优化静脉溶栓流程对基层医院高级卒中中心建设的影响研究

背景　急性缺血性脑卒中（AIS）是成年人死亡和致残的主要原因之一,如何恢复是全世界的一个主要健康问题。尽管在有效预防和治疗方面取得了相当大的进展,但仍面临着重大挑战,特别是急诊处理,静脉溶栓治疗是唯一一种改善患者预后的方法,但只有少数患者能使用。目的　探讨优化静脉溶栓流程对AIS患者入院至静脉溶栓用药时间（DNT）的影响及对高级卒中中心建设的作用。方法　收集2015年11月-2018年11月海宁市人民医院收治的采用重组组织型纤溶酶原激活物（rt-PA）静脉溶栓治疗的AIS患者186例为研究对象,根据时间进行分组,2015年11月-2018年3月患者采用常规溶栓流程为常规组,2018年4-11月患者接受优化静脉溶栓流程为优化组。比较两组患者一般资料、发病至就诊时间（OTD）、入院至CT检查时间（DTI）、入院至化验检验时间（DTL）、DNT、溶栓距发病时间（TP_WINDOW）、症状性脑出血（sICH）发生率,入院时、溶栓24 h及出院时评价美国国立卫生研究院卒中量表（NIHSS）评分,以ΔNIHSS评分≥4分为有效,出院后3个月临床结局采用改良Rankin量表（mRS）评定。结果　优化组入院时NIHSS评分低于常规组（P<0.05）。常规组与优化组患者OTD、sICH发生率、有效率、出院时NIHSS评分比较,差异均无统计学意义（P>0.05）;优化组患者DTI、DTL、DNT、TP_WINDOW、出院后3个月mRS评分低于常规组,DNT<60 min所占比例高于常规组（P<0.05）。结论　优化静脉溶栓流程可以有效缩短AIS患者DNT,并有助于DNT达标控制在60 min内,未增加溶栓出血风险且影响远期预后,值得推广。     

法律视角下我国医院伦理委员会建设中存在的问题和对策

通过系统梳理涉及伦理委员会建设的现行立法,从法律角度探讨伦理委员会的法律地位、人员组成、资质考核、操作规程、法律监督等方面存在的问题。通过剖析存在的问题,建议提高立法等级,确定性别比例和专业占比标准,参考美国伦理委员会专业认证制度加强委员资质考核;建立专门操作指南,强调跟踪审查;适当调整各方监管权限,下设专门监管机构。     

肺癌患者血浆cofilin蛋白含量检测在肺癌诊断中的应用分析

目的探讨血浆cofilin蛋白检测对诊断肺癌的价值。方法随机抽取60例肺癌患者作为实验组,80例健康体检者为对照组,检测两组血浆cofilin蛋白含量并比较。结果实验组血浆cofilin蛋白水平(0.538±0.145)ng/ml,对照组(0.187±0.132)ng/ml,实验组高于对照组(t=14.924,P=0.000);方差分析,实验组的三个临床分期的血浆cofilin蛋白水平差异有统计学意义(F=12.382,P0.05),Ⅲ期、Ⅳ期的血浆cofilin蛋白水平高于Ⅱ期(t=3.529,P=0.001;t=5.674,P=0.000),Ⅳ期高于Ⅲ期(t=2.085,P=0.045)。结论血浆cofilin蛋白的检测对诊断肺癌有重要参考价值,肺癌患者的血浆cofilin蛋白含量高于健康者,且临床分期越晚含量越高。     

7例孤立性骨浆细胞瘤的临床分析

目的 探讨孤立性骨浆细胞瘤的诊断和治疗,总结其临床特点,以提高临床诊治水平.方法 收集中山大学孙逸仙纪念医院白2007年4月至2011年6月收治7例孤立性骨浆细胞瘤患者的临床资料并对其临床特点、诊断标准及治疗和预后作一回顾性分析.结果 所有病例均经病理证实为骨浆细胞瘤并符合孤立性骨浆细胞瘤的诊断标准,其中1例伴POEMS综合征(多神经病、器官巨大症、内分泌病、M蛋白和皮肤病变综合征),1例术后6个月出现多处骨转移.所有患者治疗后随访1~13个月,平均随访时间为4个月.其中5例患者预后良好,随访期间未出现病情进展.结论 孤立性骨浆细胞瘤好发于中老年,是少见的低度恶性肿瘤.主要依靠病理确诊,手术结合适当剂量的放疗是其治疗的最佳手段.     

Oct-2、Bob.1在肺结核组织B细胞中的表达及其意义

目的探讨肺结核组织B细胞中Oct-2、Bob.1的表达与机体免疫的关系。方法采用免疫组织化学检测20例肺结核组织B细胞中Oct-2、Bob.1的表达情况。结果 (1)在肺结核组织生发中心的B细胞中Oct-2和Bob.1主要表达在细胞核;在无形成生发中心聚集的B细胞中,细胞核和细胞浆均呈阳性;(2)肺结核组织B细胞中Oct-2阳性的细胞数明显少于Bob.1阳性的细胞数,Oct-2和Bob.1阳性率分别为:10.8%、65.6%;(3)形成生发中心的肺结核组织B细胞中Oct-2和Bob.1阳性的细胞数明显高于无生发中心形成的肺结核组织,差异有统计学意义(P<0.05)。结论肺结核组织B细胞Oct-2表达低下和/或Oct-2、Bob.1表达不一致可能导致B细胞在发育过程中未能形成生发中心。     

