上海地区蝇类抗药性现状及防治对策

在杀虫剂的长期选择压力下,昆虫种群中的敏感个体的比例越来越少,抗性个体不断繁殖,使得杀虫剂原有的杀虫效果越来越差,甚至完全失去了杀虫效果.上海市自1992年开展灭蝇达标活动以来,在蝇类孳生和栖息场所,一直以凯素灵可湿性粉剂(有效成分溴氰菊酯)和奋斗呐可湿性粉剂(有效成分顺式氯氰菊酯)进行滞留喷洒灭蝇,成蝇密度高峰时期以敌敌畏快速灭蝇,使得上海市家蝇对常用杀虫剂的抗药性逐年上升,现将上海市家蝇的抗药性状况及防治对策介绍如下.     

试论岳甫嘉医案中不育的诊治思维

岳甫嘉诊病重视脉症合参,尤以诊脉见长;处方多用中和之剂,收固真阴,反对过用热药,耗散精血。诊治思维贯穿其著作《妙一斋医学正印种子编》上卷所载验案。此卷专门论述男性不育的诊治,虽仅载验案八则,但八者皆奇,诊治结合,涵盖多法,可归纳为“先清热毒,再施温补”“药用滑涩,当辨标本”“先治脾,后治肾”“脾肾同治”“先祛痰火,再滋肾阴”及“交通心肾”6类,诸法之中的诊治思维,蕴含奥妙,颇具特色,特作探析。     

融入“思政元素”的情景教学法在住院医师规范化培训中的应用

目的探讨融入“思政元素”的情景教学法对在肝病科住院医师规范化培训（简称规培）中的应用效果。方法选取进行住院医师规范化培训的学生48人，随机分为两组，试验组采用融入“思政元素”的情景教学法，对照组采用传统教学法，对两组规范化培训学生理论考试、实践技能考核成绩及教学评价满意度进行比较。结果两组学生理论考试成绩无明显差异(P＞0.05）；两组学生临床实践技能得分比较，试验组在接诊患者、临床思维路径分析、医嘱处置、病案书写、医患沟通能力和实践技能总成绩得分均优于对照组(P<0.05)；两组学生教学效果调查问卷比较，试验组在提升学习兴趣、提升自主学习能力、团结协作能力、职业道德素养和总体教学满意度方面得分均明显高于对照组(P<0.05)。结论融入“思政元素”的情景教学法在肝病科住院医师规范化培训中应用，具有良好的效果。     

基于miRNA测序技术探讨补中益气汤治疗自身免疫性甲状腺炎的潜在机制

目的 探讨补中益气汤对自身免疫性甲状腺炎（AIT）小鼠甲状腺组织miRNA表达的影响。方法 选择NOD.H-2^h4小鼠共30只，随机分为正常组、模型组、补中益气汤组（BG组），每组各10只。根据分组给予小鼠含0.05%碘化钠水8周构建小鼠AIT模型后，灌胃给药8周取材。观察每组小鼠甲状腺组织病理改变情况，并对每组小鼠甲状腺组织差异miRNA进行实验验证及生物信息学分析。结果 与正常组比较，模型组甲状腺组织炎性细胞浸润明显，血清甲状腺球蛋白抗体（TgAb）水平显著升高（P<0.01）；与模型组比较，BG组甲状腺组织炎症程度减轻，血清TgAb水平显著降低（P<0.01）。与正常组比较，模型组小鼠白细胞介素（IL）-6、IL-17表达显著增高（P<0.01），IL-1β表达明显降低（P<0.05）；与模型组比较，BG组IL-1β、IL-6、IL-17表达明显降低（P<0.05）。与正常组比较，模型组得到154个差异表达miRNA；与模型组比较，BG组得到112个差异表达miRNA。实时荧光定量聚合酶链式反应（Real-time PCR）结果表明miR-326-3p、miR-128-3p、miR-223-5p、miR-141-3p、miR-871-3p、miR-204-3p表达与测序结果趋势一致。基因本体（GO）功能富集于T细胞活化调节、氧化应激、miRNA结合等方面；京都基因与基因组百科全书（KEGG）通路富集于磷脂酰肌醇3-激酶（PI3K）/蛋白激酶B（Akt）信号通路、丝裂原活化蛋白激酶（MAPK）信号通路、环磷酸腺苷（cAMP）信号通路等途径。差异miRNA预测得到3个关键基因，果蝇母源抗皮肤生长因子蛋白（Smad3）、Janus相关激酶2（JAK2）、信号转导和转录激活因子3（STAT3）。结论 补中益气汤可能通过调节6种miRNA干预自身免疫性甲状腺炎。     

Straumann种植体53枚临床应用体会

目的 评价我院应用非潜入式种植体Straumann种植系统完成种植修复病例的临床效果.方法 选取自2009年1月～2011年10月就诊于我院口腔科使用Straumann种植系统修复的患者共计37位,排除全身及局部禁忌症,依据不同情况,分别采用常规术式、即刻种植、不翻瓣种植、骨增量技术等植入共计53枚种植体,均已完成上部结构修复.随访观察3～48个月.结果 种植体成功率为98.1%,修复成功率为100%.结论 Straumann种植体是一种临床操作方便、生物相容性好、疗效满意的非潜入式种植体.正确选择适应证、规范手术程序、精确制作修复体、认真做好口腔卫生维护,能够获得令人满意的修复效果.     

