一站式便民服务中心在县级公立综合性医院的应用实践与研究

目的：探讨县级公立综合性医院构建一站式便民服务中心的效果。方法：在县级公立综合性医院构建一站式便民服务中心,对其效果采用调查问卷法分析,就突出问题开展访谈,并采用描述性统计及定量、定性分析。结果：该中心能够显著降低患者就诊询问次数和就诊路程,但总就诊时间无明显缩短。结论：在县级公立综合性医院构建一站式便民服务中心可以有效提高门诊办公效率,方便病员就诊,提高病员的满意度,在操作上是可行的,也是有效的。     

强化序贯阿托伐他汀钙治疗急性脑梗死临床研究

目的观察强化、序贯阿托伐他汀钙治疗急性脑梗死的临床疗效。方法选择2012年6月～2013年6月来自本院神经内科就诊的100例脑梗死患者入组,患者均在发病后24小时内入院并符合急性缺血性脑卒中的临床诊断,随机分为治疗组与对照组,治疗组50例,对照组50例,治疗组加用阿托伐他汀钙40mg,口服,每天一次,强化治疗14天后,改20mg,口服,序贯治疗21天。对照组不使用阿托伐他汀钙。两组患者的活血化瘀、抗血小板聚集、脑细胞代谢等神经科治疗药物、康复方案相同,分别在治疗前和治疗后5周进行NIHSS（美国国立卫生院脑卒中量表）神经功能缺损评分、日常生活活动能力（activitiesofdailylivingADL）量表评分以及改良Rankinj量表（ModifiedRankinScale,MRS）评分,进行效疗评定。结果治疗后,治疗组的NIHSS评分、ADL评分、改良Rankinj量表评分均有明显降低,较对照组有显著差异（P〈0．05）。治疗组临床治疗效果优于对照组（P〈0．05）。结论强化、序贯阿托伐他汀钙治疗脑梗死有显著临床效果。     

91种炎症蛋白与5种心血管疾病之间的因果关系：双样本孟德尔随机化研究

摘要 目的：通过采用孟德尔随机化(MR)方法和反向孟德尔随机化方法评估91种炎症蛋白与5种心血管疾病（动脉夹层、动脉瘤、冠心病、非风湿性瓣膜病和风湿性瓣膜病）之间的因果关系。 方法：使用来自欧洲人群的全基因组关联研究（GWAS）数据,利用孟德尔随机化（MR）方法和反向孟德尔随机化方法对 91 种炎症蛋白与5种心血管疾病之间的双向因果关系进行评估分析。MR分析方法包括inverse variance weighted (IVW)、Weighted median、MR-Egger、Simple Mode和Weighted mode。敏感性分析包括 Cochran''s Q 检验、MR-Egger 截距检验、MR-PRESSO 方法和 leave-one-out 方法。 结果：共有16种炎症蛋白可能与心血管疾病风险存在相关性,包括CCL20、CD5、CCL28、IL20RA、LAP-TGF-β1、TSLP、CST5、LIF、EIF4EBP1、CCL4、IL22RA1、IL-10、IL-17C、MCP-2/CCL8、NRTN和MCP-3/CCL7。此外,心血管疾病的进展可能会导致总共 10 种炎症蛋白水平的变化,包括 CCL11、IL-8、TNF-β、FGF19、IL10RA、FGF-21、IL10RB、β-NGF、CD5 和 MCP-1/CCL2。 结论：本研究结果表明,多种炎症蛋白与5种心血管疾病之间存在双向因果关系,证明了进一步研究各种炎症蛋白与上述心血管疾病之间的相关性存在更深入的研究空间。     

