直接抗病毒药物治疗丙型肝炎合并透析患者的临床应用

丙型肝炎病毒（HCV）感染在慢性肾功能不全患者中较常见，尤其是在进行透析的患者中，HCV感染较普通患者的风险极大增加，同时还会导致肝细胞癌及肝硬化的发病率明显升高。近年来直接抗病毒药物（DAAs）在慢性丙型肝炎的治疗中取得了较好的疗效及安全性，本文通过总结DAAs在丙型肝炎合并透析患者中的应用进展，发现对于基因1~6型HCV合并透析患者，推荐使用G/P方案；由于索磷布韦（SOF）经肾脏代谢，在重度肾损害人群中的血药浓度较高，因此SOF组合方案并不推荐用于丙型肝炎合并透析患者的治疗。     

磁锚定技术辅助腹腔镜阑尾切除术的实验研究

目的:验证自行设计加工的磁锚定装置在减戳孔腹腔镜阑尾切除术中应用的可行性。方法:设计加工适用于辅助减戳孔腹腔镜阑尾切除术的磁锚定装置,该装置包括内置抓钳和锚定磁体2个部分。以6只健康雄性Beagle犬为模型,用磁锚定装置代替传统腹腔镜阑尾切除术中的副操作孔抓钳,经主操作孔置入磁锚定内置抓钳并钳夹于阑尾尖部,体外放置锚定磁体,锚定磁体与内置抓钳的靶磁体相吸,移动锚定磁体即可改变内置抓钳的牵拉方向,从而有效牵拉暴露手术术野,完成减戳孔腹腔镜阑尾切除手术。记录手术操作时间、术中出血量,评价利用磁锚定装置进行阑尾切除时操作的安全性和可行性。结果:6只Beagle犬均顺利完成磁锚定技术辅助减戳孔腹腔镜阑尾切除,手术时间27~38 min,出血量均小于10 ml,术后实验犬状态良好,未出现并发症。结论:磁锚定装置用于减戳孔腹腔镜阑尾切除手术操作简单、安全可行,在相关设计进一步优化基础上,可尝试或试验性用于临床。     

二维斑点追踪技术评价低温兔左室纵向功能

目的:探讨应用二维斑点追踪技术评价低温条件下兔左心室纵向功能的价值。方法:30只新西兰兔随机分成对照组(n=10),低温组A(n=10),低温组B(n=10)。先行常规心脏数据测量,然后采用组织多普勒(TDI),之后应用斑点追踪成像(STI)中的获取基底段、中间段、心尖段及整体水平SL、SrLs.SrL E,SrL A及分层应变技术获取3个长轴切面心内膜下、中层和心外膜下心肌收缩期纵向峰值应变(SL)。结果:①与对照组相比,A组心内膜下心肌LS值的减低,差异有统计学意义(P<0.05),B组3层心肌SL值的减低明显,差异有统计学意义(P<0.01)②与对照组相比,A组大部分纵向应变及应变率减低(P<0.05);B组基底段、中间段、心尖段及整体水平SL,SrL S、SrLE、SrLA均减低(P<0.01)结论:随低温时间延长,左室壁3层心肌SL值受累程度不同,心内膜应变较心外膜更加敏感,二维班点追踪技术比LVEF及TDI更早发现左室功能减低。     

腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤的临床应用

目的对比研究腹腔镜下外生性肾血管平滑肌脂肪瘤"蘑菇状"剜除与标准肾部分切除术的安全性及有效性，为肾血管平滑肌脂肪瘤腹腔镜下"蘑菇状"剜除术术式的建立提供临床依据。 方法选取海南医学院第二附属医院与解放军总医院2018年1月至2019年5月期间，接受腹腔镜手术的肾血管平滑肌脂肪瘤患者53例，其中25例沿肿瘤假包膜行"蘑菇状"剜除术(A组)、28例行肾部分切除术(B组)。比较两组手术患者的肾动脉阻断时间、手术时间、术中出血量、术后24 h血红蛋白、术后eGFR(estimated glomerular filtration rate,估计肾小球率过滤)的变化、术后住院时间和术后肿瘤复发率。 结果53例手术无术中转开放，无死亡病例。肾动脉阻断时间：A组(11.9±2.2)min、B组(21.5±6.5) min(P<0.001)。手术时间：A组(87.9±24.8)min、B组(114.3±38.9) min(P<0.001)。术中出血量：A组20 ml(20～40)ml、B组50 ml(50～100)ml(P<0.001)。术后24 h血红蛋白变化：A组(7.4±4.3) g/L、B组(12.4±8.8) g/L(P＝0.013)。术后24 h eGFR变化：A组(6.2±7.2 )ml(min·1.73 m²)，B组(12.7±12.8)ml(min·1.73 m²)(P＝0.027)。术后6个月eGFR变化：A组(1.5±3.7)ml(min·1.73 m²)、B组(6.5±5.6)ml(min·1.73 m²)(P<0.001)。术后住院时间：A组4.0 d(3～4)d、B组4.5 d(3～6)d(P＝0.023)。术后随访两组术后肿瘤均无复发。 结论采用腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤在肾动脉阻断时间、术中出血量、术后24 h血红蛋白、术后eGFR变化、术后住院时间等方面均优于传统肾部分切除术，两组术后肿瘤均无复发；该方法安全、有效，适于临床推广。     

Effects of box handle position and carrying range on bi-manual carrying capacity for females

