闭角型青光眼患者红细胞免疫功能与EPO和ET-1的相关性

目的：探讨闭角型青光眼患者红细胞免疫功能与血清促红细胞生成素(EPO)和血浆内皮素-1(ET-1)的相关性。

方法：选取2017-06/10期间我院收治的闭角型青光眼患者30例(病例组)与眼部正常者30例(对照组)为研究对象。测定并比较两组受试者红细胞免疫功能、血清EPO和血浆ET-1浓度,分析之间的相关性。

结果：病例组受试者红细胞C3b受体花环率明显低于对照组(10.81%±2.01% vs 18.06%±3.44%),红细胞免疫复合物花环率明显高于对照组(17.21±3.49% vs 11.74±2.14%),血清EPO浓度明显高于对照组(26.10±5.22 mU/mL vs 22.68±4.06mU/mL),血浆ET-1浓度明显高于对照组(70.85±7.16ng/L vs 58.43±5.09ng/L)。闭角型青光眼患者红细胞C3b受体花环率与血清EPO浓度呈显著正相关(r=0.271,P<0.05),与血浆ET-1浓度无明显相关性。

结论：闭角型青光眼患者红细胞免疫功能与血清EPO浓度呈正相关。     

气道压力释放通气对急性呼吸窘迫综合征患者呼吸机相关性肺损伤的影响

目的 通过测定机械通气对急性呼吸窘迫综合征（Acute Respiratory Distress Syndrome,ARDS）患者支气管肺泡灌洗液（BronchoAlveolar Lavage Fluid,BALF）与血清中肺损伤标记物的变化,明确气道压力释放通气（Airway Pressure Release Ventilation,APRV）与小潮气量保护性通气（Low Tidal Volume Protective Ventilation,LTV）对ARDS患者呼吸机相关性肺损伤（Ventilator-Induced Lung Injury,VILI）的影响。方法 收集深圳大学总医院及海南省人民医院2018-01至2019-05内ARDS住院患者40例,以随机数字法分为两组：A组21例,B组19例,A组先予APRV通气24 h,随后转为LTV 24 h;B组先予LTV 24 h,再转为APRV 24 h,比较干预治疗0 h、24 h、48 h两组患者氧合指数、呼吸力学、BALF及血清中肺泡表面活性蛋白（Pulmonary Surfactant Protein D,SP-D）、重组...     

Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review

BackgroundPeriprosthetic osteolysis is a serious complication following total hip arthroplasty (THA). However, most orthopedic surgeons only focus on bone loss and hip reconstruction. Thus, it was required to understand the treatment algorithm for periprosthetic osteolysis integrally.Case PresentationA 52‐year‐old Asian male presented with chronic hip pain. A mass appeared on the medial side of the proximal left thigh at more than 20 years after bilateral THA. Radiographs revealed catastrophic periprosthetic osteolysis, especially on the acetabular side. Large amounts of necrotic tissue and bloody fluids were thoroughly debrided during revision THA. A modular hemipelvic prosthesis was used for revision of the left hip. Four years later, the patient presented with right hip pain, where a mass appeared on the medial side of the proximal right thigh. A primary acetabular implant with augment was used for revision of the right hip. Laboratory evaluation of bloody fluid retrieved from surgery revealed elevated levels of inflammatory markers.ConclusionInflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long‐term following THA. Therefore, in spite of revision THA, interrupting the cascade inflammatory might be the treatment principle for periprosthetic osteolysis.     

剖宫产术后再次妊娠阴道分娩的研究

随着剖宫产率的逐年上升,剖宫产术后再次妊娠率也随之增加.术后再次妊娠能否经阴道分娩已成为产科医生重视的问题.近年越来越多的研究从剖官产术后阴道分娩的适应证、禁忌证、高危因素、注意事项、缩宫素的应用、影响因素、优越性及危险性等方面探讨阴道试产的可行性.研究证实,剖宫产史并非再次妊娠剖宫产的绝对指征,剖宫产术后阴道分娩与再次剖宫产相比利多弊少,选择合适的病例进行阴道试产是安全可行的.     

Target nursing care on anxiety and depression in patients with gallbladder cancer during perioperative period

Background:This study retrospectively investigated the effects of target nursing care (TNC) on anxiety and depression in patients with gallbladder cancer (GBC) during the perioperative period.Methods:This retrospective study analyzed the data of 80 patients with GBC during perioperative period. These records were divided into an intervention group (n = 40) or a control group (n = 40). All 80 patient records in both groups were administered routine nursing care (RNC). The patients in the intervention group also underwent TNC. The primary outcomes were depression (measured using the Hamilton Depression Scale, HAMD) and anxiety (assessed using the Hamilton Anxiety Scale, HAMA). The secondary outcomes were quality of life (assessed using the 36-Item Short Form Health Survey, SF-36) and adverse events. We collected and analyzed the outcome data before and after treatment.Results:After treatment, patients in the intervention group showed more promising effects on depression (HAMD, P < .01) and anxiety (HAMA, P < .01) than those in the control group did. However, there were no significant differences in the quality of life before and after treatment. No TNC- or RNC-associated adverse events were reported in patient records.Conclusion:This study found that TNC was more effective than RNC in relieving depression and anxiety. Future studies should be conducted to validate the present findings.     