异位中肾管囊肿合并异位睾丸恶变1例报告并文献复习

目的:报告1例罕见异位中肾管囊肿合并异位睾丸恶变病例,提高对本病的诊治水平。方法:回顾分析异位中肾管囊肿合并异位睾丸恶变的病例的临床资料,结合国内外相关文献,探讨异位中肾管囊肿合并异位睾丸恶变的发病机制、诊断及治疗。结果:经腹切除巨大囊肿及右侧异位恶变睾丸,左侧隐睾行下降固定,病理示"右异位中肾管囊肿,右侧异位睾丸精原细胞瘤",随访1年无转移。结论:异位中肾管囊肿合并异位睾丸恶变极为罕见,影像学检查可协助诊断,但最终需病理确诊,应早期行手术切除。后续治疗取决于隐睾恶变的病理类型及分期。     

A randomised comparison of single-incision versus traditional transobturator midurethral sling in women with stress urinary incontinence: results of a 24-month follow-up

Introduction and hypothesis

Midurethral sling procedures have become the principal surgical treatment for women with stress urinary incontinence (SUI). The 1-year results of this international trial comparing the efficacy and morbidity of a single-incision midurethral sling (SIMS; MiniArc) and a transobturator standard midurethral sling (SMUS; Monarc) showed that MiniArc is non-inferior regarding subjective cure and superior with regard to postoperative pain and recovery. The objective was to compare subjective and objective cure, morbidity and surgery-related discomfort following SIMS and transobturator SMUS up to a 24-month follow-up.

Methods

We carried out a non-blinded, randomised, controlled trial. Women with symptomatic SUI were eligible. Primary outcome was subjective cure, defined as an improvement on the Patient Global Impression of Improvement (PGI-I), at 12, 24 and 36 months. Secondary outcomes were objective cure based on the cough stress test, disease-specific quality of life questionnaires, surgical parameters and physical performance during recovery. Analysis was by intent to treat. Differences between the two groups regarding dichotomous variables were Chi-squared tested and presented as relative risks (RR) with corresponding 95 % confidence intervals.

Results

We randomised 97 women to MiniArc and 96 to Monarc. At the 24-month follow-up, subjective cure was 84 % following MiniArc and 89 % following Monarc (RR ?5; 95% CI ?0.17 to 0.06). Objective cure was 93 % following MiniArc and 94 % following Monarc (RR ?1; 95% CI ?0.10 to 0.07). Both procedures have low complication rates.

Conclusions

At the 2-year follow-up, the non-prespecified analysis of this randomised trial showed that the MiniArc, a single-incision sling, had similar subjective and similar objective cure rates, although non-inferiority to Monarc for subjective cure could not be demonstrated.

     

肠道转运蛋白与中药有效成分的吸收

本文介绍了肠道主要转运蛋白的种类、结构、分布部位、底物、抑制剂或诱导剂,中药成分可作为肠道转运蛋白的底物、抑制剂或诱导剂影响其他药物在肠道中的吸收。有些中药间的配伍通过影响转运蛋白的作用,从而影响有效成分在肠道的吸收。     

2型糖尿病患者自我效能影响因素分析

目的：探讨2型糖尿病患者自我效能的影响因素。方法2014年1~2月,从某社区卫生服务中心随机抽取372例2型糖尿病患者,进行糖尿病自我效能量表测量;采用单因素方差分析寻找自我效能的影响因素,将有统计学意义的因素运用多元回归进行统计学分析。结果该糖尿病人群自我效能得分为（99.02±16.06）分,59.9%处于中等水平;糖尿病教育、干预措施、医保类型、合并高脂血症为2型糖尿病自我效能的影响因素。结论2型糖尿病患者的自我效能有待改善,需加强2型糖尿病患者尤其合并高脂血症者的自我管理教育。     

Rigid membranes of Malayan ovalocytes: a likely genetic barrier against malaria

A high frequency of nonhemolytic hereditary ovalocytosis in Malayan aborigines is thought to result from reduced susceptibility of affected individuals to malaria. Indeed, Kidson et al. recently showed that ovalocytes from Melanesians in Papua New Guinea are resistant to infection in culture by the malarial parasite Plasmodium falciparum. In order to determine if protection against parasitic invasion in these ovalocytes might be the result of some altered membrane material property in these unusual cells, we measured their membrane and cellular deformability characteristics using an ektacytometer . Ovalocytic red cells were found to be much less deformable in comparison to normal discoid red cells. Similar measurements on isolated membrane preparations revealed a marked reduction in ovalocytic membrane deformability. To produce equal deformation of ovalocytic and normal membranes, ovalocytes required an 8-10-fold increase in applied shear stress, indicating that their membrane was capable of deforming under sufficient stress. To test the possibility that this increased membrane rigidity might confer resistance to parasitic invasion, we performed an in vitro invasion assay using Plasmodium falciparum merozoites and Malayan ovalocytes of varying deformability from seven different donors. The level of infection of the ovalocytes ranged from 1% to 35% of that in control cells, and the extent of inhibition appeared to be closely related to the reduction in membrane deformability. Moreover, we were able to induce similar resistance to parasitic invasion in nonovalocytic normal red cells by increasing their membrane rigidity with graded exposure to a protein crosslinking agent. Our findings suggest that resistance to parasite invasion of Malayan ovalocytes is the result of a genetic mutation that causes increased membrane rigidity.