性激素结合球蛋白对多囊卵巢综合征患者行IVF-ET促排卵效果及妊娠结局的预测

目的 探讨性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）患者行体外受精-胚胎移植（IVF-ET）助孕治疗的促排卵效果及妊娠结局的预测价值。方法 收集2015年1月至2017年12月就诊于湖北医药学院附属人民医院生殖医学中心行IVF-ET助孕治疗的181例PCOS不孕患者的临床资料。将患者分为三组：低SHBG组：SHBG<18.2 nmol/L,30例。高SHBG组：SHBG>135.5 nmol/L,29例。正常SHBG组：18.2 nmol/L≤SHBG≤135.5 nmol/L,122例。比较三组患者的一般资料、促排卵情况及妊娠结局。结果 随着血清SHBG水平升高,BMI、基础LH/FSH、FAI降低,基础FSH升高,各组间差异有统计学意义（P<0.05）;随着血清SHBG水平增高,PCOS不孕患者的正常受精率、胚胎着床率、临床妊娠率及活产率增高,Gn量及流产率降低,差异也均存在统计学意义（P<0.05）,但优质胚胎率及早产率三组间差异无统计学意义（P>0.05） 。血清SHBG水平与BMI （r=-0.389, P<0.001）、基础LH/FSH （r=-0.225, P=0.002）、FAI （r=-0.606, P<0.001）及Gn量 （r=-0.209, P=0.005）呈负相关,与基础FSH（r=0.205, P=0.006）呈正相关。结论 PCOS不孕患者在IVF-ET助孕治疗中,血清SHBG水平越高,助孕效果越好。     

普胸术后快速性心律失常危险因素分析及预警系统的建立

目的：分析普胸术后快速性心律失常发生的危险因素,初步建立预测心律失常发生的预警系统。方法：对412例普胸外科手术患者的围术期临床资料进行单因素和多因素分析,确定危险因素,建立预警评分系统。结果：应用logistic回归分析确定普胸术后发生快速性心律失常的风险因素为：术前肺功能（P〈0．01）、术前心功能（P〈0．01）、手术类别（P〈0．01）和手术时间（P〈0．01）。根据心律失常发生可能性方程,建立普胸术后快速性心律失常发生危险评分系统如下：术前肺功能异常（10分）、术前心功能异常（8分）、肺和食管切除手术（26分）、手术时间≥4h（12分）;根据方程预测率来绘制ROC曲线,所对应的预测普胸术后发生快速性心律失常的风险得分为26分,敏感度为92．4％,特异度为51．4％,26分以下的心律失常发生率为14．6％（27／185）,26分以上的发生率为52．9％（120／227）,两者比较差异有统计学意义（P〈0．01）。结论：普胸术后快速性心律失常预擎评分系统简单易行,结果比较可靠,能给术后心律失常的早期干预提供帮助。     

Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

OBJECTIVEAlthough elevated glucose levels are reported to be associated with adverse outcomes of coronavirus disease 2019 (COVID-19), the optimal range of glucose in patients with COVID-19 and diabetes remains unknown. This study aimed to investigate the threshold of glycemia and its association with the outcomes of COVID-19.RESEARCH DESIGN AND METHODSGlucose levels were assessed through intermittently scanned continuous glucose monitoring in 35 patients for an average period of 10.2 days. The percentages of time above range (TAR), time below range (TBR), time in range (TIR), and coefficient of variation (CV) were calculated. Composite adverse outcomes were defined as either the need for admission to the intensive care unit, need for mechanical ventilation, or morbidity with critical illness.RESULTSTARs using thresholds from 160 to 200 mg/dL were significantly associated with composite adverse outcomes after adjustment of covariates. Both TBR (<70 mg/dL) and TIR (70–160 mg/dL), but not mean sensor glucose level, were significantly associated with composite adverse outcomes and prolonged hospitalization. The multivariate-adjusted odds ratios of the CV of sensor glucose across tertiles for composite adverse outcomes of COVID-19 were 1.00, 1.18, and 25.2, respectively.CONCLUSIONSPatients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels >160 mg/dL and <70 mg/dL and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients.     

Symptoms of long-term exposure to moxa smoke in acupuncturists: a correlation analysis

OBJECTIVE

To investigate the effects of long-term exposure to moxa smoke on acupuncturists and to consider the association between physical symptoms and gender, age, secondhand smoke (SHS) exposure, and the duration of exposure.

