乳腺癌辅助放疗后甲状腺功能减退的研究进展

甲状腺功能减退(HT)是乳腺癌放射治疗后的并发症之一,对患者的生活质量产生严重影响,但在过去这一并发症并未得到放疗医生的关注。近年来,许多研究开始致力于乳腺癌放疗中甲状腺的保护,并得出了一些结论,这些结论能够指导合理限制放疗中甲状腺的剂量,从而降低HT的发生率。     

内关穴位按压配合生姜敷贴法对妊娠剧吐患者胃动素水平的影响

目的:探究内关穴位按压配合生姜敷贴法对妊娠剧烈呕吐患者胃动素水平的影响。方法:选取2017年1月至2019年3月张家港市中医医院收治的妊娠剧烈呕吐患者70例作为研究对象,按照治疗方案不同分为对照组和观察组,每组35例。对照组予以常规对症治疗,观察组在此基础上引入内关穴位按压配合生姜敷贴法进行治疗,2组患者治疗时间均为7 d。观察2组患者临床疗效以及呕吐清水、食入即吐、头晕厌食、恶心呕吐等中医症候积分;记录2组患者呕吐次数、止吐时间、住院天数、妊娠恶心呕吐生命质量量表(NVPQOL)、妊娠专用恶心呕吐量化表(PUQE),并分别于治疗前后采用放免测试法检测患者血清中胃动素,采用试带法检测2组患者尿酮体水平,同期比较2组患者上述指标的差异。结果:观察组临床疗效(94.29%)明显高于对照组(74.29%)(χ~2=5.285,P=0.022);经过治疗后,2组患者呕吐清水、食入即吐、头晕厌食、恶心呕吐等中医症候积分均出现显著降低,且观察组低于对照组(P<0.01);2组患者尿酮体均显著降低,且观察组低于对照组(P<0.01);2组患者胃动素均显著升高,且观察组高于对照组(P<0.01);2组患者PUQE、NVPQOL评分均显著降低,且观察组低于对照组(P<0.01);观察组呕吐次数、止吐时间、住院时间等均明显优于对照组(P<0.05);此外,观察组复发率为5.71%(2/35),对照组复发率为22.86%(8/35),组间差异有统计学意义(χ~2=4.200,P=0.040)。结论:内关穴位按压配合生姜敷贴法治疗妊娠剧吐疗效显著,能够有效改善机体尿酮体及胃动素水平,且可显著缩短患者呕吐时间及住院时间,减少呕吐次数,提高生命质量。     

针刺配合GnRH-a治疗卵巢巧克力囊肿剥除术患者的疗效观察

目的观察针刺配合促性腺激素释放激素激动剂(GnRH-a)对卵巢巧克力囊肿(OEC)剥除术患者的治疗效果。方法选取2015年6月至2018年10月张家港市中医医院诊治的86例行OEC剥除术的患者作为研究对象。通过随机分组的方式将患者分为观察组(n=43)与对照组(n=43)。对照组术后接受常规治疗,观察组在对照组基础上采用针刺配合GnRH-a治疗,比较两组治疗前后的内分泌功能、卵巢储备功能、月经情况、囊肿复发率及妊娠结局。结果治疗后,观察组E 2、FSH、LH等激素水平低于对照组,差异具有统计学意义(P<0.05);观察组基础状态卵泡数、卵巢体积优于对照组,差异具有统计学意义(P<0.05);观察组月经期、痛经VAS评分低于对照组,差异具有统计学意义(P<0.05);观察组囊肿复发率和妊娠成功率优于对照组,差异具有统计学意义(P<0.05)。结论针刺配合GnRH-a可以有效调节OEC患者的血清性激素水平,改善患者的卵巢储备功能,降低患者术后复发率,提高妊娠成功率,值得进行临床推广。     

Associations of disordered eating with the intestinal microbiota and short-chain fatty acids among young adults with type 1 diabetes

