鞍山市铁东区公共场所卫生基层问题及解决建议

笔者作为基层卫生监督工作人员经过十多年的公共场所卫生监督工作,通过对鞍山市铁东区公共场所卫生监督情况进行分析。发现当前存在许多公共场所卫生监督执法困难和难题,主要表现为卫生监督队伍薄弱,新兴公共场所剧增,公共场所执法依据不确定性（无法可依）等问题。笔者提出相应的解决建议,应转变卫生监督观念,提高监督管理质量。     

连花清瘟制剂治疗社区获得性肺炎疗效及安全性的系统评价和Meta分析

目的 探究连花清瘟制剂治疗社区获得性肺炎的疗效和安全性。方法 系统检索PubMed、Embase、Cochrane Collaboration、中国知网、维普、万方医学网数据库中所有口服连花清瘟制剂治疗社区获得性肺炎的临床随机对照试验,时间为从建库至2023年2月,制订纳排标准并对检索结果进行筛选,采用风险评估工具（ROB）量表对最终纳入研究的方法学质量进行评价,使用R软件进行数据合并及Meta分析。结果 共纳入30篇文献,包含2 800例患者,在使用抗生素等常规治疗的基础上联合使用连花清瘟,结果显示加用连花清瘟可以提高治愈率［相对危险度（RR）=1.32,95%置信区间（95%CI）［1.23,1.42］,P<0.000 1］并缩短退热时间［均数差（MD）=-1.45,95%CI［-1.93,-0.97］,P<0.000 1］,以患者群体将退热时间分为普通人群及特殊人群亚组,结果均显示加用连花清瘟可以缩短退热时间（普通人群MD=-1.51,95%CI［-2.07,-0.94］,P<0.000 1,特殊人群MD=-1.22,95%CI［-2.16,-0.29］,P=0.010 6）,且不会增加不良反应发生率（RR=0.85,95%CI［0.62,1.15］,P<0.000 1）。使用剪补法补充9篇阴性结果虚拟文献后,加用连花清瘟仍然可以提高CAP的治愈率（RR=1.20,95%CI［1.13,1.29］,P<0.000 1）,结果稳定。结论 CAP治疗中使用抗生素的基础上加用连花清瘟可以提高治愈率并缩短退热时间。     

不同程度铅中毒大鼠模型的制备

目的：建立不同程度大鼠铅中毒模型。方法：Wistar大鼠分别自由饮用不同浓度的醋酸铅1、3、6个月,以原子吸收法测定全血和脑匀浆液的铅水平。结果：实验组全血和脑匀浆中的铅水平均明显高于对照组（P〈0．01）,且二者的铅水平随染铅时问的延长、浓度的增加均明显升高（P〈0．05）。结论：以不同时间、不同浓度染铅均成功地建立了大鼠铅中毒模型。     

带有双侧部分输尿管的猪膀胱模型在宫腔镜培训中的应用

目的　为获得最大程度模拟人类子宫的宫腔镜精细电切培训用模型。 方法　获取带有双侧部分输尿管的猪膀胱,指导学员进行宫腔镜手术技巧的培训（实验组模型）,同期使用传统的培训模型四腔猪心（对照组模型）,考核为双向性,指导教师以考核内容进行打分,学员则填写调查问卷来评价模型。 结果　3站宫腔镜手术模拟培训中,两组模型训练学员的成绩及学员对模型的评价均有统计学差异（P<0.05）,认为膀胱模型膨起度良好,视野清晰,便于辨识解剖结构,能够更逼真模拟宫腔实际操作的困难状况。 结论　猪膀胱因其最大程度模拟人类子宫及其术中实际困难情境,是宫腔镜技术培训的理想模型。     

问卷调查在采集女性盆腔脏器脱垂患者病史中的应用

目的:比较问卷调查与回顾性病例分析采集盆腔脏器脱垂(POP)患者信息的异同,从而确定症状问卷调查表的重要性.方法:按照现况调查的方法对2009年11月—2010年4月门诊收治的105例POP患者进行现场问卷调查,按照回顾性分析的方法采集2007年1月—2009年10月因POP住院手术治疗的209例患者的病史.采用SPS...     

