Pentacam眼前节测量分析系统与IOLMaster测量老年人前房深度及角膜曲率半径的比较和一致性分析

目的分别利用Pentacam眼前节测量分析系统和IOLMaster光学相干生物测量仪测量老年人的角膜曲率半径（Coreneal Radii,R1andR2）和前房深度（anterior chamber depth,ACD）,比较两种方法的测量结果的差异并做一致性评价。方法48例（90只眼）,年龄60～84岁,平均年龄（68．2±7．7）岁,应用Pentacam和IOLMaster分别测量前房深度和角膜曲率半径。应用统计学软件MedCalc（版本11．5．1．0）对测量结果进行分析。分别对Pentacam与IOLMaster测量到的ACD,R1和R2值进行配对t检验,相关性分析以及Bland—Altman一致性分析。结果Pentacam测得的ACD值为（2．69士O．16）Inm,IOLMaster测得的ACD值为（2．644-0．15）Into,差异有统计学意义（t=4．89,P=0．0001oPentacam测得的R1值为（7．81±0．19）inm,IOLMaster测得的R1值为（7．794-0．16）mill,差异有统计学意义（t=-3．20,P=0．0019oPemacam测得的R2值为（7．61±0．14）mill,IOLMaster测得的R2值为（7．60±0．13）mm,差异无统计学意义（r=2．01,P=0．0510）.Pentacam与IOLMaster测量得的ACD,R1,R2值均呈现正相关。Pentacam和IOLMaster测得的ACD,R1,R2值经Bland-Altman分析具有良好的一致性。结论在老年人中Pemacam和IOLMaster在角膜曲率半径和前房深度的测量上有着良好的一致性,可在临床应用中灵活应用,综合分析。     

三导联心电图与脉搏血氧仪测量新生儿出生后早期心率结果比较

［摘要］　目的　比较三导联心电图(ECG)与脉搏血氧仪(PO)测量新生儿出生后早期心率的差异。方法　选择2019年5月至2021年5月于江苏大学附属医院出生的新生儿86例,男54例,女32例。胎龄(35.44±3.75)周,出生体重(2 497.97±1 004.98)g。其中,极低出生体重儿26例。所有新生儿出生后同时放置三导联ECG和PO,比较三导联ECG和PO的放置耗时、获得稳定心率耗时、检测总耗时以及早期获得稳定心率的比例。观察新生儿在出生后的前10 min内,两种方式测得心率的变化及差异。结果　三导联ECG放置耗时长于PO,获得稳定心率耗时、测量心率总耗时均短于PO,差异有统计学意义（P<0.05）。对于极低出生体重儿,三导联ECG放置耗时长于PO,获得稳定心率耗时短于PO,差异有统计学意义（P<0.05）,但两者在测量心率总耗时方面比较差异无统计学意义（P>0.05）。在前30 s内,新生儿经三导联ECG和PO获得稳定心率的比例分别为79.07%（68/86）和62.79%（54/86）,差异有统计学意义（P=0.000）。对于极低出生体重儿,前30 s内经三导联ECG和PO获得稳定心率的比例分别为46.15%（12/26）和34.62%（9/26）,差异无统计学意义（P=0.405）。在新生儿出生后的前6 min,PO测得的心率较三导联ECG低,随后两者测得值趋于接近。结论　三导联ECG获得稳定心率所需时间明显短于PO,且在前30 s内获得稳定心率的比例高于PO。在新生儿出生后的前6 min,PO所测得的心率低于三导联ECG。     

TEG与常规凝血试验检测下肢深静脉血栓患者凝血功能结果的相关性和一致性研究

［摘要］　目的　探讨下肢深静脉血栓（DVT）患者血栓弹力图实验（TEG）检测与常规凝血试验检测结果的相关性与一致性。方法　对2017年9月至2021年1月安徽医科大学附属合肥医院介入科收治的87例DVT住院患者TEG与常规凝血试验检测结果进行回顾性分析,对二者结果进行统计学分析。结果　TEG检测中相关参数与常规凝血试验检测指标具有明显相关性,TEG的R值与凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）呈正相关（r=0.231,r=0.395）;TEG的K值与APTT呈正相关（r=0.237）,与纤维蛋白原（FIB）、血小板计数（PLT）呈负相关（r=-0.521,r=-0.431）;TEG的α-angle与FIB、PLT值呈正相关（r=0.542,r=0.471）;TEG的MA值与FIB、PLT值呈正相关（r=0.674,r=0.596）,差异均有统计学意义（P<0.05）。对凝血状态的判断,TEG的MA值与PLT、FIB具有一致性（Kappa=0.148,Kappa=0.210;P<0.05）。结论　对于DVT患者,其TEG检测与常规凝血试验检测呈现显著相关性,但二者一致性较差,两种方法尚无法相互替代。TEG提供了常规凝血试验之外的补充信息,值得在临床推广应用。     

