强直性脊柱炎的中医康复指导

整理中医药对强直性脊柱炎的辨证施治,以及涉及饮食调养、药膳、中成药、验方、外治法、功能锻炼、日常保健等防治措施。中医药防治强直性脊柱炎,有规范的诊断标准和防治措施,在该病的治疗康复中发挥着重要的作用。     

Lower-Income Predicts Increased Smartphone Use and Problematic Behaviors Among Schoolchildren During COVID-19 Related School Modification: A Longitudinal Study

BackgroundAs the coronavirus disease 2019 (COVID-19) has continued for a couple of years, the long-term effects of the pandemic and the subsequent school curriculum modification on the mental health of children and parents need to be investigated. To clarify the changes that can occur during one school year and to predict the risk factors for vulnerable groups, this study identified parameters relative to children’s screen time, their problematic behavior, and parental depression.MethodsA total of 186 participants were analyzed who were parents of elementary schoolchildren in South Korea. These parents were required to complete a web-based questionnaire twice. The questionnaires were conducted in June 2020 and September 2021. Participants’ general demographics including family income, children’s screen time, sleep patterns, problematic behavior, and parental depression were assessed via the parental questionnaire that included various measurement tools.ResultsChildren’s body mass index (BMI) increased significantly in 2021 (18.94 ± 3.75 vs. 18.14 ± 3.30, P < 0.001). Smartphone frequency of use per week (5.35 vs. 4.54, P < 0.001) and screen time per day (3.52 vs. 3.16, P < 0.001) significantly increased during the period of the COVID-19 pandemic. The television screen time (2.88 vs. 3.26, P < 0.001), frequency of viewing (3.77 vs. 4.77, P < 0.001), and children’s problematic behaviors significantly decreased (9.15 vs. 11.85, P < 0.001). A lower income household was a key predictor of increased smartphone frequency (B = 1.840, 95% confidence interval [CI], 0.923–2.757, P < 0.001) and smartphone screen time (B = 1.992, 95% CI, 1.458–2.525, P < 0.001). The results showed that the lower income household (B = 5.624, 95% CI, 2.927–8.320, P < 0.001) and a child’s psychiatric treatment history (B = 7.579, 95% CI, 5.666–9.492, P < 0.001) was the most significant predictor of problematic behaviors of children and parental depression (B = 3.476, 95% CI, 1.628–5.325, P < 0.001; B = 3.138, 95% CI, 1.827–4.450, P < 0.001).ConclusionThis study suggested that children’s smartphone screen time and BMI increased during COVID-19 because of the school curriculum modification following school closures in South Korea. The increased children’s problematic behaviors and parental depression were predicted by lower-income households and the previous psychiatric history of children. These results indicate that multiple social support systems to the vulnerable group are needed during the ongoing pandemic and that a modified school setting is required.     

软骨肿瘤异柠檬酸脱氢酶基因突变的研究进展

软骨肿瘤是常见的原发性骨肿瘤,根据频发或特异的驱动基因变异可以对软骨肿瘤进行分子分型,从而更精准地指导临床诊疗.异柠檬酸脱氢酶(IDH)是一类代谢酶家族,广泛参与糖代谢、氨基酸代谢和脂类代谢过程.IDH1/IDH2突变后的代谢产物能够导致基因过甲基化和组蛋白修饰改变,进而诱发肿瘤.既往研究显示,良性和恶性软骨肿瘤中均存...     

代谢组学在妇科常见肿瘤治疗和预后评估中的应用

卵巢癌、子宫内膜癌和宫颈癌是妇科常见的三大恶性肿瘤,尽管随着手术、放化疗等综合治疗的不断发展,妇科常见恶性肿瘤患者的预后得到了大幅提升,但由于早期没有明显症状且缺乏准确诊断或发现时已是晚期,仍有相当比例的患者预后不佳,生命受到严重威胁。因此,寻找新的治疗靶点和监测疗效的有效标志物至关重要。代谢组学（metabonomics）是肿瘤研究领域颇受关注的研究方法,其理论基础是肿瘤存在有别于正常组织的代谢特征,肿瘤独特的代谢特征与生物表型存在紧密的关联。代谢组学通过对生物系统中内源性代谢物进行全面分析,阐明肿瘤在发生和进展过程中某些关键生化途径的重塑机制,并对其进行解析与精准干预。综述代谢组学在妇科常见肿瘤治疗和预后评估中的应用,预期其可为妇科常见肿瘤的个性化、精准化治疗提供潜在靶点,为妇科常见肿瘤筛选预后生物标志物提供重要参考。     

突发性聋临床分析

目的探讨突发性聋的治疗方法及预后因素。方法96例突发性聋病例采用川芎嗪、皮质类固醇激素、抗病毒药物为主的综合治疗,其中43例辅以高压氧治疗,分析患者年龄、初诊听力损失程度、听力曲线类型、治疗早晚、有无眩晕与预后的关系。结果痊愈25例,显效46例,痊愈率为26.04%,痊愈、显效率为73.96%;重度听力损失组,高压氧治疗组痊愈、显效率高于非高压氧治疗组(P<0.05);年龄18～40岁组,发病后10天内就诊组,轻、中度听力损失组,初诊听力曲线为平坦型和上升型组,无眩晕组疗效分别好于对照组(P<0.05)。结论年龄18～40岁,发病后10天内就诊,轻、中度听力损失组,初诊听力曲线为平坦型和上升型,无眩晕者预后好。     

