品管圈活动对缩短门诊患者输液前等待时间的影响

目的:探讨品管圈活动对缩短门诊患者输液前等待时间的影响。方法:成立品管圈活动小组,选定缩短门诊患者输液前等待时间为活动主题,对输液患者等待时间的现状进行调查,分析输液患者等待时间过长的原因,制定相应的整改措施并组织实施。结果:实施品管圈活动后输液患者输液前等待抱怨率降低、平均等待时间缩短,与实施前比较差异均有统计学意义(P0.05)。结论:品管圈活动的开展可缩短门诊患者输液前等待时间,提高工作效率,增加门诊患者的满意度。     

CD4+CD25-Foxp3+T淋巴细胞的表型鉴定及其在初发系统性红斑狼疮中的意义

Objective To compare the phenotypes of abnormal CD4+CD25-Foxp3+ T cells with traditional regulatory T cells (CD4+CD25+Foxp3+) in patients with untreated new-onset lupus (UNoL) and investigate their clinical relevance. Methods The expressions of surface markers (CD25, CD127, CCR4, GITR, CTLA-4) and intracellular marker(Foxp3) on the peripheral blood mononuclear cells from twenty-two UNoL patients were analyzed by flow cytometry analysis, and their clinical relevance were assessed. Results There were no significant differences between CD4+CD25-Foxp3+ and CD4+CD25+Foxp3- T cells in the expressions of GITR, CTLA--4 and CCR4 (P>0.05), but they were significantly lower than those of CD4+CD25+ Foxp3+ T cells in UNoL patients (P<0.01). The percentages of CD127low- in CD4+Foxp3+CD25high,CD4+Foxp3+ CD25low and CD4+Foxp3+CD25+ T cells were (93.8±3.5 )%, (93.7±2.3)% and (92.0±2.1)% respectively (P> 0.05), whereas the expressions of Foxp3 on CD4+CD127low- T subpopulations showed significant differences in CD4+CDI27low-CD25high (91.4±2.6)%, CD4+CD127low-CD25low (71.9±3.3)% and CD4+CD127low-CD25- (9.0± 2.2)% T cells(P<0.01 ). The frequency of CD+CCR4+CD25high T cells correlated negatively with SLEDAI (r=-0.695,P<0.001).and it was significantly lower in lupus nephritis patients(1.10±0.17)%compared with SLE patients without nephritis [(1.61±0.23)%,P<0.01]and healthy controls [(1.75±0.10)%,P<0.01], furthermore,the frequency of CD4+CCR4+CD25low-T cells in lupus nephritis was significantly higher than that in healthy controls[(11.5±2.3)%vs (8.0±1.0)%,P<0.01].Conclusion The increased CD4+CD25-Foxp3+ T cells in the Untreated Newonset Lupus(UNoL)patients mimic activated T effector cells.CD4+CD25high-CD127low-T cells can be used to isolate live CD4+CD25highFoxp3+regulatory T cells.CCR4+regulatory T cells may be involved in the pathogenesis of lupus nephritis.     

成人左肾静脉压迫综合征并IgA肾病三例

３例均为女性，年龄１９－３２岁，起病时均有感冒或劳累后发现尿色变深、肉眼血尿；尿常规检查发现蛋白尿、血尿。病史从１个月到７年。体检 均为瘦长体型，心、肺、腹无异常，无水肿。尿常规：蛋白（－）－（３＋），ＲＢＣ（－）～（３＋），ＷＢＣ（－）。３例尿 ＲＢＣ位相镜：正形 ＲＢＣ ６８ ０００／ｍｌ，２５ ０００／ｍｌ，６１２ ５００／ｍｌ；畸形ＲＢＣ ５５ ８００／ｍｌ，１９ ５００／ｍｌ，５４５０００／ｍｌ，畸形／正形比：８０％，７８％，８９％。尿蛋白圆盘电泳均为中、大分子蛋白尿。ＡＮＡ（－），ｄｓ－ＤＮＡ…     

支撑喉镜联合鼻内镜系统声带良性病变手术治疗临床疗效观察

目的 探讨分析支撑喉镜联合鼻内镜系统声带良性病变手术治疗临床疗效.方法 共对60例声带良性病交患者进行手术后疗效分析,手术治疗60例患者中,声带息肉25例(双侧5例,单侧15例),声带小结18(均为双侧)例,Reinker水肿17例(均为双侧).结果 术后随诊1～2年,其中52例治愈,7例好转(Reinker水肿5例,声带小结1例,声带息肉1例),1例复发(声带息肉).讨论 支撑喉镜联合鼻内镜系统下行声带手术具有术野明亮而清晰,立体感强,极易发现喉内微小病变,切除病变准确彻底而不伤正常组织,术后功能恢复好,有利于科研与教学等优点.     

