2008-2018年云南省人间布鲁菌病流行特征及灰色GM(1,1)模型预测

目的分析云南省布鲁菌病(简称布病)流行特征,建立灰色GM(1,1)模型,预测云南省布病病情。方法收集中国疾病预防控制信息系统和云南省统计局2008-2018年云南省布病疫情数据和人口资料,分析布病流行病学特征(包括时间、地区、人群分布),并以灰色GM(1,1)模型进行建模,预测2019、2020年云南省布病发病率。结果2008-2018年云南省共报告布病病例1216例,年均发病率为0.2374/10万,呈逐年递增趋势(χ²趋势=843.34,P<0.01)。病例报告主要集中在3-9月份,占总病例数的69.41%(844/1216)。病例报告数居前5位的州市分别为红河州(289例)、曲靖市(264例)、昆明市(258例)、大理州(160例)、玉溪市(134例),占总病例数的90.87%(1105/1216)。职业以农民为主,占79.03%(961/1216)。建立灰色GM(1,1)模型预测2019、2020年云南省布病发病率分别为0.4876/10万和0.4817/10万。结论云南省布病发病较以往上升,应对重点地区、重点人群进行针对性防控,并对预测结果进行前瞻性评价,逐步完善云南省布病预测模型。     

我国31家省级中医院医生福利待遇满意度及人口学影响因素研究

目的调查我国省级中医院医生福利待遇满意度及人口学影响因素。方法选取全国31个省（自治区、直辖市）31家省级中医院医生进行福利待遇满意度问卷调查。采用SPSS 25.0 软件对数据进行统计学分析。结果被调查中医院医生过去1 a税后实际收入中位数为12万元。薪酬、法定假期、学习深造、餐食、休息室数量满意度分别为27.83%、33.56%、58.67%、44.30%、69.84%。性别、年龄、行政职务是薪酬满意度影响因素,性别、学历、职称、科室和行政职务是法定假期满意度影响因素,性别、年龄、学历和行政职务是学习深造满意度影响因素,性别、学历、职称、科室和行政职务是餐食满意度影响因素,性别、职称、科室和行政职务是休息室数量满意度影响因素。结论被调查中医院医生福利待遇整体情况呈向好趋势,但实际收入不高,薪酬满意度较低。中医院应积极落实国家相关政策要求,根据不同人口学特征医生不同需求,多途径提高医生福利待遇。     

国产辛伐他汀调脂疗效的多中心随机对照临床试验

目的　了解国产辛伐他汀 ( SS)的调脂疗效。方法　以默沙东生产的舒降之为对照 ,进行多中心随机对照临床观察。将 16 0例高脂血症患者随机分为试验组 (国产 SS,A组 )、对照组 (进口 SS,舒降之 ,B组 )和开放组 (国产 SS,C组 ) ,其中 A、B组为单盲。每例受试者均于每日晚餐后口服 SS10 mg,疗程 8周 ,且保持受试前的饮食和生活习惯不变。分别于受试后的 4周和 8周随访。结果　完成试验 15 5例 ,脱落 5例 (均因病员不合作 )。疗程4周时 ,A、B、C三组的血总胆固醇 ( TC)分别下降 16 .88%、19.2 3%和 14.10 % ,血甘油三酯 ( TG)分别下降19.2 7%、15 .6 6 %和 17.96 % ,HDL- C分别升高 7.6 9%、7.46 %和 6 .6 9% ,L DL- C分别下降 2 3.0 %、2 7.84%和2 4.43% ,三组间比较无显著性差异 ( P>0 .0 5 )。疗程 8周时 ,A、B、C三组的 TC分别下降 2 5 .0 3%、2 6 .5 3%和2 5 .2 2 % ,TG分别下降 2 3.85 %、2 4.74%和 2 4.75 % ;HDL- C分别升高 9.2 3%、8.95 %和 8.89% ,L DL- C分别下降33.72 %、35 .5 0 %和 30 .99% ,三组间比较也无显著性差异 ( P>0 .0 5 )。不良反应主要为消化道症状 ,其发生率 A、B、C三组分别为 2 0 .34 %、2 2 .81%和 17.95 % ,三组间无显著性差异 ( P>0 .0 5 )。 4周与 8周时比较 ,8周的疗效呈     

The prognostic value of platelet-to-lymphocyte ratio on the long-term renal survival in patients with IgA nephropathy

Purpose

Platelet-to-lymphocyte ratio (PLR) was established showing the poor prognosis in several diseases, such as malignancies and cardiovascular diseases. But limited study has been conducted about the prognostic value of PLR on the long-term renal survival of patients with Immunoglobulin A nephropathy (IgAN).

