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。     

阻生智牙拔除术后不同医嘱告知模式对

目的 比较阻生智牙拔除术后不同医嘱告知形式对疼痛、出血、肿胀等术后常见并发症发生率的影响,为降低智牙拔除术后并发症及提高患者满意度提供帮助。方法 随机选取2018年1月—2018年10月间在中南大学湘雅医院口腔颌面外科就诊的150例拔除下颌阻生智牙的患者,随机分为3组,每组50例。第1组术后接受术后医嘱口头告知,第2组术后医嘱书面告知,第3组术后医嘱口头和书面同时告知。术前获取患者的年龄、性别和受教育程度等个人信息。术后7 d记录并分析患者疼痛、出血、肿胀等并发症和对医疗行为满意度。采用SPSS 22.0软件包对数据进行统计学分析。结果 150例受试者中,男69例,女81例,平均年龄（24.6±2.6）岁。结果表明,术后医嘱口头告知组患者的术后疼痛程度显著高于书面医嘱组（P=0.001）和口头加书面医嘱组（P=0.000）,患者满意度最低;同时接受口头和书面医嘱告知的患者,术后满意度最高。结论 术后医嘱告知方式可以显著影响下颌阻生智牙拔除术后的疼痛强度和患者满意度。     

Antileismanial activity,mechanism of action study and molecular docking of 1,4‐bis(substituted benzalhydrazino)phthalazines

To identify new agents for the treatment of American cutaneous leishmaniasis, a series of eight 1,4‐bis(substituted benzalhydrazino)phthalazines was evaluated against Leishmania braziliensis and Leishmania mexicana parasites. These compounds represent a disubstituted version of the 1‐chloro‐4‐(monoaryl/heteroarylhydranizyl)phthalazine that exhibited a significant response against L. braziliensis according to our previous findings. Two disubstituted phthalazines 3b and 3f were identified as potential antileishmanial agents against L. braziliensis parasites, exhibiting a submicromolar IC₅₀ response of 2.37 and 7.90 µM on the promastigote form, and of 1.82 and 4.56 µM against intracellular amastigotes, respectively. In particular, compound 3b showed interesting responses against amastigote isolates from reference, glucantime‐resistant and clinical human strains, which were by far superior to the biological response found for the glucantime drug. With regard to the toxicity results, both 3b and 3f exhibited moderate LD₅₀ values against murine macrophages (BMDM), with good selectivity indexes on promastigotes and intracellular amastigotes of L. braziliensis. A comparison of biological response was established between the monosubstituted and disubstituted versions of these benzalhydrazino‐phthalazines. Easy synthetic procedure and significant response against amastigote strains including against resistant lines made compound 3b a potential candidate for further pharmacokinetic and in vivo experiments as antileishmanial agent, and as a platform for further structural optimization. Mechanism‐of‐action studies and molecular docking simulations discarded to inhibition of superoxide dismutase as possible mode of action.     

心脑清软胶囊联合匹伐他汀治疗高脂血症的临床研究

目的探讨心脑清软胶囊联合匹伐他汀治疗高脂血症的临床疗效。方法选取2017年7月—2018年7月在河北省第七人民医院进行治疗的88例高脂血症患者,根据住院号的奇偶数分为对照组和治疗组,每组各44例。对照组饭后口服匹伐他汀钙片,1片/次,1次/d。治疗组在对照组治疗基础上饭后口服心脑清软胶囊,2粒/次,3次/d。两组均治疗8周后进行效果比较。观察两组的临床疗效,比较两组治疗前后血脂指标、肥胖指标、血清学指标和氧化应激指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是81.82%、93.18%,两组比较差异具有统计学意义(P0.05)。治疗后,两组总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前显著降低,而高密度脂蛋白胆固醇(HDL-C)水平均增高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组TC、TG、LDL-C水平显著低于对照组,而HDL-C水平高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组体质量、肥胖度、体质量指数、体脂率都明显下降,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组这些肥胖指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组超敏C反应蛋白(hs-CRP)、肿瘤坏死因素-α(TFN-α)、干扰素-γ(IFN-γ)、嗜酸粒细胞阳离子蛋白(ECP)、总氧化态(TOS)水平均较治疗前显著下降,而总抗氧化态(TAS)和对氧磷酶-1(PON1)表达水平均增高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组hs-CRP、TFN-α、IFN-γ、ECP、TOS水平低于对照组,而TAS和PON1表达水平均高于对照组,两组比较差异具有统计学意义(P0.05)。结论心脑清软胶囊联合匹伐他汀治疗高脂血症具有较好的临床疗效,可有效降低血脂水平和肥胖指标,改善机体炎症反应,改善机体氧化应激状态,具有一定的临床推广应用价值。     

