泌尿外科腔镜立体化培训医学生的实践

随着腹腔镜技术在泌尿外科的广泛应用,对开展腹腔镜技术的医师进行系统的理论学习及规范的操作培训显得尤为重要.本文通过在泌尿外科腔镜临床带教实践中的探索,对立体化培训形式进行总结和详细的阐述.     

奥维环境消毒液对ICU环境微生物消毒效果与评价

目的比较奥维环境消毒液与含氯消毒剂对医院重症监护病房(ICU)环境的消毒效果。方法选取了6间ICU,分别对呼吸机操作面板或按钮、床头桌或床边护栏、电脑键盘按键各30例用两种消毒剂进行消毒,消毒前及消毒后15、min分别进行采样,比较两者的杀菌率。结果床头桌或床边护栏25处(83.3%)、电脑键盘按键28处(93.3%)、呼吸机操作面板或按钮23处(76.7%)消毒前超过了卫生部规定的标准(<5 CFU/cm2);两种消毒剂的15、min的杀菌率均达到90.0%,差异无统计学意义。结论两种消毒剂消毒效果无差异,但与含氯消毒剂相比,奥维环境消毒液安全性高、材料兼容性好、完全降解等特点是消毒人群密集和耐药菌较多的ICU环境的较理想选择。     

急性放射性皮肤溃疡发生发展过程中VEGF的表达水平与单纯伤口愈合的对比研究

目的 探讨血管内皮生长因子VEGF在急性放射性皮肤溃疡组织中的表达水平及对溃疡形成、发展、愈合的影响。方法 采用雌性Wistar大鼠,以⁶⁰Co γ射线局部照射法建立急性放射性皮肤溃疡动物模型,并以手术法建立单纯皮肤伤口动物模型,观察病变55 d,采用免疫组化、原位杂交和图像分析等方法检测单纯伤口及皮肤溃疡组织中VEGF的转录和表达水平。结果 照后14 d照射野内开始出现皮肤溃疡,之后逐渐扩大、融合、加深。皮肤受照射区多种细胞,特别是溃疡床表皮细胞、成纤维细胞及血管内皮细胞中VEGF的转录及表达水平均较正常皮肤组织有所增强,但与单纯伤口组比较,溃疡组织中VEGF的转录及表达水平明显降低。结论 辐射诱导的皮肤溃疡组织中VEGF表达水平较单纯伤口组降低可能与溃疡发生、发展及难愈合的分子机制相关。     

艾滋病医护人员工作倦怠与应对方式的相关研究

[目的]探讨工作倦怠与应对方式的关系,为预防和减轻艾滋病医护人员工作倦怠提供帮助。[方法]采用中式工作倦怠问卷(CMBI)和简易应对方式问卷(SCSQ)对342名河南省艾滋病医护人员进行测查,用频数统计、相关和分层回归进行分析。[结果]艾滋病医护人员工作倦怠总体检出率达到75.5%,其中,轻度倦怠为35.4%,中度倦怠为32.2%,高度倦怠为7.9%。艾滋病医护人员消极应对方式得分显著低于全国常模(t=3.651,P﹤0.001)。其消极应对与耗竭和人格解体呈显著正相关(r=0.242,P﹤0.01;r=0.144,P﹤0.01);积极应对与成就感降低呈显著负相关(r=-0.340,P﹤0.01)。积极应对对其成就感降低有显著负向预测作用(t=-6.380,P﹤0.01);消极应对对其耗竭和人格解体有显著正向预测作用(t=4.338,P﹤0.01;t=2.215,P﹤0.05)。[结论]应对艾滋病医护人员的工作倦怠问题给予更多关注,并考虑应对方式对其工作倦怠的影响。     

