诊断GERD必要的特殊检查

目前,pH监测是GERD（包括NERD在内）诊断的“金标准”。其它的辅助性诊断方法有Bernstein试验、PPI试验、食管内压检测、x线检查、闪烁照相术、Bilitec检测和阻抗法检查等均可依情选用。     

尿道狭窄的内切开治疗

尿道狭窄是泌尿外科常见病,治疗方法多种多样,疗效各异。我院从1993~2005年应用尿道内切开治疗尿道狭窄30例,效果满意。现报告如下。1资料与方法1.1临床资料本组30例,均为男性,平均年龄42.8(20~74)岁。前列腺术后并发尿道狭窄8例,骨盆骨折尿道会师术后尿道狭窄10例,骨盆骨折致尿道损伤单纯膀胱造瘘术后尿道狭窄2例,炎症性尿道狭窄6例,骑跨伤并尿道狭窄4例,病程2个月~5年,狭窄长度0.5~2.5cm。1.2手术方法术前均行尿道造影明确狭窄程度、长度及部位,采用连续硬膜外麻醉,取截石位,置入F210°尿道内切开镜,边冲洗边将尿道镜插至狭窄处远端,接监…     

尿激酶原联合尼可地尔术前冠状动脉灌注对ST段抬高型心肌梗死患者经皮冠状动脉介入术后心功能和炎性反应及预后的影响

目的 探讨尿激酶原联合尼可地尔对ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)术后心功能、炎性反应和不良心血管事件(MACE)发生的影响.方法 入选2018年11月～2019年11月在我院心内科收治的126例行PCI的STEMI患者为研究对象,按照随机数表法分为观察组和对照组,各63例,对照组给予...     

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??Objective??To investigate the efficacy and safety of propofol used as anesthesia and deep sedation during flexible bronchoscopy in children. Methods??The clinical data of 206 children with atelectasis who underwent flexible bronchoscopic alveolar lavage in the Endoscopy Room of the Respiratory Department of Hebei Children’s Hospital from January 2016 to January 2017 were retrospectively analyzed. Children for ASA??/?? level were divided into two groups according to the sedation method :there were 106 cases in the propofol group??2 mg/kg?? and 100 cases in the midazolam group??0.1 mg/kg??. To compare the onset time of anesthetict??heart rate??HR????respiratory rate??RR????mean arterial pressure??MAP????percutaneous oxygen saturation??SPO2?? before and after anesthesia induction??T0??T1????during endoscopy placement??T2??and after awakening??T3?? at 4 time points??operative duration??the waked duration of postoperation??the rate of adverse reactions??hiccups??respiratory depression??in the operation and Ramsay score between two groups. All data were analyzed by SPSS 20.0 statistical software. Results????1??There were statistically significant differences at the onset time of anestheticts??operative duration and the rate of side-effects between the two groups??P??0.05??. There was no statistical differences in awake time??P??0.05??.??2??There was no significant difference in MAP or SPO2 at time points of T0??T1??T2??T3??P??0.05????whereas the difference in HR and RR at time points of T1??T2??T3 between the two groups was statistically significant??P??0.05??. ??3??The sedative effect of propofol group was significantly better than that of midazolam group in Ramsay sedative scoring. Conclusion??Propofol used for anesthesia and deep sedation works fast??safely and effectively in flexible bronchoscopy for children??the time to gain consciousness is short??the operation time is short and there is fewer side effects??which is worth promoting.     

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??Objective    To evaluate the cytotoxicity?? biocompatibility and biological safety of PGMA pre-impregnated quartz fiber in vitro?? providing scientific basis for clinical application. Methods    According to standard of GBT16886.5-2003 and YYT0268-2008 documents?? the cellular cultivation and cytotoxicity test in vitro were conducted to evaluate the target materials on the morphology?? growth and proliferation of cultured cells ??L929 and GE1??. Results        The range of cell relative growth rate ??RGR?? of 50% and 100% extraction of non-polymerized composite were 44.59%-65.66% ??L929?? and 52.06%-62.86% ??GE1???? and the cytotoxicity was grade 2-3. The range of cell relative growth rate ??RGR?? of 50% and 100% extraction of polymerized composite were 90.56%-100.89% ??L929?? and 89.99%-101.21% ??GE1???? and the cytotoxicity was grade 0-1. Conclusion    Polymerized PGMA pre-impregnated quartz fiber is safe and fit for the clinical application.     

