基于标准化患者法评价四川农村基层医生两种慢性病诊断准确性及其影响因素

目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。     

应用精细化管理提高GMP模拟车间实训课教学质量

目的通过对GMP模拟车间实训课学生评教数据分析,探讨精细化管理对其教学质量的影响,从而提高GMP模拟车间实训课教学质量。方法通过对管理前后学生教学质量评价进行对比,选取最适合GMP模拟车间的管理方法。结果采取精细化管理后,学生教学质量评价从35.71%提高到96.42%。结论对GMP模拟车间精细化管理能够有效提高该课程的教学质量,给社会带来更大的经济效益和社会效益。     

跟骨撕脱性骨折的分类和治疗

作者将5个足标本人为造成跟骨撕脱性骨折,对其受伤机制和X线检查特点进行观察,通过22例跟骨撕脱骨折病人的临床研究,对跟骨撕脱骨折根据受伤机制和撕脱部位进行了分类。提出了各类骨折的X线投照方法和意义,也提出了各类骨折的最佳治疗方法。     

Is barium esophagram enough? Comparison of esophageal motility found on barium esophagram to high resolution manometry

BackgroundThe aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM).MethodsThis is a retrospective review of patients that underwent laparoscopic fundoplication by two surgeons at a single institution from 10/1/2015-6/29/2019. Patients with large paraesophageal hernias and patients without both BE and HRM were excluded.ResultsForty-six patients met the inclusion criteria. BE was found to be concordant with HRM for esophageal motility in only 21 patients (46%). Setting HRM as the gold standard, BE had a sensitivity of 14% (95% CI: 5%–35%), specificity of 72% (95% CI: 52%–86%), PPV of 30% (95% CI: 11%–60%), and NPV of 50% (95% CI: 35%–66%). The accuracy was 46%, while a McNemar test showed p = 0.028.ConclusionTraditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery.     

3种全脑放疗技术对中耳剂量学研究

目的 比较脑转移瘤全脑放射治疗（WBRT）3种放疗技术对中耳的剂量学差异,对比3种放疗技术在改善靶区剂量和保护中耳腔和咽鼓管峡部的优劣势。方法 选取2018年7月1日—2019年8月1日我院收治的30例脑转移瘤患者,分别设计固定野调强放疗（ff-IMRT）计划、容积旋转调强放疗（VMAT）和三维适形放疗（3DCRT）计划,要求处方剂量（40 Gy）覆盖95%的计划靶区（PTV）。对比分析3组计划的靶区和危及器官剂量学参数、机器跳数等差异。结果 ff-IMRT计划的适形指数（0.93 ±0.02）优于VMAT计划（0.89 ±0.01）和3DCRT计划（0.73 ±0.03）,差异有统计学意义（P < 0.05）;ff-IMRT、VMAT和3DCRT 3种计划的均匀指数分别为（0.05 ±0.01）、（0.08 ±0.1）、（0.08 ±0.01）,差异无统计学意义（P > 0.05）;梯度指数分别为（1.77 ±0.1）、（1.61 ±0.07）、（1.39 ±0.08）,差异有统计学意义（P < 0.05）;机器跳数分别为（1551.97 ±85.05）、（303.7 ±24.28）、（226.2 ±2.5）,差异有统计学意义（P < 0.05）。ff-IMRT、VMAT和3DCRT 3种计划中耳腔最大剂量点（D_max）分别为ff-IMRT（2557.54 ±477.39）cGy、VMAT（3107.9 ±362.28）cGy、3DCRT（4055.37 ±71.45）cGy;咽鼓管峡部D_max分别为ff-IMRT（2425 ±380.4）cGy、VMAT（2902.4 ±526.3）cGy、3DCRT（3862.7 ±135.9）cGy,差异均有统计学意义（P < 0.05）。结论 在全脑放射治疗中,ff-IMRT和VMAT与3DCRT相比明显减少了双侧中耳腔和咽鼓管峡部的照射剂量;而VMAT与ff-IMRT相比,明显减少机器跳数、降低了机器损耗,WBRT时推荐使用VMAT技术。     

血清25-羟维生素D和白细胞介素-22对急性肺炎患儿病情的诊断价值

目的 探究血清25-羟维生素D[25(OH)D]和白细胞介素-22(IL-22)对急性肺炎患儿病情的诊断价值。方法 选取2021年3月至2022年3月自贡市第一人民医院收治的96例急性重症肺炎患儿作为重症肺炎组,另选96例普通肺炎患儿作为普通肺炎组、96例体检健康儿童作为健康对照组。采用化学发光微粒子免疫检测法检测血清25(OH)D水平,采用酶联免疫吸附法（ELISA）检测IL-22水平;采用Pearson法分析重症肺炎患儿血清25(OH)D、IL-22水平与急慢性健康状况评分Ⅱ（APACHEⅡ评分）、序贯器官衰竭评分（SOFA评分）的相关性;采用受试者工作特征（ROC）曲线评估25(OH)D、IL-22对重症肺炎患儿危重症的诊断价值。结果 重症肺炎患儿血清25(OH)D与APACHEⅡ评分及SOFA评分呈负相关（r=-0.521、-0.484,P<0.05）,血清IL-22与APACHEⅡ评分及SOFA评分呈负相关（r=-0.614、-0.419,P<0.05）。ROC曲线显示,25(OH)D对危重症诊断的曲线下面积（AUC）为0.745,IL-22对危重症诊断的AUC为...     

甲型H1N1流感病毒致血栓性血小板减少性紫癜1例

正血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)属于危重症血液病,临床罕见,若不能及时诊治会造成极高的病死率。临床若具有典型"五联征":发热、溶血性贫血、紫癜或血小板减少症相关的出血、神经系统症状、伴有血尿和/或蛋白尿或尿素氮升高的肾病即可诊断,行血浆     

Low-molecular fraction of wheat protein hydrolysate stimulates glucagon-like peptide-1 secretion in an enteroendocrine L cell line and improves glucose tolerance in rats

The incretin hormone glucagon-like peptide-1 (GLP-1) is secreted by enteroendocrine L cells. Stimulating endogenous GLP-1 secretion by dietary factors is a promising strategy to increase GLP-1 action. Several studies have examined the specific physiological function of wheat protein hydrolysate. Some reports suggested that intake of wheat protein ameliorates hyperglycemia. We hypothesized that wheat protein hydrolysate reduces blood glucose concentration via stimulation of GLP-1 secretion. In this study, we investigated whether wheat protein hydrolysate stimulates GLP-1 secretion and its molecular mechanism in an enteroendocrine L cell line (GLUTag cells), and we examined the effect on glucose tolerance via stimulation of GLP-1 secretion followed by induction of insulin secretion in rats. The low-molecular fraction of wheat protein hydrolysate (LWP) significantly increased GLP-1 secretion, whereas the high-molecular fraction did not. This increase was found to involve activation of the Ca²⁺/calmodulin-dependent kinase II pathway mediated by G protein-coupled receptor family C group 6 subtype A. Moreover, preadministration of LWP ameliorated hyperglycemia via the stimulation of GLP-1 secretion followed by induction of insulin secretion in rats. Furthermore, this LWP-induced glucose-lowering effect was significantly attenuated by the administration of a GLP-1 receptor antagonist. These results demonstrate that LWP significantly increased GLP-1 secretion through activation of the Ca²⁺/calmodulin-dependent kinase II pathway mediated by G protein-coupled receptor family C group 6 subtype A in GLUTag cells. Moreover, preadministration of LWP ameliorated hyperglycemia via the stimulation of GLP-1 secretion followed by induction of insulin secretion in rats.