光固化复合树脂在前牙美容修复中的应用及对患者牙体形态的影响

目的:探讨光固化复合树脂进行前牙美容修复的临床效果及对牙体形态的影响.方法:选取2018年2月-2019年2月笔者医院收治的接受前牙美容修复治疗的200例患者为研究对象,随机分为研究组和对照组各100例,对照组给予纳米复合树脂修复治疗,研究组给予光固化复合树脂修复治疗.观察分析两组患者治疗效果、并发症发生率、牙齿美观评...     

腹腔镜胆囊切除术治疗结石性胆囊炎的临床效果观察

目的 探讨腹腔镜胆囊切除术和传统开腹术治疗结石性胆囊炎疗效及对患者免疫功能影响。方法 选取我院2013年6月~2017年6月我院收治的结石性胆囊炎患者90例,根据随机数字表法分为观察组和对照组,每组45例。对照组采用传统开腹手术治疗,观察组采用腹腔镜胆囊切除术治疗,观察两组患者术中出血量、手术时间、胃肠功能恢复时间、住院时间、术后并发症情况,并比较两组患者血清炎性因子和免疫球蛋白水平。结果 观察组患者术中出血量、胃肠功能恢复时间、住院时间均少于对照组,差异有统计学意义（P＜0.05）。治疗后,两组患者血清炎性因子水平均上升,但观察组患者CRP、IL-6、TNF-α上升程度低于对照组（P＜0.05）;治疗后,两组患者免疫球蛋白水平均下降,但观察组患者IgA、IgG、IgM下降程度低于对照组,差异有统计学意义（P＜0.05）。观察组患者术后并发症发生率为4.44%,低于对照组的15.56%,差异有统计学意义（P＜0.05）。结论 相比于传统开腹手术,腹腔镜胆囊切除术可减少术中出血量,缩短结石性胆囊炎恢复时间和住院时间,对患者炎症反应、免疫功能影响较小,安全性较高。     

自发性脑出血患者血清miR-143 和HMGA2 表达水平与预后的预测价值研究

目的 分析自发性脑出血 (spontaneous intracerebral hemorrhage, sICH)患者血清微小核糖核酸（microRNA, miR）-143,高迁移率族蛋白 A2（high mobility group protein A2 ,HMGA2）的水平及其与预后的关系。方法 选取 2020年 8月～2022年 6月首都医科大学附属北京友谊医院平谷医院收治的 129例 sICH患者作为 sICH组,根据 sICH患者脑出血体积分为小血肿组 50例（n=50,<10 ml）、中血肿组（n=45,10~30 ml）和大血肿组（n=34,>30 ml）;根据 sICH患者住院 30天内是否死亡,将患者分为死亡组（n=40,预后不良）和存活组（n=89,预后良好）,另选取同期来医院体检的 131例健康者作为对照组。收集受试者临床资料,分别采用荧光定量 PCR法和酶联免疫吸附法检测 sICH患者入院 24 h内、健康者体检时血清 miR-143和 HMGA2水平;分析 sICH患者血清 miR-143和 HMGA2水平与美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表 (GCS)、Rankin量表 (mRS)评分间的相关性, miR-143和 HMGA2对 sICH患者预后不良的预测价值以及影响 sICH患者预后不良的危险因素。结果 与对照组比较, sICH组血清 miR-143水平（0.35±0.10 vs 1.03±0.07）降低, HMGA2水平（266.97±79.38mg/ml vs 153.13±40.24mg/ml）升高,差异具有统计学意义（t=63.599,14.618,均 P<0.001）。小血肿组、中血肿组和大血肿组 sICH患者血清 miR-143水平（0.38±0.11,0.34±0.10,0.27±0.09）依次降低, HMGA2水平（212.01±78.72mg/ml,251.62±79.31mg/ml, 368.11±80.44mg/ml）依次升高,差异具有统计学意义（F=11.895,40.424,均 P<0.001）。与存活组比较,死亡组患者血清 miR-143水平（0.30±0.06 vs 0.37±0.12）降低, HMGA2水平（316.81±80.03mg/ml vs 244.57±79.09mg/ml）升高,差异具有统计学意义（t=3.493,4.781,均 P<0.05）。sICH患者血清 miR-143水平与 NIHSS,mRS评分呈负相关（r=-0.423,-0.498,均 P<0.001）,与 GCS评分呈正相关（r=0.546,P<0.001）。HMGA2水平与 NIHSS,mRS评分呈正相关（r=0.875,0.863,均 P<0.001）,与 GCS评分呈负相关（r=-0.659,P<0.001）。血清 miR-143,HMGA2及二者联合预测 sICH患者预后不良的曲线下面积分别为 0.733,0.811,0.856,NIHSS评分高 [OR（95%CI）=1.968（1.108~3.495）]、 GCS评分低 [OR（95%CI）=1.923（1.043~3.545）]、mRS评分高 [OR（95%CI）=2.130（1.204~3.768）]、血清 miR-143水平低 [OR（95%CI）=2.013（1.120~3.617）]和 HMGA2水平高 [OR（95%CI）=2.330（1.325~4.097）]是 sICH患者预后不良的危险因素（均 P<0.05）。结论 sICH患者血清 miR-143和 HMGA2异常表达与患者出血体积及预后有关,可作为 sICH患者病情评估和预后评估的辅助指标。     

