超声乳化术对青光眼眼内压及角膜内皮细胞的影响

目的 探讨超声乳化术对青光眼眼内压及角膜内皮细胞的影响。方法 2011年8月~2015年2月选择在笔者医院诊治的青光眼患者92例（92只眼）,根据入院顺序分为对照组与治疗组各46例,对照组给予玻璃体切割手术,治疗组给予超声乳化术,观察两组术后眼内压、角膜水肿程度和角膜内皮细胞变化情况。结果 两组术后1个月的眼内压分别为12.98±4.33和16.24±3.49mmHg,都明显低于术后1天的23.45±7.21和23.10±6.35mmHg,同时治疗组术后1个月的眼内压明显低于对照组（P<0.05）。治疗组术后1个月的角膜水肿程度明显轻于对照组,差异有统计学意义（P<0.05）。两组术后1个月的细胞密度与细胞面积变异系数都低于术后1天（P<0.05）,同时治疗组术后1个月的细胞密度与细胞面积变异系数明显少于对照组（P<0.05）。结论 超声乳化术在青光眼患者中的应用能促进眼内压的降低,减轻对于角膜内皮细胞的损伤,减少术后角膜水肿程度,应用安全性佳,值得推广应用。     

结膜瓣大小对滤过泡形态及青光眼滤过术后眼压影响的临床研究

目的评估大结膜瓣和小结膜瓣对青光眼滤过术后滤过泡的功能及眼压的影响。方法青光眼滤过术中55眼行大结膜瓣,55眼行小结膜瓣。术后3个月对比两组的滤过泡形态及眼压情况。结果大结膜瓣组与小结膜瓣组相比眼压显著降低,两组滤过泡形态对比也有统计学差异。结论青光眼滤过术采用大结膜瓣术后效果较好,并可防止手术失败。     

回弹式眼压计与非接触式眼压计在角膜病患者眼压测量中的对比研究

摘要:目的 检验回弹式眼压计Icare与非接触式眼压计(non-concacttonometer,NCT)对角膜病患者眼压测量值的 一致性。方法 收集在华中科技大学同济医学院附属同济医院住院治疗的角膜病患者32例(64只眼),其中2例是双眼 患角膜病,根据是否有角膜病变分为正常角膜组(30眼)和角膜病组(34眼),分别采用Icare和 NCT 眼压计测量眼压。 根据测量能否获得数据判断两种仪器的测量成功率。根据 NCT测量的结果,在正常角膜组及角膜病组内又分为高眼压 (>21mmHg)和正常眼压(10~21mmHg),比较Icare眼压计与 NCT测得眼压值的差异,数据进行配对t检验。结果 两种眼压计对正常角膜眼测量成功率均为100%;对于角膜病眼,Icare眼压计成功率为100%,而 NCT 为53.7%,原因 是严重的角膜溃疡、瘢痕、睑裂缝合术后患者无法采用 NCT测量,而Icare眼压计仍可正常测量。在正常角膜组内,高眼 压眼 NCT比Icare眼压计测量结果平均高(6.2±3.5)mmHg(P<0.05),正常眼压眼 NCT比Icare眼压计测量结果平均 高(2.0±3.4)mmHg(P<0.05);在角膜病组内,高眼压眼 NCT比Icare眼压计测量结果平均高(8.4±6.8)mmHg(P< 0.05),正常眼压眼 NCT比Icare眼压计测量结果平均高(2.5±4.9)mmHg(P<0.05)。结论 角膜病眼眼压测量成功 率Icare眼压计高于 NCT;无论是正常角膜眼还是角膜病眼,Icare眼压计测量的数值均低于 NCT,这种偏移在眼压高于 21mmHg的情况下更加显著。     

