脓毒性休克液体复苏与监测的研究进展

脓毒性休克是脓毒症合并出现的严重循环障碍和细胞代谢紊乱,有较高病死率.合理的液体复苏和及时的病情监测对于脓毒性休克患者的预后有重要意义.了解该领域最新研究进展,有助于提高对脓毒性休克患者的救治成功率.笔者现对脓毒性休克患者液体复苏与监测的最新研究和临床实践进行综述,为今后这类患者的液体复苏及监测提供一定参考,以改善脓毒性休克患者的器官功能和临床预后.     

微波治疗在高龄腹股沟疝患者皮内缝合中的效果观察

目的：探讨微波治疗仪在皮内缝合的高龄腹股沟患者的临床疗效。方法回顾性分析2010年6∽12月,南京大学医学院附属南京鼓楼医院收治的60∽80岁腹股沟患者50例为试验组,2005年6∽12月收治的60∽80岁腹股沟患者48例为对照组,试验组手术切口为皮内缝合,术后微波治疗仪治疗2次／d,对照组常规方法。观察二组患者术后恢复的情况：切口疼痛程度、住院时间、切口感染率及患者满意度。结果二组患者在切口疼痛程度、住院时间、切口感染率、患者满意度差异有统计学意义（t＝7．695、6．707,χ2＝9．363、6．477,P＝0．000、0．000、0．000、0．010）,二组患者切口愈合情况差异无统计学意义（t＝8．454,P＝0．123）。结论微波治疗仪治疗皮内缝合的高龄腹股沟疝,恢复快,切口感染率低、出院早,患者满意度高。     

Bounds on sufficient-cause interaction

A common goal of epidemiologic research is to study how two exposures interact in causing a binary outcome. Sufficient-cause interaction is a special type of mechanistic interaction, which requires that two events (e.g. specific exposure levels from two risk factors) are necessary in order for the outcome to occur. Recently, tests have been derived to establish the presence of sufficient-cause interactions, for categorical exposures with at most three levels. In this paper we derive prevalence bounds, i.e. lower and upper bounds on the prevalence of subjects for which sufficient-cause interaction is present. The derived bounds hold for categorical exposures with arbitrary many levels. We apply the bounds to data from a study of gene–gene interaction in the development of Rheumatoid Arthritis. We provide an R-program to estimate the bounds from real data .     

尿激酶疏通深静脉导管血凝性堵管循证护理效果观察

目的　观察在尿激酶疏导深静脉导管血凝性堵管中实施循证护理的方法及效果。方法　选取2019年1月至2021年5月间在广州市胸科医院接受各种深静脉导管治疗患者720例为研究对象,其中62例为外周静脉穿刺中心静脉置管（PICC）和中心静脉导管（CVC）血凝性堵管,男37例,女25例,年龄22～73（41.53±4.10）岁。根据研究方案,其中31例采用三通开关负压技术通管,31例采用2 ml注射器负压技术通管,均采取尿激酶疏通方案并实施循证护理干预,所有数据采用XLS统计并采用SPSS 18.0软件总结分析62例患者的导管再通率及凝血功能及血小板变化情况。结果　经实施循证护理干预,三通开关负压疏通法复通率达到83.87%（26/31）,2 ml注射器负压疏通法复通率达到100.00%（31/31）,两种疏通方法比较,差异有统计学意义（χ²=33.055,P<0.05）。凝血功能指标中D2聚体指标正常者9例,偏高者53例;纤维蛋白原指标正常者12例,偏高者50例;血小板检测结果显示正常者50例,偏高者9例,偏低者3例。未对临床治疗产生影响,未对导管功能造成影响,未造成导管损伤。结论　经长期临床实践研究证实,实施循证护理可显著提升PICC、CVC等深静脉导管的再通率,保障临床治疗顺利实施,具有较高的临床推广应用价值。     

