舌癌VEGF-C表达与颈淋巴结转移的关系及其临床意义

目的 :研究淋巴管生长因子 (VEGF C)表达与舌癌颈淋巴结转移的关系及其临床意义。方法 :收集一期行颈淋巴清扫术的舌癌病例 74例 ,行原发灶的VEGF C免疫组化染色及颈淋巴结的细胞角蛋白 (Cytokeratin ,CK)AE1/AE3免疫组化染色 ,观察原发灶的VEGF C表达情况及颈淋巴结转移情况。结果 :74例患者中 ,VEGF C高表达 39例 (5 2 .7% ) ,VEGF C低表达 35例 (47.3% ) ,有颈淋巴结转移者 38例 (5 1.4 % )。Fisher’s精确概率检验表明T1、T2期舌癌VEGF C表达和颈淋巴结转移密切相关。单因素Logistic回归表明T1、T2期舌癌淋巴结转移与VEGF C表达、T分期及N分期相关 ,而多因素Logistic回归表明T1、T2期舌癌淋巴结转移仅与VEGF C表达相关(P <0 .0 1)。结论 :VEGF C表达对评估早期舌癌颈淋巴结转移有重要意义。     

基于智慧医院建设优化服务质量的探索

围绕新形势下智慧医院建设的背景与现状,分析了智慧医院建设中存在的问题,提出了优化医院服务质量、改善就医环境体验的相关措施。     

Predictors of post coronary artery bypass grafting atrial fibrillation

Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312(33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement ( ≥40 mm), a history of AF, prolonged p-wave duration ( ≥ 120 ms) and increased number of grafts (≥3). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of β-blockers,hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.     

洗洁精对雄性大鼠生殖功能的影响

目的:评价家庭日常生活用洗洁精对雄性大鼠的生殖毒理。方法:将2种市售民用洗洁精(LB、BM)以1/万、1‰、1%3个剂量溶于饮水中,10周龄SD雄性大鼠自由摄取连续100d,以饮用正常水大鼠为对照组,进行比较分析。结果:LB和BM洗洁精3个剂量下,对动物生长发育和体重均无明显影响,对生殖系统的附睾和会阴复合体组织重量无明显影响,在1%剂量下睾丸组织明显减轻(P(0.05),比对照组分别下降12.3%和11.7%。2种洗洁精在3个剂量下的储精囊和前列腺均水肿,重量明显增加,表现出明显的剂量效应关系;精子功能分析中运动性、精子数目、精子形态等指标,均明显下降(P(0.05～0.0001),且表现出明显的剂量效应关系;睾丸组织形态分析显示LB在1%剂量下生精功能受到明显抑制和阻断。实验结果表明生殖毒性LB强于BM。结论:雄鼠在大剂量长期摄入LB和BM洗洁精可产生明显的生殖毒性作用。     

腹膜透析患者出院后延续护理需求与生活质量调查

目的:探讨腹膜透析患者出院后不同阶段的延续护理需求及生活质量的变化。方法:采用纵向调查法,于患者出院后第1、3、6及12个月分别使用自行设计的一般资料调查表、腹膜透析患者延续护理需求量表、肾脏病专用生活质量简表(KDQOL-36TM)开展4次调查。结果:腹膜透析患者出院后12个月内延续护理需求总分呈先上升后下降趋势,分别为(121.17±8.57)、(121.54±7.75)、(125.88±8.07)和(123.15±8.10)分,患者生活质量总分呈逐渐下降趋势,分别为(45.57±5.03)、(45.52±4.93)、(44.89±5.05)和(44.58±5.07)分。结论:腹膜透析患者不同阶段的延续护理需求及生活质量不同,医护人员应针对患者不同阶段的护理需求提供个性化的护理干预,提高患者生活质量。     

