不同时间进行硬膜外镇痛对产妇产程时间的影响及母婴分娩结局分析

目的 探讨不同时间进行硬膜外镇痛对产程时间的影响和母婴分娩结局的影响。方法 选取我院收治的产妇165例为研究对象,选取的时间范围为2016年3月～2019年2月,按照产妇入院顺序分为活跃组、潜伏组和自然组,每组55例,活跃组产妇进行活跃期硬膜外镇痛,潜伏组产妇进行潜伏期硬膜外镇痛,自然组产妇进行自然分娩。观察三组产妇的产程时间、产妇的分娩状况以及不同时间点的视觉模拟评分(VAS),以及采用Apgar评分判断新生儿窒息情况。结果 潜伏组产妇的宫口扩张速度明显快于活跃组和自然组,潜伏期产妇的活跃期和第二产程明显短于活跃组和自然组,差异有统计学意义(P0.05);三组产妇的第三产程差异无统计学意义(P0.05)。活跃组和潜伏组产妇的缩宫素使用率分别为50.91%和45.45%,明显高于自然组18.18%,产妇器械助产率分别为25.45%和30.91%,明显高于自然组14.54%,差异有统计学意义(P0.05);活跃组和潜伏组产妇的剖宫产率分别为9.09%和7.27%,明显低于自然组21.82%,差异有统计学意义(P0.05);三组产妇的顺产率差异无统计学意义(P0.05);三组新生儿的窒息情况差异无统计学意义(P0.05)。分娩后10 min和40 min,自然组产妇的VAS评明显高于活跃组和潜伏组,差异有统计学意义(P0.05)。结论 在潜伏期对产妇进行硬膜外镇痛可以缩短产妇的活跃期和第二产程时间,加快宫口扩张,减轻产妇的疼痛,提高母婴结局。     

不同材料固定义齿修复后牙连续缺损的效果及对口腔生物膜的影响

目的 研究不同材质义齿与修复材料对口腔生物膜的影响。方法 选择自2018年5月～2019年5月我院收治的120例2颗后牙连续缺损患者进行研究。将选取的120例牙体缺损患者平均分为三组,分别通过二氧化锆全瓷冠、钴铬合金烤瓷冠和银钯合金烤瓷冠进行修复。修复后三组患者均通过构建口腔生物膜体外模型对口腔生物膜形成情况进行分析;通过涂布等平板计数法对口腔生物膜平板菌落计数和口腔生物膜变形链球菌代谢产物进行分析。结果 三组患者口腔生物膜的形成、平板菌落计数和变形链球菌代谢产物的终pH值和ΔpH之间存在显著差异。其中二氧化锆组患者生物膜形成量较其他两组患者多,而平板菌落计数和变形链球菌代谢产物的pH值变化较小,三个指标的变化规律一致。结论 不同材质义齿与修复材料对口腔生物膜的影响不同。二氧化锆对患者口腔生物膜影响效果较其他两种材质与修复材料好,可进行临床推广。     

血清甲状腺激素水平与肝硬化类型的相关性研究

目的 探讨不同类型肝硬化患者血清甲状腺激素水平的改变情况。方法 选择2010年1月至2013年6月本院住院治疗的原发性胆汁性肝硬化（PBC）、酒精性肝硬化和病毒性肝炎后肝硬化患者共84例,回顾性统计患者血清甲状腺激素和总胆红素检测结果。结果 84例患者根据疾病类型分为PBC组17例、酒精性肝硬化组25例、病毒性肝炎后肝硬化组42例。3组患者血清总三碘甲状腺原氨酸（TT3）和血清总甲状腺素（TT4）均降低,且3组患者间差异有显著统计学意义（P〈0.001和P=0.001）,其中以PBC患者外周血TT3水平最低,酒精性肝硬化患者外周血TT4水平最低。相对于无黄疸患者,有黄疸的肝硬化患者血清游离三碘甲状腺原氨酸（FT3）和TT3水平下降明显,差异均有统计学意义（P〈0.001和P=0.001）。结论 肝硬化患者多存在甲状腺激素水平的异常改变,且不同类型肝硬化患者血清甲状腺激素改变可能存在差异。     

