个体化手术治疗遗传性运动感觉神经病引起的柔韧性高弓内翻足

目的评估个体化手术方案对于遗传性运动感觉神经病(HMSN)引起的柔韧性高弓内翻足的临床疗效。方法回顾性分析足踝外科2013年4月至2019年3月收治的HMSN柔韧性高弓内翻足患者共17例(26足)的临床资料,患足均采用个体化的软组织手术(松解、延长、转位)与截骨手术(后足、中足和跖骨的截骨术)治疗。测量所有患足术前与末次随访时跟骨倾斜角(Pitch角)、跟骨第1跖骨角(Hibb′s角)、距骨第1跖骨角(Meary′s角)与跟骨内外翻角(CVA角)的变化情况,评估术前与末次随访的Maryland评分,采用李克特量表评价患者主观满意度。结果术后所有患者切口均Ⅰ期愈合,无并发症发生。所有患者均获得完整随访,随访时间13~26(17.2±3.8)个月。末次随访时患足的Pitch角、Hibb′s角、Meary′s角、CVA均较术前改善,差异有统计学意义(P<0.01);末次随访时Maryland评分较术前[(88.7±8.2)分vs(67.1±7.9)分]改善,差异有统计学意义(P<0.01)。李克特量表评价非常满意10例(58.8%),满意5例(29.4%),一般2例(11.7%),主观满意率88.2%。结论对于HMSN引起的柔韧性高弓内翻足,及早的采用个体化手术治疗大多可获得满意效果。     

儿童医院内呼吸道感染病原菌与药物敏感性分析

目的：了解和分析儿童医院内呼吸道感染的病原菌分布及其耐药状况,为防控医院内感染提供科学依据。方法对396例医院内感染儿童患者送检的上呼吸道标本按常规方法进行微生物培养,并用 K-B 法测定细菌对临床常用抗菌药物的敏感性。结果396例上呼吸道标本中,有225例共分离出微生物234株,阳性分离率为56．8％（225/396）;分离出的234株病原菌中,革兰阴性菌的构成比为72．6％（170/234）,其中以克雷伯菌属的检出率最高,为49．4％（84/170）。革兰阳性菌的构成比为23．5％（55/234）,以葡萄球菌属的检出率较高,为58．2％（32/55）。234株病原菌对9种临床常用的抗菌药物敏感率较高的是亚胺培南,其次是氨基糖苷类。结论对儿童患者有感染症侯的有必要留取上呼吸道标本做细菌学检查和药物敏感性试验。     

基于微信等移动平台对冠心病病人延续性护理效果的Meta分析

目的:通过Meta分析探讨基于微信等移动平台的延续性护理对冠心病病人的护理效果。方法:选取中国知网、万方数据库、维普、中文生物医学期刊数据库等中文数据库进行文献检索,由2名评价员单独对检索的文献质量进行评价。采用RevMan 5.2软件对提取的资料进行Meta分析。结果:共纳入9项随机对照试验(RCT),包含1769例研究对象。3项研究服药依从性的监测指标是连续变量,延续性护理相较于常规护理能有效提高病人的服药依从性[SMD=1.60,95%CI(0.75,2.46),P<0.001];3项研究运动依从性的监测指标是分类资料,Meta分析结果显示延续性护理组与常规护理组在提高病人运动依从性方面差异无统计学意义[RR=2.05,95%CI(0.89,4.73),P=0.09];5项研究护理满意度的监测指标是分类资料,Meta分析结果显示延续性护理组与常规护理组在提高病人满意度方面差异无统计学意义[RR=1.22,95%CI(1.00,1.49),P=0.05]。结论:基于微信等移动平台的延续性护理相较于常规护理可明显提高冠心病病人的服药依从性。但是目前国内此类研究较少,研究质量不高,需要更多全面、深入的RCT研究进行论证。     

