营养风险与腹膜后肿瘤患者住院时间的相关性研究

目的 探讨营养风险与腹膜后肿瘤患者住院时间的相关性。方法 采用回顾性研究，选取2012年1月至2018年12月四川大学华西医院血管外科新入院腹膜后肿瘤患者60例，采用营养风险筛查表评估患者营养风险，收集患者体质指数、围术期血红蛋白和白蛋白水平、住院天数、术后恶心呕吐发生情况、术后排气、排便时间和首次进食时间。采用单因素分析比较不同患者住院时间，采用多重线性逐步回归分析患者住院时间的影响因素。结果 纳入的60例腹膜后肿瘤患者中，40例患者（66.7%）术前存在营养风险，52例患者（86.7%）术后存在营养风险；单因素分析显示，患者术前、术后营养风险 （术前P<0.001，术后P=0.043）、术前白蛋白 （P=0.019）、术后血红蛋白 （P=0.019）、术后白蛋白（P=0.025） 水平以及术后恶心呕吐 （P=0.001） 均会影响患者的住院时间；患者住院时间与围术期营养风险筛查工具评分、术后首次进食时间、术后排气时间和排便时间具有相关性，且相关性强（r=0.759~0.770； P<0.01）；多因素分析显示术前营养风险是腹膜后肿瘤患者住院时间的重要预测因素（β=0.399）。结论 术前营养风险是腹膜后肿瘤患者住院时间的预测因子。     

犀角地黄汤加味通过NF-κB信号通路对败血症导致的炎症和肺损伤的影响

目的研究犀角地黄汤加味对败血症导致的炎症和肺损伤的影响,探讨其对核转录因子-κB(NF-κB)信号通路的调控作用。方法制备败血症小鼠模型,测量血清中乳酸脱氢酶(LDH)反映败血症小鼠的器官损伤程度;HE染色观察败血症小鼠肺组织病理学变化;酶联免疫吸附法测定肺组织中细胞因子白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、小鼠巨噬细胞炎症蛋白-2(MIP-2)水平;免疫组化法检测肺组织中粒细胞分化抗原-1(Gr-1)的阳性表达;TUNEL法分析败血症小鼠肺中的TUNEL阳性细胞数量;Western blotting法检测肺组织中NF-κB p65蛋白表达。结果犀角地黄汤加味减轻了败血症小鼠的炎症反应和肺损伤程度,以及嗜中性粒细胞浸润。犀角地黄汤加味显著减少了败血症小鼠肺中的TUNEL阳性细胞数量。结论犀角地黄汤加味可以减轻败血症导致的炎症和肺损伤,可能是通过抑制NF-κB信号通路发挥作用。     

渐进性关腹术：一种新的暂时性腹腔关闭术后早期确定性腹壁关闭技术

正损害控制性剖腹术提出已经近30年,随着负压封闭引流辅助的暂时性腹腔关闭(temporary abdominal closure,TAC)技术的发展和成熟,TAC显著改善了腹腔间隙综合征、严重腹部创伤和腹腔感染等患者的全身血液灌注和脏器功能,降低了病死率~([1-2])。虽然临床高度重视开放腹腔术后的早期腹部切口确定性关闭,但仍然有10%～25%的患者需要植皮形成计划性腹疝(planned ventral hernia,PVH)~([3]),这些患者需要在6～12个月后行确定性腹壁重建,常需应用腹壁分离技术~([4])或生物补片~([5])等人工材料,可能发生肠瘘、切口感染等并发症,     

Effects of Price,Information, and Transactions Cost Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Randomized Experiment in the Philippines

