晚期血吸虫病救治绩效评估管理系统的开发研究

目的构建晚期血吸虫病(晚血)救治绩效评估管理系统,分析评价历年来晚血救治工作。方法运用数据库管理技术和C++编程技术开发该系统,录入历年晚血病案信息输入该系统进行管理,并应用相关信息对晚血救治工作进行成本效果、成本效用、成本效益及综合评价。结果制作了一套集晚血成本效益、成本效用分析和综合评价的软件计算公式系统,该系统具有构建清晰、操作简单、界面友好,方便录入、存储和查询晚血病案信息等特点,能对晚血救治工作进行绩效评估。结论该系统满足了现行晚血救治工作的需求,易于推广使用。     

胃肠道间质瘤的分子学机制及靶向治疗

C-kit/PDGFRA基因发生功能获得性突变和因此引发的KIT蛋白自主磷酸化是胃肠道间质瘤(gastrointestinal stromal tumors,GISTs)发生过程中最具特征性的分子机制.这一发现使得imatinib靶向治疗GISTs成为可能并取得重大疗效,但研究发现不同类型的GISTs对imatinib治疗的反应也不尽相同,并且随着其临床应用的增加,耐药性及不良反应也随之出现,迫使imatinib临床停药或改为二线用药.因此,GISTs是由不同生物学机制引发的一组疾病,本文就GISTs的分子生物学机制及靶向治疗药物作一综述.     

PICC置管前评估的临床实践指南构建及AGREE评价

目的构建以证据为基础的经外周穿刺中心静脉导管(PICC)置管前评估的临床实践指南并进行AGREE评价。方法通过现况调查,制作PICC置管前评估的系统评价,对PICC置管前评估相关临床实践指南进行文献内容分析,构建指南草案并通过德尔菲法对指南相关附件进行修订,使用AGREE评估系统进行评价。结果指南形成包含置管护士、环境与设备、患者评估、导管选择、穿刺技术与穿刺部位、知情同意6个方面共31项推荐意见。AGREE评价的标准化总分分别为98%、93%、95%、92%、89%、100%,6名PICC护理专家均给予"强烈推荐"评价。结论该指南是基于我国临床现状、循证证据、患者意愿和偏好、专业人员判断的循证性临床实践指南,可作为PICC置管前评估的依据。     

Epidemiologic investigation of burns in the elderly in Sichuan Province

Objective

This study analysed the epidemiology of burns in the elderly in Sichuan Province, China, with the objective of formulating a prevention programme.

Methods

A retrospective review of elderly patients admitted to the Burn Centre of West China Hospital during 2003–2009 was performed, including patient demographics, education and burn aetiology.

Results

A total of 103 patients, mean age 69.5 years (range 60–95 years; 58 male, 45 female) were admitted. The most common causes of burn were flames (51.5%), scalding (37.9%), electrical (4.9%) and chemical (2.9%), respectively. The majority occurred at home (68.9%), principally in the kitchen (35.9%), while 19.4% occurred in the workplace. Burns with total body surface area (TBSA) of 0–10% accounted for 52.5% of those admitted for treatment; 10–30% TBSA burns accounted for 20.3%; 30–50% TBSA burns accounted for 15.5%; and burns with a TBSA >50% accounted for 11.7%. Only 6% of patients received appropriate first aid, and 32% did not receive treatment until more than 24 h after injury. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns.

Conclusions

Burn-prevention programmes should promote improved living conditions and medical insurance, with prevention education for the elderly, especially in rural areas.     

