儿童艰难梭菌感染临床特征及疾病复发危险因素分析

目的 分析儿童艰难梭菌感染(CDI)的临床特征及疾病复发危险因素。方法 选择2014年9月至2022年10月于上海市儿童医院消化感染科住院治疗的138例CDI患儿的临床资料。根据治疗后疾病复发情况将患儿分为复发组(n=39)和非复发组(n=99)。比较两组临床数据资料,并通过二元logistic回归分析CDI复发的危险因素。结果 138例初发CDI患儿中男81例,女57例,中位年龄4.80岁。复发组腹泻、伪膜性肠炎和医院获得性CDI(HA-CDI)的人数比例高于未复发组,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,伪膜性肠炎和HA-CDI是促进CDI患儿复发的独立危险因素(P<0.05)。结论 伪膜性肠炎和HA-CDI是住院CDI患儿复发的独立危险因素,需引起临床医师的重视。     

RSPO2 and RANKL signal through LGR4 to regulate osteoclastic premetastatic niche formation and bone metastasis

Therapeutics targeting osteoclasts are commonly used treatments for bone metastasis; however, whether and how osteoclasts regulate premetastatic niche and bone tropism are largely unknown. In this study, we report that osteoclast precursors (OPs) can function as a premetastatic niche component that facilitates breast cancer (BCa) bone metastasis at early stages. At the molecular level, unbiased GPCR ligand/agonist screening in BCa cells suggested that R-spondin 2 (RSPO2) and RANKL, through interaction with their receptor LGR4, promoted osteoclastic premetastatic niche formation and enhanced BCa bone metastasis. This was achieved by RSPO2/RANKL-LGR4 signal modulating the WNT inhibitor DKK1 through Gα_q and β-catenin signaling. DKK1 directly facilitated OP recruitment through suppression of its receptor LDL receptor–related protein 5 (LRP5) but not LRP6, upregulating Rnasek expression via inhibition of canonical WNT signaling. In clinical samples, RSPO2, LGR4, and DKK1 expression showed a positive correlation with BCa bone metastasis. Furthermore, soluble LGR4 extracellular domain (ECD) protein, acting as a decoy receptor for RSPO2 and RANKL, significantly alleviated bone metastasis and osteolytic lesions in a mouse bone metastasis model. These findings provide unique insights into the functional role of OPs as key components of the premetastatic niche for BCa bone metastasis and identify RSPO2/RANKL-LGR4 signaling as a promising target for inhibiting BCa bone metastasis.     

Complex atrial flutter ablation after mechanical mitral valve replacement in patient with rheumatic heart disease:A case report

INTRODUCTION Radiofrequency ablation is often difficult to treat arrhythmias caused by rheumatic heart disease.Because this type of arrhythmia is caused by myoc...     

一站式入出院信息化服务体系建设

以陆军军医大学第一附属医院为例,详细阐述一站式入出院信息服务系统主要功能、工作流程及应用成效,指出该系统有助于实现患者入出院一站式精准化管理,提高医护人员工作效率及患者满意度。     

国家中医临床研究基地文献信息库系统研究与设计

以中国中医科学院广安门医院为例,介绍国家中医临床基地文献信息库建设原则,设计中医药特色文献系统,阐述系统架构、功能、建设步骤以及围绕基地3个重点病种建设的7个文献信息库主要内容。     

突发公共卫生事件形势下医学文献资源保障与服务

以上海交通大学医学院图书馆为例,介绍文献资源服务模式与内容,阐述新型冠状病毒肺炎疫情期间数字资源保障服务举措并提出相关建议,包括多平台结合保障远程资源获取,鼓励并规范出版商资源开放与公益服务,创新发展在线教育健全服务推广。     

Baseline Objective Malnutritional Indices as Immune-Nutritional Predictors of Long-Term Recurrence in Patients with Acute Ischemic Stroke

Background: The controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) score were designed as indicators of patients’ immune-nutritional status. This study aimed to investigate the prognostic impact of the CONUT and PNI scores on long-term recurrent ischemic stroke (RIS) and adverse outcomes for adults with acute ischemic stroke (AIS). Methods: This retrospective study enrolled 991 AIS patients. Multivariable Cox regression models were used to assess the relationships of the malnutritional indices and RIS and major cardiovascular events (MACEs). Results: During a median follow-up at 44 months (IQR 39–49 months), 203 (19.2%) patients had RIS and 261 (26.3%) had MACEs. Compared with normal nutritional status, moderate to severe malnutrition was significantly related to an increased risk of RIS in the CONUT score (adjusted hazard ratio (HR) 3.472, 95% confidence interval (CI) 2.223–5.432, p < 0.001). A higher PNI value tertile (tertile two, adjusted HR 0.295, 95% CI 0.202–0.430; tertile three, adjusted HR 0.445, 95% CI 0.308–0.632, all p < 0.001) was related to a lower risk of RIS. Similar results were found for MACEs. The PNI exhibited nonlinear association with the RIS and both two malnutritional indices improved the model’s discrimination when added to the model with other clinical risk factors. Conclusions: This study demonstrated that the CONUT and PNI are promising, straightforward screening indicators to identify AIS patients with impaired immune-nutritional status at higher risk of long-term RIS and MACEs.     

跨平台移动卵巢癌患者远程管理系统建设

建立跨平台移动卵巢癌患者远程管理系统,介绍系统开发相关技术、总体架构、各功能模块,包括病史采集、复查内容管理、医患交流管理等,指出该系统能够实现医患双方及时沟通,提供智能化服务。     

清末以前舌色分类与现代舌色分类的比较

目的：探讨清束以前舌色分类与现代舌色分类的差异及演变。方法：采用文献调研的方法,收集清末以前古医籍中和现代医籍中舌色分类的内容。结果：清末以前出现的舌色分类共8类,共计39种舌色描述类型,而现代舌色分类为4类．舌色描述类型仅十余种。现代中医舌色的分类与清代以前比较,黑舌、蓝舌已经消失,一些舌色的描述用语已基本不使用．新出现了淡黯舌和暗红舌的描述。结论：从舌色种类的演变历史来看。舌色的分类经历了一个由简到繁、由繁返约的过程．当前中医临床舌色分类的描述带有很强的主观性．因此对中医舌色的分类需要进一步开展理论研究和色度学的定量研究．以促进其规范化和客观化．