四川省三州地区卫生人力资源配置与公平性评价分析

目的:了解2011-2017年四川省三州地区卫生人力资源配置现状,为三州地区卫生人力资源的合理配置提供参考。方法:利用千人卫生人力资源拥有量指标、基尼系数和卫生人力资源密度指数(HRDI)分析卫生人力资源配置现状及其公平性。结果:三州地区千人卫生人力资源拥有量呈增长趋势;基尼系数大多超过0.4,仅护士按人口分布的基尼系数较小;卫生人力资源密度指数较小,需要量、缺乏量及缺乏比例均较大。结论:三州地区卫生人力得到一定程度改善;但配置公平性较差,尤其按地理、经济分布很不均衡;医护人员短缺,需要重点投入。     

Reduction of silver complexes: towards an ever more elaborated insight in the influence of the type of ligand on the reaction rate

The present work deals with the investigation of the electrochemical reduction of silver thiosulphate (1,2-Ag(S₂O₃)₂^3?), thiocyanate (1,3-Ag(SCN)₃^2?) and 1,8-dihydroxy-3,6-dithiaoctane (1,2-Ag(DTO)₂⁺) complexes. The influence of the ligand type on the charge transfer rate is explained by the changing positions of the density distributions of electronic energy levels of the three complexes. The basics for this approach are the theories of energy band models (EBMs). An experimental methodology is developed to determine the energy density distributions. A Ti/TiO₂ substrate, obtained by galvanostatically anodising Ti, is put forward as an appropriate substrate for this investigation, and its semiconducting properties are determined. On this substrate, charge transfer (CT) controlled currents can be measured in a sufficiently large potential domain for the three systems. A method of pre-plating is optimised such that the overall semiconducting character of the substrate is kept during the monitoring of the (quasi-)stationary current/voltage diagrams. The active surface areas, necessary for the calculation of the current density/potential curves, are calculated. The positions of the energy density distributions, obtained by the derivation of the current density/voltage diagrams, of the three complexes, show that thiosulphate exhibits the smallest density of accepting energy levels in the given potential domain. For potentials above 0.5 V vs. SCE, the DTO complex has the largest density of vacant energy levels, but for lower potentials the situation is reversed.     

Changes in bone mineral density following laparoscopic sleeve gastrectomy: 2-year outcomes

BackgroundEmerging evidence suggests that sleeve gastrectomy (SG) leads to significant bone mineral density (BMD) losses, but there is a paucity of studies evaluating skeletal consequences beyond 12-months post-operatively.ObjectivesTo evaluate BMD changes 2 years postoperatively.SettingA university hospital.MethodsThirty-three women (mean age: 34.4 ± 12.3 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at baseline and at 3 (M3), 6 (M6), 12 (M12), and 24 (M24) months postoperatively. Data collected included BMD at the total hip, femoral neck, and lumbar spine measured by dual-energy x-ray absorptiometry and anthropometrics, biochemical, nutritional, and physical activity parameters.ResultsAt M24, patients achieved a mean body mass index and excess weight loss of 32.4 ± 5.1 kg/m² and 64.5 ± 21.4%, respectively; however, weight stabilized at M12. Femoral neck BMD decreased significantly from baseline to M24 (.924 ± .124 versus .870 ± .129 g/cm², P < .001), with no change between M12 and M24 (P = .273). Total hip BMD decreased significantly from baseline to M24 (1.004 ± .105 versus .965 ± .132 g/cm², P < .001) but increased between M12 and M24 (P = .001). No significant changes were noted in lumbar spine BMD. The percentage of changes in the femoral neck and the total hip BMD from baseline to M24 positively correlated with postoperative excess weight loss (r = .352, P = .045, and r = .416, P = .018, respectively).ConclusionDespite notable weight loss, women who underwent SG experienced significant bone loss at the total hip and femoral neck more than 2 years postoperatively. Future studies should investigate intervention strategies to attenuate skeletal deterioration after SG.     