单中心近10年腹主动脉瘤1246例流行病学研究

目的 回顾性分析近10年中国医科大学附属第一医院收治的腹主动脉瘤（AAA）病人的流行病学特点，为研究近10年AAA流行病学变化趋势，以及为AAA的进一步预防和诊治提供依据。方法 纳入自2011年1月至2020年12月中国医科大学附属第一医院诊治的1246例AAA病人的病案资料，回顾性分析包括病人年龄、性别、就诊时间、就诊科室、首发症状、住院时间、住院费用、术式选择等信息，分析近10年AAA流行病学变化特点。结果 入院病人平均年龄为（66.9±10.5）岁，男女占比约为4∶1。男性AAA病人以同型半胱氨酸升高为主，女性以血脂升高为主。AAA病人的主要合并症为3级高血压（41.9%）、冠心病（31.1%）和合并髂动脉瘤（25.8%）。男性AAA合并髂动脉瘤比率明显高于女性（27.8% vs.17.8%，P＜0.01）。72.7%的AAA病人首诊原因为体检发现，其次是AAA破裂（18.7%）。AAA病人急诊与门诊就诊例数呈逐年升高态势，急诊与门诊就诊占比约为2∶3。65~69岁为现阶段住院病人主要年龄段。各年份男性占比约为80%，年龄段65~69岁为男性占比可达近90%。各年份腔内修复术（EVAR）是AAA的主要治疗方式，行EVAR治疗病人的例数和比例总体趋势逐年增加，行EVAR治疗的占比随病人年龄增加而逐渐增大。近10年AAA病人的病死率呈降低趋势，2015年后病死率总体维持在2%～3%，以男性为主，年龄段70~74岁的病死率最高为5.8%。AAA病人平均住院（17.0±16.4）d，平均住院费用为（11.3±10.7）万元。结论 近10年AAA住院病人有逐年增高趋势，主要患病人群为年龄＞60岁男性，男女临床特点有较大差异。采用EVAR治疗的占比逐年增加。对于老年AAA人群，尤其是年龄段65~69岁男性AAA病人，在AAA的防治过程中应给予更多关注。     

晚期肿瘤患者营养状况与焦虑、抑郁的相关性分析

目的 研究晚期肿瘤患者营养状况与焦虑、抑郁不良情绪的相关性。方法 筛选2019年1月至2020年1月在重庆市 巴南区人民医院肿瘤科住院的晚期肿瘤患者，调查营养风险筛查2002（NRS 2002）评分、体质指数（BMI）、血液学指标（总蛋白、 白蛋白、血红蛋白）；用住院患者焦虑抑郁量表（HADS）对患者的焦虑、抑郁情况进行评估；分析晚期肿瘤患者营养状况与焦 虑、抑郁之间的关系。结果 1501例晚期肿瘤患者中 22.39%（336/1501）的患者 BMI<18.5 kg/m2，NRS 2002≥3 分发生率为 56.70%（851/1501）。存在营养风险患者总蛋白、白蛋白、血红蛋白以及BMI更低；比较不同癌种，晚期消化道肿瘤患者营养不 足及存在营养风险比例最高。焦虑症状阳性率为78.61%（1180/1501），抑郁症状阳性率为69.62%（1045/1501），NRS 2002评分 与焦虑、抑郁呈正相关；BMI与焦虑、抑郁呈负相关。结论 晚期肿瘤患者营养不足、营养风险发生率高，焦虑、抑郁不良情绪普 遍，NRS 2002评分越高，BMI越低，焦虑抑郁程度越重。针对营养风险高、营养不足的晚期肿瘤患者我们应加强营养治疗以及 对焦虑、抑郁不良情绪的干预。     