粪菌移植在医学生群体中的认识情况及接受程度调查

  目的  通过调查不同年级医学生对粪菌移植(fecal microbiota transplantation, FMT)的认知情况及接受程度,为该治疗手段的临床应用及未来发展提供启发。  方法  以电子问卷形式对北京协和医学院-清华大学医学部临床医学八年制2014—2021级医学生群体展开调查。按照学生所在年级分为临床组(2014—2016级)、过渡组(2017—2018级)和基础组(2019—2021级),通过数据分析及组间比较,探讨不同组别医学生对FMT认知及接受情况。  结果  共发放问卷210份,回收有效问卷205份,有效回收率97.6%。不同年级医学生对FMT认知程度存在显著差异(P＜0.001)。35.6%(73/205)的医学生对FMT完全不了解,其中以基础组比例最高,与临床组和过渡组相比,差异均具有统计学意义(59.7%比10.3%,P＜0.001;59.7%比32.0%,P=0.001)。77.1%(158/205)的医学生同意将FMT用于患者疾病治疗,其中临床组(82.8%)和过渡组(82.7%)较基础组(66.7%)的比例更高,不同意将FMT用于患者疾病治疗的主要顾虑为“循证医学证据尚不足”“担心会感染其他未知疾病”等。78.0%(160/205)的医学生同意将FMT用于自身疾病治疗,临床组、过渡组、基础组的比例分别为77.6%、81.3%、75.0%。此外,83.7%(169/202)的医学生愿意捐赠自己的粪菌以供患者使用。  结论  医学生对FMT的整体认知不足,但随受教育年限的增加,其认知程度不断提高。同时,多数医学生愿意接受FMT作为患者及自身疾病治疗的一种探索性尝试且粪菌捐赠意愿积极,这将有助于推动FMT相关临床研究在国内的开展。未来应重视FMT相关研究在医学生群体中的推广工作,为相应新技术的发展与改进带来更多思考与建议。     

肠道菌群与系统性红斑狼疮

系统性红斑狼疮(systemic lupus erythematosus, SLE)是一种以慢性炎症和多器官损害为特征的自身免疫性疾病, 主要累及育龄期女性, 目前尚无法根治。SLE病因不明, 发病风险与遗传及环境因素相关。近年来研究表明, SLE患者存在肠道菌群组成和功能紊乱, 继而可引起肠道屏障功能破坏、慢性炎症和自身免疫激活, 这可能是SLE发生发展的重要机制。本文对这一领域的相关研究进展予以概述, 探讨菌群干预作为SLE防治新策略的潜在应用价值, 并对未来SLE相关肠道菌群研究的发展方向进行展望。     

鼻内镜下电凝治疗鼻出血

目的探讨鼻内镜下电凝治疗鼻出血的疗效。方法对我科收治的57例反复鼻腔出血患者行鼻内镜检查并采取电凝治疗,对其效果进行回顾性临床分析。结果 57例患者均在鼻内镜下电凝止血治疗,获得成功,术后随访3～6个月未复发。治愈率100%。结论鼻内镱下电凝治疗鼻出血具有定位准确,视野清晰,止血彻底。患者痛苦小,损伤小,并发症少的优点。     

CD4+CD25-Foxp3+T淋巴细胞的表型鉴定及其在初发系统性红斑狼疮中的意义

Objective To compare the phenotypes of abnormal CD4+CD25-Foxp3+ T cells with traditional regulatory T cells (CD4+CD25+Foxp3+) in patients with untreated new-onset lupus (UNoL) and investigate their clinical relevance. Methods The expressions of surface markers (CD25, CD127, CCR4, GITR, CTLA-4) and intracellular marker(Foxp3) on the peripheral blood mononuclear cells from twenty-two UNoL patients were analyzed by flow cytometry analysis, and their clinical relevance were assessed. Results There were no significant differences between CD4+CD25-Foxp3+ and CD4+CD25+Foxp3- T cells in the expressions of GITR, CTLA--4 and CCR4 (P>0.05), but they were significantly lower than those of CD4+CD25+ Foxp3+ T cells in UNoL patients (P<0.01). The percentages of CD127low- in CD4+Foxp3+CD25high,CD4+Foxp3+ CD25low and CD4+Foxp3+CD25+ T cells were (93.8±3.5 )%, (93.7±2.3)% and (92.0±2.1)% respectively (P> 0.05), whereas the expressions of Foxp3 on CD4+CD127low- T subpopulations showed significant differences in CD4+CDI27low-CD25high (91.4±2.6)%, CD4+CD127low-CD25low (71.9±3.3)% and CD4+CD127low-CD25- (9.0± 2.2)% T cells(P<0.01 ). The frequency of CD+CCR4+CD25high T cells correlated negatively with SLEDAI (r=-0.695,P<0.001).and it was significantly lower in lupus nephritis patients(1.10±0.17)%compared with SLE patients without nephritis [(1.61±0.23)%,P<0.01]and healthy controls [(1.75±0.10)%,P<0.01], furthermore,the frequency of CD4+CCR4+CD25low-T cells in lupus nephritis was significantly higher than that in healthy controls[(11.5±2.3)%vs (8.0±1.0)%,P<0.01].Conclusion The increased CD4+CD25-Foxp3+ T cells in the Untreated Newonset Lupus(UNoL)patients mimic activated T effector cells.CD4+CD25high-CD127low-T cells can be used to isolate live CD4+CD25highFoxp3+regulatory T cells.CCR4+regulatory T cells may be involved in the pathogenesis of lupus nephritis.     

