电子病案与医疗保险

目的 为了早日实现电子病案的普及与全民医疗保险网上自动审核与赔付. 方法 从目前电子病案与医疗保险报销制度存在的问题,以及有效的解决途径等方面进行了探讨. 结果 加强电子病案生成质量的管理与网络安全管理的法制化,是实现电子病案与医疗保险网上赔付,降低患者的医疗成本,为社会各界提供方便、安全、快捷信息服务的保障. 结论 实现电子病案与医疗保险数字化、信息化数据交换平台,是促进、推广电子病案与医疗保险网上赔付的纽带,是医院人性化、社会化、信息化管理发展的必然趋势.     

Effect of 4-week Whole Body Vibration on Distal Radius Density

Objective To assess the effects of high-frequency loading using whole body vibration on distal radius density in adults. Methods The volunteers diagnosed with osteoporosis or osteopenia in the First Hospital of Jilin University from January 2011 to December 2014 were recruited. All the subjects performed foot-based, whole body vibrations on the vibration platform (35 Hz, 0.25 g) once a day, for 15 minutes per session over a period of 4 weeks. The bone mineral density of distal radius (rBMD) was measured using dual-energy X-ray absorptiometry at before, 2-week, and 4-week after the vibration treatment. Blood pressures were measured at the end of the vibration treatment. Results A total of 114 volunteers were enrolled. The average rBMD before the treatment was 0.331±0.014 g/cm2. It was reached 0.337±0.019 g/cm2at the end of the fourth week, increased by 1.79% (P<0.05). Whole body vibration increased rBMD of men and women respectively (1.77% and 1.80%, P<0.05). Blood pressures did not change in any of the groups. Conclusion A 4-week whole body vibration was feasible and contributed to increase of rBMD.     

我院新区洁净手术室的设置与维护

洁净手术室的配备是医院现代化建设的重要标志,它在控制术后感染、提高医院手术效率及改善医护人员工作环境方面起到了积极作用。本文详细介绍了我院新区洁净手术室净化空调系统的配置、控制及其净化处理过程,并给出了洁净手术室维护的注意事项。     

MicroRNA‐1322 regulates ECRG2 allele specifically and acts as a potential biomarker in patients with esophageal squamous cell carcinoma

A short tandem repeat (STR) polymorphism in the 3′UTR region of esophageal cancer‐related gene 2 (ECRG2, also known as SPINK7) has been widely reported to be associated with the incidence and the prognosis of esophageal squamous cell carcinoma (ESCC). This study explores how the microRNA binding to the STR region affects ECRG2 expression in ESCC. Dual‐luciferase reporter assays were used to verify the effects of the four microRNAs (miR‐580, miR‐1182, miR‐1272, and miR‐1322) predicted to bind the STR region of the ECRG2 3′ untranslated region (UTR). The expression of identified effective microRNA was then analyzed in 44 paired ESCC and adjacent normal tissues and 402 case–controlled serum samples (divided into a discovery group and an independent validation group) by real‐time RT‐PCR assay. We found that only miR‐1322 could significantly down‐regulate the ECRG2 with TCA3 allele (P < 0.01), but it could not down‐regulate the ECRG2 with TCA4 allele significantly (P > 0.05). MiR‐1322 was also expressed significantly higher in ESCC tissue and serum samples than in controls (both P < 0.01). Additionally, serum levels of miR‐1322 yielded an under receiver operating characteristic (ROC) curve area of 0.847 (95% CI, 0.795–0.890) for discriminating ESCCs from healthy controls in the discovery group and a similar result was obtained in the validation group (under ROC area is 0.845; 95%CI, 0.780–0.897). We conclude that miR‐1322 can regulate ECRG2 in an allele‐specific manner and that serum levels of miR‐1322 can serve as a potential diagnostic biomarker for patients with ESCC. © 2012 Wiley Periodicals, Inc.     

广西地区1278例老年人结直肠癌临床流行病学分析

目的 分析60岁以上老年人结直肠癌的临床流行病学特征.方法 从广西医科大学第一附属医院病案信息科数据库导出结直肠肛门外科2003年1月-2010年12月住院病例资料,其中有病理诊断的结直肠癌初次住院患者2810例,根据年龄分为老年组(≥60岁)、中年组(36～59岁)和青年组(≤35岁),比较三组的病例资料.结果 老年人结直肠癌发病中位年龄为69岁,男女比为1.97∶1;肿瘤以直肠、乙状结肠和右半结肠为主要部位;术前心血管疾病、肺部炎症性疾病、Ⅱ型糖尿病和结直肠腺瘤合并率为13.46％、4.15％、7.36％、7.20％,明显高于中、青年组(P＜0.05);术前癌性肠梗阻合并率6.89％,高于中年组(P＜0.05);同时性肝转移率为11.58％,不同年龄组相比差异无统计学意义(P＞0.05);管状腺癌为主要组织学类型,占86.85％,高度恶性组织学类型包括黏液腺癌、印戒细胞癌和未分化癌,占4.46％,明显低于中、青年组(P＜0.05).结论 广西地区老年人群结直肠癌患者中,男性约为女性两倍,女性患者比例未出现明显增加;临床以术前基础并发症多、比较容易发生癌性肠梗阻、伴发结直肠腺瘤的比例较高为特点;病理以管状腺癌为主要组织学类型,高度恶性组织学类型较青壮年少,预后较好.     