神经内科门诊患者焦虑障碍、睡眠障碍与应对方式的关系

目的 调查神经内科门诊患者焦虑障碍与睡眠障碍之间的关系,并探讨应对方式在二者之间的潜在中介作用。方法 以2019年1—12月该院就诊的102例神经内科门诊患者为研究对象。分别采用综合医院用焦虑量表、匹兹堡睡眠指数问卷和应对方式问卷评估患者的焦虑障碍、睡眠障碍与应对方式。结果 焦虑障碍与睡眠障碍呈正相关(r=0.592,P=0.003)。多元线性回归分析显示,成熟应对方式如问题解决(β=—0.493,P=0.002)与混合应对方式如合理化(β=—0.336,P=0.021)对睡眠障碍与焦虑障碍的关系具有负向预测作用,而不成熟应对方式如幻想(β=0.237,P=0.041)、退避(β=0.223,P=0.040)对睡眠障碍与焦虑障碍的关系具有正向预测作用。结论 有效应对方式能够缓解焦虑障碍对睡眠障碍的负面影响。     

双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

术中多普勒监护在鞍旁肿瘤手术中的应用

目的探讨术中多普勒监护(IDM)在鞍旁肿瘤手术中的意义。方法对45例鞍旁肿瘤手术中应用IDM的病例资料进行回顾性分析。结果术后无死亡病例,3例出现暂时的肢体偏瘫。结论在鞍旁肿瘤手术过程中合理应用IDM,有助于最大程度避免术中血管的损伤及减轻血管的受损伤程度,可减少术后并发症。     

Association between clustering of cardiovascular risk factors and resting heart rate in Chinese population: a cross-sectional study

BACKGROUNDEpidemiologic studies have explored the association between a single cardiovascular risk factor (CVRF) and resting heart rate (RHR), but the research on the relation of multiple risk factors with RHR remains scarce. This study aimed to explore the associations between CVRFs clustering and the risk of elevated RHR.METHODSIn this cross-sectional study, adults aged 35–75 years from 31 provinces were recruited by the China PEACE Million Persons Projects from September 2015 to August 2020. We focused on seven risk factors: hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, alcohol use, and low physical activity. Multivariate logistic regression was used to calculate odds ratios (OR) for elevated RHR (> 80 beats/min).RESULTSAmong 1,045,405 participants, the mean age was 55.67 ± 9.86 years, and 60.4% of participants were women. The OR (95% CI) for elevated RHR for the groups with 1, 2, 3, 4 and ≥ 5 risk factor were 1.11 (1.08–1.13), 1.36 (1.33–1.39), 1.68 (1.64–1.72), 2.01 (1.96–2.07) and 2.58 (2.50–2.67), respectively (P_trend < 0.001). The association between the CVRFs clustering number and elevated RHR was much more pronounced in young males than in other age-sex subgroups. Clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR than those comprising more behavioral risk factors. CONCLUSIONSThere was a significant positive association between the CVRFs clustering number and the risk of elevated RHR, particularly in young males. Compared clusters comprising more behavioral risk factors, clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR. RHR may serve as an indicator of the cumulative effect of multiple risk factors.

Over the past several years, the rapid development of smart wrist-worn devices has resulted in a convenient approach to monitoring resting heart rate (RHR) in daily life. RHR is becoming a promising indicator of cardiovascular health. Observational studies have shown that elevated RHR is associated with increased all-cause and cardiovascular mortality in populations with or without cardiovascular disease (CVD).^[1,2] Elevated RHR has also been found to be associated with cardiovascular risk factors (CVRFs), such as hypertension, diabetes mellitus, dyslipidemia, low physical activity and smoking, indicating its potential to reflect total cardiac risk.^[3–7] There is abundant epidemiologic evidence supporting the association between a single CVRF and RHR, but studies exploring associations between multiple CVRFs and RHR are limited. CVRFs tend to cluster within individuals, and several weak risk factors combined may result in a much higher risk than that due to a single strong risk factor. According to a cross-sectional survey in China, more than 45% of Chinese adults have two or more coexisting CVRFs.^[8] Thus, it is important to consider the situation of multiple CVRFs clustering. However, very few studies have analyzed the association between CVRFs clustering and RHR, and several aspects remain unknown. Firstly, prior studies mainly focused on the relation between metabolic risk factors and RHR.^[9–11] Behavioral risk factors such as smoking, physical activity and alcohol use have rarely been considered, even though these risk factors also have a significant effect on heart rate.^[3,5,7] Secondly, most studies merely dealt with the relation of CVRFs clustering number with RHR, while regarding each number of risk factors, different combinations of risk factors have not yet been considered before.^[9,12] It is important to consider different CVRF clustering patterns since some risk factors combined may lead to a higher risk of elevated RHR than others, even if the number of CVRFs is the same. Thirdly, prior studies did not assess associations stratified by sex and age. It has been well documented that RHR levels differ by sex and age. The RHR in women was on average 2–7 beats/min higher than that in men, and there was a decrease in the RHR with age.^[13,14] As such, whether the associations of CVRFs clustering with RHR varied between sex and age remains unclear. Taking advantage of the large sample size in our study, we are able to include a wider range of CVRFs (metabolic and behavioral risk factors), comprehensively evaluate the association between these CVRFs clustering and RHR, and further explore sex and age differences. This finding may inform us whether RHR can be used as a simple and efficient metric for the identification of high-risk individuals who require more intensive risk factor evaluation and earlier cardiovascular health monitoring in resource-constrained countries with substantial CVD burdens, such as China. To bridge this knowledge gap, we used data from the China PEACE Million Persons Projects, a nationwide screening project, to explore (1) the association between the number of CVRFs clustering and elevated RHR in the overall population and populations stratified by age and sex; and (2) the associations between different CVRFs clusters and the risk of elevated RHR in the overall population and populations stratified by sex.     