Intraocular lens-blocking technique for intraocular foreign body removal

The aim of this study was to describe a novel technique for intraocular foreign body (IOFB) removal. Phacoemulsification was performed in all patients, followed by a complete microincision vitrectomy to free all tissues surrounding the IOFB. A three-piece intraocular lens (IOL) was placed in the capsular bag, and an opening was made in the upper center of the capsule. The IOFB was removed and lifted to the anterior chamber through the capsular opening and IOL edge. The IOFB was confined to the anterior chamber by the IOL, and then easily extracted through the main corneal incision. The technique was adopted in six eyes of six patients. All IOFBs were removed successfully in all patients without intraoperative or postoperative complications. The IOL-blocking technique is a useful approach for IOFB removal.     

继续教育对基层医务人员有关慢性阻塞性肺疾病相关认知的影响研究

目的了解基层医务人员对慢性阻塞性肺疾病的认知、过去一年继续教育情况及继续教育对慢性阻塞性肺疾病相关认知的影响。方法选取2019年10月1—31日2372名来自社区卫生服务中心(站)、乡镇卫生院和村卫生室的医务人员自愿在线填写了调查问卷,内容包括个人基本特征,对慢性阻塞性肺疾病危险因素和诊断的认知及继续教育情况。结果基层医务人员熟知吸烟、二手烟、长期呼吸道疾病史、室外空气污染和职业性粉尘等危险因素,但是对室内空气污染和遗传因素认知不足,并且仍有12.1%的基层医务人员知晓吸烟是危险因素,但正在吸烟或戒烟6个月以内。80%的调查对象知道肺功能是诊断慢性阻塞性肺疾病的金标准,但仅60.7%的调查对象能正确判读肺功能结果。过去一年中仅44.3%的基层医务人员接受了相关继续教育。继续教育对提升基层医务人员慢性阻塞性肺疾病危险因素和诊断相关认知的影响差异有显著性(OR=1.524,95%CI 1.289～1.802;OR=1.528,95%CI 1.289～1.812)。结论加大继续教育的惠及范围,有针对性地加强基层医务人员对室内空气污染和遗传因素的认知,同时在基层配备肺功能仪的前提下,开展以实操...     

微格教学法在口腔癌游离皮瓣修复术后临床护理教学中的应用

目的:观察微格教学法应用于口腔癌病人游离皮瓣修复术后临床护理的教学效果。方法:选取2018年1月—2020年12月,山西省某三级甲等综合医院和山西省某三级甲等中医院收治的80例口腔癌病人,采用随机数字表法分为试验组和对照组,各40例。对照组护士接受常规护理教学方法,试验组护士接受微格教学法,学习掌握口腔癌病人游离皮瓣修复术后护理。评价两组护士实践能力以及病人并发症发生率、住院时间及护理满意度。结果:试验组护士无菌操作、气道管理、吸痰法、导尿术、鼻饲法及静脉输液实践操作考核成绩均高于对照组,差异有统计学意义(P<0.05),试验组病人并发症发生率低于对照组,住院时间短于对照组,病人满意度高于对照组,差异均有统计学意义(P<0.05)。结论:微格教学法应用于口腔癌游离皮瓣术后护理的教学中,能更好地指导护士进行正确地护理,提高病人满意度,缩短病人住院时间,降低病人并发症发生率,促进病人康复。     

ROC曲线评价尿微量白蛋白和血清Cystatin C在2型糖尿病早期肾损伤中的诊断价值

目的 应用ROC曲线(relative operating characteristic)评价尿微量白蛋白(mAlb)及Cystatin C在糖尿病肾病的早期诊断价值.方法 对152例尿常规检查蛋白阴性的糖尿病患者应用单光子发射计算机断层摄影显像技术行肾动态显像和肾小球滤过率检查,并与尿微量白蛋白及Cystatin C行ROC分析.结果 Cystatin C临界点取1.3 mg/L时ROC曲线下面积0.893,敏感性78.26%,特异性84.9%,阳性似然比5.17,阴性似然比0.52,Youden指数0.736,比数积52.41.尿微量白蛋白临界点取15.6 mg/L时,ROC曲线下面积0.681,敏感性60.87%,特异性79.2%,阳性似然比3.23,阴性似然比0.27,Youden指数0.564,比数积46.38.结论 血清Cystatin C较尿微量白蛋白在2型糖尿病肾病早期损伤诊断中有更好的灵敏性和特异性.     

体检人群尿微量白蛋白/肌酐比值参考区间初步分析

目的 探讨并建立体检人群尿微量白蛋白/肌酐比值(UACR)的参考区间.方法 选取北京同仁医院健康体检人群1820例留取的随机中段尿,检测其尿微量白蛋白与尿肌酐并计算尿微量白蛋白与肌酐比值,对其结果进行回顾性分析,观察不同组别结果的分布特征.结果 依性别分组,UACR值男性组明显低于女性组(P<0.01),依年龄分为以下...