长效干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其对静息能量消耗和营养状态的影响*

目的 探讨应用长效α-干扰素联合利巴韦林治疗慢性丙型肝炎(CHC)患者疗效及静息能量消耗和营养状态的变化。方法 2017年4月～2019年4月我院收治的CHC患者48例,采用随机数字表法分为观察组24例和对照组24例,分别给予聚乙二醇干扰素α-2a(peg-IFNα-2a)和利巴韦林治疗或干扰素α-2a(IFNα-2a)联合利巴韦林治疗48 w。测量静息能量消耗(REE)和预测静息能量消耗(pREE),常规检测血清前白蛋白(PA)和白蛋白(ALB)水平,计算体质指数(BMI)。结果 在治疗48 w结束和随访6 m时,观察组完全应答率分别为62.5%和54.2%,显著高于对照组的37.5%和29.2%,差异有统计学意义(P＜0.05);在观察组,用药前REE和pREE分别为(1504.6±481.5)kcal/d和(1432.3±229.3)kcal/d,在治疗结束时显著增加至(1822.1±546.7)kcal/d和(1241.8±208.6)kcal/d,对照组用药前REE和pREE分别为(1505.2±482.1)kcal/d和(1433.5±231.2)kcal/d,在治疗结束时,显著增加至(1824.4±547.6)kcal/d和(1243.1±208.8)kcal/d, 但两组之间REE和pREE变化无显著性差异(P>0.05);治疗前,观察组BMI及血清PA和ALB水平分别为(19.2±2.0)kg/m²、(161.5±45.2)mg/L和(38.4±4.2)g/L,在治疗结束时分别降为(17.1±1.5)kg/m²、(135.8±40.2)mg/L和(34.2±3.2)g/L,治疗前对照组BMI及血清PA和ALB水平分别为(19.3±2.1)kg/m²、(161.3±45.0)mg/L和(38.5±4.4)g/L,在治疗结束时分别降为(17.2±1.5)kg/m²、(136.3±40.2)mg/L和(34.2±3.1)g/L,但两组之间这些指标的变化无显著性差异(P>0.05)。结论 相对于IFNα-2a与利巴韦林联合,应用peg-IFNα-2a与利巴韦林联合治疗CHC患者能够获得更好的治疗效果,但无论何种治疗方案,均增加了能量消耗,降低了体质量和血清白蛋白水平,提示标准方案抗病毒治疗的不良反应还是值得重视的。     

A comparative study of Thai massage and muscle energy technique for chronic neck pain: A single-blinded randomized clinical trial

BackgroundMyofascial pain syndrome (MPS) is the most common form of muscle disorders. Traditional Thai massage (TM) and muscle energy (ME) technique have been used to treat patients with MPS for long time but head-to-head comparisons of these interventions have not been established.AimThe aim of the current study was to compare the effects of TM and the ME technique on pain intensity (PI), pressure pain threshold (PPT), neck disability (ND), and neck flexion range of motion (NFROM) in patients with chronic neck pain associated with myofascial trigger points (MTrPs).DesignA randomized, single-blinded clinical trial.SettingDepartment of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University.PopulationForty-five patients with chronic neck pain associated with MTrPs were recruited.MethodsThe patients were randomly allocated to the TM, ME, or control groups, with each having eight treatment sessions over a period of two weeks. PI, PPT, ND, and NFROM were assessed before, immediately after the first treatment session, and one day after the last treatment session.ResultsBased on the results, both TM and the ME technique resulted in a significant improvement in all parameters (p < 0.05) compared to the control group. Additionally, no significant difference was observed between TM and the ME technique in all parameters.ConclusionsThe application of TM or the ME technique can be a practical alternative approach for the treatment of chronic neck pain associated with MTrPs.     

基于虚拟教研室的公共卫生安全素养培育课程构建及实践

目的:探讨基于虚拟教研室的公共卫生安全素养培育课程构建及实践。方法:选取某医学院校专科护理专业学生(护生)为研究对象,将护理1班45人作为试验组,将护理2班43人作为对照组,对照组对公共卫生安全知识实施线上与线下的常规教学,试验组实施基于虚拟教研室的公共卫生安全素养培育课程。比较两组护生内容掌握情况及学习满意度。结果:试验组护生的学习成绩明显高于对照组(P<0.01),试验组护生对教学的满意度为95.6%(43/45),明显高于对照组(P<0.05)。结论:基于虚拟教研室的公共卫生安全素养培育课程构建既可以广泛促进不同专业教师进行教学研究交流,全面提高教师教书育人能力,又可以使护生在学习过程中接触不同专业、不同领域的知识与技能,注重护生主体作用,提高学习效果和学习满意度。     

数字化视频监控在手术安全核查制度中的应用与管理

目的介绍数字化视频监控在手术安全核查制度中的应用与管理。方法回顾性分析实施数字化视频监控前后存在的问题,利用数字化视频监控采集的图像对手术三方安全核查执行中存在的问题进行根本原因分析(RCA),提出改进和防范措施。结果实施数字化视频监控后,提高了手术团队成员手术患者安全核查制度依从性,未发生手术病人、手术部位、手术方式错误,确保了手术病人安全。结论提高了手术团队成员手术安全核查制度执行的依从性;实现手术室常态工作下的规范化、标准化管理,确保手术病人安全。     

