动态血压负荷值与高血压病左室肥厚的关系探讨

对７８ 例高血压病患者进行了２４ 小时动态血压监测,并分析其２４ 小时、白昼和夜间血压负荷值。结果Ａ组（单纯高血压组）血压负荷值明显高于正常,但夜间血压负荷值较白昼明显降低。Ｂ组（高血压左室肥厚组）血压负荷值较Ａ组明显增高,尤其是夜间血压负荷值明显增高（Ｐ＜ ０．０５、０．０１）。提示动态血压负荷值增高对高血压左室肥厚（ＬＶＨ）的发生起重要作用。     

Diagnostic Approaches to Childhood Obstructive Sleep Apnea Hypopnea Syndrome

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep disorder in adults that is increasingly recognized in children, affecting 1 to 3% of children. Children experience a spectrum of severity related to the degree of upper airway obstruction, the duration of the disease, and the presence or absence of hypoxemic episodes. Failure to diagnose and treat OSAHS can result in serious, but generally reversible consequences for the child including impaired growth, neurocognitive and behavioral dysfunction, and cardiorespiratory failure. Even mild OSAHS appears linked to reversible health consequences. Adenotonsillar hypertrophy is the major predisposing factor for OSAHS in childhood. However, enlarged tonsils and adenoids can be a normal finding in young children and are not diagnostic for OSAHS. The identification of children with OSAHS is often difficult because affected children may have no signs or symptoms when awake. Furthermore, clinical assessment cannot reliably distinguish between simple snoring and OSAHS. Adenotonsillectomy is the most common therapy for OSAHS in children, but surprisingly, only a small percentage of children undergo any diagnostic testing prior to surgery. Thus, the challenge is to develop new diagnostic strategies that effectively screen, identify, and treat children most likely to benefit from specific treatment.     

Serum markers detect the presence of liver fibrosis: a cohort study

BACKGROUND & AIMS: Histologic examination of a liver biopsy specimen is regarded as the reference standard for detecting liver fibrosis. Biopsy can be painful and hazardous, and assessment is subjective and prone to sampling error. We developed a panel of sensitive automated immunoassays to detect matrix constituents and mediators of matrix remodeling in serum to evaluate their performance in the detection of liver fibrosis. METHODS: In an international multicenter cohort study, serum levels of 9 surrogate markers of liver fibrosis were compared with fibrosis stage in liver biopsy specimens obtained from 1021 subjects with chronic liver disease. Discriminant analysis of a test set of samples was used to identify an algorithm combining age, hyaluronic acid, amino-terminal propeptide of type III collagen, and tissue inhibitor of matrix metalloproteinase 1 that was subsequently evaluated using a validation set of biopsy specimens and serum samples. RESULTS: The algorithm detected fibrosis (sensitivity, 90%) and accurately detected the absence of fibrosis (negative predictive value for significant fibrosis, 92%; area under the curve of a receiver operating characteristic plot, .804; standard error, .02; P < .0001; 95% confidence interval, .758-.851). Performance was excellent for alcoholic liver disease and nonalcoholic fatty liver disease. The algorithm performed equally well in comparison with each of the pathologists. In contrast, pathologists' agreement over histologic scores ranged from very good to moderate (kappa = .97-.46). CONCLUSIONS: Assessment of liver fibrosis with multiple serum markers used in combination is sensitive, specific, and reproducible, suggesting they may be used in conjunction with liver biopsy to assess a range of chronic liver diseases.     

Preliminary enquiry into the availability, price and quality of malaria rapid diagnostic tests in the private health sector of six malaria-endemic countries