脑中线区出血性损伤与脑弥散性轴索损伤的预后分析

目的探讨CT显示脑中线区出血性损伤对DAI患者预后的影响。方法选择经CT证实脑内存在出血灶的诊断为DAI的住院患者43例。测量D,根据D将患者分组,采用Glasgow昏迷积分和Glasgow预后评定方法评估患者的病情及预后。结果D≤2cm者,其Glasgow积分和Glasgow预后评分明显低于D〉2cm者。结论出血性损伤距中线的距离与DAI患者的预后密切相关,可作为判断DAI预后的指标。     

Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: A retrospective study of 31 patients

The aim of this study was to evaluate the efficacy of minimally invasive spinal decompression combined with local chemotherapy in treating patients with thoracic/lumbar tuberculosis (TB) and abscess compression of the spinal canal. Clinical data of 31 patients with thoracic/lumbar TB and spinal epidural abscess, admitted to our hospital between December 2005 and June 2014 were retrospectively analyzed. All patients received initial conservative treatment but achieved unsatisfactory results and then underwent minimally invasive spinal canal decompression, focus debridement and catheter drainage through a posterior interlaminar approach. Postoperatively, a short-course (1–2 months) of local chemotherapy was given. The patients were followed up on a regular basis. The neurologic status was graded according to the American Spinal Injury Association (ASIA) score system. Kyphotic deformity was evaluated using Cobb angle measurement. Patients were followed up for an average of 37 months (range: 12–96 months). At the last follow-up, ASIA scores were improved in all patients, and there was a mild increase in the Cobb angle, but satisfactory spinal stabilization was achieved. Hepatorenal function, erythrocyte sedimentation rate and C-reactive protein levels all returned to normal. One complication was observed, where the patient had worsened deficit postoperatively but achieved a satisfactory recovery (from Grade C to Grade E) one year after a second surgery. Minimally invasive spinal canal decompression combined with local chemotherapy appears to be an effective treatment for patients with thoracic/lumbar TB and abscess compression in the spinal canal.     

脑室内血肿动物模型制作方法的研究

目的:通过研究脑室内血肿动物模型的制作方法,为神经内镜技术的培训提供较理想的疾病模型。方法:将60头实验用猪平均分为3组,分别采用CT定位下脑室穿刺自体血注入法、超声引导下脑室穿刺自体血注入法、神经内镜下脉络丛动脉切断法制作脑室内血肿疾病模型。通过对比3种方法的优缺点,确定一种操作简单、适宜培训的模型制作方法。结果:CT定位下脑室穿刺自体血注入法的成功率为90%(18/20),超声引导下脑室穿刺自体血注入法成功率为65%(13/20),神经内镜下脉络丛动脉切断法成功率为15%(3/20)。结论:CT定位下脑室穿刺自体血注入法制作脑室内血肿动物模型成功率较高,可重复性强,可为培训神经内镜技术提供较理想的疾病模型。     

MTA和Dycal氢氧化钙用于年轻恒牙部分活髓切断术的疗效比较

目的:比较MTA和Dycal氢氧化钙用于年轻恒牙部分活髓切断术的疗效。方法:选择年轻恒牙意外露髓患者50例,随机分为两组。分别应用MTA和Dycal氢氧化钙作为盖髓剂进行年轻恒牙部分活髓切断术治疗,术后3、6、12个月复查,观察治疗效果,评价临床疗效。结果:术后3个月复查,比较两组之间近期临床疗效无统计学差异。术后12个月复查,比较两组之间远期临床疗效,MTA实验组明显高于对照组,两组有显著性差异。结论:应用MTA作为盖髓剂进行年轻恒牙部分活髓切断术治疗,疗效优于Dycal氢氧化钙。     

Intensification of medical management in type 2 diabetes: A real-world look at primary care practice

AimsTo determine which drugs were selected to be added to metformin for patients on dual anti-diabetic medication in the management of type 2 diabetes and to assess HbA1c and BMI outcomes at 6 and 12 months after the initiation of a second anti-diabetic medication.MethodsA retrospective chart review of electronic medical record data. Second line anti-diabetic medication added to metformin between 7/1/2012 to 8/31/2017 in the primary care practice in Fairview Health System in Minnesota.Results3413 patients met the selection criteria of type 2 diabetes, 18 years and older, dual anti-diabetes therapy with metformin being the first prescribed. The most frequently prescribed medications added to metformin were sulfonylurea and basal insulin accounting for 51% (1724/3413) and 37% (1268/3413) respectively. Mean HbA1c reductions at 6 and 12 months among 2134 patients with baseline and follow-up HbA1c data respectively were: GLP-1 agonist (−1.3, P < 0.001; −1.2, P < 0.001), sulfonylurea (−1.1, P < 0.001; −0.9, P < 0.001), basal insulin (−1.1, P < 0.001; −1.0, P < 0.001), DPP4 inhibitor (−0.7, P = 0.223; −0.8, P = 0.049).Patients prescribed a GLP-1 agonist had a higher mean baseline BMI (BMI =40.3 kg/m²) and this was the only group with a statistically significant BMI reduction from baseline at 6 and 12 months (−1.5, P = 0.049 and −1.8, P = 0.041).Conclusion and relevanceType 2 diabetes patients treated with sulfonylurea, basal insulin and GLP-1 agonist as an add on to metformin had significant reductions in HbA1c. Patients prescribed a GLP-1 agonist had a significant BMI reduction.     

