洛丁新合并黛安神治疗原发性高血压疗效观察

目的：通过干预焦虑情绪,提高与心理因素密切相关的原发性高血压的治疗效果。方法：将会诊中发现有明显焦虑情绪的66例原发高血压患者随机分为两组,均用洛丁新降压8周,第一组同步用抗焦虑药黛安神。结果：降压有效率分别是93．94％,60．61,结论：有焦虚情绪的第二组治疗效果明显低于第一组。     

转铁蛋白受体和铁蛋白在缺铁性贫血诊断中的意义

目的 :探讨可溶性转铁蛋白受体 (sTfR)、血清中铁蛋白 (SF)在缺铁性贫血诊断中的意义。方法 :分别应用免疫比浊法和化学发光法测定缺铁性贫血、隐性缺铁患者和正常对照组的转铁蛋白受体和铁蛋白。结果 :缺铁性贫血组sTfR的值为 7.2 3± 4 .5 2mg/L ,明显高于隐性缺铁组 (2 4 3± 0 77mg/L ,P <0 0 1)和正常对照组 (1 34± 0 35mg/L ,P <0 0 1)。缺铁性贫血组和隐性缺铁组的SF分别为 :4 3± 1 8μg/L ,7 2± 3 7μg/L ,两组均明显低于对照组 (46 5± 18 2 μg/L)。结论 :sTfR是诊断缺铁性贫血的较敏感的指标 ,SF是诊断隐性缺铁可靠指标。联合检测sTfR和SF ,尤其是计算sTfR/SF对于早期诊断缺铁性贫血具有重要意义。     

iNOS、p53在幽门螺杆菌相关胃病中的表达

目的 :研究幽门螺杆菌 (H pylori)感染时不同胃粘膜病变中诱生型一氧化氮合酶 (iNOS)与p5 3的表达情况 ,探讨H pylori感染与胃癌形成的分子机制。方法 :采用免疫组化法检测 12 6例患者胃粘膜iNOS与p 5 3的表达情况。H pylori检测采用尿素酶试验法和Warthin—Starry银染法。结果 :12 6例患者中H pylori阳性 72例 ,H pylori阴性 5 4例。iNOS在炎性细胞的表达率CSG和CAG组明显高于DyS和GC级 (P <0 0 5 )。iNOS在腺上皮细胞的表达率DyS和GC组明显高于CSG和CAG组 (P <0 0 5 )。结论 :炎性细胞来源的iNOS起引发凋亡的作用 ,而腺上皮细胞产生的iNOS有抑制凋亡的作用。H pylori感染激活iNOS通过p5 3介导凋亡可能是H pylori诱发癌变的机制之一。     

Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

模拟器训练在实施股动脉穿刺点ExoSealTM封堵止血系统操作的多中心对照研究

背景与目的：介入手术已成为血管外科的主要治疗手段,对于手术直接相关的股动脉穿刺点封堵处理是手术操作收尾的一个重要环节。鉴于国内外目前尚缺乏关于封堵止血系统模拟器训练应用效果的高级别证据,本研究旨在评估模拟器训练在实施股动脉穿刺点ExoSealTM封堵止血系统操作的临床应用效果以及在血管介入操作基础教学培训中的应用价值。 方法：采用前瞻性对照设计,选择2020年5月—2020年10月7个中心的8名血管介入医师分别用两种不同方式进行封堵操作培训。4名血管介入医师通过阅读ExoSealTM说明书和观看视频进行培训（对照组）,另4名血管介入医师的培训方式为在前者基础上增加专业人员指导下的模拟器使用（研究组）。培训结束后,在主诊医师监管下,每名医师对接受血管介入手术,并在股总动脉使用6 F鞘管的患者,采用ExoSealTM封堵止血系统对穿刺点进行封堵。两组医师各操作50例患者,比较两组的操作时间、出血量、器械成功率、股动脉栓塞发生率、二次干预率、24 h内发生血肿率。 结果：研究组在ExoSealTM封堵止血系统操作中,所需的操作时间和出血量均少于对照组（24.50 s vs. 30.00 s,P=0.003;8.60 mL vs. 11.22 mL,P=0.019）。研究组的器械成功率（98.0%）高于对照组（96.0%）,但差异无统计学意义（P=0.558）。两组均无动脉栓塞、二次干预和24 h内发生血肿情况。 结论：ExoSealTM封堵止血系统模拟器的训练能够提高股动脉封堵的安全性和有效性。该模拟器的训练应常规用于血管介入操作的基础教学培训中。     

Clinical Characteristics and Controllable Risk Factors of Osteoporosis in Elderly Men with Diabetes Mellitus

