Mason手术在中下段直肠癌局部切除术中的应用价值

目的探讨Mason手术在中下段直肠癌局部切除术中的应用价值.方法对本院近14年来采用Mason手术作局部切除的54例中下段直肠癌病例进行回顾性分析.结果Tis期癌17例,T1期癌20例,T2期癌15例,T3期癌2例.所有标本切缘经病理检查未发现癌残留.平均随访期为66个月.5年存活率为95%.术后局部复发1例(1.9%).术后无肛门失禁发生,伤口感染和直肠皮肤瘘各2例(3.7%).结论Mason手术是中下段直肠癌局部切除术的理想术式.术前高质量的肠道清洁准备,术中正确处理肛门外括约肌的切断与修复,完整彻底地切除肿瘤,是该手术成功的关键.     

基于芽头颜色差异的丹参优良品系筛选研究

目的 :比较芽头颜色不同丹参植株的形态特征差异,探讨以芽头颜色作为评价丹参种质优劣指标的可行性。方法 :依据芽头颜色的不同将大田丹参植株划分为紫色、中间色与绿色3种类型,对不同类型植株采用根段繁殖进行株系繁育,对繁育后不同株系植株的地上部分与地下部分形态特征指标进行测定比较,并利用SPSS 17.0软件进行主成分分析。结果:紫色芽头类型植株的根段出苗率、株高、冠幅、植株叶片数量、根长、根粗、支根数及鲜根重均显著高于绿色芽头类型,但绿色芽头类型植株的花枝数与开花率远高于紫色芽头类型植株,芽头中间色类型居中,主成分分析显示绿色芽头类型、中间色芽头类型组、紫色芽头类型的综合得分分别为14.590,16.460,22.971。结论:紫色芽头类型丹参植株营养生长强于绿色芽头类型植株,但生殖生长恰恰相反,紫色芽头类型丹参植株药材产量远高于绿色芽头类型植株,芽头颜色可以作为丹参良种选育的重要参考指标。     

迷你临床演练评估在肾脏内科住院医师规范化培训中的应用研究

目的　观察迷你临床演练评估（Mini-CEX）在肾内科住院医师规范化培训中的应用效果。方法　对2017年3月至2018年3月在我院肾内科规范化培训的80名住院医师运用Mini-CEX进行考核;考核内容主要包括病史采集、体格检查、临床诊断、治疗方案、医患沟通、人文关怀、临床整体能力7方面。同时对肾内科9名教师和上述80名住院医师进行Mini-CEX反馈问卷调查,内容包括教师和住院医师对Mini-CEX的看法和满意度。应用SPSS 21.0对组间数据比较行独立样本t检验。结果　通过Mini-CEX考核,住院医师的各项临床能力在规培结束时明显高于规培初期,差异均有统计学意义（P<0.05）。住院医师最大的提高表现在治疗方案、整体临床能力和体格检查方面。治疗方案考核结果显示,规培结束时住院医师平均得分为（7.525±1.062）,明显优于规培初期平均得分（5.175±1.035）,差异有统计学意义（P=0.000）。其次是临床诊断和人文关怀,住院医师培训后平均得分均高于培训初期（P<0.05）。临床诊断考核结果显示,规培结束时平均得分为（6.925±1.071）,优于规培初期得分（5.425±1.238）,差异有统计学意义（P=0.000）。教师和住院医师的Mini-CEX反馈问卷调查显示,教师认为Mini-CEX是一种较好的评估方式（88.9%）,还可促进自身学习（77.8%）。住院医师认为Mini-CEX贴近临床实践,以病房和临床实践作为基础测评,考核内容较全面,可提高自身临床技能（85.0%）和综合素质（87.5%）,对Mini-CEX整体满意度达92.5%。结论　Mini-CEX运用于肾内科住院医师规范化培训中,能有效提高住院医师的临床综合能力,有助于提高规培教学质量。     

Impact of the coronavirus pandemic on mental prosperity of medical care laborers in tertiary consideration hospital: A case report

Since the outbreak of the Corona pandemic in December 2019, many people affected, especially medical care laborers, who deal with the treated cases. Coronavirus disease 2019 not only affects the body parts, but also extends to the psychological symptoms. The purpose of this research is to explore the impact of the pandemic on the mental prosperity of the laborers.Clinical staff members from the administration emergency clinic, Lahore, were enlisted. A poll was used to collect data on the segment information, a sleeping disorder, despondency and stress manifestations. Correlation of the segment information and the mental factors were done among the sleeping and non-sleeping disorder samples.All 356 medical service laborers were selected for this investigation. There were manifestations of misery in 222 (62.35%), nervousness in 227 (64.76%), stress in 197 (55.33%) and sleep deprivation in 190 (53.37%) of members. Gentle to extreme side effects of melancholy (91.65% vs 28.9%), nervousness (83.1% vs 41.6%) and stress (84.26% vs 22.22%) were seen predominately in the sleep deprivation gathering (P < .001). Insomnia was more pronounced in the members with low training levels (78.08%) versus post-advanced education (30.9%). Paramedics, attendants, and medical service laborers in confinement/serious consideration units were more inclined to the sleep deprivation (P < .001). Mental prosperity of medical care laborers was influenced because of Coronavirus pandemic. Attendants, paramedics, and those working in the detachment unit showed a critical sleeping disorder.The results and indicators have proven that there is a relationship between the infection with the Corona pandemic and occurrence of disorders in psychological behavior. Therefore, the psychological rehabilitation sessions must be conducted for those infected and those in contact with the Corona cases to relieve the burden of that patients to raise their psychological conditions and support the immune system such that resist against the infection.     

