情景式引导联合针对性健康教育在永久性起搏器植入术后患者功能锻炼中的应用观察

目的:分析永久性起搏器植入手术患者采用情景式引导以及针对性健康教育对患者功能锻炼的影响.方法:选择在某院进行永久性起搏器植入手术治疗的74例患者为研究对象,其治疗时间均在2018年11月～2019年11月之间,采取随机数字排列表法将其分为常规组和实验组各37例.常规组患者实施基础健康教育指导,实验组患者实施情景式引导以...     

桡动脉穿刺冠状动脉内介入治疗的临床应用

目的：探讨经桡动脉穿刺选择性冠状动脉造影及冠状动脉腔内成形术（PTCA）及支架术的临床意义。方法：对102例具备冠状动脉造影适应证的患者,采用经桡动脉穿刺法行右、左冠状动脉造影,并根据冠状动脉造影结果决定是否行经皮冠状动脉腔内成形术（PTCA）及支架术。结果：冠状动脉狭窄（50-70）％21例（21／102,占21％）,〉75％以上68例（68／102,占67％）,68例行PTCA及支架植入术,〈50％13例（13／102,占12％）,冠状动脉正常25例（25／70,占35．5％）。结论：通过冠状动脉造影,可以定性诊断,指导治疗;桡动脉穿刺具有出血并发症少等优点。     

肿瘤标志物检测对卵巢成熟、未成熟畸胎瘤的诊断价值

背景与目的:卵巢成熟、未成熟畸胎瘤术前鉴别诊断较困难,本研究期望通过血清肿瘤标志物联合检测的方法,为其诊断及鉴别诊断提供有价值依据。方法:收集1995年1月至2005年12月在中山大学肿瘤防治中心初治并经病理确诊为单纯型卵巢畸胎瘤的272例患者的临床资料,统计分析血清糖链抗原125(carbohydrate antigen125,CA125)、糖链抗原153(CA153)、糖链抗原199(CA199)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、甲胎蛋白(alpha-fetoprotein,AFP)、癌胚抗原(carcinoembryonic antigen,CEA)的检测水平在卵巢成熟及未成熟畸胎瘤中的差异。结果:254例卵巢成熟畸胎瘤患者,中位年龄30岁,血清CA125、CA153、CA199、NSE、AFP、CEA平均值分别为25.5×103u/L,11.8×103u/L,106.6×103u/L,12.6μg/L,2.7μg/L和2.5μg/L。18例卵巢未成熟畸胎瘤患者,中位年龄23岁,上述6项指标的平均值分别为140.3×103u/L,16.8×103u/L,112.0×103u/L,18.0μg/L,369.5μg/L和3.2μg/L。未成熟畸胎瘤患者血清中CA125、CA153、AFP平均水平及表达阳性率均高于成熟畸胎瘤患者,差异有统计学意义(P<0.05)。单独应用一项指标,CA125、CA153、AFP对未成熟畸胎瘤诊断性能的特异度均较高,而CA125的灵敏度最高(50.0%)。使用CA125、CA153、AFP三项指标联合检测明显提高了灵敏度(71.4%)。结论:术前肿瘤标志物,尤其是CA125、CA153、AFP联合检测对卵巢未成熟型与成熟型畸胎瘤的鉴别诊断有一定参考价值。     

