影响住院医师规范化培训开展的因素分析

目的 探讨影响住院医师规范化培训开展的相关因素。方法 本文选取解放军总参谋部总医院住院医师规范化培训的相关数据,以到位率为参考,研究影响培训开展的因素。结果 通过回顾性统计分析,发现培训时间、院方政策、外请专家等与培训的到位率有关。结论 住院医师规范化培训的培训时间、院方政策、外请专家等对顺利开展培训、提高培训质量有潜在的影响。     

2010-2013年开封市顺河区水痘流行病学分析

目的了解开封市顺河区2010--2013年水痘的发病情况及流行特征,为制定预防控制措施提供依据。方法采用描述流行病学方法,对4年的水痘疫情资料进行分析。结果4年共报告水痘病例621例,无死亡病例,年均发病率69．90／10万;无暴发疫情。1、4．5、6、11、12月病例较多,占73．91％。城、乡发病率差异无统计学意义（P〉0．05）。病例集中在15岁以下儿童,占87．28％;职业以学生和幼托儿童为主,占81．32％;男性明显高于女性（P〈0．01）。结论水痘严重危害儿童身心健康,应引起关注。建议国家有关部门将水痘纳入法定传染病监测与管理。     

小儿肺炎合并心力衰竭30例临床护理及观察

目的探讨多巴胺联合酚妥拉明同时配合综合护理治疗小儿肺炎合并心力衰竭的疗效及应用价值。方法选择我院治疗的小儿肺炎合并心力衰竭60例作为分析对象,采用随机数字表法分为观察组和对照组,对照组采取西医常规治疗,观察组在对照组基础上给予多巴胺联合酚妥拉明同时配合综合护理措施,记录两组疗效。结果观察组治疗总有效率为93.34%,对照组治疗总有效率为70.00%,组间对比差异有统计学意义（P〈0.05）。结论采用多巴胺联合酚妥拉明同时配合综合护理治疗小儿肺炎合并心力衰竭临床疗效可靠,能够减轻患者心脏负担,降低心肌耗氧量,值得在临床上大力推广使用。     

Ⅰ期非小细胞肺癌电视胸腔镜与开胸肺叶切除术中淋巴结清扫的对比

目的比较Ⅰ期非小细胞肺癌电视胸腔镜(VATS)肺叶切除术与开胸肺叶切除术中淋巴结清扫的效果。方法将60例拟行肺癌手术治疗的患者按患者意愿分为观察组(n=38)和对照组(n=22)。对照组采用传统开胸肺叶切除术,观察组行VATS肺叶切除术。比较两组患者淋巴结清扫总个数、淋巴结清扫时间、术后引流时间及并发症。结果对照组淋巴结清扫总个数及并发症发生率分别为(13.2±2.6)个和9.1%,观察组分别为(12.4±2.2)个和7.9%,差异无统计学意义(P0.05);观察组清扫时间明显大于对照组,差异有统计学意义[(34.2±4.8)min vs(22.7±3.3)min,P0.05];观察组术后引流时间明显小于对照组,差异有统计学意义[(5.4±1.6)d vs(8.4±2.8)d,P0.05]。结论临床Ⅰ期非小细胞肺癌电视胸腔镜肺叶切除术中淋巴结的清扫可达到与开胸手术同样的效果,且具有创伤小、术后恢复快的优点。     

Epilepsy-related psychosis: A role for autoimmunity?