胰岛素瘤一例并文献复习

目的 总结分析胰岛素瘤的临床特点,探讨其诊断治疗方法.方法 对我院收治的1例胰岛素瘤患者的临床资料进行回顾性研究,并结合国内外有关文献报道进行分析.结果 该例胰岛素瘤患者有典型的Whipple三联征.血糖1.9～3.6 mmol/L,胰岛素释放指数＞0.3;腹部超声检查示胰腺区低回声结节,腹部CT检查示胰腺占位;剖腹探查结合B型超声检查示胰腺体部有直径约2.1 cm×1.0 cm结节.结论 典型的临床表现、B超及CT薄层扫描结合胰岛素水平测定是诊断胰岛素瘤的有效方法,外科手术切除肿瘤是治疗的有效手段.     

美沙酮戒毒安全剂量的研究

目的：制定美沙酮戒毒的安全剂量范围。方法：检测男性（女性）戒毒人员体重指数（BMI）,计算出戒毒者服用美沙酮的剂量,按吸食毒品的类别和剂量换算美沙酮用量,检测2位死亡者生化指标和尿美沙酮含量,分析死亡原因。结果：两例死亡病例尿美沙酮含量为300ng／ml即0．3mg／L。肝脏是美沙酮代谢的主要场所,从尿中和大便中排出未经变化的药量小于血药量的10％左右。美沙酮的治疗血浓度为0．48—0．86mg／L,中毒血药浓度为2．0mg／L,致死血浓度〉4．0mg／L。故可推算出两例病例血中美沙酮含量在3mg／L左右,已达中毒剂量。结论：美沙酮替代疗法给药剂量应个体化,防止诱发死亡。     

黑色素瘤相关抗原A3基因在肿瘤中的表达、机制调控及相关应用

黑色素瘤相关抗原A3（melanoma-associated antigen A3,MAGE-A3）表达于多种恶性肿瘤,而在正常组织中不表达（除睾丸和胎盘外）,具有肿瘤特异性,也是肿瘤特异性免疫治疗的理想靶点。在恶性肿瘤中MAGE-A3表达调控机制尚不明确,通过基因甲基化/脱甲基化、抑制抑癌基因p53的转录活性、调控caspase作用、作为靶基因接受成纤维细胞生长因子受体2信号通路的作用等,使其发挥生物学功能。未来,利用其制备多基因联合修饰的肿瘤基因工程疫苗,精确地诊断、判断预后,并且在肿瘤疾病中做功能性靶向治疗等值得期待。本文就黑色素瘤相关抗原A3基因在肿瘤中的表达、机制调控及相关应用进行综述。     

变应性鼻炎诊疗现状调查

目的 变应性鼻炎(allergic rhinitis,AR)是鼻科常见病之一,但患者的就诊率不高,部分患者对疗效不满意,表明临床诊疗过程中存在亟待改进的问题.本研究针对中国部分大中城市的耳鼻咽喉头颈外科医师进行AR诊疗现状调查,通过剖析存在的问题,为提高临床诊疗水平提供参考.方法 采用问卷调查方式在全国13个省或自治区(63个市)和4个直辖市,针对508名耳鼻咽喉头颈外科医师,调查AR患者门诊状况、诊断状况和治疗状况.结果 AR患者占全部耳鼻咽喉头颈外科门诊患者的比例平均为19%±14%,占全部鼻腔鼻窦疾病门诊患者的35%±17%.既往使用过鼻用糖皮质激素或H1受体拮抗剂等抗过敏药物的患者为42%±26%.可进行皮肤点刺试验和血清特异性IgE检查的医师比例分别为74%和20%.仅依据患者症状和体征诊断,不进行皮肤点刺试验和血清特异性IgE检查等临床检测的比例为6l%±29%,而综合病史和皮肤点刺试验或血清学检测的诊断比例为35%±28%.从医师治疗成人AR患者的药物处方比例来看,鼻用糖皮质激素平均为70%4-27%,口服和鼻用H1受体拮抗剂分别为49%±32%和36%±28%.过敏原特异性皮下免疫治疗占23%4±26%,口服白三烯受体拮抗剂和鼻用色甘酸钠分别为18%±22%和16%±22%.重视复诊随访患者所占比例平均为24%±17%,对复诊和随访重视程度一般的患者所占比例为35%4±19%,而几乎不复诊随访的患者所占比例为39%±24%.结论 AR已成为我国耳鼻咽喉头颈外科门诊患者求诊的主要疾病,但无论是患者对疾病的整体认识,还是专科医师的整体诊治水平,均需要在现有基础上尽快提高.     

腹腔镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄62例

目的总结腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄的临床经验,探讨其手术技巧和相关并发症的防治。方法回顾性分析2010年3月至2014年7月本院经腹腔镜行幽门环肌切开治疗的62例先天性肥厚性幽门狭窄患儿临床资料。结果62例中,59例顺利完成手术,术中3例幽门黏膜损伤中转开腹手术,术后1例并发脐部戳孔疝,经修补治愈,1例术后仍有呕吐,行开放手术证实为肌层切开厚度不够所致。所有病例均无呕吐及肠粘连、肠梗阻等并发症发生。结论腹腔镜下行幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄疗效确切,术中损伤小,术后瘢痕小,但需要较高的腹腔镜操作技术。