基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响

目的探讨基于微信平台的健康教育对中青年居家腹膜透析患者负性情绪和自我管理能力的影响。方法选取2018年9月至2020年7月我院收治的中青年居家腹膜透析患者74例,随机分为实验组和对照组各37例。对照组采用常规健康教育,实验组采用基于微信平台的健康教育。比较两组患者干预前后的负性情绪和自我管理能力。结果干预前,两组的SDS、SAS、ESCA评分比较差异无统计学意义(P>0.05);干预后,实验组的SDS、SAS评分低于对照组,ESCA评分高于对照组(P<0.05)。结论基于微信平台的健康教育可有效改善中青年居家腹膜透析患者的焦虑、抑郁等负性情绪,显著提升其自我管理能力。     

2005—2015年全国肝癌发病趋势分析

目的 通过分析《中国肿瘤登记年报》中肝癌发病的变化趋势,为有效开展肝癌防治工作提供科学参考依据。 方法 整理2005—2015年肝癌发病数据,运用Joinpoint软件进行回归模型分析我国肝癌发病率变化趋势,利用R软件进行负二项回归模型分析肝癌在人群水平上发病的危险因素。 结果 2005—2015年我国肝癌标化发病率基本表现为农村高于城市,男性高于女性。肝癌标化发病率总体呈下降趋势(AAPC=-0.818,P<0.05);城乡男性肝癌年龄别发病率大多在30~岁年龄组呈快速上升趋势,农村和城市女性年龄别发病率分别在45~和50~岁年龄组,随时间增长呈快速上升趋势。城市人群的发病风险是农村人群的1.198倍(95%CI:1.041~1.379,P＜0.05),男性是女性的3.715倍(95%CI:3.228~4.275,P＜0.001),每增加5岁,肝癌的发病风险平均增大8.0%(OR=1.080,95%CI:1.077~1.083,P＜0.001)。 结论 2005—2015年我国肝癌发病情况总体呈下降趋势,但存在城乡、性别及年龄差异,需要制定更加有效完善的预防措施,从而达到预防肝癌的最优效果。     

家庭生态系统视角下长子女情绪和行为问题研究

目的 研究二孩家庭中长子女情绪和行为问题现状,并在家庭生态系统内分析其影响因素。方法 于2020年4-7月在河南省商丘市选取538名长子女为研究对象,采用长处和困难问卷、儿童版父母教养方式问卷以及家庭亲密度和适应性量表进行调查。 结果 长子女情绪和行为困难总分异常检出率为15.1%(81/538),多因素Logistic回归分析显示,8~13岁的年龄差(OR=2.406,95% CI:1.159～4.995),竞争的同胞关系(OR=4.773,95% CI:1.933～11.785),父/母亲过度保护(OR=2.821,95% CI:1.076～7.392)/(OR=4.113,95% CI:1.903～8.890)、父亲拒绝(OR=3.215,95% CI:1.324～7.807)的教养方式,以及规律型家庭(OR=4.055,95% CI:1.312～12.533)中长子女情绪行为异常风险显著升高;而相较于抑郁质,其他气质类型长子女情绪行为异常风险显著降低(OR=0.227、0.228、0.230,95% CI:0.073～0.707、0.069～0.754、0.071～0.744),相较于低收入家庭(月收入＜2 000元),其他高收入家庭长子女情绪行为异常风险显著降低(OR=0.272、0.334、0.133、0.228;95% CI:0.095～0.778、0.119～0.939、0.035～0.501,0.056～0.924)。结论 二孩家庭中长子女情绪行为问题高于同期儿童青少年水平,需关注二孩家庭中的长子女,根据不同特征的个体进行针对性的干预。     