Methods

We performed an observational cohort study enrolling patients with biopsy-proven IgAN recorded from November 2011 to March 2016. The definition of composite endpoint was eGFR decrease by 50%, eGFR?<?15 mL/min/1.73 m², initiation of dialysis, or renal transplantation. Patients were categorized by the magnitude of PLR tertiles into three groups. The Kaplan–Meier curves and multivariate Cox models were performed to determine the association of PLR with the renal survival of IgAN patients.

Results

330 patients with a median age of 34.0 years were followed for a median of 47.4 months, and 27 patients (8.2%) had reached the composite endpoints. There were no differences among the three groups (PLR?<?106, 106?≤?PLR?≤?137, and PLR?>?137) in demographic characteristics, mean arterial pressure (MAP), proteinuria, and estimated glomerular filtration rate (eGFR) at baseline. The Kaplan–Meier curves showed that the PLR?>?137 group was significantly more likely to poor renal outcomes than the other two groups. Using univariate and multivariate cox regression analyses, we found that PLR?>?137 was an independent prognostic factor for poor renal survival in patients with IgAN. Subgroup analysis revealed that the PLR remained the prognostic value for female patients or patients with eGFR less than 60 mL/min/1.73 m².

Conclusions

Our results underscored that baseline PLR was an independent prognostic factor for poor renal survival in patients with IgAN, especially for female patients or those patients with baseline eGFR less than 60 mL/min/1.73 m².

     

Incomplete Administration of Intravenous Vancomycin Prophylaxis is Common and Associated With Increased Infectious Complications After Primary Total Hip and Knee Arthroplasty

BackgroundVancomycin is often used as antimicrobial prophylaxis in patients undergoing total hip or knee arthroplasty. Vancomycin requires longer infusion times to avoid associated side effects. We hypothesized that vancomycin infusion is often started too late and that delayed infusion may predispose patients to increased rates of surgical site infections and prosthetic joint infections.MethodsWe reviewed clinical data for all primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients at our institution between 2013 and 2020 who received intravenous vancomycin as primary perioperative gram-positive antibiotic prophylaxis. We calculated duration of infusion before incision or tourniquet inflation, with a cutoff of 30 minutes defining adequate administration. Patients were divided into two groups: 1) appropriate administration and 2) incomplete administration. Surgical factors and quality outcomes were compared between groups.ResultsWe reviewed 1047 primary THA and TKA patients (524 THAs and 523 TKAs). The indication for intravenous vancomycin usage was allergy (61%), methicillin-resistant staphylococcus aureus colonization (17%), both allergy and colonization (14%), and other (8%). 50.4% of patients began infusion >30 minutes preoperatively (group A), and 49.6% began infusion <30 minutes preoperatively (group B). Group B had significantly higher rates of readmissions for infectious causes (3.6 vs 1.3%, P = .017). This included a statistically significant increase in confirmed prosthetic joint infections (2.2% vs 0.6%, P = .023). Regression analysis confirmed <30 minutes of vancomycin infusion as an independent risk factor for PJI when controlling for comorbidities (OR 5.22, P = .012).ConclusionLate infusion of vancomycin is common and associated with increased rates of infectious causes for readmission and PJI. Preoperative protocols should be created to ensure appropriate vancomycin administration when indicated.     

