地鳖纤溶蛋白口服时间/pH依赖结肠靶向微囊的开发及评价＊

地鳖中的纤溶活性蛋白是从地鳖中提取的具有抗栓及抗肿瘤作用的有效成分，其口服易被上消化道酶分解从而限制了应用。采用恒流泵滴制法开发地鳖纤溶活性蛋白时间/pH依赖口服结肠靶向微囊（EnpolypHaga fibrinolytic protein oral colon targeting microcapsules， CTM-EFP）。采用单因素实验和正交实验相结合的方法寻找到包封率为60.17 % ± 2.72 %、载药量为15.50 % ± 0.44 % 的最佳配方。扫描电子显微镜（SEM）显示微囊呈球形、表面光滑，在人工肠液中24 h的累积释放度为99.53 % ± 0.69 %，在人工胃液中24 h累积释放度为7.43 ± 1.04 %，通过时间/pH依赖达到结肠靶向作用。CTM-EFP在人工肠液中的体外释放曲线符合Korsmeyer方程，提示地鳖纤溶活性蛋白（EnpolypHaga fibrinolytic protein， EFP）是通过扩散和侵蚀机制结合释放的。CTM-EFP为EFP的口服给药提供了一种新的剂型，为EFP应用于临床提供参考。     

Survival effects of time to surgery for Stage I lung cancer: A population-based study

ObjectivesTo examine the impact of time to surgery (TTS) on survival among patients with stage I non-small cell lung cancer (NSCLC).MethodsAll patients in the Canadian province of Ontario with stage I NSCLC from 2007 to 2017 were included. A logistic regression identified the predictors of TTS and a flexible parametric model estimated survival rates based on TTS.ResultsOver the study period, 6428 patients with stage I NSCLC undergoing surgical resection were identified, of which 62.5% had TTS >28 days. Less than half these patients (40.8%) underwent open resection, with 19.3% undergoing open sublobar and 21.5% undergoing open lobectomy. Adenocarcinoma and squamous cell carcinoma tumors accounted for 33.3% and 22.0% of cases, respectively. The majority (85.6%) of patients lived in urban areas within 50 km of a regional cancer center (76.9%). Variables that predicted TTS >28 days include age and extent of resection. After adjustment for VATS vs. open resection, age, sex, frailty, year of diagnosis, histology of tumor, and extent of resection, the hazard ratio for TTS >28 days was 1.26 (95%CI:1.13–1.40), indicating a 26% increased risk of all-cause mortality (p < 0.0001). The highest 5-year survival was observed for patients with stage I disease undergoing resection within 28 days.ConclusionsThe present study found age and extent of resection to be associated with increased TTS. Importantly, patients with TTS >28 days had reduced long-term survival.     

2型糖尿病患者扫描式葡萄糖监测系统指标与尿白蛋白/肌酐比值的相关性研究

背景 随着血糖监测技术的发展，近些年来人们开始使用扫描式葡萄糖监测系统（FGMS）"全景式"地观察2型糖尿病（T2DM）患者的血糖水平，明确FGMS指标与T2DM并发症之间的关系有助于提高其临床应用价值，但目前相关研究较少。 目的 探究佩戴FGMS的T2DM患者葡萄糖在目标范围内时间（TIR）等指标与尿白蛋白/肌酐比值（UACR）的相关性。 方法 选取2019年1月至2021年10月于北京大学人民医院老年科就诊并佩戴FGMS的T2DM患者79例，以尿液检查中UACR是否<30 mg/g将患者分为无白蛋白尿组（n=50）和白蛋白尿组（n=29）。比较两组患者的临床特征、实验室检查指标及FGMS指标等。采用Pearson相关、Spearman秩相关分析探讨TIR、高血糖时间（TAR）与糖化血红蛋白（HbA1c）的相关性。分别采用Pearson相关、Spearman秩相关、偏相关分析探讨FGMS指标与lnUACR的相关性。使用多因素Logistic回归分析探究T2DM患者发生白蛋白尿的影响因素，采用受试者工作特征（ROC）曲线评估TIR对白蛋白尿的预测价值。 结果 白蛋白尿组T2DM病程长于无白蛋白尿组，三酰甘油（TG）、HbA1c、平均血糖（MBG）、TAR、平均血糖标准差（SDBG）、最大葡萄糖波动幅度（LAGE）、平均葡萄糖波动幅度（MAGE）、连续每隔2 h血糖净作用（CONGA2）高于无白蛋白尿组，TIR低于无白蛋白尿组（P<0.05）。Pearson相关、Spearman秩相关分析结果显示，TIR与HbA1c呈负相关（P<0.001），TAR与HbA1c呈正相关（P<0.001）。Pearson相关、Spearman秩相关、偏相关分析结果均表明，TIR与lnUACR呈负相关（P<0.001），MBG、TAR、SDBG、LAGE、MAGE、CONGA2与lnUACR呈正相关（P<0.001）。多因素Logistic回归分析结果显示，TIR>70%〔OR=0.038，95%CI（0.003，0.467）〕是T2DM患者出现白蛋白尿的保护因素（P<0.05），TAR升高〔OR=1.046，95%CI（1.000，1.094）〕是T2DM患者出现白蛋白尿的危险因素（P<0.05）。TIR预测T2DM患者出现白蛋白尿的ROC曲线下面积（AUC）为0.784〔95%CI（0.674，0.894）〕（P=0.003），灵敏度为78%，特异度为83%，最佳切点为69.71%。 结论 在FGMS指标中，TIR>70%是T2DM患者出现白蛋白尿的保护因素，TAR升高是T2DM患者出现白蛋白尿的危险因素。同时，SDBG、LAGE、MAGE、CONGA2等多种反映血糖波动的指标也与UACR密切相关。对TIR水平较低及TAR、SDBG、LAGE、MAGE、CONGA2水平较高的T2DM患者进行FGMS筛查有助于早期识别及预防白蛋白尿的发生、发展。     

