Association of blood pressure and long‐term change with chronic kidney disease risk among Chinese adults with different glucose metabolism according to the 2017 ACC/AHA guidelines

Whether the definition of hypertension according to 2017 AHA/ACC guidelines and blood pressure (BP) changes was related to the increased risk of chronic kidney disease (CKD) remained debated. This prospective cohort study aimed to investigate the association of BP and long‐term BP change with CKD risk with different glucose metabolism according to the new hypertension guidelines. This study examined 12 951 participants and 11 183 participants derived from the older people cohort study, respectively. Participants were divided into three groups based on blood glucose and the risks were assessmented by the logistic regression model. During a 10 years of follow‐up period, 2727 individuals developed CKD (21.1%). Compared with those with BP < 130/80 mmHg, individuals with increased BP levels had significantly increased risk of incident CKD. Participants with BP of 130–139/80–89 or ≥140/90 mmHg had 1.51‐ and 1.89‐fold incident risk of CKD in patients with diabetes mellitus (DM). Compared with individuals with stable BP (−5 to 5 mmHg), the risk of CKD was reduced when BP decreased by 5 mmHg or more and increased when BP increased ≥5 mmHg among normoglycemia and prediabetes participants. Similar results were observed for rapid estimated glomerular filtration rate (eGFR) decline. In conclusion, the BP of 130–139/80–89 mmHg combined with prediabetes or DM had an increased risk of incident CKD and rapid eGFR decline in older people. Long‐term changes of BP by more than 5 mmHg among normoglycemia or prediabetes were associated with the risk of incident CKD and rapid eGFR decline.     

Association between serum uric acid and the metabolic syndrome among a middle- and old-age Chinese population

Our aim was to study whether there is causal association between serum uric acid and metabolic syndrome (MetS). A cross-sectional study was performed, including a total of 27,009 subjects (23,345 subjects having uric acid data) from the Dongfeng-Tongji Cohort study. The MetS was defined by the International Diabetes Foundation criteria of 2005. Association analysis was performed by logistic regression. A genetic risk score was calculated by adding the uric acid increasing alleles in two SNPs (rs11722228 in SLC2A9 and rs2231142 in ABCG2) which were identified from our genome-wide association study on uric acid levels. The causal association was examined by mendelian randomization analysis. Among a middle- and old-age Chinese population, serum uric acid concentrations were strongly associated with the risk of MetS and its several components (P < 0.0001). The effects were stronger in women than in men. Despite the lack of statistical significance, both SNPs exhibited a trend with increased MetS risk (rs11722228, OR = 1.06, 95 % CI 0.99–1.14; rs2231142, OR = 1.02, 95 % CI 0.95–1.10), consistent with their increasing uric acid effects. Each additional uric acid increasing allele in the genetic risk score was associated with 3 % increased MetS risk (OR = 1.03, 95 % CI 0.98–1.09; P = 0.23). Further adjustment for serum uric acid attenuated the trend of individual SNP and genetic risk score with increased MetS risk (all OR < 1.0). These findings suggested that serum uric acid was associated with MetS risk in a middle- and old-age Chinese population. Whether this association was causal remained to be investigated in the future studies.     

骶管内注射吗啡用于混合痔术后镇痛效果的观察

目的探讨骶管内吗啡注射用于混合痔术后镇痛的效果。方法160例混合痔手术患者,分观察组（80例）与对照组（80例）,观察组于术前骶管内注入吗啡1mg,观察术后镇痛效果,并发症及伤口情况。结果与对照组比较,观察组疼痛在术后各个环节均明显减轻,且并发症发生率低,肛门伤口无明显影响。结论混合痔术前采用骶管内吗啡注射是一种简单、安全、有效的镇痛方法。     

不同方法处理大鼠髁颈骨折对关节窝表面结构影响

用幼年大鼠为实验对象，造成动物髁颈骨折后，分别给予非固定与骨间复位固定，通过扫描电镜观察比较对关节窝表面结构的影响。结果表明两处理组早、中期关节窝表面结构紊乱，后期逐渐恢复，但仍较对照组粗糙，两组间区别不明显。提示对年轻者髁颈骨折宜采取保守治疗。     

Inverse association between plasma homocysteine concentrations and type 2 diabetes mellitus among a middle-aged and elderly Chinese population

Background and aims

Plasma homocysteine concentrations have been reported to be associated with type 2 diabetes mellitus (T2DM) with controversial findings. The aim of the present study was to investigate the association between plasma homocysteine concentrations and T2DM.

14C-尿素呼气试验对幽门螺杆菌感染的诊断价值

目的：评估^14C-尿素呼气试验（^14C-UBT）对幽门螺杆菌（HP）感染的诊断价值。方法：对2000例1月内未曾使用可能影响HP检测结果的药物者同步完成快速尿酶试验（RUT）、病理、^14C-UBT检测，以病理（HE染色）、RUT均阳性为诊断HP感染的标准，评价^14C-UBT对HP感染的诊断价值。结果：^14C-UBT的敏感性89.7％，特异性98.4％，阳性预测值98.4％，准确性93.4％，阴性预测值88.1％。结论：^14C-UBT是HP感染无创伤、敏感而特异的诊断方法。     

盐酸丁咯地尔治疗老年糖尿病周围神经病44例临床观察

目的:观察盐酸丁咯地尔治疗老年糖尿病周围神经病的疗效。方法:对90例糖尿病周围神经病变患者进行随机对照临床观察,治疗组在常规治疗基础上加用盐酸丁咯地尔150mg加入生理盐水250mL中治疗,每日1次;对照组在常规治疗基础上给予ATP40mg,辅酶A 100U加入生理盐水250mL中,每日1次。结果:治疗组显效11例,有效27例,无效6例,总有效率为86.3%,明显高于对照组的54％,经x~2检验P<0.01,且未见明显副作用。结论:盐酸丁咯地尔是治疗老年糖尿病周围神经病较理想的药物。     

医院手术部层流洁净系统运行质量安全管理措施

目的观察医院手术部层流洁净系统运行质量,加强安全管理措施。方法通过现场仪器分析检测方法,对某医院手术部层流洁净系统运行质量进行了监测。结果各级别手术室和辅助用房在层流洁净系统运行30min后,所有部位室内环境微小气候平均合格率达到98%以上。1 000级手术区和周边区空气中沉降菌指标有97%以上达标;10万至30万级洁净区域沉降菌指标合格率均达到100%。结论该医院手术部层流洁净系统运行质量可靠,管理规范,主要靠严格执行操作规程。     

哮喘的预防性辨证施护

支气管哮喘属祖国医学"哮病"范畴,临床上表现为反复发作的以喉中痰鸣有声,呼吸气促困难,甚至喘息不能平卧,胸闷或咳痰等。在哮喘病缓解期应加强心理护理、调畅情志,起居调护、顺应四时,饮食调养、顺应辨证,治未病等多种预防性护理干预,可明显提高患者的生活质量。