针灸推拿联合腰部核心肌力训练在腰椎间盘突出症患者中的应用效果

目的 探讨针灸推拿联合腰部核心肌力训练对腰椎间盘突出症患者腰椎功能障碍指数（ODI）评分、腰背肌力及简式疼痛问卷表（MPQ）评分的影响。方法 选取2017年1月至2019年8月在辽宁省人民医院骨科接受治疗的136例腰椎间盘突出症患者作为研究对象,采用随机数字表法将其分为研究组（n=68）和对照组（n=68）。对照组患者采用腰部核心肌力训练治疗的方法,研究组患者在对照组基础上采用针灸推拿治疗的方法。比较两组患者的ODI评分、腰背肌力、MPQ各项评分及总有效率。结果 治疗后,两组患者的ODI评分均低于治疗前,差异有统计学意义（P<0.05）,且研究组患者的ODI评分低于对照组,差异有统计学意义（P<0.05）;治疗后,两组患者的腰背肌力均优于治疗前,差异有统计学意义（P<0.05）,且研究组患者的腰背肌力优于对照组,差异有统计学意义（P<0.05）;治疗后,两组患者的MPQ各项评分均低于治疗前,差异有统计学意义（P<0.05）,且研究组患者的MPQ各项评分低于对照组,差异有统计学意义（P<0.05）;治疗后,研究组患者的总有效率高于对照组,差异有统计学意...     

Distinct histopathological phenotypes of severe alcoholic hepatitis suggest different mechanisms driving liver injury and failure

Intrahepatic neutrophil infiltration has been implicated in severe alcoholic hepatitis (SAH) pathogenesis; however, the mechanism underlying neutrophil-induced injury in SAH remains obscure. This translational study aims to describe the patterns of intrahepatic neutrophil infiltration and its involvement in SAH pathogenesis. Immunohistochemistry analyses of explanted livers identified two SAH phenotypes despite a similar clinical presentation, one with high intrahepatic neutrophils (Neu^hi), but low levels of CD8⁺ T cells, and vice versa. RNA-Seq analyses demonstrated that neutrophil cytosolic factor 1 (NCF1), a key factor in controlling neutrophilic ROS production, was upregulated and correlated with hepatic inflammation and disease progression. To study specifically the mechanisms related to Neu^hi in AH patients and liver injury, we used the mouse model of chronic-plus-binge ethanol feeding and found that myeloid-specific deletion of the Ncf1 gene abolished ethanol-induced hepatic inflammation and steatosis. RNA-Seq analysis and the data from experimental models revealed that neutrophilic NCF1-dependent ROS promoted alcoholic hepatitis (AH) by inhibiting AMP-activated protein kinase (a key regulator of lipid metabolism) and microRNA-223 (a key antiinflammatory and antifibrotic microRNA). In conclusion, two distinct histopathological phenotypes based on liver immune phenotyping are observed in SAH patients, suggesting a separate mechanism driving liver injury and/or failure in these patients.     

肝脏血管平滑肌脂肪瘤的诊治分析

目的 总结肝脏血管平滑肌脂肪瘤( hepatic angiomyolipoma,HAML)的临床、影像及病理特点,提高对HAML的诊治水平. 方法 收集新疆医科大学附属肿瘤医院3例经手术切除和术后病理确诊的HAML患者,结合相关文献,分析肝HAML的临床表现、典型影像及病理学特点.结果 1例术前确诊,另2例误诊为肝脏其他肿瘤.3例术后随访32～39月,均未见肿瘤复发及转移.临床上,HAML与其他肝良性肿瘤相比无特异性.因3种组织比例差异,影像学表现呈现多样性,在众多影像检查中以CT诊断率最高.常规病理检查加免疫组化可确诊及分型,其中免疫组化标记HMB-45阳性具有重要诊断意义. 结论 HAML是一种少见的肝脏良性肿瘤,术前诊断率低,但只要掌握其影像特点,结合临床病史及实验室检查,术前确诊已成为可能.积极手术治疗,预后良好.     

儿童重症监护室真菌肺炎11例临床分析

目的:探讨儿童真菌肺炎的临床易感因素及预防、治疗措施.方法:回顾性分析重庆医科大学附属儿童医院ICU 2007年6月～2008年4月11例确诊为真菌肺炎儿童患者的临床表现、影像学表现、实验室检查、治疗及转归.结果:真菌肺炎好发于年龄小的婴幼儿,病原菌以白色念珠菌多见.9例(占81.8%)合并有先天性心脏病,11例确诊前均有长时间静脉使用广谱抗生素及气管插管机械通气史.所有病例都有咳嗽、咯痰,其中10例有不同程度发热.该组患儿均使用两性霉素B治疗.11例患儿中死亡2例(18.2%),放弃1例(9.1%),治愈8例(72.7%).结论:念珠菌是儿童深部真菌感染的常见病原菌,其发病率和预后与宿主因素、抗生素的使用和抗真菌治疗密切相关.     