Renal replacement therapies in pediatric intensive care patients: Experiences of one center in Turkey

BACKGROUND: Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children. METHODS: The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005. RESULTS: Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient. CONCLUSION: In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.     

原发性高血压合并脑梗塞患者血管紧张素Ⅱ-1型受体基因多态性的研究

目的 探讨血管紧张素Ⅱ－1型受体（angiotensin Ⅱ type 1 receptor,AT1R)基因A1166／C多态性与原发性高血压及合并脑梗塞的关系。方法 应用聚合酶链反应－限制性片段长度多态性方法检测70名健康人、72例原发性高血压无合并症患者及70例原发性高血压合并脑梗塞患者的AT1R基因型；生化技术测定血脂水平。结果 原发性高血压无合并症组及合并脑梗塞组的C等位基因频率分别为11．1％和10．7％，均显著高于正常对照组的3．6％（P＜0．05）；而两者之间的C等位基因频率差异无显著性（P＞0．05）；牟发性高血压患者血浆脂蛋白a水平与AT1R基因正相关。结论 提示AT1R基因可能是原发性高血压的重要遗传因素，但与高血压病患者是否易患脑梗塞无关。     

HCV associated glomerulopathy in Egyptian patients: clinicopathological analysis

BACKGROUND: Hepatitis C virus (HCV) infection in Egypt has reached an epidemic proportion and is associated with many extra hepatic manifestations; Glomerulonephritis (GN) is one of the most consequences of HCV infection often resulting in end stage renal disease in some cases. Detection of viral genome or particles within the kidney biopsies from HCV-infected patients has proven to be difficult. Histological characterization of renal lesions still represents a major challenge. The aim of our work was to describe the histological pattern of HCV-associated nephropathy. METHODS: Fifty Patients--out of 233--presented to Mansoura Urology and Nephrology clinic with manifestations of glomerular disease were screened for HCV antibodies by a 3rd generation ELISA test. Those tested positive for HCV antibodies were confirmed by PCR for HCV-RNA and subjected to more detailed clinical, biochemical and histological study. Kidney biopsies and in appropriate cases liver biopsies were examined by LM and electron microscopy (EM). RESULTS: Histological study of renal biopsies revealed membranoproliferative (MPGN) type 1 to be the most common lesion encountered (54%), followed by focal segmental glomerulosclerosis (FSGS) (24%), mesangioproliferative GN (18%), membranous nephropathy (MN) (4%) in that order. EM examinations of renal biopsies were successful in identifying HCV like particles in frozen renal tissue. CONCLUSION: HCV-associated glomerulopathy is a distinct category of glomerulonephritis. Results of LM showed some peculiar features. In addition, we were successful in location and detection of HCV particles in renal tissues by EM.     

多囊卵巢综合征患者复方醋酸环丙孕酮治疗前后激素和糖代谢变化的临床观察

为观察达英-35治疗多囊卵巢综合征(PCOS)在明显降低黄体生成素(LH)及睾酮(T)水平,改善患者内分泌状况的同时,是否改善其胰岛素抵抗(IR),35例PCOS患者服用复方醋酸环丙孕酮(达英-35)治疗3个周期,观察用药前后临床特征、血清激素水平、空腹血糖、空腹胰岛素(FIN)的变化.结果显示,治疗后34例PCOS患者月经恢复,多毛及痤疮评分下降(P<0.01),双侧卵巢体积明显缩小(P<0.01).血清LH、FSH、T水平和LH/FSH明显下降(P<0.01).FIN水平明显下降(P<0.01),IR也有相应降低(P<0.01),空腹血糖(FBG)和胰岛素敏感性指数(ISI)无明显改变(P>0.05).达英-35有很强的抗雄作用,明显改善了PCOS患者的内分泌状况和临床症状.