肺不张与晚期非小细胞肺癌预后的相关性研究及其机制的初步探讨

目的探讨肺不张与Ⅲ、Ⅳ期不能手术切除的晚期非小细胞肺癌预后的关系。方法回顾性分析122例晚期非小细胞肺癌患者,合并肺不张纳入At(+)组,其余纳入At(-)组。采用Kaplan-Meier法进行生存分析,Log-rank检验比较生存期的差异,多因素Cox比例风险模型进行预后影响因素分析,并记录所有患者初次就诊时的相关实验性检查指标,利用t检验及曼-惠特尼U检验统计两组的差异,研究肺不张与相关实验性检查指标的关系。结果 38.5%的患者初次就诊时合并肺不张。At(+)组的中位数生存时间明显优于At(-)组[17个月(95%CI15.146～18.854)vs.14个月(95%CI12.252～15.748),P=0.01],Ⅲ期患者尤为显著[19个月(95%CI10.946～27.054)vs.16个月(95%CI13.981～18.019),P=0.008],而Ⅳ期患者无显著差异[12个月(95%CI10.760～13.240)vs.11个月(95%CI9.042～12.958),P=0.398]。Ⅲ期合并肺不张的患者血小板计数及神经元特异性烯醇化酶(NSE)水平明显低于无肺不张的患者(P=0.0013,P=0.0397)。多变量Cox回归分析显示肺不张、体力状态(PS)评分、TNM分期是影响晚期非小细胞肺癌预后的独立因素(P=0.041,P=0.005,P=0.000)。结论肺不张是晚期非小细胞肺癌预后的有利因素,肺不张与血小板计数及NSE水平相关。     

Predictors of short-term and long-term memory of sensory and affective dimensions of pain.

The purpose of this investigation was to establish predictors of the dimensions of pain intensity and pain unpleasantness recalled at 1 week and 18 months after an invasive therapeutic procedure, root canal therapy (RCT). Pretreatment measures of mood state and RCT-related expectations of sensory and affective dimensions of pain by using a visual analog scale (VAS) format were obtained. VAS measures of experienced pain intensity and unpleasantness were obtained immediately after treatment. Patients[apos ] memory of their RCT-related pain intensity and unpleasantness was assessed by phone call. Regression analysis showed that after controlling for age, experienced pain intensity predicts 1-week memory of pain intensity (adjusted R(2) [equals].34, P [lt ].01), whereas patients[apos ] pretreatment affective state predicts the memory of pain intensity at 18 months (adjusted R(2) [equals].24, P [lt ].01) and the memory of pain unpleasantness at 1 week (adjusted R(2) [equals].40, P [lt ].01) and 18 months (adjusted R(2) [equals].62, P [lt ].01). These findings point to the contribution of preexisting affective state to the sensory and affective dimensions of pain recollection and illustrate the importance of anxiety management for minimizing patient[apos ]s long-term recollection of the aversiveness of outpatient medical and dental procedures.     

NCF4基因rs4821544T/C多态性与炎症性肠病关联性meta分析

目的研究高加索人群嗜中性粒细胞胞浆因子4(NCF4)基因rs4821544T/C多态性与炎症性肠病的相关性。方法全面检索关于NCF4基因rs4821544T/C多态性与炎症性肠病关联性的病例对照研究,纳入符合条件的研究,并进行数据合并。利用rs4821544T/C不同的遗传模型比值比(OR)及其95%CI作为效应指标进行分析。结果共15个病例对照研究纳入22317例对象,其中克罗恩病患者8155例,溃疡性结肠炎患者3257例,健康对照10905例。Meta分析结果表明,rs4821544T/C多态性与克罗恩病易感性的相关性有统计学意义[CC vs.TT:OR(95%CI)=1.38(1.17~1.51),P=0.000;CC/TC vs.TT:OR(95%CI)=1.11(1.05~1.21),P=0.039;CC vs.TC/TT:OR(95%CI)=1.30(1.13~1.47),P=0.000)]。而rs4821544T/C多态性与溃疡性结肠炎易感性的相关性无统计学意义[CC vs.TT:OR(95%CI)=1.11(0.90~1.36),P=0.296;TC vs.TT:OR=1.04(0.94~1.14),P=0.441;CC/TC vs.TT:OR(95%CI)=1.04(0.95~1.18),P=0.381;CC vs.TC/TT:OR(95%CI)=1.06(0.90~1.24),P=0.429]。结论高加索人群克罗恩病易感性与NCF4基因rs4821544T/C多态性有关,而溃疡性结肠炎与该基因多态性无关。     

