全同步肾阻抗血流图临床应用研究

目的：探讨全同步肾阻抗血流图（RNG）对慢性肾炎（CGN）分型诊断与鉴别诊断及肾功能不全判定的价值；方法：在200例正常人研究的基础上，检测85例CGN及高血压病人的全同步RNG，并与临床诊断，肾功能及肾B超作对照分析。结果：CGN普通型仅见Q-B轻度延长，CGN高血压型Hd/Hs增大，慢性肾功能衰竭（CRF）Hs及C波显著降低而Hd/Hs正常，高血压肾硬化Hs及C波降低伴Hd/Hs增大，上述各组Q-B/B-X均见增大，但组间无显著差异性，而高血压病Ⅰ期均为正常，肾功能不全代偿期各参数的正常，氮质血症期Hs及C波降低伴Hd/Hs增大，而CRF仅Hs及C波显著降低。且各组均见有显著差异。结论：全同步RNG对CGN分型诊断与鉴别诊断及肾功能不全的分期判定均有重要价值。其波幅参数较之时间参数更具诊断意义。     

Efficacy and safety of omalizumab for the treatment of refractory chronic spontaneous urticaria in Japanese patients: Subgroup analysis of the phase 3 POLARIS study

Background

Omalizumab, a humanized anti-IgE monoclonal antibody, proved efficacious and well tolerated in patients with chronic spontaneous urticaria (CSU) refractory to H₁ antihistamines (H₁AH) in the POLARIS study (NCT02329223), a randomized, double-blind, placebo-controlled trial in East Asian patients. However, data in Japanese patients, who have specific baseline characteristics (e.g., low angioedema incidence, different background medications) that may impact clinical outcomes, are lacking. This pre-specified analysis presents additional patient-level data over time, pharmacokinetic and pharmacodynamics data for omalizumab and IgE, and efficacy and safety data for omalizumab in Japanese patients.

Automated malaria detection by depolarization of laser light

Anecdotal experience with full blood count (FBC) technology incorporating analysis of depolarized laser light (DLL) for the enumeration of eosinophils showed that malaria infection generated unusual distributions in the white cell channels. The objective of this study was to identify and define criteria for a diagnosis of malaria using this technology. To determine sensitivity, specificity, and positive and negative predictive values, 224 directed samples referred specifically for malaria were used; true positives were defined as those in which malaria was identified by microscopic and/or immunological methods. For the DLL method, positive was defined as one or more large mononuclear cell(s) for which the 90 degrees depolarized signal exceeded the 90 degrees polarized signal. To determine possible utility in a routine haematology laboratory setting, 220 random undirected FBC samples were evaluated for possible malaria infection by the DLL method. Of the 224 directed samples, 95 were malaria positive as determined by microscopic and/or immunological methods, and 129 were negative. For the DLL method, overall sensitivity was 72% (90% in the case of Black Africans), and specificity 96%. Positive and negative predictive values overall were 93% and 82% respectively. In the utility study a single positive result was identified among the 220 samples studied. This was found to be from a patient with malaria. The detection of unexpected malaria by automated screening FBC analysis could substantially lower the mortality and morbidity from unascertained infection, especially in indigenous African peoples.     

TransPRK与LASEK术治疗高度近视的临床疗效

目的：对比观察TransPRK与LASEK术治疗高度近视的临床疗效。

方法：选择行激光矫正的高度近视患者120例240眼。随机分TransPRK术组60例120眼,LASEK术组60例120眼。观察术后1wk眼部刺激症状、术后2wk视力、术后3mo haze的发病率、术后1a屈光度等。

结果：两种方法均取得良好的手术效果。术后第1d TransPRK组无刺激症状者：86眼(71.7%),视物清楚,睁眼来医院复查。LASEK组术后81眼(67.5%)无刺激症状; 术后2wk视力与术前矫正视力比较,TransPRK组109眼(90.8%),LASEK组87眼(72.5%); 术后3mo haze的发病率,TransPRK组0级113眼,LASEK组0级109眼。

