PDCA循环持续改进临床用血申请审核审批

目的探讨PDCA循环法在临床用血申请审核审批过程中的应用及效果。方法应用PDCA循环法对临床用血申请审核审批进行质量持续改进,对临床用血申请审核审批不合格及未用血后疗效评估申请进行原因分析,制订相应的措施、持续改进计划。结果通过PDCA循环,临床用血申请的审核审批率由干预前的82.7%提高至99.2%,审核审批率明显提高;疗效评估率由2012年的90.3%上升至2013年的97.7%。结论采用PDCA循环能有效提高临床用血申请审核审批率和输血后疗效评估率,持续改进临床输血质量管理,促进临床科学、合理、有效用血。     

Innate immune receptor NOD2 promotes vascular inflammation and formation of lipid‐rich necrotic cores in hypercholesterolemic mice

Atherosclerosis is an inflammatory disease associated with the activation of innate immune TLRs and nucleotide‐binding oligomerization domain‐containing protein (NOD)‐like receptor pathways. However, the function of most innate immune receptors in atherosclerosis remains unclear. Here, we show that NOD2 is a crucial innate immune receptor influencing vascular inflammation and atherosclerosis severity. 10‐week stimulation with muramyl dipeptide (MDP), the NOD2 cognate ligand, aggravated atherosclerosis, as indicated by the augmented lesion burden, increased vascular inflammation and enlarged lipid‐rich necrotic cores in Ldlr^?/? mice. Myeloid‐specific ablation of NOD2, but not its downstream kinase, receptor‐interacting serine/threonine‐protein kinase 2, restrained the expansion of the lipid‐rich necrotic core in Ldlr^?/? chimeric mice. In vitro stimulation of macrophages with MDP enhanced the uptake of oxidized low‐density lipoprotein and impaired cholesterol efflux in concordance with upregulation of scavenger receptor A1/2 and downregulation of ATP‐binding cassette transporter A1. Ex vivo stimulation of human carotid plaques with MDP led to increased activation of inflammatory signaling pathways p38 MAPK and NF‐κB‐mediated release of proinflammatory cytokines. Altogether, this study suggests that NOD2 contributes to the expansion of the lipid‐rich necrotic core and promotes vascular inflammation in atherosclerosis.     

优化静脉溶栓流程对基层医院高级卒中中心建设的影响研究

背景　急性缺血性脑卒中（AIS）是成年人死亡和致残的主要原因之一,如何恢复是全世界的一个主要健康问题。尽管在有效预防和治疗方面取得了相当大的进展,但仍面临着重大挑战,特别是急诊处理,静脉溶栓治疗是唯一一种改善患者预后的方法,但只有少数患者能使用。目的　探讨优化静脉溶栓流程对AIS患者入院至静脉溶栓用药时间（DNT）的影响及对高级卒中中心建设的作用。方法　收集2015年11月-2018年11月海宁市人民医院收治的采用重组组织型纤溶酶原激活物（rt-PA）静脉溶栓治疗的AIS患者186例为研究对象,根据时间进行分组,2015年11月-2018年3月患者采用常规溶栓流程为常规组,2018年4-11月患者接受优化静脉溶栓流程为优化组。比较两组患者一般资料、发病至就诊时间（OTD）、入院至CT检查时间（DTI）、入院至化验检验时间（DTL）、DNT、溶栓距发病时间（TP_WINDOW）、症状性脑出血（sICH）发生率,入院时、溶栓24 h及出院时评价美国国立卫生研究院卒中量表（NIHSS）评分,以ΔNIHSS评分≥4分为有效,出院后3个月临床结局采用改良Rankin量表（mRS）评定。结果　优化组入院时NIHSS评分低于常规组（P<0.05）。常规组与优化组患者OTD、sICH发生率、有效率、出院时NIHSS评分比较,差异均无统计学意义（P>0.05）;优化组患者DTI、DTL、DNT、TP_WINDOW、出院后3个月mRS评分低于常规组,DNT<60 min所占比例高于常规组（P<0.05）。结论　优化静脉溶栓流程可以有效缩短AIS患者DNT,并有助于DNT达标控制在60 min内,未增加溶栓出血风险且影响远期预后,值得推广。     

