单手保护会阴法对自由体位分娩产妇分娩结局的影响

目的:探讨单手保护会阴法对自由体位分娩产妇分娩结局的影响。方法:选取2016年5月1日~2017年5月31日给予常规助产方式分娩的产妇78例作为对照组,选取2017年6月1日~2018年6月30日给予自由体位单手保护会阴法分娩的产妇78例作为观察组。比较两组会阴裂伤程度、产后出血率、新生儿窒息率及临床满意度。结果:观察组干预后会阴裂伤程度轻于对照组(P<0.05),产后出血率、新生儿窒息率均低于对照组(P<0.05),临床满意度高于对照组(P<0.05)。结论:单手保护会阴法在自由体位分娩中可减轻产妇会阴裂伤程度,降低产后出血率和新生儿窒息率,提高临床满意度。     

医院进修人员医院感染知识水平的调查与分析

目的调查医院进修人员医院感染知识水平,并分析相关影响因素,以制定合理的进修人员培训方案。方法采用自制《医院感染相关知识网络问卷》,通过网络问卷调查方式,对来自外院520名医院进修人员进行调查,并用单因素分析及多元线性回归分析进行影响因素分析。结果医院进修人员医院感染知识平均得分为(65.60±14.95)分,多元线性回归分析结果显示,不同学历、工龄及所在医院等级均会对进修人员的医院感染知识水平造成影响(P均<0.05)。结论进修人员医院感染知识掌握程度一般,受多种因素影响,需要加强针对性的培训。     

妊娠期糖尿病孕妇产后阴道微生态状况分析

目的探讨妊娠期糖尿病孕妇产后阴道微生态的状况,为孕妇产后恢复阴道微生态提供重要实验依据。方法回顾性分析2018年1-12月在武汉市江汉区妇幼保健院进行体检的128例妊娠期糖尿病孕妇(实验组)与120例健康孕妇(对照组)产后阴道微生态状况,比较两组间阴道微生态形态学(阴道优势菌、阴道菌群密集度、阴道菌群多样性、阴道清洁度、Donders评分、其他病原微生物及Nugent评分等)与功能学(阴道pH值、过氧化氢、凝固酶、β-葡萄糖醛酸苷酶、唾液酸苷酶、白细胞酯酶)的差异变化。结果实验组产后阴道优势菌以革兰阳性球菌(48.44%)和革兰阴性杆菌(34.38%)为主,对照组以革兰阳性杆菌(88.33%)为主,两组间比较差异有统计学意义(P<0.05)。实验组菌群密集度较低,以Ⅰ级和Ⅱ级为主,而对照组密集度则以Ⅲ级和Ⅳ级为主,差异有统计学意义(P<0.05),且两组间菌群构成及多样性也明显不同,差异有统计学意义(P<0.05)。与对照组相比,实验组阴道清洁度较差,白细胞数目明显增多,阴道病原菌感染率为91.41%,以细菌性阴道病及混合感染患者居多,其中有症状者为84.38%,显著高于对照组,差异有统计学意义(P<0.05)。实验组阴道pH值较对照组显著升高,实验组过氧化氢、凝固酶、β-葡萄糖醛酸苷酶、唾液酸苷酶和白细胞酯酶阳性率显著高于对照组,差异有统计学意义(P<0.05)。结论妊娠期糖尿病孕妇产后阴道菌群较健康孕妇有明显异常,阴道微生态失衡,需恢复正常阴道微生态,减少阴道病原菌感染的发生。     

Improving Lipophagy by Restoring Rab7 Cycle: Protective Effects of Quercetin on Ethanol-Induced Liver Steatosis