Endocrine and Metabolic Complications After Bariatric Surgery

Bariatric surgery is the most effective therapeutic option for obese patients; however, it carries substantial risks, including procedure-related complications, malabsorption, and hormonal disturbance. Recent years have seen an increase in the bariatric surgeries performed utilizing either an independent or a combination of restrictive and malabsorptive procedures. We review some complications of bariatric procedures more specifically, hypoglycemia and osteoporosis, the recommended preoperative assessment and then regular follow up, and the therapeutic options. Surgeon, internist, and the patient must be aware of the multiple risks of this kind of surgery and the needed assessment and follow up.     

Oxidative phosphorylation versus glycolysis: what fuel do spermatozoa use?

Spermatozoa are highly specialized cells. Adenosine triphosphate (ATP), which provides the energy for supporting the key functions of the spermatozoa, is formed by 2 metabolic pathways, namely glycolysis and oxidative phosphorylation (OXPHOS). It is produced in the mitochondria through OXPHOS as well as in the head and principal piece of the flagellum through glycolysis. However, there is a great discrepancy as to which method of ATP production is primarily utilized by the spermatozoa for successful fertilization. Mitochondrial respiration is considered to be a more efficient metabolic process for ATP synthesis in comparison to glycolysis. However, studies have shown that the diffusion potential of ATP from the mitochondria to the distal end of the flagellum is not sufficient to support sperm motility, suggesting that glycolysis in the tail region is the preferred pathway for energy production. It is suggested by many investigators that although glycolysis forms the major source of ATP along the flagellum, energy required for sperm motility is mainly produced during mitochondrial respiration. Nevertheless, some studies have shown that when glycolysis is inhibited, proper functioning and motility of spermatozoa remains intact although it is unclear whether such motility can be sustained for prolonged periods of time, or is sufficiently vigorous to achieve optimal fertilization. The purpose of this article is to provide an overview of mammalian sperm energy metabolism and identify the preferred metabolic pathway for ATP generation which forms the basis of energy production in human spermatozoa during fertilization.     

内镜黏膜下剥离术治疗早期胃癌 扩大指征的安全性分析

目的 探讨内镜黏膜下剥离术治疗早期胃癌扩大指征的安全性。 方法 回顾性分析该院2005年12月~2013年5月行胃癌根治术的早期胃癌病理资料，筛选出符合内镜黏膜下剥离术扩大指征的病例，比较不同浸润深度、分化类型的淋巴结转移情况。 结果 入组157例患者中发生淋巴结转移13例。黏膜内癌（m癌）、黏膜肌层癌（mm癌）、分化型黏膜下层癌（sm1癌）的淋巴结患者转移率分别为0.0%（0/18）、6.6%（4/61）、11.5%（9/78），3组间比较（χ2=2.954，P =0.228）、m癌与mm癌比较（χ2=1.243，P =0.265）、mm癌与分化型sm1癌比较（χ2=1.002，P =0.317），差异均无显著性（P >0.05）。分化好与分化差的淋巴结转移率分别为2.3%（2/86）、15.5%（11/71），比较（χ2=8.879，P =0.003），差异具有显著性（P <0.05）。 结论 大部分符合扩大指征的早期胃癌行内镜黏膜下剥离术治疗是安全可行的，黏膜内癌更为可靠，黏膜下癌因缺乏精确的术前评价体系，需慎重选择内镜下治疗，尤其是分化程度差者，建议行胃癌根治术。     

Weak Satiety Responsiveness Is a Reliable Trait Associated with Hedonic Risk Factors for Overeating among Women

Some individuals exhibit a weak satiety response to food and may be susceptible to overconsumption. The current study identified women showing consistently low or high satiety responses to standardised servings of food across four separate days and compared them on behavioural, psychological and physiological risk factors for overeating and future weight gain. In a crossover design, 30 female participants (age: 28.0 ± 10.6; body mass index (BMI): 23.1 ± 3.0) recorded sensations of hunger in the post-prandial period following four graded energy level breakfasts. Satiety quotients were calculated to compare individuals on satiety responsiveness across conditions. Body composition, resting metabolic rate (RMR), energy intake, food reward and craving, and eating behaviour traits were assessed under controlled laboratory conditions. A distinct low satiety phenotype (LSP) was identified with good consistency across separate study days. These individuals had a higher RMR, greater levels of disinhibition and reported feeling lower control over food cravings. Further, they consumed more energy and exhibited greater wanting for high-fat food. The inverse pattern of characteristics was observed in those exhibiting a consistently high satiety phenotype (HSP). Weak satiety responsiveness is a reliable trait identifiable using the satiety quotient. The LSP was characterised by distinct behavioural and psychological characteristics indicating a risk for overeating, compared to HSP.