从虚痰瘀毒论治顽固性心力衰竭

顽固性心力衰竭的发生发展与虚、痰、瘀、毒密切相关。其病因病机演变极为复杂,主要表现为阳（气）虚、痰湿、血瘀、热毒等方面。从虚痰瘀毒论治顽固性心力衰竭,可根据其不同证候阶段所表现的阳（气）虚、痰湿、瘀血、热毒的轻重不同进行辨证治疗,从而找出虚—痰—瘀—毒的辨证及治疗规律。在顽固性心力衰竭早期多表现为气虚血瘀,痰浊痹阻;当顽固性心力衰竭形成后,则以瘀阻心脉为主要表现,且易形成痰瘀互结。虚、痰、瘀、毒四者并不是孤立存在的,而是具有密切的内在联系性。气虚血瘀、痰湿壅盛、热毒入络是形成顽固性心力衰竭的重要因素,益气温阳、祛痰利湿、化瘀通络、清热解毒是治疗顽固性心力衰竭的主要治法。     

Efficacy and safety of immunosuppressive therapies in the treatment of high-risk IgA nephropathy: A network meta-analysis

Background:IgA nephropathy (IgAN) is one of the significant contributing factors of end-stage renal disease (ESRD). It is reported that over half of patients with IgAN accompany multiple high-risk factors, which increase the risk of ESRD progression. Studies have shown that immunosuppressive agents were beneficial in high-risk IgAN, but the efficacy and safety have not been fully demonstrated yet. The present study aims to elucidate the efficacy of commonly used immunosuppressants in high-risk IgAN and their relative safety profiles via a network meta-analysis strategy.Methods:Randomized controlled trials (RCTs) eligible for this network meta-analysis were included to evaluate the efficacy and safety of different immunosuppressants for high-risk IgAN. Main outcomes and measures include incidence of renal composite end point, the rate of total remission, adverse events, and proteinuria. Besides, subgroup analysis and cluster analysis were carried out.Results:This network meta-analysis of 37 RCTs involving 3012 participants found that Mycophenolate mofetil (MMF) combined with corticosteroids (CS) was superior to other interventions in end point events and proteinuria. Cyclosporine A (CsA) plus CS was the best option for clinical remission rate, and supportive care (SC) was the safest treatment. Cluster analysis showed that MMF+CS and Leflunomide (LEF)+CS were best protocols in efficacy and safety. Subgroup analysis indicated the best benefits of MMF were presented among the Asian population, and the benefits increased with the increase of follow-up duration. The effect of Cyclophosphamide (CTX) +CS on crescent IgAN was better than that of other risk factors. Moreover, the increasing follow-up duration was negatively associated with the effect.Conclusions:MMF+CS and LEF+CS appear to serve as the best choice for treating high-risk IgAN than other immunosuppressive therapies.     

FCGR3A和FCGR3B基因拷贝数变异对HBV感染转归的影响

目的 探讨FCGR3A和FCGR3B基因拷贝数变异与HBV感染后不同转归和疾病进展的相关性。方法 收集2014年1月—2018年12月安徽医科大学第一附属医院和第二附属医院感染病科住院和门诊841例慢性HBV感染者和296例自限性HBV感染者外周血标本,并将慢性HBV感染者根据病情进展程度进一步分为慢性乙型肝炎（CHB）组、肝硬化（LC）组、肝细胞癌（HCC）组。采用AccuCopy技术定量分析两组患者外周血FCGR3A和FCGR3B基因拷贝数变异。计量资料两组间比较采用独立样本t检验,多组间比较采用单因素方差分析和Kruskal-Wallis H检验;计数资料组间比较采用χ²检验。同时采用χ²检验分析FCGR3基因CNV在不同组间的分布差异。应用年龄和性别校正的logistic回归模型综合分析CNV对HBV感染慢性化的影响。结果 慢性HBV感染组与自限性HBV感染组的FCGR3A、FCGR3B 拷贝数变异频率分布差异均有统计学意义（χ²值分别为11.406、19.143,P值均<0.05）。在慢性HBV感染后疾病...