Postictal psychosis (PIP) is a serious psychiatric complication of epilepsy that occurs in approximately 6% of patients following multiple complex partial or generalized seizures. The psychosis is classically described as having a pleomorphic phenomenology, including paranoid, grandiose, and religious delusions as well as multimodal hallucinations with prominent affective changes and agitation. Little is understood about the pathophysiology of the condition.There has been a recent increase in interest in the relevance of autoimmunity to the pathogenesis of both epilepsy and psychosis. Studies have demonstrated the presence of antibodies directed against synaptic autoantigens (such as the N-methyl-d-aspartate receptor or the voltage-gated potassium channel complex) in approximately 10% of cases of sporadic epilepsy. These same autoantibodies are known to cause encephalopathy syndromes which feature psychiatric symptoms, usually psychosis, as a prominent part of the phenotype as well as other neurological features such as seizures, movement disorders, and autonomic dysfunction. It is beginning to be asked if these antibodies can be associated with a purely psychiatric phenotype.Here, we hypothesize that PIP may be an autoimmune phenomenon mediated by autoantibodies against synaptic antigens. More specifically, we outline a potential mechanism whereby long or repeated seizures cause short-lived blood–brain barrier (BBB) dysfunction during which the brain becomes exposed to pathogenic autoantibodies. In essence, we propose that PIP is a time-limited, seizure-dependent, autoantibody-mediated encephalopathy syndrome. We highlight a number of features of PIP that may be explained by this mechanism, such as the lucid interval between seizures and onset of psychosis and the progression in some cases to a chronic, interictal psychosis.     

成年人骶前肿瘤的临床特点及外科治疗方法的选择

目的探讨成年人骶前肿瘤的临床特点及外科治疗方法。方法回顾性分析2007—2012年诊治的24例成年人骶前肿瘤的临床特点及治疗措施。所有患者术前均行直肠指检及影像学检查明确定位诊断,经旁骶尾入路17例,经腹入路4例,经腹经骶联合入路3例。结果切口一期愈合22例,术后并发切口感染2例,经换药后治愈。无围手术期死亡病例。24例中有20例术后随访3—17个月,1例经腹入路患者术后复发,再行手术切除治愈。结论直肠指检、影像学检查是成年人骶前肿瘤的主要诊断方法,可指导手术方式,大多数肿瘤都可以采用经旁骶尾入路切除。     

Oxyresveratrol protects human lens epithelial cells against hydrogen peroxide-induced oxidative stress and apoptosis by activation of Akt/HO-1 pathway

Oxidative stress induced by hydrogen peroxide (H₂O₂) triggers human lens epithelial cell (HLEC) apoptosis and initiates cataract formation. Oxyresveratrol (Oxy) was reported to possess antioxidant and free radical scavenging activities. Herein, we investigated the effects of Oxy on H₂O₂-induced oxidative stress and apoptosis in HLECs and the associated mechanisms. Cell viability was detected by MTT assay. The oxidative damage was assessed by measuring the activities of superoxide dismutases-1 (SOD-1), catalase (CAT), glutathione reductase (GSH), and malondialdehyde (MDA). Apoptosis was analyzed by flow cytometry analysis. The changed expressions of heme oxygenase-1 (HO-1) and protein kinase B (Akt) pathways were evaluated by qRT-PCR and western blot. We found that exposure to H₂O₂ dose-dependently reduced cell viability, and induced oxidative stress and apoptosis in HLECs, which were reversed by pretreatment with Oxy. Oxy increased p-Akt and HO-1 expressions in H₂O₂-stimulated HLECs. Akt and HO-1 expressions form a regulatory axis and Oxy activated the Akt/HO-1 pathway in H₂O₂-stimulated HLECs. Inhibition of the Akt/HO-1 pathway by LY294002 or ZnPP attenuated the effects of Oxy on oxidative stress and apoptosis in H₂O₂-stimulated HLECs. In conclusion, Oxy protected H₂O₂-induced oxidative stress and apoptosis through activating the Akt/HO-1 pathway, suggesting the protective effect of Oxy against H₂O₂-induced cataract.     