术后早期活动对腹部手术病人快速康复影响的Meta分析

[目的]评价术后早期活动对腹部手术病人术后快速康复进程的影响。[方法]利用计算机检索万方、CNKI、维普、PubMed、the Cochrane Library、EMbase、Sciencedirect数据库建库至2018年8月31日发表的有关腹部手术病人术后采取早期活动的随机对照试验、病例对照试验。由2名研究者分别对符合纳入标准的研究进行质量评价和数据提取,采用RevMan 5.3.5对术后结局指标进行Meta分析。[结果]共纳入10项随机对照试验,纳入分析的971例病人中实验组(术后早期活动采取精细化护理流程)485例,对照组(术后早期活动采取传统护理流程)486例。与对照组相比,实验组术后首次排气时间较短[WMD=-13.10,95%CI(-19.88,-6.32),P<0.05],术后首次排便时间较短[WMD=-14.23,95%CI(-22.15,-6.31),P<0.05],术后第1天疼痛评分较低[WMD=-0.41,95%CI(-0.56,-0.26),P<0.05],术后第1天睡眠时间较多[WMD=0.87,95%CI(0.58,1.16),P<0.05],术后第2天睡眠时间较多[WMD=1.08,95%CI(0.85,1.32),P<0.05],术后第3天睡眠时间较多[WMD=0.96,95%CI(0.76,1.16),P<0.05],术后胃肠道不适发生率较低[OR=0.24,95%CI(0.14,0.41),P<0.05]。[结论]现有证据表明,术后早期活动的精细化护理能够有效促进腹部手术病人的胃肠功能恢复,缓解疼痛,改善睡眠质量,促进病人快速康复。     

心理干预及健康教育对冠心病心绞痛病人生活质量影响的系统评价

[目的]系统评价心理干预及健康教育对冠心病心绞痛病人生活质量的疗效,为临床护理提供循证依据。[方法]检索相关数据库,分析软件为RevMan 5.3,对与本研究相关的随机对照试验(RCT)研究中收集的数据进行综合分析。[结果]采用生活质量量表(SF-36)评价病人的生活质量,随机效应模型结果显示,与对照组相比,干预组病人生活质量明显得到改善,社会功能[MD=14.09,95%CI(12.61,15.58),P<0.00001]、睡眠质量[MD=3.35,95%CI(2.71,3.99),P<0.00001]、自我管理[MD=9.97,95%CI(9.05,10.89),P<0.00001]、生理功能[MD=11.11,95%CI(9.17,13.05),P<0.00001];采用西雅图心绞痛调查量表进行评价,随机效应模型结果显示,与对照组相比,干预组病人生活质量得到明显改善,身体活动受限度[MD=7.34,95%CI(6.41,8.26),P<0.00001]、疾病认知度[MD=1.80,95%CI(1.52,2.08),P<0.00001]、心绞痛发作[MD=0.79,95%CI(0.50,1.08),P<0.00001]、心绞痛稳定[MD=0.51,95%CI(0.44,0.57),P<0.00001]、治疗满意度[MD=2.39,95%CI(0.87,3.91),P=0.002]。[结论]在常规治疗护理的基础上对冠心病心绞痛病人给予心理干预及健康教育,可有效改善病人的生活质量,具有良好的临床应用价值。     

Cytochrome-c-oxidase redox changes during visual stimulation measured by near-infrared spectroscopy cannot be explained by a mere cross talk artefact

