糖尿病足溃疡复发因素及预防策略的研究进展

综述糖尿病足溃疡复发的影响因素包括足底压力、周围神经病变、周围血管病变、足部外伤、血糖控制不佳及其他(吸烟、日常活动负重、C-反应蛋白水平升高),预防复发的措施包括识别和筛查高危因素、卸载足部压力、选择合适的治疗鞋和鞋垫、手术卸载、自我护理、健康教育、信息化管理、依从性管理等,提出采取多种预防措施的综合性护理干预有助于减少糖尿病足溃疡的复发率。     

颅骨缺损修复材料的研究现状

对临床常用的颅骨缺损修复材料性能进行综合比较,树脂-羟磷灰石复合材料(颅颌优)由于其优良的理化、生物学性能、可随意塑型及CAD/CAM技术的导入,是目前相比较而言能够满足临床颅骨缺损修复需要的材料。     

基于CiteSpace的中医药防治脂肪肝病相关文献的可视化分析*

目的 借助CiteSpace软件对我国近20年中医药防治脂肪肝病的研究进行可视化分析。方法 检索2000年1月1日至2021年7月20日收录于中国知网、维普、万方的有关于中医药防治脂肪肝病相关文献,对年发文量、期刊来源、作者、关键词、研究机构进行可视化分析。结果 （1）总计检索文献1 427篇,最终纳入文献1 408篇。（2）发文量处于小幅度的波动,说明目前处于稳定发展。（3）期刊来源前3的期刊为广州中医药大学学报、光明中医和北京中医药大学学报。（4）发文量大于10篇的有10位作者,通过可视化分析（N=526,E=432）,说明有432个合作关系路径,进一步说明作者之间合作密切;结合单位可视化分析可知（N=491,E=0）,作者之间的合作多在同一个单位,缺乏跨地域合作。（5）文献共现关键词的结果展现了中医药防治脂肪肝病的研究方向,包括临床、实验以及研究进展3方面,而有效关键词聚类进一步展示中医药防治脂肪肝病研究的热点有临床观察、脂联素、决明子、临床研究、TNF-α、辨证论治、临床疗效。（6）关键词突显显示,非酒精性脂肪肝病与中医证型、数据挖掘、2型糖尿病、代谢组学以及肠道菌群的相关性是目前的热点。（7）高被引文献显示,2017年临床肝胆病杂志《非酒精性脂肪性肝病中医诊疗专家共识意见(2017)》、2005中西医结合肝病杂志《脂肪肝中医证型分类的文献分析》以及世界中医药《中医药治疗非酒精性脂肪性肝病的优势与展望》为中医药防治脂肪肝病的研究奠定了基础。结论 中医药防治脂肪肝病的文献主要涉及临床观察、实验研究和综述,近些年研究热点主要在辨证论治、数据挖掘用药规律、中医证型与代谢组学以及肠道菌群关联性,既总结了中医的临床经验,又通过相关指标客观化,为中医药防治脂肪肝病提供了研究基础和防治思路。     

A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

Purpose

A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them.

Materials and methods

Patients who had undergone total hip and knee arthroplasty surgery because of hip and knee disease were included. The exclusion criteria were patients who were treated with immunosuppressor two weeks pre-operatively, skin conditions around the patch testing site, and other uncontrollable factors. Each patient agreed to patch testing for three days before surgery. Photographic images before patch testing, two and three days after patch testing were obtained to evaluate the final incidence of metal allergy. The patch tests contained 12 metal elements; chromium, cobalt, nickel, molybdenum, titanium, aluminium, vanadium, iron, manganese, tin, zirconium, and copper. Two independent observers evaluated the images. The results were divided into a non-metal allergy group and a metal allergy group. Pre-operative and postoperative VAS score, lymphocyte transforming test, and X-rays were collected to detect the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty.

Results

There were 96 patients who underwent pre-operative patch testing. The overall metal allergy rate was 51.1 % (49/96) in our study. Nickel, cobalt, manganese, and tin were the most common allergic metal elements in our study. Nine inappropriate cases were excluded, and 87 patients were finally included in our study. There were 36 metal allergy and 26 non-metal allergy patients in the THA group, while 11 metal allergy and 14 non-metal allergy patients were found in the TKA group. We found no relationship existed between metal allergy and post-surgery pain in total hip and knee arthroplasty.

Conclusion

Pain caused by metal allergy usually presents as persistent and recurrent pain. The white cell count, C-reactive protein, erythrocyte sedimentation rate and postoperative radiographs were not affected. Currently, patch testing and lymphocyte transforming tests are used for metal allergy diagnosis. We deemed that a relationship between post-surgery pain and metal allergy in total hip and knee patients may exist to some extent. Larger samples and longer follow-up time are essential for further study.     