旋转细胞培养系统模拟微重力环境对小鼠成纤维细胞lncRNA表达的影响

目的 研究旋转细胞培养系统(RCCS)模拟微重力环境对小鼠成纤维细胞株L929 lncRNA表达的影响.方法 体外培养L929细胞,随机分为模拟微重力组(SMG组)和正常重力组(NG组),每组3个样本.SMG组回转器轴心与地面平行旋转,NG组回转器轴心与地面垂直旋转,两组转速一致.RCCS培养7d,收集样本,提取样本总RNA,进行荧光标记和芯片杂交.利用Agilent Mouse lncRNA芯片分别检测SMG组和NG组L929细胞的lncRNA和mRNA表达,筛选差异表达显著的lncRNA,RT-qPCR验证芯片结果;利用GO和Pathway分析差异表达lncRNA的功能分布,结合mRNA差异表达谱,进行lncRNA-mRNA联合分析.结果 lncRNA芯片检测分析发现,RCCS模拟微重力环境下小鼠成纤维细胞L929共有238条差异表达的lncRNA,其中134条表达上调,104条表达下调;差异表达的mRNA共有237条,其中53条表达上调,184条表达下调.获取差异表达lncRNA的聚类分析图,对差异表达显著的4条lncRNA芯片结果进行RT-qPCR验证,结果相吻合.GO分析结果显示差异表达的lncRNA与巨噬细胞分化、伤口愈合的负性调节等生物学过程相关,Pathway分析结果显示差异表达的lncRNA与系统性红斑狼疮、TGF-β等信号通路相关.同时成功构建了lncRNA-mR-NA-TF可视化网络图.结论 RCCS模拟微重力环境显著影响L929细胞的lncRNA及mRNA表达谱,基于芯片技术的ln-cRNA靶基因预测和功能富集分析可为失重应激损伤机制探讨和修复措施建立提供理论依据.     

瞬时加速度波强与传统评价左心室收缩功能指标的比较

目的通过对左心室射血分数(LVEF)、左心室舒张末容积(EDV)、左心室收缩末容积(ESV)、瞬时加速度波强(W1)、6 min步行距离(6MWD)的比较,探索W1评价冠心病患者左心功能的价值。方法应用ProSoundα10彩色多普勒超声诊断仪检测患者EDV、ESV、LVEF、W1,随即测量患者6MWD,之后2 h内行冠状动脉造影,选择冠状动脉造影证实至少1支血管一处狭窄>50%患者83例作为研究对象。将入选者按6MWD分为2组(6 min运动距离正常组,6MWD>350 m;6 min运动距离减退组,6MWD<350 m),比较两组间EDV、ESV、LVEF、W1。结果两组EDV、ESV、W1、LVEF比较均有统计学意义(P<0.01);W1、LVEF与6MWD呈明显正相关(P<0.01);EDV、ESV与6MWD呈明显负相关(P<0.01)。结论 W1有望成为一项反映左心室收缩功能的超声指标。