川崎病患儿血小板表面PAC-1表达水平变化及意义

目的探讨川崎病(KD)患儿不同时期血小板表面血小板膜糖蛋白Ⅱb/Ⅲa纤维蛋白原受体(PAC-1)表达水平的变化,并分析其与KD冠状动脉损害的相关性。方法以2016年3—9月住院KD患儿为研究对象(27例),同时设发热对照组(36例)和健康对照组(40例);KD患儿根据超声心动图检查进一步分为冠状动脉损伤(CAL)组和无冠状动脉损伤(NCAL)组。采集各组儿童外周静脉血,采用流式细胞仪检测PAC-1表达水平。结果 KD患儿在急性期、亚急性期和恢复期,与发热及健康对照组的血小板PAC-1表达水平差异有统计学意义(P0.001),健康对照组最低;KD患儿在亚急性期血小板PAC-1表达水平最高,其次为急性期和恢复期。亚急性期时,CAL组血小板PAC-1表达水平较NCAL组明显升高,差异有统计学意义(P0.05)。结论 KD患儿在整个病程中血小板PAC-1表达水平升高,提示存在血小板活化;KD患儿亚急性期PAC-1表达水平升高最明显,且CAL组较NCAL组明显升高,提示血小板活化与KD冠状动脉损伤相关。     

危重患者气管插管拔管后吞咽功能障碍研究新进展

危重患者气管插管拔管后吞咽功能障碍可影响患者预后，严重增加社会医疗负担及照护负担。本文从危重患者气管插管拔管后吞咽功能障碍的流行病学情况及原因、影响因素和干预策略进行总结，可为危重患者气管插管拔管后吞咽功能障碍的管理提供借鉴和参考。     

生命早期饥荒暴露与成年期高血压患病风险的关联分析

目的探讨胎儿和婴儿时期饥荒暴露与成年后高血压患病风险之间的关系。方法基于2012年吉林省慢性病调查数据,选取1956-1965年出生的5960名研究对象,分为未暴露(1963-1965年)、胎儿期暴露(1959-1961年)、儿童早期暴露(1956-1958年)和过渡(1962年)4组。采用logistic回归模型探讨早期饥荒暴露与成年期高血压患病风险之间的关系。结果胎儿期暴露(OR=1.249,95%CI:1.049~1.486)和儿童早期暴露(OR=1.360,95%CI:1.102~1.679)均是高血压的危险因素。在农村地区,与未暴露相比,胎儿期暴露(OR=1.401,95%CI:1.091~1.798)和儿童早期暴露(OR=1.460,95%CI:1.145~1.862)增加了其成年后高血压的患病危险。女性胎儿期暴露于饥荒中高血压风险增加36.0%(95%CI:7.8%~71.7%),女性儿童早期暴露于饥荒高血压风险增加31.9%(95%CI:4.8%~66.0%)。结论胎儿期暴露于饥荒中可能会增加成年后高血压的患病风险。因此,生命早期均衡营养对预防成年后高血压的发生有重要意义。     

Porcine reproductive and respiratory syndrome virus NADC30‐like strain accelerates Streptococcus suis serotype 2 infection in vivo and in vitro

Porcine reproductive and respiratory syndrome (PRRS), an economically significant pandemic disease, commonly results in increased impact of bacterial infections, including those by Streptococcus suis (S. suis). In recent years, PRRS virus (PRRSV) NADC30‐like strain has emerged in different regions of China, and coinfected with S. suis and PRRSV has also gradually increased in clinical performance. However, the mechanisms involved in host innate responses towards S. suis and their implications of coinfection with NADC30‐like strain remain unknown. Therefore, the pathogenicity of NADC30‐like strain and S. suis serotype 2 (SS2) coinfection in vivo and in vitro was investigated in this study. The results showed that NADC30‐like increased the invasion and proliferation of SS2 in blood and tissues, resulting in more severe pneumonia, myocarditis, and peritonitisas well as higher mortality rate in pigs. In vitro, NADC30‐like strain increased the invasion and survival of SS2 in porcine alveolar macrophages (PAM) cells, causing more drastic expression of inflammatory cytokines and activation of NF‐ĸB signalling. These results pave the way for understanding the interaction of S. suis with the swine immune system and their modulation in a viral coinfection.