CD4+CD25-Foxp3+T淋巴细胞的表型鉴定及其在初发系统性红斑狼疮中的意义

Objective To compare the phenotypes of abnormal CD4+CD25-Foxp3+ T cells with traditional regulatory T cells (CD4+CD25+Foxp3+) in patients with untreated new-onset lupus (UNoL) and investigate their clinical relevance. Methods The expressions of surface markers (CD25, CD127, CCR4, GITR, CTLA-4) and intracellular marker(Foxp3) on the peripheral blood mononuclear cells from twenty-two UNoL patients were analyzed by flow cytometry analysis, and their clinical relevance were assessed. Results There were no significant differences between CD4+CD25-Foxp3+ and CD4+CD25+Foxp3- T cells in the expressions of GITR, CTLA--4 and CCR4 (P>0.05), but they were significantly lower than those of CD4+CD25+ Foxp3+ T cells in UNoL patients (P<0.01). The percentages of CD127low- in CD4+Foxp3+CD25high,CD4+Foxp3+ CD25low and CD4+Foxp3+CD25+ T cells were (93.8±3.5 )%, (93.7±2.3)% and (92.0±2.1)% respectively (P> 0.05), whereas the expressions of Foxp3 on CD4+CD127low- T subpopulations showed significant differences in CD4+CDI27low-CD25high (91.4±2.6)%, CD4+CD127low-CD25low (71.9±3.3)% and CD4+CD127low-CD25- (9.0± 2.2)% T cells(P<0.01 ). The frequency of CD+CCR4+CD25high T cells correlated negatively with SLEDAI (r=-0.695,P<0.001).and it was significantly lower in lupus nephritis patients(1.10±0.17)%compared with SLE patients without nephritis [(1.61±0.23)%,P<0.01]and healthy controls [(1.75±0.10)%,P<0.01], furthermore,the frequency of CD4+CCR4+CD25low-T cells in lupus nephritis was significantly higher than that in healthy controls[(11.5±2.3)%vs (8.0±1.0)%,P<0.01].Conclusion The increased CD4+CD25-Foxp3+ T cells in the Untreated Newonset Lupus(UNoL)patients mimic activated T effector cells.CD4+CD25high-CD127low-T cells can be used to isolate live CD4+CD25highFoxp3+regulatory T cells.CCR4+regulatory T cells may be involved in the pathogenesis of lupus nephritis.     

西南少数民族药食两用植物“茴香菖蒲”不同部位的挥发油成分研究

茴香菖蒲Acorus macrospadiceus是贵州等地少数民族常用的药食两用植物。该文采用水蒸气蒸馏法提取茴香菖蒲叶片和根状茎的挥发油,结合气相色谱-质谱(GC-MS)联用技术分别对其挥发油进行成分分析,经计算机谱库检索(NIST14.0,NIST14.0s)和人工解析,应用峰面积百分比法计算相对含量。结果显示,从茴香菖蒲叶片和根状茎中分别分离出了30和43个色谱峰,分别鉴定出25和36个化合物,鉴定出的化合物的相对含量占各自挥发油总量的97.85%和97.18%。茴香菖蒲叶片和根状茎中挥发油的主要成分均为草蒿脑(estragole),其相对含量占各自挥发油总量的93.56%和71.62%。茴香菖蒲叶片和根状茎挥发油中均含有草蒿脑、β-石竹烯(β-caryophyllene)、茴香烯(trans-anethole)、β-榄香烯(β-elemene)、莰醇(endo-borneol)等14种挥发性成分,其相对含量分别占各自挥发油总量的96.98%和77.47%,但各成分含量在不同部位中的含量存在一定差异,且具有各自独特的挥发油成分。通过对茴香菖蒲不同部位挥发性成分的分析与研究,结合植物资源自身特点发现,其叶片更具有开发利用前景。另外,应注意茴香菖蒲在作为药用时,要与石菖蒲A.tatarinowii加以区分。该文为茴香菖蒲的进一步开发和可持续利用提供了理论参考。