上海市普陀区在职教师甲状腺结节流行状况调查及影响因素分析

目的:调查上海市普陀区在职教师体检人群中甲状腺结节检出状况,并分析导致结节产生的可能影响因素。方法:采用横断面研究方法,选取2018年1～12月在体检站进行体检的普陀区在职教师1 755人次进行甲状腺超声和血生化检查,同时收集其工作岗位、精神压力、睡眠情况等信息。结果:普陀区在职教师甲状腺结节患病率为68.60%(1 204/1 755),结节大小在2 mm×1mm～43 mm×38 mm,多发854例(占70.93%)明显多于单发350例(占29.07%),其中双叶结节、实性结节较为多见。女性患病率为79.14%(751/949),明显高于男性患病率56.20%(453/806)(χ2=106.415,P0.001)。甲状腺结节患病率随年龄的增长而升高,≥51岁人群患病率最高,为77.78%(χ2=145.620,P0.001),不同性别患病率均随年龄增长而升高(P0.001),所有年龄段中女性患病率均高于男性,差异有统计学意义(P0.05)。不同岗位间患病率相比较,差异无统计学意义(P0.05)。Logistic回归分析显示:性别(OR=2.836,95%CI:2.149～3.743)、年龄(OR=1.736,95%CI:1.500～2.008)、岗位(OR=1.945,95%CI:1.722～2.196)、血糖(OR=3.369,95%CI:1.822～6.229)、精神压力(OR=9.884,95%CI:6.289～15.532)、血脂(OR=9.121,95%CI:4.897～16.988)、睡眠情况(OR=9.513,95%CI:6.322～14.313)是甲状腺结节患病的危险因素。结论:上海市普陀区在职教师甲状腺结节患病率较高,女性患病率高于男性,性别、年龄、岗位、血糖、精神压力、血脂、睡眠情况等是甲状腺结节患病的危险因素。倡导教师在工作中合理安排工作,树立健康管理观念,提高健康管理水平。     

住院病人术后早期医疗质量投诉的原因及对策

目的探讨住院病人术后早期发生医疗质量投诉的原因及预防策略。方法回顾性分析2007年1月-2007年12月15例住院病人术后早期医疗质量投诉事件的处理资料。结果15例术后早期医疗质量投诉事件中因术后早期病人死亡投诉4例，因术后并发症投诉6例，因术后治疗效果不认可投诉3例，因费用问题投诉1例，因术后服务态度投诉1例。结论医务人员在医疗活动中必须严格遵守医疗卫生管理法律、法规部门规章和诊疗护理规范、常规，保障医疗安全，避免医疗质量投诉。     

Clinical Study on Yishen Qufeng Shengshi Recipe (益肾祛风胜湿方) for Glomerular Proteinuria Patients: A Randomized Controlled Trial

Objective: To explore the therapeutic effect of Yishen Qufeng Shengshi Recipe(益肾祛风胜湿方,YQSR) in patients with glomerular proteinuria. Methods: A total of 145 patients with glomerular proteinuria were selected and randomly assigned to the treatment group(108 cases) and the control group(37 cases) according to a random number table in a ratio of 3:1. All patients received conventional and symptomatic treatment. In addition, patients in the treatment and control groups were given YQSR(200 m L, twice per day, orally) and losartan(50 mg/d orally), respectively for 6 months. The 24-h urine protein quantity, blood urea nitrogen, and serum creatinine in the two groups were measured at multiple time points before and after treatment. Results: At the end of the study, 5 cases were lost to follow-up in the treatment group and 1 in the control group. Finally, the statistical data included 103 cases in the treatment group and 36 cases in the control group. The total effectiveness after 2, 4, and 6 months was 81.6%(84/103), 87.4%(90/103), and 92.2%(95/103), respectively, in the treatment group and 47.2%(17/36), 55.6%(20/36), and 61.1%(22/36), respectively, in the control group, with significant difference between the two groups(P0.01 at all observation points). In the treatment group, the curative effect after 6 months was better than that after 2 months(P0.05). The 24-h urine protein quantity was significantly lower in the treatment group at 3, 4, 5, and 6 months than that in the control group(P0.05 or P0.01, respectively). Conclusion: YQSR could significantly reduce the amount of glomerular proteinuria in the early stage.     

