血尿酸水平与冠心病患者糖代谢状况的研究

目的研究不同尿酸水平与冠心病患者糖代谢状况的关系。方法根据尿酸水平将237例冠心病患者分为3组,即低尿酸组、尿酸正常组和高尿酸组,分析各组糖代谢状况,同时分析不同糖代谢状况患者的尿酸水平。结果新诊断糖尿病、总糖尿病和糖调节异常比例在低尿酸组(28.57%、65.71%及80.00%)和高尿酸组(35.14%、64.86%及86.49%)均显著高于正常尿酸组(17.58%、45.45%及67.27%)(P均<0.05)。结论低尿酸水平和高尿酸水平均与冠心病患者的糖代谢状况相关。     

吕仁和教授运用四逆散治疗内科杂病经验

四逆散出自《伤寒论》,治疗少阴枢机不利,阳气不得宣达的四肢逆冷证。该方选药寓意深奥,吕仁和教授善用四逆散,广泛运用于人体各系统疾病,临床辨证化裁疗效颇彰,本文总结了吕仁和教授应用四逆散治疗内科杂病的经验。     

真实世界大数据冠心病患者中西医联合治疗规律初探

目的:观察及分析真实世界中冠心病患者的中西药使用情况,为冠心病中西医结合治疗提供参考和借鉴。方法:选择全国17家三甲医院中第一诊断为冠心病的住院患者,采集其药物信息,使用频数及关联方法进行分析。结果:84 697人中男性47564人,女性32 882人,患者年龄中位数为71岁。76 172人有用药记录,包括278种西药和331种中药。西药使用最多的为阿司匹林,共51 132例(67.08%),其次为硝酸异山梨酯(46 291例,占60.72%)、氯吡格雷(34 030例,占44.64%)等;中成药使用最多者为丹红注射液,共15 174例(19.92%),其次为疏血通注射液(10 166例,占13.35%)。药物归类后,西药位于前列者为抗血小板药、硝酸酯类药物、他汀类药物、β受体阻滞剂、钙离子拮抗剂、血管紧张素转化酶抑制剂;中药使用最多的为活血化瘀注射液,其次为活血化瘀口服药、扶正类口服药、通腑药等。进行关联规则后显示冠心病西药间联合用药最为常见,中西药联合使用中活血化瘀口服药、活血化瘀注射液与西药间的联合用药更为常见,尤其是与抗血小板药、硝酸酸类药物。结论:冠心病的西药治疗符合指南推荐,但使用率较低;中药逐渐成为冠心病治疗的重要方法,活血化瘀是冠心病中药治疗中的重要组成部分。     

危急值报告流程在门诊患者中的应用

目的探讨危急值报告流程在内、外科门诊患者就诊过程中的应用及效果。方法制订门诊危急值报告及处理流程,完善抢救物品,组织人员培训及演练,畅通危重患者转运通道。结果 18例门诊患者就诊过程中突发危急情况,成功救治和转运17例,死亡1例,患者及家属对所采取措施表示满意,无投诉。结论门诊医护人员应加强责任心,严格落实危急值报告制度及处理流程,提高门诊危重患者的急救护理水平。     

非综合征型耳聋线粒体基因突变的检测

目的：通过分析内蒙古鄂尔多斯市特殊教育学校非综合征型耳聋患者群体中mtDNA 12SrRNA A1555G突变,以探讨该群体与线粒体突变的关系。方法：对鄂尔多斯市特殊教育学校102名非综合征型耳聋患者进行耳聋病因问卷调查、纯音听阈测试、声导抗测试、提取外周血DNA,聚合酶链反应扩增mtDNA目的片段,对扩增片段进行限制性内切酶检测,对阳性标本进行DNA序列分析。结果：该校102名学生中,全部为感音性耳聋,其中54例使用过氨基糖苷类抗生素,7例（6.9%）存在线粒体基因A1555G位点突变。结论：该群体线粒体A1555G位点的突变率高于以往的报道,携带有该突变的个体对氨基糖苷类抗生素有高度易感性,该基因突变是感音神经性耳聋的原因之一。     

热球子宫内膜去除术与宫腔镜内膜电切术治疗围绝经期功血的临床研究

目的:探讨热球子宫内膜治疗仪治疗围绝经期功能失调性子宫出血(简称功血)的临床疗效。方法:以52例经热球子宫内膜去除术治疗的围绝经期功血患者为观察组,50例经宫腔镜子宫内膜电切术治疗的患者为对照组,对两组的手术时间、术中出血量及临床疗效进行比较。结果:观察组的手术时间明显短于对照组(15.5±2.8 min vs 21.6±3.6 min),术中出血量少于对照组(12.3±5.7 ml vs 22.8±7.6 ml),两组比较差异均有统计学意义(P<0.01);观察组总有效率为98.1%,对照组总有效率为92.0%,差异无统计学意义(P>0.05);观察组术后无月经及点滴量月经率明显高于对照组(P<0.01)。结论:热球子宫内膜去除术治疗围绝经期功血疗效确切,并发症少,是一种安全、简便、有效的方法。     