Chronic alcohol consumption retards lipophagy, which contributes to the pathogenesis of liver steatosis. Lipophagy-related Rab7 has been presumed as a crucial regulator in the progression of alcohol liver disease despite elusive mechanisms. More importantly, whether or not hepatoprotective quercetin targets Rab7-associated lipophagy disorder is unknown. Herein, alcoholic fatty liver induced by chronic-plus-single-binge ethanol feeding to male C57BL/6J mice was manifested by hampering autophagosomes formation with lipid droplets and fusion with lysosomes compared with the normal control, which was normalized partially by quercetin. The GST-RILP pulldown assay of Rab7 indicated an improved GTP-Rab7 as the quercetin treatment for ethanol-feeding mice. HepG2 cells transfected with CYP2E1 showed similar lipophagy dysfunction when exposed to ethanol, which was blocked when cells were transfected with siRNA-Rab7 in advance. Ethanol-induced steatosis and autophagic flux disruption were aggravated by the Rab7-specific inhibitor CID1067700 while alleviated by transfecting with the Rab7^Wt plasmid, which was visualized by immunofluorescence co-localization analysis and mCherry-GFP-LC3 transfection. Furthermore, TBC1D5, a Rab GTPase-activating protein for the subsequent normal circulation of Rab7, was downregulated after alcohol administration but regained by quercetin. Rab7 circulation retarded by ethanol and corrected by quercetin was further revealed by fluorescence recovery after photobleaching (FRAP). Altogether, quercetin attenuates hepatic steatosis by normalizing ethanol-imposed Rab7 turnover disorders and subsequent lipophagy disturbances, highlighting a novel mechanism and the promising prospect of quercetin-like phytochemicals against the crucial first hit from alcohol.     

抗体联合检测在类风湿关节炎早期诊断中的临床意义

目的 探讨抗角蛋白抗体(AKA)、类风湿因子(RF)和抗环瓜氨酸肽抗体(抗-CCP抗体)联合检测在类风湿关节炎(RA)早期诊断中的临床意义.方法 对RA患者68例,非RA其他风湿病患者90例同时检测AKA,RF和抗CCP抗体,AKA用间接免疫荧光法进行检测,RF和抗-CCP抗体用酶联免疫吸附法定量检测.结果 RA组中3种抗体的阳性率显著高于非RA组(P＜0.01);抗CCP抗体对RA诊断的敏感性(69.1%)明显高于AKA(33.8%,P＜0.01),与RF比较,差异无显著性(80.9%,P＞0.05);抗CCP抗体和AKA特异性(94.4%,93.3%)较高,与RF比较,差异有显著性(74.4%,P＜0.01);抗CCP抗体和RF联合检测敏感性达89.7%.结论 RF敏感性较高,特异性较差;抗CCP抗体对RA有适度的敏感性和很高的特异性,对诊断RA具有良好的应用价值;抗CCP抗体和RF联合检测具有更高的敏感性.     

罗哌卡因复合不同剂量地塞米松行肌间沟臂丛神经阻滞在患儿上肢手术后的镇痛效果

目的 观察罗哌卡因复合不同剂量地塞米松行肌间沟臂丛神经阻滞(ISBPB)对患儿上肢骨折手术后镇痛效果的影响。方法 选择上肢骨折手术患儿73例,男46例,女27例,年龄3～7岁,ASAⅠ或Ⅱ级。随机分为三组：单纯罗哌卡因组(R组,n=24)、罗哌卡因复合地塞米松0.1 mg/kg组(D1组,n=24)和罗哌卡因复合地塞米松0.2 mg/kg组(D2组,n=25),三组药液容量均为0.3 ml/kg。患儿在麻醉后行超声引导下ISBPB,均保留自主呼吸。记录痛觉阻滞时间、运动阻滞时间、阻滞后24 h内镇痛药物(布洛芬混悬液、氢吗啡酮)的使用情况。记录膈神经阻滞、Horner综合征、声带麻痹、阻滞侧感觉异常等术后并发症的发生情况。结果 D2组痛觉阻滞时间明显长于R组(P<0.05)。R组和D1组痛觉阻滞时间差异无统计学意义。三组运动阻滞时间差异无统计学意义。D1组和D2组阻滞后24 h内布洛芬混悬液使用次数、氢吗啡酮使用率明显低于R组(P<0.01),D1组和D2组差异无统计学意义。三组膈神经阻滞率差异无统计学意义。三组术后未出现其余并发症。结论 与单纯罗哌卡因比较,0.25%罗哌...     

