眼科设备数据库设计初探

本文介绍了一所眼科医院设备数据库的设计思路,数据库内容以及用途。     

Toxic Clostridioides (formerly Clostridium) difficile colitis: No longer a diarrhea associated infection

BackgroundClostridioides difficile infection (CDI) is traditionally taught to be an antibiotic associated diarrheal infection. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 h) coupled with a diagnostic test. There is now a new presentation of CDI, including progression to toxic megacolon, in patients without diarrhea.MethodsWe report a case series of 9 surgical patients from a single institution who developed CDI without preceding diarrhea.ResultAll 9 patients had CDI with positive laboratory testing for C. difficile toxin. They, however, presented with a lack of or minimal bowel movements. Six patients had rapid development of abdominal distention, 1 patient had a single episode of watery stool in 3 days, while the other 2 patients presented with constipation. Seven patients received stool softeners, suppositories and/or enemas for presumed constipation. Four patients had a mild course of infection and were successfully treated medically. The other 5 patients developed toxic megacolon, and eventually required total abdominal colectomy. Out of the 5 patients that required total colectomy, 2 expired.ConclusionCDI must be suspected in patients who rapidly develop abdominal distention, vague abdominal complaints or change in bowel function even in the absence of diarrhea, especially if coupled with multi-system organ failure.     

正交试验设计结合熵权TOPSIS优选阿胶珠炮制工艺

目的 优选阿胶珠的炮制工艺。方法 采用L₉（3⁴）正交试验设计,以外观性状、水分、总灰分、特征多肽及氨基酸含量为指标,以炮制时间、炮制温度、每锅辅料用量为考察因素,结合直观分析、方差分析和熵权逼近理想解排序法（TOPSIS）对正交试验结果进行评价,优选阿胶珠炮制工艺,并进行炮制工艺验证。结果 优选的阿胶珠炮制工艺参数为炮制时间5 min、炮制温度190 ℃、蛤粉-阿胶为30∶1;验证实验中3批样品各指标的RSD为2.09%~4.91%。结论 优选的阿胶珠炮制工艺合理可行,可为阿胶珠工业化炮制生产提供参考。     

补阴益肾方联合芬吗通治疗卵巢功能早衰临床研究

目的：观察补阴益肾方联合芬吗通治疗卵巢功能早衰的疗效。方法：选取168例卵巢功能早衰患者,按随机数字表法分为研究组与对照组各84例。对照组给予芬吗通治疗,研究组给予补阴益阴方联合芬吗通治疗,3个疗程结束后评估2组临床疗效。比较2组治疗前后中医证候积分、性激素指标[血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）]、卵巢储备功能[抑制素B (INHB)、抗缪勒管激素（AMH）]及子宫内膜厚度的变化。结果：观察组临床疗效总有效率为90.48%,对照组为79.76%,2组比较,差异有统计学意义（P<0.05）。治疗后,2组中医证候主症、次症及总积分均较治疗前下降（P<0.05）,研究组上述3项指标值均低于对照组（P<0.05）。治疗后,2组FSH、LH水平均较治疗前下降（P<0.05）,E2水平均较治疗前上升（P<0.05）;研究组FSH、LH水平均低于对照组（P<0.05）,E2水平高于对照组（P<0.05）。治疗后,2组INHB、AMH水平、子宫内膜厚度均较治疗前升高（P<0.05）,研究组上述3项指标值均高于对照组（P<...     

Higher mortality rates associated with rheumatoid arthritis in Saskatchewan,Canada, 2001–2019

ObjectivesTo estimate provincial all-cause mortality rates of Saskatchewan people with rheumatoid arthritis (RA) for comparison with the general population over time and between different geographic regions.MethodsSaskatchewan provincial administrative health databases (2001–2019) were utilized as data sources. Two RA case definitions were employed: (1) ≥ 3 physician billing diagnoses, at least 1 from a specialist (rheumatologist, general internist or orthopaedic surgeon) within 2 years; (2) ≥ 1 hospitalization diagnosis (ICD-9 code 714, and ICD-10-CA codes M05, M06). Data from these definitions were combined to create an administrative data RA cohort. All-cause mortality rates across geographic regions, between rural/urban residences and between sexes were examined.ResultsOver an 18-year span, between fiscal-year 2001–2002 and fiscal-year 2018–2019, age- and sex-adjusted mortality rates ranged from 17.10 to 21.04 (95% CI 14.77, 19.44; 18.03, 24.05)/1000 RA person-years, compared with mortality rates for the general Saskatchewan population without RA, which ranged from 9.37 to 10.88 (95% CI 9.23, 9.51; 10.72, 11.05)/1000 person-years. Fiscal-year mortality rate ratios ranged from 1.82 to 2.13 (95% CI 1.56, 2.13; 1.83, 2.46). Provincial mortality rates were higher in men than in women for both general and RA populations. Northern Saskatchewan mortality rates were significantly higher in the general population but did not achieve significance compared with other provincial regions for the RA population. Regression analysis identified age, male sex, RA and geographic region as factors contributing to increased mortality. A trend towards lower mortality rates over time was observed.ConclusionHigher mortality rates were observed in the RA population overall. Men had higher mortality rates, as did residents of Northern Saskatchewan compared with residents of other regions for the general population.     