Arteriolar hyalinosis and renal outcomes in patients with immunoglobulin A nephropathy

BackgroundThe relationship between arteriolar hyalinosis and renal progression in immunoglobulin A nephropathy (IgAN) is not fully understood. We aimed to investigate the clinicopathological features and outcomes of IgAN with or without arteriolar hyalinosis.MethodsA total of 762 diagnosed with IgAN patients were retrospectively analyzed. We classified IgAN patients into two groups with or without arteriolar hyalinosis. Then, the clinicopathological characteristics of the two groups were compared. We used Kaplan–Meier survival analysis to compare the composite kidney outcome of the two groups and applied multivariate Cox regression analyses to test the association between arteriolar hyalinosis and composite kidney outcome.ResultsOverall, 412 (54.1%) patients had arteriolar hyalinosis, including 173 patients diagnosed with hypertension. IgAN patients with arteriolar hyalinosis were older and had higher proteinuria, urea, uric acid, and blood pressure, while lower eGFR than those without arteriolar hyalinosis. Subgroup analysis showed similar results in IgAN patients with hypertension. Kaplan–Meier survival analysis showed that IgAN patients with arteriolar hyalinosis had worse composite kidney outcome than those without arteriolar hyalinosis. In addition, subgroup analysis revealed that patients with hypertension have worse composite kidney outcome than those without hypertension. Multivariate Cox regression analyses confirm that arteriolar hyalinosis (HR 2.57; 95% CI 1.41–4.69; p = 0.002) is an independent risk factor for renal prognosis in IgAN patients.ConclusionsOur study demonstrated that arteriolar hyalinosis is a common vascular lesion in IgAN patients. Arteriolar hyalinosis connects closely with hypertension, and arteriolar hyalinosis is an independent risk factor for renal prognosis in patients with IgAN.     

外周血T淋巴细胞亚群对慢性肾脏病患者发生终点事件的预测价值

目的 探讨慢性肾脏病(chronic kidney disease,CKD)患者外周血CD3+、CD4+和CD8+T细胞水平,以及CD4+/CD8+T细胞比值与肾脏终点事件的关系,明确这些T细胞参数是否为CKD患者的预测指标.方法 选取在2015年3月至2019年1月我科住院的原发性CKD3～5期非透析患者568例,应...     

Altered follicular regulatory T (Tfr)- and helper T (Tfh)-cell subsets are associated with autoantibody levels in microscopic polyangiitis patients

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is an autoimmune disease characterized by B cells-derived ANCAs, and ANCA was proved to be a key factor in its pathogenesis. Follicular regulatory T (Tfr) and follicular helper T (Tfh) cells were T-cell subsets that play important roles in B-cell maturation and antibody production. However, their significances in microscopic polyangiitis (MPA) patients, one type of AAV, has not been thoroughly studied. In this study, comprehensive pattern analyses of circulating Tfr and Tfh were performed in MPA patients and healthy controls (HCs), and we found Tfr levels and Tfr/Tfh ratios were significantly decreased in MPA patients. Compared with HCs, Helios+, CD45RA-FoxP3hi, and Ki-67+ Tfr were lower in MPA patients, while CD226+ Tfr cells were higher. These phenotypes suggest that function and proliferation ability of Tfr cells were relatively impaired. Tfh subsets, including ICOS+PD-1+ and Ki-67+ Tfh, were significantly increased, suggesting that the function of Tfh was enhanced in MPA although the total Tfh levels did not change significantly. Circulating memory B cells and plasmablasts were significantly elevated and negatively correlated with Tfr levels and Tfr/Tfh ratios in MPA patients. In addition, Tfr levels and Tfr/Tfh ratios were negatively while Tfh was positively correlated with serum myeloperoxidase (MPO)-ANCA levels. Furthermore, Tfr and Tfr/Tfh ratio were also reversely associated with SCr, BUN, IL-4, and IL-21 levels. Our results suggest that the imbalance of Tfr and Tfh functional subsets is related to increased level of autoantibodies in MPA patients, and we propose a new mechanism for the pathogenesis of MPA.     

非那甾胺合成过程中两个5β异构体的分离和鉴定

在合成非那甾胺的过程中,分离到非那甾胺及其前体化合物（Ⅸ）的５β异构体（Ⅹ）和（Ⅺ）,并鉴定了它们的结构,其中（Ⅺ）未见文献报道。     

甘麦大枣汤加味对脑卒中后抑郁患者认知功能、神经递质及炎症介质的影响

目的：探究甘麦大枣汤加味对脑卒中后抑郁（PSD）患者认知功能、神经递质及炎症介质的影响。方法：选取符合纳入标准的PSD患者200例，依据随机数字表随机分为研究组100例和对照组100例。对照组患者给予基础治疗，研究组在对照组基础上给予甘麦大枣汤加味治疗，均治疗8周。比较两组治疗前后认知功能（蒙特利尔认知功能评估量表，MoCA）、神经递质[γ-氨基丁酸（GABA）、谷氨酸（Glu）、天冬氨酸（Asp）]、炎症介质[肿瘤坏死因子-α(TNF-α)、高迁移率簇蛋白B1(HMGB1)、白介素-8(IL-8)]的变化情况和临床疗效。结果：研究组治疗总有效率（96%,96/100）高于对照组（81%,81/100），差异有统计学意义（P <0.05）。重复测量方差分析显示，两组患者治疗后MOCA评分均显著升高（P <0.01），且研究组治疗后MOCA评分高于对照组（P <0.01）。两组患者治疗后GABA水平均显著升高（P <0.01）,Glu、Asp水平均显著降低（P <0.01），且研究组治疗后GABA水平高于对照组（P <0.01）,Glu、Asp水平低于...