老年患者日间手术全程质量管理模式研究

目的探索老年患者日间手术全程质量管理模式。方法通过医院病历系统采集2015年-2020年应用老年患者日间手术全程质量管理模式前后患者信息,进行对比分析。结果老年患者应用日间手术全程质量管理模式后,≥65岁老年患者日间手术人数逐年上升,占比从13.52%上升至18.62%,差异有统计学意义（χ2=6.450,P=0.011）;日间手术住院时间＞5 d的比例从0.72%下降至0.50%,差异有统计学意义（χ2=338.088,P<0.001）;不良事件发生率从3.77‰下降至1.56‰,差异有统计学意义（χ2=5.156,P=0.023）,其中严重不良事件发生率从2.08‰下降至0.35‰,差异有统计学意义（χ2=7.019,P=0.008）。结论应用日间手术全程质量管理模式能够有效提高老年患者日间手术的安全性,值得借鉴与推广。     

The Frequency and Context of Snacking among Children: An Objective Analysis Using Wearable Cameras

Snacking is a common eating behaviour, but there is little objective data about children’s snacking. We aimed to determine the frequency and context of children’s snacking (n = 158; mean age = 12.6 years) by ethnicity, gender, socioeconomic deprivation and body mass index (BMI) children. Participants wore wearable cameras that passively captured images of their surroundings every seven seconds. Images (n = 739,162) were coded for snacking episodes, defined as eating occasions in between main meals. Contextual factors analysed included: snacking location, food source, timing, social contact and screen use. Rates of total, discretionary (not recommended for consumption) and healthful (recommended for consumption) snacking were calculated using negative binomial regression. On average, children consumed 8.2 (95%CI 7.4, 9.1) snacks per day, of which 5.2 (95%CI 4.6, 5.9) were discretionary foods/beverages. Children consumed more discretionary snacks than healthful snacks in each setting and at all times, including 15.0× more discretionary snacks in public spaces and 2.4× more discretionary snacks in schools. Most snacks (68.9%) were sourced from home. Girls consumed more total, discretionary and healthful snacks than boys, and Māori and Pacific consumed fewer healthful snacks than New Zealand (NZ) Europeans. Results show that children snack frequently, and that most snacking involves discretionary food items. Our findings suggest targeting home buying behaviour and environmental changes to support healthy snacking choices.     

小剂量倍他乐克治疗扩张型心肌病临床观察

目的观察小剂量倍他乐克治疗扩张性心肌病(DCM)的疗效.方法在常规抗心衰治疗的基础上,加用小剂量倍他乐克6.25mg/d,逐步增加到治疗剂量25～50mg/d,随访观察6个月,治疗前后应用彩色超声多普勒测定左室舒张末及收缩末内径、左室收缩功能,同时测量血压、心率、心胸比率.结果小剂量倍他乐克使扩张性心肌病患者的心率由治疗前92.5±8.1次/分降至71.2±7.2次/分(P＜0.01);心功能改善,左室射血分数由治疗前33.7±11.2%提高至41.9±9.8%(P＜0.01);左室舒张末内径(LVEDd)由治疗前67.5±5.8mm缩小至58.3±4.9mm(P＜0.01),左室收缩末内径(LVEDs)由49.3±5.2降至40.2±5.4(P＜0.01).结论长期应用小剂量倍他乐克可改善扩张性心肌病患者的心功能,且付作用少.     

糖尿病脑梗死合并上消化道出血的危险因素分析

目的　探讨糖尿病性脑梗死 (DCI)并发上消化道出血的可能危险因素。方法　对DCI合并上消化道出血患者进行临床分析及病例对照研究。结果　上消化道出血发生率为 18 75 % (9/ 48) ,经 t及 χ2 检验发现 :年龄 ,有TIA或CI史 ,血糖、血尿素氮或肌酐升高 ,CI面积 >2cm或多发性CI、ECG异常等因素与对照组比较有显著性差异 (P <0 0 5 )。逐步回归显示上消化道出血与年龄、高血压、随机血糖、糖化血红蛋白、CI病灶面积>2cm或多发性CI呈正相关。结论　认为老年、高血压、高血糖、大面积及多发性CI可能是DCI合并上消化道出血的危险因素。     

以PD20-PEF和PD20-FEV1作为气道反应性判定指标的比较分析

为探讨以PD20-PEF替代PD20-FEV1作为气道反应性判定指标的可行性,对64例有呼吸系统症状者和62例无症状者进行乙酰甲胆碱支气管激发试验,同步记录PEF和FEV1,计算PD20-PEF和PD20-FEV1。虽然PD20-PEF和PD20-FEV1之间有较强的直线相关关系(P<0.001),但两者之间有显著差异(P<0.005);若以PD20-FEV1作为金标准,在有症状组中以PD20-PEF作为气道反应性判定指标的敏感性(72.7%)、特异性(73.8%)、阳性符合率(59.3%)、阴性符合率(83.8%)均不甚高;在无症状组中敏感性(66.7%)和阳性符合率(40.0%)仍低,而特异性(89.2%)和阳性符合率(96.2%)较高。认为PD20-PEF作为无症状群体的流行病学筛选指标以除外气道反应性正常者可能具有一定价值,但替代PD20-FEV1作为气道反应性指标用于临床工作则欠妥当。     

