则对每例患进行CT影像学评分与分型，并与临床治疗中的有关资料进行对照。结果 46例患CT评分后获得：轻型24例，中型13例，重型9例。轻型患较重型住院日少、恢复顺利，中转手术及死亡率均以重型为高。结论 CT评分对急性胰腺炎病情及预后评估具有重要意义。     

Long-term persistent immunogenicity after successful standard and triple-dosed hepatitis B vaccine in hemodialysis patients: A 3-year follow-up study in China

BackgroundAlthough the efficacy of hepatitis B vaccines among hemodialysis patients has been documented, the long-term persistence of immunogenicity in this population remains largely unknown. We explored the long-term persistence of immunogenicity induced by different hepatitis B vaccine regimens in hemodialysis patients.MethodsIn initial study, we conducted a randomized, multicenter, double-blind, parallel-controlled trial among hemodialysis patients in 13 hospitals in Shanxi Province, China. A total of 352 hemodialysis patients were allocated to receive 3-dose 20 μg (IM20 group) and 3-dose 60 μg (IM60 group) recombinant hepatitis B vaccine at months 0, 1, and 6. Vaccine-induced immune responses were measured at month 7. In this study, the responders (anti-HBs ≥ 10 mIU/mL) were followed up at months 18, 24, 30, 36 and 42, respectively. We used the generalized log-rank test and generalized estimating equations (GEE) to analyze the long-term durability of responses and the kinetics of anti-HBs levels, respectively.ResultsA total of 284 patients were involved in the extended follow-up period. The duration of vaccine-induced response with 75% of patients maintained protective antibody were 12 months and 18 months in the IM20 group and IM60 group, respectively (P = 0.291). The long-term persistent immunogenicity induced by 3-dose 60 μg was more satisfactory than that by 3-dose 20 μg hepatitis B vaccine in patients with hemodialysis duration ≥ five years (P = 0.023). The peak anti-HBs levels in 100–1000 mIU/mL or ≥ 1000 mIU/mL were more likely to maintain long-term protective antibody compared to anti-HBs levels in 10–100 mIU/mL (P ＜ 0.05). The kinetic profile was similar between the two groups (P = 0.334).ConclusionHigh-dose 60 μg hepatitis B vaccine could lead a satisfactory long-term durability of immunogenicity among patients with hemodialysis duration of five years or more. Peak anti-HBs level after vaccination was associated with the long-term persistence of immunogenicity.     

雷帕霉素抑制LPS诱导的RAW264.7细胞表达和释放HMGB1的机制

目的：探讨雷帕霉素抑制LPS诱导小鼠RAW264.7细胞表达和释放HMGB1的作用机制。方法:传代培养的小鼠RAW264.7细胞分5组接种于6孔板，即仅加培养液的对照组；加250 μg/L LPS的诱导组； 诱导组基础上加100 μg/L雷帕霉素的干预组；干预组基础上加rTNF-α 50 μg/L的抗干预组；及抗干预组基础上加抗鼠TNF-α 100 μg/L的抗体中和组。培养4 h后，ELISA法检测对照组、诱导组和干预组上清液中TNF-α水平；培养24 h后，RT-PCR和Western blotting法分别检测各组细胞内HMGB1 mRNA表达水平和上清液中HMGB1含量。结果:培养4 h，干预组上清液中TNF-α水平与对照组比无显著差异（P>0.05），但明显低于诱导组（P<0.05）；培养24 h, 与对照组比，诱导组细胞内HMGB1 mRNA表达明显增强（P<0.05），上清液中HMGB1含量也明显增多（P<0.05）；干预组明显减少了HMGB1 mRNA表达及上清液中HMGB1含量（P<0.05）； 与干预组比，抗干预组细胞HMGB1 mRNA表达及上清液中HMGB1含量明显增加（P<0.05）；抗体中和组细胞HMGB1 mRNA表达水平及上清液中HMGB1含量和干预组无显著差异（P>0.05）。 结论:雷帕霉素抑制LPS诱导RAW264.7细胞表达和释放HMGB1，可能部分地与其抑制TNF-α的表达有关。     

絮刺火罐疗法治疗颈椎病疗效观察141例

目的　观察絮刺火罐疗法治疗颈椎病的疗效。方法　将患者随机分为两组 ,一组运用传统的颈椎牵引法治疗 ,另一组运用絮刺火罐疗法治疗。结果　治疗 1星期时两组疗效没有明显差异 ( P>0 .0 5 ) ,治疗 2星期后絮刺火罐治疗组疗效优于传统牵引组 ( P<0 .0 5 )。结论　絮刺火罐疗法是治疗颈椎病的较好方法     

