新生儿高胆红素血症换血治疗的研究进展

新生儿高胆红素血症主要因胎儿型红细胞裂解释放产生胆红素过度所致,是新生儿最常见的疾病。近年来发病率呈上升趋势,严重危害新生儿健康。新生儿高胆红素血症最为严重的并发症是胆红素脑病(核黄疸),有很高的致残率及致死率,应予以高度重视。从目前治疗现状来看,换血疗法具有快速清除血中游离胆红素、抗体、致敏红细胞等,减少核黄疸发生的优点,故仍是治疗新生儿高胆红素血症最快速有效的方法。现就新生儿高胆红素血症换血治疗的研究进展进行综述。     

Active SB-P Versus Conventional Approach to the Protection of High-Risk Side Branches: The CIT-RESOLVE Trial

ObjectivesThe aim of this study was to determine whether an active side branch protection (SB-P) strategy is superior to the conventional strategy in reducing side branch (SB) occlusion in high-risk bifurcation treatment.BackgroundAccurate prediction of SB occlusion after main vessel stenting followed by the use of specific strategies to prevent occlusion would be beneficial during bifurcation intervention.MethodsEligible patients who had a bifurcation lesions with high risk for occlusion as determined using the validated V-RESOLVE (Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention) score were randomized to an active SB-P strategy group (elective 2-stent strategy for large SBs and jailed balloon technique for small SBs) or a conventional strategy group (provisional stenting for large SBs and jailed wire technique for small SBs) in a 1:1 ratio stratified by SB vessel size. The primary endpoint of SB occlusion was defined as an angiography core laboratory–assessed decrease in TIMI (Thrombolysis In Myocardial Infarction) flow grade or absence of flow in the SB immediately after full apposition of the main vessel stent to the vessel wall.ResultsA total of 335 subjects at 16 sites were randomized to the SB-P group (n = 168) and conventional group (n = 167). Patients in the SB-P versus conventional strategy group had a significantly lower rate of SB occlusion (7.7% [13 of 168] vs. 18.0% [30 of 167]; risk difference: –9.1%; 95% confidence interval: −13.1% to −1.8%; p = 0.006), driven mainly by the difference in the small SB subgroup (jailed balloon technique vs. jailed wire technique: 8.1% vs. 18.5%; p = 0.01).ConclusionsAn active SB-P strategy is superior to a conventional strategy in reducing SB occlusion when treating high-risk bifurcation lesions. (Conventional Versus Intentional Strategy in Patients With High Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention [CIT-RESOLVE]; NCT02644434)     

Chinese expert recommendations on management of hepatocellular carcinoma during COVID-19 pandemic: a nationwide multicenter survey

BackgroundThis study aimed to investigate the work status of clinicians in China and their management strategy alteration for patients with hepatocellular carcinoma (HCC) during the COVID-19 pandemic.MethodsA nationwide online questionnaire survey was conducted in 42 class-A tertiary hospitals across China. Experienced clinicians of HCC-related specialties responded with their work status and management suggestions for HCC patients during the pandemic.Results716 doctors responded effectively with a response rate of 60.1%, and 664 were included in the final analysis. Overall, 51.4% (341/664) of clinicians reported more than a 60% reduction of the regular workload and surgeons declared the highest proportion of workload reduction. 92.5% (614/664) of the respondents have been using online medical consultation to substitute for the “face-to-face” visits. Adaptive adjustment for the treatment strategy for HCC was made, including the recommendations of noninvasive and minimally invasive treatments such as transcatheter arterial chemoembolization for early and intermediate stage. Targeted therapy has been the mainstay for advanced stage and also as a bridge therapy for resectable HCC.DiscussionDuring the COVID-19 pandemic, online medical consultation is recommended to avoid social contact. Targeted therapy as a bridge therapy is recommended for resectable HCC considering the possibility of delayed surgery.     

The safety and efficacy evaluation of sodium-glucose co-transporter 2 inhibitors for patients with non-alcoholic fatty liver disease: An updated meta-analysis

BackgroundIn recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2is) have been increasingly used in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). This updated meta-analysis aimed to evaluate the efficacy and safety of SGLT2is for patients with NAFLD.MethodsPubMed, Embase, Cochrane Library, Web of Science, Wan Fang, China National Knowledge Infrastructure and VIP databases were searched for relevant studies from inception to April 30, 2021. Values of weighted mean differences (WMDs) and risk ratios (RRs) were determined for continuous and dichotomous outcomes, respectively.ResultsA total of 1,498 patients with NAFLD from 20 studies were included for further analysis. Pooled analyses indicated significant improvements in body mass index [WMD: ?0.84 kg/m², 95% CI (?1.09, ?0.60)], alanine aminotransferase [WMD: ?4.36 U/L, 95% CI (?7.17, ?1.54)], aspartate aminotransferase [WMD: ?2.94 U/L, 95% CI (?5.33, ?0.55)], fasting plasma glucose [WMD: ?4.08 mmol/L, 95% CI (?6.21, ?1.95)] and fibrosis-4 index [WMD: ?0.08, 95% CI (?0.11, ?0.05)] following SGLT2i treatment (p < 0.01 for all above parameters). There was no significant difference in the incidence of total adverse events between the SGLT2i group and the control group (RR = 0.78, 95% CI (0.58, 1.06), p = 0.11].ConclusionSGLT2is seem to be a promising treatment for patients with NAFLD to improve metabolic and fibrosis indexes without increasing the incidence of adverse events. Most included studies were conducted in NAFLD patients with diabetes. Therefore, the results of this meta-analysis are more applicable to the diabetic population.     