Factors Associated with Macular Staphyloma Area on Ultra-widefield Fundus Images

PurposeTo assess the feasibility of applying ultra-widefield fundus (UWF) images for macular staphyloma area (MSA) measurement and investigate the associated factors with MSA.MethodsThis is a retrospective study. MSA was measured by UWF imaging. Central foveal thickness, subfoveal choroidal thickness, subfoveal scleral thickness were measured on spectral domain optical coherence tomography. Intraclass correlation coefficients of MSA measurement would be evaluated. Multiple linear regression analysis was used to analyze the associated factors with MSA.ResultsIn total, 135 eyes of 92 patients were enrolled. The mean age was 64.73 ± 10.84 years. Mean MSA on UWF image was 279.67 ± 71.70 mm². Intraclass correlation coefficients of MSA measurement was 0.965 (95% confidence interval [CI], 0.946 to 0.977; p < 0.001). In the multiple linear regression analysis, after adjusting for subfoveal choroidal thickness, best-corrected visual acuity, central foveal thickness, and subfoveal scleral thickness, the factors independently related to MSA were axial length (β = 8.352; 95% CI, 3.306 to 13.398; p = 0.001), sex (β = −26.673; 95% CI, −51.759 to −1.586; p = 0.037), age (β = 1.184; 95% CI, 0.020 to 2.348; p = 0.046).ConclusionsIt is feasible to measure MSA on UWF image. Female, longer axial length, and older age may indicate larger MSA.     

Correction: Preparation and characterization of a novel drug-loaded Bi-layer scaffold for cartilage regeneration

Correction for ‘Preparation and characterization of a novel drug-loaded Bi-layer scaffold for cartilage regeneration’ by Yunqing Yue et al., RSC Adv., 2022, 12, 9524–9533, https://doi.org/10.1039/D2RA00311B.

The authors regret that part of Fig. 1 and the Graphical Abstract were reproduced from a published article without appropriate acknowledgment. The reference to be included is Girão et al., Compos. B. Eng., 2018, 154, 99–107, https://doi.org/10.1016/j.compositesb.2018.08.001.Girão et al. have granted permission for part of their Fig. 1 to be used in “Preparation and characterization of a novel drug-loaded Bi-layer scaffold for cartilage regeneration”.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.     

神经内镜手术对幕上高血压性脑出血患者的疗效分析：一项单中心、回顾性、对照研究

目的：探讨神经内镜手术治疗幕上高血压性脑出血的效果。方法 ：回顾性选取2022年1月至2022 年12月我中心收治的42例幕上高血压性脑出血手术患者,以治疗方式分为神经内镜组和开颅手术组。神经内镜组患者采用神经内镜手术治疗,共22例;开颅手术组患者采用传统开颅手术,共20例。对比两组患者术后残余血肿量、术后3月mRS评分、死亡率及并发症率。结果：神经内镜组的术后残余血肿量小于15ml的患者比率77.3%（17/22）高于开颅手术组35.0%（7/20）,差异有统计学意义（P=0.022）;神经内镜组和开颅手术组的患者中,术后3个月预后良好的患者分别为14例（63.6%）和4例（20.0%）,差异有统计学意义（P<0.001）;开颅手术组中,1名（5.0%）患者发生了术后再出血,而神经内镜组中,1名（4.5%）患者发生了术后再出血,差异有统计学意义（P=0.001）;两组手术患者的肺部感染发生率均为100%,差异无统计学意义（P=1.000）;神经内镜组的术后死亡率13.6%（3/22）也低于开颅手术组30.0%（6/20）,差异有统计学意义（P<0.001）。结论：神经内镜手术治疗可提高幕上高血压性脑出血患者的血肿清除率,降低并发症发生率及死亡率,改善患者预后。     