穴位埋线治疗失眠症30例临床观察

［摘要］　目的　观察穴位埋线治疗失眠症的临床疗效。方法　将60例失眠患者按就诊顺序半随机分为两组,治疗组（n=30）给予穴位埋线治疗,对照组（n=30）给予阿普唑仑治疗。比较两组睡眠改善情况。结果　治疗组治愈18例,好转9例,未愈3例。对照组治愈13例,好转7例,未愈10例。两组疗效比较差异有统计学意义（P<0.05）。结论　穴位埋线治疗失眠症疗效良好,复发率低,值得临床推广。     

糖尿病脑梗死患者检测高半胱氨酸和非高密度脂蛋白胆固醇的临床意义

［摘要］　目的　探讨2型糖尿病(T2DM)并发脑梗死患者血清高半胱氨酸(Hcy)和非高密度脂蛋白胆固醇(non-HDL-C)的水平及临床意义。方法　选取132例脑梗死患者根据是否伴有T2DM分为T2DM组49例,非糖尿病组83例,并与健康人对照组58名比较。分别测定Hcy、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）,计算出non-HDL-C。结果　三组间六项指标差异均有统计学意义（P<0.01）,T2DM并发脑梗死组、非糖尿病并发脑梗死组患者血清Hcy、TG水平显著升高,HDL-C显著降低（P<0.01）;T2DM组non-HDL-C显著高于健康人对照组（P<0.01）。T2DM并发脑梗死患者的血清TC、TG、LDL-C、non-HDL-C水平显著高于非糖尿病组（P<0.05）。脑梗死患者的Hcy与血脂无相关性;non-HDL-C与TC、TG和LDL-C呈正相关。结论　T2DM并发脑梗死患者血清Hcy、non-HDL-C水平显著升高,可以作为T2DM并发脑梗死风险预测以及降糖、降脂治疗效果评估的指标。     

康艾注射液联合化疗对肺鳞癌患者临床疗效和免疫功能及生活质量的影响

［摘要］　目的　探讨康艾注射液联合化疗对晚期肺鳞癌患者临床疗效和免疫功能及生活质量的影响。方法　收集2017年7月至2020年10月广东医科大学附属医院94例肺鳞癌初治患者,按照随机数字表法分为对照组（45例）和观察组（49例）。对照组接受顺铂+吉西他滨化疗,观察组在对照组的基础上联合康艾注射液辅助治疗,两组均治疗4个疗程。比较两组治疗前后T细胞计数、治疗后的临床疗效、生活质量评分及化疗不良反应情况。结果　治疗后,观察组的客观缓解率高于对照组,差异有统计学意义（P<0.05）,但两组的疾病控制率差异无统计学意义（P>0.05）;观察组KPS评分高于对照组,差异有统计学意义（P<0.05）;观察组T淋巴细胞总数、T辅助细胞绝对值、T抑制细胞绝对值高于对照组,差异有统计学意义（P<0.05）;观察组恶心呕吐、血小板减少、白细胞减少不良反应发生率低于对照组,差异有统计学意义（P<0.05）。结论　康艾注射液联合化疗可提高晚期肺鳞癌患者免疫功能和生活质量,降低不良反应,从而提高临床疗效,值得临床推广。     

