前臂皮瓣联合钛网和颊脂垫修复口腔癌术后的上颌骨缺损

目的观察前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损的临床效果。方法对3例上颌牙龈癌和1例腭部腺样囊性癌分别行上颌骨次全切除或全切除术,遗留的缺损用4 cm×5 cm~5 cm×7 cm大小的前臂皮瓣联合钛网和颊脂垫修复。其中钛网用于恢复上颌骨前外侧面、牙槽突和腭部形态,前臂皮瓣用于修复腭部口腔面黏膜缺损,颊脂垫用于修复腭部鼻腔面黏膜缺损。术后通过临床检查及CT和鼻内窥镜检查评价其效果。结果随访1~3年,肿瘤无复发,移植皮瓣全部成活,面部外形及牙槽突和腭部形态恢复良好,鼻腔面钛网被软组织覆盖,佩戴可摘局部义齿修复缺牙后,语言和进食功能恢复良好。结论前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损效果理想。     

Clinical value of the renal pathologic scoring system in complement-mediated thrombotic microangiopathy

ObjectivesThis study was initiated to establish a renal thrombotic microangiopathy (TMA) scoring system based on clinical needs and investigate its predictive value for patients’ long-term outcomes.MethodsKidney biopsy-proven Complement-mediated TMA (C-TMA) patients from January 2000 to December 2017 in Peking University First Hospital were retrospectively studied. Both acute and chronic TMA-related lesions, including 15 pathologic indices, were semiquantitatively scored. The interobserver and intraobserver reproducibility and correlation between the pathologic indices and clinical parameters were analyzed. Furthermore, the patients were divided into 2 groups by dialysis use at baseline, and the association of these pathologic indices with their prognostic outcomes was assessed between the two groups.ResultsNinety-two patients with renal biopsy-proven C-TMA were enrolled. All fifteen included pathology indices showed good or moderate interobserver and intraobserver reproducibility and correlated well with several clinical parameters. Several clinicopathological indices were worse in the dialysis group than in the nondialysis group, such as serum creatinine, hemoglobin, platelet count, and estimated glomerular filtration rate. Moreover, morphologic features in the dialysis group presented with more severe vascular lesions. Interstitial fibrosis and chronic tubulointerstitial lesions were related to a trend of high risk of continuous dialysis in the dialysis group. Based on univariate and multivariable Cox regression analysis, more severe glomerular lesions, including glomerular mesangiolysis, glomerular basement membrane double contours and glomerular mesangial proliferation, were identified as risk factors predicting worse prognosis.ConclusionsOur renal C-TMA semiquantitative scoring system is reliable with good reproducibility and prognostic value in clinical practice, which needs further validation.     

老年桥本氏甲状腺炎患者碘营养与SOD、IP-10 及甲状腺激素水平相关研究

目的：探讨老年桥本氏甲状腺炎（Hashimoto thyroiditis,HT）患者碘营养状况与超氧化物歧化酶（superoxide dismutase,SOD）活力、干扰素诱导蛋白-10（interferon-inducible protein 10,IP-10）和甲状腺激素水平的相关性。方法：通过检测92例唐山市工人医院内分泌科就诊的老年桥本氏甲状腺炎患者,及同期体检的40例临床健康老年人的尿碘、血清SOD活力、IP-10水平及甲状腺功能等相关指标,比较不同碘营养状况对SOD活力、IP-10水平、HT发病和甲状腺激素水平的影响,分析碘、SOD和IP-10三者之间的相关性。结果：与对照组相比,老年桥本患者尿碘（216.63 μg/L）和IP-10水（194.41 ng/L）平均较高,而SOD（92.99 U/mL）活性较低。碘充足组促甲状腺激素、血清游离三碘甲状腺原氨酸、血清游离甲状腺素和IP-10水平明显升高,SOD活力明显降低。相关分析发现尿碘与SOD活性呈负相关,与血清IP-10水平成正相关,血清SOD活性与IP-10水平呈负相关（r=0.662）。结论：过量碘摄入与老年桥本氏甲状腺炎相关,高碘能够影响患者甲状腺功能、氧化应激状态和趋化因子水平。     