北京平谷区社区居民超重和肥胖及中心性肥胖流行现况调查

背景　超重与肥胖被证明是糖尿病、高血压、动脉硬化性心血管疾病及肿瘤等慢性病的重要危险因素。最新资料显示,我国超重与肥胖总人群数量已接近总人口1/4,及时了解不同地区超重及肥胖患病情况,为制定肥胖乃至慢性病防控策略提供理论依据。目的　了解北京市平谷区社区居民超重、肥胖及中心性肥胖的流行现况,为地区早期防治肥胖相关疾病提供科学依据。方法　2013年6月-2014年9月首都医科大学附属北京友谊医院平谷医院联合北京大学人民医院,在平谷区采取多阶段随机抽样的方法抽取社区居民进行调查研究。以24 kg/m2≤体质指数<28 kg/m2为超重,28 kg/m2≤体质指数<35 kg/m2为肥胖,体质指数≥35 kg/m2为重度肥胖;男性腰围≥90 cm,女性腰围≥85 cm为中心性肥胖。统计社区居民性别、年龄、居住地及超重、肥胖、重度肥胖、中心性肥胖患病率。根据各阶段的抽样比例以及平谷区不同性别25~75岁人口各年龄构成比计算不同地区不同性别各年龄组的总抽样比例,并取其倒数作为其权重,统计分析时进行加权处理。结果　共发放问卷4 002份,回收有效问卷4 002份,有效回收率为100.00%。加权后北京市平谷区社区居民436 519例,超重173 023例,超重患病率为39.64%〔95%CI（39.49%,39.78%）〕;肥胖114 808例,肥胖患病率为26.30%〔95%CI（26.16%,26.43%）〕;重度肥胖8 180例,重度肥胖患病率为1.87%〔95%CI（1.82%,1.91%）〕;中心性肥胖205 140例,中心性肥胖患病率为47.00%〔95%CI（46.85%,47.14%）〕。男性社区居民超重患病率高于女性,女性社区居民肥胖、重度肥胖、中心性肥胖患病率高于男性（P<0.05）。不同年龄社区居民超重、肥胖、重度肥胖、中心性肥胖患病率比较,差异均有统计学意义（P<0.05）。城市社区居民超重、肥胖、中心性肥胖患病率高于农村,农村社区居民重度肥胖患病率高于城市（P<0.05）。多因素Logistic回归分析结果显示,年龄及居住地是社区居民中心性肥胖患病率的独立影响因素（P<0.05）。结论　北京市平谷区社区居民肥胖、超重及中心性肥胖患病率整体较高,且高于全国水平,年龄和地区影响中心性肥胖的发生,年龄越高中心性肥胖发生的危险越高。男性在中青年时就要重视中心性肥胖的防控,女性45岁以后（绝经期）要重视中心性肥胖的预防,中青年人群是超重、肥胖及中心性肥胖防控的重点人群。     

Albumin replacement therapy in immunocompromised patients with sepsis – Secondary analysis of the ALBIOS trial

BackgroundThe best fluid replacement strategy and the role of albumin in immunocompromised patients with sepsis is unclear.MethodsWe performed a secondary analysis of immunocompromised patients enrolled in the ALBIOS trial which randomized patients with severe sepsis or septic shock to receive either 20% albumin (target 30 g per liter or more) and crystalloid or crystalloid alone during ICU stay.ResultsOf 1818 patients originally enrolled, 304 (16.4%) were immunocompromised. One-hundred-thirty-nine (45.7%) patients were randomized in the albumin while 165 (54.2%) in the crystalloid group. At 90 days, 69 (49.6%) in the albumin group and 89 (53.9%) in the crystalloids group died (hazard ratio - HR - 0.94; 95% CI 0.69–1.29). No differences were observed with regards to 28-day mortality, SOFA score (and sub-scores), length of stay in the ICU and in the hospital, proportion of patients who had developed acute kidney injury or received renal replacement therapy, duration of mechanical ventilation. Albumin was not independently associated with a higher or lower 90-day mortality (HR 0.979, 95% CI 0.709–1.352) as compared to crystalloid.ConclusionAlbumin replacement during the ICU stay, as compared with crystalloids alone, did not affect clinical outcomes in a cohort of immunocompromised patients with sepsis.