The detection of redox changes in cytochrome-c-oxidase ([Cyt-ox]) in response to cerebral activation by non-invasive NIRS is hampered by methodological spectroscopic issues related to the modification of the Beer-Lambert law. Also, the question whether a change in the enzyme's redox-state is elicited by functional stimulation is unresolved. In a previous study, we found physiological evidence in favour of an activation-induced increase in oxidation of the enzyme [J. Cereb. Blood Flow Metab. 19 (1999) 592], while in a second study on spectroscopic cross talk, we found that the [Cyt-ox] changes to potentially be an artefact of the spectroscopic approach [J. Biomed. Opt. 7 (2002) 51]. Here, we use two different stimuli which differentially activate areas either rich or poor in [Cyt-ox] content (blob/interblob in visual cortex V1 and pale/thin stripes in V2) to further clarify this apparent discrepancy. In a first experiment, two stimuli were presented in an alternating fashion for 20 s and all stimulation periods were separated by resting periods of 40 s. We observed similar changes in [Cyt-ox] for both stimuli. To become more sensitive to the potentially very small optical changes related to changes in [Cyt-ox], we tried to minimise global haemodynamic and metabolic effects in a second experiment by omitting the resting periods. Our hypothesis was that [Cyt-ox] changes could be fully explained by cross talk as it is predicted from our last study [J. Biomed. Opt. 7 (2002) 51]. However, in more than half of the experiments, we were not able to model the changes in Cyt-ox calculated from measured attenuation spectra as a cross talk artefact. We interpret this finding as an argument in favour of the existence of [Cyt-ox] changes in response to functional stimulation. This finding, however, does not lessen the liability of the [Cyt-ox] changes to cross talk and calls for great caution when [Cyt-ox] changes are derived from NIRS measurements based on the modified Beer-Lambert approach. Further (invasive) validation studies are required.     

盆底超声检查观察二次自然分娩对女性盆底结构的近期影响

目的通过盆底超声检查观察二次自然分娩后产妇近期盆底结构变化。 方法选取从2016年10月至2017年10月在浙江省立同德医院产后42 d复查的二次自然分娩和初次自然分娩产妇各50例。盆底超声检查观察所有产妇膀胱颈活动度（BND）、最大Valsalva状态时膀胱后角、膀胱颈倾斜角、膀胱颈旋转角、肛提肌裂孔面积,以及尿道内口漏斗化、会阴体活动过度、子宫下垂和直肠膨出发生情况。采用组间配对t检验比较初次自然分娩组与二次自然分娩组产妇BND、最大Valsalval状态时膀胱后角、膀胱颈倾斜角、膀胱颈旋转角、肛提肌裂孔面积。采用χ²检验子宫下垂、直肠膨出、尿道内口漏斗化、会阴体活动过度发生率。 结果二次自然分娩组产妇BND、最大Valsalval状态时膀胱后角、膀胱颈倾斜角、膀胱颈旋转角、肛提肌裂孔面积均较初次自然分娩组产妇增大[（29.37±5.32）mm vs （22.63±6.35）mm,（148.8±14.97）^° vs（141.2±15.20）^°,（73.69±16.03）^° vs （69.8±15.25）^°,（44.41±19.27）^° vs（40.0±17.52）^°,（21.47±5.19）cm² vs （19.15±4.10）cm²],且差异均有统计学意义（t=5.761,P<0.001;t=2.519,P=0.001,t=2.476,P=0.001;t=3.123;P=0.001;t=2.481,P<0.001）。二次自然分娩组产妇子宫下垂、尿道内口漏斗化、会阴体活动过度发生率均高于初次自然分娩组产妇[46.0%（23/50）vs 20.0%（10/50）,12.0%（6/50）vs 6.0%（3/50）,20.0%（10/50）vs 6.0%（3/50）],且差异均有统计学意义（χ²=7.644,P=0.006;χ²=3.342,P=0.043;χ²=4.332,P=0.037）,二次自然分娩组与初次自然分娩组产妇直肠膨出发生率差异无统计学意义[4.0%（2/50）vs 2.0%（1/50）,χ²=1.197,P=1.000]。 结论经盆底超声检查发现二次自然分娩对女性盆底近期影响较初产自然分娩明显,同时盆底超声检查可为盆底障碍性疾病筛查和诊断提供可靠依据。     

