"互联网+医疗"背景下的腰椎间盘突出症医院-家庭康复模式研究

目的 探讨基于"互联网+医疗"背景下的腰椎间盘突出症(lumbar disc herniation,LDH)医院-家庭康复模式的优势.方法 纳入本院2018年1月～2018年12月门诊收治的80例LDH患者,采用随机数字表法分成"互联网+医疗"模式组(观察组)与传统医疗模式组(对照组)各40例.观察组采用"互联网+医疗"康复治疗模式,对照组采用传统医疗康复模式.比较两组治疗前、治疗后1个月、3个月、6个月腰腿疼痛VAS评分、腰椎JOA评分,治疗后6个月临床疗效及患者满意度.结果 两组患者均完成治疗.两组治疗后各时间点腰部及腿部VAS评分、腰椎JOA评分均优于治疗前(P<0.05);观察组治疗后各时间点的腰腿VAS评分、腰椎JOA评分均优于对照组(P<0.05).观察组优良率为87.50％,对照组为62.50％,观察组优良率明显高于对照组(P<0.05).观察组满意度明显优于对照组(P<0.05).结论 基于"互联网+医疗"的医院-家庭康复模式能缓解临床症状,获得较好的疗效,提升患者的满意度,该模式为传统医疗模式的升级和转型提供了方向和依据.     

Full‐Endoscopic Foraminotomy with a Novel Large Endoscopic Trephine for Severe Degenerative Lumbar Foraminal Stenosis at L5S1 Level: An Advanced Surgical Technique

To (i) introduce the technical notes of a novel full‐endoscopic foraminotomy with a large endoscopic trephine for the treatment of severe degenerative lumbar foraminal stenosis at L₅S₁ level; (ii) assess the primary clinical outcomes of this technique; (iii) compare the effectiveness of this full‐endoscopic foraminotomy technique and other previous techniques for lumbar foraminal stenosis. From January 2019 to August 2019, a retrospective study of L₅S₁ severe degenerative lumbar foraminal stenosis was performed in our center. All patients who were diagnosed with severe foraminal stenosis at L₅S₁ level and failed conservative treatment for at least 6 weeks were identified. Patients with segmental instability or other coexisting contraindications were excluded. A total of 21 patients were enrolled in the study. All patients were treated by full‐endoscopic foraminotomy using large endoscopic trephine. The visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated preoperatively and at 1, 3, 6 months, and 1 year after the surgery, and the modified MacNab criteria were used to evaluate clinical outcomes at the last follow‐up. There were 10 males and 11 females with a mean age of 66.38 ± 9.51 years. Five patients had a history of lumbar surgery. The mean operative time was 63.57 ± 25.74 min. The mean follow‐up time was 13.29 ± 1.38 months. The mean postoperative hospital stay time was 1.29 ± 0.56 days. The mean preoperative VAS score significantly decreased from 7.38 ± 1.02 to 2.76 ± 1.09 (t = 19.759, P < 0.01), 2.25 ± 1.02 (t = 21.508, P < 0.01), 1.60 ± 1.05 (t = 31.812, P < 0.01), and 1.45 ± 1.10 (t = 25.156, P < 0.01) at 1 month, 3 months, 6 months, and 1 year after the operation. The mean preoperative ODI score significantly decreased from 64.66% ± 4.91% to 30.69% ± 4.59% (t = 33.724, P < 0.01), 29.44% ± 4.50% (t = 32.117, P < 0.01), 24.22% ± 4.14% (t = 33.951, P < 0.01), and 22.44% ± 4.94% (t = 30.241, P < 0.01) at 1 month, 3 months, 6 months, and 1 year after the operation. At the last follow‐up, 19 patients (90.48%) got excellent or good outcomes. One patient suffered postoperative dysesthesia, and the symptoms were controlled by conversion treatment. One patient took revision surgery due to the incomplete decompression. There were no other major complications. Percutaneous endoscopic decompression is minimally invasive spine surgery. However, the application of endoscopic decompression for L₅S₁ foraminal stenosis is relatively difficult due to the high iliac crest and narrow foramen. Full‐endoscopic foraminotomy with the large endoscopic trephine is an effective and safe technique for the treatment of degenerative lumbar foraminal stenosis.     

Immunogenicity,safety and reactogenicity of ROTAVAC® in healthy infants aged 6–8 weeks in Vietnam

BackgroundROTAVAC® is derived from human 116E rotavirus (RV) neonatal strain. In this study, we evaluated the immunogenicity, safety and reactogenicity of ROTAVAC® in Vietnam.MethodWe conducted a phase IV clinical trial in healthy infants aged 6–8 weeks using the complete regimen of ROTAVAC® with three doses. Serum anti-RV IgA was measured by enzyme-linked immunosorbent assay to assess the geometric mean concentration in infants who received the complete regimen of the vaccine.ResultsA total of 360 participants were enrolled in this clinical trial. The mean age ± standard deviation at enrollment was 6.9 ± 0.6 weeks. The anti-RV IgA titer was 4.01 ± 3.74 mg/ml pre-vaccination and substantially increased to 29.27 ± 80.64 mg/ml post-vaccination. The value of logIgA significantly increased (p = 0.003) from 0.28 ± 0.79 to 1.03 ± 0.54. The proportion of participants with equal to and greater than 3-fold and 4-fold shifts in pre- to post-vaccination antibody titer (IgA) were 55.4% and 48.3%, respectively. No adverse events or serious adverse events were recorded immediately within 30 min after the administration of each dose. The most common adverse events within 14 days after each visit were fever, unusual crying and irritability. Other adverse events occurred at a low rate, and no case of intussusception was noted.ConclusionsThe complete regimen of ROTAVAC® demonstrated an immunological response with clinically acceptable safety profile. Post-completion of this study, ROTAVAC® is now a WHO-prequalified vaccine and available in Vietnam.     