This study utilizes a psychophysical approach to examine the effects on carrying capacity for bi-manual carrying tasks involving different handle positions and carrying ranges. A total of 16 female subjects participated in the experiment in groups of two people, and each group of subjects performed the tasks in a random order with 12 different combinations of carrying task. The independent variables are handle position (upper, middle, lower) and carrying range (F–F: floor height carried to floor height, F–W: floor height carried to waist height, W–W: waist height carried to waist height, W–F: waist height carried to floor height), the dependent variable is the maximum acceptable carried weight (MAWC), heart rate (HR), and the rating of perceived exertion (RPE). The results show that the handle position has a significant effect on MAWC and overall RPE but no significant effect on HR. Carrying range has a significant effect on the MAWC and HR, but no significant effect on overall HR. The handle position and carrying range have a significant interaction on the MAWC and HR. The RPE for different body parts shows significant differences, and the hands feel the most tired. Overall, this study confirms that the lower handle position with the W–W carrying range is the best combination for a two-person carrying task.     

我院药物代谢酶和药物作用靶点基因检测与精准药学服务实践与总结

目的回顾我院药物代谢酶和药物作用靶点相关基因检测与精准药学服务实践过程,总结经验,与同行分享。方法从准备工作、相关检测项目的确定,学术推广、项目优化和开展情况等方面详细阐述我院基因检测开展过程与精准药学服务情况。结果根据临床需求,我院已开展了以心脑血管药和抗精神病药为主的27种药物,26项检测,2018年全年位1587名患者提供个体化用药建议,受到临床医生和患者欢迎。结论基于代谢酶和药物作用靶点相关基因检测的个体化用药建议是临床药师参与精准治疗的重要途径,有助于医生和药师之间的沟通,有利于提高药学服务水平。     

膝骨关节炎患者关节滑液中IL-17水平与疾病严重程度的相关性

目的 探讨膝骨美节炎(KOA)患者美节滑液中IL 17的水平与疾病严重程度的相关性，为临床诊治KOA 提供新思路及新方法。方法 选取2017年1月?2018年12月南充市中心医院康复科收治的15。例膝骨美节炎患者作 为实验组，同时纳入30例健康志愿者作为对照组。实验组釆用视觉模拟量表(VAS)评价膝关节的疼痛程度，采用膝关 节学会评分系统(KSS)评价膝关节的功能及采用Kellgren Lawrence (KL)分级系统评价膝关节X线严重程度，通过 ELISA试验检测两组膝关节滑液中IL17的水平。采用Spearman相关分析KOA患者关节滑液中IL 17水平与膝关节 疼痛程度、膝关节功能及X线严重程度的相关性。结果 实验组关节滑液中IL17的水平明显高于对照组(P <0. 05). IL 17水平在滕美节炎KL分级之间比较，差异无统计学差异(P>0. 05)。IL 17的水平与膝关节VAS评分呈正相关 (P=0. 914,P<0.01),IL 17的水平与KSS呈负相关(P=—0. 847,P<0. 01), IL 17的水平与KL分级无相关性(r = 0.050,P= 0.545)。结论 IL 17可反应膝骨关节炎患者疼痛程度及功能损伤程度，但不能反映疾病的X线严重程度。 IL 17可作为一个生化指标反应膝关节炎疼痛程度及膝关节功能，临床通过减少关节滑液中IL 17,可能会减轻膝骨关 节炎患者的临床症状。     

The Associations of Dietary Inflammatory Potential With Musculoskeletal Health in Chinese Community-Dwelling Older People: The Mr. OS and Ms. OS (Hong Kong) Cohort Study

Inflammation, an important contributory factor of muscle and bone aging, is potentially modulated by diet. This study examined the associations of dietary inflammatory index (DII) score with musculoskeletal parameters and related disease outcomes in 3995 community-dwelling Chinese men and women aged ≥65 years in Hong Kong. DII score at baseline was estimated from a food frequency questionnaire. Bone mineral density (BMD) and muscle mass estimated by dual-energy X-ray absorptiometry (DXA), hand grip strength, gait speed, and chair stand test were measured at baseline, year 4, and year 14. The associations of DII score with the longitudinal changes of musculoskeletal parameters, and incidence of osteoporosis, sarcopenia, and fractures were examined by using general linear model, multinomial logistic regression model, and Cox proportional hazards regression model, respectively. After multiple adjustments, each tertile increase in DII score in men was associated with 0.37 (95% confidence interval [CI], 0.10–0.64) kg loss in grip strength and 0.02 (95% CI, 0.01–0.03) m/s loss in gait speed over 4 years. In men, the highest tertile of DII was associated with a higher risk of incident fractures, with adjusted and competing death adjusted hazard ratio (HR) (95% CI) of 1.56 (1.14–2.14) and 1.40 (1.02–1.91), respectively. In women, DII score was not significantly associated with any muscle-related outcomes or incidence of fracture, but a significant association between higher DII score and risk of osteoporosis at year 14 was observed, with the highest tertile of DII score having adjusted odds ratio (OR) (95% CI) of 1.90 (1.03–3.52). In conclusion, pro-inflammatory diet consumption promoted loss of muscle strength and physical function, and increased risk of fractures in older Chinese men. Pro-inflammatory diets had no significant association with muscle related outcomes but increased the long-term risk of osteoporosis in older Chinese women. © 2022 American Society for Bone and Mineral Research (ASBMR).