缺血性卒中相关性肺炎危险因素的病例对照研究

目的 探讨缺血性卒中相关性肺炎的危险因素。方法 回顾性纳入2018年1月—2020年12月期间唐山市协和医院神经内科住院的急性缺血性卒中(acute ischemic stroke, AIS)患者,收集人口统计学及临床资料。根据是否发生卒中相关性肺炎(stroke - associated pneumonia, SAP)分为非SAP组和SAP组,比较两组的各项临床资料,并采用多因素logistic回归分析SAP的独立影响因素。结果 共纳入721例患者,平均年龄(65.63±12.07)岁;SAP组年龄、入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分,冠心病、心房颤动、卒中史、吞咽障碍和入院格拉斯哥昏迷评分≤10分的比例、同型半胱氨酸、纤维蛋白原和白细胞计数均高于非SAP组,而SAP组入院舒张压、高密度脂蛋白胆固醇、白蛋白、白蛋白与球蛋白比值、血红蛋白和红细胞计数均低于非SAP组,差异均有统计学意义;多因素logistic回归分析显示,年龄增高(OR = 1.055,95%CI:1.009～1.103)、入院NIHSS评分增加(OR = 1.290,95%CI:1.154～1.444)、白细胞计数升高(OR = 1.267,95%CI:1.101～1.457)是SAP发生的危险因素。结论 缺血性卒中相关性肺炎与高龄、入院NIHSS评分增加和白细胞计数升高相关。     

唐山地区3家医院脑梗死二级预防中叶酸的应用现况调查

目的:了解唐山市部分医院脑梗死二级预防中叶酸的应用现状,找到与相关指南之间的差距,为改进脑梗死二级预防工作提供参考。方法:研究对象为唐山市3家医院诊断为脑梗死的住院患者共573例,按照血浆总同型半胱氨酸(tHcy)水平将入选病例分为3组,调查不同组别患者二级预防中叶酸的应用现状。结果:叶酸的使用率在血浆tHcy重度升高组为62.9%,在中度升高组中为50.7%,在轻度升高组中为38.1%,3组间比较差异有统计学意义(P<0.05);但叶酸的使用量3组间比较差异无统计学意义(P>0.05)。结论:唐山地区部分医院对叶酸应用于脑梗死二级预防已经有了一定程度的认识,但使用率、使用量等与相关指南尚有距离,需进一步加强对医务人员的培训。     

骨科医院医院感染的调查与分析

目的 了解骨专科医院医院感染的流行病学特征及现状,分析医院感染的危险因素,为制定有针对性的感染控制方案提供依据.方法 对医院2010年11月1日-2011年10月31日住院患者进行前瞻性监测与回顾性调查分析.结果 全院医院感染率为1.20％,以ICU最高,为10.53％,其次是康复科、内科、手科及儿科,分别为8.01％、3.74％、2.45％及1.16％,关节科与骨肿瘤科全年无医院感染病例的发生；全院以手术部位感染为主,占66.49％,其次为泌尿系统、呼吸系统及皮肤软组织,占16.22％、13.51％及3.78％；医院感染病例检出的病原菌中革兰阴性菌占79.62％,革兰阳性菌20.38％,其中铜绿假单胞菌最多,占29.30％,其次为阴沟肠杆菌、大肠埃希菌、金黄色葡萄球菌、鲍氏不动杆菌,分别占20.38％、10.83％、10.83％、10.19％;金黄色葡萄球菌中有11株为耐甲氧西林金黄色葡萄球菌,检出率为64.71％；表皮葡萄球菌中耐甲氧西林表皮葡萄球菌2株,检出率为13.33％;产超广谱β-内酰胺酶肺炎克雷伯菌、大肠埃希菌各1株,检出率为9.09％、5.88％.结论 应根据各科室医院感染的特点制定有针对性的感染控制方案并予以实施,开展对多药耐药菌的监测工作；加强医护人员医院感染知识的培训及监督管理工作.     

Protective effect of gastrodin on bile duct ligation-induced hepatic fibrosis in rats

