室间隔缺损并重度肺动脉高压外科疗效的多因素分析

目的:总结室间隔缺损(VSD)合并重度肺动脉高压(PH)的外科治疗疗效及其影响因素。方法:回顾性分析和随访62例VSD伴重度PH患者的诊治和预后情况,并对多种影响因素进行t检验及多元线性回归分析。结果:本组住院死亡6例,占9.6％;随访8个月～7年,1、3、5年生存率分别为96.4％、91.1％、80.4％;对多种相关因素进行t检验及多元线性回归分析,提示年龄,VSD的大小、位置,肺/体平均动脉压比值(Pp/Ps)>0.95与否,心功能,术后6个月肺动脉压/手术前肺动脉压>0.75与否,围术期综合性降肺动脉压处理,手术后定期应用前列腺素E1(PGE1)等与生存期有明显相关性。结论:明确VSD的位置,围术期综合性降肺动脉压处理不仅对选择手术时机有指导意义,而且可以降低手术死亡率,手术后定期应用PGE1可提高生存率。     

移动卒中单元救治流程的优化及应用效果

目的 探讨优化移动卒中单元（mobile utroke unit,MSU）救治流程对急性缺血性脑卒中患者的效果。 方法 回顾性分析该院2020年1月—6月MSU出车接诊的30例急性缺血性脑卒中静脉溶栓患者,其中MSU救治流程优化后静脉溶栓的18例患者为试验组,MSU运行初期、流程优化前实施静脉溶栓的12例患者为对照组。收集两组的临床资料,比较两组的护理效率及临床结局。结果 试验组的卒中专科护士首次静脉穿刺成功例数、发病至静脉溶栓时间、呼叫120至静脉溶栓时间、MSU到达现场至静脉溶栓时间均优于对照组,差异具有统计学意义（P<0.05）。两组发病至呼叫120时间、呼叫120至MSU到达现场时间、静脉溶栓24 h内症状性颅内出血例数、静脉溶栓后90 d改良Rankin量表评分≤2分的例数比较,差异无统计学意义（P>0.05）。结论 通过优化救治流程可有效缩短患者发病至静脉溶栓时间、呼叫120至静脉溶栓时间及MSU到达现场至静脉溶栓时间,提高护士工作效率,提升患者救治质量。     

分析比较急性髌骨外侧脱位与膝关节多发韧带损伤后内侧髌股韧带损伤的特点

 目的 分析比较急性髌骨外侧脱位(lateral patellar dislocation,LPD)与膝关节多发韧带损伤(multiligament knee injuries,MLKIs)后内侧髌股韧带(medial patellofemoral ligament,MPFL)损伤的特点。方法 回顾性分析急性LPD 92例和MLKIs 83例患者的MRI资料,根据患者年龄分为青少年组(年龄≤18岁)84例和成人组(年龄＞18岁)91例,对LPD和MLKIs伴发MPFL损伤程度、部位进行统计学分析。结果 青少年LPD组50例中,MPFL部分撕裂20例,完全撕裂25例,未损伤5例;青少年MLKIs组34例患者中,MPFL部分撕裂9例,完全撕裂6例,未损伤19例;两组比较,差异有统计学意义(χ²=21.725,P<0.05)。青少年LPD组MPFL髌骨侧损伤19例,股骨侧14例,体部2例,多部位损伤10例;青少年MLKIs组MPFL髌骨侧损伤3例,股骨侧7例,多部位损伤5例;青少年LPD组和MLKIs组间MPFL髌骨侧、股骨侧、多部位损伤发生率差异均具有统计学意义(χ²=19.753,9.644,8.193,P值均小于0.01)。成人LPD组42例中,MPFL部分撕裂17例,完全撕裂19例,未损伤6例;成人MLKIs组49例中,MPFL部分撕裂13例,完全撕裂7例,未损伤29例;两组比较,差异有统计学意义(χ²=20.771,P<0.05)。成人LPD组MPFL髌骨侧损伤11例,股骨侧15例,体部2例,多部位损伤8例;成人MLKIs组MPFL髌骨侧损伤4例,股骨侧9例,多部位损伤7例;LPD组和MLKIs组间MPFL髌骨侧、股骨侧、多部位损伤发生率差异均具有统计学意义(χ²=14.773,12.777,6.822,P均<0.01)。结论 急性LPD比MLKIs更易导致MPFL损伤,MPFL髌骨侧损伤、股骨侧损伤和多部位损伤LPD也较MLKIs更常见。     