中医药治疗围绝经期综合征的临床研究进展

围绝经期综合征影响女性的工作及生活.本文通过查阅近年来临床治疗围绝经期的相关文献,从病因病机、中药治疗、针灸治疗等方面对调理冲任、平衡阴阳、有效控制病情等中医药的治疗优势进行了归纳.     

新型冠状病毒肺炎患者焦虑抑郁及影响因素调查

目的了解新型冠状病毒肺炎患者的焦虑抑郁状况及其影响因素,为采取针对性心理护理干预提供参考。方法采用焦虑自评量表及抑郁自评量表,对148例新型冠状病毒肺炎患者进行调查。结果焦虑发生率为21.63%,抑郁发生率为50.00%;多元线性回归分析显示:有无胸闷/心慌的感觉、与世隔绝的感觉、容易激动/感到烦恼、担心家人病情/被传染、担心能否治愈是新型冠状病毒肺炎患者发生焦虑的影响因素(P0.05,P0.01)。睡眠、与世隔绝的感觉、担心家人病情/被传染、担心能否治愈是患者发生抑郁的影响因素(均P0.01)。结论新型冠状病毒肺炎患者存在一定的焦虑与抑郁,临床应启动针对性心理护理干预,缓解患者焦虑、抑郁情绪。     

Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy

Breast Cancer Research and Treatment - Studies that report equivalent oncologic outcomes of sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) for T1-2N1mi breast...     

清热解毒化浊片对肠源性内毒素血症大鼠肝肺促炎因子IL-8及抗炎因子IL-10的影响*

目的〓探讨清热解毒化浊片对肠源性内毒素血症（IETM）大鼠肝肺促炎因子IL-8及抗炎因子IL-10的影响。方法〓采用高脂、糖、酒精复合因素干预12周建立IETM肝肺损伤大鼠模型。造模成功后,随机分为清热解毒化浊片组、模型组和正常组3组。经治疗4周后观察肝、肺组织病理学改变,采用全自动生化仪检测血清谷氨酰氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷氨酰氨基转移酶（GGT）、碱性磷酸酶（ALP）活性,动态浊度法检测血浆内毒素（LPS）,免疫组化二步法测定IL-8、IL-10在肝肺组织中的表达。结果〓光镜下观察,清热解毒化浊片组大鼠肝、肺组织炎性浸润情况明显改善。与正常组比较,模型组血清ALT、AST、GGT、ALP明显升高（P<0.01,P<0.05）,血浆LPS明显升高（P<0.01）;肝、肺组织IL-8表达明显升高（P<0.01）。与模型组比较,清热解毒化浊片组血清ALT、AST、GGT、ALP均明显降低（P<0.01,P<0.05）,血浆LPS明显降低（P<0.01）;肝、肺组织IL-8明显降低（P<0.01）,肝、肺组织IL-10明显升高（P<0.01）。结论〓本实验表明清热解毒化浊片可通过降低血浆LPS,促进抗炎因子IL-10的表达,降低炎性因子IL-8的表达,改善IETM所致的肝、肺损伤。     

c-myc在间变性大细胞淋巴瘤中的表达及其意义

目的 探讨c-myc在系统性间变性大细胞淋巴瘤(ALCL)中蛋白表达和基因异常与临床病理特征、免疫组织分型的关系.方法 选取ALCL患者87例,应用免疫组织化学EnVision法检测c-mvc、间变性淋巴瘤激酶(ALK)、CD3、CD10、CD20、CD30、EMA的蛋白表达情况;应用荧光原位杂交(FISH)技术检测c-myc和ALK基因异常情况;统计分析c-myc蛋白表达和基因异常与各临床病理参数间的关系.结果 免疫组织化学结果:87例ALCL中,ALK阳性者54例(62.1％),c-myc阳性者27例(31.0％),c-myc和ALK蛋白联合表达20例(23.0％).c-myc蛋白表达率、c-myc和ALK蛋白联合表达率随ALCL临床分期的增加而升高,且在国际预后指数(IPI)高危组中表达率高于低危组(P＜0.05).FISH检测结果:87例ALCL中,50例(57.5％)发现ALK基因的易位,19例(21.8％)发现ALK基因的多拷贝.所有患者均未发现c-myc基因的易位,但19例(21.8％)检测到c-myc基因的多拷贝.c-myc基因多拷贝的发生率在ALK蛋白阳性和阴性组中差异无统计学意义(P＞0.05),在c-myc蛋白阳性和阴性组中发生率差异有统计学意义(P＜0.05),在IPI高危组中发生率高于低危组(P＜0.05).结论 c-myc蛋白表达及基因异常与ALCL临床分期、IPI相关,可作为判断ALCL恶性程度和预测预后的指标.