舌神经至不同下颌磨牙牙龈缘距离的关系分析

目的探讨舌神经至不同下颌磨牙牙龈缘的距离,为患者进行相关手术治疗提供可靠临床依据,尽量避免患者术后发生舌神经损伤情况,提高患者生活质量。方法在本院2000年至2012年之间所收集的成人头部标本中随机选取20例进行解剖,所有标本均已进行防腐固定措施,使用专用测量工具对标本左侧舌神经、右侧舌神经与下颌第1、2、3磨牙牙龈缘距离分别进行测量,记录测量结果并进行统计学分析,得出结论。结果左侧舌神经与右侧舌神经相距下颌第1、2、3磨牙牙龈缘水平距离、垂直距离以及45度角距离相近,且P>0.05,左侧舌神经与右侧舌神经相距下颌第1磨牙牙龈缘距离无统计学意义。结论在对患者进行下颌磨牙舌侧骨嵴修整术或阻生智齿拔除术治疗时,应根据人体舌神经解剖学知识,以及舌神经至不同下颌磨牙的牙龈缘距离范围,尽量避免对患者舌神经造成伤害,从而有效预防患者术后发生暂时性或永久性舍感觉丧失并发症,提高患者生活质量。     

广东省珠海地区不同人群梅毒感染情况分析

目的通过对珠海地区不同人群进行梅毒血清学检测,了解珠海地区不同人群中梅毒的感染情况,为今后加强梅毒的防治工作提供依据。方法采用酶联免疫吸附试验(ELISA)、甲苯胺红不加热血清反应素试验(TRUST),检测珠海地区吸毒人群、性工作者、外来务工人群和无偿献血人群的梅毒感染情况。结果珠海地区吸毒人群、性工作者、外来务工人群、无偿献血人群的梅毒抗体阳性率分别为9.20%、0.98%、0.89%,0.52%;梅毒感染率分别为4.29%、0.65%、0.66%、0.24%,吸毒人群梅毒抗体阳性率及感染率均明显高于其他人群。各人群中,梅毒以隐性感染为主。结论珠海地区在开展性病防治工作时,应对不同人群采取不同措施,加强性健康宣传教育工作,提高人们对梅毒等性病的认知水平,增强自我保护意识,防止梅毒从吸毒者向暗娼或嫖客向家庭成员传播扩散。     

不同频率脉冲电磁场对骨保护素基因敲除小鼠骨代谢指标影响

目的采用不同频率的脉冲电磁场干预骨保护素基因敲除小鼠骨质疏松模型,探讨脉冲电磁 场治疗骨质疏松的最适治疗频率。方法8周龄雌雄各半骨保护素基因敲除小鼠30只,随机分为 A、B、C 3组,每组10只,粤组为空白对照组,不进行干预;B组小鼠每天在强度为4皂栽,频率为8 HZ 的磁场中照射治疗20 min,共30 d;C组小鼠每天在强度为4 mT,频率为32 HZ的磁场中照射治疗20 min,共30凿。各组小鼠在治疗前及治疗30d后用酶联免疫法（ELISA )法检测抗酒石酸酸性磷酸酶 缘遭及血清骨钙素值。结果8HZ、32HZ两治疗组在治疗后抗酒石酸酸性磷酸酶5遭,血清骨钙素含 量与A对照组之间比较差异有统计学意义（P <0.05 ), 8 HZ、32 HZ两治疗组之间治疗前与治疗后所 测三种指标比较差异无统计学意义（P >0.05 )。结论脉冲电磁场对骨保护素基因敲除小鼠骨质疏 松有肯定治疗效果,应用频率为8-32 HZ的磁场治疗能产生相同的治疗效果。     

Role of different negative pressure values in the process of infected wounds treated by vacuum‐assisted closure: an experimental study

Vacuum‐assisted closure (VAC) device is widely used to treat infected wounds in clinical work. Although the effect of VAC with different negative pressure values is well established, whether different negative pressures could result in varying modulation of wound relative cytokines was not clear. We hypothesise that instead of the highest negative pressure value the suitable value for VAC is the one which is the most effective on regulating wound relative cytokines. Infected wounds created on pigs' back were used to investigate the effects of varying negative pressure values of VAC devices. Wounds were treated with VAC of different negative pressure values or moist gauze, which was set as control. The VAC foam, semiocclusive dresses and moist gauze were changed on days 3, 5, 7 and 9 after wounds were created. When changing dressings, tissues from wounds were harvested for bacteria count and histology examination including Masson's trichrome stain and immunohistochemistry for microvessels. Western blot was carried out to test the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Results showed that on days 3 and 5 the number of bacteria in wounds treated by VAC with 75, 150, 225 and 300 mmHg was significantly decreased compared with that in wounds treated by gauze and 0 mmHg pressure value. However, there was no difference in wounds treated with negative pressure values of 75 , 150, 225 and 300 mmHg at any time spot. Immunohistochemistry showed that more microvessels were generated in wounds treated by VAC using 75 and 150 mmHg negative pressure comparing with that using 225 and 300 mmHg on days 3 and 5. However this difference vanished on days 7 and 9. Morphological evaluation by Masson's trichrome staining showed increased collagen deposition in VAC of 75 and 150 mmHg compared with that in VAC of 225 and 300 mmHg. Western blot showed that the expression of VEGF and bFGF significantly increased when the wounds treated with 75 and 150 mmHg negative pressure values compared with the wounds treated with 225 and 300 mmHg on day 5. Treatment using VAC with different negative pressure values more than 75 mmHg has similar efficiency on reducing bacteria in the infected wound. VAC with negative pressure values of 75 and 150 mmHg promote wound healing more quickly than other pressure values. Moreover, comparing with vigorous negative pressure, relatively moderate pressures contribute to wound healing via accelerated granulation growth, increased angiogenic factor production and improved collagen fibre deposition. Further study of this model may show other molecular mechanisms.     