Retracted Article: MicroRNA-135a alleviates lipid accumulation and inflammation of atherosclerosis through targeting lipoprotein lipase

MicroRNAs (miRNAs) have recently attracted increasing attention for their involvement in atherosclerosis (AS). The purpose of this study was to further explore the function and underlying mechanism of miR-135a in AS progression. The expression levels of miR-135a and lipoprotein lipase (LPL) mRNA were detected by qRT-PCR, and LPL protein expression was measured by western blotting. The levels of blood lipids and inflammatory cytokines, and LPL activity were assessed using corresponding Assay Kits, and an HPLC assay was used to determine the levels of free cholesterol (FC), total cholesterol (TC) and cholesterol ester (CE). A Dil-oxLDL binding assay was performed to evaluate the ability of cholesterol uptake. The direct interaction between miR-135a and LPL was confirmed by a dual-luciferase reporter assay and RNA immunoprecipitation assay. Our data indicated that miR-135a was downregulated in serum samples of AS patients and mice. Upregulation of miR-135a alleviated lipid metabolic disorders and inflammation in AS mice. Moreover, miR-135a negatively regulated lipid accumulation and inflammation in ox-LDL-treated THP-1 macrophages. Mechanistically, miR-135a directly targeted LPL and repressed LPL expression. LPL mediated the regulatory effect of miR-135a on lipid accumulation and inflammation in ox-LDL-treated THP-1 macrophages. In conclusion, our study indicated that miR-135a upregulation ameliorated lipid accumulation and inflammation at least partly by targeting LPL in THP-1 macrophages, highlighting miR-135a as a potential antiatherogenic agent.

MicroRNAs (miRNAs) have recently attracted increasing attention for their involvement in atherosclerosis (AS).     

硫酸沙丁胺醇口服液对儿童支气管哮喘的治疗效果

目的：探讨硫酸沙丁胺醇口服液对儿童支气管哮喘的治疗效果。方法2013年4~12月在河南省开封市中心医院门诊接受治疗,经肺功能检查有可逆性气道阻塞,支气管舒张试验阳性的轻、中度哮喘急性发作患儿100例,将其随机分为研究组（n=50）和对照组（n=50）,两组患儿均给予基础治疗,观察组在上述基础治疗上再给予硫酸沙丁胺醇口服液治疗,所有患儿每天早晚监测血压,并记录2周后的哮喘日间与夜间症状评分,晨间用力肺活量（FVC）、第一秒用力呼出量（FEV1）、最大呼气流量占正常预计值之比（PEF%）,并记录治疗效果及不良反应。结果研究组治疗2周后哮喘日间症状评分、哮喘夜间症状评分、临床疗效评分分别为（0.11±0.00）、（0.03±0.01）、（0.04±0.00）分,均低于对照组,差异有统计学意义（P＜0.05）。 FVC、FEV1、PEF分别为（82.0±5.6）%、（84.2±5.2）%、（82.3±3.3）%,均较对照组升高,差异均有统计学意义（均P＜0.05）。两组不良反应事件发生率分别为4.0%、4.0%,组间比较差异无统计学意义（P＞0.05）。结论硫酸沙丁胺醇用于儿童支气管哮喘效果明显,可改善哮喘轻中度急性发作的临床症状及肺功能,缓解支气管平滑肌痉孪,解除喘息,安全性高,可用于治疗儿童支气管哮喘。     

150例白内障合并高度近视应用改良超声乳化手术的临床疗效分析

目的：分析改良超声乳化手术应用于治疗白内障合并高度近视的临床效果。方法选择2011年8月～2013年12月在本院诊治为白内障合并高度近视患者138例（150眼）,随机分为对照组和研究组,73例（75眼）对照组患者行常规超声乳化手术,65例（75眼）研究组患者行改良超声乳化手术,比较并分析两组患者手术前后相关数据。结果手术后,研究组患者的术后1个月角膜内皮细胞计数、术后3个月角膜内皮细胞计数与术后并发症发生率均明显优于对照组,差异均有统计学意义（P＜0.05）。结论白内障合并高度近视患者应用改良超声乳化手术临床疗效显著,具有推广应用与研究价值。