Survival and Outcomes of Newly Diagnosed Multiple Myeloma Patients Stratified by Transplant Status 2007-2018: Retrospective Analysis from the Canadian Myeloma Research Group Database

BackgroundConsiderable progress has been made in therapeutic options for multiple myeloma (MM). Understanding the current landscape of MM treatment options and associated outcomes in the real world is important in providing key insights into clinical and knowledge gaps which could be targeted for further optimization.MethodsThe Canadian Myeloma Research Group Database (CMRG-DB) is a prospectively maintained disease-specific database with >7000 patients. The objective of this study was to describe the trends in the treatment landscape and outcomes including early mortality, time to next treatment, and overall survival (OS) in each line of treatment stratified by autologous stem cell transplant (ASCT) receipt among newly-diagnosed MM patients in Canada between 2007 and 2018.ResultsA total of 5154 patients were identified among which 3030 patients (58.8%) received an upfront ASCT and 2124 (41.2%) did not. At diagnosis, the median age was 64 years and 58.6% were males. Bortezomib and lenalidomide were most frequently used (>50%) in first and second-line treatment respectively among both the ASCT and non-ASCT cohort. The median OS was 122.0 months (95% Cl 115.0-135.0 months) and 54.3 months (95% CI 50.8-58.8 months) for the ASCT and non-ASCT cohort respectively with an incremental decrease in OS in each subsequent line of treatment.ConclusionWe present the largest study to date in the Canadian landscape showing the characteristics, therapy usage, and outcomes among MM patients. This information will be critical in benchmarking current outcomes and provide key insight into areas of unmet needs and gaps for improvement of MM patients nationally.     

Temporal changes in extra-axial brain hematoma's signal intensity in magnetic resonance images of trauma patients: A preliminary,technical study

IntroductionDating the exact or estimated time of trauma is an important issue facing forensic medicine. Several clinical and radiological methods were used to achieve this purpose. In the recent study, we aimed to track the changes in the signal intensity of the extra-axial brain hematoma using magnetic resonance imaging (MRI) conventional sequences as well as diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC).Materials and methodsConsidering inclusion and exclusion criteria, all patients with blunt head trauma were involved. After proper management., stabilization, and resuscitation, the participants were assessed using conventional sequences of MRI and DWI twenty-four hours, forty-eight hours, and three weeks after the injury. Temporal changes of signal intensity were compared by Wilcoxon ranged test.ResultsSixteen patients sustaining blunt head trauma were included in this study. The study showed that during the time, diffusion restriction could be seen in an extraaxial hematoma. At the first 24 hours, the signal of hematoma was void in 87.5% of DWI and 100% of ADC. On the second day, they were hypo-signal in 75% of DWI and 100% 0f ADCs, and after three weeks, 100% of cases were hyper-signal in DWI and hypo-signal ADCs.ConclusionThis preliminary study has shown that the DWI can be used to detect and track the extra-axial hematoma. The signal intensity was void during the first twentyfour hours, although it became hypo-signal after 48 hours. Of note, the diffusion restriction is noted after three weeks.     

