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31.
目的探讨慢加急性乙型肝炎肝衰竭患者最优化的临床治疗方案。方法收集2008年1月—2010年1月在福建医科大学附属传染病医院住院治疗的302例慢加急性乙型肝炎肝衰竭患者,所有患者分为A组(内科治疗)57例,B组(内科+抗病毒治疗)80例,c组(内科+抗病毒+人工肝治疗)124例,D组(内科+抗病毒+人工肝+中医治疗)41例。观察患者治疗基线、治疗第1、4、8、12周及治疗结束时的肝功能、。肾功能、凝血酶原活动度(胛A)、HBVDNA等指标,并在治疗结束后随访48周观察其存活情况。应用Kruskal—Willis H检验比较治疗后的临床疗效,应用Cox比例风险回归模型进行生存分析。结果治疗4周后四组间的临床疗效差异无统计学意义(H=3.213,P=0.360),治疗12周后的临床疗效差异有统计学意义(H=8.722,P=0.033)。四组1年病死率分别为36.84%(21/57)、32.50%(26/80)、26.61%(33/124)和24.39%(10/41)。C组治疗方法的死亡风险是B组的0.566倍(P=0.036);D组治疗方法的死亡风险是B组的0.396倍(P=0.016)。结论在内科治疗的基础上加用核苷(酸)类药物及人工肝单纯血浆置换术可明显提高慢加急性乙型肝炎肝衰竭患者的生存率。 相似文献
32.
目的 探究当前八年制临床医学专业通识教育阶段大学英语课程实施现状及存在的问题,并结合现状提出改进措施。方法 通过问卷分析及访谈的方式对四川大学华西医学中心从事八年制双语课程教学教师、四川大学外国语学院从事八年制大学英语课程教学教师及部分教务管理教师进行调研,分析教学中存在的问题及探索改进措施。结果 学生对大学英语课程重视程度较高,但任课教师反映学生的参与度较低。整体上,大学英语课程教学效率较低,亟待改进。结论 八年制大学英语课程实施效率不理想,原因来自教师、学生双方,需从两方面进行改进。 相似文献
33.
《Transplantation proceedings》2023,55(5):1152-1155
BackgroundNeutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII = N × P/L), and neutrophil percentage-albumin ratio (NPAR) have become accepted markers of inflammation in recent years. These indices are used as indicators of disease activity, mortality, and morbidity in many diseases. This study evaluated the relationship between inflammatory indices and graft function in pediatric kidney transplant recipients.MethodsMedical records of pediatric patients who underwent kidney transplantation at Ege University between 1995 and 2020 were reviewed retrospectively. Demographic, clinical, and laboratory data were recorded during the third month, first year, and fifth year of transplantation and at the last visit.ResultsThe median age of the 119 patients (60 boys/59 girls) at the time of transplantation was 154 months, and the median follow-up period was 101 months. According to Spearman correlation analysis, patients' final creatinine levels were positively correlated with NLR (r = 0.319), PLR (r = 0.219), SII (r = 0.214), and NPAR (r = 0.347) of the last visit; final estimate glomerular filtration rate levels were negatively correlated with NLR (P = .010, r = −0.250) and NPAR (P = .004, r = −0.277). The median NPAR of the patients with chronic allograft dysfunction at the last visit was found to be statistically significantly higher than without (P = .032).ConclusionNLR, PLR, SII, and NPAR values are correlated with creatinine levels after 5 years of kidney transplantation. The NPAR and final creatinine levels had the highest correlation coefficient among these inflammatory markers. These results suggest that inflammatory markers, especially NPAR, may be a candidate to be an indicator of ongoing inflammation in the graft. 相似文献
34.
Xin Li Shaojie Kou Guo Chen Bingjie Zhao Jingdong Xue Rui Ding Xiaoyan Zhao Miaoqing Ye Yueqing Yang Rensong Yue Fenping Li 《International wound journal》2023,20(8):3015-3022
A meta-analysis investigation to measure the relationship between vitamin D deficiency (VDD) and diabetic foot ulcer (DFU). A comprehensive literature inspection till February 2023 was applied and 1765 interrelated investigations were reviewed. The 15 chosen investigations enclosed 2648 individuals with diabetes mellitus in the chosen investigations' starting point, 1413 of them were with DFUs, and 1235 were without DFUs. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the relationship between VDD and DFU by the dichotomous and continuous approaches and a fixed or random model. Individuals with DFUs had significantly lower vitamin D levels (VDL) (MD, −7.14; 95% CI, −8.83 to −5.44, P < 0.001) compared to those without DFU individuals. Individuals with DFUs had a significantly higher number of VDD individuals (OR, 2.27; 95% CI, 1.63-3.16, P < 0.001) compared to those without DFU individuals. Individuals with DFU had significantly lower VDL and a significantly higher number of VDD individuals compared to those without DFU individuals. However, caused of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values. 相似文献
35.
36.
