2008~2017上海市居民健康素养时序变化与孕产妇及婴幼儿死亡率的相关性

目的 探讨上海市居民健康素养水平与孕产妇死亡率和婴儿死亡率的关系。 方法 数据来源于上海统计局及其他相关文献。利用描述性统计分析三者变化趋势,采用Spearman秩相关和广义线性模型分析健康素养与孕产妇死亡率和婴幼儿死亡率的相关和回归结果。 结果 2008年至2017年上海市居民健康素养水平由6.97%持续上升至25.36%,而孕产妇死亡率和婴幼儿死亡率发生了相反的变化。Spearman秩相关分析结果表明,居民健康素养水平、健康生活方式与行为、科学健康观素养水平、安全与急救素养水平与孕产妇死亡率呈负相关(相关系数分别为-0.817、-0.683、-0.783、-0.717, P<0.05),健康素养水平、健康生活方式与行为、科学健康观素养水平、安全与急救素养水平、基本医疗素养水平与婴儿死亡率呈负相关(相关系数分别为-0.833、-0.717、-0.883、-0.800、-0.683, P<0.05)。回归结果表明,居民健康素养水平、健康生活方式与行为、科学健康观素养水平、安全与急救素养水平对孕产妇死亡率和婴幼儿死亡率均有影响,另外基本医疗素养水平对婴幼儿死亡率有影响,均有统计学意义(P<0.05)。 结论 健康素养与孕产妇死亡率和婴幼儿死亡率分别呈负相关。从回归结果来看,它对母婴健康结果有重要影响。建议从政府政策、社区健康促进项目、健康素养监测活动方面促进健康素养提升。     

ⅠA期肺腺癌胸腔镜肺叶切除与肺段切除预后分析

目的：对比胸腔镜肺叶切除与肺段切除在病理ⅠA期（T1aN0M0）肺腺癌中的肿瘤学疗效,同时寻找影响此类患者预后的独立危险因素。方法：回顾性分析自2012年12月—2014年1月连续就诊于南京医科大学第一附属医院的159例ⅠA期肺腺癌患者的临床、病理资料及生存状况。采用Kaplan-Meier法比较两种术式患者的短期疗效,Cox回归分析寻找影响预后的独立危险因素。结果：胸腔镜肺叶切除术3年总体生存率及无进展生存率为88%和85%,肺段切除为97%和96%（P＜0.05）。Cox回归分析结果显示,肿瘤大小、病理亚型均是肿瘤复发（RR=18.219,95％CI：2.484～133.652,P=0．004;RR=2.107,95％CI：1.403～3.163,P<0.001)和患者死亡（RR=12.765,95％CI：1.332～122.37,P=0．027;RR=2.223,95％CI：1.376～3.499,P=0．001)的独立危险因素。贴壁型、腺泡型、乳头型、微乳头及实性型肺腺癌患者3年总体生存率和3年无进展生存率分别为98%和97%、88%和88%、78%和78%、75%和58%（P<0．05）。结论：肿瘤大小及病理亚型对ⅠA期肺腺癌患者的预后有显著影响,在严格掌握手术适应证的前提下接受肺段切除手术的ⅠA期肺腺癌患者预后不亚于接受肺叶切除术者。     

饮食诱导肥胖抵抗和肥胖大鼠血中激素水平的比较

目的　研究饮食诱导肥胖抵抗 (DIO R)和肥胖 (DIO)大鼠血中胰岛素、瘦素 (leptin)和神经肽Y(NPY)水平的差别。方法　采用 5 0只健康雄性SD大鼠 ,随机分为基础组和高脂组 ,分别用基础饲料和高脂饲料喂养 13周 ,然后根据体重筛选出DIO R和DIO组 ,观察体重、摄食量和体脂含量的变化 ,放免法测血清胰岛素、leptin和血浆NPY含量。结果　DIO R大鼠体重、摄食量和体脂含量均明显低于DIO大鼠 (P <0 0 5 ) ;血清胰岛素、血浆NPY含量显著低于DIO大鼠 (P <0 0 5 ) ;高脂饲料使大鼠血清leptin水平明显增加 (P <0 0 5 ) ,但DIO R与DIO大鼠间无明显差别 (P >0 0 5 )。结论　高脂饲料能够诱导SD大鼠发生肥胖和肥胖抵抗 ,胰岛素 leptin NPY反馈环的平衡在肥胖抵抗的发生中起重要作用。     