脑脊液神经元特异性烯醇化酶对脑弥漫性轴索损伤预后的评估价值

目的：探讨脑脊液神经元特异性烯醇化酶（ NSE）含量变化与脑弥漫性轴索损伤（ DAI）预后的关系。方法 DAI患者79例（实验组）用放射免疫测定法检测,伤后24 h、2～3 d、7 d、14 d脑脊液中NSE 浓度,并与15例无神经系统疾病患者比较（对照组）。伤后3个月后根据格拉斯哥预后评分将实验组分为预后良好组41例、预后不良组29例和死亡组9例,分析脑脊液NSE水平与DAI预后的关系。结果实验组NSE脑脊液浓度明显高于对照组（P＜0．01）,预后不良组脑脊液NSE水平明显高于预后良好组（P＜0．05）。死亡组脑脊液NSE水平明显高于预后良好组和预后不良组（ P＜0．01）。脑脊液NSE水平动态观察情况显示：预后良好组脑脊液NSE水平稳步下降,至伤后7 d时接近对照组水平。预后不良组伤后7 d时NSE水平仍高于对照水平,至14 d接近对照组。死亡组在伤后脑脊液NSE水平持续升高并持续维持在较高的水平。结论 DAI损伤中NSE浓度越高,恢复正常的时间越长,其预后越差。脑脊液NSE的动态检测可作为监视临床病情判断预后的可靠指标。     

重组人粒细胞集落刺激因子对急性肺损伤幼鼠炎症因子表达的影响

目的 探讨重组人粒细胞集落刺激因子(rh G-CSF)对急性肺损伤幼鼠炎症因子表达的影响。方法 选取120只SD幼鼠,随机分为实验组和对照组,每组60只。采用经尾静脉注射精制大肠杆菌内毒素脂多糖5 mg/kg建立急性肺损伤模型。实验组采用皮下注射rh G-CSF 30μg/(kg·d)进行干预,对照组则注射同等剂量的生理盐水,比较两组肺组织及支气管肺泡灌洗液在干预后第5、10、14天转化生长因子β1(TGF-β1)、肿瘤坏死因子α(TNF-α)和白介素1β(IL-1β)的表达水平。结果 在实验干预后第5、10、14天,实验组支气管肺泡灌洗液及肺组织的TGF-β1、TNF-α和IL-1β水平均低于对照组,差异有统计学意义(P 0. 05)。结论rh G-CSF能够有效地减轻急性肺损伤幼鼠的机体炎性反应。     

Chinese Herbal Medicine Combined with Entecavir for HBeAg Positive Chronic Hepatitis B: Study Protocol for a Multi-Center, Double-Blind Randomized-Controlled Trial

Background: The domestic prevalence of chronic hepatitis B(CHB) in China is 7.18% in 2006, imposing great societal healthcare burdens. Nucleot(s)ide analogues(NUCs) anti-hepatitis B virus(HBV) therapies are widely applied despite the relatively low rate of seroconversion and high risk of drug-resistant mutation. More effective treatments for CHB deserve further explorations. Combined therapy of NUCs plus Chinese herbal medicine(CHM) is widely accepted in China, which is recognized as a prospective alternative approach. The study was primarily designed to confirm the hypothesis that Tiaogan-Yipi Granule(调肝益脾颗粒, TGYP) or Tiaogan-Jianpi-Jiedu Granule(调肝健脾解毒颗粒, TGJPJD) plus entecavir tablet(ETV) was superior over ETV monotherapy in enhancing HBeA g loss rate. Methods: The study was a nationwide, large-scale, multi-center, double-blind, randomized, placebo-control ed trial with a designed duration of 108 weeks. A total of 16 hospitals and 596 eligible Chinese HBeA g positive CHB patients were enrolled from November 2012 to September 2013 and randomly allocated into 2 groups in 1:1 ratio via central randomization system: experimental group(EG) and control group(CG). Subjects in EG received CM formulae(TGYP or TGJPJD, 50 g per dose, twice daily) plus ETV tablet(or ETV placebo) 0.5 mg per day in the first 24 weeks(stage 1), and CHM granule plus ETV tablet(0.5 mg per day) from week 25 to 108(stage 2). Subjects in CG received CHM Granule placebo plus ETV tablet(0.5 mg per day) for 108 weeks throughout the trial. The assessments of primary outcomes(HBV serum markers and HBV-DNA) were conducted by a third-party College of American Pathologists(CAP) qualified laboratory. Adverse effects were observed in the hospitals of recruitment. Discussion: The study was designed to compare the curative effect of CM plus ETV and ETV monotherapy in respect of HBe Ag loss, which is recognized by the European Association for the Study of the Liver as "a valuable endpoint". We believe this trial could provide a reliable status for patients' "journey" towards durable responses after treatment discontinuation. The trial was registered before recruitment on Chinese Clinical trial registry(No. ChiC TR-TRC-12002784, Version 1.0, 2015/12/23).     