结论：TransPRK组刺激症状明显轻于LASEK组,TransPRK组比LASEK组术后视力恢复快; TransPRK组比LASEK组术后haze的发病率低,以上均有统计学差异(P<0.01); 术后两组1、3、6、12mo两组视力、屈光状态、视觉质量均无统计学意义(P>0.05)。两种手术方式矫正高度近视疗效无明显差异,均具有较好的安全性、有效性及可预测性。     

全程陪护对产后出血及剖宫产率的影响研究

目的：探讨助产士全程陪护对降低产妇分娩出血率和提高顺产率的效果。方法选择2012年7月至2013年7月期间收治的480例产妇为研究对象,并将其随机分为两组。对照组280例给予常规陪护;研究组200例给予助产士全程陪护,实施一对一人性化陪护。比较两组产妇的分娩方式、产程、分娩出血量及满意度。结果研究组的平均分娩时间为（7．31±0．98） h,明显少于对照组的（10．86±2．23）h（t＝16．513,P＜0．05）;研究组的剖宫产率为3．00％,明显低于对照组的16．79％（χ2＝22．573,P＜0．05）。研究组产妇的SAS评分为（46．39±2．65）分,明显少于对照组的（57．36±6．71）分（t＝13．402,P＜0．05）;研究组的产后出血率为3．50％,明显低于对照组的8．93％（χ2＝5．526,P＜0．05）;但两组新生儿Apgar评分比较无显著性差异（ P＞0．05）。研究组产妇的回访满意度为94．00％,明显高于对照组的76．43％,两组比较有显著性差异（χ2＝26．468,P＜0．05）。结论助产士全程陪护能够有效的缩短分娩时间,提高产妇的分娩质量,稳定产妇的情绪,降低产妇分娩出血率,值得临床推广。     

护士专职夜班岗位的设置与管理

目的:探讨护士专职夜班岗位设置与管理的实践效果及体会。方法:于2012年6月起在中南大学湘雅二医院胸外科、心脏大血管外科和骨科4个病区试点护士专职夜班岗位,比较实施前后患者对护理服务满意度、护士对工作满意度、夜班护理质量的变化。结果:实施护士专职夜班岗位后患者对护理服务满意度、护士工作满意度均明显提升(P<0.05),夜班护理质量提升。结论:建立在岗位管理基础上的护士夜班岗位管理,能够提高护理管理效能和护理服务满意度,促进责任制整体护理的深入开展。     

有限元模拟全内镜下精准椎板开窗减压术及生物力学分析

文题释义： 全内镜下精准椎板开窗：在内镜可视下及术中影像学实时监测下,对椎板开窗切除范围精准可控。 有限元分析：是一种采用较简单的小问题来替代较复杂的大问题,从而只需对简单的小问题进行求解的分析方法,可对脊柱的形状、材料属性及边界条件等进行描述,是一种研究人体力学的有效科学手段。 背景：目前内镜微创减压手术已应用于腰椎管狭窄症的治疗,但对镜下精准椎板开窗范围的研究较少。 目的：利用退变腰椎有限元模型,评估分析全内镜下不同分区精准椎板开窗减压手术对腰椎活动度及应力分布的影响。 方法：随机选取1名腰椎管狭窄症患者,采集CT数据,使用相关生物力学软件建立腰椎L_4-5节段有限元模型(M1),并进行有效性验证。继而有限元模拟内镜可视下精准椎板开窗减压手术,结合腰椎管狭窄症临床病理分型,建立椎板开窗减压相应范围L_4-5节段手术模型,分别为L₄椎板下缘+L_4-5关节突关节部分切除模型(M2)、L_4-5部分关节突关节+L₅椎板上缘切除模型(M3)、L₄椎板下缘+L_4-5部分关节突关节+L₅椎板上缘切除模型(M4)、L₄椎板下缘+L_4-5部分关节突关节+L₅椎板上缘+ Over-the-Top对侧部分关节突切除模型(M5)及L₄椎体下缘+L_4-5关节突关节1/2以上+L₅椎板上缘切除模型(M6)(以上椎体均保留峡部,除M6外,关节突关节均保留50%以上的关节面)。分别对完整脊柱(M1)及5种模拟手术模型(M2、M3、M4、M5、M6)施加相同载荷边界条件,进行前屈、后伸、左/右侧弯、左/右旋转6种工况下腰椎活动度及椎间盘等效应力的对比分析。 结果与结论：①与完整脊柱M1模型比较,M2、M3、M4及M5模型在各工况下活动度值相近,但M6模型的活动度值较M1明显增大,为M1活动度的151%-264%,特别是后伸和旋转工况为甚;②在椎间盘等效应力方面,M2、M3、M4及M5模型在椎间盘前区、左/右区工况下等效应力上升趋势不明显,在椎间盘后区、中区等效应力有所增加,最大增加幅度达53%,但未出现较大应力集中的情况;而M6模型椎间盘各区域等效应力均出现较大程度上升趋势,特别在前屈工况下最大达完整退变模型(M1)的3倍;③结果表明,过大椎板开窗明显影响腰椎稳定性,同时相应节段椎间盘应力增加,易加速椎间关节退变。内镜微创减压手术精准可控,针对不同类型腰椎管狭窄症采用个性化治疗方案,保证减压效果的同时,可有效维持手术节段的生物力学特性。 ORCID: 0000-0001-8935-3117(蒋强) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Safety and Efficacy of Edoxaban,an Oral Factor Xa Inhibitor,Versus Enoxaparin for Thromboprophylaxis After Total Knee Arthroplasty: The STARS E-3 Trial