Background and aimsDisordered eating (DE) in type 1 diabetes (T1D) includes insulin restriction for weight loss with serious complications. Gut microbiota-derived short chain fatty acids (SCFA) may benefit host metabolism but are reduced in T1D. We evaluated the hypothesis that DE and insulin restriction were associated with reduced SCFA-producing gut microbes, SCFA, and intestinal microbial diversity in adults with T1D.Methods and resultsWe collected stool samples at four timepoints in a hypothesis-generating gut microbiome pilot study ancillary to a weight management pilot in young adults with T1D. 16S ribosomal RNA gene sequencing measured the normalized abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry measured SCFA (total, acetate, butyrate, and propionate). The Diabetes Eating Problem Survey—Revised (DEPS-R) assessed DE and insulin restriction. Covariate-adjusted and Bonferroni-corrected generalized estimating equations modeled the associations. COVID-19 interrupted data collection, so models were repeated restricted to pre-COVID-19 data.Data were available for 45 participants at 109 visits, which included 42 participants at 65 visits pre-COVID-19. Participants reported restricting insulin “At least sometimes” at 53.3% of visits. Pre-COVID-19, each 5-point DEPS-R increase was associated with a ?0.34 (95% CI -0.56, ?0.13, p = 0.07) lower normalized abundance of genus Anaerostipes; and the normalized abundance of Lachnospira genus was ?0.94 (95% CI -1.5, ?0.42), p = 0.02 lower when insulin restriction was reported “At least sometimes” compared to “Rarely or Never”.ConclusionDE and insulin restriction were associated with a reduced abundance of SCFA-producing gut microbes pre-COVID-19. Additional studies are needed to confirm these associations to inform microbiota-based therapies in T1D.     

Monocyte to high-density lipoprotein ratio presents a linear association with atherosclerosis and nonlinear association with arteriosclerosis in elderly Chinese population: The Northern Shanghai Study

Background and aimsInflammation closely correlates with atherosclerosis and cardiovascular disease (CVD). Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a novel inflammation index that can be obtained by routine blood tests. We aimed to investigate the associations between MHR and atherosclerosis and arteriosclerosis.Methods and resultsWe enrolled 2451 participants from the Northern Shanghai Study. Atherosclerosis (carotid plaque (CP), lower extremity atherosclerotic (LEA) assessed by ankle-brachial index) and arteriosclerosis (arterial stiffness (AS) assessed by carotid-femoral pulse wave velocity) were measured using standard methods. In the univariable logistic regression model, higher MHR was significantly associated with increased AS, CP, and LEA risk. In the multivariable logistic regression model, after adjustment for age, sex, hypertension, diabetes mellitus, body mass index, smoking habit, low-density lipoprotein cholesterol, and family history of premature CVD, quartile 4 (Q4) of MHR was associated with an increased risk of AS (odds ratio (OR) = 1.41; 95% confidence interval (CI):1.05–1.88; P _{for trend} = 0.036), CP (OR = 1.35; 95%CI:1.04–1.77; P _{for trend} = 0.044), and LEA (OR = 2.23; 95%CI:1.49–3.35; P _{for trend}< 0.001). Similar results were observed when MHR was analyzed as a continuous variable. The restricted cubic spline (RCS) curve showed that the association between MHR and AS was nonlinear (P _nonlinear = 0.021), but not LEA (P _nonlinear = 0.177) or CP (P _nonlinear = 0.72).ConclusionMHR presents a linear association with atherosclerosis and a nonlinear association with arteriosclerosis in the elderly Chinese population. These findings may indicate the need for early assessment and intervention for inflammation.The registration number for clinical trials: NCT02368938.     

要点集成释放方案在腹腔镜下胃癌根治术手术室护理中的应用

目的 观察将要点集成释放方案应用于腹腔镜下胃癌根治术手术室护理中所取得的成效。方法　2021年1至6月于我院手术室行腹腔镜手术的胃癌病例55例为对照组，2021年7至12月于我院手术室行腹腔镜手术的胃癌病例55例为试验组，对照组按胃癌腹腔镜根治术常规手术室模式施护，试验组定制胃癌腹腔镜手术室护理要点集成释放方案并付诸实践，对两组干预后手术成功率、手术顺利安全性指标做出比较。结果　试验组手术室护士胃癌腹腔镜手术室护理要点掌握度评分显著高于对照组，试验组胃癌腹腔镜手术病例的手术成功率较对照组高，术时出血量、手术耗时、手术室相关并发症发生率较对照组低，（P＜0.05）。结论　将要点集成释放方案应用于腹腔镜下胃癌根治术手术室护理之中，可显著促升手术室护士相关护理要点掌握度，提高该类受术者手术成功率，降低术时出血量、手术耗时与相关并发症概率。