新生儿肺部超声在早产儿肺部感染评价中的价值

目的 探讨新生儿肺部超声在早产儿肺部感染评价中的价值。 方法 选取肺部感染早产儿80例为观察组，无肺部感染的早产儿80例为对照组，均给予新生儿肺部超声检查，比较2组肺部超声评分、氧合指数、呼吸指数，比较观察组不同病情、预后患儿肺部超声评分、氧合指数、呼吸指数,分析肺部超声评分和氧合指数、呼吸指数的相关性。 结果 观察组肺部超声评分、氧合指数低于对照组，呼吸指数高于对照组，差异有统计学意义（P＜0.05）。观察组极危重患儿肺部超声评分、氧合指数低于危重和非危重患儿，呼吸指数高于危重和非危重患儿，危重患儿肺部超声评分、氧合指数低于非危重患儿，呼吸指数高于非危重患儿，差异有统计学意义（P＜0.05）。肺部超声评分与呼吸指数呈负相关（r=-0.455，P＜0.05），与氧合指数呈正相关（r=0.470，P＜0.05）。观察组死亡患儿肺部超声评分、氧合指数低于存活患儿，呼吸指数高于存活患儿，差异有统计学意义（P＜0.05）。肺部超声评分预测患儿预后的ROC曲线下面积为0.874，高于呼吸指数和氧合指数（P＜0.05），其截断值为20分时，敏感度和特异度为88.50%和75.00%。 结论 新生儿肺部超声在早产儿肺部感染评价中有较好的效果，值得临床使用。     

认知重构干预对急性心肌梗死介入手术患者不良情绪及疾病感知的影响

目的探讨认知重构干预对急性心肌梗死(AMI)介入手术患者不良情绪及疾病感知的影响。方法72例AMI介入手术患者随机分为两组各36例,对照组给予常规护理干预,研究组在对照组基础上给予认知重构干预,比较两组的不良情绪、疾病感知以及治疗依从性。结果干预后,研究组的HAMA、HAMD评分均低于对照组,疾病感知各项评分均高于对照组(P<0.05)。研究组的治疗依从性为94.44%,高于对照组的75.00%(P<0.05)。结论认知重构干预对急性心肌梗死介入手术患者的不良情绪及疾病感知均有积极的影响,可提升患者的治疗依从性。     

控制性低中心静脉压在原发性肝癌伴肝炎后肝硬化患者腹腔镜肝切除中的应用

背景与目的:在肝脏切除手术中采用控制性低中心静脉压(CLCVP)技术可有效减少肝断面出血,然而,低中心静脉压(CVP)所产生的相对低血压和潜在低灌注可能造成不良影响,这使其推广应用受到一定程度的限制。本研究探讨CLCVP技术在原发性肝癌伴肝炎后肝硬化患者腹腔镜肝切除手术中的应用效果和安全性。方法:回顾性分析2017年4月—2019年3月在安徽医科大学第一附属医院肝胆胰外科行全腹腔镜解剖性肝切除手术的44例原发性肝癌伴肝炎后肝硬化患者临床资料,所有患者均接受同一组医生手术,其中24例患者术中采用CLCVP技术(观察组),另外20例患者术中未采用CLCVP对照组(对照组),分析并比较两组术前、术中、术后的相关临床资料。结果:两组患者术前资料包括性别、年龄、BMI、Child分级、肝硬化程度、肝肾功能指标差异均无统计学意义(均P0.05)。两组手术均顺利完成,无围手术期死亡病例。观察组术中、术后均未见低CVP相关气栓、肝肾损伤等并发症。与对照组比较,观察组术中动脉收缩压、CVP明显降低,手术时间与肝门阻断时间明显缩短、术中出血和手术输血率明显降低,但术中乳酸指标明显升高(均P0.05)。两组的术后出血、感染、胸腔积液、胆汁漏的发生率以及肝肾功能指标、拔管时间、住院时间方面均无统计学差异(均P0.05),但观察组患者术后引流量多于对照组(P0.05);两组术后复发率亦无统计学差异(P0.05)。结论:在做好术前肝功能评估和术中密切观测患者灌注指标的前提下,CLCVP技术对肝炎后肝硬化患者腹腔镜肝切除手术是安全可靠的,虽然低CVP会使机体灌注减少,机体无氧代谢增强,乳酸含量增高,但对肝肾功能及肝癌的复发无明显影响,而且较低的CVP能够有效减少术中出血量和输血量,缩短手术时长和肝门阻断时间,降低长时间缺血缺氧对肝脏的打击。总之,在无严重心、肺、脑、肾基础疾病的肝炎后肝硬化患者腹腔镜肝切除手术中,CLCVP是一种值得推荐的控制肝断面出血技术。     