冠心病患者血清同型半胱氨酸 胱抑素C N-末端脑利钠肽前体水平变化及临床意义

［摘要］　目的　探讨冠心病（CHD）患者血清中同型半胱氨酸（HCY）、胱抑素C（CysC）、N-末端脑利钠肽前体（NT-proBNP）水平变化及临床意义。方法　应用日立7100全自动生化分析仪及FIA8000免疫分析仪,分别检测52例冠心病患者和52名健康体检者血清中HCY、CysC及NT-proBNP的含量,并对结果进行统计学分析。结果　冠心病患者血清中HCY、CysC及NT-proBNP含量均显著高于健康体检者,两者差异具有统计学意义（P<0.01）;心肌梗死组与无心肌梗死组HCY、NT-proBNP水平两者比较差异具有统计学意义（P<0.05或P<0.01）,CysC含量两者之间差异无统计学意义(P>0.05)。结论　联合检测血清中HCY、CysC及NT-proBNP水平,对临床诊断与治疗冠心病具有一定的指导意义。     

慢性精神分裂症患者脑结构异常的MRI线性测量研究

［摘要］　目的　探究慢性精神分裂症患者的脑结构异常情况。方法　选取自贡市精神卫生中心2017-01～2019-08收治的50例慢性精神分裂症患者作为研究组,另选择50名健康志愿者作为对照组,均行脑部磁共振成像（MRI）扫描。采用线性测量法测量第三脑室宽度、尾状核头部宽度、脑室前角间距、三角区域间距、外侧裂宽度、海马高度、胼胝体厚度等指标,并进行组间比较。结果　研究组第三脑室宽度、左侧尾状核头部宽度、右侧尾状核头部宽度、左侧外侧裂宽度、右侧外侧裂宽度显著大于对照组（P<0.05）。两组在脑室前角间距、三角区域间距、左侧海马高度、右侧海马高度及胼胝体厚度方面比较差异无统计学意义（P>0.05）。结论　慢性精神分裂症患者存在脑结构异常,MRI线性测量对慢性精神分裂症的诊断和鉴别诊断有一定意义。     

下腔静脉塌陷指数在指导早产儿肺出血液体治疗中的应用价值

［摘要］　目的　探讨下腔静脉塌陷指数（IVC-CI）在指导早产儿肺出血液体治疗中的应用价值。方法　选择2016年7月至2020年6月厦门市儿童医院收治的肺出血的早产儿46例,其中22例接受床旁测量IVC-CI（观察组）,24例未接受床旁测量IVC-CI（对照组）。在常规治疗（包括机械通气、止血等）基础上,观察组结合IVC-CI动态评估容量状况,指导液体治疗;对照组予经验性液体治疗。比较两组观察时段内患儿液体入量及乳酸、氧合指数改善时间。结果　Pearson相关性分析结果显示,观察组IVC-CI与Hb下降程度呈正相关（r=0.859,P=0.000)。在发现肺出血后0 h～5 h 59 min,观察组液体输入量高于于对照组,而在6 h～23 h 59 min的液体输入量低于对照组,差异有统计学意义（P<0.05）;在24～48 h,两组液体输入量差异无统计学意义（P>0.05）。观察组乳酸恢复正常及氧合指数下降50%时间均快于对照组,差异有统计学意义（P<0.05）。观察组呼吸机治疗时间短于对组组,差异有统计学意义［（127.27±34.18）h vs （154.08±45.45）h;t=2.245,P=0.003］。结论　超声指导下检测IVC-CI能动态评估容量状态,针对性地指导早产儿肺出血液体治疗,有助于病情恢复。     

生物反馈联合普芦卡必利治疗老年功能性便秘的疗效观察

［摘要］　目的　观察生物反馈（BF）联合普芦卡必利治疗老年功能性便秘（FC）的效果。方法　选择2020年7月至2021年12月苏州科技城医院收治的老年FC患者84例,采用随机数字表法分为观察组和对照组,每组42例。观察组采用BF疗法联合普芦卡必利进行治疗,对照组采用普芦卡必利进行治疗,连续治疗6周。比较两组的临床疗效、便秘评分、每周自发性完全排便（SCBM）次数、复发率和不良反应发生情况。结果　与治疗前比较,观察组和对照组治疗后的便秘评分降低,每周SCBM次数增加,差异有统计学意义（P<0.05）,且观察组较对照组改善更显著（P<0.05）。观察组总有效率高于对照组,差异有统计学意义（83.33% vs 61.90%, χ²=4.850,P=0.028）。随访3个月,观察组复发5例（11.90%）,对照组12例（28.57%）,两组复发率比较差异有统计学意义（χ²=30.612,P<0.001）。两组不良反应发生率比较差异无统计学意义（7.14% vs 9.52%, χ²=0.000,P=1.000）。结论　BF联合普芦卡必利能够有效治疗老年FC,复发率低,且安全性良好。     

