激光联合复方血栓通胶囊治疗糖尿病视网膜病变合并黄斑水肿的疗效观察

目的:分析糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效。方法:选取我院2017年1月—2019年1月收治的200例糖尿病视网膜病变合并黄斑水肿患者为研究对象,随机分为两组。对照组单独行激光治疗,观察组于对照组基础上联合复方血栓通胶囊治疗,对比两组临床疗效、治疗前后IL-6(白介素-6)、VEGF(血管内皮生长因子)、NOS(血清一氧化氮合成酶)水平变化情况。结果:对照组总有效率(68.00%,68/100)较观察组总有效率(98.00%,98/100)更高(P<0.05);与对照组对比,观察组治疗后NOS水平更高,IL-6、VEGF水平更低(P<0.05)。结论:糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效显著,值得推广。     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

坐位腰椎旋转手法时腰椎单元内在应力和位移的实时监测

目的:用三维有限元法,分析施行坐位腰椎旋转手法时退变腰椎单元的内在应力及位移分布的特点,以探讨手法的作用机制、安全性及其合理性。方法:使用正常L4,5腰椎CT片,以Mimics软件系统逐层重建,建立L4,5三维有限元模型。根据手法原理,将坐位腰椎旋转手法进行分解,把各项力学参数代入三维有限元模型进行计算分析。观察手法作用时腰椎间盘的位移和内在应力的变化。结果:最大的应力集中点分布于环椎体峡部、椎弓根、上位椎体小关节面的下端。椎间盘的应力集中分布于环前外侧部,右后外侧部应力大于左后外侧部。最大位移出现在上位椎体的上关节。左侧小关节面相对位移较大,左侧椎间孔变大;右侧椎小关节面间移位小,右侧椎间孔变小,椎间盘右后外侧部向后突出。结论:模拟坐位腰椎旋转手法时,向健侧旋转优于向患侧旋转。     

学龄前儿童的屈光异常与弱视调查

目的了解屈光检查在学龄前儿童弱视普查中的临床用途。方法应用日本尼康手提全自动检影仪对学龄前儿童进行小瞳孔验光,发现屈光有异常的儿童,再进一步进行散瞳检影验光。结果学龄前儿童屈光异常主要以远视散光和混合散光为主,近视与近视散光较少。学龄前儿童屈光异常的发病率是7.87%,弱视发病率为4.04%,接近全国其他同类报告(3.83%)。结论儿童弱视屈光普查优于视力普查,准确性高、效率高。     

孕妇自控吸入笑气在人流术中的镇痛效果观察

目的:通过孕妇在人工流产手术中自控吸入笑气的方法,发挥笑气的镇痛作用,达到人工流产镇痛的目的。方法:将300例早期妊娠,年龄在18~44岁的孕妇,随机分为两组,观察组让术者自己双手紧握面罩进行笑气吸入,时间掌握在人工流产手术扩宫前30s开始至手术结束,对照组予无菌棉签浸2%利多卡因2m l涂布宫颈粘摸,并在宫颈内口留置2~3m in取出,按常规进行手术。观察两组在手术中的镇痛情况、术中出血、人流综合征等情况。结果:观察组较对照组镇痛效果显著(P<0.01),同时能明显降低人流综合征的发生率(P<0.01),不增加手术出血量。结论:孕妇在手术中自控笑气的吸入,可以随时调整面罩的位置,控制吸入时间,操作简单、方便,镇痛作用迅速,效果明显,同时不增加手术出血量,人工流产综合症发生率低,对呼吸、循环系统无明显不良影响,精神反应轻微,是一种理想的人工流产镇痛方法。     

赤芝中新颖杂萜-三萜杂聚体的分离纯化及其改善C2C12细胞胰岛素抵抗作用

目的 赤芝 (Ganoderma lucidum) 在民间被用于糖尿病治疗,但缺乏数据支撑,需探索其化学成分及其是否具有抗糖尿病作用以利于临床推广。方法 采用多种分离技术,如 MCI gel CHP 20P、RP-18、Sephadex LH-20、硅胶柱色谱、 制备薄层色谱 (Preparative Thin-Layer Chromatography,PTLC) 和高效液相色谱 (High Performance Liquid Chromatography, HPLC) 等,对云南产赤芝的低极性成分进行研究,利用一维 (One Dimensional,1D) 和二维 (Two Dimensional,2D) 核磁共振波谱 (Nuclear Magnetic Resonance Spectroscopy,NMR) 等方法鉴定化合物结构,在C2C12细胞胰岛素抵抗体外模型中研究其活性。结果 从云南2个产地赤芝中分离鉴定8个杂萜-三萜杂聚体类新化合物,ganolucinins D-K (1-8),其中化合物7和8可上调胰岛素受体底物1 (Insulin Receptor Substrate 1,IRS1) 和蛋白激酶B (Protein Kinase B,PKB/Akt) 磷酸化, 8可促进C2C12细胞葡萄糖摄取。结论 赤芝中可能存在一系列杂萜-三萜杂聚体类化合物,其中化合物8具有改善胰岛素抵抗潜力,可能是灵芝抗糖尿病的药效物质之一。     