13种抗生素对革兰阴性杆菌抗菌活性及耐药性分析

目的 :研究临床常用抗生素的体外抗菌活性 ,分析其耐药特点 ,为临床合理用药提供可靠依据。方法 :对本实验室分离的 316株革兰阴性杆菌进行了体外药敏分析 ,并测定其产 β 内酰胺酶及超广谱 β 内酰胺酶的百分率。结果 :头孢哌酮 /舒巴坦 (舒普深CFS)的MIC90 为 8mg/L ;依米配能 /西司他丁 (泰能IPM)的MIC90 为 4mg/L ,耐药率分别为 8%和 16 % ;而其他抗生素的MIC90 为 12 8mg/L或 2 5 6mg/L ,耐药率均大于 30 %。细菌 β 内酰胺酶总检出率为 5 4 1% ,超广谱 β 内酰胺酶 (ESBL)检出率为 12 1%。结论 :CFS和IPM对临床常见革兰阴性杆菌耐药率较低。由于持续高产量 β 内酰胺酶及超广谱β 内酰胺酶的产生 ,不仅使得三代头孢菌素的耐药率较高 ,也使得庆大霉素、阿米卡星和环丙沙星等抗生素出现较为严重的交叉耐药现象。建议临床医生在三代头孢菌素的使用上应参考实验室报告 ,合理选择 ,避免耐药菌株的产生。     

Closed Incision Negative Pressure Wound Therapy for Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundPersistent wound drainage after total joint arthroplasty (TJA) increases the risk of surgical site infections (SSIs). Closed incision negative pressure wound therapy (ciNPWT) decreases infections in traumatic wounds, but evidence for its use after elective TJA is limited. The purpose of this meta-analysis of level I studies is to determine the effect of ciNPWT on risk of SSI and wound complications following TJA.MethodsMEDLINE, EMBASE, CINAHL, and Cochrane Library were searched for randomized controlled trials comparing ciNPWT vs standard dressings after total hip (THA) and total knee arthroplasty (TKA). Studies exclusively involving THA for femoral neck fractures were excluded. Risk of SSI and noninfectious wound complications (blisters, seroma, hematoma, persistent drainage, dehiscence, and wound edge necrosis) following TJA were analyzed.ResultsSSI risk was lower with ciNPWT compared to standard dressings (3.4% vs 7%; relative risk [RR] 0.48, P = .007), specifically in revision THA and TKA (4.1% vs 10.5%; RR 0.41, P = .03). ciNPWT increased the noninfectious complication risk after primary TKA (RR 4.71, P < .0001), especially causing wound blistering (RR 12.66, P < .0001). ciNPWT decreased hospital length of stay by 0.73 days (P = .04) and reoperation rate (RR 0.28, P = .01).ConclusionciNPWT decreases SSI risk compared to standard dressings after revision TJA, but not primary TJA. ciNPWT is associated with >12-fold increased risk of wound blistering after primary TKA. ciNPWT plays a role in revision TJA management, but additional randomized controlled trials with uniform wound assessment methods must be performed to sufficiently power findings and draw conclusions on the use of ciNPWT after primary TJA.     

Outcome of Debridement,Antibiotics, and Implant Retention With Modular Component Exchange in Acute Culture-Negative Periprosthetic Joint Infections

BackgroundModular component exchange and culture-directed antibiotic treatment is routinely employed for acute periprosthetic joint infection (PJI). However, as many as 7%-23% of PJIs have been reported to yield negative culture results. The efficacy of debridement, antibiotics, and implant retention (DAIR) with modular component exchange in the setting of acute culture negative PJI remains largely unknown. The aim of our study is to evaluate the outcomes of DAIR with modular component exchange in acute culture-positive and culture-negative PJI.MethodsA total of 149 consecutive patients with primary total joint replacements (90 total knee arthroplasties and 59 total hip arthroplasties) who underwent DAIR with modular component exchange for acute PJI with at least 3 years of follow-up were evaluated: (1) 46 culture-negative PJI patients and (2) 103 culture-positive PJI patients. Reinfection and aseptic revision rates along with complication rates were compared.ResultsThe reinfection rate for DAIR in acute culture-negative PJI was 13.0% compared to 19.4% in culture-positive PJI (P = .48). Mean survival time from reinfection between culture-negative (7.7 ± 0.4 years) and culture-positive (7.4 ± 0.3 years) PJI groups did not differ significantly (P = .40). Aseptic revision rates were 8.7% and 4.9% (P = .46), respectively, with loosening being the primary reason for implant failure in both cohorts.ConclusionsDespite lack of an identifying organism to guide postoperative antibiotic therapy, DAIR with modular component exchange for acute culture-negative PJI was associated with similar reinfection rates compared to acute culture-positive PJI, suggesting that culture negativity may not be a contraindication to DAIR in patients with acute PJI.     