准分子激光原位角膜磨镶术后眼压分析

目的：探讨准分子激光原位角膜磨镶术（ＬＡＳＩＫ）术后眼压的变化及非接触式眼压计（ｎｏｎｃｏｎｔａｃｔｔｏｎｏｍｅｔｒｙ,ＮＣＴ）用于激量ＬＡＳＩＫ术后眼压的可靠性。方法：采用非接触式眼压计测量眼压,对ＬＡＳＩＫ术前、术后随访１月以上２７例５１只眼患者眼压进行统计学分析。结果：术前平均眼压为１６７３±２３８ｍｍＨｇ,术后１月的平均眼压为１０７８±２９１ｍｍＨｇ,明显低于术前,二者差异有显著性（Ｐ＜０００１）。结论：ＬＡＳＩＫ术后ＮＣＴ测量眼压低于术前。非接触式眼压计用于ＬＡＳＩＫ术后监测眼压有一定的优越性,但有待进一步完善     

Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis

Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis. Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study. The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell (SFC)/10 ⁶ periphreral blood monocyte cell (PBMC) according to the instruction of testing kits. The gold standard for diagnosis of TBL was the combination of microbiology results, histopathology results and patient's response to anti-TB treatment. Diagnostic efficacy of T-SPOT.TB was evaluated, including sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Among 91 patients who met the inclusion criteria, we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up. According to the gold standard, there were 37 cases of true TBL (9 confirmed TBL and 28 probable TBL), 30 cases of non-TBL, and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses. The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%, 66.7%, 79.1%, 76.7%, 83.3%, 2.68 and 0.16, respectively. The number of SFCs of T-SPOT.TB in TBL patients [432(134-1264)/10 ⁶ PBMCs] was higher than that in non-TBL patients [0 (0-30) /10 ⁶PBMCs] with a significant difference (Z=-5.306, P <0.001).Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.     

超声乳化联合小梁切除术治疗青光眼合并白内障患者的眼压视力及并发症分析

目的：：评价临床应用超声乳化白内障吸除术联合小梁切除术治疗青光眼合并白内障患者对眼压、视力及并发症的影响。方法：选取我院近年来收治的90例青光眼合并白内障患者作为研究对象,按照治疗方法不同分为联合治疗组与对照组各45例,对照组采用小梁切除术治疗,联合治疗组联合超声乳化白内障吸除术治疗,比较两组患者术后眼压、视力及并发症情况。结果：两组患者手术前患眼视力平均值、眼压水平比较并无明显差异(P>0.05),术后1周、1个月、3个月时视力水平均逐步提升、眼压均逐步下降,但同期组间比较联合治疗组较对照组改善更明显( P<0.05);联合治疗组、对照组术后并发症发生率分别为8.8％、22.0％,联合治疗组并发症发生率明显低于对照组( P<0.05),具有统计学意义。结论：临床应用超声乳化白内障吸除术联合小梁切除术治疗青光眼合并白内障可有效恢复术后视力、降低眼压,且并发症相对较少、安全性较高,值得推广应用。     

静脉盐水负荷试验在原发性醛固酮增多症诊断中的应用

目的探讨静脉盐水负荷试验在原发性醛固酮增多症(原醛症)诊断中的应用价值。方法2004~2006年临床确诊原醛症患者65例,其中醛固酮瘤27例,特发性醛固酮增多症(特醛症)26例,原发性肾上腺增生11例,醛固酮癌1例。所有患者检测血电解质,血、尿醛固酮及立位血浆肾素活性等生化指标,同时行静脉盐水负荷试验。以19例原发性高血压患者作为对照组。结果与对照组比较,原醛症组患者的血、尿醛固酮明显升高,而血钾及立位血浆肾素活性则低;原醛症组和对照组静脉盐水负荷后血醛固酮不能抑制者分别为95.4%(62/65)和21.1%(4/19);该试验对原醛症诊断的敏感性和特异性分别为95.4%和93.9%。65例原醛症患者中,醛固酮瘤和原发性肾上腺增生患者的血钾较特醛症患者低,而血、尿醛固酮则高;醛固酮瘤、特醛症、原发性肾上腺增生及醛固酮癌患者的静脉盐水负荷后血醛固酮的抑制率分别为16.1%、28.9%、15.4%和5.2%。结论原发性肾上腺增生患者生化指标改变与醛固酮瘤患者类似,均较特醛症患者更为明显。静脉盐水负荷试验是一项安全且可靠的原醛症确诊方法,其敏感性和特异性均较高。     

Difficulties faced by patients with chronic diseases in the primary care setting in Singapore: a cross-sectional study