影响肝门部胆管癌术后远期预后的因素

目的 探讨影响肝门部胆管癌术后远期预后的相关因素。方法 将2011年1月至2017年12月在首都医科大学附属北京朝阳医院肝胆外科诊治的49例肝门部胆管癌患者作为研究对象,通过随访观察,对临床数据进行单因素及多因素分析,讨论其对远期预后的影响。结果 患者的1、3、5年生存率分别为87.3%、30.8%和6.2%,中位生存时间为29个月。单因素分析显示,术前是否行经皮肝穿刺胆管引流（percutaneous transhepatic cholangic drainage,PTCD）、病理分化程度、肿瘤大小、神经侵犯是可能影响预后的因素。多因素COX比例风险模型分析表明,患者的有神经侵犯和肿瘤低分化程度是降低患者预后的独立危险因素（P<0.05）。结论 肝门部胆管癌患者术后总体预后不良,分化程度低及伴有神经侵犯是其独立危险因素。     

医疗器械清洗后放置时间与污染度的关系

目的 探讨复用医疗器械清洗后放置时间与污染度的关系,为提高灭菌质量提供最佳的包装时间.方法 将清洗后检测合格的360件复用关节器械裸露放置于消毒供应中心器械检查包装区,随机分成6组各60件,分别放置15 min、30 min、1h、2h、3h、4h后采用ATP生物荧光技术进行污染度监测.结果 器械放置15 min、30 min、1h、2h、3h、4h合格率分别为100％、96.7％、83.3％、58.3％、33.3％、16.7％,不同时间合格率比较,差异有统计学意义(P＜0.01).放置15 min、30 min与放置1h合格率比较,差异无统计学意义(均P＞0.00313);其他时间合格率显著低于1h合格率(均P＜0.00313).结论 清洗后的器械不宜超过1h包装.     

结直肠癌及其筛查认知情况、筛查意愿与文化程度相关性的调查分析

目的了解门诊患者对结直肠癌及其筛查认知程度和筛查意愿,为提高结直肠癌筛查率提供依据。方法向广州地区某家综合性医院门诊患者随机发放自制问卷,对其结直肠癌的认知程度及筛查意愿和相关影响因素进行调查。结果共216例门诊患者纳入研究,其中高学历组（高中、中专及以上学历）96例（44.4%）,低学历组（初中及以下学历）120例（55.5%）。对结直肠癌认知程度高学历组是低学历组的1.8倍（83.3%vs46.7%,P〈0.01）。比起高学历组,低学历组患者对结直肠癌相关筛查手段、大便潜血检查、肠镜更缺乏认识（均P〈0.05）。晚期发现结直肠癌预后差、早发现则生存概率高的问题上,高学历组比低学历组患者更认同（75.0%vs40.0%,P〈0.01）。如果得到医师推荐,高学历组比低学历患者更愿意接受大便潜血检查（79.2%vs66.7%,P〈0.05）。结论门诊患者对结直肠癌及其筛查认知程度偏低,其中低学历患者对结直肠癌的认识尤为不足。在结直肠癌筛查的相关宣传中,要侧重对低学历患者的宣教。     

Adjective production by Russian-speaking children with specific language impairment

Research on specific language impairment (SLI) has primarily focused on the acquisition of nouns and verbs. Less attention has been given to other content-word classes, such as adjectives and adverbs. This article investigates adjective production by 7- to 10-year-old Russian-speaking children with SLI and their typically developing (TD) peers and focuses on the production of antonymous adjectives and degree markers in an elicitation experiment. The results show that degree morphology is more impaired in SLI than antonymy. In antonym production, children with SLI were able to catch up with their TD peers by age 8. In the domain of degree, however, the SLI group lagged behind the TD controls across all ages studied. Error analysis indicates that language-impaired children have particular difficulty with agreement inflection and affixal negations. They also substitute adjectives with specific meanings by more general terms. The implications of this study for the morphological-richness hypothesis are discussed.