双源CT对心脏周围脂肪组织与冠状动脉粥样硬化的相关性

  目的  探讨双源CT测量心周脂肪组织（pericardial adipose tissue，PAT）体积、心外膜脂肪组织（epicardial adipose tissue，EAT）体积、EAT/PAT比值，分析与冠状动脉粥样硬化程度的相关性。  方法  收集223例临床怀疑冠心病患者，所有患者均行双源CT冠状动脉造影检查。应用Circulation软件评价冠状动脉病变情况。分析PAT体积、EAT体积、EAT/PAT比值与性别，有、无冠状动脉粥样硬化及冠状动脉粥样硬化程度的相关性。  结果  有、无冠状动脉硬化组，PAT体积、EAT体积均无性别差异（P > 0.05），EAT/PAT比值存在性别差异（P < 0.05）。男、女性PAT体积、EAT体积、EAT/PAT比值与有、无冠状动脉粥样硬化成正相关（P < 0.05）；所有患者PAT体积、EAT体积、EAT/PAT比值与有、无冠状动脉粥样硬化均成正相关（P < 0.05）。  结论  EAT体积较PAT体积与CAS相关性更高，而EAT/PAT较PAT体积、EAT体积与CAS具有更高的相关性，应能更准确地预测CHD。     

慢性乙肝患者焦虑和抑郁状况调查及相关因素分析

目的探讨慢性乙肝患者焦虑和抑郁状况及相关影响因素。方法选取2018年6月—2020年5月资阳市第四人民医院收治的慢性乙肝患者142例,进行汉密尔顿抑郁量表(hamilton depression scale,HAMD)、汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)评估,并收集相关临床资料,分析焦虑和抑郁的发生情况及其影响因素。结果慢性乙肝患者焦虑和抑郁的患病率为26.06%和32.39%,焦虑和抑郁的共病率为13.38%。单因素分析结果显示,较高文化程度、管理者及有危险有害饮酒的患者焦虑患病率较高,差异均有统计学意义(P<0.05),独居、较高文化程度及一般文职人员的患者抑郁患病率较高,差异均有统计学意义(P <0.05)。多因素Logistic回归分析结果显示,管理者和危险有害饮酒是慢性乙肝患者焦虑的影响因素,危险有害饮酒是患者抑郁的影响因素。结论慢性乙肝患者焦虑抑郁的患病率较高,不同婚姻状况、职业、文化程度、饮酒情况及病程的患者焦虑抑郁程度具有差异,管理者职业和饮酒增加慢性乙肝患者发生焦虑的风险,饮酒增加发生抑郁的风险。     

多部门联动提高外来骨科器械的规范化管理

目的 探讨多部门联动提高外来骨科器械的规范化管理方法,有效应对外来骨科器械管理环节存在的各种问题.方法 制定并实行外来器械准入制度,对外来器械接收、清洗、包装、灭菌、保管、发放、再接收、厂家取走各环节进行规范化流程管理.结果 2011 年10-12 月,医院实行多部门联动提高外来骨科器械的规范化管理后,观察组器械使用过程中各种差错发生率明显低于2011 年7-9 月管理前的对照组,两组比较差异有统计学意义(P<0.05).结论 多部门联动提高骨科外来手术器械的规范化管理,可使外来骨科器械管理更加科学规范,有效保证灭菌质量和节约成本,是医疗安全的重要保障.     

胰腺癌多层螺旋CT影像表现与病理对照分析

目的探讨胰腺癌多层螺旋CT影像表现,并与病理对照分析,为胰腺癌治疗提供一定的诊断价值。方法选取64例经多层螺旋CT扫描的胰腺癌患者,均由病理切片证实,其中胰腺癌32例,胰腺炎32例,并将胰腺炎和胰腺癌强化后的CT值进行比较分析。结果螺旋CT扫描能够显示肿瘤的部位、大小、形状和密度,并且能够清楚显示肿瘤与周边器官和血管的关系。胰腺癌出现腹膜后淋巴结转移25例,腹腔动脉受累26例,肠系膜上静脉受累22例,肝转移16例、胰管扩张28例、胆囊壁增厚24例,而胰腺炎患者仅出现胰管扩张7例、胆囊壁增厚8例。在胰腺的实质期强化效果最好,且胰腺实质的强化和肿瘤组织的对比显著,差异有统计学意义(P<0.05)。结论多层螺旋CT在增强扫描方面对胰腺癌诊断具有非常重要的价值。     

An Analysis of China' s Industrial Structural Changes Based on DPG Model

产业结构调整对促进我国经济增长具有重要作用.利用1997-2002-2007年中国投入产出表数据,根据完全需要系数矩阵计算了最终需求各项生产诱发系数和生产诱发依存度；根据同比例增长的偏离DPG( Deviation from Proportional Growth)要因分析方法,从各产业和分解最终需求各项两方面分析了不同时期影响中国经济增长的主要因素.分析结果表明1997 - 2007年出口始终是中国经济增长的主要源泉,其中1997 -2002年间,经济增长的主要因素是出口和政府消费的增长；2002- 2007年间,经济增长的主要因素是技术进步和出口；但居民消费的持续下降提示政府在加强内需,调整宏观经济政策方面的必要性和紧迫性.     