婴儿胆汁淤积性肝病的治疗进展

  目的  探讨茵陈五苓散对胆汁淤积幼龄大鼠肝功能的保护作用及可能机制。  方法  幼龄SD大鼠随机分为对照组、模型组、熊去氧胆酸组（UDCA, 0.10 g/kg）、茵陈五苓散高、中、低剂量组（100.0、200.0、400.0 g/kg）,每组12只,雌雄各半。给药6 d后,采用0.5 % α – 萘异硫氰酸酯（ANIT, 50 mg/kg）花生油溶液灌胃,建立胆汁淤积模型。造模后继续给药2 d,最后一次给药12 h后,收集大鼠胆汁,生化法检测血清碱性磷酸酶（ALP）、γ – 谷氨酰转移酶（γ-GT）、总胆汁酸（TBA）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平和肝匀浆中超氧化物歧化酶（SOD）、丙二醛（MDA）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH-Px）水平;苏木精 – 伊红染色（HE）观察各组大鼠肝组织病理变化;Western blot检测肝组织中Kelch样环氧氯丙烷相关蛋白1（Keap1）、核因子E2相关因子2（Nrf2）、还原型辅酶/醌氧化还原酶（NQO1）和血红素加氧酶1（HO-1）蛋白表达。  结果  与对照组比较,模型组大鼠血清ALP、γ-GT、TBA、ALT、AST水平均显著升高（P < 0.05）;胆汁流量、肝组织中SOD、CAT、GSH-Px水平显著降低,MDA水平明显增加（P < 0.05）;肝细胞索排列紊乱,细胞肿大伴点状坏死,有空泡样改变,大量炎性细胞浸润;肝组织Keap1蛋白表达显著升高,Nrf2、NQO1、HO-1蛋白表达显著降低（P < 0.05）。与模型组比较,UDCA组、茵陈五苓散高、中剂量组大鼠血清ALP、γ-GT、TBA、ALT、AST水平均显著降低（P < 0.05）;胆汁流量、肝匀浆中SOD、CAT、GSH-Px水平均显著升高,MDA水平明显降低（P < 0.05）;肝组织病理损伤减轻,Keap1蛋白表达明显降低,Nrf2、NQO1、HO-1蛋白表达明显升高（P < 0.05）。  结论  茵陈五苓散对ANIT诱导幼龄大鼠胆汁淤积型肝损伤具有保护作用,其机制可能与抑制Keap1表达,上调Nrf2表达,提高机体的抗氧化能力,减轻氧化应激损伤有关。     

新疆男男性行为人群高危行为安全套使用状况及其影响因素分析

  目的  了解新疆男男性行为人群（MSM）队列失访率和随访保持率以及分析失访原因。  方法  于2010年6月 — 2015年3月在新疆乌鲁木齐市、伊宁市、阿克苏市3个地区招募HIV抗体阴性MSM,建立前瞻性队列研究。每3个月进行定位随访,每6个月进行行为学调查和HIV抗体检测。单因素分析采用多组比较的χ²检验,多因素分析采用多元logistic回归。  结果  队列共纳入1 041名调查对象,6个月随访人数900人（86.46 %）,12个月随访884人（84.92 %）;6个月失访141人（13.54 %）,12个月失访157人（15.08 %）.单因素分析结果显示,年龄、文化程度、户籍所在地、月收入、艾滋病相关知识、调查地区、参加队列原因、寻找性伴场所、安全套使用频次、近6个月性伴数量以及感染丙肝状况是MSM失访与随访之间的差异存在统计学意义的变量（P < 0.05）。多因素分析结果显示,文化程度（OR = 0.089,95 % CI = 0.060～0.133,P < 0.001）、调查地区（OR = 1.800,95 % CI = 1.231～2.632,P = 0.002）、参加队列原因（OR = 0.663,95 % CI = 0.465～0.946,P = 0.023）、近6个月性伴数量（OR = 4.070,95 % CI = 2.002～8.278,P < 0.01）是队列失访的影响因素。  结论  新疆MSM队列失访率较高,文化程度、调查地区、参加队列研究的原因以及近6个月性伴数量均与队列失访有关。     