用于产后性功能障碍患者的低频脉冲反馈电刺激和阴道哑铃训练联合性行为疗法的临床研究

目的探讨低频脉冲反馈电刺激、阴道哑铃训练联合性行为疗法在产后女性性功能障碍康复治疗中的应用价值。方法选取2017年8月至2019年2月深圳市龙华中心医院诊治的80例产后性功能障碍患者作为研究对象。按照随机数字表法将其平均分为观察组与对照组,每组40例患者。观察组患者在对照组治疗基础上给予低频脉冲反馈电刺激和阴道哑铃训练及性行为疗法,对照组患者实施常规盆底肌肉锻炼,两组患者均连续治疗4周。比较两组患者治疗前后阴道动态压力变化、盆底功能(PFDI-20评分、PFIQ-7评分)、负性情绪(SAS评分、SDS评分)、性功能(FSFI评分)和生活质量(SF-36评分)改善情况。结果①阴道动态压力:治疗后,两组患者阴道动态压力均比治疗前有所增加,且观察组高于对照组(均P<0.05);②盆底功能:治疗后,两组患者PFDI-20评分、PFIQ-7评分均比治疗前有所降低,且观察组低于对照组(均P<0.05);③负性情绪:治疗后,两组患者SAS评分、SDS评分均比治疗前有所降低,且观察组低于对照组(均P<0.05);④性功能:治疗后,两组患者FSFI评分均比治疗前有所提高,且观察组高于对照组(均P<0.05);⑤生活质量:治疗后,两组患者SF-36评分均比治疗前有所提高,且观察组高于对照组(均P<0.05)。结论低频脉冲反馈电刺激和阴道哑铃训练联合性行为疗法可以有效增加患者阴道动态压力,改善盆底功能和负性情绪,有利于提高患者性功能,促进患者生活质量改善,可以在临床中推广应用。     

经脐单孔腹腔镜在子宫肌瘤剔除术中的应用研究

目的 探讨经脐单孔腹腔镜技术在子宫肌瘤剔除手术中应用的安全可行性.方法 收集2017年1月至12月大连市妇幼保健院收治的经由同一术者施术的腹腔镜下子宫肌瘤剔除术患者60例的临床资料,分为单孔腹腔镜组(单孔组)和多孔腹腔镜组(多孔组),各30例.比较两组手术时间、术中出血量、术后血红蛋白下降幅度、术后住院时间、术后病率(术后24h至术后5天有连续2天体温≥38℃)、术后并发症、术后24hVAS评分、体象量表BIS评分、切口美观满意度CS评分等指标.结果 60例均成功完成手术,无改变手术方式.单孔组与多孔组手术时间[(89.00±14.04) vs.(55.23±15.47) min]比较差异有统计学意义(P＜0.05).单孔组与多孔组术中出血量[(44.00±8.21) vs.(40.00±6.32) mL]、术后Hb下降幅度[(11.13±3.89) vs.(9.33±2.41)g/L]、术后住院时间[(4.40±0.74) vs.(4.87±0.64)d]、术后病率比较差异均无统计学意义(P＞0.05).单孔组与多孔组术后24 h VAS评分[(5.03±0.39) vs.(5.90±0.61)]、BIS评分[(5.07±0.26)vs.(5.87±0.74)]、CS评分[(40.27±1.28)vs.(36.47±2.07)]比较,差异有统计学意义(P＜0.05).两组患者术后均无切口出血、感染、切口疝、黏连性肠梗阻等并发症,单孔组1例切口延期愈合.结论 经脐单孔腹腔镜技术在子宫肌瘤剔除术中应用是可行的,并具有和常规多孔腹腔镜一样的效果与安全性,比多孔腹腔镜更美观并迎合女性患者爱美的需求.     

The influence of the tibial plateau slopes on injury of the anterior cruciate ligament: a meta-analysis

Purpose

The purpose of this meta-analysis was (1) to examine the effect of the tibial plateau slopes (medial and lateral) on anterior cruciate ligament (ACL) injury and (2) to investigate gender differences between ACL-injured subjects and gender-matched controls.