INTRODUCTIONPatients with chronic diseases face difficulties when navigating the healthcare system. Using the Healthcare System Hassles Questionnaire (HSHQ) developed by Parchman et al, this study aimed to explore the degree of hassles faced by patients in primary care in Singapore and identify the characteristics associated with greater hassles.METHODSA cross-sectional study was conducted on patients with chronic diseases at Hougang Polyclinic, Singapore, using the interviewer-administered HSHQ. The mean HSHQ score was compared with that reported by Parchman et al. The associations between the number of chronic diseases, demographic variables and healthcare hassles were assessed using multivariate linear logistic regression analysis.RESULTSIn total, 217 outpatients aged 21 years and above were enrolled. Their overall mean HSHQ score (4.77 ± 6.18) was significantly lower than that of patients in the study by Parchman et al (15.94 ± 14.23, p < 0.001). Patients with five or more chronic diseases scored 3.38 (95% confidence interval [CI] 0.11–6.65, p = 0.043) points higher than those with one chronic disease did. With each increasing year of age, the mean HSHQ score decreased by 0.17 (95% CI −0.26 to −0.08, p = 0.001) points. Patients with polytechnic/diploma/university education and higher scored 2.65 (95% CI 0.19–5.11, p = 0.035) points higher than those with primary education and lower did.CONCLUSIONPatients in our population reported less hassles than those in the study by Parchman et al did. Increasing age and lower education level were associated with less hassles. Further analysis of the types of chronic diseases may yield new information about the association of healthcare hassles with the number and types of chronic diseases.     

B超、CT、MRCP及ERCP诊断胆管癌临床价值的Meta分析

目的 系统评价B超、CT、磁共振胰胆管造影(MRCP)及经内镜逆行性胰胆管造影术(ERCP)诊断胆管癌的价值.方法 收集PubMed、Medine、Embase、中国知网(CNKI)、万方5大电子文献数据库中所有关于胆管癌的文献,对B超、CT、MRCP及ERCP怀疑胆管癌的患者进行系统回顾,评价指标包括灵敏度及特异度,采用汇总受试者工作特征(SROC)曲线得出曲线下面积(AUC)及各自的Q值,分析4种检查方法的诊断价值.结果 共纳入44篇文章,总病例数4 364例.B超、CT、MRCP合并灵敏度、特异度分别为0.75、0.72,0.82、0.80,0.85、0.87,ERCP细胞学及ERCP图像灵敏度、特异度分别为0.62、0.98,0.88、0.84),Q值分别为0.690 8、0.787 8、0.841 7(ERCP细胞学及ERCP图像分别为0.846 1、0.833 2).结论 CT、MRCP及ERCP 3者诊断胆管癌的准确性相当,均明显高于B超,是有效的辅助检查方法.ERCP细胞学检查合并特异度明显高于其他检查方法,对高度怀疑胆管恶性肿瘤者具有高度的临床诊断价值.     

24小时眼压的研究进展

既往研究表明,眼压在昼夜不同的时间有不同的变化,24 h眼压波动现在也被认为是诊治青光眼的一个重要依据。近年来随着研究方法的发展,人们对眼压24 h波动有了更深程度的认识,并发现了眼压波动与体位、灌注压及角膜生物力学间的关系。该文对健康人、屈光不正及各种青光眼患者的24 h眼压波动相关的研究进展予以综述。     

一种增强MLPA检测SNP位点的特异性方法

目的:在传统多重连接探针扩增(MLPA)技术基础上建立一种更为特异的检测单核苷酸多态性(SNP)位点的方法。方法:设计针对Kras基因216 G-C SNP位点的MLPA探针,使用不同方法优化MLPA实验,观察其对SNP位点检测时的影响。结果:直接用锁核酸(LNA)修饰MLPA探针的SNP位点或添加阻滞探针均可显著提高SNP检测时的特异性,3个LNA修饰的阻滞探针能最好地保证检测的灵敏度和特异性。结论:成功地建立了一种增强MLPA检测SNP位点的特异性方法。     

Periconceptional Folic Acid Supplementation in Chinese Women: A Cross-sectional Study