法律视角下我国医院伦理委员会建设中存在的问题和对策

通过系统梳理涉及伦理委员会建设的现行立法,从法律角度探讨伦理委员会的法律地位、人员组成、资质考核、操作规程、法律监督等方面存在的问题。通过剖析存在的问题,建议提高立法等级,确定性别比例和专业占比标准,参考美国伦理委员会专业认证制度加强委员资质考核;建立专门操作指南,强调跟踪审查;适当调整各方监管权限,下设专门监管机构。     

肺癌患者血浆cofilin蛋白含量检测在肺癌诊断中的应用分析

目的探讨血浆cofilin蛋白检测对诊断肺癌的价值。方法随机抽取60例肺癌患者作为实验组,80例健康体检者为对照组,检测两组血浆cofilin蛋白含量并比较。结果实验组血浆cofilin蛋白水平(0.538±0.145)ng/ml,对照组(0.187±0.132)ng/ml,实验组高于对照组(t=14.924,P=0.000);方差分析,实验组的三个临床分期的血浆cofilin蛋白水平差异有统计学意义(F=12.382,P0.05),Ⅲ期、Ⅳ期的血浆cofilin蛋白水平高于Ⅱ期(t=3.529,P=0.001;t=5.674,P=0.000),Ⅳ期高于Ⅲ期(t=2.085,P=0.045)。结论血浆cofilin蛋白的检测对诊断肺癌有重要参考价值,肺癌患者的血浆cofilin蛋白含量高于健康者,且临床分期越晚含量越高。     

Reliability and Validity of the King's Health Questionnaire for Male Lower Urinary Tract Symptoms in Taiwan

Objectives: To investigate the reliability and validity of the King's Health Questionnaire (KHQ), and understand the impacts of lower urinary tract symptom (LUTS) on health‐related quality of life (HR‐QoL). Methods: A cross‐sectional design was used and a convenience of 393 men participated in the study. The reliability was measured by testing the Cronbach's α coefficients. Factor analysis was used to explore the underlying factor structure of the KHQ. The discriminant validity was assessed using the one‐way analysis of variance (ANOVA) tests with post hoc analysis (Games‐Howell method) by comparing the differences scores in KHQ domains between men with three LUTS severity groups (mild, moderate, and severe). Results: Men with severe, moderate, mild LUTS accounted for 7.9, 25.4, and 66.7%, respectively. Internal consistency of KHQ was excellent with Cronbach's α coefficients of 0.750–0.943. Factor analysis showed three underlying components to explain constructive validity. The KHQ subscores in both the severe and moderate LUTS groups were significantly higher than those in mild LUTS group (all P < 0.05), implying that the discriminant validity was adequate. Excepting for two single‐item questions, the first three greater disparities in KHQ domains between the severe and mild LUTS groups were “Emotion”, “Sleeping/Energy”, and “Physical limitation”, while the least disparities was found in “Personal relationships” domain. Conclusion: LUTS could produce a substantial impact on different domains of HR‐QoL. The traditional Chinese KHQ has suitable reliability and validity for men with general LUTS, and might be a useful tool for HR‐QoL measure in future.     

7例孤立性骨浆细胞瘤的临床分析

目的 探讨孤立性骨浆细胞瘤的诊断和治疗,总结其临床特点,以提高临床诊治水平.方法 收集中山大学孙逸仙纪念医院白2007年4月至2011年6月收治7例孤立性骨浆细胞瘤患者的临床资料并对其临床特点、诊断标准及治疗和预后作一回顾性分析.结果 所有病例均经病理证实为骨浆细胞瘤并符合孤立性骨浆细胞瘤的诊断标准,其中1例伴POEMS综合征(多神经病、器官巨大症、内分泌病、M蛋白和皮肤病变综合征),1例术后6个月出现多处骨转移.所有患者治疗后随访1~13个月,平均随访时间为4个月.其中5例患者预后良好,随访期间未出现病情进展.结论 孤立性骨浆细胞瘤好发于中老年,是少见的低度恶性肿瘤.主要依靠病理确诊,手术结合适当剂量的放疗是其治疗的最佳手段.