甘肃省1995～1999年艾滋病监测分析

目的 了解甘肃省艾滋病流行趋势、现状和传播途径,为甘肃省艾滋病防治策略提供依据。方法 对1995～1999年甘肃省HIV血清学监测资料及5例HIV亚型进行分析研究。结果 传播方式以血为主(55.56％),并有性途径,也存在母婴途径的可能。感染者包括以静注吸毒者为代表的高危人群和一般人群。有A、B、C三个亚型存在,分别分布在不同人群中。结论 甘肃省虽处在艾滋病流行的低感染阶段,但存在HIV感染的多样性和复杂性。当前我省艾滋病防治工作的重点是控制静脉吸毒引起的传播。     

中医药治疗冠心病室性早搏的研究进展

分析了冠心病室性早搏的病因病机,从10个方面综述了近年来中药方剂辨证治疗该病的研究进展,并介绍了中药注射剂治疗该病的情况,认为中医药治疗冠心病室性早搏有较好的疗效,但也提出一些不足之处.     

Learning curve of totally thoracoscopic pulmonary segmentectomy

Totally thoracoscopic pulmonary segmentectomy (TTPS) is a feasible and safe technique that requires advanced thoracoscopic skills and knowledge of pulmonary anatomy. However, data describing the learning curve of TTPS have yet to be obtained. In this study, 128 patients who underwent TTPS between September 2010 and December 2013 were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, namely, ascending phase (A), plateau phase (B), and descending phase (C), through cumulative summation (CUSUM) for operative time (OT). Phases A, B, and C comprised 39, 33, and 56 cases, respectively. OT and blood loss decreased significantly from phases A to C (P <0.01), and the frequency of intraoperative bronchoscopy for target bronchus identification decreased gradually (A, 8/39; B, 4/33; C, 3/56; P = 0.06). No significant differences were observed in demographic factors, conversion, complications, hospital stay, and retrieved lymph nodes among the three phases. Surgical outcomes and techniques improved with experience and volume. CUSUM_OT indicated that the learning curve of TTPS should be more than 72 cases.     

Impact of Relative Blood Glucose Changes on Mortality Risk of Patient with Acute Ischemic Stroke and Treated with Mechanical Thrombectomy

Background and purpose: The impacts of stress hyperglycemia and hypoglycemia on mortality of acute ischemic stroke patients treated with mechanical thrombectomy (MT) are largely unclear. This study aimed to use stress hyperglycemia ratio (SHR) to evaluate the influence of pretreatment relative blood glucose changes on mortality risk after MT. Methods: The study retrospectively enrolled 321 acute ischemic stroke patients treated with MT. SHR was calculated as random blood glucose at admission divided by average blood glucose which estimated by glycosylated hemoglobin (HbA1c). Patients with HbAlc greater than or equal to 6.5% were considered to have background hyperglycemia, patients were tertiled according to their SHR. Binary logistic regression was used to analyze 90 days mortality between SHR categories. Results: Compared with the middle tertiles group (Q2) which the blood glucose is closet to baseline glycaemia, patients in the lowest tertiles group (Q1) and highest tertiles group (Q3) have a higher mortality risk (odds ratio [OR], 3.80; 95% confidence interval [CI], 1.31-11.06) (OR, 3.18; 95% CI, 1.25-8.12), the differences is still significant after further adjusted for admission hyperglycemia (≥11.1 mmol/L). In patients without background hyperglycemia, the mortality risk is significantly higher in Q3 group (OR, 3.01; 95% CI, 1.06-8.53), no significant differences was found between three groups after adjusted for admission hyperglycemia (≥11.1 mmol/L). Conclusions: SHR identified acute ischemic stroke patients with relative hyperglycemia and hypoglycemia may have higher mortality risk after MT.