Does the Use of a Tourniquet Influence Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundIntraoperative tourniquet use in total knee arthroplasty (TKA) is a common practice which may improve visualization of the surgical field and reduce blood loss. However, the safety and efficacy associated with tourniquet use continues to be a subject of debate among orthopedic surgeons. The primary purpose of this study is to evaluate the effects of tourniquet use on pain and opioid consumption after TKA.MethodsThis is a multicenter randomized controlled trial among patients undergoing TKA. Patients were preoperatively randomized to undergo TKA with or without the use of an intraoperative tourniquet. Frequency distributions, means, and standard deviations were used to describe baseline patient demographics (age, gender, race, body mass index, smoking status), length of stay, surgical factors, visual analog scale pain scores, and opioid consumption in morphine milligram equivalents.ResultsA total of 327 patients were included in this study, with 166 patients undergoing TKA without a tourniquet and 161 patients with a tourniquet. A statistically significant difference was found in surgical time (97.87 vs 92.98 minutes; P = .05), whereas none was found for length of stay (1.73 vs 1.70 days; P = .87), postop visual analog scale pain scores (1.73 vs 1.70; P = .87), inpatient opioid consumption (19.84 vs 19.27 morphine milligram equivalents; P = .74), or outpatient opioid consumption between the tourniquet-less and tourniquet cohorts, respectively. There were no readmissions in either cohort during the 90-day episode of care.ConclusionUtilization of a tourniquet during TKA has minimal impact on postoperative pain scores and opioid consumption when compared with patients who underwent TKA without a tourniquet.     

Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?

BackgroundAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.MethodsA retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.ResultsSixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.ConclusionAt our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%.     

紫菀的研究进展及质量标志物预测分析

紫菀是临床常用的化痰止咳要药,始载于《神农本草经》。紫菀化学成分丰富,主要包括萜类及其苷、肽类、黄酮、蒽醌、香豆素、有机酸、酚类、甾醇、挥发油及苯丙素类等。现代药理学研究表明,紫菀在抗肿瘤、抗病毒、抗氧化等方面也具有显著的药理活性。对紫菀的资源分布、化学成分、药理活性研究进展进行综述,并依据质量标志物的概念及确定原则对紫菀的质量标志物进行预测分析,以期为紫菀质量标准的深入研究提供参考。     

箭叶淫羊藿不同时期根际微生物群落组成及其与有效成分累积的相关性分

目的 通过分析箭叶淫羊藿Epimediumsagittatum不同生育期根际微生物群落结构及其与主要药用有效成分累积之间的相关性,探讨箭叶淫羊藿根际土壤微生物对其药材有效成分的影响,为箭叶淫羊藿的优质高产栽培提供科学依据。方法 以三年生箭叶淫羊藿的根际土为研究对象,采用高通量测序技术对根际细菌和真菌群落结构进行分析,同时测定根际土壤理化性质、酶活性及不同生育期药材总黄酮、淫羊藿苷等有效成分含量,通过皮尔逊相关性分析探究土壤生态因子与有效成分之间的关系。结果 高通量测序结果显示,箭叶淫羊藿根际细菌优势菌属包括Candidatus＿Solibacter、苔藓杆菌属、嗜酸栖热菌属、芽单胞菌属等,其中,Candidatus＿Solibacter属在5个生长时期的平均丰度值最高。根际真菌优势菌属中被孢霉属相对丰度占比最大,在花蕾期样品中的丰度值高达44.27%。UPGMA聚类和非度量多维标定法（NMDS）分析表明,花蕾期、盛花期、果实膨大期及盛果期的根际土壤细菌和真菌结构相似,而药材质量稳定期与前4个时期的根际微生物群落结构存在明显差异。同时,皮尔逊相关性分析结果显示：总黄酮含量与有效磷呈显著正...     

基于熵权法评价干燥方法对经典名方华盖散基准样品质量属性的影响

目的 优选经典名方华盖散基准样品的干燥方法。方法 采用真空干燥、真空带式干燥、喷雾干燥、冷冻干燥方法制备华盖散基准样品,应用扫描电子显微镜、差式扫描量热分析、HPLC等方法测定基准样品的质量属性,以得粉率、玻璃化转变温度及成分含量转移率等为评价指标,运用熵权法对各指标赋予权重进行综合评价。结果 喷雾干燥基准样品粒子呈类球形、粒径最小,冷冻干燥基准样品不规则、蓬松、溶化性好。指标成分盐酸麻黄总碱、苦杏仁苷、橙皮苷、甘草苷、甘草酸转移率分别为85.66%～104.78%、90.81%～104.16%、91.42%～94.86%、83.98%～94.69%、87.85%～94.45%,指纹图谱相似度均大于0.9。结论 经综合评价得出冷冻干燥方法最佳,3批验证工艺重复性、可行性较好,为经典名方基准样品质量属性研究提供了理论依据和实践价值。