配对血糖监测方案干预对糖尿病患者疾病自我管理能力的效果评价

目的探讨配对血糖监测方案对糖尿病患者疾病自我管理能力及血糖控制水平的影响。 方法以2017年1月至2018年6月在北京大学第一医院糖尿病共同照护门诊规律就诊（频率为每3个月一次复诊）一年以上的患者为研究对象,进行干预前后分析。分别在患者初诊及随访1年后测定糖化血红蛋白（HbA1c）、身高、体质量,计算体质量指数（BMI）,并使用《糖尿病自我管理行为量表6》评价其自我管理能力。于患者初诊时指导患者居家进行餐前餐后配对血糖监测,并依据监测结果适当调整饮食、运动等活动。于1年诊时,调查患者就诊前1个月平均每周实际配对血糖监测频次。采用Wilcoxon检验比较不同配对监测频次患者在自我管理能力评分各方面（饮食、运动、自我血糖监测、遵医嘱血糖监测、足部护理和用药）的差异。采用t检验比较不同配对监测频次组间BMI及HbA1c的差异。 结果符合入选标准并完成数据收集及量表评估的患者共153例。1年诊就诊前1个月内,平均每周配对血糖监测<1次的患者86例为非配对监测组,配对血糖监测≥1次的患者67例为配对监测组。1年诊时,配对监测组与非配对监测组在饮食［7.00（5.00~7.00）分vs 5.00（3.00~7.00）分］、自我监测血糖［4.50（2.00~7.00）分vs 2.00（0.25~4.00）分］及遵医嘱血糖监测［5.00（2.00~7.00）分vs 2.00（0~3.75）分］方面比较得分均较高,差异均具有统计学意义（Z=-2.663,P=0.008;Z=-3.851,P<0.001;Z=-3.892,P<0.001）;在运动、足部护理及用药方面得分比较,差异均无统计学意义（P均>0.05）。在初诊和1年诊时,非配对监测组和配对监测组BMI和HbA1c方面比较,差异均无统计学意义（P均>0.05）。 结论配对血糖监测方案有助于糖尿病患者依据血糖结果调整饮食,促进健康饮食行为,并提高其血糖监测依从性。     

早期皮损组织液的定量PCR检测在梅毒诊断中的价值分析

目的探讨早期皮损组织液的荧光定量聚合酶链反应(FQ-PCR)检测在梅毒诊断中的价值。方法选择2014年9月至2016年9月该院收治的40例疑似梅毒患者,患者在判断为疑似病例后,于次日清晨抽取5mL静脉血送至免疫实验室,进行甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体抗体ELISA检测;并收集皮损组织液,进行FQ-PCR检测;均采用苄星青霉素治疗3、6个月后再次检测,记录转阴率。结果 ELISA、FQ-PCR总检出率比较,差异无统计学意义[97.50%(39/40)与95.00%(38/40),P0.05];ELISA、FQ-PCR总检出率均明显比TRUST总检出率高,差异有统计学意义[97.50%(39/40)与67.50%(27/40),95.00%(38/40)与67.50%(27/40),P0.05];在治疗后3个月、6个月时,ELISA、FQ-PCR转阴率均明显高于TRUST,差异有统计学意义(P0.05),FQ-PCR转阴率和ELISA比较,差异无统计学意义(P0.05);在FQ-PCR检测结果中,治疗后TP-DNA定量平均值均得到明显降低,Ⅰ期、Ⅱ期和治疗前比较,差异有统计学意义(P0.05)。结论采用早期皮损组织液FQ-PCR可有效测定梅毒螺旋体DNA,有利于梅毒诊断,临床应用价值高。     

Technology evaluation: VEGF165 gene therapy, Valentis Inc

Valentis Inc, formerly GeneMedicine, is developing a vascular endothelial growth factor (VEGF165) non-viral gene therapy using its proprietary PINC polymer for plasmid condensation. Two physician-initiated phase II angioplasty trials are ongoing, one for treating peripheral vascular disease and one for treating coronary artery disease [281714], [347153]. In February 2000, the trials were expected to be completed in the fourth quarter of 2000 [356225]; however, in October 2000, it was reported that the trial for peripheral vascular disease would be completed in the first quarter of 2001 [385232]. In March 2000, Valentis initiated a trial incorporating Valentis's DOTMA-based cationic lipid gene delivery system and the VEGF165 gene with Eurogene's local collar-reservoir delivery device. The trial is designed to demonstrate that the VEGF165 gene, delivered locally to the outside surface of a blood vessel, will transfect and express in the smooth muscle cells of the vessel wall [360683]. In March 1999, Valentis was awarded with a Phase II SBIR grant of $686,260. The aim of grant was to advance the development of non-viral gene therapies for ischemia. Specifically, Valentis intended to select an optimal promoter to be used with the VEGF expression plasmid. Valentis also intended to evaluate the gene therapy system in a rabbit ischemia model and complete the necessary preclinical studies for submission of an IND [318137].     

