我院综合干预抗菌药物临床应用专项整治活动措施及成果分析

介绍我院在抗菌药物临床应用专项整治活动中所采取的一系列综合干预措施,对比分析干预前后抗菌药物使用情况,结果显示我院Ⅰ类切口手术和介入手术抗菌药物预防使用率明显下降,处方合格率明显上升,我院抗菌药物合理应用专项整治活动中采取的各项措施切实有效,综合干预措施值得推广。     

Anisotropic PDMS/Alumina/Carbon Fiber Composites with a High Thermal Conductivity and an Electromagnetic Interference Shielding Performance

The development of polymer-based composites with a high thermal conductivity and electromagnetic interference (EMI) shielding performance is crucial to the application of polymer-based composites in electronic equipment. Herein, a novel strategy combining ice-templated assembly and stress-induced orientation was proposed to prepare polydimethylsiloxane (PDMS)/alumina/carbon fiber (CF) composites. CF in the composites exhibited a highly oriented structure in the horizontal direction. Alumina was connected to the CF, promoting the formation of thermal conductive pathways in both the horizontal and vertical directions. As the CF content was 27.5 vol% and the alumina content was 14.0 vol%, the PDMS/alumina/CF composite had high thermal conductivities in the horizontal and vertical directions, which were 8.44 and 2.34 W/(m·K), respectively. The thermal conductivity in the horizontal direction was 40.2 times higher than that of PDMS and 5.0 times higher than that of the composite with a randomly distributed filler. The significant enhancement of the thermal conductivity was attributed to the oriented structure of the CF and the bridging effect of alumina. The PDMS/alumina/CF composite exhibited an excellent EMI shielding effectiveness of 40.8 dB which was 2.4 times higher than that of the composite with a randomly distributed filler. The PDMS/alumina/CF composite also exhibited a low reflectivity of the electromagnetic waves. This work could provide a guide for the research of polymer-based composites with a high thermal conductivity and an EMI shielding performance.     

银杏二萜内酯葡胺注射液用于6300例缺血性脑卒中患者的上市后临床安全性再评价研究

进一步评价银杏二萜内酯葡胺注射液上市后扩大用药人群范围对缺血性脑卒中患者的临床安全性。采用多中心、前瞻性、开放、非对照的临床研究设计方法,于2013年6月—2014年12月,在82家临床单位开展银杏二萜内酯葡胺注射液上市后临床安全性再评价研究。完成病例入组6 300例,试验中,共观察记录到29例次不良反应,ADR发生率为0.46%,其中约86.21%(25例次)的ADR为轻度,表现为一过性,无需干预即可缓解或消失;13.79%(4例次)为中度,头痛2例次,头晕1例次,皮疹1例次;未见重度不良反应。银杏二萜内酯葡胺注射液安全性研究中发生的不良反应均为前期已知不良反应或注射剂常见不良反应,整体不良反应发生率较低且风险可控。     

参松养心胶囊联合美托洛尔治疗心律失常临床研究

目的观察参松养心胶囊联合美托洛尔对心律失常的临床治疗效果。方法选取心内科住院患者114例,随机分为治疗组和对照组,治疗组采用参松养心胶囊联合美托洛尔治疗,对照组采用美托洛尔治疗。结果治疗组总有效率96．5％,对照组总有效率80．7％,两组总有效率比较差异具有统计学意义（P〈0．05）。动态心电图改善情况比较,治疗组总有效率达到94．7％。对照组总有效率达到75．4％,两组患者总有效率比较具有差异统计学意义（P〈0．05）。治疗组患者在治疗过程中均未出现明显的不良反应;对照组有2例患者出现窦性心动过缓,肝肾功能和血常规检查未见异常。结论参松养心胶囊联合美托洛尔治疗心律失常效果明显,优于单纯使用美托洛尔,是临床上治疗心律失常安全有效的中西药联合治疗用药。     

基于潜变量增长混合模型的老年共病择期手术患者护理依赖发展轨迹研究

目的 探讨老年共病择期手术患者护理依赖发展轨迹的类别及影响因素.方法 选取江苏省5所综合性三级医院的598例老年共病择期手术患者作为研究对象,采用一般资料调查表、疾病累积评分量表、护理依赖量表分别于术后3 d(T1)、出院时(T2)及出院后1周(T3)进行追踪调查,利用潜变量增长混合模型及无序多分类logistic回归...     