Microcirculation in white atrophy

There are two clinical phenomena which, owing to the French School, are still subject to violent criticism: the phenomenon described by M. Raynaud (1862) and the white atrophy termed Milian's (1929). Perhaps badly defined by the authors, the facts have been reviewed, but microcirculation - that of gauges less than 30 to 50 m - does not occupy the whole picture. The proof is that in direct capillaroscopy, functional explorations and biopsy are strikingly monotonous and lacking in exactitude. Capillaroscopy provides the usual aspects of cicatrization, "capillary" neogenesis and their histogenic disorders: central avascular zone, corona limited with loops in "club" formation, or in "clusters" owing to their confluence, "key" loops at the periphery near to the normal loops. These "neocapillaries" pose problems of the immaturity of the neovascular elements and of hydraulics in venous stasis. Of course, there are disorders of capillary permeability, and these are linked especially with vascular neogenesis, but it would not be reasonable to speak of "cutaneous infarctus", or "vascularitis", the necessary criteria being absent. On the contrary, we believe that it all comes down to a "histoangiopathy" by deterioration of the pericapillary sheath of proteoglycanes and of the interstitial conjunctiva. The anomalies are of the type of the deteriorations in plastic polymers and the apparatus of the endarterial bloc, which are included. A "trapping" of the leucocytes in the declivitous areas must also play a part.     

Endothelium and angiogenesis in white coat hypertension

Hypertensive patients are at particular risk of cardiovascular complications, possibly related to endothelial damage or dysfunction, or to abnormal angiogenesis. The aim of this study was to compare the risk conferred by white coat hypertension (WCH) vs sustained hypertension in the development of the endothelial dysfunction and abnormal angiogenesis by evaluating nitric oxide (NO=NO2+NO3), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and E-selectin levels in plasma. The study group included 102 subjects, 34 with WCH (17 male and 17 female patients) aged 49+/-11 years, 34 sustained hypertensives (HT) (15 male and 19 female patients) aged 47+/-11 years and 34 normotensive control subjects (NT) (16 male and 18 female patients) aged 48+/-10 years. WCH was defined as clinical hypertension and daytime ambulatory blood pressure less than 135/85 mmHg. The subjects were matched for age, gender, body mass index and the patients with smoking habit, dyslipidaemia, and diabetes mellitus were excluded from the study. The NO, ET-1, VEGF and E-selectin levels were analysed by ELISA technique. The WCH subjects had significantly higher levels of NO than the HT (41.68+/-2.23 vs 32.18+/-2.68 micromol/l; P<0.001) and significantly lower values than the NT (48.24+/-4.29 micromol/l; P<0.001). ET-1 levels of the WCH group were significantly higher than the NT (8.10+/-0.92 vs 5.95+/-0.26 ng/ml; P<0.001) and significantly lower than the HT (11.46+/-0.59 ng/ml; P<0.001). Considering with VEGF, the WCH group had significantly higher levels than the NT (195.88+/-11.84 vs 146.26+/-18.67 pg/ml; P<0.001), but the difference from the HT group was not significant (203.35+/-7.48 pg/ml; P=0.062). E-selectin in the WCH group was significantly lower than the HT (4.77+/-0.52 vs 8.49+/-2.85; P<0.001), but the difference from the NT group was not significant (3.86+/-0.67; P=0.077). Our data demonstrate that WCH is associated with endothelial dysfunction and abnormal angiogenesis. The degree of these changes is not as severe as observed in hypertensive population.     