A quasi-experimental evaluation of advance care planning improves consistency between elderly individuals and their surrogates regarding end-of-life care preferences: Development and application of a decision aid with cartoon pictures

ObjectiveThis study sought to develop a decision aid with cartoon pictures and evaluate its effectiveness in increasing consistency between elderly individuals and their surrogates regarding end-of-life care.MethodsA pre-post quasi-experimental design was adopted using the Life Support Preferences Questionnaire. The intervention had two components: (1) increasing participants’ knowledge of medical treatments related to end-of-life care, and (2) sharing their end-of-life wishes. The experimental group received an intervention, whereas the control group received usual care.ResultsA total of 110 participants in 55 pairs of elderly individuals with average aged 86.4 and their surrogates (27 in the experimental group, 28 in the control group) were recruited from a veterans hospital in northern Taiwan. Nearly 90 % of elderly individuals were male. The multiple linear regression showed that the inconsistent gap between elderly individuals and their surrogates in the experimental group decreased 12 points than the control group after controlling the covariances (B = ?12.116, p = 0.032).ConclusionThe intervention improved the consistency between elderly individuals and their surrogates regarding end-of-life care.Practice implicationsA decision aid with cartoon pictures may support the discussion of end-of-life care in older Asian populations.     

Central nervous system diseases related to pathological microglial phagocytosis

Microglia are important phagocytes of the central nervous system (CNS). They play an important role in protecting the CNS by clearing necrotic tissue and apoptotic cells in many CNS diseases. However, recent studies have found that microglia can phagocytose parts of neurons excessively, such as the neuronal cell body, synapse, or myelin sheaths, before or after the onset of CNS diseases, leading to aggravated injury and impaired tissue repair. Meanwhile, reduced phagocytosis of synapses and myelin results in abnormal circuit connections and inhibition of remyelination, respectively. Previous studies focused primarily on the positive effects of microglia phagocytosis, whereas only a few studies have focused on the negative effects. In this review, we use the term "pathological microglial phagocytosis" to refer to excessive or reduced phagocytosis by microglia that leads to structural or functional abnormalities in target cells and brain tissue. The classification of pathological microglial phagocytosis, the composition, and activation of related signaling pathways, as well as the process of pathological phagocytosis in various kinds of CNS diseases, are described in this review. We hypothesize that pathological microglial phagocytosis leads to aggravation of tissue damage and negative functional outcome. For example, excessive microglial phagocytosis of synapses can be observed in Alzheimer's disease and schizophrenia, leading to significant synapse loss and memory impairment. In Parkinson's disease, ischemic stroke, and traumatic brain injury, excessive microglial phagocytosis of neuronal cell bodies causes impaired gray matter recovery and sensory dysfunction. We therefore believe that more studies should focus on the mechanism of pathological microglial phagocytosis and activation to uncover potential targets of therapeutic intervention.     

Concurrent primary carcinoid tumor arising within mature teratoma and clear cell renal cell carcinoma in the horseshoe kidney: report of a rare case and review of the literature

Primary carcinoid tumor arising in a mature teratoma of the horseshoe kidney is exceptionally rare and only 4 such cases have been reported in the world literature to date. The simultaneous occurrence of different subtypes of renal cell carcinoma (RCC) or RCC coexistence with non-RCC neoplasms from the same kidney is unusual and infrequently reported. Herein we report a case of primary carcinoid tumor arising within mature teratoma, concurrent with a clear cell RCC in the horseshoe kidney of a 37-year-old man. Histologically, both the carcinoid tumor and clear cell RCC demonstrated the characteristic morphology in their classic forms. In addition to the carcinoid tumor, the mature teratoma consisted of variably sized, large cystic spaces lined by cytologically bland mucinous columnar epithelium, pseudostratified columnar epithelium, ciliated epithelium and mature smooth muscle fibers were also identified within the cystic wall. Furthermore, foci of round, small nodules composed of mature prostatic acinus were noted in the teratoma which was confirmed by exhibiting strong immunoreactivity for prostate specific antigen. The present case serves to expand the histologic component that may be encountered in the mature terotoma of the kidney and further broadens the spectrum of primary tumors occurring in the horseshoe kidney.     

D-二聚体检测在产前高凝中的应用

目的 探讨D-二聚体检测在产前高凝状态判断中的意义.方法 通过对420例孕末期妇女进行D-二聚体检测并追踪观测产后临床情况,进行比较分析.结果 >0.5 mg/L时,要尤其注意DIC的危险,特别是>5.0 mg/L,一定要采取治疗措施.结论 对于孕末期妇女检测D-二聚体高于正常值的妇女临床应严加注意.