LCBDE+LC与ERCP+LC治疗胆囊结石合并胆总管结石的网状Meta分析

目的 近年来,腹腔镜胆囊切除术（LC）、腹腔镜胆总管探查术（LCBDE）、内镜逆行胰胆管造影术（ERCP）普遍应用于胆系结石的治疗,本Meta分析比较了三种治疗胆囊结石合并胆管结石的手术方式的疗效及安全性,即LCBDE+LC、术前ERCP（PreERCP）+LC、术中ERCP（IntraERCP）+LC。方法 计算机检索Medline、PubMed、Cochrane Library、Embase数据库,查找1990—2019年关于LCBDE+LC、PreERCP+LC、IntraERCP+LC治疗胆囊结石合并胆总管结石的随机对照试验（RCT）研究。按照纳入与排除标准,选择文献、评价质量、提取数据,采用Stata软件进行网状Meta分析。计算累积排序概率曲线下面积（SUCRA）,用于预测各手术方式的有效性及安全性,主要结局指标为结石清除率,病死率,胰腺炎、胆漏、出血,以及中转开腹率。结果 共有19篇RCT研究纳入分析,共计2 627例患者。网状Meta分析结果显示：（1）结石清除率：IntraERCP+LC优于LCBDE+LC、PreERCP+LC,差异具有统计学意义（P＜0.05）;（2）病死率：LCBDE+LC、PreERCP+LC、IntraERCP+LC三者之间的差异均无统计学意义（P＞0.05）;（3）胰腺炎：PreERCP+LC的发生率高于LCBDE+LC、IntraERCP+LC,差异具有统计学意义（P＜0.05）;（4）出血：LCBDE+LC、PreERCP+LC、IntraERCP+LC三者之间的差异均无统计学意义（P＞0.05）;（5）胆漏：LCBDE+LC的发生率高于PreERCP+LC、IntraERCP+LC,差异具有统计学意义（P＜0.05）;（6）中转开腹率：PreERCP+LC与IntraERCP+LC、LCBDE+LC与IntraERCP+LC之间的差异均无统计学意义（P＞0.05）,而LCBDE+LC发生率高于PreERCP+LC,差异具有统计学意义（P＜0.05）。结论 LCBDE+LC、PreERCP+LC、IntraERCP+LC三种手术方式均可用于治疗胆囊结石合并胆总管结石,其中IntraERCP+LC的结石清除率最高,LCBDE+LC的胆漏风险较大,而PreERCP+LC的胰腺炎风险最高。     

"健康中国"战略下临床医学专业本科生职业医学教育的实践与探索

临床医学专业学生是职业病的诊断、治疗、康复和预防的未来主干力量,因而在"健康中国"战略下采用多元化教学方式培养学生解决问题的能力,提高临床医学生学习职业医学的积极性,推进职业医学专业人才队伍建设,对维护全体劳动者身体健康、促进经济社会协同发展具有重要意义。     

Nacre surface transformation to hydroxyapatite in a phosphate buffer solution

Nacre, also known as mother-of-pearl, constitutes the inner layer of mollusc shells. Nacre is a natural composite material consisting mostly of calcium carbonate in the aragonite crystal form and some organic matter. Previous studies have shown that geological aragonite, coral and nacre can convert hydrothermally to hydroxyapatite (HAP) in phosphate solution by a solid-state topotactic ion-exchange reaction. This conversion typically occurs within the range of 140-260 degrees C, although higher temperatures are possible. In this work, we have found that nacre can transform to HAP in a phosphate buffer solution at room temperature via a surface reaction. The morphology of the nacre-transformed HAP surface was investigated by scanning electron microscopy (SEM). The HAP surfaces were characterized by X-ray photoelectron spectroscopy (XPS) and secondary ion mass spectroscopy (SIMS). A layer covered with packed particles was found in contrast to the tablet structure typical of nacre surfaces. XPS and SIMS indicated that the mineral phase of the nacre surface had converted from an aragonite phase to an HAP phase. Fourier transform infrared spectroscopy (FTIR) showed that phosphate (PO(4)) bands appeared after nacre was soaked in a phosphate buffer and the intensity of the PO(4) bands increased with exposure time. The FTIR was consistent with XPS and SIMS results. We suggest that this surface reaction occurs by a dissolution-precipitation mechanism. Calcium ions are released from the nacre surface, react with phosphate ions in the buffer solution, and then precipitate as HAP on the nacre surface.     

Relationship between a novel human cytotoxin (factor 2) produced by a B cell line (Karpas 160) and phorbol-myristate-acetate-associated cytotoxicity.

We found that 160b cells, a subclone of Karpas 160 human B cell line, spontaneously secreted a novel cytotoxin, factor 2 (F2). F2 was also extracted from the cells by 60% ammonium sulphate, 0.5% CHAPS and 0.28% Triton X-114. We were able to show that phorbol myristate acetate (PMA) greatly enhanced the production of F2, and PMA may also account for part of the putative F2 cytotoxic activity to K562 cells in crude preparations. We compared the cytotoxic effect of F2 with PMA-associated F2-like cytotoxicity to K562 cells as well as the adequacy of our schemes to purified F2 with regard to its separation from PMA. We found that it was possible to separate PMA from F2 preparations by gel filtration and Rotofor preparative isoelectric focusing. The fate of PMA was also monitored with 3H-PMA and chromatographic profiles of 3H-PMA were studied using DE52 and gel filtration chromatography. We were able to establish that less than 2.9% of the cytotoxicity to K562 was due to PMA. We also found that the radioactive peaks and cytotoxicity peaks to K562 were not well correlated, indicating that the cytotoxicity was not mainly due to remaining PMA. Activated charcoal removed virtually all F2 and PMA but not tumour necrosis factor activity. Our results also showed that cytotoxicity to K562 resulting from F2 or PMA-associated proteins had different physicochemical properties, indicating that they are different molecular entities. These findings are consistent with the earlier observation that 160 cells produce F2 spontaneously and that PMA can amplify its production significantly.