血管内皮生长因子C和微淋巴管密度与胆管癌淋巴结转移及预后的关系

目的:探讨胆管癌组织中血管内皮生长因子C(VEGF-C)的表达及微淋巴管密度(MLVD)与胆管癌临床病理特征及预后的关系。方法:应用免疫组化法分别检测47例胆管癌、40例近癌的非癌胆管及15例正常肝外胆管组织中VEGF-C的表达和D2-40标记的MLVD。分析两者间的相关性,及其与临床病理特征和预后的关系。结果:胆管癌组织中VEGF-C的阳性表达率明显高于近癌的非癌胆管和正常胆管组织(均P<0.05),胆管癌和近癌的非癌胆管组织中MLVD明显高于正常胆管组织(均P<0.05);VEGF-C的表达以及MLVD与胆管癌浸润深度、TNM分期、淋巴结转移密切相关(P<0.05),且MLVD还与胆管癌分化程度有关(P<0.05);VEGF-C阳性胆管癌组织MLVD明显大于其阴性胆管癌组织(P<0.05),且VEFG-C表达与MLVD呈正相关(r=0.615,P<0.05);VEFG-C阴性表达患者预后明显优于其阳性表达患者,复发者胆管癌组织中的MLVD明显高于无复发者(P<0.05),且MLVD与患者生存期呈负相关(r=-0.542,P<0.05)。结论:VEGF-C的表达和MLVD与管癌淋巴结转移、预后密切相关,VEGF-C可能是预测胆管癌淋巴结转移的有效指标之一。     

Bisphosphonates and glucocorticoid osteoporosis in men: results of a randomized controlled trial comparing zoledronic acid with risedronate

Background

We studied 265 men (mean age 56.4 years; range 18-83 years), among patients enrolled in two arms of a double-blind, 1-year study comparing the effects of zoledronic acid (ZOL) with risedronate (RIS) in patients either commencing (prednisolone 7.5 mg/day or equivalent) (prevention arm, n = 88) or continuing glucocorticoid therapy (treatment arm, n = 177).

Methods

Patients received either a single ZOL 5 mg infusion or RIS 5 mg oral daily at randomization, along with calcium (1000 mg) and vitamin D (400-1200 IU). Primary endpoint: difference in percentage change from baseline in bone mineral density (BMD) at the lumbar spine (LS) at 12 months. Secondary endpoints: percentage changes in BMD at total hip (TH) and femoral neck (FN), relative changes in bone turnover markers (β-CTx and P1NP), and overall safety.

Findings

In the treatment subpopulation, ZOL increased LS BMD by 4.7% vs. 3.3% for RIS and at TH the percentage changes were 1.8% vs. 0.2%, respectively. In the prevention subpopulation, bone loss was prevented by both treatments. At LS the percentage changes were 2.5% vs. − 0.2% for ZOL vs. RIS and at TH the percentage changes were 1.1% vs. − 0.4%, respectively. ZOL significantly increased lumbar spine BMD more than RIS at Month 12 in both the prevention population (p = 0.0024) and the treatment subpopulation (p = 0.0232) in men. In the treatment subpopulation, ZOL demonstrated a significantly greater reduction in serum β-CTx and P1NP relative to RIS at all time-points. In the prevention subpopulation, ZOL significantly reduced β-CTx? at all time-points, and P1NP at Month 3 (p = 0.0297) only. Both treatments were well tolerated in men, albeit with a higher incidence of influenza-like illness and pyrexia events post-infusion with ZOL.

Interpretation

Once-yearly ZOL preserves or increases BMD within 1 year to a greater extent than daily RIS in men receiving glucocorticoid therapy.     