The oncological and obstetric outcomes of cervical squamous cell carcinoma at stage IA1 managed with the loop electrosurgical excision procedure

ObjectiveTo evaluate the efficacy and superiority of loop electrosurgical excision procedure (LEEP) in managing stage IA1 cervical microinvasive squamous cell carcinoma (MISCC) without lymph-vascular space invasion (LVSI).Materials and methodsThe oncological and reproductive outcomes of a series of patients affected by stage IA1 MISCC without LVSI, initially treated by LEEP between February 2006 and December 2017, were retrospectively reviewed.ResultsUltimately, 109 patients were included. The mean age at diagnosis was 35.4 years old, and 36 patients were nulliparous. Multifocal lesions were identified in 15 patients (13.8%). The mean cone depth was 17.4 mm. Resection margins were positive/unevaluable and negative in 26 (23.9%) and 83 (76.1%) cases, respectively. Among cases undergoing salvage treatments, the residual disease rate for patients with positive/unevaluable margins was significantly higher than those with negative margins (P = 0.003). During the follow-up period of 43.0 ± 28.9 months, no relapse was identified. Fifteen of 20 patients (75.0%) conceived successfully, with a full-term live birth rate of 93.3%.ConclusionsFor stage IA1 MISCC without LVSI unexpectedly found in a loop excision, initial LEEP with clear margin is efficient and adequate. For cases with multifocal MISCC, or for those young patients who wish to become pregnant in the future, LEEP is the optimal choice.     

联用灯盏花素选择性动脉介入治疗老年重症急性胰腺炎的临床观察

目的：观察联用灯盏花素选择性动脉介入治疗老年重症急性胰腺炎患者的临床疗效。 方法：将60例老年SAP患者（年龄≥60岁）随机分为观察组（32例）和对照组（28例），对照组采用奥曲肽与抗生素持续性胰腺区域动脉灌注，观察组采用以上灌注药物加用灯盏花素持续性胰腺区域动脉灌注，比较两组治疗效果。 结果：治疗7 d后，两组APACHE II评分均较治疗前降低（均P<0.05），但观察组的APACHE II评分明显低于对照组（P<0.05）；两组血清肿瘤坏死因子α（TNF-α）、白介素6（IL-6）水平均较治疗前明显降低（均P<0.05），但观察组两者的下降程度大于与对照组（均P<0.05）。观察组总并发症发生率明显低于对照组（34.38% vs. 60.71%，P<0.05），观察组中转手术率与病死率均低于对照组（12.5% vs. 21.5%；9.38% vs. 14.29%），但差异无统计学意义（均P>0.05）。 结论：联用灯盏花素选择性动脉介入治疗老年SAP具有良好的疗效。     

Impact of heparanase on glomerular endothelium glycocalyx during sepsis

Objective To observe the impact of heparanase on glomerular endothelium glycocalyx during sepsis and to investigate the prevention of glycocalyx injury. Methods C57/BL6 mice were injected with lipopolysaccharide (LPS) or tumor necrosis factor-α(TNF-α) and sacrificed one hour later. Glomerular endothelium glycocalyx traced with lanthanum was observed by transmission electron microscope(TEM). Western blotting was used to observe heparanse protein expression of renal cortex tissue. Human renal glomerular endothelial cells (HRGECs) were stimulated with TNF-α and active heparanase protien expression was detected by Western blotting. Mice were administrated with heparin sodium or heparinase Ⅲ and renal endothelium glycocalyx was observed by TEM. Urine during twenty-four hours was collected to measure urinary albumin and creatinine. The ratio of albumin to creatinine was calculated and compared among groups. Results The glomerular endothelium glycocalyx of LPS group and TNF-α group was degradated and the one of podocyte was integrated. Renal cortex tissue heparanase protein expression was significantly increased since one hour after LPS injection (P＜0.01). The protein expression of activited heparanase of HRGECs which were stimulated with TNF-α was increased (P＜0.05). Administration of heparin sodium which could inhibit the activity of heparanase could prevent the glycocalyx form degradation. The ratio of urine albumin to creatinine of heparin sodium group was decreased compared with LPS group (P＜0.05) and the ratio of heparinase Ⅲ group was higher than control group(P＜0.01) as a result of degradation of glomerular endothelium glycocalyx. Conclusions During the early stage of sepsis, TNF-α can induce glomerular endothelium heparanase to increase and active, and consequently the glycocalyx is degradated which leads to albuminuria. Inhibition of heparanase can protect glomerular endothelium glycocalyx and prevent albuminuria.     

老年高血压病病人饮食治疗依从性的调查分析

[目的]了解老年高血压病病人的饮食治疗依从性。[方法]采用自行设计的老年高血压病病人饮食治疗依从性调查问卷对56例老年高血压病病人进行饮食治疗依从性调查。[结果]56例老年高血压病病人饮食治疗依从性得分为72.8分±11.9分,其中依从性得分≥8 0分1 4例（占25.0%）;影响老年高血压病病人饮食治疗依从性的主要因素有高血压病病程、超重或肥胖和医疗付费方式。[结论]老年高血压病病人的饮食治疗依从性不高,有待提高;主要影响因素为高血压病病程、超重或肥胖和医疗付费方式,应采取措施提高老年高血压病病人饮食治疗依从性。     

影响癫痫儿童生活质量相关领域的研究概况

癫痫是一种因大脑神经元的正常功能发生异常所致的神经系统慢性疾病,主要发生在儿童和青少年期,具有一定的遗传性。由于癫痫疾病本身打破了神经元的正常脑电生理,对大脑皮质产生重复累积的损害,可使患儿的认知功能、精神心理、社会行为、睡眠等受到严重影响,导致癫痫患儿后期的生活质量受到威胁,甚至可干扰成年以后的生活和发展。随着对癫痫疾病的深入研究,对癫痫的治疗不再仅局限于控制癫痫发作,关注患儿及其家庭的生活质量也变得同等重要。如何改善和提高癫痫儿童的生活质量已成为专科临床医师进行临床评估的一部分。文章就癫痫儿童生活质量相关领域的研究进行综述。