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??Analysis on clinicopathological characteristics and prognostic factors of breast cancer in young women GAO Guo-xuan, YU Da-peng, ZHANG Hong, et al. Breast Disease Center, Peking University First Hospital, Beijing 100034, China
Corresponding author: YE Jing-ming, E-mail: md_ye@sina.com
GAO Guo-xuan and YU Da-peng contributed qually to this work
Abstract Objective To explore the clinical and pathological characteristics of breast cancer in young women????35 years old?? and to analyze their association with treatment and prognosis. Methods The records of 110 breast cancer in young women treated from January 2008 to December 2014 were reviewed. Statistical methods were used for analyzing the correlation between clinical and pathological characteristics such as T-stage, N-stage, IHC (Immunohistochemistry) and the morbidity as well as prognosis. The clinical and pathological characteristics of breast cancer in young women were compared with patients ≥35years using the χ2 test. Kaplan-Meier curves were reported for OS (overall survival) and PFS (progression-free survival), and the log-rank test was used to compare the difference in groups. Cox proportional models were fitted for multivariate analysis. Results All of the patients were women and the median age was 32 (21 to 34)-year old, accounted for 5.71% (110/2189) of the breast cancer treated at the same period. The morbidity of Luminal A-like and Luminal B-like(HER2 negative) in ??35-year group were higher than ≥35-year group(P??0.001). Patients??35 years chose breast-conserving or mastectomy combined reconstruction surgery were much more than older group(P??0.001). The median follow-up duration of breast cancer in young women was 31.5 months, the 5-year OS rate was 93.3% and the 5-year PFS rate was 89.3%. It is concluded that the N-stage??P??0.001??and M-stage??P??0.001??were the influencing factors of the PFS by multivariate Cox regression analysis. The N-stage??P??0.001??was the influencing factor of OS. Conclusion Breast cancer in young women had special clinical and pathological characteristics. The endocrine therapy should be strengthened as well as protecting fertility. Patients??35 years demanded high quality of life and appearance, and the option of surgical treatment should be personalized.     

联盟实体“玩”投资

据今年1月14日中国医药物资协会最新发布的《2011中国省级药店联盟发展状况》蓝皮书显示,2011年省级药店联盟共增加6家,联盟成员单位则增加至300家,门店数量增加了10527家,省级联盟的总数量达到了14家.而在这些统计的背后,还有一个更重要的关乎联盟成长的数字,那就是在这14家联盟当中,已经有6家成立了实体公司.     

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??Multi-disciplinary team and conversion therapy for colorectal cancer with unresectable liver metastases??A report of 86 patients WEI-Ye*??YE Qing-hai??YU Yi-yi??et al. *Department of General Surgery, Zhongshan Hospital??Fudan University??Shanghai200032??China
Corresponding author??QIN Xin-yu??E-mail??qin.xinyu@zs-hospital.sh.cn
Abstract Objective To analyze safety and effect of the conversion therapy for initially unresectable colorectal liver metastases (CLMs) under the guidance of multi-disciplinary team (MDT). Methods The retrospective analysis was conducted for 86 patients with unresectable CLMs received MDT management and arrived conversion therapy successfully from January 2008 to December 2011 in Zhongshan Hospital of Fudan University. The perioperative and survival outcomes??prognostic factors were evaluated. Results During the mean follow-up of 41 months (24-68 months), according to the finding time of liver metastases of 86 patients??recurrence events were 73 patients??and 39 patients died. The 1 year??2 year and 3 year overall survival rate (OS) was 90.6%??75.6% and 65.1% respectively. The median OS time was ??47.5±3.1?? months. The 1 year??2 year and 3 year disease free survival rate (DFS) was 72.1%??48.8% and 31.4% respectively. The median DFS time was ??22.0±2.9?? months. The OS and DFS were no significant difference when compared 86 patients with initially unresectable CLMs successfully arrived conversion therapy with 99 patients with initial resectable CLMs??P >0.05??. The perioperative mortality rate was 1.5%??and operative complication rate was 24.4%. Tumor regression grade and early tumor shrink could predict the prognosis of CLM patients received conversion therapy. Conclusion The conversion therapy under the guidance of MDT mode is safe and effective for unresectable CLMs. The mid-term survival rate is similar with initially resectable CLMs??and long-term survival is expected.