Objective To investigate the status of folic acid (FA) supplementation and determinants of its use inpregnant Chinese women Methods In this cross-sectional study, questionnaires were used to collect information of participantsand FA supplementation. Women were recruited between 6 and 12 weeks postpartum in Tianjin, China,between July 2015 and July 2016 Results A total of 1,921 women were recruited in the study. Approximately 93.1% of the studyparticipants used FA, while 14.4% of the women taking FA from three months prior to preconception tothree months post-conception. Women who took FA for three months prior to preconception throughat least three months into their pregnancy were more likely to be between 30 and 34 years old (OR =2.91, 95% CI: 1.15, 7.33), employed (OR = 2.07, 95% CI: 1.17, 3.67), primigravida (OR = 5.20, 95% CI:3.02, 8.96), married to spouses with an intermediate education level (OR = 2.92, 95% CI: 1.45, 5.89), andearn a high family income (OR = 3.19, 95% CI: 1.57, 6.49) Conclusion The prevalence of periconceptional FA intake was far below the requirements of theNational Health and Family Planning Commission of China; therefore, knowledge of FA supplementationshould be strengthened among women who are or planning to become pregnant.     

手持式动态心电记录仪（SnapECG）对于不同心律失常诊断的敏感性和特异性研究

目的：探讨手持式动态心电记录仪（SnapECG）对于常见不同心律失常诊断的敏感性及特异性,为其在临床实际应用提供参考依据。方法：入选2018年9月至2019年12月间经12导联心电图或24小时动态心电图确诊为心律失常的住院患者,用12导联心电图和SnapECG同时采集患者心电图形,以12导联心电图诊断结果为标准,探讨SnapECG对常见快速和缓慢型心律失常诊断的敏感性、特异性。结果：本研究共采集373例常见心律失常的心电图,其中快速型心律失常180例（48.3%）,缓慢型心律失常193例（51.7%）。SnapECG对常见快速型心律失常诊断的敏感性和特异性分别为85.9%和98.2%,对常见缓慢型心律失常诊断的敏感性和特异性分别为96.0%和100.0%。SnapECG对房早、房速、房扑的诊断敏感性欠佳（分别为70%,50%,13%）,对其他常见快速和缓慢型心律失常的诊断敏感性达83.3%-100.0%;对各类常见快速型和缓慢型心律失常的诊断特异性达88.5%-100.0%。结论：SnapECG具有便携、易操作的特点,可实现远程传输,便于进行常见心律失常的诊断及随访。SnapECG对常见不同快速和缓慢型心律失常的诊断特异性高,对与P波相关的心律失常的诊断敏感性有待进一步提高。     

4种靶特异性抗体检测对肺结核的临床诊断价值

目的:探讨4种靶特异性抗原结核抗体对肺结核的临床诊断价值。方法:选取分别含LAM、38ku/16ku蛋白、纯化BCG蛋白、人型PPD的4种结核抗体检测试剂盒,对110例肺结核、100例对照标本进行测定,运用卡方(χ2)检验,比较各组间敏感性、特异性的差异。结果:LAM-IgG、38ku/16ku-IgG、BCG-IgG和PPD-IgG的敏感性分别为74.5%、70.9%、80.0%和83.6%;特异性分别为91.0%、99.0%、93.0%和84.0%;痰菌阳性的阳性检出率分别为85.7%、88.6%、91.4%和91.4%;痰菌阴性的阳性检出率分别为69.3%、62.7%、74.7%和80.0%。结论:4种靶特异性抗原结核抗体对肺结核诊断的敏感性无显著差异,特异性存在非常显著的差异;以PPD为靶抗原的国产结核抗体试剂盒价格低廉,有很高的敏感性和较高的特异性,适宜推广使用。     

昆明城镇企事业单位人群高血压发病现况分析

目的 了解昆明地区企事业单位人群高血压发病状况,针对性提出健康促进建议.方法 对2008年4～10月在我院体检中心例行健康体检的21209名企事业单位人员的血压结果进行分析.结果 高血压检出率为12.31%,SBP、DBP、PP均随年龄增长而升高,50岁以前男性总检出率显著高于女性(t=13.76,P＜0.01),以女性为对照(作为基线),男:女的相对危险性(RR)呈负二次曲线势,男性50岁以前为显著,高达1.63～4.12倍.结论 昆明城镇企事业人群高血压的检出率及发病年龄分布,与全国大多数城市高血压的年龄分布动态趋势较为一致.综合性医院体检中心应率先开展、实践健康管理,从综合控制危险因素水平、早诊早治和配合临床对高血压病人实施规范化管理三个环节入手,构筑高血压防治的全面战线.     