康柏西普及光凝治疗弥漫型糖尿病性黄斑水肿的效果

目的:比较单纯康柏西普玻璃体内注射、单纯黄斑格栅激光光凝及二者联合治疗对弥漫型糖尿病性黄斑水肿(DME)的效果。方法:回顾性研究。将2016年8月至2019年10月长治医学院附属和平医院弥漫型DME 74例(82眼)分为单纯康柏西普玻璃体内注射组(A组,31眼)、单纯黄斑格栅激光光凝组(B组,24眼)和康柏西普联合激光光凝组(C组,27眼)。治疗后随访6个月,观察比较治疗前后视力、黄斑中心区厚度、FFA及注射次数。结果:治疗后A组和C组BCVA及黄斑中心区厚度(CMT)均较治疗前改善(P<0.05);B组治疗后BCVA无改善;B组CMT治疗后1个月无改善,治疗后3及6个月CMT下降(P<0.05)。治疗后BCVA及CMT的改善程度A组和C组差异无统计学意义,但均优于B组(P<0.05)。治疗后6个月FFA改善率3组间差异无统计学意义。治疗后6个月内康柏西普平均注射次数C组少于A组(P=0.001)。结论:康柏西普玻璃体内注射联合黄斑格栅激光光凝与单纯康柏西普注射治疗弥漫型DME效果相近,均优于单纯黄斑格栅激光光凝;黄斑格栅激光光凝可减少康柏西普注射次数。     

Seasonal influenza vaccination among cancer patients: A systematic review and meta-analysis of the determinants

Cancer patients are among high-risk individuals for whom seasonal influenza vaccine (SIV) is recommended, but rates of vaccination in this subpopulation remain suboptimal; even in jurisdictions with universal influenza vaccination programs. We sought to summarize the evidence to better understand the determinants of SIV uptake (vaccine receipt) among cancer patients. We searched MEDLINE, Embase, and CINAHL from 2000 to February 12, 2020, focusing on articles on the determinants of seasonal influenza vaccination among cancer patients, published in English. Study selection was conducted independently by 2 reviewers. One reviewer extracted data from the included studies and another reviewer checked the extracted data for errors. Outcomes were sociodemographic and health-related factors. We pooled adjusted results from studies using the inverse variance, random-effects method, and reported the odds ratios (OR) and their 95% confidence intervals (CI). Out of 2664 citations, 10 studies (mostly from USA and South Korea) met our eligibility criteria. Overall, being older (OR 2.23, 95% CI 1.46-3.38; I² 92.3%, [6 studies]), a nonsmoker (1.43, 1.32-1.51; I² 0%, [4 studies]), having a chronic illness (1.18, 1.07-1.29; I² 15.7%, [5 studies]), having had a medical check-up in the past year (1.75, 1.65-1.86; I² 0%, [2 studies]), and having health insurance (1.39, 1.13-1.72; I² 21.8%, [3 studies]) were associated with increased SIV uptake. Compared with being African-American, being Caucasian was also associated with increased SIV uptake (1.79, 1.47-2.13; I² 10.7%, [3 studies]). Limited evidence suggests seasonal influenza vaccination among cancer patients may be determined by some sociodemographic and health-related factors.     

山西东南部贲门癌危险因素病例对照研究

目的探讨山西省东南部地区农村居民饮食、行为等各种影响因素与贲门癌(GCC)发生的关系。方法在山西省东南部地区,采用以人群为基础的1∶2配对病例对照研究方法,对120例GCC患者和240名对照进行问卷调查,采用单因素和多因素条件logistic回归对所获资料进行分析。结果胃癌家族史(OR=2.83,95%CI=1.74～3.94)、吸烟(OR=2.89,95%CI=1.57～5.30)、喜食烫食(OR=1.32,95%CI=1.12～2.79)可能是GCC的危险因素;体质指数≥24(OR=0.20,95%CI=0.06～0.67)、经常饮茶(OR=0.43,95%CI=0.15～0.78)、常吃新鲜水果(OR=0.62,95%CI=0.36～0.91)可能是GCC的保护因素。结论生活习惯和饮食习惯是农村居民GCC的主要危险因素之一,应对其采取综合性的预防措施。     

新型拔罐治疗器的设计与实现

拔罐疗法是中医治疗学的重要组成部分,通过皮部作用实现调营卫、行气血、通经络的治疗效果。将传统中医拔罐技术与现代科技相结合,制作了一款罐内负压、温度可调,操作简便易行的新型拔罐治疗器,文中描述了该拔罐器的结构,给出了压力、温度的调节方法。经实验验证该拔罐器理疗效果佳,具有较好的推广前景。