利用微信公众号宣传平台提升门诊服务质量的实践探讨

为深入贯彻落实"互联网+医疗健康"便民惠民活动,不断优化门诊服务流程,提高服务效率与质量,门诊管理者积极探索,创新服务模式,以微信公众号建设为突破口,主动宣传国家医改新政策,落实分级诊疗,提升服务水平。通过线上服务模式,加强与患者的沟通,提供贯穿诊前、诊中、诊后全流程的信息化便民服务,有效缓解了门诊"三长一短"的现象,实现了患者有序就医,患者满意度提高。尤其在疫情防控期间,对于减少人员聚集、保障就医安全等方面起到了积极的作用。     

Multi‐center Retrospective Study of Factors Affecting Perioperative Transfusion of Packed Red Blood Cells for Pelvic Fracture Patients

ObjectiveTo analyze the use of packed red blood cells (PRBCs) for patients with pelvic fracture and evaluate factors associated with PRBC transfusion for patients with pelvic fracture.MethodsThis retrospective cohort study collected 551 patients with pelvic fractures from six hospitals between September 1, 2012, and June 31, 2019. The age span of patients varied from 10 to 95 years old, and they were classified into two groups based on high‐energy pelvic fractures (HE‐PFs) or low‐energy pelvic fractures (LE‐PFs). The study''s outcome was the use of PRBCs, fresh frozen plasma (FFP), and albumin. Demographic data, characteristics, laboratory tests, clinical treatment details, and clinical outcomes were compared between the two groups. Factors that were statistically associated with perioperative PRBCs in univariate analyses were included to conduct an optimal scale regression to determine the independent factors for perioperative PRBCs.ResultsA total of 551 patients were screened from six hospitals, and after inclusion and exclusion, 319 were finally included and finished the follow‐up from admission to discharge, while four patients died during hospitalization. Three hundred and nineteen patients were classified into two groups by their injury mechanisms. A total of 230/319 (72.1%) patients were classified into the HE‐PF group, and 89/319 (27.8%) patients were classified into the LE‐PF group. Patients in the HE‐PF group were transfused with 4.5 (3–8) units of PRBCs, 300 (0–600) ml of FFP, and 0 (0–30) g of albumin, while patients in the LE‐PF group were transfused with 3.5 (2–4.5) units of PRBCs, 0 (0–295) ml of FFP, and 0 (0–0) g of albumin (all P < 0.001). There were higher proportions of male patients and patients under 65 in the HE‐PF group (all P < 0.001). HE‐PF group patients were more severely injured and likely to take external fixation. The optimal scale regression revealed four significant factors associated with perioperative transfused PRBCs, which were patients on admission with hemorrhagic shock (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.148, P = 0.039), and methods of pelvic fixation (importance = 0.008, P = 0.026), ranked by the importance.ConclusionPatients with HE‐PFs had increased transfusions of PRBCs, FFP, and albumin, and hemorrhagic shock on admission, Tile classification, Hb levels, and stabilization methods were found to be associated with perioperative PRBCs.     

Epidemiologic Correlation and Drug Resistance Analysis of Pathogenic Bacteria in Different Open Limb Injury External Conditions

ObjectiveTo study the epidemiological correlation and drug resistance of external factors of infection caused by open injury of limbs to pathogens.MethodsThis experiment is a retrospective study. We took the geographical location and climate of Nanchang, Jiangxi Province, China as the background, analyzed 2017 strains of pathogens from 1589 patients with limb trauma infection in a University Affiliated Hospital from 2012 to 2017. Patients were divided into three groups according to the type of incision: I, In‐hospital infection of clean limb incision, II, In‐hospital infection with open injury, III, Community infection with open injury of the limb. Groups II and Groups III were divided into six subgroups according to the causes of trauma, including: accidents from non‐motor vehicles, machinery, cutting/piercing, pedestrian injuries, struck by/against, pedal cycles, and other injuries. We found eight common pathogens of orthopedic infection, which were mainly divided into Gram‐positive bacteria (G+, mainly including Staphylococcus) and Gram‐negative bacteria (G‐, mainly Enterobacteriaceae). The relationship between main pathogens and damage mechanism, apparent temperature and relative humidity was discussed in this study. SPSS v22.0 was used for statistical analysis of the data. Friedman''s two‐way ANOVA was used to analyze the difference between the injury mechanism and incidence of pathogenic bacteria. Linear regression was used to determine the trend between the incidence of major pathogens and seasonal temperature and humidity. The level of significance was set as P < 0.05.ResultsThere was no significant difference in the distribution of pathogens between Groups II and Groups III (P>0.05). The drug resistance of Groups III was significantly higher than that of Groups II and Groups I. G+ bacteria were resistant to cephalosporin, ceftriaxone and other cephalosporins and erythromycin and other macrolides. They were sensitive to vancomycin and linezolid. G‐ were resistant to the first‐ and the second‐generation cephalosporins, including cefotetan and cefazolin, and ampicillin and other penicillins, while they were sensitive to third‐generation cephalosporins, such as ceftazidime, as well as to levofloxacin and other quinolones, meropenem, and other beta‐lactamases. The correlation between the injury mechanism and infection of pathogenic bacteria was not significant. The monthly average apparent temperature and relative humidity were correlated with the infection rate of pathogenic bacteria.ConclusionIn open injury of extremities, apparent temperature and relative humidity is an important risk factor for infection by pathogenic bacteria and the drug resistance of pathogenic bacteria in out‐of‐hospital infection was lower than that of hospital infection.     