云南省普洱市思茅区大面积野鼠自毙疫情实验室检测结果与分析

目的 调查引起云南省普洱市思茅区大面积野鼠自毙疫情的病原体,以便为采取相应措施提供科学依据。方法 通过现场流行病学调查,采集119只自毙野鼠样本,解剖取脏器进行鼠疫耶尔森菌病原体分离、噬菌体裂解实验、F1抗原、caf1基因等病原学、免疫学及分子生物学检测,以排除鼠疫。同时,脏器样本接种绵羊血琼脂平板、巧克力平板、麦康凯平板、沙氏琼脂培养基等营养培养基和选择性培养基,分离培养细菌、真菌类病原体;选取10只组织腐败较轻的自毙鼠,按肺组织、脑组织、腹腔脏器组织分为3份样本后,研磨、离心,再以0.22μm滤膜过滤,收集离心上清液、滤膜滤出液和滤膜截留残渣共9份样本,腹腔接种雄性、体质量30~40g昆明小鼠,每组2只,每只0.5ml。另接种0.5ml Hank’s液2只鼠作对照。共接种昆明小鼠20只。死亡小鼠解剖观察病理变化,取脏器组织接种上述培养基进行细菌分离培养。结果 鼠疫耶尔森菌病原学、免疫学和分子生物学检测均为阴性;自毙野鼠脏器镜检、分离培养及接种实验动物均检出G- 短小杆菌,经梅里埃VITEK 2GN、GP卡、16S rRNA扩增鉴定为多杀巴斯德菌 (Pasteurella multocida,Pm) ,概率为99%;分离到的G+粗大杆菌为腊样芽孢杆菌,概率为99%。结论 多杀巴斯德菌可能是这次发生野鼠大面积死亡的病原菌。该病原体的生物学特性及危害值得进一步关注。     

2016—2020年河南省餐饮单位食源性疾病暴发事件流行病学特征分析

目的 分析河南省餐饮单位食源性疾病暴发的流行病学特征,提出相关监管建议。方法 收集2016—2020年河南省餐饮类食源性疾病暴发监测数据,采用SPSS 19.0软件对数据进行流行病学分析。结果 河南省2016—2020年共报告发生在餐饮单位的食源性疾病暴发事件224起,占同时期全省食源性疾病暴发事件总数的57.44%,发病2577人,占发病总人数的73.37%,死亡1人,占死亡总人数的14.29%。餐饮类暴发事件场所主要集中在宾馆饭店,事件报告数100起,占总事件数的44.64%。在查明原因的事件中,致病菌是引发食源性疾病暴发事件的主要因素,占总事件数的19.64%;加工储存不当引起的事件数量最多,占总事件数的27.33%。结论 建议加强对餐饮单位重点环节和危险因素的监管,建立健全餐饮单位食品安全知识培训制度,加强食品安全监管多部门沟通合作机制。     

经旋股内侧动脉深支和旋股外侧动脉升支介入治疗股骨头缺血性坏死的应用解剖

对 50例成人下肢标本的旋股内侧动脉深支和旋股外侧动脉升支的起源、起点、外径、走行、分布以及经这二支血管介入有关的结构进行观测 ,为介入治疗股骨头缺血性坏死提供更接近病变部位及可进行插管的血管。结果表明 ,旋股外侧动脉升支与横支共干起自旋股外侧动脉者占 68% ,升支单独起自旋股外侧动脉占 2 6 % ;旋股内侧动脉深支由旋股内侧动脉主干延续而来。旋股内、外侧动脉深支或升支起点外径分别为 3 0± 0 8mm、 2 8± 0 7mm。从股动脉的起点 ,经股深动脉、旋股外侧动脉至其升支长度为 7 1± 1 1cm ;经股深动脉、旋股内侧动脉至其深支长度为 5 6± 1 4cm。旋股内侧动脉与其深支间约呈 90 。 角 ;旋股外侧动脉与其升支间约呈 1 33。 角。旋股内、外侧动脉深支 (升支 )为营养股骨头和颈的血管 ,这二支血管符合导管插入要求     

手部肌腱吻合术后康复

目的作者自2000年初至2004年7月进行手部肌腱吻合120例,随访120例,手部肌腱吻合术后进行程序化的康复训练,方法肌腱吻合法均采用3-0或4-0聚丙烯单针缝线、改良的Bunnell、Kessler和肌腱编制缝合法,患者肌腱均为I期手术吻合,术后伤口I/乙愈合105例、II/乙15例,手部肌腱吻合术后均采用程序化的康复训练, 结果对手部肌腱吻合术后的患者进行程序化的康复训练,取得良好的效果. 结论本康复训练程序目前已逐渐形成我院的治疗常规,并逐步推广和普及.     

Acupoint-specific fMRI patterns in human brain

Specific central nervous system (CNS) responses to acupuncture have recently attracted attention. It is important to understand the differences in fMRI images of the brain evoked by acupuncture at an acupoint and at a nearby "sham" point. Here, we report analyses of fMRI images of the brains of 37 healthy volunteers in response to acupuncture at Liv3 (Taichong) and LI4 (Hegu) versus their sham points. We found common activation areas in response to Liv3 or LI4 acupuncture in the middle temporal gyrus and cerebellum, along with deactivation areas in the middle frontal gyrus and inferior parietal lobule, compared with the effects of acupuncture at sham points. Acupuncture at Liv3 evoked specific activation at the postcentral gyrus, posterior cingulate, parahippocampal gyrus, BA 7, 19 and 41, but deactivation at the inferior frontal gyrus, anterior cingulate, BA 17 and 18, compared with acupuncture at its sham point. Acupuncture at LI4 evoked specific activation at the temporal pole, but deactivation at the precentral gyrus, superior temporal gyrus, pulvinar and BA 8, 9 and 45, compared with acupuncture at its sham point. These observations reveal that acupuncture at acupoints induces specific patterns of brain activity, and these patterns may relate to the therapeutic effects of acupuncture.