深圳市2019年中学生健康素养水平及影响因素分析

  目的  了解深圳市中学生的健康素养水平及其影响因素,为进一步制定针对性的干预措施提供科学依据。  方法  于2019年10—12月,采用多阶段分层随机整群抽样法在深圳市10个区抽取7 423名中学生进行问卷调查,采用多因素线性回归分析影响健康素养及各维度得分的因素。  结果  被试学生健康素养总得分为(107.39±22.31)分,其中体力活动(16.81±5.28)分、人际关系(20.69±4.10)分、压力管理(21.64±5.53)分、精神成长(14.93±3.96)分、健康意识(15.61±4.96)分和营养(17.71±4.65)分。多因素线性回归分析显示,女生、普通高中和职业高中、非住校生与中学生健康素养呈负相关(B值分别为-3.04,-7.72,-9.99,-3.85),父、母亲受教育程度高与中学生健康素养得分呈正相关(B值分别为1.56,2.78)(P值均 < 0.05)。  结论  深圳市中学生具有较高的健康素养水平,与学校类型、父母亲受教育程度等因素有关。建议进一步采取措施提高中学生的健康素养水平。     

群体辨证论治的传承创新与现实意义

目的：纠正对辨证论治的理解偏差,全面精准应用该体系指导临床诊疗实践。方法：通过回顾辨证论治形成与发展的历史脉络,分析人们对辨证论治体系认识局限性原因,找到正确应用的路径。结果：辨证论治从古至今都包含整体与个体二个方面,可现在大家只强调其个体辨证论治的一面,忽略了群体辨证论治的临床应用。结论：完整的辨证论治体系包含个体辨证论治和群体辨证论治二个方面,二者同等重要,不可偏废。随着大数据时代和循证医学的推进,中医群体辨证论治理论具有更加突出的临床现实指导意义。     

Clinical observation on Xiaoyu decoction () plus psychotherapy in treating functional dyspepsia) plus psychotherapy in treating functional dyspepsia

Objective: To explore the relationship between mental symptoms and functional dyspepsia (FD), and the effect of Xiaoyu decoction (XYD) plus psychotherapy on FD.Methods: SCL-90 scale and FD symptom scale were used to estimate the condition of 56 healthy subjects and 56 patients of FD before and after 4 weeks treatment with XYD plus psychotherapy.Results: There was significant difference in SCL-90 scales between the healthy subjects and the FD patients before treatment (P < 0. 01). After treatment, the mental symptoms and the symptom of FD in the patients were markedly improved, as compared with those before treatment, the difference was significant (P < 0.01).Conclusion: Mental symptoms, such as depression and anxiety existed commonly in FD patients, were closely related to FD. XYD plus psychotherapy could cure it effectively.     

Survival outcomes after breast-conserving therapy compared with mastectomy for patients with early-stage metaplastic breast cancer: a population-based study of 2412 patients

BackgroundPrevious studies revealed that patients with early-stage metaplastic breast cancer (MBC) underwent mastectomy more often than breast-conserving therapy (BCT) mainly due to the larger tumor size. This study was performed to compare the survival outcomes following BCT versus mastectomy for patients with early-stage MBC.MethodsSurveillance, Epidemiology, and End Results (SEER) database was used to identify women diagnosed with early-stage MBC (T1-3N0-3M0) between 2001 and 2016, who were treated with either BCT or mastectomy. We assessed overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan-Meier method and hazard ratios using Cox proportional hazards models.ResultsA total of 2412 MBC patients were identified, 881 (36.5%) of whom underwent BCT and 1531(63.5%) underwent mastectomy. The median follow-up time was 73 months. Most of patients had older age (≥50 years old), larger tumor size, higher American Joint Committee on Cancer (AJCC) stage and hormone receptor negativity. After adjustment for confounding variables, patients who underwent BCT had significantly improved OS (5-year OS: 84.3% vs 62.5%; 10-year OS: 73.0% vs 52.1%; adjusted HR = 0.76, 95%CI: 0.59–0.97, p = 0.028) and BCSS (5-year BCSS: 89.1% vs 70.8%; 10-year BCSS: 83.9% vs 67.5%; adjusted HR = 0.72, 95%CI: 0.53–0.96, p = 0.026) than those who underwent mastectomy, and this improvement remained significant for all T and N stages of MBC except for N2-3 stage.ConclusionBCT conferred improved OS and BCSS compared with mastectomy for patients with early-stage MBC, and the improvement persisted in almost all of the subgroups of different T and N stages.