基于人工智能的高血压性脑出血医疗文本信息自动识别系统

目的 构建基于人工智能的高血压性脑出血医疗文本信息自动识别系统,快速识别和分析患者临床信息,高效地输出正确的诊疗方案。方法 基于国内外最新高血压性脑出血诊疗指南,经多位高年资神经外科医生和专业人工智能团队共同讨论,构建基于语言表征模型和专家模块的高血压性脑出血医疗文本信息自动识别及决策系统（即H系统）。随后将收集到的高血压性脑出血病例分为训练集、测试集和验证集,以数据库中病例的真实治疗方案为金标准,先总体评价H系统的准确性,再将其与神经外科医生进行对比,分析H系统的判读效率。结果 在测试集中,H系统所输出的治疗方案的准确率为94.0%（91.5%~96.5%）,特异度为91.8%（86.3%~97.3%）,灵敏度为95.5%（89.3%~98.2%）,曲线下面积（area under the curve,AUC）值为0.936（0.922~0.950）（P=0.000）;在验证集中,H系统所输出的治疗方案的准确率为93.3%（89.5%~97.1%）,特异度为 89.9%（83.4%~96.4%）,灵敏度为95.8%（92.3%~99.3%）,AUC值为0.928（0.891~0.966）（P=0.000）。在处理同样的70例病例时,H系统用时（334.60±4.46）s,而神经外科医生用时（12 550.28±95.45）s;在50 min内,H系统处理的病例数为（383±3）例,而神经外科医生处理的病例数为（11±4）例。结论 本研究所构建的H系统能够对高血压性脑出血患者的急诊病例进行自动识别和分析,并快速输出准确的诊疗方案,可协助医生对高血压脑出血进行急诊诊疗。     

Altereporenes A–E,five epoxy octa-hydronaphthalene polyketides produced by an endophytic fungus Alternaria sp. YUD20002

Five previously undescribed epoxy octa-hydronaphthalene polyketides, altereporenes A–E (1–5) were isolated from rice culture of the endophytic fungus Alternaria sp. YUD20002 derived from the tubers of Solanum tuberosum. Their structures were determined on the basis of comprehensive spectroscopic analyses, while the absolute configurations were elucidated by the comparison of experimental and calculated specific rotations. Meanwhile, the antimicrobial, cytotoxic, anti-inflammatory and acetylcholinesterase inhibitory activities of compounds 1–5 were also investigated.

Five previously undescribed epoxy octa-hydronaphthalene polyketides, altereporenes A–E (1–5) were isolated from rice culture of the endophytic fungus Alternaria sp. YUD20002 derived from the tubers of Solanum tuberosum.     