脑梗塞对大鼠膀胱功能的影响

目的探讨脑梗塞对大鼠膀胱功能的影响。方法雄性SD大鼠,用线栓法制作大脑中动脉栓塞模型。脑梗塞24小时后,测定膀胱容量、排尿潜时、膀胱内压、尿流率、尿道抵抗值。结果大鼠脑梗塞后膀胱功能发生明显变化,排尿量减少、排尿潜时缩短、尿流率降低、尿道抵抗增强。结论脑梗塞可致大鼠膀胱过度活动症。*     

经腹膜后腹腔镜肾上腺切除术治疗肾上腺偶发瘤的效果

目的 探讨腹腔镜肾上腺肿瘤切除术治疗肾上腺偶发瘤的效果。方法 选取2015年1月至2021年1月广州医科大学附属第二医院收治的60例肾上腺偶发瘤患者作为研究对象,采用随机数字表法将其分为研究1组与研究2组,每组各30例。研究1组患者采用经腹膜后腹腔镜肾上腺切除术,研究2组患者采用经腹腹腔镜肾上腺肿瘤切除术。比较两组患者的手术指标、并发症及生活质量。结果 研究1组患者的手术时间、术后进食时间、术后下床活动时间、住院时间短于研究2组,差异有统计学意义（P<0.05）;研究1组患者的术中出血量少于研究2组,差异有统计学意义（P<0.05）;研究1组患者的并发症总发生率低于研究2组,差异有统计学意义（P<0.05）。两组患者术前的生活质量（QOL）评分比较,差异无统计学意义（P>0.05）;研究1组患者术后的QOL各项评分均高于研究2组,差异有统计学意义（P<0.05）。结论 对肾上腺偶发瘤采取经腹膜后腹腔镜肾上腺切除术治疗后,可显著减少手术时间及出血量,缩短住院时间,且并发症少,安全性高,术后生活质量改善明显,值得应用与推广。     

Research on Design and Performance of Self-Compacting Cement Emulsified Bitumen Mixture (CEBM)

To meet the needs of the road industry for maintenance operations, a new cement emulsified bitumen mixture (CEBM) with early-strength, self-compacting, and room-temperature construction characteristics was designed. The strength formation mechanism of CEBM was revealed with a scanning electron microscope (SEM) and the surface free energy (SFE) theory. The mechanical properties and road performance of the CEBM were investigated extensively. The results show that before the demulsification of emulsified bitumen, the SFE of the bitumen–aggregate–water three-phase system was reduced due to the replacement of the bitumen–aggregate interface with water. The adhesion work between the emulsified bitumen and the aggregate is negative, which means the adhesion between the emulsified bitumen and the aggregate will not occur spontaneously due to the existence of water. The liquid emulsified bitumen improves the workability of the mixture and ensures that the mixture can be evenly mixed and self-compacted. After demulsification, the work of adhesion between the residual bitumen and the aggregate is positive, which means residual bitumen and aggregate can bond spontaneously. In addition, the hydration products of cement and aggregate form a skeleton, and the emulsified bitumen film wraps and bonds the cement and aggregate together, creating strength. The emulsified bitumen, cement content, and curing conditions have significant effects on the stability of CEBM. The recommended dosage of emulsified bitumen and cement is 8% and 8–10%, respectively. This material integrates the hardening effect of cement and the viscoelastic performance of bitumen and has good workability, mechanical properties, and road performance. Therefore, the CEBM is technically feasible for application to bitumen pavement.