新生儿足跟采血取右侧斜坡位效果探讨

目的 探讨斜坡位在新生儿足跟采血中的应用方法及效果.方法 将80例符合接受足跟采血要求的足月新生儿随机分为两组,观察组(40例)新生儿采取右侧、抬高床头30 °的斜坡体位采血,对照组(40例)采取平卧住采血.结果观察组新生儿采血情况优于对照组,溢奶发生率低于对照组(均P＜0.05).结论 新生儿足跟采血取右侧、抬高床头...     

慢性病毒性肝炎患者对血液污染利器的认知情况调查

目的了解慢性病毒性肝炎患者对血液污染利器认知的情况,以制定相应策略和措施进行预防、阻断医源性利器对人群造成的意外伤害。方法采用现况调查的方法对首都医科大学附属北京地坛医院肝病中心50例慢性病毒性肝炎患者进行问卷式调查,获取资料进行处理分析。结果应用利器的原因中糖尿病测血糖,糖尿病注射胰岛素,注射干扰素以及前两者同时存在者分别占2％、14％、76％和8％。所用利器的处理方式中随手扔掉,盖回针帽再扔,放入自制的利器盒和带回医院的分别占22％、64％、10％和4％。受访者对医用血液污染利器危害的严重程度评分,由重到轻依次为扎伤自己、扎伤他人、传染他人和传染自己。受访者认为血液污染利器可以传播的疾病主要是乙型肝炎、丙型肝炎和艾滋病,认知率均达90％,普遍认为高血压病、癌症是不会通过该途径传播的。受访者认为正确的处理血液污染利器的方式中,直接扔到医用垃圾箱（袋）,盖回针帽再扔到医用垃圾箱（袋）,放入特制的利器盒及不知如何处理的比例分别是2％、20％、62％和16％。愿意使用免费提供的利器盒者为98％。结论慢性病毒性肝炎患者对于血液污染已用利器处理知识的掌握整体比较全面,但是也存在一定问题,譬如对血液传播疾病的种类,对医用血液污染利器的处理方式等还有待进一步宣传教育。     

Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET

The purpose of this study was to determine the actual standardized uptake value (SUV) by using the lesion size from computer tomography (CT) scan to correct for resolution and partial volume effects in positron emission tomography (PET) imaging. This retrospective study included 47 patients with lung lesions seen on CT scan whose diagnoses were confirmed by biopsy or by follow up CT scan when the PET result was considered negative for malignancy. Each lesion's FDG uptake was quantified by the SUV using two methods: by measuring the maximum voxel SUV (maxSUV) and by using the lesion's size on CT to calculate the actual SUV (corSUV). Among small lesions (2.0 cm or smaller on CT scan), ten were benign and 17 were malignant. The average maxSUV was 1.43+/-0.77 and 3.02+/-1.74 for benign and malignant lesions respectively. When using an SUV of 2.0 as the cutoff to differentiate benignity and malignancy, the sensitivity, specificity, and accuracy were 65%, 70%, and 67% respectively. When an SUV of 2.5 was used for cutoff, the sensitivity, specificity, and accuracy were 47%, 80%, and 59% respectively. The average corSUV was 1.65+/-1.09 and 5.28+/-2.71 for benign and malignant lesions respectively. Whether an SUV of either 2.0 or 2.5 was used for cutoff, the sensitivity, specificity, and accuracy remained 94%, 70%, and 85% respectively. The only malignant lesion that was falsely considered benign with both methods was a bronchioalveolar carcinoma which did not reveal any elevated uptake of fluorine-18 fluorodeoxyglucose (FDG). Of the large lesions (more than 2.0 cm and less than 6.0 cm), one was benign and 19 were malignant and the corSUV technique did not significantly change the accuracy. It is concluded that measuring the SUV by using the CT size to correct for resolution and partial volume effects offers potential value in differentiating malignant from benign lesions in this population. This approach appears to improve the accuracy of FDG-PET for optimal characterization of small lung nodules.     

高校医院社区卫生服务现状调查与思考

目的:通过分析高校社区卫生服务的现状和存在问题,探讨改善高校社区卫生服务的相应对策.方法:研究近年来高校社区卫生开展预防、保健、健康教育、医疗、康复、计划生育技术指导“六位一体”的服务实践中的现状及经验.结果:高校社区卫生服务已逐渐成熟.结论:高校医院作为具有固定服务对象的医疗服务单位,开展社区卫生服务工作有着得天独厚的优势.     