高仿真模拟教学法对护生自我效能感影响的Meta分析

[目的]评价高仿真模拟教学法对于护生自我效能感的影响。[方法]通过检索the Cochrane Library、PubMed、Web of Science、Science Direct、Nurimedia、万方、中国知网数据库,收集自建库至2019年6月1日发表的关于高仿真模拟教学法(试验组)和传统教学法(对照组)对护生自我效能感影响的随机对照试验研究以及类实验研究,用RevMan 5.3软件对所纳入的文献进行Meta分析。[结果]共纳入相关文献6篇,Meta分析结果显示,试验组护生的自我效能感高于对照组[SMD=0.29,95%CI(0.16,0.42),P<0.0001];亚组分析显示,无论是在亚洲还是欧美,高仿真模拟教学法均可提高护生的自我效能感[亚洲:SMD=0.32,95%CI(0.12,0.52),P<0.001;欧美:SMD=0.27,95%CI(0.09,0.44),P=0.003]。高仿真模拟教学法对护生的学业自我效能感的影响结果差异无统计学意义[SMD=0.09,95%CI(-0.13,0.32),P=0.42],对一般自我效能感的影响结果差异有统计学意义[SMD=0.39,95%CI(0.23,0.55),P<0.00001]。[结论]现有证据表明,高仿真模拟教学法可以提高护生的自我效能感,其中对护生的一般自我效能感影响更加显著。本研究纳入文献较少,未来仍需更多高质量的研究加以证实。     

Technology evaluation: gemtuzumab ozogamicin, Celltech Group

Gemtuzumab ozogamicin (CMA-676) is a cytotoxic drug (calichaemicin) linked to a human monoclonal antibody that targets CD33, and which has been jointly developed and launched by Celltech Group and the Wyeth-Ayerst Research division of American Home Products as a treatment for acute myeloid leukemia (AML). Wyeth-Ayerst submitted an NDA to the US FDA in October 1999 for approval to treat AML patients who have relapsed after initial chemotherapy [346494]. In January 2000, the FDA assigned CMA-676 Priority Review status [351745], and in March 2000, the US FDA's Oncologic Drugs Advisory Committee voted that there was sufficient evidence of improved safety and acceptable efficacy to support accelerated approval for the treatment of AML in patients who have relapsed following initial chemotherapy [360113], [361883]. In May 2000, the FDA gave final approval for CMA-676 for the treatment of patients of 60 years and over in first relapse with CD33+ AML who are not considered candidates for cytotoxic chemotherapy [367212], [367215]. CMA-676 was launched (as Mylotarg) in the US on 1 June 2000 by AHP. An EMAA is in preparation and is expected to be submitted by the end of 2000 [382163]. In September 2000, Merill Lynch predicted sales of 2.9 million Pounds in 2002, rising to 17.9 million Pounds in 2004 [383742], while in January 2000, Lehman Brothers predicted peak sales in excess of US$200 million [360128]. In December 1999, Lehman Brothers predicted peak sales of US$150 million, with Celltech receiving royalties from AHP. Possible first-line therapy could follow depending on further studies, creating a potential market of US$300 million [352078].     

导管加温后纤维支气管镜引导经鼻建立人工气道的临床应用

目的 探讨气管插管导管加温软化后再经纤维支气管镜(纤支镜)引导经鼻建立人工气道行机械通气支持的优越性和安全性.方法 209例接受纤支镜引导经鼻置管行机械通气支持治疗的患者被随机分为加温组(105例,置管前先将导管加温到52 ℃)和常规组(104例,置管前导管温度23～26 ℃),导管由纤支镜引导经鼻建立人工气道.加温组置管前不应用麻黄素喷鼻.结果 ①导管加温组首次置管成功者所需时间[(14.48±8.31)s,99例]明显短于常规组[(23.85±11.97)s,96例,P＜0.01).②加温组清醒状态下患者的首次置管成功率为100.0%(28/28例),显著高于常规组(87.5%,21/24例,P＜0.05).③加温组首次置管成功者30 s内置管成功率为93.9%(93/99例),明显高于常规组(68.6%,66/96例,P＜0.01).④加温组首次置管成功者中导管向气管内推送困难的发生率为5.05%(5/99例),常规组为32.29%(31/96例),两者比较差异有显著性(P＜0.01).⑤加温组首次置管成功者中鼻出血发生率为4.0%(4/99例),明显低于常规组(15.6%,15/96例),差异有显著性(P＜0.01).⑥加温组清醒状态下首次置管成功者的鼻出血发生率为3.6%(1/28例),常规组为28.6%(6/21例),两者比较差异有显著性(P＜0.05).结论 导管加温后纤支镜引导经鼻建立人工气道,在置管前鼻腔黏膜表面无需使用缩血管药物,插管前准备时间缩短,避免了药物引发的心血管反应;提高了清醒状态下患者对插管操作的依从性和置管成功率.     