基于规律成簇的间隔短回文重复序列及其相关蛋白技术检测乙型肝炎病毒共价闭合环状DNA方法的建立

目的建立一种基于规律成簇的间隔短回文重复序列及其相关蛋白(CRISPR/Cas13a)的乙型肝炎病毒(HBV)共价闭合环状DNA(HBV cccDNA)检测方法。方法提取2017年6月至2020年10月于首都医科大学附属北京佑安医院就诊的4例乙型肝炎患者肝脏总DNA后,使用HindⅢ内切酶和质粒安全性ATP依赖DNA酶(PSAD)分别进行酶切;根据松弛环状DNA(rcDNA)和cccDNA的结构差异,设计特异性扩增HBV cccDNA的引物,对酶切后的产物进行滚环扩增(RCA)和PCR扩增;并筛选crRNA,建立基于CRISPR/Cas13a技术的HBV cccDNA检测新方法。结果利用α-1-抗胰蛋白酶(A1AT)和HBV表面抗原(HBsAg)引物对双重酶切后的产物进行扩增,验证产物中HBV基因组的存在;利用HBV cccDNA和HBV rcDNA引物对PSDA酶切后的产物扩增,验证了产物中只存在HBV cccDNA;利用RCA后的阳性样本作为模板梯度稀释,然后进行PCR扩增转录后使用CRISPR/Cas13a检测,计算出检测下限为10拷贝/μl。结论本研究建立了RCA-PCR-CRISPR-Cas13a的新型检测方法,可对HBV cccDNA进行高灵敏度和高特异性检测,为乙型肝炎患者抗病毒治疗评估、治疗终点的确定以及调整治疗方案提供了有效的监测手段。     

Quantitative histology as a diagnostic tool for celiac disease in children and adolescents

ObjectiveTo measure the villous height, the crypt depth, and the number of intraepithelial lymphocytes/100 enterocytes of the small intestinal mucosa of children and adolescents with celiac disease; and to classify these findings according to Q- Marsh and Q-histology scales.MethodsRetrospective study of a database from the Department of Pathology of biopsies from the second portion of the duodenum of pediatric patients. According to the histological report, three groups were established: celiac disease at diagnosis (n = 50), controls (n = 26), giardiasis (n = 10). In each biopsy, software (cellSens and Image J) evaluated 5 villous heights, 5 crypt depth and the number of intraepithelial lymphocytes/100 enterocytes.ResultsThe celiac group had the lowest mean villous height (197.83 μm) of all three groups (control = 477.70 μm; giardiasis = 397.04 μm. The celiac group's villous:crypt ratio (0.78) was significantly lower than the control group (1.89). The number of intraepithelial lymphocytes ≥25 was exclusive to the celiac group, with a sensitivity and specificity of 100 %. Only celiac patients were included in types 2 and 3 of the Q-histology classification.ConclusionCeliac disease patients showed shorter villous height than other groups, and the number of intraepithelial lymphocytes ≥25 was the best parameter to differentiate celiac from controls and giardiasis groups. Intraepithelial lymphocytes ≥25/100 enterocytes associated with any degree of villous atrophy, the classic Marsh 3 type, set the histological parameters of celiac disease. Quantitative histology is a valuable tool for diagnosing celiac disease, enabling histological changes in a short time, and the Q-histology scale appears to be more suitable than the Q-Marsh scale.     

Florid cemento-osseous dysplasia-related osteonecrosis: A series of cases

ObjectiveThe aim of this study was to assess the clinicopathological features of florid cemento-osseous dysplasia (FCOD)-related osteonecrosis highlighting their histopathological aspects and bone structure.MethodsTwenty-two FCOD-related osteonecrosis cases were evaluated retrospectively. Osteonecrosis, osteomyelitis, bacterial colonization, bone resorption, reactive bone, osteon-like structure, lamellar bone, and basophilic lines were analyzed. Specific staining and fluorescence and polarized light microscopy analyses were also performed.Results: The mandible was more affected by FCOD-related osteonecrosis. There was a predominance of African-Brazilian women in the fifth and seventh decades of life. Osteomyelitis was present in 82 % of cases whereas bone resorption and bacterial colonization were present in 100 % of FCOD-related osteonecrosis cases. Thick basophilic lines were seen in all cases (100 %). Actinomycosis and osteoclasts were not often.ConclusionsThis study showed female adult preference, mandibular location, and some findings such as osteomyelitis, bone resorption, and bacterial colonization were histopathological features more frequent in FCOD-related osteonecrosis. In the absence of a close clinical and radiographic correlation, the morphology of the necrotized bone similar to cementum could help to recognize FCOD.