云南怒江州傈僳族高尿酸血症伴发高脂血症、高糖血症人群状况分析

目的调查怒江州傈僳族高尿酸血症伴发高脂血症、高糖血症人群的状况.方法收集怒江人民医院8 746例体检者的尿酸、甘油三酯、胆固醇及血糖结果并进行统计学分析.结果被调查傈僳族8 746例人群中,高尿酸血症检出人数为2 385例,检出率27.27%.高糖血症检出人数682例,检出率7.80%.高甘油三酯血症检出人数1 043例,检出率11.93%.高胆固醇血症检出人数1 912例,检出率21.86%.男性检出率明显高于女性(P<0.05).高尿酸血症、高糖血症、高甘油三酯血症和高胆固醇血症发生率存在年龄差异.高尿酸血症伴发高脂血症、高糖血症的检出率明显高于对照人群(P<0.05).结论怒江州傈僳族高尿酸血症发生率较高,男性易患高尿酸血症,高尿酸血症易伴发高脂血症、高糖血症,应引起足够重视和积极防治.     

Venous thromboembolism in the emergency department: A survey of current best practice awareness in physicians and nurses in China

BACKGROUND: For emergency department (ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism (VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses (response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no significant differences were found with respect to job (doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses’ current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years (n=83) scored significantly higher on the questionnaire than those under 5 years (n=91) (95.75 vs. 79.97, P=0.039). There was a significant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime. CONCLUSION: Our survey has shown deficiencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events (including VTE).     

胶原多糖基纳米羟基磷灰石仿生骨支架材料的研制

目的依据仿生原理制备新型的胶原多糖基纳米羟基磷灰石（HA）复合骨支架材料,并与成骨细胞复合培养,检测其细胞相容性。方法以胶原分子与透明质酸钠的交联产物为模板,调制钙磷盐在液相中沉积其上,得到矿化胶原多糖基复合材料;采用液相分离法与少量聚乳酸复合进一步制备成为三维多孔支架,使用成骨细胞（Mc3T3-E1）接种于该支架上培养。用X—ray衍射、扫描电镜、万能材料测试机等对材料进行观察和测试分析;并用倒置相差显微镜、荧光显微镜、扫描电镜、CCK-8细胞计数试剂盒、碱性磷酸酶（ALP）活性测定等观察和分析细胞在支架材料中的生长、分化情况。结果胶原多糖基纳米HA仿生复合材料的晶粒度较低,晶体极为细小,与天然骨中羟基磷灰石的组装结构类似;该复合支架为多孔状,孔隙率约82％,孔径大小为200～650μm;抗压性能好,成骨细胞可在其上贴附、生长和繁殖,并表现出较高的成骨活性。结论所制备的胶原多糖基纳米HA仿生骨支架材料,无论从组分和结构上均与天然松质骨类似,与成骨细胞相容性好,可望成为较理想的骨组织工程支架材料。     

急诊科拥挤度变化规律研究:昼夜节律和节假日效应

目的 通过分析急诊科患者流量和拥挤度变化规律,分析急诊科拥挤度影响因素,找寻客观评估急诊科拥挤度指标.方法 前瞻性队列观察研究,分析一家大型临床教学医院急诊科患者流量和拥挤度变化规律,观察患者流量的24h变化节律和节假日效应、政策效应.并对影响急诊科拥挤度的相关因素进行多因素回归分析.结果 工作日急诊患者流量24h变化规律特征明显,患者流量高峰在20:00-22:00,低谷则在4:00-6:00,而拥挤度评分高峰和低谷滞后2h.急诊患者流量有明显周末和长假日双峰效应,急诊患者流量也受政策性因素影响.多因素回归分析显示时间段内(2 h)急诊来诊人数(B=0.027,P＜0.01)、急诊床位占用率(B=5.25,P＜0.01)与下一个时段急诊科拥挤度显著相关.结论 急诊医疗资源需求具有波动性的,急诊患者流量呈现周期性变化和节假日效应,决策者在着手解决急诊科拥挤问题时需要考虑这一规律.当急诊系统内部和外部环境稳定时,患者流量和急诊床位占用率是预测急诊科拥挤度重要的客观指标.     

硫酸钙对人骨髓基质干细胞向成骨细胞转化时基因表达的影响

目的 观察硫酸钙(CS)在人骨髓基质干细胞(BMSCs)向成骨细胞转化过程中对成骨基因表达的影响,探讨硫酸钙修复骨缺损可能的生物学机制.方法 制备硫酸钙浸提的成骨诱导液(实验组)与常规的成骨诱导液(对照组),分别加入人BMSCs培养瓶(各3例),使其向成骨细胞的诱导分化,注意观察细胞的分化和生长.培养至第7天时进行RNA的抽提、纯化和质量检测,并合成cDNA,采用成骨功能基因芯片分别检测实验组和对照组中各种成骨基因的变化.结果 实验组和对照组细胞均生长良好,缓慢增殖,但实验组向成骨细胞分化的趋势要明显较对照组好.成骨基因芯片共检测到89种基因,其中有23种基因表达改变显著(Fold change＞2,P＜0.05).表达上调超过2倍的基因包括:AMELY、BMP2、COL4A3、COMP、EGF、FLT1、IGF1、ITGA2、MMP10、MMP2、TGFB2、TGFBR1、VDR和VEGFA.表达下调超过2倍的有:COL2A1、COL15A1、COL1A1、COL1A2、COL5A1、CSF2、FGF1、ITGA3和MMP8.结论 硫酸钙促进了人BMSCs向成骨细胞转化的过程,这种作用与硫酸钙促进成骨基因表达上调、合成活性因子增加相关,说明硫酸钙具有潜在的骨诱导活性,可以作为良好的骨修复替代材料,促进细胞的骨修复能力.     