Doris Franke Miroslav Živičnjak Jochen H. H. Ehrich 《Pediatric nephrology (Berlin, Germany)》2009,24(6):1093-1096
Despite major progress in dialysis, nutrition and drug treatment in the past 20 years, growth of infants and toddlers with
chronic kidney disease (CKD) remains a major challenge in paediatric nephrology. Our hypothesis is that early growth deficit
is one of the most important factors for impaired final height in children with CKD, and we conclude that early implementation
of recombinant human growth hormone (rhGH) therapy should be offered to infants with growth failure. Infants with delayed
growth, adequate caloric intake and stable parameters of bone metabolism are candidates for rhGH therapy. One predictive factor
for the selection of infants for rhGH treatment may be growth retardation at birth. Our conclusion from the limited published
data is that the use of rhGH in young children with CKD is effective and safe. Compared with its use in older children, the
early use of growth hormone requires lower absolute dosages of rhGH, which therefore reduce the annual treatment costs and
allow earlier renal transplantation. Furthermore, an early start on rhGH improves the psychosocial situation later in childhood
and may lead to a further improvement in adult height. A multi-centre randomised controlled study should be initiated to analyse
the short-term and long-term effects of early rhGH therapy on infants with CKD.
Remark from the EditorsThe article by Mencarelli et al. was published in the May 2009 issue of the Journal and can be found at doi:. 相似文献
37.
目的:了解重庆地区近年来丙型肝炎病毒(hepatitis C virus,HCV)基因型分布、演变和可能的临床意义,为更好防治丙型肝炎提供依据。方法:回顾性研究2010年1月至2013年12月期间在重庆医科大学附属第二医院就诊并有基因分型结果的丙型肝炎患者的基因型分布,并与该地区其它文献报道的数据相比较,探讨基因型演变的可能影响因素。结果:共收集941例HCV感染者,检出4种基因型、9种基因亚型,成功进行基因分型有857例(均为单一基因型,分型率91.1%)。其基因型分布为:1a 30例(3.5%)、1b 238例(27.8%)、2a 42例(4.9%)、2b 1例(0.1%)、3a 132例(15.4%)、3b 244例(28.5%)、3k 6例(0.7%)、6a124例(14.5%)、6b 40例(4.7%)。与5年前的结果比较发现HCV 1b、2a亚型明显下降,3型、6型比例上升,差异具有统计学意义。结论:3b、1b型为目前重庆地区丙型肝炎患者感染HCV的主要基因型,3a、6a型亦占有较大比例,提示重庆地区HCV流行的基因型呈现多样性。 相似文献
38.
Natural orifice transluminal endoscopic surgery (NOTES) is considered the new frontier for minimally invasive surgery. NOTES
procedures such as peritoneoscopy, splenectomy, and cholecystectomy in animal models have been described. The aim of our experiment
was to determine the feasibility and technical aspects of a new endoluminal surgical procedure. After approval from Columbia’s
IACUC, a transvaginal laparoscopically assisted endoscopic cholecystectomy was performed on four 30 kg Yorkshire pigs. The
first step was to insert a 1.5 cm endoscope into the vagina under direct laparoscopic vision. Then the gallbladder was reached
and, with the help of a laparoscopic grasper to hold up the gallbladder, the operation was performed. At the end of the procedure
the gallbladder was snared out through the vagina attached to the endoscope. There were no intraoperative complications such
as bleeding, common bile duct or endo-abdominal organ damage. Total operative time ranged between 110 and 155 min. Based on
our experience in the porcine model, we believe that a transvaginal endoscopic cholecystectomy is feasible in humans.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
39.
Intraoperative Iatrogenic Rupture of Hepatocellular Carcinoma 总被引:2,自引:0,他引:2
Intraoperative iatrogenic rupture of hepatocellular carcinoma (HCC), which can occur during hepatic resection when large tumors are being mobilized, may adversely affect the operative outcome. Little information is available in the literature on this serious intraoperative complication. The aim of the present study is to document iatrogenic rupture of HCC as a serious complication during hepatic resection and its effects on the operative and long-term outcomes of patients with this complication. A retrospective study was performed on all patients with intraoperative iatrogenic rupture of HCC during hepatic resection from 1989 to 1997, and the operative and long-term survival outcomes were compared with those of patients without the complication. Among 194 patients who underwent hepatic resection for a large HCC (> or =5 cm) during the study period, 8 (4.1%) had intraoperative iatrogenic rupture of the tumor. When compared with 186 patients with similar clinical parameters but without intraoperative rupture, patients with intraoperative rupture had significantly more intraoperative blood loss (median 5.7 vs. 2.0 L;p = 0.01) and blood transfusion requirement (median 3.1 vs 0.9 L; p = 0.02). On follow-up, patients in the intraoperative rupture group had a significantly higher intraperitoneal extrahepatic recurrence rate (33.3% vs. 2.9%; p =0.02) and significantly shorter survival (median 11.5 vs. 37.9 months,p = 0.04) when compared with patients without the complication. Intraoperative iatrogenic rupture is a serious complication of hepatic resection for HCC because it is associated with increased intraoperative blood loss, increased incidence of intraperitoneal extrahepatic recurrence, and short survival. Extreme care should be taken during mobilization of the tumor, and an alternative operative approach in the presence of a difficult hepatic resection of a large HCC may be required to avoid the complication. 相似文献
40.