Methods

The PubMed database was searched through to 1 November 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments, and control for potential confounding factors. A meta-analysis was conducted, and either a fixed- or a random-effects model was used to calculate the overall weighted mean difference (WMD).

Results

Twelve studies (n = 1,871: 923 patients in the ACL-injured group and 938 patients in the control group) were included. The medial tibial plateau slope in the ACL group ranged from 1.8° ± 3.7° to 12.1° ± 3.3° while it ranged from 2.9° ± 2.8° to 9.5° ± 3° among the controls. The lateral tibial plateau slope in the ACL ranged from 1.8° ± 3.2° to 11.5° ± 3.5° and 0.3° ± 3.6° to 9° ± 4° in the control group. Statistically significant increased angles were observed in ACL-injured group compared to control group for medial tibial plateau slope (WMD, 1.1°; 95 % confidence interval, 0.5°–1.7°) and lateral tibial plateau slope (WMD, 1.8°; 95 % confidence interval, 1.3°–2.3°). Sensitivity analysis and subgroup analysis proved this to be a reliable result.

Conclusions

The current meta-analysis suggests that both, increased medial and lateral tibial plateau slopes, are associated with increased susceptibility to ACL injury regardless of gender. In addition, this study indicates a stronger evidence for lateral tibial plateau slope to be associated with ACL injury compared with medial tibial plateau slope due to the larger increased angle value and on the basis of consistency among the included studies.

Level of evidence

III.     

FIB、FAR和血清肿瘤标记物联合检测在ESCC患者诊断及其临床进展中的意义

目的：探讨纤维蛋白原(FIB)、纤维蛋白原与白蛋白比值(FAR)和血清肿瘤标记物联合检测在食管鳞状细胞癌(ESCC)患者诊断及其临床进展中的意义。方法：选取2018年4月—2021年10月河北医科大学第四医院收治的66例ESCC患者,作为ESCC组。收集ESCC患者初诊时的临床病理资料及血常规、凝血功能、生化、血清肿瘤标记物包括癌胚抗原(CEA)和鳞状细胞癌抗原(SCCAg)等相关实验室检测指标。另选取无良恶性肿瘤、心血管等疾病的相对健康志愿者30例,作为对照组。比较两组患者各指标的差异,并分析不同TNM分期中各指标的表达水平,制作ROC曲线评价FIB、FAR、CEA和SCC-Ag对ESCC临床进展的价值;分析其与ESCC患者临床病理指标之间的相关性。结果：ESCC组FIB、FAR、纤维蛋白原与前白蛋白比值(FPR)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)等指标的水平明显高于对照组(P<0.05);III~IV期FIB、FAR、CEA和SCC-Ag水平明显高于I~II期,同时,ROC曲线显示其对ESCC临床进展均具有预测价值(P<0.05),且四者联合检测对ESCC临床进展具有更高的诊断价值;FIB、FAR、SCC-Ag高值组(以ROC曲线得到的cut off值为界值)患者N分期和TNM分期均明显高于低值组(P<0.05);FAR高值组患者的肿瘤最大直径和T分期也明显高于低值组(P<0.05);CEA高值组患者TNM分期明显高于低值组,男性多于女性(P<0.05)。结论：血浆FIB、FAR和血清CEA、SCC-Ag水平与ESCC诊断和临床进展密切相关,与单独检测血清肿瘤标记物相比,四者联合检测用于预测ESCC的临床进展效能更好,值得临床推广使用。     

Survival in Women Diagnosed With Breast Cancer During Pregnancy

IntroductionPregnancy rarely coincides with breast cancer, but when it does, uncertainties remain about how survival is affected. In a nation-wide study, we investigated survival in women diagnosed with breast cancer during pregnancy.Materials and MethodsThrough health registries, we identified women with breast cancer at ages 15-44 years from 1973-2016 in Denmark and included 156 who were pregnant at diagnosis and 11,110 who were not. We compared overall mortality in pregnant and non–pregnant women using multivariate Cox regression stratified by time since cancer: <2 and ≥2 years.ResultsDuring the first 2 years after diagnosis, the hazard ratio of overall death was 2.28 (95% CI: 1.48-3.52) for pregnant versus non–pregnant breast cancer patients after adjustment for age and calendar period and 1.62 (95% CI: 1.05-2.50) after further adjustment for extent of disease. Adjusting for additional tumor characteristics, the hazard ratio was still significantly increased. Beyond the first 2 years, there was no excess mortality.ConclusionOur study identifies the early period after breast cancer as a period of particular interest in future studies on survival after breast cancer in pregnancy. We found no evidence that survival is affected by pregnancy when 2 or more years have passed since diagnosis.