肾康注射液联合穴位敷贴治疗慢性肾功能衰竭疗效及作用机制

目的:探讨肾康注射液联合穴位敷贴治疗慢性肾功能衰竭(CRF)的临床疗效及作用机制。方法:选取150例CRF患者,依据随机数字表法分为两组,各75例。对照组予肾康注射液治疗,治疗组予肾康注射液联合穴位敷贴治疗。比较两组总有效率、治疗前后症状体征积分、肾功能、氧化应激和肾纤维化指标。结果:治疗组总有效率92.00%高于对照组的74.67%(P<0.05)。治疗后两组症状体征有所缓解,且治疗组恶心呕吐、腰膝酸软、倦怠乏力、脘腹胀满、口渴不饮、食欲欠佳积分均低于对照组(P<0.05)。治疗后两组血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)、活性氧(ROS)、丙二醛(MDA)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、半胱氨酸蛋白酶抑制蛋白C(Cys-C)均较治疗前降低,内生肌酐清除率(Ccr)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)较治疗前升高,且治疗组上述指标优于对照组(P<0.05)。治疗组总不良反应发生率为6.67%,与对照组的14.67%比较差异无统计学意义(P>0.05)。结论:肾康注射液联合穴位敷贴治疗CRF疗效显著,可明显缓解患...     

The anterior versus posterior approach for the treatment of ossification of the posterior longitudinal ligament in the cervical spine: A systematic review and meta-analysis

Study Design: Systematic review and meta-analysis.Objective: To compare the effectiveness and safety between anterior and posterior approach, and determine the best surgical methods for the treatment of ossification of the posterior longitudinal ligament (OPLL) in the cervical spine.Methods: We searched the Cochrane Library, PubMed, CNKI and Wanfang Med Data databases from January 2007 to March 2018. Japanese Orthopaedic Association (JOA) scores, cervical lordosis, functional recovery rates, excellent and good outcomes of the surgical approaches, and complication and reoperation rates were analyzed. RevMan 5.3 was utilized for data analysis.Results: Eleven studies were included in the meta-analysis. By comparing the anterior and posterior approaches for the treatment of OPLL in the cervical spine, statistically significant differences were found in the preoperative initial JOA, the postoperative final JOA scores, functional recovery rates, complication rates, excellent and good outcomes of the surgical approaches and reoperation rates. However, no statistically significant difference in the occurrence of the preoperative and postoperative cervical lordosis was noted.Conclusion: The anterior approach is superior to the posterior approach in terms of the postoperative final JOA score, functional recovery rate, and clinical outcomes. Although the complication and reoperation rates of the anterior approach are higher than those of the posterior approach. We recommend the anterior approach for the treatment of OPLL when patients with occupying ratio ≥ 60%. In addition, high-quality studies with long-term follow-up and large sample size are also needed.     

内蒙古自治区不同生态系鼠疫自然疫源地动物鼠疫流行现状及流行风险简析

内蒙古面临着多种类型疫源地鼠疫流行和复燃的风险。蒙古旱獭疫源地虽然暂未在国内发现动物间鼠疫流行,但过去检出过阳性血清,同时蒙古旱獭种群数量持续增加且分布范围不断扩大,毗邻的蒙古国和俄罗斯联邦的蒙古旱獭疫源地动物间鼠疫持续流行;达乌尔黄鼠疫源地动物间鼠疫时隐时现;长爪沙鼠疫源地动物间鼠疫流行猛烈,并频频波及人间。由于蒙古旱獭和达乌尔黄鼠鼠疫耶尔森菌菌株毒力明显高于长爪沙鼠鼠疫耶尔森菌菌株,且在历史上曾给当地带来深重灾难,因此内蒙古自治区鼠疫防控重点应在常规鼠疫监测的基础上,进一步加强蒙古旱獭和达乌尔黄鼠疫源地流行动态的监测,警惕该两个疫源地复燃并波及人间。     

The association between metabolic syndrome and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging males: evidence based on propensity score matching

BackgroundTo investigate the association between lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and metabolic syndrome (MetS) in aging Chinese males.MethodsA dataset that included 3,568 non-MetS cases and 1,020 MetS cases (after data cleansing) was downloaded from the China Health and Retirement Longitudinal Study (CHARLS). To balance the intergroup covariates, propensity score matching (PSM) was employed in the analyses. Univariate logistic regression and multivariate logistic regression were then performed to investigate the relationship between LUTS/BPH and MetS in aging Chinese males.ResultsBefore PSM, multivariate logistic regression showed that participants with MetS had a 1.47 times higher risk of LUTS/BPH compared to non-MetS cases in the final model (P<0.001). It also revealed that participants with low high-density lipoprotein (HDL), abdominal adiposity, or high triglycerides had a higher probability of LUTS/BPH [odds ratio (OR) =1.56 for low HDL; OR =1.50 for abdominal adiposity; and OR =1.48 for high triglyceride, P<0.001], while participants with hyperglycemia or hypertension had identical odds of LUTS/BPH (P>0.05). After PSM, 1,000 pairs were successfully matched. It was also found that MetS cases had a 1.60 times higher risk of LUTS/BPH compared to non-MetS cases (P<0.001), and participants with low HDL, abdominal adiposity, high triglycerides, or hyperglycemia had a higher likelihood of LUTS/BPH than their counterparts (P<0.001). However, the probability of LUTS/BPH in hypertensive patients remained similar to that in non-hypertensive patients (P>0.05).ConclusionsAging Chinese males with MetS had a higher probability of LUTS/BPH. Also, patients with low HDL, abdominal obesity, high triglycerides, or hyperglycemia had an increased risk of LUTS/BPH; however, this was not the case for hypertensive patients.     

Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy

BackgroundThis study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types.MethodsTwo optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed.ResultsFor 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA.ConclusionsThrough different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.     

Comprehensive analysis of the lncRNA-miRNA-mRNA regulatory network for bladder cancer

BackgroundLong non-coding RNAs (lncRNAs) are essential regulators for various human cancers. However, these lncRNAs need to be further classified for cancer. In the present study, we identified novel competing endogenous RNA (ceRNA) network for bladder cancer (BC) and explored the gene functions of the ceRNA regulatory network.MethodsDifferential gene expression analysis were performed on The Cancer Genome Atlas Urothelial Bladder Carcinoma (TCGA-BLCA) datasets to identify differentially expressed messenger RNAs (mRNAs), lncRNAs, and microRNAs (miRNAs). Based on the competing endogenous RNA (ceRNA) hypothesis, a lncRNA-miRNA-mRNA network was constructed using the StarBase database and visualization by Cytoscape software. Functional enrichment analyses of Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were performed via R package ClusterProfiler. The protein-protein interaction network was constructed by STRING database and visualization by Cytoscape. Finally, we used CIBERSORT and the TIMER database to analyze the immune infiltrations for BC.ResultsThe regulatory network was constructed via TCGA BLCA cohort. The differential expressions of lncRNA, miRNA, and mRNA were 186, 200, and 2,661, respectively. There were 106 lncRNA, miRNA, and mRNA included in the ceRNA network. In this network, Calcium Voltage-gated Channel Auxiliary Subunit Alpha2delta1 (CACNA2D1, P<0.001), domain containing engulfment adaptor1 (GULP1, P=0.001), latent transforming growth factor beta binding protein 1 (LTBP1, P=0.006), myosin light chain kinase (MYLK, P=0.001), serpin family E member 2 (SERPINE2, P=0.002), spectrin beta non-erythrocytic 2 (SPTBN2, P=0.047), and hsa-miR-590-3p (P<0.001) significantly affected the prognosis of BC patients. Functional enrichment analyses showed that the biological functions included negative regulation of protein phosphorylation, cell morphogenesis, and sensory organ morphogenesis. Important cancer pathways of KEGG included parathyroid hormone synthesis secretion action, the notch signaling pathway, MAPK signaling pathway, the Rap1 signaling pathway, signaling pathways regulating the pluripotency of stem cells, and the transforming growth factor-β signaling pathway. Our findings demonstrated that the ceRNA network has important biological functions and a significant influence on the prognosis of BC.ConclusionsThe lncRNA-miRNA-mRNA network constructed in the present study could provide useful insight into the underlying tumorigenesis of BC, and can determine new molecular biomarkers for the diagnosis and therapeutical treatment of BC.     

躯体形式障碍患者社会支持与家庭功能特征研究

目的 探讨躯体形式障碍患者社会支持及家庭功能特征。方法 2017—2018年,收集就诊于综合医院心理门诊的躯体形式障碍患者48例,以性别、年龄、学历匹配正常人群47例进行对照研究,用一般人口学调查表、社会支持评定量表(SSRS)、家庭功能评定量表(FAD)、家庭亲密度及适应性量表(FACES-II)进行评估,采用多元线性回归分析对躯体形式障碍的危险因素进行分析。结果 躯体形式障碍患者在社会支持总分[(34.58±7.47)vs(40.25±7.16)]、客观支持评分[(7.54±2.34)vs(8.85±2.89)]、主观支持评分[(20.02±4.44)vs(23.30±4.52)]、社会支持利用度评分[(6.00±2.02)vs(7.79±2.05)]、家庭亲密度评分[(54.35±10.87) vs (63.91±15.55)]、适应性评分[(35.75±10.27)vs (42.38±13.37)]均低于正常对照组(t值分别为-3.78、-2.43、-3.57、-4.28、-3.47、-2.71,P值分别为0.000、0.017、0.001、0.000、0.001、0.008);两组在问题解决、角色、情感反应、行为控制因子的评分差异无统计学意义(P值均＞0.05),躯体形式障碍患者在沟通评分[(2.69±0.57) vs (2.11±0.36),(t=5.95,P=0.004)]、情感介入评分[(2.60±0.36) vs (2.24±0.49),(t=4.13,P=0.032)]、家庭总的功能评分[(2.80±0.56)vs( 2.07±0.43),(t=7.14,P=0.004)]均高于正常对照组。多元线性回归分析结果显示问题解决、角色、情感反应是躯体形式障碍的危险因素(R=0.91,P＜0.01)。结论 躯体形式障碍患者在社会支持、家庭亲密度、适应性、沟通、情感介入方面表现较差,问题解决、角色、情感反应对躯体形式障碍的发病具有预测作用,其中影响最显著的为情感反应因子。     

以价值为导向的医保支付制度实施路径

价值医疗权衡医疗成本与所获健康结果之间的关系,关注的是整体健康结果。医保支付制度需要以价值为导向,以经济为杠杆,引导服务提供方以最小的成本产生最优的医疗服务。微观上,对单家机构实施以疾病诊断相关分组和病种分值付费为主的多元支付制度;中观层面,探索捆绑支付、以结果为导向的多方风险共担机制;宏观上,实行医联体内的总额预付。通过探索适用于当前中国医疗服务特点的以价值为导向的医保支付制度,提高医疗机构内在动力,优化就诊结构,最终实现整体健康水平的提升。