T-Cell Immunoglobulin- and Mucin-Domain-Containing Molecule 3 Genetic Variants and HIV+ Non-Hodgkin Lymphomas

T cell immunoglobulin- and mucin-domain-containing molecule 3 (TIM-3) has been established as a negative regulatory molecule and plays a critical role in inflammatory diseases such as rheumatoid arthritis, hepatitis B and C, and human immunodeficiency virus (HIV)-related inflammation. Recent studies have shown that chronic inflammation may greatly affect the pathogenesis of non-Hodgkin lymphomas (NHL). The aim of this study was to investigate whether polymorphisms in the TIM-3 gene were associated with susceptibility to non-NHL and HIV-related NHL. Three polymorphisms in TIM-3 gene (?1516G/T, ?574G/T, and +4259T/G) were identified by polymerase chain reaction-restriction fragment length polymorphism in 434 NHL patients, 62 HIV-related NHL cases, and 512 healthy controls. Results showed that the prevalence of ?574GT genotype and +4259TG genotype were significantly increased in the NHL cases than in controls (odds ratio (OR)?=?2.72, 95 % confidence interval (CI)?=?1.50–4.92, p?=?0.0006 and OR?=?2.59, 95 % CI?=?1.49–4.49, p?=?0.0005, respectively). The ?1516G/T polymorphism did not reveal significant difference between patients and healthy controls. When analyzing the TIM-3 polymorphisms in HIV-related NHL patients, data showed that HIV+ NHL patients had higher prevalence of ?574GT or +4259TG genotypes than those cases without HIV infection (OR?=?3.48, 95 % CI?=?1.67–7.28, p?=?0.0005 and OR?=?2.92, 95 % CI?=?1.42–6.01, p?=?0.0026, respectively). These results suggested polymorphisms in TIM-3 gene could be new risk factors for NHL as well as HIV-related NHL and suggested a possible role of the inflammatory factor in these diseases.     

Effect of Perceived Organizational Support on Fatigue of Chinese Nurses during the COVID-19 Pandemic: Resilience as a Mediator

As working for the nurse is believed to be one of the most stressful professions, nurses are particularly at risk of experiencing fatigue. Especially during the COVID-19 pandemic, fatigue among nurses may affect physical and mental health seriously, which is attracting increasing attention of researchers and clinical practitioners to find effective prevention measures to alleviate nurses’ fatigue. This study aims to investigate the mediational effect of resilience on the relationship between nurses’ perceived organizational support and fatigue. A total of 476 nurses from secondary and above hospitals in Hebei province, China during March and April in 2020, were investigated with Perceived Organizational Support Scale, Resilience Scale and Work Fatigue Inventory. Structural equation modeling was conducted to explore the mechanisms of nurses’ perceived organizational support on fatigue. Results revealed that perceived organizational support can decrease the nurses’ mental/physical/emotional fatigue through the mediating role of resilience. These findings guide for hospital managers to identify effective prevention strategies to alleviate the fatigue of clinical nurses.     

The role of innate immunity in myasthenia gravis

Myasthenia gravis (MG) is a T cell-driven, B cell-mediated and autoantibody-dependent autoimmune disorder against neuromuscular junctions (NMJ). Accumulated evidence has emerged regarding the role of innate immunity in the pathogenesis of MG. In this review, we proposed two hypothesis underlying the pathological mechanism. In the context of gene predisposition, on the one hand, Toll-like receptors (TLRs) pathways were initiated by viral infection in the thymus with MG to generate chemokines and pro-inflammatory cytokines such as Type I interferon (IFN), which facilitate the thymus to function as a tertiary lymphoid organ (TLO). On the another hand, the antibodies against acetylcholine receptors (AChR) generated by thymus then activated the classical pathways on thymus and neuromuscular junction (NMJ). Futher, we also highlight the role of innate immune cells in the pathogenic response. Finally, we provide some future perspectives in developing new therapeutic approaches particularly targeting the innate immunity for MG.     