四角融合术后腕关节稳定性的衡量指标

目的提出衡量腕关节四角融合术后融合体稳定性的指标,探讨术后如何改善腕功能。方法12具新鲜尸体前臂标本,男8具,女4具,左右各6肢,模拟行四角融合术后,固定于腕关节动力学测试仪上,模拟腕关节的掌屈、背伸、尺倾、桡倾等运动,运动前后摄腕关节正、侧位X线片,测量并观察头月角(α)、桡月角(β)、头月正位角(θ)、融合体高度(H)和融合体宽度(W)的变化,并行统计学分析。结果腕关节由运动前中立位至掌屈50°时,α、β、H值与运动前相比,差异均有统计学意义(P<0.01);背伸至40°时,α、β、H值与运动前相比,差异有统计学意义(P<0.01)。腕关节由中立位至桡倾15°时,θ与W与运动前比较,差异有统计学意义(P<0.05);至尺倾25°时,θ与W的运动前比较,差异有统计学意义(P<0.05)。结论头月角、桡月角、头月正位角、融合体高度和融合体宽度等指标可用于衡量四角融合术后融合体的稳定性。     

Incidence and seroprevalence of hepatitis E virus infection in pregnant women infected with hepatitis B virus and antibody placental transfer in infants

BackgroundHepatitis E has poor outcomes in pregnant women. Superinfection of hepatitis E virus (HEV) in patients infected with hepatitis B virus (HBV) may worsen liver disease.ObjectivesTo estimate the incidence and seroprevalence of HEV infection among HBV-infected pregnant women, to investigate the transplacental transfer of maternal anti-HEV IgG, and to compare the maternal and neonatal outcomes in anti-HEV positive and negative pregnant women.Study designTotally 391 HBV-infected pregnant women were recruited from April 2012 to October 2014. Paired mothers and infants were followed up at an average 9.8 months postpartum. Anti-HEV IgG and IgM were tested by ELISA.ResultsOf the pregnant women, none was anti-HEV IgM positive and 42 (10.7%) were IgG positive. At the follow-up, 3 seronegative women converted to anti-HEV IgG positive, with an estimated incidence of 17 per 1000 person-years. No significant differences of gestational age, preterm birth rate, Apgar score and birthweight were observed between newborns of anti-HEV IgG positive and negative mothers. Of the 42 neonates born to anti-HEV IgG positive mothers, 38 (90.5%) had anti-HEV IgG in their cord blood. The neonatal and maternal anti-HEV IgG levels were positively correlated (r = 0.827, p < 0.05). All infants were negative for both anti-HEV IgM and IgG at the follow-up.ConclusionsHBV-infected pregnant women rarely have novel HEV infection during late pregnancy in Jiangsu, China. Maternal anti-HEV IgG efficiently transfers into the fetuses, and disappears in infants before 10 months old.     