Objectives This enquiry aimed to provide a snap‐shot of availability, price and quality of malaria rapid diagnostic tests (RDTs) in private health facilities at selected sites in six malaria‐endemic countries in Africa, South East Asia and South America. Methods In each study site, data collectors surveyed private healthcare facilities which were selected based on accessibility from their home institution. Using a questionnaire, information was recorded about the facility itself and the malaria RDT(s) available. Where possible, a small number of RDTs were procured and quality control tested using a standardized procedure. Results Of the 324 private healthcare facilities visited, 35 outlets (mainly private clinics and hospitals) were found to supply 10 different types of RDTs products. RDT prices across the six countries ranged from US$1.00 to $16.81. Five of the 14 malaria RDTs collected failed quality control testing. Conclusions In the private outlets sampled, the availability of RDTs was limited. Some of the RDTs whose quality we tested demonstrated inadequate sensitivity. This presents a number of risks. Given the more widespread distribution of antimalarials currently planned for private sector facilities, parasite‐based diagnosis in this sector will be essential to adhere to the WHO guidelines for effective case management of malaria. Considerable regulation and quality control are also necessary to assure the availability of accurate and reliable RDTs, as well as adequate case management and provider adherence to RDT results. Public sector engagement is likely to be essential in this process.     

加味柴胡疏肝散基准样品HPLC指纹图谱及关键质量属性量值传递规律研究

目的 建立加味柴胡疏肝散（Modified Chaihu Shugan Powder,MCSP）基准样品HPLC指纹图谱及多成分含量测定的方法,结合化学模式分析,探究关键质量属性的传递规律。方法 制备40批MCSP样品,利用HPLC法,以乙腈-0.2%磷酸水溶液为流动相,采用“中药色谱指纹图谱相似度评价软件（2012年版）”计算其相似度,结合化学计量法分析多产地多批次MCSP基准样品,结合指标性成分含量以及转移率,进行量值传递分析及整体质量研究。结果 建立的40批MCSP基准样品相似度大于0.90,指纹图谱相似度良好,29个共有峰中指认出其中13个色谱峰,所建立的多成分含量测定方法稳定可靠。芍药内酯苷、芍药苷、阿魏酸、芸香柚皮苷、柚皮苷、橙皮苷、橙皮素、新橙皮苷、去氢木香内酯、柴胡皂苷A的平均转移率分别为29.96%、22.08%、32.98%、22.42%、33.26%、15.50%、34.23%、56.94%、8.66%、8.69%。结论 采用指纹图谱结合多指标成分含量测定及转移率等评价指标对MCSP基准样品进行了量值传递综合考察,初步构建MCSP全过程质量控制体系,为制剂开发及MCSP的进一步研究提供参考。     

经典名方“竹茹汤”的物质基准量值传递分析

为阐明竹茹汤物质基准的关键质量属性,制备18批物质基准对应实物,建立竹茹汤物质基准指纹图谱及其含量测定的检测方法,明确其指纹图谱共有峰的色谱峰归属,相似度范围,浸出物范围,指标性成分葛根素、甘草苷和甘草酸的含量以及转移率范围。结果表明,18批竹茹汤物质基准对应实物共标定25个共有峰,指纹图谱相似度均大于0.95。汇总特征峰信息可知,葛根、甘草、生姜分别贡献21、3、1个色谱峰;18批物质基准对应实物的浸出物18.45%～25.29%;不同批次物质基准对应实物的指标性成分含量和转移率:葛根素质量分数2.20%～3.07%,转移率38.5%～45.9%;甘草苷质量分数0.24%～0.85%,转移率15.9%～37.5%;甘草酸质量分数0.39%～1.87%,转移率16.2%～32.8%。该实验采用浸出物、指纹图谱及指标性成分含量测定相结合的模式,对经典名方竹茹汤物质基准的量值传递过程进行分析,初步建立了科学稳定的物质基准质量评价方法,为经典名方竹茹汤的后续开发及相关制剂的质量控制提供依据。     

导管/静脉直径比预测血液肿瘤患者有症状性PICC相关血栓的研究

目的 探讨PICC导管/静脉直径比在预测血液肿瘤患者有症状性导管相关血栓的最佳临界值。方法 选取留置PICC的273例血液肿瘤患者作为研究对象,根据患者临床症状结合彩超监测有症状性血栓发生情况,通过logistic回归分析和受试者工作特征曲线确定导管/静脉直径比最佳临界值。结果 6.23%患者发生了有症状性导管相关血栓。导管/静脉直径比35%～45%、≥46%的患者发生导管相关血栓的的风险分别是≤34%患者的16.762、15.529倍。导管/静脉直径比38%是预测导管相关血栓的最佳临界值。结论 导管/静脉直径比与血液肿瘤患者PICC导管有症状性血栓的发生密切相关,临床置管操作时,应尽可能保证该比值≤38%。     

