STEMI患者低血清白蛋白及不良事件的关系及其危险因素分析

目的研究STEMI患者低血清白蛋白(SA)及不良事件危险因素。 方法选取110例STEMI患者,按照SA水平和不良事件情况分为低SA组和高SA组、不良事件组和无不良事件组。分析STEMI患者低SA及发生不良事件的危险因素。 结果低SA组年龄、糖尿病、冠心病、心衰、肌酐、全球急性冠状动脉事件登记(GRACE)评分高于高SA组,男性占比、吸烟、血红蛋白、肾小球滤过率(eGFR)低于高SA组(P＜0.05)。不良事件组男性占比低于无不良事件组,超敏C反应蛋白、GRACE评分、院内感染、低SA血症高于无不良事件组(P＜0.05)。年龄、性别、糖尿病、吸烟、心衰、血红蛋白、肌酐、eGFR和GRACE评分是STEMI患者发生低SA血症的危险因素。低SA与STEMI患者不良事件相关(P＜0.05)。性别、超敏C反应蛋白、GRACE评分、院内感染和低SA血症是STEMI患者发生院内不良事件的危险因素。 结论低SA与STEMI患者不良事件相关,低SA血症是STEMI患者发生院内不良事件的危险因素。     

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

As primary providers of preventive and curative community case management services in low‐ and middle‐income countries (LMICs), community health workers (CHWs) have emerged as a formalised part of the health system (HS). However, discourses on their practices as formalised cadres of the HS are limited. Therefore, we examined their role in care, referral (to clinics) and rehabilitation of severe acute malnutrition (SAM) cases. Focusing on SAM was essential since it is a global public health problem associated with 30% of all South Africa's (SA's) child deaths in 2015. Guided by a policy analysis framework, a qualitative case study was conducted in two rural subdistricts of North West province. From April to August 2016, data collected from CHW's training manuals and guideline reviews, 20 patient record reviews and 15 in‐depth interviews with four CHW leaders and 11 CHWs. Using thematic content analysis which was guided by the Walt and Gilson policy triangle, data was manually analysed to derive emerging themes on case management and administrative structures. The study found that although CHWs were responsible for identifying, referring, and rehabilitating SAM cases, they neglected curative roles of stabilisation before referral and treatment of uncomplicated cases. Such limitations resulted from restrictive CHW policies, inadequate training, lack of supportive supervision and essential resources. Concurrently, the CHW program was based on weak operational and administrative structures which challenged CHWs practices. Poor curative components and weak operational structures in this context compromised the use of CHWs in LMICs to strengthen primary healthcare. If CHWs are to contribute to Sustainable Development Goal (SDG) 3 by reducing SAM mortality, strategies on community management of acute malnutrition coupled with thorough training, supportive supervision, firm operational structures, adequate resources and providers’ motivation should be adopted by governments.     

心钠素对犬冠状动脉循环的调节作用

目的 :探讨生理及病理状态下心钠素调节冠状动脉循环的意义。方法 :应用测量冠状动脉直径的超声波晶体及测冠脉血流的多普勒探针 ,制成动物模型。将犬分别进行如下处理 :单独应用心钠素 ( 2 5、5 0和 1 0 0 ng· kg-1 · min-1 )持续静脉注射 ;HS- 1 4 2 - 1 ( HS)预处理后应用心钠素 ;单独应用 HS,测量冠状动脉直径、冠状动脉血流、平均动脉压、心率、血浆心钠素和环磷酸鸟苷浓度。结果 :单独应用心钠素可扩张冠状动脉直径 ,降低平均动脉压 ,对冠状动脉血流及心率无影响 ,增加血浆心钠素和环磷酸鸟苷浓度 ;HS处理后用心钠素 ,仅增加血浆心钠素浓度 ,其他指标均受抑制 ,单独用 HS对指标无影响。结论 :在以心功能不全为代表的病态下心钠素浓度升高 ,可通过直接扩张血管对维持冠脉循环起重要作用     

金黄色葡萄球菌耐药性的研究

目的:监测金黄色葡萄球菌(SA)的耐药状况,为临床治疗SA感染提供依据。方法:对浙江省中医院2001年6月至2002年5月临床分离出的122例金黄色葡萄球菌进行药敏试验和临床资料分析。结果:临床分离的葡萄球菌在病区、标本分布方面以重症监护病房和痰标本多见。耐苯唑西林金黄色葡萄球菌(MRSA)占70.5％(86/122);苯唑西林敏感金黄色葡萄球菌(MSSA)占29.5％(36/122)。耐万古霉素金黄色葡萄球菌占3.3％(4/122)。结论:耐苯唑西林的金黄色葡萄球菌表现为多重耐药性,且对12种抗生素的耐药率明显高于苯唑西林敏感的葡萄球菌,P<0.01。发现4株耐万古霉素的金黄色葡萄球菌。     

Sleep disturbance in pain clinic patients

One hundred out-patients, referred to a multidisciplinary pain clinic for the management of chronic pain, were questioned regarding their sleeping habits and were grouped according to whether they reported 'good,' 'fair' or 'poor' sleep. All patients were administered questionnaires to measure illness behaviour, depression and anxiety. Information was also obtained regarding the site, intensity and quality of pain as well as amount of general activity. 'Good' and 'poor' sleepers were found to differ on most measures, particularly depression, pain intensity, activity levels and hypochondriasis. These findings suggest that reported sleep disturbance may provide an index of impairment and act as an indicator of psychological disturbance in chronic pain patients.     

HS-GGT和AFP-mRNA联合分析在肝癌诊断中的临床价值

目的　探讨肝癌特异性γ 谷氨酰转移酶 (HS GGT)和AFP mRNA联合分析在肝癌诊断中的临床价值。方法　从肝癌患者外周血有核细胞中提取总RNA ,以逆转录聚合酶链反应 (RT PCR)扩增分析AFP mMNA ,同时定量分析患者血HS GGT水平 ,比较它们在肝癌诊断中的临床价值。结果　所设计RT PCR扩增AFP基因片段大小为 15 9bp ,肝癌患者外周血AFP mRNA阳性率为60 3 % ,显著高于急性肝炎、慢性肝炎、肝硬化、肝外肿瘤及正常对照组 (P <0 0 1)。另外 ,AFP mRNA阳性率 ,在AFP浓度低于 5 0ng/ml肝癌组中为 5 7 1% ,在伴肝外转移的肝癌组中全数阳性。AFP mRNA阳性与肿瘤大小间无明显相关性 ,与HS GGT联合分析诊断肝癌的总阳性率达 93 6% 结论　HS GGT定量和外周血AFP mRNA分析有助于肝癌诊断、远处转移或术后复发的监测     

Electroacupuncture-reduced sedative and analgesic requirements for diagnostic EUS: a prospective,randomized, double-blinded,sham-controlled study

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