The effect of postmastectomy radiation therapy on high-risk patients with T1-2N0 breast cancer

BackgroundThe prognostic impact of postmastectomy radiation therapy (PMRT) on high-risk patients with T1-2N0 breast cancer is controversial. We aimed to investigate the effect of PMRT on high-risk patients with T1-2N0 breast cancer.MethodsA total of 3439 patients diagnosed with T1-2N0 breast cancer who received mastectomy between 2000 and 2016 in our institute were retrospectively analyzed. Leveraging the Fine and Gray competing risks regression in unirradiated patients, risk factors of locoregional recurrence (LRR) were identified. All patients were stratified into high-risk (3 or 4 risk factors) and low-risk (no more than 2 risk factors) groups. The prognostic effect of PMRT was estimated in two subgroups. This subgroup analysis was also performed in patients with T2N0 breast cancer.ResultsThe median follow-up was 89 months. The 5-year cumulative incidence of LRR was 2.2% in unirradiated patients. Tumor size, estrogen receptor (ER) status, histologic grade and lymphovascular invasion (LVI) were identified as independent risk factors of LRR. In the high-risk group, PMRT was correlated with a 8.3% risk reduction of 5-year LRR, 7.8% risk reduction of 5-year distant recurrence (DR), and 6.4% risk reduction of 5-year breast cancer mortality (BCM), whereas it was not correlated with LRR, DR, or BCM in low-risk group. In patients with T2N0 breast cancer, PMRT was associated with decreased LRR, DR and BCM in high-risk group, other than low-risk group.ConclusionsPMRT presented heterogenous effect on patients with T1-2N0 breast cancer. Patients at high risk of LRR were more likely to benefit from PMRT.     

洛匹那韦/利托那韦联合干扰素治疗新型冠状病毒肺炎的疗效

目的　探讨洛匹那韦/利托那韦联合干扰素治疗新型冠状病毒肺炎（新冠肺炎）的有效性及安全性。方法　选取2020年1月3日—4月7日于我中心住院治疗的62例新冠肺炎确诊患者作为研究对象,并将其分为治疗组（43例）和对照组（19例）,其中对照组采用常规对症支持治疗,治疗组在对照组常规治疗基础上使用洛匹那韦/利托那韦抗病毒治疗;同时,根据患者临床分型对上述患者实施非重症组与重症组亚组分析。比较对照组和治疗组核酸转阴时间、住院时间、退热时间、症状缓解时间及药物不良反应发生情况。结果　在非重症组患者中,治疗组与对照组在退热时间、症状缓解时间、核酸转阴时间及住院时间方面的差异均无统计学意义（P均＞0.05）;而在重症组患者中,治疗组核酸转阴时间显著长于对照组[（23.62±2.12 ）d vs.（9.25±0.95）d],差异有统计学意义（P＜0.05）。在药物不良反应方面,治疗组腹泻发生率为46.5%,显著高于对照组,差异有统计学意义（P＜0.05）,但均为轻到中等程度腹泻,经对症治疗后腹泻症状消失。结论　洛匹那韦/利托那韦联合干扰素治疗新冠肺炎非重症患者效果不明显,治疗重症患者,核酸转阴时间更长,虽临床应用总体安全性较好,但存在腹泻等不良反应,不推荐使用。     

负压创面治疗技术治疗慢性创面患者的效果

目的探讨在慢性创面患者中应用负压创面治疗技术的效果。方法选取2019年1月至2020年1月天津武清中医院收治的56例慢性创面患者,按照随机数字表法分为对照组和试验组,每组28例。对照组给予普通清创换药治疗,试验组给予负压创面治疗,比较两组植皮时间、愈合时间、住院总费用、疼痛程度。结果试验组植皮时间、愈合时间均短于对照组,住院总费用少于对照组,视觉模拟评分法(VAS)评分低于对照组,差异均有统计学意义(P<0.05)。结论负压创面治疗技术应用于慢性创面患者中的效果显著,能够缩短植皮时间、愈合时间,减少住院费用,减轻疼痛感。