多囊卵巢综合征中西医研究进展

多囊卵巢综合征因育龄期妇女不孕而被人认识,随着研究的深入,育龄期前后内分泌紊乱、代谢障碍亦渐渐被认识。该文从中西医两个角度对多囊卵巢综合征形成、生理、病理等基础及临床研究进行综述,以了解国内外对多囊卵巢综合征的研究动态以及在临床诊疗的规范与瓶颈,试图为今后的研究提供参考。     

国医大师朱良春教授塞因塞用法辨治小儿便秘

朱良春教授认为,小儿便秘致病多因气机升降逆乱,运传失常,糟粕不能顺降而滞于肠道所致,其病因的根本在于脾胃虚弱,脾不升,胃不降,故主张治疗小儿便秘用塞因塞用之法,即用补法,可选用局方四君子汤加味。若反用攻伐,则气机逆乱,运化无权,病程更糟。     

Antibiotic cement-coated intramedullary nail is cost-effective for the initial treatment of GAⅢ open tibia fractures

ObjectiveTo evaluate the cost-effectiveness of antibiotic cement-coated intramedullary nails (IMN) in the initial management of Gustilo-Anderson type Ⅲ (GAIII) open tibia fractures.MethodsA break-even equation was used to analyze the costs associated with antibiotic cement-coated IMN and postoperative infection following GAⅢ open tibia fractures. This equation produced a new infection rate, which defines what percentage the antibiotic coated IMN needs to decrease the initial infection rate for its prophylactic use to be cost-effective. The postoperative infection rate used for calculations was 30%, a value established in current literature for these fracture types (6–33%). The institutional costs associated with a single operative debridement and resultant inpatient stay and treatment were determined. A sensitivity analysis was conducted to demonstrate how various total costs of infection and different infection rates affected the break-even rate, the absolute risk reduction (ARR), and the number needed to treat (NNT).ResultsFinancial review yielded an average institutional cost of treating a postoperative infection to be $13,282.85. This number was inclusive of all procedures during an inpatient stay. The added cost of the antibiotic coated implant to the hospital is $743.42. Utilizing the break-even formula with these costs and a 30% initial infection rate, antibiotic coated IMN was economically viable if it decreased infection rate by 0.056% (NNT = 1,785.714).ConclusionThis break-even analysis model suggests the initial use of an antibiotic coated IMN in the setting of GAⅢ open tibia fractures is cost-effective.     

欣胃颗粒对胃癌前病变大鼠胃黏膜关键因子Akt、P-GP表达的影响

目的探讨欣胃颗粒对胃癌前病变(PLGC)大鼠胃黏膜Akt、P-gp表达的影响。方法将健康的雄性Wistar大鼠120只根据体质量编号,按随机数字表法将Wistar大鼠随机分为4组。除空白组外,其他3组均自由饮用N-甲基-N’-硝基-N-亚硝基胍(MNNG),采用标准的饲料雷尼替丁喂养,热盐水灌胃,同时配合饥饱失常的复合造模法进行造模。至16周结束,随机抽取模型组大鼠4只做胃黏膜病理组织学检查,确认模型成功后全部停止造模及干预药物。模型制备成功后随即处死所有大鼠,剖腹取胃,应用免疫组织化学法、Western Blot法检测胃黏膜组织中Akt、P-gp基因和蛋白的表达情况。结果模型组胃黏膜Akt、P-gp的表达较其他各组显著升高,欣胃颗粒可降低Akt、P-gp基因和蛋白的表达。结论欣胃颗粒可通过下调PLGC大鼠模型胃组织Akt、P-gp基因和蛋白的表达,从而促进抗细胞的增殖。     

Proximal avulsion of five ligaments and revised diagonal principle in tibial plateau fractures