氟哌噻吨美利曲辛片对白大衣高血压患者白大衣效应及血压昼夜节律的影响

目的探讨氟哌噻吨美利曲辛片对白大衣高血压患者白大衣效应及血压昼夜节律的影响。方法前瞻性选取120例白大衣高血压患者,进行汉密尔顿焦虑量表(HAMA)评分,HAMA总分7分者共77例,然后将其按随机数字表法分为两组:治疗组39例,使用氟哌噻吨美利曲辛片,对照组38例,使用安慰剂。比较两组治疗前后动态血压监测各指标、诊室血压(CBP)值、白大衣效应(WCE)值、血压昼夜节律的变化。结果(1)治疗组治疗后白昼动态平均血压dSBP、dDBP略有上升(均为P0.05),夜间动态平均血压nSBP、nDBP略有下降(均为P0.05),24 h动态平均血压24 h SBP、24 h DBP无明显变化(均为P0.05),对照组动态血压各指标均无明显变化(均为P0.05),两组组间比较差异无统计学意义(均为P0.05)。(2)治疗组治疗后CBP较治疗前有明显下降(均为P0.01),对照组无明显变化(均为P0.05),两组组间比较有统计学意义(均为P0.01)。治疗组治疗后WCE值较治疗前均明显缩小(均为P0.01),对照组无明显变化(均为P0.05),两组组间比较差异有统计学意义(均为P0.01)。(3)治疗组患者治疗后杓型血压昼夜节律的发生率明显升高(P=0.006),对照组无明显变化(P=1.0),两组组间比较差异有统计学意义(P=0.031)。结论氟哌噻吨美利曲辛片能明显降低伴有焦虑的白大衣高血压患者WCE值,改善血压昼夜节律,可作为此类患者的一种较好的用药选择。     

Prognosis and prevention of white atrophy

White atrophy, defined by Milian, is a smooth ivory white plaque, slightly depressed, of variable dimensions, and surrounded by a pigmented telangiectasic area, several millimetres across. It is usually localised in the lower limbs and mostly affects middle-aged women. It is a symptom with multiple aetiopathology. It is to be bound in isolation, or forming part of the clinical picture of various affections caused by degeneration in the cutaneous vascularization. Sometimes it causes ulceration resistant to the available treatments. Some authors suggest an immunological pathology of vascular occlusion. Others consider that it is result of a localized disorder of coagulation or fibrinolysis.     

Role of white cells and neoplastic cells in haemostasis

The aim of this review was to assess the role of white cells and neoplastic cells in haemostasis.     

Prevalence of hypertension in Hispanic and non-Hispanic white populations

Mexican nationals in Mexico City and Mexican Americans in San Antonio, Tex, have a lower adjusted prevalence of hypertension than San Antonio non-Hispanic whites, especially after adjusting for the greater obesity of San Antonio Mexican Americans. The concomitant examination of a new study from Spain may better explain the association of genetic and environmental factors with hypertension. Three population-based epidemiological studies conducted in Mexico City, Spain, and San Antonio, Tex, were available for comparisons. Hypertension was defined as systolic blood pressure > or = 140 mm Hg, diastolic blood pressure > or = 90 mm Hg, or the use of antihypertensive medications. The prevalence of hypertension was independently associated with age, body mass index, glucose tolerance, and alcohol consumption, with comparable degrees of relationship in all 4 populations. Relative to San Antonio non-Hispanic whites, an excess prevalence of hypertension was observed in Spaniards (odds ratio [OR], 1.53; 95% confidence interval [95% CI], 1.24 to 1.90). A deficit in hypertension prevalence was statistically significant in Mexican nationals (OR, 0.67; 95% CI, 0.53 to 0.85) and close to significance in San Antonio Mexican Americans (OR, 0.86; 95% CI, 0.71 to 1.03). Thus, obesity, educational attainment, type 2 diabetes, glucose tolerance, and marked alcohol consumption (> or = 14 drinks/wk) do not fully explain the increased prevalence of hypertension in Spain and the lower prevalence of hypertension in Mexican-origin populations. Although we cannot conclude definitively that these differences are genetically driven, our results suggest no relationship between Spanish genetic admixture and the deficit in hypertension prevalence in Mexican-origin populations.     

Analogues of red and white muscle in squid mantle

In five species of squid, varying in life-style from fast-swimming pelagic predators to sluggish benthic forms, the circular muscle of the mantle was found to be metabolically and structurally differentiated into inner, middle, and outer zones. In the middle zone, mitochondrial abundance and the ratios of oxidative to glycolytic enzyme activities were low. This zone was sandwiched between thinner bands of muscle lining both the inner and outer edges of the mantle. In these bands, mitochondrial abundance and the ratios of oxidative to glycolytic enzyme activities were high. It is proposed that this metabolic differentiation is analogous to the development of red and white muscles in vertebrates and that it serves a similar function, white muscle mainly supporting burst-type swimming and red muscle sustaining steady-state oxidative work.