信息管理与信息系统专业实践教学质量保障与监控体系构建与探索

结合内蒙古医科大学信息管理与信息系统专业建设经验,分析该专业实践教学存在的问题,阐述其实践教学体系重构路径、实践教学质量保障与监控体系构建方法,为相关研究提供参考。     

高危患者发生医院内获得性压力性损伤现况调查与影响因素分析

目的 调查高危压力性损伤患者发生医院内获得性压力性损伤的现况并分析主要影响因素.方法 跟踪调查1239例高危压力性损伤患者医院内获得性压力性损伤发生情况,并采用多因素Logistic回归分析方法分析影响因素.结果 高危患者中医院内获得性压力性损伤发生率为8.7％,以尾骶部、2期为主.多因素分析显示:压力性损伤风险评估量...     

IFI27 is a potential therapeutic target for HIV infection

BackgroundTherapeutic studies against human immunodeficiency virus type 1 (HIV-1) infection have become one of the important works in global public health.MethodsDifferential expression analysis was performed between HIV-positive (HIV+) and HIV-negative (HIV-) patients for {"type":"entrez-geo","attrs":{"text":"GPL6947","term_id":"6947"}}GPL6947 and {"type":"entrez-geo","attrs":{"text":"GPL10558","term_id":"10558"}}GPL10558 of {"type":"entrez-geo","attrs":{"text":"GSE29429","term_id":"29429"}}GSE29429. Coexpression analysis of common genes with the same direction of differential expression identified modules. Module genes were subjected to enrichment analysis, Short Time-series Expression Miner (STEM) analysis, and PPI network analysis. The top 100 most connected genes in the PPI network were screened to construct the LASSO model, and AUC values were calculated to identify the key genes. Methylation modification of key genes were identified by the chAMP package. Differences in immune cell infiltration between HIV + and HIV- patients, as well as between antiretroviral therapy (ART) and HIV + patients, were calculated using ssGSEA.ResultsWe obtained 3610 common genes, clustered into nine coexpression modules. Module genes were significantly enriched in interferon signalling, helper T-cell immunity, and HIF-1-signalling pathways. We screened out module genes with gradual changes in expression with increasing time from HIV enrolment using STEM software. We identified 12 significant genes through LASSO regression analysis, especially proteasome 20S subunit beta 8 (PSMB8) and interferon alpha inducible protein 27 (IFI27). The expression of PSMB8 and IFI27 were then detected by quantitative real-time PCR. Interestingly, IFI27 was also a persistently dysregulated gene identified by STEM. In addition, 10 of the key genes were identified to be modified by methylation. The significantly infiltrated immune cells in HIV + patients were restored after ART, and IFI27 was significantly associated with immune cells.ConclusionThe above results provided potential target genes for early diagnosis and treatment of HIV + patients. IFI27 may be associated with the progression of HIV infection and may be a powerful target for immunotherapy.     

无充气腋窝入路全腔镜下甲状腺切除术的“场景式”扶镜技巧与质量控制

随着腔镜甲状腺手术的发展及推广,该手术方式被越来越多的医疗中心和患者接受,但因其操作空间相对腹腔镜和胸腔镜更狭小,且镜头和主刀的操作器械共用空间,两者相互干扰及视角显露等问题,常成为影响手术的难点。为解决该问题,笔者从扶镜手的视觉角度出发,引入场景式的概念,通过三个部分规范无充气腋窝全腔镜下甲状腺切除手术中扶镜手的操作要点及质量控制。第一部分为规范术前准备及扶镜手操作区域的划分;第二部分为扶镜操作要点：“眼关六路、三个平面、进退展转”的十二字扶镜质量控制;第三部分为三层递进镜下视野场景的扶镜质量控制：将手术区域分为喉返神经区、甲状腺上极区、气管前区,借此来规范扶镜手在不同场景的扶镜要点和视角引导。通过扶镜技巧与质量控制,手术过程中的视野显露更充分、清晰,视觉引导更流畅,镜头、器械之间的相互干扰更小,术中平均擦拭或浸泡镜头次数显著减少,甚至手术过程中无需二次擦镜,保证操作的连续性,节省了手术时间。笔者就以上要点、操作技巧及细节进行阐述。