慢性乙型肝炎患者外周血细胞因子IL-17A、IL-2、IL-21、IL-4表达水平及意义

目的 探索初治慢性乙型肝炎（CHB）患者外周血中细胞因子表达水平及其与病毒载量和肝脏炎症程度的关系,以期为临床动态评估病情和预后方面提供新思路。方法 选择2018年10月至2019年11月就诊于海军军医大学第一附属医院感染科的初治慢性乙型肝炎病毒（HBV）感染者68例,健康对照者12名,通过ELISA检测外周血中细胞因子IL-17A、IL-2、IL-21和IL-4表达水平,同时检测HBV DNA及转氨酶水平。统计学处理采用Mann-Whitney U检验、Kruskal-Wallis H检验及Spearman相关性分析。结果 相较于健康对照者,初治CHB患者外周血IL-17A高 [17.50（11.99,25.36）vs14.14（9.01,23.68）pg/ml,Z=-2.001,P=0.045],IL-2低[57.19（31.10,79.92）vs73.06（62.41,105.84）pg/ml,Z=-2.509,P=0.012],IL-21高[37.12（23.85,77.66）vs（20.95±5.72）pg/ml,Z=-3.485,P<0.01],IL-4表达水平无差异。不同免疫状态的IL-17A表达有明显差异（H=8.870,P=0.031）。炎症活动状态CHB患者的IL-17A和IL-21更低、IL-2更高（P＜0.05）,IL-4无差异（P＞0.05）。HBeAg阳性CHB患者、HBeAg阴性CHB患者与健康对照者外周血细胞因子IL-17A、IL-2、IL-21比较,差异有统计学意义（IL-17A：H=10.061,P=0.007;IL-2：H=6.576,P=0.037;IL-21：H=12.444,P=0.002）。初治CHB患者外周血IL-17A、IL-21、IL-4与HBV DNA无相关性（r=0.02、0.23、0.07,均P>0.05）,IL-2与HBV DNA存在弱相关（r=0.32,P=0.01）。初治HBV患者外周血IL-17A、IL-21与ALT存在相关性（IL-17A：r=0.59,P<0.01;IL-21：r=0.49,P<0.01）,与AST存在相关性（IL-17A：r=0.47,P<0.01;IL-21：r=0.36,P<0.01）,而IL-2、IL-4与ALT和AST均无明显相关。ALT≥300U/L的初治CHB组、ALT＜300U/L的初治CHB组与健康对照者外周血细胞因子IL-17A、IL-2、IL-21比较,差异有统计学意义（IL-17A：H=27.557,P<0.01;IL-2：H=8.581,P=0.014;IL-21：H=21.438,P<0.01）。ROC曲线分析结果显示,IL-17A判断肝脏炎症程度的AUC值为0.8933（95%CI：0.7930-0.9936）,IL-21判断肝脏炎症程度的AUC值为0.7600（95%CI：0.6227-0.8973）。结论 IL-17A、IL-2和IL-21参与慢性HBV感染进程：初治CHB患者无论HBeAg阳性与否或炎症程度高低,外周血IL-17A和IL-21升高,IL-2下降;IL-2与HBV DNA有一定相关性;IL-17A和IL-21与ALT及AST均存在正相关;检测IL-17A和IL-2有助于病情评估与预后判断。     

美国肺癌防治工作对中国的启示

据《CA：A Cancer Journal for Clinicians》杂志发布的2021年美国癌症统计报告,自1991年以来,美国癌症死亡率呈持续下降趋势,至2018总体下降31%,提示因癌症死亡人数减少了约320万。尽管一些常见癌症死亡率下降趋势放缓,但由于控烟工作有效、医疗技术水平提高、癌症筛查的普及,加速推动...     

Identification of target genes responsive to JP-8 exposure in the rat central nervous system

Concern for the health risk associated with occupational exposure to jet fuel has emerged in the Department of Defense. Jet propulsion fuel-8 (JP-8) is the fuel used in most US and North Atlantic Treaty Organization (NATO) jet aircraft, and will be the predominant fuel both for military land vehicles and aircraft into the twenty-first century. JP-8 exhibits reduced volatility and lower benzene content as compared to JP-4, the predominant military aircraft fuel before 1992, possibly suggesting greater occupational exposure safety. However, the higher rates of occupational exposure through fueling and maintenance of increasingly larger numbers of aircraft/vehicles raise concerns with respect to toxicity. Clinical studies of workers experiencing long-term exposure to certain jet fuels demonstrated deficits in CNS function, including fatigue, neurobehavioral changes, psychiatric disorders, and abnormal electroencephalogram (EEG). In the present study, cDNA nylon arrays (Atlas Rat 1.2 Array, Clontech Laboratories, Palo Alto, CA) were utilized to measure changes in gene expression in whole brain tissue of rats exposed repeatedly to JP-8, under conditions that simulated possible real-world occupational exposure (6 h/day for 91 days) to JP-8 vapor at 1,000 mg/m3. Gene expression analysis of the exposure group compared to the control group revealed a modulation of several genes, including glutathione S-transferase Yb2 subunit (GST Yb2); cytochrome P450 IIIAl (CYP3A1); glucose-dependent insulinotropic peptide (GIP); alpha1-proteinase inhibitor (alpha1-AT); polyubiquitin; GABA transporter 3 (GAT-3); and plasma membrane Ca2+-transporting ATPase (brain isoform 2) (PMCA2). The implications of these vapor-induced changes in gene expression are discussed.