彩色多普勒超声诊断糖尿病下肢动脉病变的价值

目的 探讨彩色多普勒超声(CDI)在糖尿病下肢动脉病变的诊断价值。方法 用彩色多普勒超声对100例非胰岛素依赖型糖尿病(NIDDM)病人及50例正常对照组进行双下肢动脉检查并测定血浆胰岛素、血糖、糖基血红蛋白浓度。结果 糖尿病组的动脉硬化发生率明显高于对照组。糖尿病发病年限、病人的年龄以及血糖控制情况与下肢动脉病变发生率有关。结论 糖尿病病人下肢动脉有明显损伤，动脉硬化发生率增高。     

年轻妇女子宫内膜癌的误、漏诊原因分析及早期诊断

目的对年轻妇女子宫内膜癌的误诊、漏诊原因进行分析以期提高早期诊断确诊率.方法对1980年～1997年间临床误诊、漏诊的18例年轻妇女子宫内膜癌进行回顾性分析.结果18例误、漏诊患者占同期年轻妇女子宫内膜癌患者的67%,误、漏诊疾病为功能失调性子宫出血病、原发性不孕、继发性不孕、卵巢癌、肠癌、子宫肌瘤、上节育环后子宫出血等.结论反复月经失调、不育者并且卵巢增大的年轻妇女应警惕子宫内膜癌的可能性.年轻妇女在患子宫内膜癌的同时有患第二原发癌的可能性,特别是有癌瘤家族史者.年轻妇女子宫内膜癌多数分化较好在病理上与复杂性子宫内膜增生过长,腺瘤样增生,重度不典型增生很难区分,必须特别注意.     

Clinical outcomes of patients receiving daptomycin for the treatment of Staphylococcus aureus infections and assessment of clinical factors for daptomycin failure: A retrospective cohort study utilizing the Cubicin® Outcomes Registry and Experience

Background: Daptomycin is most commonly used as a second-line treatment. Previous studies have not differentiated the effect of prior antibiotic therapy on daptomycin clinical outcomes.Objectives: The primary objective of this study was to compare clinical outcomes of patients treated with daptomycin as first-line therapy versus after prior antibiotic therapy (specifically, vancomycin). A secondary objective was to identify other factors associated with the clinical failure of daptomycin therapy.Methods: This was a retrospective cohort study using data from a postlabeling registry database. The effects of relevant patient characteristics on the clinical outcome of individuals treated for Staphylococcus aureus infections with daptomycin were examined in an unblinded approach using univariate and multivariate analyses. Only patients with an evaluable clinical outcome (ie, cure, improvement, failure) and culture-confirmed S aureus infection were included in the analysis cohort.Results: Of 1227 clinically evaluable patients, 250 (20%) received daptomycin as first-line therapy and 977 (80%) received daptomycin after other prior antibiotic therapy. Overall, 53% of patients were male; 64% were aged 31 to 65 years and 26% were aged ≥66 years. Race information was collected beginning in 2007; of the patients studied, 71% were white and 18% were black. The initial daptomycin dose (mean [SD]) overall was 5.1 (1.1) mg/kg and was highest for patients with endocarditis (5.9 [1.2] mg/kg) and lowest for those with uncomplicated skin and skin structure infections (4.4 [0.9] mg/kg). Clinical success, defined as an outcome of cured or improved at the end of daptomycin therapy, was reported for 1140 (93%) of the 1227 evaluable patients. The clinical success rates for first-line therapy with daptomycin and after prior antibiotics were both 93%. Using univariate analysis, 8 variables were associated with clinical failure (receipt of daptomycin in an intensive care unit setting, severe renal dysfunction [creatinine clearance <30 mL/min], dialysis, diabetes mellitus (DM), concomitant antibiotics, bacteremia, endocarditis, and failure of prior vancomycin therapy) and 3 with clinical success (outpatient daptomycin therapy and complicated and uncomplicated skin and skin structure infections). Using the stepwise multivariate regression analysis, only the presence of endocarditis (odds ratio [OR] = 2.56; 95% CI, 1.18–5.54; P = 0.017), bacteremia (OR = 1.77; 95% CI, 1.04–3.02; P = 0.037), severe renal dysfunction (OR = 1.78; 95% CI, 1.05–3.03; P = 0.034), and DM (OR = 1.79; 95% CI, 1.10–2.93; P = 0.02) were identified as factors independently associated with clinical failure of daptomycin therapy. Of the remaining patients, 9% were aged 18 to 30 years and 0.7% were aged 12 to 17 years.Conclusions: In this retrospective study, after controlling for clinical factors that are associated with suboptimal outcomes, clinical outcomes with daptomycin did not differ whether it was used as first-line therapy or after other antibiotics. Endocarditis, bacteremia, severe renal dysfunction, and DM were associated with higher rates of clinical failure of daptomycin treatment.     