消化性溃疡合并上消化道出血影响因素分析

目的探讨消化性溃疡合并上消化道出血的影响因素。方法收集笔者所在医院315例消化性溃疡合并上消化道出血患者为研究组;同期门诊选取656例消化性溃疡无上消化道出血并发症的患者为对照组。再根据研究组中HP阳性者根除HP后随访2年,观察上消化道再出血情况。所有入选患者均统计幽门螺杆菌检测结果、NSAIDs服用、性别、年龄、饮酒史、血小板计数等情况。结果 NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）;年龄对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.01）;合用不同种类NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）。结论 NSAIDs增加消化性溃疡合并上消化道出血的风险;年龄与消化性溃疡合并上消化道出血相关,大于60岁的老龄消化性溃疡患者更易合并上消化道出血;合用不同种类NSAIDs较单用NSAIDs者消化性溃疡更易合并上消化道出血。     

Time trends in risk and risk determinants of non-Hodgkin lymphoma in solid organ transplant recipients

Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk was eightfold increased (RR 7.9; 95% confidence interval [CI] 6.6-9.4), and increased risks persisted after ≥15 years of follow-up among kidney (6.1; 95% CI 3.5-10) and nonkidney recipients (44; 14-103). Among nonkidney recipients, NHL risk was lower in the 2000s compared with the 1990s (0.5; 95% CI 0.3-1.0; p = 0.04). A high average dose of antithymocyte immunoglobulin (ATG) conferred an eightfold increased risk of NHL (OR 8.5; 95% CI 1.9-38). To conclude, posttransplant NHL risk decreased during the last decade among nonkidney recipients, possibly because of a more careful use of ATG, the introduction of new drugs, or both.     

Regions of homozygosity in three Southeast Asian populations

The genomes of outbred populations were first shown in 2006 to contain regions of homozygosity (ROHs) of several megabases. Further studies have also investigated the characteristics of ROHs in healthy individuals in various populations but there are no studies on Singapore populations to date. This study aims to identify and investigate the characteristics of ROHs in three Singapore populations. A total of 268 samples (96 Chinese, 89 Malays and 83 Indians) are genotyped on Illumina Human 1 M Beadchip and Affymetrix Genome-Wide Human SNP Array 6.0. We use the PennCNV algorithm to detect ROHs. We report an abundance of ROHs (≥500 kb), with an average of more than one hundred regions per individual. On average, the Indian population has the lowest number of ROHs and smallest total length of ROHs per individual compared with the Chinese and Malay populations. We further investigate the relationship between the occurrence of ROHs and haplotype frequency, regional linkage disequilibrium (LD) and positive selection. Based on the results of this data set, we find that the frequency of occurrence of ROHs is positively associated with haplotype frequency and regional LD. The majority of regions detected for recent positive selection and regions with differential LD between populations overlap with the ROH loci. When we consider both the location of the ROHs and the allelic form of the ROHs, we are able to separate the populations by principal component analysis, demonstrating that ROHs contain information on population structure and the demographic history of a population.     

Heritability, Assortative Mating and Gender Differences in Violent Crime: Results from a Total Population Sample Using Twin, Adoption, and Sibling Models

Research addressing genetic and environmental determinants to antisocial behaviour suggests substantial variability across studies. Likewise, evidence for etiologic gender differences is mixed, and estimates might be biased due to assortative mating. We used longitudinal Swedish total population registers to estimate the heritability of objectively measured violent offending (convictions) in classic twin (N = 36,877 pairs), adoptee-parent (N = 5,068 pairs), adoptee-sibling (N = 10,610 pairs), and sibling designs (N = 1,521,066 pairs). Type and degree of assortative mating were calculated from comparisons between spouses of siblings and half-siblings, and across consecutive spouses. Heritability estimates for the liability of violent offending agreed with previously reported heritability for self-reported antisocial behaviour. While the sibling model yielded estimates similar to the twin model (A ≈ 55%, C ≈ 13%), adoptee-models appeared to underestimate familial effects (A ≈ 20–30%, C ≈ 0%). Assortative mating was moderate to strong (r _spouse = 0.4), appeared to result from both phenotypic assortment and social homogamy, but had only minor effect on variance components. Finally, we found significant gender differences in the etiology of violent crime.