南京市不同人群对骨质疏松症知晓情况调查

目的了解南京市一般人群、医护人员和骨质疏松症患者对骨质疏松症相关知识的知晓情况及其影响因素,为制定合理有效的骨质疏松症健康教育策略提供参考依据。方法采用自行设计的问卷对三类人群进行自填式问卷调查。结果医护人员正确认识骨质疏松症的知晓率83.1%,明显高于一般人群的49.1%和患者的44.8%(P=0.000)。关于骨质疏松健康危害的调查选项只有2名医护人员答案完全正确。预防骨质疏松的知识知晓率,医护人员为31.3%,明显高于一般人群10.2%和患者人群7.9%(P=0.000)。调查相关信息的获取和愿意接受的来源中,医护人员主要来自于医疗结构,一般人群和患者人群主要来自媒体机构。结论一般人群和骨质疏松症患者关于骨质疏松症的知识知晓率低,医疗机构在对社会人群的骨质疏松症健康教育中没有发挥应有的作用;而医护人员的骨质疏松症知识也仍然需要加强教育。     

The effect of using different types of periodic contact rate on the behaviour of infectious diseases: a simulation study

This paper studies the effect of using different types of seasonally varying contact rate on the behaviour of the seasonally varying infectious diseases for an SEIR epidemic model. Our target is to investigate the long term behaviour of the system in response to changes in beta(1), the amplitude parameter of the seasonal contact rate, which is our bifurcation parameter. This amplitude parameter is used as a filter to plot the length in years of the period of the stable endemic periodic solution of the SEIR model. Another main aim of this simulation study is to explain how can the type of the contact rate affect the behaviour of the disease dynamics. The simulation results have indicated that using different functional forms of seasonally varying contact rate generates different patterns of solutions for each disease parameter set and type of contact rate. So prediction of the type of disease outbreaks depends on the form of contact rate. Thus it is important to determine which type of contact rate is more likely to match the actual dynamics of each disease. Also these results have shown how the dynamics of the disease depend on the amplitude of the seasonally varying contact rate. Apart from some of the results for measles with a sinusoidal periodic function the simulation results are original and give a clear and a much broader insight into the features of the dynamics of these diseases [D. Greenhalgh, I.A. Moneim, SIRS epidemic model and simulations using different types of seasonal contact rate, Syst. Anal. Modelling Simul. 43(5) (2003) 573-600; I.A. Moneim, D. Greenhalgh, Threshold and stability results for an SIRS epidemic model with a general periodic vaccination strategy, J. Biol. Syst. 13(2) (2005), to appear].     

不同剂型桂枝葛根汤治疗颈性眩晕的疗效比较

摘 要 目的：观察不同剂型桂枝葛根汤治疗颈性眩晕的疗效差异,并初步探讨其作用机制。方法：96例颈椎病患者随机分为饮片组、配方颗粒组和葛根定眩胶囊组各32例,分别采用桂枝葛根汤饮片、配方颗粒和葛根定眩胶囊治疗14 d,比较3组患者的疗效和治疗前后血流动力学指标变化,酶联免疫法测定3组患者治疗前后IL-6及IL 1β的表达。结果：3组总有效率比较,差异无统计学意义（P＞0.05）。治疗后3 组患者眩晕和头痛评分均较治疗前明显改善（P＜0.01）,饮片组眩晕评分优于胶囊组（P＜0.05）。治疗后3组患者基底动脉和双侧椎动脉的Vs和Vm均较治疗前明显增加（P＜0.01),且配方颗粒组和胶囊组椎动脉的Vm低于饮片组（P＜0.05或P＜0.01）。治疗后,饮片组和配方颗粒组血清IL 6水平较治疗前明显降低(P<0.05),饮片组和胶囊组血清IL-1β水平较治疗前明显降低(P<0.05);胶囊组血清IL-6水平显著高于其他两组(P<0.05),饮片组血清IL 1β水平显著低于配方颗粒组和胶囊组(P<0.05)。结论：桂枝葛根汤三种剂型治疗颈性眩晕的总有效率相当,部分疗效指标饮片相比配方颗粒和胶囊更优。此作用可能与增加脑血流及抑制相关炎症因子IL-6及IL-1β的表达有一定关联。