The aging human cochlear nucleus: Changes in the glial fibrillary acidic protein,intracellular calcium regulatory proteins,GABA neurotransmitter and cholinergic receptor

The human auditory system is highly susceptible to environmental and metabolic insults which further affect the biochemical and physiological milieu of the cells that may contribute to progressive, hearing loss with aging. The cochlear nucleus (CN) is populated by morphologically diverse types of neurons with discrete physiological and neurochemical properties. Between the dorsal and the ventral cochlear nucleus (DCN and VCN), the VCN is further sub-divided into the rostral (rVCN) and caudal (cVCN) sub-divisions. Although, information is available on the age related neurochemical changes in the mammalian CN similar reports on human CN is still sparse. The morphometry and semiquantitative analysis of intensity of expression of glial fibrillary acidic protein (GFAP), calcium binding proteins (calbindin, calretinin and parvalbumin), gamma amino butyric acid (GABA) and nicotinic acetyl choline receptor (nAchR) beta 2 immunostaining were carried out in all three sub-divisions of the human CN from birth to 90 years. There was increased GFAP immunoreactivity in decades 2 and 3 in comparison to decade 1 in the CN. But no change was observed in rVCN from decade 4 onwards, whereas intense staining was also observed in decades 5 and 6 in cVCN and DCN. All three calcium binding proteins were highly expressed in early to middle ages, whereas a significant reduction was found in later decades in the VCN. GABA and nAchR beta 2 expressions were unchanged throughout in all the decades. The middle age may represent a critical period of onset and progression of aging changes in the CN and these alterations may add to the deterioration of hearing responses in the old age.     

MicroRNAs as ideal biomarkers for the diagnosis of lung cancer

Lung cancer (LC) is one of the most prevalent causes of cancer death with a high mortality rate worldwide. While various sets of microRNAs (miRNAs) have been found to be highly sensitive and specific biomarkers for the early diagnosis of LC (the first word of abstract), conflicting results on their diagnostic accuracy are still present in individual studies. Thus, we aimed to conduct a systematic review and meta-analysis of the published literature to comprehensively assess the diagnostic value of miRNAs for predicting LC. The sensitivity and specificity of each included study were used to plot the summary receiver operator characteristic (SROC) curve and to calculate the area under the SROC curve (AUC). All analyses were performed using the Stata 12.0 software. Twenty-six articles were involved in our meta-analysis, 18 of which focused on single miRNA assays and 15 on multiple miRNA assays. For single miRNA profiling, the pooled parameters calculated from all studies are as follows: sensitivity (SEN), 0.72; specificity (SPE), 0.74; positive likelihood ratio (PLR), 2.7; negative likelihood ratio (NLR), 0.39; and diagnostic odds ratio (DOR), 7. For multiple miRNA profiling, the pooled estimates for the overall studies are as follows: SEN, 0.81; SPE, 0.84; PLR, 4.9; NLR, 0.23; and DOR, 22, which are significantly better than the diagnostic performance of the single miRNA profiling. In addition, subgroup analyses based on sample types suggested that blood-based multiple miRNA assays were more accurate than non-blood-based studies. In conclusion, the current meta-analysis shows that multiple miRNA assays were more accurate in diagnosing LC than single miRNA assays. However, further large-scale investigations are urgently needed to confirm our results and verify the feasibility of routine clinical utilization.     

2型糖尿病患者胃排空影响因素分析

目的评估2型糖尿病患者胃排空和病程、血糖、血管病变及血清维生素B12的关系。方法选取2009年10月-2010年5月上海市普陀区中心医院内分泌科住院2型糖尿病患者100名及糖调节正常者40名,口服胃助显剂后超声检测15、30、45、60、759、0 min胃排空率,并计算半排空和全排空时间。每位受试者测空腹及早餐后血糖、糖化血红蛋白、血清维生素B12。分析糖尿病患者胃排空影响因素。结果口服胃助显剂后,病程5年以上糖尿病患者胃半排空和全排空时间较糖调节正常者和病程小于5年患者显著延长;15、30、456、0 min胃排空率明显小于糖调节正常组和5年以下糖尿病患者。大量白蛋白尿患者较尿白蛋白阴性患者45、607、5 min胃排空率下降、全排空时间延长。糖尿病患者胃排空时间与血清维生素B12水平和早餐后2 h血糖负相关。结论超声方法可反映糖尿病患者胃排空。长期高血糖患者胃排空明显减慢。糖尿病胃轻瘫可能与微血管病变及维生素B12缺乏有关。胃排空减慢可能通过延缓糖尿病患者碳水化合物吸收降低餐后血糖波动。     

检测HM·CAP对幽门螺杆菌感染的诊断价值探讨

目的　探讨高分子量细胞相关蛋白 (Highmolecularweightcell-associatedprotein ,HM·CAP)对幽门螺杆菌 (Hp)的诊断价值。方法　对 40例正常人及 12 0例胃部疾病病人进行了HM·CAP检测 ,对其中 116例病人同时进行14 C -尿素酶呼吸试验 (UBT)、Hp培养及病理组织学对比。结果　 40例正常人中 ,有 7例HM·CAP阳性 ,14 0例病人中 ,78例阳性。我们以14 C -UBT、Hp培养及病理组织学来评估HM·CAP对Hp的诊断价值 ,其敏感性分别为 97 4%、10 0 %、97 3 % ,特异性为 94 7%、74 5 %、90 % ,诊断符合率为96 6%、88 8%、94 8%。结论　HM·CAP是一种具有较高敏感性及特异性的诊断Hp感染的方法。