布比卡因蛛网膜下腔阻滞不同给药方式对瘢痕子宫剖宫产术产妇麻醉的效果分析

目的探究布比卡因蛛网膜下腔阻滞不同给药方式对瘢痕子宫剖宫产术产妇麻醉的效果。方法选取2018年1月至2020年2月于本院行剖宫产术分娩的瘢痕子宫产妇102例,根据给药方式的不同分为对照组和观察组,各51例,两组均行布比卡因蛛网膜下腔阻滞麻醉。对照组实施单项注射,观察组实施双向注射,比较两组手术不同时间段血流动力学指标、手术指标、新生儿娩出后的Apgar评分及麻醉不良反应发生率。结果麻醉前、麻醉后即刻、麻醉后5 min、麻醉后15 min、手术结束,两组HR、MAP、SpO;比较差异无统计学意义;观察组手术时间短于对照组,差异有统计学意义(P<0.05);两组术中出血量、平均补液量、新生儿娩出后的Apgar评分比较差异无统计学意义;观察组不良反应发生率为3.92%,低于对照组的19.61%,差异有统计学意义(P<0.05)。结论与单向注射相比,瘢痕子宫产妇实施剖宫产术分娩时行双向注射给药麻醉效果更佳,不良反应更少,手术效果更好,值得临床推广应用。     

腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉对老年股骨粗隆间骨折患者麻醉效果的影响

目的探究腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉对老年股骨粗隆间骨折患者麻醉效果的影响。方法选取本院2017年8月至2019年11月收治的94例老年股骨粗隆间骨折患者,按照随机数字表法分为对照组(n=48)和观察组(n=46)。对照组行蛛网膜下腔阻滞麻醉复合腰硬外麻醉,观察组行腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉。比较两组手术不同时间段血流动力学指标[平均动脉压(MAP)及心率(HR)]情况。结果 T1、T2、T3、T4时段,观察组MAP及HR水平均高于对照组,差异有统计学意义(P<0.05)。结论老年股骨粗隆间骨折患者经腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉更有利于稳定术中血流动力学指标。     

基于人口流动的海南省新型冠状病毒肺炎输入风险和防控效果评估

目的对海南省各市县2020年1月10日—3月7日新型冠状病毒肺炎输入风险进行评估,并对2021年春运期间采取“常态化防控”措施效果进行评估。方法收集海南省每日报告输入病例数及30个省份每日报告病例数和百度迁徙指数,计算海南省各市县输入风险指数,对全省及各市县输入风险进行量化评估。分析输入风险指数与输入病例间关系,据此构建“疫情应急围堵”阶段输入病例拟合模型,预测2021年春运期间仍然采取“应急围堵”策略可能的输入病例数,与实际输入病例数相比较,以评估2021年春运期间采取“常态化”疫情防控策略的效果。结果海南省报告输入病例112例,平均输入风险指数为0.98。海口市、三亚市和儋州市输入风险最高,除海口外,各市县输入风险指数1月24日左右达到最大值,以滞后4 d和5 d输入风险指数构建的两阶段广义相加模型对输入病例数的拟合程度最好(R^(2)_(adjust1)=83.50%,R^(2)_(adjust2)=82.00%,MRE=17.61%)。如继续采取“应急围堵”策略,预计2021年春运期间海南省将有10例输入病例,“常态化”防控策略下,实际上海南省无输入病例发生。结论海口和三亚等旅游城市输入风险较高,湖北省和广东省是主要的疫情输入省份,广义相加模型可以较好地对“应急围堵”阶段海南省新冠肺炎输入病例进行拟合。与“应急围堵”策略相比较,2021年春运期间采取的“常态化”疫情防控策略使海南省减少了约10例输入病例。     

褪黑素介导抗炎、抗氧化、抗骨质疏松作用在椎间盘退变修复中的研究进展

目前,椎间盘退行性疾病（disc degeneration disease,DDD）已成为临床上中老年人的常见病,且发病年龄有年轻化趋势。椎间盘退变（intervertebral disc degeneration,IDD）是指椎间盘（intervertebral disc,IVD）在内外部因素共同作用下引起的老化、退化等一系列生理、病理过程,被认为是DDD的基本病理过程,是引发患者腰痛的主要原因,因此修复IDD是治疗DDD的重点。IDD过程中伴随着炎症介质的产生、炎症相关信号通路的活化以及氧化应激的发生。褪黑素作为一种吲哚类激素,具有显著的抗炎及抗氧化作用,近年来受到研究者关注,越来越多的研究表明褪黑素对IVD具有保护作用,对治疗骨质疏松症（osteoporosis,OP）也有一定的作用,其有望成为IDD修复的治疗药物。笔者拟对褪黑素在椎间盘退变修复中的最新研究进展做一综述,以期为后续研究及IDD的早期药物干预和修复治疗策略提供思路。     

¿Es segura y eficaz la colecistostomía percutánea en la colecistitis aguda? Análisis de los efectos adversos asociados a la técnica

IntroductionThe main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure.Material and methodObservational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy.ResultsOf 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%).ConclusionWe consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.     

