内镜下全腹膜外Sublay修补在腹壁疝中的应用

目的评价腹壁疝内镜下全腹膜外Sublay(TES)手术的效果并总结经验。方法回顾性总结国内10所医院自2016年3月至2019年7月115例腹壁疝内镜下TES手术的患者资料。分析患者情况、疝的特点、手术经过和结果。结果115例计划实施TES的患者中,因严重腹膜破损中转为IPOM修补患者1例,其余均成功手术。可以缝合缺损患者108例(94.74%),需要永久补片固定患者15例(13.16%)。放置引流患者76例(66.67%),中位手术时间为144 min,术中无严重并发症发生。随访时间3~45个月,总并发症发生率为20例(17.54%),其中出现血清肿患者5例(4.38%)。绝大多数患者术后仅出现轻微疼痛,未出现慢性疼痛。结论在腹壁疝的治疗中,对熟悉腹壁解剖的外科医师而言,TES是一种有效、安全的修复手段。在熟悉手术的基础上适应症可逐步拓展。     

上海市松江区成年人高尿酸血症与慢性肾病关系的队列研究

目的 分析社区成年人高尿酸血症（HUA）与慢性肾病（CKD）发病风险的关系。方法 基于华东区域自然人群队列,对7 276例基线时未患CKD的上海市松江区20~74岁常住居民进行基于社区的前瞻性队列研究。CKD的诊断根据美国肾脏基金会慢性肾脏病实践指南的标准,HUA定义为血清尿酸（SUA）>420 μmol/L（男性）或>360 μmol/L（女性）。采用Cox比例风险模型分析HUA与CKD发病风险的关联。结果 经过中位时间2.65年的随访,队列人群新发CKD病例301例,累积发病率为4.14%,发病密度为16.01/1 000人年（95% CI：14.20~17.82）。CKD发病人群HUA的基线患病率显著高于非CKD发病人群。多因素Cox回归分析显示,HUA与CKD发病风险呈显著正关联,HUA患者的CKD发病风险HR值为1.92（95% CI：1.46~2.53）。在对性别、年龄、BMI、2型糖尿病、高血压等因素分层后,HUA与CKD发病风险仍呈显著正关联;在相加模型中,年龄与HUA存在交互作用,交互作用指数为1.78（95% CI：1.18~2.68）。结论 上海市松江区成年人CKD的发病率较高,HUA为CKD发病的独立危险因素。     

Polyphenols intervention is an effective strategy to ameliorate inflammatory bowel disease: a systematic review and meta-analysis

Abstract

Whether polyphenols could ameliorate inflammatory bowel disease (IBD) is still conflicting. To explore the efficacy of polyphenols as an adjuvant therapy for IBD, we conducted this systematic review and meta-analysis. Literature search was performed using PubMed, Web of Science, Scopus and Cochrane databases. Finally, 12 randomized controlled trials (RCTs) were included. In contrast to control group, curcumin treatment significantly improved clinical remission in intention-to-treat (ITT) (OR = 3.36, 95% CI: 1.09–10.37) and per-protocol (PP) analysis (OR = 5.13, 95% CI: 1.84–14.27). Meanwhile, curcumin could significantly ameliorate endoscopic remission (OR = 5.69, 95% CI: 1.28–25.27) and clinical response (OR = 4.69, 95% CI: 1.03–21.47) in PP analysis. Heterogeneity was present across the studies. In conclusions, polyphenols might be an effective adjuvant treatment for ameliorating IBD. Considering the relatively few studies included in our present study, further clinical trials are required to verify the effects of polyphenols on IBD.     

基于床位效能评价优化综合医院床位配置的应用研究

目的 运用疾病诊断相关组（diagnosis related groups） DRG指标作为医院医疗服务能力评价指标,结合病床运行效率综合评价单位病床利用效能,为医院床位合理配置提供决策依据。方法 以某三级甲等医院2019年运行数据及DRG数据为基础,以病床周转次数及病床占用率绘制科室病床运行效率散点图;以单床年DRG权重为产出指标,结合科室病例组合指数（case mix index）CMI值绘制病床产出效能散点图; 结合运行效率及产出效率综合评价科室病床利用效能并将其分为A、B、C、D、E五类。分别利用病床工作效率指标及病床产出效率指标95%CI计算各科室病床数的合理区间。结果 39个临床科室中,病床利用效能综合评价为A类有5个科室、B类科室14个、C类科室3个、D类科室10个、E类科室7 个。 有6个科室实际开放床位较为合理,病床工作效率与病床产出效率判定结果均为合适,14个科室的判定结果均为偏多,5个科室的判定结果均为偏少,余14个科室的床位配置判定结果发生了变化。 结论 结合DRG指标与传统运行效率指标对医院科室床位利用效能进行综合评价兼顾了效率和质量,其结果更为全面、客观;可为医院调整内部结构,优化床位配置提供科学依据,助力医院精细化管理。     