CIP2A在子宫内膜样腺癌中的表达及临床意义

目的:探究蛋白磷酸酶2A(CIP2A)在子宫内膜样腺癌中的表达情况及临床意义。方法:选取2011年1月至2014年3月行手术切除并经病理证实的50例子宫内膜样腺癌(EAC)及同期行门诊刮宫术获取的40例正常增生期子宫内膜(NE)组织标本。应用RT-PCR、Western blot法检测EAC和NE组织中CIP2A mRNA及蛋白水平，免疫组化法检测CIP2A阳性表达情况。分析CIP2A在EAC和NE组织中的表达差异及与子宫内膜样腺癌临床病理特征的关系。采用Kaplan-Meier法分析CIP2A不同表达水平对患者预后生存的影响，通过COX分析预后独立危险因素。结果:免疫组化染色显示:CIP2A在子宫内膜样腺癌中呈高表达，阳性着色定位于细胞浆和细胞核中，EAC组织中CIP2A阳性表达率显著高于NE组织(P＜0.01)。RT-PCR和Western blot检测显示EAC组织中CIP2A mRNA及蛋白表达水平高于NE组织(P＜0.01)。CIP2A表达与EAC的组织学分级、FIGO分期、宫颈管受累情况、p53表达及Ki-67增殖指数有关（P＜0.05）。Kaplan-Meier法生存分析显示EAC患者5年无病生存率为92.0%、总生存率为88.0%；CIP2A表达、组织学分级、FIGO分期、肌层浸润深度、附件转移、脉管内癌栓及Ki-67增殖指数与患者预后不良相关（P＜0.05）。多因素分析显示，组织学分级、FIGO分期及脉管内癌栓是影响子宫内膜样腺癌患者预后生存的独立危险因素（P＜0.05）。结论:CIP2A在子宫内膜样腺癌中呈高表达，与患者总生存率下降相关，并非影响患者预后的独立危险因素。     

Cardiovascular effects and mechanisms of sodium-glucose cotransporter-2 inhibitors

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a new type of drug for the treatment of diabetes, and they have been proven to have a good hypoglycemic effect. Several lines of clinical evidence have shown that SGLT2 inhibitors can significantly reduce the risks of atherosclerosis, hospitalization for heart failure, cardiovascular death, and all-cause mortality and delay the progression of chronic kidney disease. Because of the protective effects of SGLT2 inhibitors on the heart and kidney, they are being studied for the treatment of heart failure and chronic kidney disease in patients without diabetes. Therefore, it is necessary for cardiologists, patients with diabetes, and nephrologists to fully understand this type of drug. In this review, we summarize the following three aspects of SGLT2 inhibitors: the recent clinical evidence of their cardiovascular benefits, their mechanisms of action, and their safety.     

Cardiac Denervation for Arrhythmia Treatment with Transesophageal Ultrasonic Strategy in Canine Models

Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself. Two weeks after the ablation, the QT and QTc of the experimental group decreased compared with those of the sham group and at baseline (both p values < 0.001). Histologic examination revealed that left SGs were destroyed. No major complications were observed. This approach may be further explored as a method for ganglia remodeling evaluation and as a strategy of ganglia modification for arrhythmia and for other diseases.     