消痤洁肤乳膏治疗寻常痤疮临床研究

目的探讨消痤洁肤乳膏治疗寻常痤疮的临床疗效。方法对278例寻常痤疮患者随机分为治疗组168例和对照组110例,分别给予消痤洁肤乳膏及复方克林霉素搽剂局部外搽,每日2次。对患者进行细菌学检查、皮脂溢出率测定以及临床疗效评价。结果皮脂溢出率在用消痤洁肤乳膏治疗前为(1.84×10-2±0.63×10-2)g/(m2.m in),治疗4周后为(1.09×10-2±0.43×10-2)g/(m2.m in),治疗前后比较有显著降低(P<0.05)。治疗组与对照组治疗后的细菌清除率分别为85.3%和84.0%,总有效率分别为94.6%和82.7%。结论消痤洁肤乳膏为一种治疗寻常痤疮的安全、有效的外用制剂。     

2例静滴头孢噻肟钠致过敏反应的护理

头孢噻肟钠为第三代头孢菌素,抗菌谱广,适用于敏感细菌所致的肺炎及其他下呼吸道感染、尿路感染、脑膜炎、败血症等,现将我科应用头孢噻肟钠致过敏反应的护理报告如下。1病例介绍病例1患者,女性,22岁,咳嗽5天,于2006年11月5日来门诊就诊,患者神志清,精神好,皮肤无异常。既往无使用青霉素及头孢类药物过敏史,门诊诊断为“上呼吸道感染”。遵医嘱给予等渗盐水250ml加头孢噻肟钠3.0静滴,滴速60滴/min。当滴入约20ml左右,患者感到面部瘙痒难忍,并出现散在丘疹,立即停用头孢噻肟钠,给予NS 10ml 地塞米松10mg静推,扑尔敏10mg肌注,于10min后,患者…     

Statistics and replication experiments: Comparing interaction effects

A method is presented that allows the comparison and combination of interaction effects obtained in two or more experiments. Using an analysis of variance model, we first evaluated the interaction effects found in experiments conducted by Alloy and Abramson (1979, Experiment 2) and Bryson, Doan, and Pasquali (1984). Both experiments examined the same independent (level of depression and outcome frequency) and dependent (judgment of control) variables. Whereas Alloy and Abramson reported a significant depression ×outcome frequency interaction for female subjects, Bryson et al. failed to find any significant interaction effects. The latter authors challenged the replicability of the Alloy and Abramson results. Our reanalyses of the results from these two studies indicated that, for females, Bryson et al. produced an interaction effect not different from that of Alloy and Abramson. Our next task was to compare the conclusions reached from our analytical approach with those based on standard meta-analytic methods (Rosenthal, 1984). Finally, we evaluated the general utility of the two analytical approaches and made some general comments about replication experiments. We thank Margaret Murray for her contributions to early stages of this project. The comments and advice of Rebecca Warner, Paul Sweeney, William Stine, Carolyn Mebert, Ellen Cohn, Vernon Padgett, David Sugarman, and several anonymous reviewers are appreciated.     

空化效应与超声治疗仪

本文简要综述在超声作用下，液体中空化气泡快速闭合瞬间所产生的放电、发光、高温、高压、高能量密度、冲击波、微冲流、微聚变、高精度时钟等奇特的理化效应。这些效应构成了近年来迅速发展的超声治疗、超声手术、超声美容等的物理机制，也为设计、改进及合理应用这类超声治疗仪提供了科学依据     

大肠埃希菌和肺炎克雷伯菌中质粒介导的喹喏酮类耐药研究

目的:研究国内11家医院分离大肠埃希菌(ECO)和肺炎克雷伯菌(KPN)中质粒介导的喹喏酮类耐药。方法:收集北京大学第三医院无重复临床分离产超广谱β-内酰胺酶(ESBL s)的ECO和KPN共84株,另10家医院相应菌株共155株,北京协和医院对头孢西丁不敏感的ECO和KPN共25株。采用琼脂稀释法测定抗生素最低抑菌浓度M IC;接合实验判断该基因位置和移动性;聚和酶链反应(PCR)及其产物测序确定基因型。结果:北医三院84株菌中1株KPN(编号24)阳性,ECO的发生率是0;余10家医院155株产ESBL s菌株中没有阳性结果;协和医院25个临床株中3株KPN(编号P 3、P 6、P 10)阳性。这4株菌只有P 6接合试验阳性,相应接合子qnr-PCR阳性。环丙沙星C IP对该菌的M IC是0.5μg/m l,对该接合子的M IC是1μg/m l,而对受体菌EC 600的M IC是0.125μg/m l。对24号标本和P 6标本及其接合子进行测序证实:二者的qnr↑序列和AY 878718(qnrA)100%同源,并且qnr基因的上游都有ORF 513存在。结论:北医三院和北京协和医院分类株中存在质粒介导的喹喏酮类耐药基因qnr,其他医院分离株本次研究中未发现该基因。