CT和电子鼻内镜诊断儿童腺样体肥大的价值观察

目的探究CT和电子鼻内镜在儿童腺样体肥大诊断中的应用价值。方法选取2018年3月至2019年3月在我院鼻咽喉科门诊确诊的87例腺样体肥大患儿为病例组,另选取同期体检的健康儿童63例为对照组,两组均接受CT检查,比较两组的正中矢状位腺样体最大厚度与鼻咽腔前后径比值(A/N)、鼻咽后气道宽度(PAS)和鼻咽腔容积,并将病例组患儿的CT诊断结果与电子鼻内镜检查结果进行比较,绘制绘制受试者工作特征曲线(ROC)分析A/N值对儿童腺样体肥大诊断的价值。结果病例组患儿的A/N值高于对照组,PAS和鼻咽腔容积小于对照组(P<0.05);腺样体肥大患儿CT扫描可见鼻咽气腔变形,存在不同程度的后鼻孔阻塞,腺样体形态呈弧扇形、波浪形或长条形,咽旁间隙较清晰,邻近骨质无破损;CT检查与电子鼻内镜检查结果比较,差异无统计学意义(P>0.05);ROC曲线分析结果显示,CT检查A/N值的AUC为0.885,当A/N值为0.61时,Younden’s指数为0.664,敏感度为88.10%,特异度值为78.26%,对儿童腺样体肥大具有较高的诊断价值(P<0.05)。结论CT检查对儿童腺样体肥大的诊断与电子鼻内镜检查一致性较好,可为腺样体肥大的诊断提供准确、全面的测量数据,是一种安全有效的检查方法,值得临床推广与应用。     

膀胱癌基因芯片生物信息分析及功能探讨

目的 从分子水平探讨膀胱癌的发病机制,为临床诊断及预后评估提供新思路。 方法 从基因芯片数据库中下载人膀胱癌的相关基因芯片数据GSE31189（包括52例尿路上皮癌和40例正常膀胱组织）,使用Morpheus（software.broadinstitute.org/morpheus/）在线工具分析癌症尿路上皮组织和正常尿路上皮组织的差异表达基因,然后使用生物技术信息基因云（GCBI,https://www.GCBI.com.cn)在线分析系统进行差异表达基因信号通路富集以及差异基因之间相互作用的分析,最后选择差异基因通过细胞计数试剂盒8（CCK-8）、侵袭实验和免疫印迹法初步验证其功能。 结果 按q值进行排序并筛选出差异最大的前20个基因,其中膀胱癌中上调基因18个,下调基因2个。基因分类（GO）分析发现,这些差异基因主要集中在炎症反应、免疫反应,负调控凋亡过程,来自RNA聚合酶Ⅱ启动子的转录负调控等多个生物学功能。信息通路（Pathway）分析结果显示,这些差异基因主要参与癌症中转录失调、代谢途径、核因子（NF）-κB信号通路等生物学过程。基因网络分析发现,CXC趋化因子受体4（CXCR4）、丝裂原活化蛋白激酶10（MAPK10）是这些基因网络的中心环节。初步体外实验表明,基质金属蛋白酶12（MMP-12）下调后,膀胱癌细胞的增殖明显减少,侵袭能力下降,细胞外调节蛋白激酶（ERK）磷酸化水平下降。 结论 通过多重生物信息学分析可以找出膀胱肿瘤中关键基因,CXCR4、MAPK10是膀胱基因网络中的关键环节,MMP-12在膀胱癌细胞中高表达,下调MMP-12可抑制膀胱癌细胞增殖和侵袭,它可能通过ERK途径发挥其生物学功能。     

Advances in neovascularization after diabetic ischemia

With the high incidence of diabetes around the world, ischemic complications cause a serious influence on people’s production and living. Neovascularization plays a significant role in its development. Therefore, neovascularization after diabetic ischemia has aroused attention and has become a hot spot in recent years. Neovascularization is divided into angiogenesis represented by atherosclerosis and arteriogenesis characterized by coronary collateral circulation. When mononuclear macrophages successively migrate to the ischemia anoxic zone after ischemia or hypoxia, they induce the secretion of cytokines, such as vascular endothelial growth factor and hypoxia-inducible factor, activate signaling pathways such as classic Wnt and phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt) pathways, trigger oxidative stress response, activate endothelial progenitor cells or enter the glycolysis or lactic acid process and promote the formation of new blood vessels, remodeling them into mature blood vessels and restoring blood supply. However, the hypoglycemic condition has different impacts on neovascularization. Consequently, this review aimed to introduce the mechanisms of neovascularization after diabetic ischemia, increase our un-derstanding of diabetic ischemic complications and their therapies and provide more treatment options for clinical practice and effectively relieve patients’ pain. It is believed that in the near future, neovascularization will bring more benefits and hope to patients with diabetes.