PurposeThe aim of the study was to analyze the incidence of proximal avulsion of the five main ligaments and to revise the diagonal tension/compression concept in tibial plateau fractures.MethodsComputed tomographic images of 1263 cases of tibial plateau fractures were retrospectively analyzed by the OTA/AO classification and four-column nine-segment classification. The correlation between proximal avulsion of five ligaments and the injury mechanism was analyzed.ResultsIn total, 1263 tibial plateau fractures in 1253 patients were included. A total of 92 cases (7.3%) associated with proximal avulsions were identified among the 1263 tibial plateau fracture cases obtained from our institution's database. The 92 avulsions occurred in 82 patients, among whom 10 patients had two different avulsions in a single knee. The incidence of proximal avulsion fracture of the medial and lateral collateral ligament was 3.6% (45/1263) and 2.1% (26/1263), respectively. The incidence of avulsion of the anterior cruciate ligament and avulsion of the posterior cruciate ligament was much lower at 0.2% (2/1263) and 0.1% (1/1263), respectively. Proximal avulsion of the patellar ligament occurred in 18 cases (incidence rate = 1.4%). Several combinations of injuries, composed of distal tibial plateau fractures and proximal avulsion of ligaments, were identified.ConclusionsAmong the patients with tibial plateau fracture, the incidence of proximal avulsion of the five ligaments was 7.3% (92/1263). The four-column and nine-segment classification is an exhaustive method for recording injuries in these ligaments. The revised diagonal injury concept is useful for understanding the injury mechanism and choosing the appropriate surgical strategy.     

Low expression of RGL4 is associated with a poor prognosis and immune infiltration in lung adenocarcinoma patients

Lung adenocarcinoma (LUAD) is a frequently diagnosed histologic subtype with increasing morbidity and mortality. RalGDS-Like 4 (RGL4) has not been reported to be associated with cancer risk, prognosis, immunotherapy or any other treatments. We perform a bioinformatics analysis on data downloaded from the Cancer Genome Atlas (TCGA)-LUAD, and we find that low expression of RGL4 is accompanied by worse outcomes and prognosis in LUAD patients. As a promising predictor, the potential influence and mechanisms of RGL4 on overall survival are worth exploring. Moreover, RGL4 expression is significantly associated with a variety of tumor-infiltrating immune cells (TIICs), particularly memory B cells, CD8⁺T cells and neutrophils. Subsequently, we evaluated the most notable KEGG pathways, including glycolysis gluconeogenesis, the P53 signaling pathway, RNA degradation, and the B cell receptor signaling pathway, among others. Our findings provide evidence that the decreased expression of RGL4 is significantly associated with poor prognosis and immune cell infiltration in patients with LUAD and highlight the use of RGL4 as a novel predictive biomarker for the prognosis of LUAD and other cancers. RGL4 may also be used in combination with immune checkpoints to identify the benefits of immunotherapy.Subjects: Bioinformatics, Genomics, Oncology, Thoracic surgery.     

医院大型设备绩效审计方法探讨——基于全成本核算及净现值法

针对目前医院大型医疗设备绩效审计方法的缺陷,提出了以全成本核算数据为基础,使用净现值法对大型医疗设备绩效进行审计的思路,还原了医疗设备所创造的真实效益,为医院经营决策提供可靠的数据依据。     

竹节香附素A对人胃癌细胞株BGC-823细胞周期及STAT3信号通路的影响

目的?研究竹节香附素A(Raddeanin A,RA)在体外对胃癌细胞BGC-823的周期阻滞作用及对STAT3信号通路的影响。方法?应用MTT法检测RA对人低分化细胞BGC-823细胞的增殖影响,应用流式细胞仪检测RA对BGC-823细胞周期的阻滞作用,细胞划痕实验检测RA对BGC-823迁移、侵袭能力的影响,应用Western blot检测其对STAT3信号通路的影响。结果?RA在给药12、24、48h后,与对照组相比,对BGC-823细胞的增殖抑制有显著效果,呈现时间-浓度依赖关系。流式细胞周期结果显示,RA作用于人胃癌细胞BGC-823 12h后,S期比例与对照组相较显著上升,而G₂/M期比例下降,表明细胞被阻滞于S期。在浓度为8、16μmol/L时,镜下显示迁移过去的胃癌细胞数目均明显低于对照组,Western blot结果显示RA能下调p-STAT3蛋白的表达。结论?RA能有效抑制人胃癌细胞的增殖并阻滞其细胞周期于S期,并且抑制STAT3信号通路中p-STAT3的表达。