妊娠糖尿病患者血清、脐血及胎盘组织中 Visfatin和 Chemerin的表达与胰岛素抵抗发生机制的研究

目的　探讨妊娠糖尿病（ gestational diabetes mellitus，GDM）患者血清、脐血及胎盘组织中的内脏脂肪组织（Visfatin）、脂肪因子趋化素（ Chemerin）的表达变化及与患者发生胰岛素抵抗的关系。方法　选取阜阳市人民医院 2018年 12月～ 2020年 4月妊娠分娩的 GDM孕妇 100例作为 GDM组、糖耐量正常孕妇 100例作为 NGT组。统计分析两组的一般资料、血糖指标、血脂指标，检测两组研究对象血清、脐血、胎盘组织中的 Visfatin，Chemerin表达水平，分析 Visfatin，Chemerin表达与胰岛素抵抗指数（ HOMA-IR）的相关性；通过重组慢病毒载体构建 Visfatin， Chemerin过表达的 3T3-L1脂肪细胞，分析 Visfatin，Chemerin过表达对 3T3-L1脂肪细胞增殖、葡萄糖消耗量、 Akt及 pAkt蛋白表达的影响。结果　GDM 组的 FPG(5.84±0.52mmol/L)，Fins(18.96±3.75μU/ml)，HbA1c(6.42%±0.89%)， HOMA-IR(2.48±0.66)，TC(5.22±0.57mmol/L)和 TG(2.41±0.43mmol/L)测定值均高于 NGT组 (4.61±0.40mmol/L，     

基于正交试验的肾造瘘管固定方案研究

目的 探讨基于正交试验的肾造瘘管不同固定方案的比较效果。方法 将14Fr硅胶肾造瘘管固定在聚乙烯展板和拉力显示器上，以固定材料、固定方法、面积为3个影响因素，每个因素3个水平，每组进行3次试验再求平均值作为最后拉力值F，共进行9个固定方案共27次试验。利用L9（33）正交试验矩阵研究不同材料（医用橡皮膏、医用透气胶带、医用无纺布胶带）、固定方法（交叉固定法、“工”字固定法和改良“工”字固定法）及面积(16 cm2、24 cm2、32 cm2）对肾造瘘管固定强度的影响。结果 正交试验所选的3种影响因素中，对拉力值影响显著性排序为：材料＞方法＞面积；3种固定材料中，医用橡皮膏固定强度最大。结论 肾造瘘管固定方案中，最佳固定组合为以医用橡皮膏结合改良“工”字法固定，可为临床管道固定方案的选择提供参考。     

基于内容分析法的中医类APP现状分析

随着手机APP对人们日常工作和生活方式的改变，中医类APP日益得到关注。文章基于内容分析法对目前中医类APP现状进行梳理，分析存在的问题，对未来中医类APP的设计和开发提出建议。以每一个APP为分析单元，从一般情况、主要功能、用户评价等3个方面进行分析，建立了7个维度22个细目的编码体系，进行频数统计和分析。发现目前中医类APP功能丰富，用户广泛，成为中医药服务及中医科学传播的重要载体，具有良好的用户粘度及巨大市场需求，但存在质量良莠不齐、内容资源不佳等问题。提出中医类APP开发应符合中医药发展战略的方向，应进一步规范中医类APP隐私政策和相关法律法规；并探索中医类APP的评价标准和评价指标体系，促进和规范中医类APP的质量提升和不断发展。     

肝细胞癌TACE术后病灶存活或复发18F-FDGPET/CT和增强CT诊断价值Meta分析

目的采用Meta分析方法评价¹⁸F-脱氧葡萄糖正电子发射计算机体层摄影(¹⁸F-FDG PET/CT)和增强CT(CECT)诊断经导管肝动脉化疗栓塞术(TACE)术后存活或复发病灶的临床价值。方法根据PRISMA报告规范开展Meta分析。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方和维普数据库中¹⁸F-FDG PET/CT和CECT诊断TACE术后存活或复发病灶的临床研究,时间至2019-04。由2位研究人员独立筛选文献、提取资料,根据诊断准确性研究质量评价工具-2(QUADAS-2)评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算其汇总敏感度(Sen)和特异度(Spe),绘制受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。结果共纳入10篇¹⁸F-FDG PET/CT及13篇CECT诊断TACE术后存活或复发病灶的原始研究,分别包括322例患者的467个病灶和748例患者的943个病灶。Meta分析显示,¹⁸F-FDG PET/CT诊断TACE术后存活或复发病灶的Sen=0.92(95%CI为0.87~0.94)、Spe=0.95(95%CI为0.82~0.99)、AUC=0.97(95%CI为0.93~0.99);CECT诊断TACE术后存活或复发病灶的Sen=0.72(95%CI为0.66~0.78)、Spe=0.99(95%CI为0.93~1.00)、AUC=0.87(95%CI为0.83~0.89)。此外,CECT诊断TACE术后存活或复发Sen(Z=2.34,P=0.02)和AUC(Z=2.21,P=0.03)值低于¹⁸F-FDG PET/CT,差异有统计学意义。结论相比于CECT,¹⁸F-FDG PET/CT对TACE术后存活或复发病灶具有较高诊断效能,可视为TACE术后存活或复发病灶有效的影像学诊断方法。     