改良体位护理在腹腔镜直肠癌Dixon手术患者中的应用

目的 观察改良体位护理方法在腹腔镜直肠低位前切除手术患者中的应用效果。 方法 选取行腹腔镜直肠低位前切除术的手术患者210例,采用随机数字表法将其分为传统组和改良组,各105例。传统组采用截石位支腿架及肩档进行常规体位摆放,改良组采用自制下肢体位垫及头颈肩约束带进行改良体位摆放。比较2组体位摆放时间、患者下肢麻木情况、肩部疼痛评分及医生对手术体位摆放的满意度。 结果 改良组体位摆放时间短于传统组(t=-5.020,P=0.007),患者下肢麻木、肩部疼痛评分均低于传统组(t=-6.732,P=0.002;t=-4.232,P=0.003),医生对手术体位的满意度评分高于传统组(t=3.623,P=0.001)。 结论 在腹腔镜直肠低位前切除术体位护理时,采用改良体位摆放法能明显缩短体位摆放时间,增加患者舒适度,减少体位相关并发症,提高医生满意度。     

MSCT后处理技术在诊断胰腺导管内乳头状黏液瘤中的应用

目的 探讨MSCT后处理技术在胰腺导管内乳头状黏液瘤(IPMN)中的诊断价值.方法 对18例经手术病理或超声内镜引导下细针穿刺证实的IPMN患者的临床、病理及MSCT检查资料进行回顾性分析,对MSCT双期增强扫描的原始数据均行MPR、MinIP及CPR,观察病变本身及其与胰管、周围结构的关系.结果 18例IPMN患者中,病变与扩张胰管相通18例(18/18,100%),胰管扩张 >1.0 cm 7例(7/18,38.89%),囊性病变17例(17/18,94.44%),囊实性病变1例(1/18,5.56%).主胰管型6例(6/18,33.33%)、分支胰管型9例(9/18,50.00%)、混合型3例(3/18,16.67%).MPR图像能清晰显示IPMN病变的大小、边界、有无强化的壁结节,也可较好显示病变与扩张胰管间的关系以及病变与周围结构之间的关系;MinIP图像在显示扩张胰管的全貌及病变与扩张胰管间关系等方面优于MPR图像及CPR图像;CPR图像有助于显示主胰管扩张的全貌.结论 利用MSCT多种后处理技术可整体显示病变、扩张胰管以及周围结构,在IPMN诊断方面具有重要价值.     

自体骨髓间充质干细胞治疗早期脊髓损伤疗效观察

目的 自体骨髓间充质干细胞移植治疗早期脊髓损伤的近期疗效和安全性.方法 2008年1月至2011年1月本院收治早期脊髓损伤患者64例,其中干细胞移植组35例患者通过蛛网膜下隙注射方式行白体骨髓间充质干细胞移植,同期入院但未行干细胞移植患者29例作为对照组.分别于移植前,移植后1、3、6个月采用美国脊髓损伤协会（ASIA）制定的评分标准对两组患者运动、感觉功能进行评定.同期随访血常规、凝血机制、生化全项、肿瘤标记物.结果 移植后1个月,两组患者运动、感觉功能都有不同程度恢复,且感觉功能恢复更为明显,各组间比较差异均无统计学意义（P＞0.05）.移植后3个月,各组患者运动功能评分均有所提高,各组间比较差异均无统计学意义（P＞0.05）.移植组患者感觉功能评分[（131.9±41.6）分]显著提高,与对照组[（108.3±36.4）分]比较差异有统计学意义（P＜0.05）.移植后6个月,对照组患者运动、感觉功能评分均未出现明显提高;蛛网膜下隙移植组患者仍有明显恢复,与对照组比较差异有统计学意义（P＜0.05）.随访各项检查结果均未出现明显异常.结论 蛛网膜下隙注射途径进行自体骨髓间充质干细胞移植治疗早期脊髓损伤安全,近期疗效确切,但远期疗效及安全性尚待进一步观察.