心脏内科临床医师对阻塞性睡眠呼吸暂停低通气综合征的认知度调查

目的 探讨心内科医师对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的认知水平.方法 通过问卷调查收集山东省38所公立医院的心内科医师对OSAHS的认知信息,并进行测验信度分析和相关性分析.结果 心脏内科临床医师对OSAHS发病机制的知识了解比较全面,正确率较高,对OSAHS治疗的相关知识了解较为有限,回答正确率最低.结论 心内科临床医师对OSAHS的重要性有所认识,但对诊断、特别是相关治疗知识的掌握仍有待提高,通过加强疾病宣传力度及继续教育等各种方式全面提高临床相关专业人员对OSAHS的认知程度,从而可以提高OSAHS的诊疗水平.     

普洱市部分地区人群弓形虫感染血清流行病学调查

目的 目的 掌握云南省普洱市人群弓形虫感染状况, 为制定弓形虫病防治策略提供依据。 方法 方法 选择普洱市景 东、 景谷和孟连3个县作为调查点, 采用ELISA试剂盒检测人群血清弓形虫IgG抗体。 结果 结果 共检测血清906人份, 弓形 虫IgG抗体阳性率为24.17%。其中30～岁年龄组和60～岁年龄组IgG抗体阳性率较高, 分别为30.30% （60/198） 和 32.08% （17/53）; 不同年龄组间IgG抗体阳性率差异有统计学意义 （χ2 =17.77, P＜0.01）。不同性别、 文化程度、 生活习惯 之间阳性率差异无统计学意义 （P 均＞0.05）。农民、 学生和其他职业的IgG抗体阳性率分别为26.58% （194/730）、 15.49% （22/142） 和8.82% （3/34）, 差异有统计学意义 （χ2 =12.51, P＜0.01）; 猪饲养具有圈养和散养习惯人群的阳性率分别为 23.32% （198/849） 和36.84% （21/57）, 差异有统计学意义 （χ2 =5.33, P＜0.05）。结论 结论 普洱市部分地区人群弓形虫IgG抗 体阳性率较高, 应加强弓形虫病的防控和防治知识的健康教育。     

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:

This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.

METHODS:

The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed. The data of 321 patients with no acute respiratory insufficiency as controls were also collected. Clinical variables of the first 24 hours after admission to intensive care unit were collected, including age, sex, comorbid disease, type of surgery, admission type, presence of shock, presence of acute kidney injury, presence of acute lung injury/acute respiratory distress syndrome, acute physiologic and chronic health evaluation (APACHE II) score, sepsis-related organ failure assessment (SOFA), and PaO₂/FiO₂ ratio. Duration of mechanical ventilation, length of intensive care unit stay, intensive care unit death, length of hospitalization, hospital death and one-year survival were calculated.

RESULTS:

The incidence of acute respiratory insufficiency was 37.2% (190/321). Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases (P=0.001), surgery-related infection (P=0.004), hypo-volemic shock (P<0.001), and emergency surgery (P=0.018), were independent risk factors of postoperative acute respiratory insufficiency. Compared with the patients without acute respiratory insufficiency, the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay (P<0.001), a prolonged length of hospitalization (P=0.006), increased intensive care unit mortality (P=0.001), and hospital mortality (P<0.001). Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency (P=0.029, RR: 8.522, 95%CI: 1.243–58.437, B=2.143, SE=0.982, Wald=4.758). Compared with the patients without acute respiratory insufficiency, those with acute respiratory insufficiency had a shortened one-year survival rate (78.7% vs. 97.1%, P<0.001).

CONCLUSION:

A history of chronic obstructive pulmonary diseases, surgery-related infection, hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency. Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency. Compared with patients without acute respiratory insufficiency, those with acute respiratory insufficiency had adverse short-term outcome and a decreased one-year survival rate.KEY WORDS: Acute respiratory insufficiency, Risk factors, Prognosis, Critical illness, Postoperative care, Septic shock, Chronic obstructive pulmonary disease, Survival     

凝胶色谱法测定注射用美洛西林钠舒巴坦钠中聚合物

目的建立一种利用葡聚糖凝胶柱分离测定注射用美洛西林钠舒巴坦钠中美洛西林钠聚合物的方法。方法Sephadex G-10色谱柱,流动相A为0.05 mol·L-1磷酸盐缓冲液（pH 7.0）,流动相B为超纯水,流速为1.0 ml·min-1,检测波长为254 nm,进样量200μl。结果美洛西林对照品在20.2l～60.6μg·ml-1范围内与其峰面积成良好线性关系,r=0.9992。结论本方法简便、准确、重复性好,适用于注射用美洛西林钠舒巴坦钠聚合物的定量检测。     

10年追踪分析常染色体显性遗传非综合征性耳聋(DFNA41)家系听力学及遗传学特征

目的分析中国一个连续6代常染色体显性遗传性耳聋DFNA41家系的听力学及遗传学特征。方法采用回访调查的方式对家系55位成员进行全身系统检查及临床听力学检测,对部分家系成员采集血样进行候选基因突变筛查。结果该家系所有患者听力损失表现为双侧对称性轻度至重度感音神经性耳聋:40岁以下男性患者听力曲线呈高频下降型;40岁以下女性患者低频受损,听力曲线呈上升型;40岁以上患者,男女均累及全频听力,呈平坦型听力曲线。听力损失程度随着年龄的增长而逐渐加重,至40岁左右时发展为全频中度至重度耳聋。在已完成的11个候选基因突变筛查中,未发现与该家系致病相关的基因突变。结论中国遗传性耳聋DFNA41家系的听力表型与性别及年龄有关,围绕基因型与表型的研究将有助于DFNA41家系致病基因的克隆。