多模态超声参数术前评估与直肠肿瘤术后病理结果的对比分析

目的:探讨直肠肿瘤的多模态超声参数术前评估与术后病理结果的差异。方法:选取2020年1月—2022年4月在我院治疗的直肠占位病变患者100例,术前接受经直肠超声(ERUS)、剪切波弹性成像(SWE)和超声造影(CEUS)检查,分析直肠恶性与良性病灶的ERUS、SWE和CEUS参数差异,同时用ERUS、SWE和CEUS参数构建Logistic回归方程预测直肠恶性病灶的价值。结果:恶性病灶最大径、血流峰值流速和阻力指数高于良性病灶[(4.20±1.00)cm、(25.12±3.81)cm/s和(0.80±0.14)vs(3.18±0.98)cm、(16.60±4.11)和(0.66±0.12)cm/s],差异有统计学意义(P＜0.05);恶性病灶内部回声不均匀、血流信号丰富、形态不规则和边缘模糊高于良性病灶[72.15%、75.95%、64.56%和72.15% vs 33.33%、14.29%、23.81%和47.62%],差异有统计学意义(P＜0.05)。恶性病灶平均杨氏模量(Emean)、最大杨氏模量(Emax)和最小杨氏模量(Emin)高于良性病灶[(81.19±15.53)kPa、(110.20±23.32)kPa和(61.18±15.02)kPa vs (51.14±11.40)kPa、(70.05±21.05)kPa和(36.60±11.68)kPa],差异有统计学意义(P＜0.05)。恶性病灶上升时间(RT)、达峰时间(TTP)和平均渡越时间(mTT)短于良性病灶[(6.22±1.34)s、(8.78±1.82)s和(14.65±2.34)s vs (9.10±1.32)s、(12.21±2.01)s和(18.82±2.51)s],差异有统计学意义(P＜0.05),造影剂呈“快进快出”比例高于良性病灶[70.89% vs 28.57%],差异有统计学意义(P＜0.05)。EURS、SWE、CEUS参数构建Logistic回归方程,该方程预测直肠恶性病灶的ROC曲线下面积为0.892(95%CI:0.828～0.956),灵敏度和特异度分别为83.50%和76.20%。结论:构建多模态超声参数在鉴别直肠恶性病灶方面有较好的应用价值,值得进一步研究。     

急性冠脉综合征瘀毒互结证诊断标准研究

目的 基于冠心病“瘀毒”病因病机的理论认识,建立急性冠脉综合征瘀毒互结证诊断标准。方法 采用文献系统分析与横断面临床研究构建条目池,采用德尔菲法专家咨询对条目进行筛选,采用层次分析法确定各条目权重。在此基础上,结合条目权重及临床实用性原则建立诊断标准。结果 文献系统分析筛选条目43个,横断面临床研究纳入患者400例,筛选条目39个,归纳分类后形成包含67个条目的条目池;经过两轮德尔菲专家咨询,筛选保留条目28个;通过层次分析法,确定高权重类条目（0.0430~0.1976）9个、中权重类条目（0.0153~0.0289）9个与低权重类条目（0.0060~0.0147）10个。结合临床实用性原则,优化形成包括必要指标（心绞痛程度进行性加重、近1个月反复发作性心绞痛等）、理化指标（心脏肌钙蛋白或肌酸激酶同工酶升高等）及舌象脉象（舌青紫或紫暗等、脉弦细或脉涩）3个维度的急性冠脉综合征瘀毒互结证诊断标准。两轮专家问卷咨询肯德尔和谐系数分别为0.368、0.395,格朗巴赫系数为分别为0.967、0.893,提示专家意见一致性好,结果可信度高。结论 该诊断标准涵盖了反映瘀毒互结致病特点的宏观表征和理化指标,可指导急性冠脉综合征瘀毒互结证的诊断。