Introduction

This phase 3 trial compared the safety and efficacy of edoxaban, an oral direct factor Xa inhibitor, with enoxaparin sodium (enoxaparin) for thromboprophylaxis after total knee arthroplasty (TKA) in patients in Japan and Taiwan.

Materials and methods

In this randomized, double-blind, double-dummy study, patients received oral edoxaban 30 mg once daily beginning 6 to 24 hours postsurgery or enoxaparin 2000 IU (equivalent to 20 mg) subcutaneously twice daily beginning 24 to 36 hours postsurgery for 11 to 14 days. The primary efficacy endpoint was the composite of symptomatic pulmonary embolism and symptomatic and asymptomatic deep vein thrombosis. Safety endpoints included the incidence of major bleeding, clinically relevant non-major (CRNM) bleeding, major bleeding or CRNM bleeding, all bleeding events, adverse events, and adverse drug reactions.

Results

Of 716 patients enrolled, 360 and 356 were randomized to receive edoxaban or enoxaparin, respectively. The primary efficacy outcome occurred in 22/299 (7.4%) and 41/295 (13.9%) patients in the edoxaban and enoxaparin groups, respectively (relative risk reduction = 46.8%), indicating non-inferiority (P < 0.001) and superiority (P = 0.010) of edoxaban versus enoxaparin. In the edoxaban and enoxaparin groups, major bleeding occurred in 4/354 (1.1%) versus 1/349 (0.3%) patients (P = 0.373); major or CRNM bleeding occurred in 22/354 (6.2%) versus 13/349 (3.7%) patients (P = 0.129), respectively.

Conclusions

Edoxaban 30 mg once daily was more effective for thromboprophylaxis than subcutaneous enoxaparin 2000 IU twice daily following TKA and demonstrated a similar incidence of bleeding events.     

Social consequences of early socioeconomic adversity and youth BMI trajectories: Gender and race/ethnicity differences

The present study investigated the mediating effects of adolescent BMI trajectories on socioeconomic continuity over the early life course using a nationally representative sample of 11,075 respondents. This study considered both the initial severity as well as change over time in BMI as psycho-physiological mediators. Consistent with the life course pathway model and the cumulative advantage and disadvantage principle, the results suggested that early socioeconomic adversity is associated with youth BMI trajectories over time, which in turn, impair young adult socioeconomic attainment. The results also revealed important gender and racial/ethnic differences in the hypothesized associations. These findings elucidate how early adversity exerts an enduring long-term influence on social attainment in young adulthood. Further, the findings suggest that effective obesity intervention and prevention programs should focus not only on the severity of obesity but also on growth in BMI over the early years.