MEBT/MEBO对慢性难愈合创面组织中CK10表达水平的影响

目的通过对比观察不同治疗方案对大鼠创面组织内CK10表达水平的影响,进一步揭示皮肤再生医疗技术(moist exposed burn therapy/moist exposed burn ointment, MEBT/MEBO)治疗慢性难愈合创面的部分作用机制。方法将90只SPF级Wistar大鼠随机分为空白组(18只)、急创组(18只)、慢创组(18只)、rb-bFGF组(18只)及MEBO组(18只),其中空白组大鼠仅做备皮处理,急创组大鼠建立急性创面模型,慢创组、 rb-bFGF组及MEBO组大鼠建立慢性难愈合创面模型,且空白组大鼠局部皮肤予以生理盐水纱布湿敷,急创组及慢创组大鼠创面予以生理盐水治疗, rb-bFGF组大鼠创面予以重组牛碱性成纤维细胞生长因子(recombinant bovine basic fibroblast growth factor, rb-bFGF)凝胶治疗, MEBO组大鼠创面予以湿润烧伤膏(moist exposed burn ointment, MEBO)治疗,分别于治疗第3、 7、 14天对比观察5组大鼠皮肤或创面组织的形态学变化及CK10的表达水平。结果 (1)治疗第3天,空白组大鼠皮肤组织形态与正常皮肤组织形态无明显差异,其他各组大鼠创面组织水肿明显,可见大量炎性细胞浸润及少量成纤维细胞与新生毛细血管分布;治疗第14天,空白组大鼠皮肤组织形态与正常皮肤组织形态无明显差异,慢创组大鼠创面组织内仍有少量炎性细胞浸润,且有大量排列不规则的成纤维细胞分布,而急创组、 rb-bFGF组及MEBO组大鼠创面组织内可见排列整齐的新生毛细血管及完整的毛囊和皮脂腺等皮肤附属器,组织结构接近于正常皮肤组织。(2)治疗第3、 7、 14天,空白组大鼠皮肤组织内CK10表达水平无明显变化,P 0.05,差异无统计学意义;而急创组、慢创组、 rb-bFGF组及MEBO组大鼠创面组织内CK10表达水平呈现逐渐升高的趋势,P均0.05,差异具有统计学意义。(3)治疗第7、 14天,急创组、rb-bFGF组和MEBO组大鼠创面组织内CK10表达水平均明显高于慢创组,P均0.05,差异具有统计学意义;治疗第3、 7、 14天, rb-bFGF组和MEBO组大鼠创面组织内CK10表达水平均无明显差异,P均 0.05,差异无统计学意义。结论 MEBT/MEBO治疗慢性难愈合创面的疗效不亚于rb-bFGF凝胶,且改变表皮干细胞的外界生存环境,促进表皮干细胞向正常表皮细胞增殖、分化,可能是其促进慢性难愈合创面修复的作用机制。     

组织工程重建胰腺脱细胞支架血管系统的研究*

目的：使用内皮祖细胞再内皮化胰腺脱细胞支架,并初步评价其在宿主体内生成血管的能力。方法：采用灌注法制备结构完整的全胰腺脱细胞支架;并提取大鼠骨髓单个核细胞,诱导分化为内皮祖细胞,进行原代培养;将培养完成的内皮种植于支架内,并行体内移植。结果：在移植后第10天,实验组中包含红细胞的血管管腔数为（43±6）cm2,而对照组为（8±3）cm2;在移植后第20天,实验组中包含红细胞的血管管腔数为（62±9）cm2,而对照组为（16±5）cm2,此结果具有统计学意义（P<0.05,n=6）。种植内皮祖细胞后,支架在体内能更快更多的生成新生血管,与对照组比较差异有统计学意义（P<0.05）。结论：再血管化的支架在体内移植后,与对照组相比,可以更快的与宿主循环系统形成吻合。     

Occupational exposure to textile dust and lung cancer risk: Results from the ICARE Study

Background

To investigate the association of lung cancer with occupational exposure to textile dust and specifically to cotton dust in the population‐based case‐control study ICARE.

Methods

Lifelong occupational history of 2926 cases and 3555 controls was collected using standardized questionnaires, with specific questions for textile dust exposure. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression models controlling for confounding factors including smoking and asbestos exposure.

Results

An inverse association between textile dust exposure and lung cancer was found among workers exposed ≥5% of their work time (OR = 0.80, 95%CI = 0.58‐1.09), more pronounced for distant exposures (40+ years; up to a 56% reduced risk, statistically significant). The OR of lung cancer was significantly decreased among workers exposed to cotton fibers (OR = 0.70, 95%CI = 0.48‐0.97).

Conclusions

Our results provide some evidence of a decreased risk of lung cancer associated with exposure to textile dust, particularly cotton.

     

口炎清颗粒联合布地奈德治疗慢性咽炎的疗效观察

目的探讨口炎清颗粒联合布地奈德气雾剂治疗慢性咽炎的临床疗效。方法选取2016年2月—2017年9月武汉大学中南医院收治的79例慢性咽炎患者为研究对象,所有患者按照数字表法随机分为对照组(39例)和治疗组(40例)。对照组吸入布地奈德气雾剂,0.5 mg/次,3次/d。治疗组对照组治疗的基础上口服口炎清颗粒,6 g/次,2次/d。两组患者均持续治疗3周。观察两组临床疗效,同时比较两组的临床症状改善时间和不良反应发生情况。结果治疗后,对照组和治疗组的总有效率分别为84.6%、92.5%,两组治疗比较差异具有统计学意义(P0.05)。治疗后,治疗组咽喉肿痛、咳嗽咳痰、咽部异物感、分泌物改善时间明显短于对照组,两组比较差异具有统计学意义(P0.05)。治疗期间,对照组不良反应发生率为28.2%,明显高于治疗组的10.0%,两组比较差异具有统计学意义(P0.05)。结论口炎清颗粒联合布地奈德气雾剂治疗慢性咽炎疗效确切,能够有效改善患者临床症状,且无严重不良反应,值得临床推广运用。