2015—2018年中山市急性心脑血管病流行特征分析

目的 了解2015—2018年中山市急性心脑血管病流行趋势,为制定防制策略和措施提供参考依据。方法 通过从中国疾病预防控制中心系统中获取中山市急性心脑血管病数据进行分析。结果 2015—2018年急性心脑血管病共报告发病例数35628例,粗发病率为528.23/10万（标化发病率为466.97/10万）,发病率呈现逐步下降趋势（P<0.05）,急性心脑血管病粗死亡率为150.46/10万(标化死亡率125.28/10万),粗病死率呈现逐步下降趋势（P<0.05）。年轻人群（35岁至64岁）和65岁及以上人群急性心肌梗死和脑卒中发病分别占总数的30.53%、68.09%。男性各病种类型标化发病率和标化死亡率均比女性大。急性心脑血管病发病存在季节分布特征,以冬春季的12月和1月发病明显。结论 中山市急性心脑血管病发病率处于较高水平,且发病呈现年轻化趋势,中老年人特别是男性是急性心脑血管病发病的高危人群。     

原发性肝癌患者手术前后血清SICAM-1、VEGF水平检测的临床意义

目的:分析了31例原发性肝癌患者手术前后血清SICAM-1、VEGF水平的变化。方法:采用双抗 体夹心法测定了31例原发性肝癌患者手术前后血清SICAM-1、VEGF含量,并与35名正常人作比较。结果: 手术前血清SICAM-1、VEGF水平非常显著地高于正常人组(P<0.01),手术后6个月,复发者SICAM-1、 VEGF水平持续异常,未复发者SICAM-1、VEGF水平恢复正常。结论:观察原发性肝癌患者血清SICAM-1 和VEGF水平的变化与原发性肝癌患者的病情和预后密切相关。     

试论图书馆核心竞争力的提升

随着现代信息社会的发展,图书馆的核心竞争力已关系到图书馆未来的生存和发展.文章分析了图书馆核心竞争力的构成及影响因素.提出了提升图书馆核心竞争力的策略.     

大鼠膈腹膜间皮通透性的电镜观察

腹膜腔内注射兔血液和中墨汁后，用电镜观察了大鼠膈腹膜间皮对示踪剂血细胞和碳颗粒的通透笥。在膈膜隐窝区，示踪剂经三种途径通过膈腹膜间皮。（１）间皮孔的吸收作用。示踪剂由腹膜腔经间皮孔直接进入膈毛细淋巴管，或被成纤维细胞的突起包绕。（２）间皮细胞的吞噬作用。（３）示踪剂通过间皮细胞间裂隙或细胞间连接。     

大鼠膈腹膜间皮孔的电镜观察

用扫描电镜和透射电镜观察了正常大鼠膈腹膜间皮，并观察了腹膜腔内注射中国墨汁和兔血液后大鼠膈腹膜间皮的变化以及腹膜腔和间皮下毛细淋巴管的关系。     

神经移植端侧缝合颈5/7神经根与上干桥接治疗产瘫

目的：探讨一种不影响残存神经自行恢复的产瘫臂丛神经修复新方法。方法：将上干损伤部位行松解,不切除神经瘤,将其近端的颈5或颈7神经根和神经瘤远端的臂丛上干的神经束膜切开窗口,取颈丛皮支或前臂外侧皮神经前成多段（一般每段长约2．0－2．5cm）,两端分别与颈5神经根和上干的神经束膜行端侧缝合,结果：8例患儿经术后1－11年（平均3年）的随访,4例的三角肌和肱二头肌骨力达4级和4^-级,4例达3例。3例后期进行了肩关节松解和旋前圆肌肌腱切断,结论：该方法既提供了可使损伤近端颈5神经根的新生纤维生长至上干的神经通道,又未阻断神经瘤内残存神经纤维的自行恢复,是治疗产瘫特别是Tassin2型的新术式。     

钙调蛋白基因缺陷HIS3酵母菌株的构建和鉴定

目的：构建白念珠菌钙调蛋白基因（CMD1）缺陷HS3酵母菌体,为进一步探讨钙调蛋白基因突变对真菌生长周期及致病性的影响奠定基础。方法：首先将含cmd1::TRP1置换序列的质粒I转化二倍体酵母菌株YPH501(his3trplural）,经Soutthern印迹法筛选出含TRP1序列的菌株。其次,将含CMD1序列的质粒Ⅱ转化以上TRP1阳性菌株,进行减数分裂后选择得到TRP1阳性酵母菌株单倍体。最后,将含trp1:HIS3置换序列质粒Ⅲ转化上述TRP1阳性单倍体菌株,用不含His培养基培养得到钙调蛋白基因缺陷HIS3酵母菌株。结果：经Southern印迹法证实cmd1：TRP1基因置换克隆;减数分裂后选择得到了TRP1阳性酵母菌株单倍体;质粒Ⅲ转化单倍体后经不含His培养基培养得到CMD1缺陷HIS3菌株,接种于不含Trp倍养基上未见有菌落生长,说明质粒Ⅲ转化单倍体后已将his3TRP1转换成HIS3trp1。结论：成功构建了钙调蛋白基因缺陷HIS3酵母菌株,基因型为cmd1trp1HIS3。