卵巢储备功能预测的探讨

目的 探讨多个临床指标预测卵巢储备功能的效果。方法 回顾性分析350 例行体外受精-胚胎移植患者的临床资料,应用SPSS 软件作ROC 曲线,分别计算年龄、基础卵泡刺激素（bFSH）、基础卵泡刺激素/ 基础黄体生成素（bFSH/bLH）、窦卵泡计数（AFC）4 个指标曲线下面积（AUC）,并用Logistic 回归分析及ROC 曲线,综合多个指标对卵巢储备功能预测。结果 ①年龄、bFSH、bFSH/bLH 及AFC 的AUC 分别为0.687、0.643、0.815 及0.867,均大于机会参考下面积,差异有统计学意义（P <0.05）;② Logistic 回归结果显示,综合年龄、bFSH、bFSH/bLH 及AFC 4 个指标的ROC 曲线下AUC 是0.918,差异有统计学意义（P <0.05）;排除年龄的影响,综合bFSH、bFSH/bLH 及AFC 3 个指标的ROC 曲线下AUC是0.913,差异有统计学意义。结论 AFC 是预测卵巢储备功能价值较高的单个指标。排除年龄因素的干扰,综合bFSH、bFSH/bLH 和AFC 3 个指标较单一指标更能准确地预测卵巢储备功能。     

过氧化氢在经口气管插管患者口腔护理中的应用

目的 探讨过氧化氢对经口气管插管患者预防感染性并发症的效果.方法 将90例经口气管插管机械通气患者随机分为A、B、C三组,每组各30例.A组患者采用3％过氧化氢溶液棉球擦洗联合0.9％氯化钠溶液冲洗口腔;B组采用0.9％氯化钠溶液冲洗口腔;C组按常规采用0.9％氯化钠溶液棉球进行口腔擦洗,均每日2次.观察三组患者口咽部细菌数、口腔pH值和清洁度及口腔感染的发生率.结果 三种方法护理口腔后,A、B、C三组口咽部细菌数均减少[分别为（306.70±15.57）,（436.10±19.14）,（762.33±28.46） cfu/平皿;F=116.5;P＜0.05],以A组最明显;三组方法护理后患者口腔pH值均升高[（6.70 ±0.085）,（6.41 ±0.102）,（6.35±0.076）],三组比较差异有统计学意义（F=4.415;P＜0.05）,且以A组升高最明显;三组患者牙菌斑发生率（16.67％,40.00％,33.33％）及口腔感染发生率（10.00％,20.00％,33.33％）比较,差异无统计学意义（x2值分别为4.127,4.937;P＞0.05）,三组患者口臭的发生率以A组最低（20.00％,43.33％,56.67％）,三组比较差异有统计学意义（x2=8.61,P＜0.05）.结论 应用3％过氧化氢溶液棉球擦洗联合0.9％氯化钠溶液冲洗经口气管插管患者口腔预防感染性并发症效果较好.     

RICU鲍曼不动杆菌感染的临床分布及耐药性分析

目的分析我院呼吸症监护病房(RICU)鲍曼不动杆菌(Acinetobacterbaumannii,Ab)的临床分布及耐药情况。方法分析我院入住RICU患者临床分离出的致病菌,其中对分离出Ab的标本来源、临床分布及耐药情况进行分析。结果共分离出209株,其中痰标本182株,血标本11株,尿标本8株,静脉导管4株,其他4株;分离出鲍曼不动杆菌对临床常用抗菌药物大部分耐药,对阿米卡星耐药率最低,耐药率为50.24%,其次为米诺环素,耐药率为69.38%,其他抗菌药物耐药率均大于80%。表现为多重耐药、泛耐药。多重耐药菌株为111株,占53.11%,全耐药菌株为21株,占10.05%。结论鲍曼不动杆菌为RICU感染主要致病菌,表现为多重耐药、泛耐药及全耐药,监测该菌临床分布及耐药情况,有助减少该菌在RICU定植及传播。