抗菌药物使用强度影响因子的概念及应用

目的：首次提出了抗菌药物强度影响因子（DIF）的概念,并将其应用于临床抗菌药物使用强度控制管理。方法：通过对临床科室抗菌药物使用频度（DDDs）和同期收治患者人天数（PDi）的数学分析,引入抗菌药物强度影响因子的概念,模拟计算各临床科室对全院抗菌药物使用强度影响因子的大小,并将其作为指标替代原有的药物固定分配方法。结果与结论：抗菌药物强度影响因子代表临床科室对全院抗菌药物使用强度的贡献,数值越高贡献越大。结果还表明,抗菌药物强度影响因子更能够公平地反映各临床科室的抗菌药物使用情况,方便医疗管理人员利用该因子对全院各科室抗菌药物使用情况进行指标管理。     

Vitamin D Status and Bone Mineral Density in Obese Children with Nonalcoholic Fatty Liver Disease

Whether nonalcoholic fatty liver disease (NAFLD) is related to vitamin D and bone health in obese children is unknown. The aim of this study was to evaluate vitamin D status and bone mineral density (BMD) in obese children according to their condition within the NAFLD spectrum. Anthropometric data, laboratory tests, and abdominal ultrasonography were obtained from 94 obese children. The subjects were divided into three groups according to NAFLD spectrum: normal liver, simple steatosis, and nonalcoholic steatohepatitis (NASH). Although there were no differences in vitamin D levels between the three groups, these groups showed significant differences in highly sensitive C-reactive protein (P=0.044), homeostasis model assessment of insulin resistance (HOMA-IR) (P=0.02), hepatic fibrosis scores (P<0.05), and trunk fat percentage (P=0.025). Although there were significant differences in BMDs, the age-matched BMD z-scores were not significantly different between the three groups. Serum vitamin D levels were negatively correlated with age (r=-0.368, P=0.023), serum uric acid levels (r=-0.371, P=0.022), fibrosis 4 (FIB4) (r=-0.406, P=0.011), and HOMA-IR (r=-0.530, P=0.001) in obese children with NASH. Multiple regression analysis for vitamin D in the NASH group revealed age and HOMA-IR as significant factors. In conclusion, inflammatory markers, hepatic fibrosis scores, trunk fat, and insulin resistance may reflect the spectrum of NAFLD in obese children, whereas vitamin D levels and BMD may not. In patients with NASH, however, low serum vitamin D is associated with hepatic fibrosis and insulin resistance, but not with bone health status.     

抗凋亡多肽Gly14-Humanin对动脉粥样硬化模型小鼠血小板高敏感性以及脂质斑块形成的作用

目的抗凋亡多肽Humanin可以延缓动脉粥样硬化脂质斑块形成,其机制可能是抑制氧化型低密度脂蛋白诱导的氧化性应激和内皮细胞凋亡,但Humanin对动脉粥样硬化状态下血小板高敏感性的影响尚无报道。本研究评价了Humanin衍生物([Gly14]-Humanin,HNG)对低密度脂蛋白受体(LDLR)敲除小鼠动脉粥样硬化形成以及血小板高敏感性的影响。方法将8周龄雄性野生型(wild type,WT)和低密度脂蛋白受体敲除小鼠进行实验分组,包括对照组(WT小鼠喂食普通饲料,CD组)、模型组(LDLR-/-小鼠喂食高脂饲料,HFD组)、实验组(LDLR-/-小鼠喂食高脂饲料的同时注射HNG,HFD+HNG组)。分别于4周、12周、24周,进行下腔静脉取血,分离洗涤血小板,进行血小板聚集实验并分离血清进行血脂含量的测量。适时分离主动脉进行苏丹IV染色,观察主动脉内表面粥样脂质斑块形成,利用Image-Pro Plus图像处理软件分析斑块面积大小。结果与对照组相比,喂食高脂饲料24周后,模型组小鼠主动脉内有大量粥样斑块形成,并且随着喂食高脂时间的延长,具有明显的脂蛋白水平的变化。模型组小鼠血小板在二磷酸腺苷(adenosine diphosphate,ADP)诱导下的聚集作用显著增强(P0.01),更重要的是,HFD+HNG组小鼠的斑块面积明显减小(P0.01),且血小板对ADP所诱导的血小板聚集明显低于HFD组(P0.01)。结论 HNG抑制动脉粥样硬化模型小鼠血小板高敏感性,可能是减缓动脉粥样硬化脂质斑块形成的机制之一。