心率变异性和NT-proBNP对慢性心力衰竭患者病情评估及预后的临床应用价值

目的探讨心率变异性（HRV）和血浆N末端脑钠肽前体（NT-proBNP）水平对慢性心力衰竭（CHF）患者病情评估及预后的临床应用价值。 方法选取2016年9月至2017年12月在六安市第二人民医院住院的177例CHF患者为研究对象。根据患者心功能分级,将其分为心功能Ⅱ~Ⅲ级组和心功能Ⅳ级组：心功能Ⅱ~Ⅲ级组包括心功能Ⅱ级患者28例,心功能Ⅲ级患者63例,共91例;心功能Ⅳ级组均为心功能Ⅳ级患者,共86例。对两组患者性别、伴发疾病情况的比较采用χ²检验;对两组患者年龄、血浆NT-proBNP水平,以及HRV时域指标SDNN、RMSSD、PNN50和三角指数的比较采用独立样本t检验。 结果心功能Ⅱ~Ⅲ级组CHF患者血浆NT-proBNP水平显著低于心功能Ⅳ级组,差异有统计学意义［（1545.2±147.5）ng/L vs（4012.6±983.2）ng/L,t=49.510,P<0.001］;心功能Ⅱ~Ⅲ级组CHF患者HRV时域指标SDNN、RMSSD、PNN50和三角指数均显著高于心功能Ⅳ级组患者,差异有统计学意义［（95.56±15.16）ms vs（68.74±12.58）ms,t=15.294,P<0.001;（19.04±7.62）ms vs（15.23±5.29）ms,t=9.275,P=0.001;（5.59±2.23）% vs（4.48±2.65）%,t=5.601,P=0.002;（13.22±6.82）vs（10.69±4.53）,t=2.748,P=0.011］。心功能Ⅱ~Ⅲ级组房性心律失常、心血管事件、房性心律失常伴心血管事件的发生率均明显低于心功能Ⅳ级组,差异有统计学意义［27例（29.7%）vs 40例（46.5%）,χ²=15.130,P<0.001;9例（9.9%）vs 14例（16.3%）,χ²=11.577,P<0.001;4例（4.4%）vs 8例（9.3%）,χ²=10.836,P=0.001］。 结论血NT-proBNP水平和HRV各项时域指标均对CHF患者诊断、治疗及预后具有重要临床应用价值。     