Gastrodin has been showed to possess many beneficial physiological functions, including protection against inflammation and oxidation and apoptosis. Studies showed inflammation and oxidation play important roles in producing liver damage and initiating hepatic fibrogenesis. However, it has not been reported whether gastrodin has a protective effect against hepatic fibrosis or not. This is first ever made attempts to test gastrodin against liver fibrosis in bile duct ligation (BDL) rats. The aim of the present study is to evaluate the effect of gastrodin on BDL-induced hepatic fibrosis in rats. BDL rats were divided into two groups, BDL alone group, and BDL-gastrodin group treated with gastrodin (5 mg/ml in drinking water). The effects of gastrodin on BDL-induced hepatic injury and fibrosis in rats were estimated by assessing serum, urine, bile and liver tissue biochemistry followed by liver histopathology (using hematoxylin & eosin and sirius red stain) and hydroxyproline content measurement. The results showed that gastrodin treatment significantly reduced collagen content, bile duct proliferation and parenchymal necrosis after BDL. The serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) decreased with gastrodin treatment by 15.1 and 23.6 percent respectively in comparison to BDL group did not receive gastrodin. Gastrodin also significantly increased the level of serum high density lipoprotein (HDL) by 62.5 percent and down-regulated the elevated urine total bilirubin (TBIL) by 56.5 percent, but had no effect on total bile acid (TBA) in serum, bile and liver tissues. The immunohistochemical assay showed gastrodin remarkably reduced the expressions of CD68 and NF-κB in BDL rats. Hepatic SOD levels, depressed by BDL, were also increased by gastrodin by 8.4 percent. In addition, the increases of hepatic MDA and NO levels in BDL rats were attenuated by gastrodin by 31.3 and 38.7 percent separately. Our results indicate that gastrodin significantly attenuated the severity of BDL-induced hepatic injury and fibrosis by attenuating oxidative stress and inflammation. Taken together, these findings suggest that gastrodin might be an effective antifibrotic drug in cholestatic liver disease.     

Consensus report of the joint workshop of the Italian Society of Diabetology,Italian Society of Periodontology and Implantology,Italian Association of Clinical Diabetologists (SID-SIdP-AMD)

Periodontitis has been defined as the Sixth complication of Diabetes Mellitus. Since both diabetes mellitus and periodontitis have a high prevalence in the general population, the Italian Society of Diabetology, the Italian Society of Periodontology and Implantology and the Italian Association of Clinical Diabetologists revised the present scientific literature in the present consensus report.A bi-directional interaction was demonstrated: Patients affected by type 1 and type 2 diabetes have a higher prevalence of periodontitis than the general population, due to several metabolic factors (e.g. chronic hyperglycemia, autoimmunity, dietary and life-style factors); similarly, periodontitis predisposes to type 2 diabetes mellitus mainly via the increase of systemic cytokines release. Conversely, improvement of metabolic control of diabetic patients delay the progression of periodontitis as well as periodontitis treatment reduces glycosylated hemoglobin levels in blood.Due to the bi-directional causal interaction between periodontitis and diabetes mellitus, a strict collaboration among dentists and diabetologists is required and strongly recommended. The inter-societies consensus proposes specific flow-diagrams to improve the treatment of patients and management of the general population regarding the issue of periodontitis and diabetes.     

Hepatosplenic γδ T-cell lymphoma

AIM: To investigate the clinicopathologic characteristics, immunophenotype and TCR gene rearrangements of hepatosplenic T-cell lymphoma in eight Chinese patients. METHODS: Eight Chinese patients with hepatosplenic 76 T-cell lymphomas were studied. Hematoxylin-eosin-stained slides and clinical histories were reviewed. We also carried out immunohistochemical staining for CD3, CD4, CD8, CD20, CD43, CD56, CD79a, UCHL-1, and TCR γδ. Rearrangements of TCR gamma and delta chain genes were also studied. RESULTS: The spleens were enlarged and the cut surfaces were homogeneous and red-purple in color without identifiable gross lesions or enlarged hilar lymph nodes. Histologically, lymphoma cells infiltrated the cords of Billroth and often packed the sinuses. Liver biopsy showed lymphoma cell infiltrations in the sinusoids, and three cases showed involvements of the portal tracts. Immunohistochemically lymphoma cells were positive for CD3, CD43, and CD56 in all cases. Four of eight cases were positive for CD8, and all cases were negative for CD4 (6/6). Monoclonal rearrangements of TCR y gene were demonstrated by PCR analysis in five out of the eight cases. TCR δ gene rearrangements were detected in six out of the eight cases, which demonstrated single bands on PAGE gel, and the amplification products in two cases were confirmed by sequencing. CONCLUSION: The clinicopathology of hepatosplenic γδ T-cell lymphoma in Chinese patients is similar to what was previously reported except that the splenomegaly is not so massive, and CD8 is positive.     

Effect observation of uncut roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer

Objective To investigate the effect of uncut Roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer. Methods The clinical data of 53 patients with distal gastric cancer treated by surgery in Tangshan Union Medical College Hospital from May 2016 to October 2019 were analyzed retrospectively. The operation method was laparoscopic assisted radical gastrectomy for distal gastric cancer. The anastomosis methods were uncut Roux-en-Y anastomosis in 29 cases (uncut group) and Roux-en-Y anastomosis in 24 cases (traditional group). The operation time, digestive tract reconstruction time, the time to flatus, length of hospital stay, incidence of complication and one year followed up results were compared between the two groups. Results The operation time was (196.0±28.8) min, anastomotic time was (56.1±13.8) min, postoperative exhaust time was (52.5±14.4) h, postoperative hospital stay was (12.5±2.8) d in the uncut group, and (201.0±28.5) min, (57.8±12.9) min, (53.9±14.6) h, (12.0±3.0) d in the traditional group. There was no significant difference between the two groups (P values were 0.534, 0.664, 0.717 and 0.557, respectively). Postoperative complications: Anastomotic leakage was 0(0/29), abdominal bleeding was 3.4% (1/29), alkaline reflux gastritis was 6.9% (2/29) in the uncut group and 4.2% (1/24), 4.2% (1/24) and 4.2% (1/24) in the traditional group respectively. There was no significant difference between the two groups (P values were 0.453, 1.000 and 1.000, respectively). The incidence of Roux-en-Y stasis syndrome was 0 (0/29) in the uncut group and 25.0% (6/24) in the traditional group. There was significant difference between the two groups (P=0.006). One case in the uncut group was found recanalization 8 months after operation, the patient underwent reoperation, the method of anastomosis was changed to traditional Roux-en-Y anastomosis. The patient′s symptoms of reflux and hearburn improved significantly after operation. Conclusion As a digestive tract reconstruction method for radical gastrectomy of distal gastric cancer, uncut Roux-en-Y anastomosis is safe and feasible, and can avoid Roux-en-Y stasis syndrome. © 2021, Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

头孢氨苄胃漂浮缓释片的制备与质量评价

目的制备头孢氨苄胃漂浮缓释片,并考察其漂浮延迟时间及体外药物释放度。方法采用粉末直接压片工艺制备头孢氨苄胃漂浮缓释片,采用单因素实验方法筛选得到影响头孢氨苄胃漂浮缓释片体外漂浮延迟时间、漂浮时间和释放度的关键性辅料用量范围,最终以羟丙甲纤维素(HPMC K15M)用量、碳酸氢钠用量以及压片主压力作为考察因素,以头孢氨苄胃漂浮缓释片的漂浮延迟时间和1,4和8 h时间点的药物释放度作为评价指标,通过Box-Behnken实验设计优化得到头孢氨苄胃漂浮缓释片处方设计空间,并在设计空间任取一点连续制备3批头孢氨苄胃漂浮缓释片,评价其漂浮延迟时间及体外释放度。结果优化得到头孢氨苄胃漂浮缓释片的处方设计空间,每片HPMC K15M用量为260 mg,碳酸氢钠用量为60 mg,压片主压力为8 kN,制备的头孢氨苄胃漂浮缓释片漂浮延迟时间仅为12.1±0.5 min,在12 h内药物释放平缓,无药物突释。结论通过Box-Behnken实验设计优化得到的头孢氨苄胃漂浮缓释片处方,漂浮延迟时间较短,12 h维持漂浮状态,药物释放平稳。     

Expression of p27 and PTEN and clinical characteristics in early laryngeal squamous cell carcinoma and their correlation with recurrence

Laryngeal squamous cell carcinoma is a common malignant tumor of otolaryngeal region. At present, effective treatment of laryngeal squamous cell carcinoma still depends on surgery and radiotherapy. In recent years, application of CO₂ laser resection in the treatment of stage T1 glottic carcinoma can remove the tumor completely and reduce the injury of laryngeal tissues. But recurrence still happened in some postoperative patients. Here, we selected 131 patients to compare the therapeutic effects of CO₂ laser resection and traditional split laryngeal surgery on the early laryngeal cancer, examined the expression of p27 and PTEN by immunohistochemistry in early laryngeal squamous cell carcinoma tissues in correlation to clinical outcome. After two years follow-up 14/85 (16.5%) of CO₂ laser treatment group presented with local recurrence (recurrent group), while that of split laryngeal surgery group was 6/46 (13.0%). There was no statistical significance in recurrence rate between the two groups (P > 0.05). 10 of all the 111 (9.0%) non-recurrent patients did not follow the doctor’s advice to quit smoking after the operation, while 12 in the 20 (60.0%) recurrent patients did not; the difference between the two groups was statistically significant (P < 0.01). The positive rates of p27 were 80.2% (105/131) and 43.5% (57/131), and that of PTEN were 83.2% (109/131) and 48.9% (64/131) in the cancer adjacent tissues (negative surgical margin tissues) and in laryngeal carcinoma tissues, respectively (P < 0.001). The expression rates of p27 and PTEN in laryngeal carcinoma tissues of the recurrent group were 20.0% (4/20), 10.0% (2/20) and that in non recurrent group were 47.7% (53/111) and 55.9% (62/111), respectively, with a significant difference (P < 0.001). In addition, the expression of p27 and PTEN in tumor resected marginal tissues of the recurrence group was 50.0% (10/20), 40.0% (8/20) and that in non recurrence group was 85.6% (95/111) and 91.0% (101/111), respectively; the difference was also statistically significant between both groups (P < 0.001). In conclusion, there is no statistically significant difference in tumor recurrence rate between CO₂ laser surgery and traditional split laryngeal surgery. Postoperative recurrence is closely related to resume smoking. The recurrence rate of p27 and/or PTEN-negative patients was higher than that of the positive ones,that should be followed up closely after treatment.