ObjectiveTo analyze the clinical characteristics and controllable risk factors of osteoporosis in elderly men with type‐2 diabetes mellitus (T2DM).MethodsA total of 250 elderly OP patients with T2DM were included in the present study. Patients with one or more common chronic diseases (including hypertension, coronary heart disease, heart failure, chronic bronchitis, chronic nephrosis, and cirrhosis), and a course of more than 3 years were defined as complicated with chronic diseases. Blood glucose, cholesterol, triglyceride, low‐density lipoprotein, high‐density lipoprotein, calcium, phosphorus, glycosylated hemoglobin, urea nitrogen, creatinine, fasting insulin, liver function, and 25‐hydroxy vitamin D3 levels were measured. Bone mineral density was also measured.ResultsA total of 16 patients (6.4%) had severe osteoporosis. Furthermore, 66 patients (26.4%) had blood glucose control that reached the standard, while 176 patients (70.4%) used more than two anti‐diabetic drugs. The serum testosterone level was lower than the median in 87 patients (34.8%) and in 56 smokers (22.4%). Furthermore, 138 patients (55.2%) were overweight and obese, six patients (2.4%) were underweight, 197 patients (78.8%) had chronic diseases, 88 patients (35.2%) were sticking to exercise, and 117 patients (46.8%) had less exercise. In addition, 92 patients (36.8%) were treated with osteotrophy‐protective agents, and 24 patients (9.6%) received anti‐osteoporosis therapy. Smoking, poor glycemic control, low testosterone levels, less exercise, and complications with chronic diseases were the most relevant controllable risk factors.ConclusionFor elderly male osteoporosis patients with type‐2 diabetes, smoking cessation, blood sugar control up to the standard, regular exercise, active prevention and treatment of complications, and appropriate testosterone supplementation are necessary for preventing and curing osteoporosis.     

喉癌颈部淋巴结转移的MRI诊断

目的：探讨ＭＲＩ在喉癌颈部淋巴结转移术前诊断中的作用。方法：对１９例（２４侧）喉癌患者的颈部术前触诊、ＭＲＩ扫描及颈清扫标本病理检查结果进行了对比研究。结果：喉癌颈辨别志移淋巴结在ＭＲＩ影像上基本呈圆形或类圆型,个别可表现为数个淋巴结的融合;ＭＲＩ和临床触诊诊断颈部淋巴结转移的敏感率、特异率和准确率分别为８５．７％、９０．０％、８７．５％和６４．３％、７０．０％、６６．７％,ＭＲＩ诊断的准确率明显     

冠心病患者血脂分析

目的　探讨冠心病患者血脂变化规律。方法　测定 4 0例冠状动脉 (冠脉 )造影异常患者及 2 8例造影正常者血清脂蛋白 (a) [Lp(a) ]、甘油三脂 (TG)、总胆固醇 (TC)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)水平。结果　有冠脉病变者Lp(a)水平显著高于冠脉正常者 (P <0 0 0 1)。结论　血清Lp(a)水平增高对冠心病诊断有一定预测价值。     

卡托普利和氯沙坦对自发性高血压大鼠TGF-β1表达的影响

目的：探讨血管紧张素转换酶抑制剂（ACEI）卡托普利和血管紧张素Ⅱ1型受体（AT1）拮抗剂氯沙坦对自发性高血压大鼠（SHR）主动脉和心肌组织转换生长因子β1（TGF-β1）mRNA表达的影响。方法：12周龄SHR随机分为3组．分别给卡托普利组、氯沙坦组以药物灌胃，不给药物的SHR为对照组，Wistar组给蒸馏水4周，给药前后测尾动脉血压．提取主动脉、心肌组织．RT—PCR半定量法测TGF-β1 mRNA表达。结果：SHR主动脉组织TGF-β1 mRNA表达显著增加．卡托普利和氯沙坦显著降低了SHR主动脉TGF-β1 mRNA的表达（P〈0．05或P〈0．01）。SHR与普通大鼠心肌组织TGF-β1 mRNA表达无差异。结论：早期SHR主动脉TGF-β1 mRNA表达增加，ACEI和AT1拮抗剂可减少主动脉TGF-β1 mRNA的表达．改善血管的重构。     

狗硬脑膜与阔筋膜承受拉力比较

目的比较狗阔筋膜和硬脑膜所能承受拉力的差异.方法使用XL-250A型拉力实验机分别测定同期、相同条件下取得的狗阔筋膜和硬脑膜所能承受的最大拉力.结果两种不同方向的阔筋膜的拉力强度无显著差别,阔筋膜与硬脑膜二者之间的拉力强度差别不显著,然而,二者之间每毫米所承受的拉力差别显著.结论用阔筋膜修复硬脑膜缺损足以支持脑组织.