中国中医药资源配置水平及影响因素探讨＊

目的 分析2013-2019年中国31省市中医药资源配置水平及区域差异，探讨影响资源配置水平的主要因素，为优化中国中医药资源配置提供依据。方法 选取具有代表性的每万人口中医药机构数、每万人口中医药技术人员以及每万人口中医药床位数作为中医药资源配置水平的指标，利用统计年鉴2013-2019年的面板数据，综合运用熵权法、可分解的泰尔指数以及面板时间固定效应模型，分析各省份中医药资源配置水平及区域公平性差异和影响因素。结果 中国中医药资源配置水平均值为0.165，整体呈现递增趋势，不同省份间配置水平有差异；按人口配置的总体泰尔指数优于按面积配置的指数；公平性差异主要来自于四大经济区区域内差异；经济发展水平、城镇化水平和财政自主度是影响中医药资源配置的主要因素（P<0.05）。结论 中医药资源配置整体水平呈增长趋势，资源配置的公平性有待于进一步提高，应重点关注区域内的不公平性。经济发展水平、城镇化水平和财政自主度是影响中医药资源配置水平的主要因素，建议各地区根据当地不同现状精准施策。     

缩短全口义齿修复患者平均椅旁治疗浪费时间

目的缩短全口义齿修复患者平均椅旁治疗浪费时间，提高工作质量和效率。方法按照问题解决型品管圈活动步骤进行问题改进，改进措施包括专项学习个别托盘制作、全数字化流程制作支架、改善基础设施、加强培训等。结果全口义齿修复患者平均椅旁治疗浪费时间从113 min缩短至28 min，提高了工作效率，提升了圈员能力。结论品管圈作为一项有效的质量管理工具，其应用可以缩短全口义齿修复患者平均椅旁治疗浪费时间，值得推广。     

微信小程序合并时间管理器在眼科患儿监护人出院宣教中的应用效果

目的 探讨微信小程序合并时间管理器在眼科患儿出院宣教中的应用效果,为眼科护士出院宣教干预提供借鉴。方法 采用便利抽样法,选取98例眼科患儿监护人作为研究对象,将2021年2月-5月住院的49例患儿的监护人作为对照组,进行眼科常规出院宣教,将2021年6月-9月住院的49例患儿的监护人作为观察组,使用微信小程序合并时间管理器进行出院宣教干预。比较2组患儿监护人对疾病相关知识知晓情况、满意度及按时复诊人数。结果 干预1个月后,观察组疾病相关知识问卷得分、满意度得分及按时复诊率均高于对照组(t=-5.223,P=0.001;t=-5.419,P=0.001;χ²=6.874,P=0.009)。结论 使用微信小程序合并时间管理器在眼科病房进行出院宣教,能有效提高患儿监护人出院后疾病相关知识水平、按时就诊率及监护人满意度,提升护理服务质量。     

Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: A systematic review and meta-analysis

BackgroundAdjuvant chemotherapy(AC) following the curative resection could improve the survival outcome of advanced gastric cancer(GC) patients. However, there is no specific timing interval from radical surgery to initiation of AC. Whether delayed initiation of AC could affect the survival outcome of these patients remains unclear. In this study, we performed a systematic review and meta-analysis to evaluate the relationship between delaying AC and the survival outcome of GC patients.MethodsPubMed, Embase and Cochrane Library databases were systematically searched for eligible studies that evaluated the relationship between time to AC and survival outcome. Survival data for HR and 95% CI were extracted and converted to a regression coefficient(β) corresponding to a continuous representation per 4-week delay of AC. Individual adjusted β were combined using a fixed-effects or random-effects model. Heterogeneity was assessed by I² statistic and publication bias was detected using standard error-based funnel plots.ResultsA total of 11 eligible studies involving 6,017 patients were included in this meta-analysis. Eight studies evaluated the impact of delaying AC on overall survival(OS) and five evaluated the impact of delaying AC on disease-free survival(DFS). The pooled results demonstrated that the initiation of AC per 4-week delay was associated with a significant decrease in OS(HR:1.05, 95% CI: 1.03–1.08, P < 0.001; I² = 18.5%) and DFS (HR:1.06, 95% CI: 1.02–1.10, P = 0.001; I² = 40.6%).ConclusionThe initiation of AC per 4-week delay was associated with worse survival outcomes in GC patients. If physical status and postoperative recovery were appropriated, GC patients should be recommended to receive adjuvant chemotherapy timely.