树脂加强型玻璃离子黏结剂黏结力的实验研究

目的 了解光固化树脂加强型玻璃离子水门汀的剪切强度能否满足临床需要;并比较不同条件下其剪切强度的变化.方法 收集离体前磨牙50颗,随机均分为5组.第1组(对照组):35%磷酸酸蚀30s,冲洗、干燥,涂黏结剂,采用京津釉质黏结剂黏结托槽.第2、4组:35%磷酸酸蚀30s,冲洗,湿润,采用光固化型的Fuji Ortho Lc树脂加强型玻璃离子黏结托槽.第3、5组:不酸蚀,采用光固化型的Fuji Ortho Lc树脂加强型玻璃离子黏结托槽.1、2、3组用电子万能实验机测24h的抗剪切强度,4、5组测30 min的抗剪切强度.并统计牙面上的黏结剂残留量.结果 第2、3、4组的抗剪切强度均能满足临床需要,第5组的抗剪切强度不能满足临床需要,第2组的抗剪切强度与其它各组相比差别有显著性.结论 光固化树脂加强型玻璃离子在酸蚀和免酸蚀后24h,以及酸蚀黏结30min后的剪切强度均能满足临床需要;而免酸蚀黏结30min的抗剪切强度不能满足临床需要;酸蚀后光固化树脂加强型玻璃离子的剪切强度明显增强.     

Full Genome Sequencing of Three Sedoreoviridae Viruses Isolated from Culicoides spp. (Diptera,Ceratopogonidae) in China

Sedoreoviridae is a family of viruses belonging to the order Reovirales and comprises six genera, two of which, Orbivirus and Seadornavirus, contain arboviruses that cause disease in humans and livestock. Areas such as Yunnan Province in southwestern China, have high arboviral activity due in part to warm and wet summers, which support high populations of biting flies such as mosquitoes and Culicoides. Three viral isolates previously obtained from Culicoides collected at cattle farms in Shizong County of Yunnan Province, China, between 2019 and 2020 were completely sequenced and identified as Banna virus (BAV) genotype A of Seadornavirus and serotypes 1 and 7 of epizootic hemorrhagic disease virus (EHDV) of Orbivirus. These results suggest that Culicoides tainanus and C. orientalis are potential vectors of BAV and EHDV, respectively, and represent the first association of a BAV with C. tainanus and of an arbovirus with C. orientalis. Analysis using VP9 generally agreed with the current groupings within this genus based on VP12, although the classification for some strains should be corrected. Furthermore, the placement of Kadipiro virus (KDV) and Liao ning virus (LNV) in Seadornavirus may need confirmation as phylogenetic analysis placed these viruses as sister to other species in the genus.     

New views on ultrasonography in high-flow priapism,with typical cases

Dear Editor, Priapism is an uncommon pathological erection that mainly occurs in adult males between the ages of 20 years and 50 years.1 It is defined as an inv...     

PXR activation impairs hepatic glucose metabolism partly via inhibiting the HNF4α–GLUT2 pathway

Drug-induced hyperglycemia/diabetes is a global issue. Some drugs induce hyperglycemia by activating the pregnane X receptor (PXR), but the mechanism is unclear. Here, we report that PXR activation induces hyperglycemia by impairing hepatic glucose metabolism due to inhibition of the hepatocyte nuclear factor 4-alpha (HNF4α)‒glucose transporter 2 (GLUT2) pathway. The PXR agonists atorvastatin and rifampicin significantly downregulated GLUT2 and HNF4α expression, and impaired glucose uptake and utilization in HepG2 cells. Overexpression of PXR downregulated GLUT2 and HNF4α expression, while silencing PXR upregulated HNF4α and GLUT2 expression. Silencing HNF4α decreased GLUT2 expression, while overexpressing HNF4α increased GLUT2 expression and glucose uptake. Silencing PXR or overexpressing HNF4α reversed the atorvastatin-induced decrease in GLUT2 expression and glucose uptake. In human primary hepatocytes, atorvastatin downregulated GLUT2 and HNF4α mRNA expression, which could be attenuated by silencing PXR. Silencing HNF4α downregulated GLUT2 mRNA expression. These findings were reproduced with mouse primary hepatocytes. Hnf4α plasmid increased Slc2a2 promoter activity. Hnf4α silencing or pregnenolone-16α-carbonitrile (PCN) suppressed the Slc2a2 promoter activity by decreasing HNF4α recruitment to the Slc2a2 promoter. Liver-specific Hnf4α deletion and PCN impaired glucose tolerance and hepatic glucose uptake, and decreased the expression of hepatic HNF4α and GLUT2. In conclusion, PXR activation impaired hepatic glucose metabolism partly by inhibiting the HNF4α‒GLUT2 pathway. These results highlight the molecular mechanisms by which PXR activators induce hyperglycemia/diabetes.Key words: Pregnane X receptor, Hepatocyte nuclear factor 4-alpha, Glucose transporter 2, Hepatic glucose uptake, Diabetes, Drug-induced hyperglycemia