Antitumor effects of dioscin in A431 cells via adjusting ATM/p53-mediated cell apoptosis,DNA damage and migration

Skin cancer is the deadliest type of malignant disease and causes primary mortality worldwide. Dioscin, which exists in medicinal plants, has potent anticancer effects. However, its effects on skin cancer remain unknown. In the present study, the activity and mechanism of dioscin on the human skin cancer A431 cell line were investigated, MTT, colony formation, Transwell, wound-healing, TUNEL, Comet, immunofluorescence and western blot assays were used to assess the effects of dioscin on A431 cells. The results of MTT, colony formation, Transwell and wound-healing assays revealed that dioscin suppressed proliferation, colony formation and invasion of the cancer cells. TUNEL and comet assays demonstrated that dioscin exhibited significant effects on cell apoptosis and DNA damage. Investigations into the mechanism revealed that the expression levels of phosphorylated Ataxia telangiectasia-mutated (ATM) were considerably activated by dioscin, which significantly upregulated the expression levels of p53 to activate mitochondrial apoptosis signaling. Furthermore, the expression levels of BAX, cleaved caspase-3/9 and cleaved poly (ADP-ribose) polymerase were upregulated, and the expression levels of BCL-2 were downregulated by dioscin. Additionally, dioscin markedly downregulated the expression levels of matrix metalloproteinase 2 (MMP2), MMP9, RHO and cdc42, which are all associated with tumor invasion. In addition, p53-small interfering RNA transfection experiments indicated that dioscin exhibited excellent activity against skin cancer in vitro by decreasing p53 expression. Overall, the present results suggested that dioscin inhibited skin cancer cell proliferation via adjusting ATM/p53-mediated cell apoptosis, migration and DNA damage, which should be considered as a potential option for future treatments of skin cancer.     

神经外科住院患者人文关怀感知与护士关怀实践的对比研究

目的了解神经外科住院患者及护士对护士人文关怀的感知与评价差异,为更好地实施人文关怀护理服务提供参考。方法选取86例神经外科住院患者及92名神经外科护士作为研究对象,分别使用关怀行为量表进行问卷调查。结果患者与护士对护士人文关怀的总体评分分别为4.77±0.84、4.86±0.60,无统计学差异(P>0.05),双方均在“尊重患者”及“联系患者”2个维度评分较低。在“支持和保证”维度,患者对护士人文关怀的感知水平显著低于护士自评结果(P<0.01)。结论护患双方均对护士关怀行为的评价较好且双方在对护士关怀行为的整体认知上存在较高的一致度,但护士对患者心理层面的关怀相对不足,患者对护士在“支持和保证”相关关怀行为方面具有较高的期待。护士需要进一步改进与提升人文关怀质量。     

保留自主呼吸对于重度急性呼吸窘迫综合征患者的影响：弊大于利

急性呼吸窘迫综合征（ARDS）是临床上常见的以顽固性低氧为表现的呼吸功能不全或衰竭的综合征，肺不均一性是其主要病理生理特点。传统观点认为，保留ARDS患者自主呼吸有助于改善全身氧合。但是近年来发现，对于重度ARDS患者，保留患者自主呼吸会加重肺损伤，过强的自主呼吸会导致重度ARDS患者跨肺压升高、肺内气体摆动、肺水肿加重以及人机不同步，引起患者肺内炎症加重，氧合功能恶化，最终影响患者预后，增加病死率。本文就自主呼吸对重度ARDS患者呼吸功能的影响机制展开综述。     

Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.     

住院医师规范化培训中引入Mini-CEX的实践

目的　观察对住院医师规范化培训部分学员使用Mini-CEX进行临床教学的效果。方法选取我院2015级住培学员40名，随机分为对照组和实验组，每组20人。2015年10月至2018年4月，对照组采用传统教学；实验组在传统教学基础上结合Mini-CEX活动，实验组每人在每个轮转科室至少进行2次Mini-CEX。毕业时应用改良的Mini-CEX评分量表、病例答辩和OSCE三种考核方法对两组学员进行测评。针对实施过Mini-CEX的教师和学员分别发放问卷，进行满意度调查。采用SPSS 18.0对数据进行统计分析，组间比较采用独立样本t检验，组内前后比较采用配对样本t检验。结果 Mini-CEX测评显示，两组学员各项临床能力毕业成绩均高于入学成绩，实验组学员毕业成绩优于对照组，实验组学员成绩提高分数大于对照组提高分数，差异均有统计学意义（P＜0.05）。病例答辩显示，实验组学员平均成绩为（81.16±3.75）分，优于对照组的（70.13±3.88）分，差异有统计学意义（t= -9.140，P=0.000）。OSCE考核显示，实验组平均总分为（96.300±4.681），优于对照组的（91.775±3.227）分，差异有统计学意义（t=-3.559，P=0.001）。共发放调查问卷80份，其中教师40份、学员40份，结果显示教师满意率达95.0%、学员满意率达92.5%。结论　Mini-CEX应用于住院医师规范化培训临床带教中，有利于提高学员的临床思维、医患沟通和人文关怀能力。