A cluster randomized experiment was undertaken testing two sets of interventions encouraging enrollment in the Individually Paying Program (IPP), the voluntary component of the Philippines' social health insurance program. In early 2011, 1037 unenrolled IPP‐eligible families in 179 randomly selected intervention municipalities were given an information kit and offered a 50% premium subsidy valid until the end of 2011; 383 IPP‐eligible families in 64 control municipalities were not. In February 2012, the 787 families in the intervention sites who were still IPP‐eligible but had not enrolled had their vouchers extended, were resent the enrollment kits and received SMS reminders. Half the group also received a ‘handholding’ intervention: in the endline interview, the enumerator offered to help complete the enrollment form, deliver it to the insurer's office in the provincial capital, and mail the membership cards. The main intervention raised the enrollment rate by 3 percentage points (ppts) (p = 0.11), with an 8 ppt larger effect (p < 0.01) among city‐dwellers, consistent with travel time to the insurance office affecting enrollment. The handholding intervention raised enrollment by 29 ppts (p < 0.01), with a smaller effect (p < 0.01) among city‐dwellers, likely because of shorter travel times, and higher education levels facilitating unaided completion of the enrollment form. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.     

Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study

ABSTRACT

Objectives: Limited evidence has suggested that cefoperazone-sulbactam causes coagulation disorders and bleeding.

Methods: The authors conducted a retrospective study to compare patients receiving cefoperazone-sulbactam versus those treated with cefoperazone-tazobactam or ceftazidime. Propensity-score matching was used to explore whether treatment with cefoperazone-sulbactam increased the risk of prothrombin time (PT) prolongation, coagulation disorders, and bleeding, or decreased platelets (PLT).

Results: The cohort included 23,242 patients. Among patients receiving cefoperazone-sulbactam, the risk of PT prolongation, coagulation disorders, decreased PLT, and bleeding was 5.3%, 9.2%, 15.7%, and 4.2%, respectively. Propensity-score matching analyses suggested that cefoperazone-sulbactam increased the risk of PT prolongation (aOR 2.26, 95% CI 1.61–3.18), coagulation disorders (aOR 1.81, 95% CI 1.43–2.30), and decreased PLT (aOR 1.46, 95% CI 1.25–1.72), but not increase bleeding (aOR 1.05, 95% CI 0.79–1.40) compared with ceftazidime. Patients receiving cefoperazone-sulbactam had higher risk of PT prolongation (aOR 1.53, 95% CI 1.11–2.10), coagulation disorders (aOR 1.53, 95% CI 1.21–1.95), but not decreased PLT (aOR 0.93, 95% CI 0.81–1.07) or bleeding (aOR 1.11, 95% CI 0.87–1.42), compared with those receiving cefoperazone-tazobactam.

Conclusion: Cefoperazone-sulbactam may be associated with a higher risk of PT prolongation and coagulation disorders compared with cefoperazone-tazobactam and ceftazidime.     

WT1基因与急性髓系白血病的预后及主动特异性免疫治疗的研究进展

WT1基因位于人类染色体11p13，在80%的急性髓系白血病（acute myeloid leukemia，AML）患者中高表达，是AML预后不良的分子标志，可作为AML预后评估和微小残留病变（minimal residual disease，MRD）监测的有效指标。由于WT1在AML中均有异常高表达，故认为是一种AML抗原，可作为特异性免疫治疗的新靶点。一些小规模的临床试验证实以WT1为靶点的免疫治疗是有效的、安全的，这些免疫治疗可作为那些有高危复发风险及初始标准化疗失败的AML患者的辅助治疗。本文就近几年WT1与AML的预后及有关以WT1为靶点的主动特异性免疫治疗的研究进展予以综述。     

鼻内镜微波凝固切断筛前神经治疗变应性鼻炎疗效观察

目的观察微波凝固筛前神经治疗常年变应性鼻炎的疗效。方法26例确诊为变应性鼻炎的患者在鼻内镜引导和局麻下开放前组筛房，暴露筛前血管神经骨管，微波探针接触凝固。结果术后随访1年，其中显效16例，占61．5％，有效6例，占23％，无效4例占，15．5％，总有效率84．5％。结论鼻内镜微波凝固筛前神经治疗变应性鼻炎定位准确、创伤小、术后疗效好。