持续胸痛4个月及进行性下肢无力2个月

患儿,男,5岁。因胸痛4个月,右下肢无力2个月,双下肢无力10 d入院,无排便、排尿障碍,无意识障碍,双下肢呈上运动神经元性瘫痪,无颅神经受累,无感觉障碍。脊髓MRI示颈6~胸2椎管内肿瘤,压迫脊髓。转入神经外科手术治疗,患儿手术切除肿瘤后逐渐康复,随访6年未复发。该患儿病理诊断为透明细胞型脑（脊）膜瘤（WHO Ⅱ级）。儿童胸痛伴运动障碍,应与脊膜瘤这种椎管内肿瘤鉴别。     

A Survey on Intelligent Screening for Diabetic Retinopathy

Diabetic retinopathy (DR) is one of the leading causes of vision loss and can be effectively avoided by screening, early diagnosis and treatment. In order to increase the universality and efficiency of DR screening, many efforts have been invested in developing intelligent screening, and there have been great advances. In this paper, we survey DR screening from four perspectives: 1) public color fundus image datasets of DR; 2) DR classification and related lesion-extraction approaches; 3) existing computer-aided systems for DR screening; and 4) existing issues, challenges, and research trends. Our goal is to provide insights for future research directions on DR intelligent screening.     

上颌第三磨牙对第一磨牙近中移动影响的研究

目的探讨萌出中的上颌第三磨牙是否会使上颌第一磨牙向近中移动。方法选择18～24岁正畸患者18例,均拔除4颗第一前磨牙矫治,且随机拔除一侧上颌第三磨牙,两侧其余治疗条件保持一致。治疗3个月后观察两侧上颌第一磨牙近中移动量是否存在差异。结果1)拔除上颌第三磨牙的一侧,其上颌第一磨牙在治疗3个月后未发生明显的近中移动;2)未拔除上颌第三磨牙的一侧,其上颌第一磨牙在治疗3个月后的近中移动量为1mm;3)治疗3个月后,未拔除上颌第三磨牙侧的第一磨牙近中移动量大于拔除第三磨牙侧的第一磨牙的近中移动量,其差异有统计学意义(P<0.01)。结论在正畸治疗的初始阶段,若上颌第三磨牙的萌出间隙不足,其萌出会对其近中的上颌第一磨牙产生影响,导致其近中移动而丧失支抗。     

糖皮质类固醇激素治疗急性肺损伤的进展

急性肺损伤(ALI)是全身炎症反应综合征在肺部的表现,炎症失控是其病变本质。糖皮质类固醇激素因其抗炎和免疫抑制特性而被广泛应用于临床重症疾病。本文在复习近年来文献的基础上就糖皮质激素在ALI中的应用进展作一综述。     

继续教育对基层医务人员有关慢性阻塞性肺疾病相关认知的影响研究

目的了解基层医务人员对慢性阻塞性肺疾病的认知、过去一年继续教育情况及继续教育对慢性阻塞性肺疾病相关认知的影响。方法选取2019年10月1—31日2372名来自社区卫生服务中心(站)、乡镇卫生院和村卫生室的医务人员自愿在线填写了调查问卷,内容包括个人基本特征,对慢性阻塞性肺疾病危险因素和诊断的认知及继续教育情况。结果基层医务人员熟知吸烟、二手烟、长期呼吸道疾病史、室外空气污染和职业性粉尘等危险因素,但是对室内空气污染和遗传因素认知不足,并且仍有12.1%的基层医务人员知晓吸烟是危险因素,但正在吸烟或戒烟6个月以内。80%的调查对象知道肺功能是诊断慢性阻塞性肺疾病的金标准,但仅60.7%的调查对象能正确判读肺功能结果。过去一年中仅44.3%的基层医务人员接受了相关继续教育。继续教育对提升基层医务人员慢性阻塞性肺疾病危险因素和诊断相关认知的影响差异有显著性(OR=1.524,95%CI 1.289～1.802;OR=1.528,95%CI 1.289～1.812)。结论加大继续教育的惠及范围,有针对性地加强基层医务人员对室内空气污染和遗传因素的认知,同时在基层配备肺功能仪的前提下,开展以实操...     

认知负荷理论在医疗护理领域中应用的研究进展

从认知负荷的定义、分类、测量方法以及在医疗护理领域中的应用等方面对国外最新研究进展进行综述,旨在为我国医院管理者在改善医护人员实施治疗与护理措施时认知负荷的水平发挥积极作用提供理论依据。     

Evaluation of the Immunogenicity in Mice Orally Immunized with Recombinant Lactobacillus casei Expressing Porcine Epidemic Diarrhea Virus S1 Protein

Porcine epidemic diarrhea (PED), characterized by diarrhea, vomiting, and dehydration, is an acute enteric infectious disease of pigs. The disease is caused by porcine epidemic diarrhea virus (PEDV), which infects the intestinal mucosal surface. Therefore, mucosal immunization through the oral route is an effective method of immunization. Lactic acid bacteria, which are acid resistant and bile-salt resistant and improve mucosal immunity, are ideal carriers for oral vaccines. The S1 glycoprotein of PEDV mediates binding of the virus with cell receptors and induces neutralizing antibodies against the virus. Therefore, we reversely screened the recombinant strain pPG-SD-S1/Δupp ATCC 393 expressing PEDV S1 glycoprotein by Lactobacillus casei deficient in upp genotype (Δupp ATCC 393). Mice were orally immunized three times with the recombinant bacteria that had been identified for expression, and the changes of anti-PEDV IgG and secreted immunoglobulin A levels were observed over 70 days. The results indicated that the antibody levels notably increased after oral administration of recombinant bacteria. The detection of extracellular cytokines on the 42nd day after immunization indicated high levels of humoral and cellular immune responses in mice. The above results demonstrate that pPG-SD-S1/Δupp ATCC 393 has great potential as an oral vaccine against PEDV.     

醒脑静微乳的体外释放研究

目的:研究醒脑静微乳体外释放的特性,探讨其释药机制.方法:采用HPLC测定栀子苷含量,GC测定龙脑含量,以透析法研究醒脑静微乳的体外释放并利用药物释放模型方程拟合释放曲线.结果:微乳中水溶性成分栀子苷2h内基本释放完全,释放符合Weibell方程,脂溶性成分龙脑释放符合一级方程.结论:微乳中不同性质的药物成分释放行为存在较大差异,各成分分布于微乳的不同相中.     

穴位埋线治疗围绝经期综合征60例临床观察

目的:优选提高治疗围绝经期综合征(PMS)的方法.方法:将90例患者按2∶1的比例随机分为穴位埋线组(埋线组)60例和西药组30例,并以Kupperman指数评分的改变评价2组的临床疗效.结果:埋线组的Kupperman指数与治疗前相比,有非常显著性差异;其评分改变与西药组相比,同样有显著性差异;同时,埋线组疗效优于西药组.结论:埋线疗法对PMS有较好疗效,应用方便,无不良反应,临床当予以关注.