Cartilage‐Specific Autophagy Deficiency Promotes ER Stress and Impairs Chondrogenesis in PERK‐ATF4‐CHOP–Dependent Manner

Autophagy is activated during nutritionally depleted or hypoxic conditions to facilitate cell survival. Because growth plate is an avascular and hypoxic tissue, autophagy may have a crucial role during chondrogenesis; however, the functional role and underlying mechanism of autophagy in regulation of growth plate remains elusive. In this study, we generated ^TamCartAtg7^–/– (Atg7cKO) mice to explore the role of autophagy during endochondral ossification. Atg7cKO mice exhibited growth retardation associated with reduced chondrocyte proliferation and differentiation, and increased chondrocyte apoptosis. Meanwhile, we observed that Atg7 ablation mainly induced the PERK‐ATF4‐CHOP axis of the endoplasmic reticulum (ER) stress response in growth plate chondrocytes. Although Atg7 ablation induced ER stress in growth plate chondrocytes, the addition of phenylbutyric acid (PBA), a chemical chaperone known to attenuate ER stress, partly neutralized such effects of Atg7 ablation on longitudinal bone growth, indicating the causative interaction between autophagy and ER stress in growth plate. Consistent with these findings in vivo, we also observed that Atg7 ablation in cultured chondrocytes resulted in defective autophagy, elevated ER stress, decreased chondrocytes proliferation, impaired expression of col10a1, MMP­13, and VEGFA for chondrocyte differentiation, and increased chondrocyte apoptosis, while such effects were partly nullified by reduction of ER stress with PBA. In addition, Atg7 ablation‐mediated impaired chondrocyte function (chondrocyte proliferation, differentiation, and apoptosis) was partly reversed in CHOP^–/– cells, indicating the causative role of the PERK‐ATF4‐CHOP axis of the ER stress response in the action of autophagy deficiency in chondrocytes. In conclusion, our findings indicate that autophagy deficiency may trigger ER stress in growth plate chondrocytes and contribute to growth retardation, thus implicating autophagy as an important regulator during chondrogenesis and providing new insights into the clinical potential of autophagy in cartilage homeostasis. © 2017 American Society for Bone and Mineral Research.     

Suramin promotes recovery from renal ischemia/reperfusion injury in mice

Suramin is a polysulfonated naphthylurea originally designed as a treatment for trypanosomiasis; but that has also been used to treat rodent models of fulminant hepatic failure and focal brain ischemia. In this study, we determined the effects of suramin on renal ischemia/reperfusion-induced acute kidney injury in mice, in particular its effect when administered after renal injury has been established. Increasing concentrations of suramin were given 24 hours following reperfusion, a time when serum creatinine levels were at their highest level. This treatment improved renal function, as evidenced by decreased blood urea nitrogen and serum creatinine to control values and diminished histopathologic tubular damage. Suramin-treated animals had a significant reduction in apoptotic tubular cells and infiltrating leukocytes. There was also an increase of proliferating tubular cells following reperfusion compared to the number found in untreated animals. Our study shows that suramin promotes the recovery of renal function and has effective therapeutic applications when given after the occurrence of renal injury.     

腹腔镜胆道手术患者双管型喉罩通气的可行性

目的 探讨双管型喉罩（PLMA）用于腹腔镜胆道手术患者通气的可行性。方法 择期行腹腔镜胆囊切除术或腹腔镜胆总管探查术患者80例，年龄21-63岁，ASAⅠ或Ⅱ级，随机分为PLMA组和气管导管（TT）组，每组40例。用纤维支气管镜观察PLMA的到位情况。记录患者插管时、插管后3min、拔管时和拔管后3min的平均动脉压和心率，间歇正压通气15min时和气腹15min时的气道峰压（Ppeak）、潮气量（Vτ）和呼气末CO2分压（PETCO2）。结果 两组的插管时间、间歇正压通气15min时和气腹15min时的Ppeak、VT、PETCO2差异无统计学意义（P〉0．05）。两组首次插管后通气成功率均为95％，纤维支气管镜确认PLMA首次正确到位率为87．5％。PLMA组插管时、插管后3min、拔管时和拔管后3min的平均动脉压和心率较TT组降低（P〈0．05或0．01）。拔管时TT组65％出现呛咳或挣扎反应，术后2、24h咽痛发生率分别为22．5％、25％，而PLMA组均无拔管反应和术后咽痛。结论 与气管导管相比，双管型喉罩操作简便，应激反应小，通气可靠，可避免术后咽喉部并发症。     

术中双腔支气管插管位置监测方法的评估

目的比较五种监测方法在术中核查双腔支气管插管位置变化的价值。方法选择需行单肺通气的手术患者60例,放置手术体位后同时监测气道阻力、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、流量-容量环和支气管气囊压力,3min后使用纤维支气管镜对双腔支气管插管位置进行判断及调整。结果气道阻力监测的灵敏度为63．64％,特异度为89．80％;PETCO2监测的灵敏度为54．55％,特异度为87．76％;流量-容量环监测的灵敏度为81．82％,特异度为85．71％。结论气道阻力监测、PETCO2监测、流量-容量环监测有助于临床判断双腔支气管插管位置。     

牙周组织再生研究新进展

目的 对牙周组织再生研究新进展进行综述.方法 查阅国内外近年组织工程技术在牙周组织再生中应用的相关文献,研究牙周组织再生和治疗新方法.结果 种子细胞、信号分子、支架材料及组织血管化是牙周组织再生的基本要素.它们之间有协同作用,如用生长因子基因修饰种子细胞、支架材料对生长因子进行控释等,将会增强它们在组织修复中的作用.结论 牙周组织工程技术在牙周组织再生和牙周治疗中具有巨大潜力和广阔前景.