Factors Associated with Field Epidemiology Investigation: A Cross-sectional Study in China

The public health problem caused by disease outbreak cause increasing global concern. Field epidemiology investigation (FEI), which involves the timely use of epidemiology to solve urge nt public health problems, is a crucial core capacity for the public health workforce. When an acute public health problem occurs, there is an urge nt n eed to identify the origin, path, cases, and vulnerable population, and to implement timely intervention. FEI can be con ducted not only for in fectious disease epidemics but also for non-communicable events such as poisoning, vaccination accidents, and environmental pollution. While situations do not always meet the statutory standard of a public health emergency, it remains necessary to conductan in vestigation to prevent event from becoming a serious public health problem.     

基层医务人员对成人高等教育需求情况的研究

目的 调查基层卫生技术人员基本情况、继续医学教育现状和对成人高等教育需求,明确医学成人教育培养目标,加快成人教育教学管理模式改革,提升基层卫生人才培养质量。方法 对2019年参加某市基层卫生培训的全市12个县市区,106家乡镇卫生院和50个社区卫生服务中心的1 233名(23期)卫生技术人员进行问卷调查和访谈。结果 目前基层医务人员基础学历相对较低,有成人高等教育需求,集中在20～50岁年龄段,护理、医技专业对成人高等教育较临床专业需求量大。但是随着国家对基层卫生的重视,临床本科及以上学历卫生技术人员数量日益增多,对研究生学历的需求也日益增加。结论 基层卫生人力资源规模和质量提升要求不断提高,在成人高等教育中一定要做好为基层人才进一步深造的充分准备,同时要将人文教育纳入教育过程中,稳定基层卫生队伍。     

A Cross-sectional Study of Health-related Behaviors in Rural Eastern China

Objective This study examined the status of health-related behaviors among rural residents and the factors influencing the practice of such behaviors. Methods One thousand and ninety subjects aged 15 years or over in a rural community, Anhui Province, China were surveyed. A questionnaire was used to collect information on the health knowledge, attitude and behavior of the subjects. Information on health behavior included smoking, drinking, dietary habits, regular exercises, sleeping pattern and oral health behavior. Results The prevalence of smoking and drinking in the male subjects was 46.5% and 46.9%, respectively. There was a positive significant association between smoking and drinking. Only 8.3% of all subjects ate three regular meals a day regularly. Among subjects who ate two meals a day, 89.7% did not have breakfast. Only 1.7% of subjects took part in regular exercise. About 85% of subjects slept 6 to 8 h per day. Only 38.4 % of the respondents had the habit of hand washing before eating and aft     

老年人代谢综合征与血清铁蛋白间的相关性研究

[目的]探讨老年人血清铁蛋白与代谢综合征及其不同组分间的关系。[方法]对1645名老年人进行血压、身高、腰围测量,称重。检测血清胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、空腹血糖与血清铁蛋白。[结果]有代谢综合征者比无代谢综合征者的血清铁蛋白值高(P0.05)。血清铁蛋白四分位各组间比较空腹血糖、甘油三酯、HDL-C、BMI、腰围、收缩压、舒张压(P0.05或P0.01),四组间年龄、总胆固醇、LDL-C无差异。与血清铁蛋白呈正相关联的参数有腰围(P0.001)、舒张压(P0.001),空腹血糖(P0.01)负相关联的参数为HDL-C(P0.001)。[结论]在老年人中,有代谢综合征者比无代谢综合征者的血清铁蛋白值高,随着血清铁蛋白的递增空腹血糖、甘油三酯、体重指数、腰围、收缩压、舒张压增加,HDL-C下降。以腰围、舒张压、HDL-C、空腹血糖与血清铁蛋白关联较大。