营养干预对学生知识行为及超重肥胖的影响

目的 在“营养校园”试点学校进行为期一年的营养干预,分析评价干预效果。方法 在石家庄新华区选取一所小学和一所初中进行干预,从三、五、七年级中分别随机抽取2个班级的学生在干预前后进行调查。干预方法包括开展营养健康教育、促进身体活动、科学营养供餐支持等综合措施,通过问卷和体格测量调查学生干预前后的营养知识、饮食行为及超重肥胖变化情况。结果 干预后,营养知识题目的正确率显著提高（χ2=613.737,P<0.001）,总体正确率为59.8%。学生早餐食物种类（χ2=19.841,P<0.001）和早餐摄入频率（χ2=5.405,P<0.05）均有显著改善。总体超重肥胖率未见显著改善,按性别、年级分层分析发现,女生超重肥胖率降低（χ2=1.891,P<0.05）,5年级（χ2=4.923,P<0.05）和7年级（χ2=10.563,P<0.01）学生超重肥胖率降低,且高年级学生降幅更明显。结论 以校园为基础开展综合营养干预措施,可以提高学生的营养知识水平,并改善学生的不良饮食行为及超重肥胖现状。     

Transfer of germinal vesicle to ooplasm of young mice could not rescue ageing-associated chromosome misalignment in meiosis of oocytes from aged mice

BACKGROUD: Transferring a germinal vesicle (GV) from an aged woman's oocyte into ooplasm from a younger woman has been proposed as a possible way to overcome the problem of age-related decline in female fertility. Here we assessed this possibility by determining whether ooplasts derived from young mice could rescue ageing-associated chromosome misalignment in meiosis of oocytes from aged mice. METHODS: Three groups of reconstructed oocytes, young GV-young cytoplast (group YY), aged GV-young cytoplast (group AY), and young GV-aged cytoplast (group YA), were created by micromanipulation and electrofusion. RESULTS: Nuclear transplantation was successful in 89.8-94.4% of GV-ooplast complexes, and maturation rate of the reconstructed oocytes was 93.5-97.9%. Confocal microscopy analysis showed a significantly higher rate (49.2%) of chromosome misalignment in ageing mice than in young mice (16.9%), and 57.1% of oocytes in group AY exhibited chromosome misalignment, while the abnormality rate in groups YY and YA was 16.3 and 16.7% respectively. Calcium imaging showed that the three groups of reconstructed oocytes exhibited a similar pattern of calcium oscillations upon stimulation with bovine sperm extracts. Fertilization rate and developmental capacity to 2-cell embryos were also similar among the three groups of oocytes. CONCLUSIONS: Our findings suggest that: (i) the ooplasm from young mice could not rescue ageing-associated chromosome misalignment in meiosis of GV from aged mice; and (ii) behaviour of chromosome alignment over metaphase spindle is predominantly determined by GV material.     

使用自相关和时间序列检测的方法检测心室纤颤信号

心室纤颤信号必须准确而及时地识别,如果不使用除颤器及时进行除颤,病人会迅速死亡。另一方面,如果心室纤颤信号没有发生,而误判为心室纤颤信号,给予电击,则病人的心脏受到不应有的损伤,这也属于严重的医疗事故。因此快速与准确的识别显得十分重要。自70年代以来,世界上许多科学家都在探讨各种方法,以期望使用计算机自动识别心室纤颤信号,但均因达不到实时判别的要求或准确率不够高而不能用于自动除颤器检测的设计方案。本文介绍了一种准确率高而又较简易的快速识别法。这一方法是取一秒心电信号,进行有限长度离散信号的自相关,然后对该自相关函数作零切割,让自相关函数变成一串二进制脉冲串,接着以一秒信号的脉冲串数作为特征参数,设计分类器。经证明,心室纤颤信号(VF信号)(Ventricular Fibrillation)和心动过速信号(VT信号)(Ventricular Tachycar-dia)的特征参数均属于高斯分布。因此可用Wald时间序列检测方法对VF信号和VT信号分类。这个算法可用于计算机进行实时处理和分析,同时此法与取样率无关,适用于各种取样系统,是一个较理想的方法。