当归饮子对血虚风燥型湿疹模型幼鼠的影响及作用机制＊

目的 研究当归饮子对血虚风燥型湿疹模型幼鼠的影响并探讨其作用机制。方法 采用2，4-二硝基氯苯（DNCB）、乙酰苯肼（APH）结合物理刺激制备血虚风燥湿疹模型，50只SD大鼠随机分为空白组、模型组、当归饮子高剂量组（30 g·kg^-1）、当归饮子低剂量组（15 g·kg^-1）、地氯雷他定组（0.8 mg·kg^-1），连续灌胃15天。观察幼鼠体重、脾脏指数、胸腺指数；通过湿疹皮损评分、HE染色组织病理学改变评价当归饮子对血虚风燥湿疹的治疗效果；采用酶联免疫吸附法（ELISA）检测血清γ-干扰素（IFN-γ）、白介素-4（IL-4）、免疫球蛋白E（IgE）、白三烯B4（LTB4）、白三烯C4（LTC4）含量；采用逆转录聚合酶链式反应（RT-PCR）检测皮肤组织半胱氨酰白三烯受体1（CysLTR1）和半胱氨酰白三烯受体2（CysLTR2）表达水平，以探索当归饮子治疗血虚风燥湿疹的作用机制。结果 与正常组相比，模型组幼鼠体重明显减轻（P<0.05），脾脏指数增大、胸腺指数减小（P<0.05）；幼鼠背部出现红斑、糜烂、渗出、水肿、鳞屑等皮损；病理学呈现大量中性粒细胞浸润、表皮海绵水肿、角化过度伴角化不全；IFN-γ水平下降（P<0.05），IL-4、IgE、LTB4、LTC4水平及皮肤CysLTR1和CysLTR2受体表达水平上调（P<0.01）。与模型组相比，当归饮子高、低剂量组及地氯雷他定组体重均明显上升（P<0.05），脾脏指数减小、胸腺指数增大（P<0.05）；皮损均明显改善（P<0.05），病理改变呈表皮炎症消失，真皮乳头水肿消失；IFN-γ水平显著上升（P<0.05），IL-4、IgE、LTB4、LTC4水平明显下降（P<0.05）；皮肤CysLTR1和CysLTR2受体表达水平均明显下降（P<0.05），其中以当归饮子高剂量组最为明显（P<0.05）。结论 当归饮子治疗血虚风燥型湿疹模型幼鼠疗效明显，机制可能与其调控湿疹幼鼠Thl／Th2失衡、下调血清LTB4、LTC4水平及皮肤CysLTR1、CysLTR2受体表达水平有关。     

重组人干扰素α-2b栓联合心理行为干预对慢性宫颈炎患者血清炎性因子、免疫功能及负性情绪的影响

目的 探究重组人干扰素α-2b栓联合心理行为干预对慢性宫颈炎患者血清炎性因子、免疫功能及负面情绪的影响.方法 选取我科2017年4月～2019年12月期间105例慢性宫颈炎患者,根据随机数字表法分组.对照组52例给予微波治疗联合心理行为干预,观察组53例增加重组人干扰素α-2b栓治疗,观察两组患者的临床疗效;血清炎性因子水平、免疫功能、负性情绪及不良反应.结果 治疗后观察组白细胞介素-2(IL-2)、超敏C反应蛋白(hs-CRP)水平、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分均低于对照组,血管内皮生长因子(VEGF)、自然杀伤T细胞(NKTs)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平、总有效率高于对照组(P＜0.05).观察组不良反应发生率9.43％,与对照组的7.69％相比无统计学差异(P＞0.05).结论 重组人干扰素α-2b栓联合心理行为干预对慢性宫颈炎患者治疗,可降低患者炎症因子水平和负性情绪,促进免疫功能恢复,提升临床疗效,药物安全性高.     

Osseointegration of porous titanium and tantalum implants in ovariectomized rabbits: A biomechanical study

BACKGROUNDToday, biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty. Long-term stable fixation of these implants depends on the osseointegration of the acetabular cup bone tissue into the acetabular cup implant, and their ability to withstand functional loads.AIMTo compare the strength of bone-implant osseointegration of four types of porous metal implants in normal and osteoporotic bone in rabbits.METHODSThe study was performed in 50 female California rabbits divided into non-ovariectomized (non-OVX) and ovariectomized groups (OVX) at 6 mo of age. Rabbits were sacrificed 8 wk after the implantation of four biomaterials [TTM, CONCELOC, Zimmer Biomet''s Trabecular Metal (TANTALUM), and ATLANT] in a 5-mm diameter defect created in the left femur. A biomechanical evaluation of the femur was carried out by testing implant breakout force. The force was gradually increased until complete detachment of the implant from the bone occurred.RESULTSThe breakout force needed for implant detachment was significantly higher in the non-OVX group, compared with the OVX group for all implants (TANTALUM, 194.7 ± 6.1 N vs 181.3 ± 2.8 N; P = 0.005; CONCELOC, 190.8 ± 3.6 N vs 180.9 ± 6.6 N; P = 0.019; TTM, 186.3 ± 1.8 N vs 172.0 N ± 11.0 N; P = 0.043; and ATLANT, 104.9 ± 7.0 N vs 78.9 N ± 4.5 N; P = 0.001). In the OVX group, The breakout forces in TANTALUM, TTM, and CONCELOC did not differ significantly (P = 0.066). The breakout force for ATLANT in the OVX group was lower by a factor of 2.3 compared with TANTALUM and CONCELOC, and by 2.2 compared with TTM (P = 0.001). In the non-OVX group, the breakout force for ATLANT was significantly different from all other implants, with a reduction in fixation strength by a factor of 1.9 (P = 0.001).CONCLUSIONTANTALUM, TTM, and CONCELOC had equal bone-implant osseointegration in healthy and in osteoporotic bone. ATLANT had significantly decreased osseointegration (P = 0.001) in healthy and in osteoporotic bone.