德尔菲法在“营养教育效果综合评价问卷”制定中的应用

  目的  探讨与慢性病营养防控相关谣言的慢性病类别分布、传播者、传播渠道、传播受害者等特征和形式,为建立慢性病防控相关营养谣言的辟谣机制提供政策和策略建议。  方法  于2019年9 — 12月通过检索2015年1月1日 — 2019年11月31日间的相关文献,开展专家访谈进行调研。  结果  慢性病营养防控相关信息中存在谣言最多的慢性病为癌症,占25.13 %;主要传播者是自媒体,占40.91 %;认为线上线下传播比例为8 : 2的占比为55.56 %,说明主要传播途径是线上传播;慢性病营养防控相关谣言受害者以老年人（38.89 %）和慢性病患者（27.78 %）居多,达66.67 %。  结论  慢性病营养防控相关谣言以网络谣言传播的形式为主,传播源头管控难度大,造成的潜在危害和影响巨大,应建立以线上辟谣为主、社会多元主体共治谣言的长效机制。     

经右桡动脉-右股静脉途径介入封堵动脉导管未闭的安全性及有效性分析

目的探讨经右桡动脉-右股静脉途径介入封堵动脉导管未闭的安全性及有效性。方法选取介入封堵动脉导管未闭患者45例,分为经右桡动脉-右股静脉途径封堵动脉导管未闭(PDA)(桡动脉组)14例,经右股动脉-右股静脉途径封堵PDA(股动脉组) 31例,比较两组的手术成功率、平均手术时间、造影清晰度、手术并发症发生率。结果两组平均手术时间、手术成功率比较,差异无统计学意义。两组手术并发症比较,有差异,P<0.05。结论两种手术途径均安全有效,但经右桡动脉途径介入封堵中,平均卧床时间及手术并发症均明显低于传统手术路径,值得推广。     

葡萄糖酸锌兔体内药物动力学及生物利用度研究

本文介绍了用原子吸收分光光度法测定葡萄糖酸锌(Zinc Gluconate,ZG)兔体内血清锌浓度,用一室模型分析了ZG在家兔体内的药动学参数以及硫酸锌片剂,ZG水剂相对于ZG片剂对锌的生物利用度,硫酸锌片剂,ZG水剂相对于ZG片剂对锌的生物利用度分别为24.9％和62.1％。实验结果表明:ZG具有口服吸收快,维持时间长,峰浓度高的特点,是一优于硫酸锌的良好补锌剂。     

Efficacy of short-term multidisciplinary intensive rehabilitation in patients with different Parkinson's disease motor subtypes: a prospective pilot study with 3-month follow-up

Parkinson's disease(PD) can be classified into three motor-based subtypes: postural instability/gait difficulty(PIGD), tremor dominant(TD), and indeterminate.The neuropathophysiological mechanisms of the three motor subtypes are different, which may lead to different responses to therapy.Sixty-nine patients with idiopathic Parkinson's disease(Hoehn–Yahr stage ≤ 3) were screened from 436 patients with Parkinsonism recruited through outpatient services and the internet.According to the Movement Disorder Society Unified Parkinson's Disease Rating Scale(MDS-UPDRS) TD/PIGD ratio, the patients were divided into PIGD(TD/PIGD ≤ 0.09; n = 36), TD(TD/PIGD ≥1.15; n = 19), and indeterminate(TD/PIGD = 0.90–1.15; n = 14) groups.All patients received 2 weeks of multidisciplinary intensive rehabilitation treatment(MIRT) during hospitalization, as well as a remote home rehabilitation health education class.Compared with the scores at admission, all patients showed significant improvements in their MDS-UPDRS III score, walking ability, balance, and posture control at discharge.Moreover, the MDS-UPDRS III score improvement was greater in the PIGD group than in the TD group.The follow-up data, collected for 3 months after discharge, showed that overall symptom improvement in each group was maintained for 1–3 months.Furthermore, there were no significant differences in the duration or grade effects of symptom improvement among the three groups.These findings suggest that 2 weeks of MIRT is effective for improving motor performance in all three motor subtypes.Patients in the PIGD group had a better response after hospitalization than those in the TD group.This study was approved by the Institutional Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University of China(approval No.2018 bkky022) on May 7, 2018 and registered with the Chinese Clinical Trial Registry(registration No.Chi CTR1900020771) on January 19, 2019.