B族链球菌四种筛查方法的比较

目的评估B族链球菌肉汤增菌培养法(Todd-Hewitt型,T-H)、直接培养法、液体显色培养法及核酸环介导恒温扩增法(LAMP)在孕晚期妇女筛查中的临床应用。方法回顾性研究。采集2016年10月至2018年4月在广州医科大学附属广州市妇女儿童医疗中心产科门诊产检妊娠35~37周孕妇直肠阴道分泌物标本969份,采用双盲法,以T-H肉汤增菌培养法为参考方法,分3个研究阶段先后比较直接培养法、液体显色培养法及LAMP法的检验性能。以敏感度、特异度、符合率、阳性预测值、阴性预测值及尤登指数为评价指标,一致性用Kappa检验。结果增菌培养法共检测标本969份,阳性90份(9.3%)。以增菌培养法为参考,敏感度从高到低依次为LAMP法[100%(25/25)]、直接培养法[81.5%(22/27),95%CI:65.8%~97.1%]、液体显色培养法[71.1%(27/38),95%CI:55.9%~86.2%];特异度则依次为直接培养法[100%(282/282)]、液体显色培养法[98.1%(455/464),95%CI:96.8%~99.3%]、LAMP法[94.0%(125/133),95%CI:89.9%~98.1%];符合率依次为直接培养法[98.4%(22+282)/309]、液体显色培养法[96.0%(27+455)/502]、LAMP法[94.9%(25+125)/158]。而直接培养法(0.889)、LAMP法(0.832)与增菌培养法的一致性Kappa值均≥0.75,液体显色培养法则为0.708。直接培养法有18.5%(5/27)的漏检率,LAMP法漏检率为零、假阳性率为6.0%(8/133),液体显色培养法的漏检率、假阳性率分别为28.9%(11/38)、1.9%(9/464)。结论本研究所比较的几种GBS筛查方法中,仅LAMP法与增菌培养法在敏感度、特异度及符合率上均具较好的一致性,而其他两种方法存在一定的漏检。临床实验室可根据实际条件、技术力量选择使用,或参照欧美指南推荐的孕晚期增菌培养筛查与产时核酸检测相结合,以最大程度满足临床需求。     

Technology evaluation: DISC

Cantab is developing its DISC technology as a potential gene therapy product for cancer (DISC-Onc) and neurological and blood disorders (DISC-GT). Clinical trials are expected to commence in early 1999 [296831]. The DISC technology utilizes a herpes virus that has had a gene removed to prevent it from replicating [250526]. Phase I trials in leukemia were scheduled to commence in 1998 [250526], however, it was decided that although DISC-Onc is capable of carrying genes into leukemic cells, the levels of immunomodulator genes did not meet the target initially set for the commencement of trials. Hence, Cantab turned its attention to other cancers, and hoped to identify an alternative target for phase I trials in the first half of 1998 [279798]. Additional preclinical work using a murine version of the lead construct produced a significant therapeutic effect in animal tumor models [289716]. DISC-Onc is envisaged to deliver immunogenic genes such as cytokine or stimulatory protein genes [275129]. Cantab, in collaboration with Nottingham Trent University and Birmingham University, has shown that the DISC-Onc has delivered genes effectively to human colorectal, gastric and ovarian cancer tumors. Transfection rates have been shown to be favorable and have been proven to be at least as good as, if not better than, other vectors [279798]. Also, DISC-Onc carrying a functional GM-CSF, has antitumor activity in mouse models of renal cancer and leukemia [250526], [261768]. The DISC Neurology technology (DISC-GT), for gene therapy of neurological disease, is being developed in collaboration with Cambridge University, and enables HSV-driven long-term gene expression in nerve cells [279798].     

Is normal pregnancy atherogenic?

Serum cholesterol, triacylglycerols and low-density lipoprotein (LDL) subfractions were determined in 120 primagravid women during normal gestation (40 in each trimester) and in 20 non-pregnant age-matched controls. LDL subfractions were determined by PAGE, and an LDL score was calculated. The higher the score, the smaller the subfractions. The objective of the study was to determine the effects of the hyperlipidaemia, high oestrogen concentrations and insulin resistance known to exist in normal pregnancy on LDL subfraction formation. Pregnant women had an increased mean serum cholesterol concentration [5.78 (S.D. 1.09) mmol/l] in the first trimester compared with the non-pregnant controls [5.11 (0.77) mmol/l; P<0.01]. The serum cholesterol concentration increased progressively throughout gestation to a mean of 8.14 (1.39) mmol/l in the third trimester (P<0.001 compared with the second trimester). Triacylglycerol concentrations in the first trimester were similar to those of controls, and there was a non-significant increase by the second trimester to 1.32 (0.44) mmol/l. However, by the third trimester the mean triacylglycerol concentration had doubled [2.58 (0.98) mmol/l; P<0.001 compared with the first and second trimester]. During gestation the LDL score increased dramatically, from 1.17 (0.39) during the first trimester to 2.01 (0.37) in the second trimester (P<0.001) to 2.73 (0.48) in the third trimester (P<0.001 compared with the second trimester). Thus an atherogenic lipid profile develops during normal gestation. The significance of these changes remains unclear, but thay may have important implications for mother and foetus.