血管性认知功能障碍与常规检查的相关性分析

目的 探讨常规检查与血管性认知功能障碍（VCI）的相关性。方法 选取2015 年1 月—2015 年 12 月在锦州医科大学附属第一医院神经内科就诊的缺血性脑卒中患者239 例，将患者分为正常组、血管性 痴呆组及血管性认知功能障碍非痴呆型组，对患者的一般资料、伴随疾病、实验室检查、颈动脉彩超及神 经心理学结果进行评估和分析。结果 3 组患者年龄和文化程度比较，差异有统计学意义（P <0.05）；3 组 患者慢性阻塞性肺疾病、高脂血症、高血压、低密度脂蛋白、血糖、总胆固醇、白蛋白及谷草转氨酶比较， 差异有统计学意义（P <0.05）；正常组在神经心理学评估MoCA 和MMSE 得分上高于其他两组（P <0.05）。 结论 常规检查与VCI 具有相关性，可用于早期筛查和协助诊断VCI。     

Recommendations for Routine Reporting on Indications for Cesarean Delivery in Developing Countries

ABSTRACT: Background: Cesarean delivery rates are increasing rapidly in many developing countries, particularly among wealthy women. Poor women have lower rates, often so low that they do not reach the minimum rate of 1 percent. Little data are available on clinical indications for cesarean section, information that could assist in understanding why cesarean delivery rates have changed. This paper presents recommendations for routine reporting on indications for cesarean delivery in developing countries. These recommendations resulted from an international consultation of researchers held in February 2006 to promote the collection of comparable data to understand change in, or composition of, the cesarean delivery rate in developing countries. Methods: Data are presented from selected countries, categorizing cesareans by three classification systems. Results: A single classification system was recommended for use in both high and low cesarean delivery rate settings, given that underuse and overuse of cesarean section are evident within many populations. The group recommended a hierarchical categorization, prioritizing cesareans performed for absolute maternal indications. Categorization among the remaining nonabsolute indications is based on the primary indication for the procedure and include maternal and fetal indications and psychosocial indications, required for high cesarean delivery rate settings. Conclusions: Data on indications for cesarean sections are available everywhere the procedure is performed. All that is required is compilation and review at facility and at higher levels. Advocacy within ministries of health and medical professional organizations is required to advance these recommendations since researchers have inadequately communicated the health effects of both underuse and overuse of cesarean delivery. (BIRTH 35:3 September 2008)     

Improvement in the routine screening performance of cytotechnologists over time

BACKGROUND:

Documenting the performance of gynecologic screening in actual practice settings is difficult to achieve. In the current study, the screening performance of 11 individual cytotechnologists as well as that of the overall laboratory over 2 consecutive time periods was examined using the rapid prescreening (RPS) method.

METHODS:

RPS was performed by all cytotechnologists in a single laboratory over 2 separate 8‐month periods. The sensitivity of screening for individual and groups of cytotechnologists was examined. For purposes of comparison, cytotechnologists were divided into 2 groups: screeners with an overall routine sensitivity ≥95% and screeners with an overall sensitivity <95%.

RESULTS:

Atypical squamous cells (ASC) were used as a threshold, and routine screening sensitivity was found to vary from 68.3% to 96.8%. The overall sensitivity of the laboratory for RPS and routine screening was 43.6% and 88.4%, respectively. Over time, the overall laboratory sensitivity of routine screening improved from 85.3% to 91.3% (P = .01). During this same time frame, the sensitivity of the screeners with an overall sensitivity <95% improved from 79.3% to 91.2% (P < .001), whereas the sensitivity of screeners with an overall routine sensitivity ≥95% remained the same (96.1% to 96.4%; P = .6).

CONCLUSIONS:

In addition to improved overall performance of the laboratory by detecting and correcting errors, the results of the current study indicate that using RPS consistently over time might play a role leading to improved performance of cytotechnologists with an overall routine sensitivity <95% but not of cytotechnologists with an overall routine sensitivity ≥95%. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

国产瑞格列奈治疗2型糖尿病的疗效和安全性

目的对国产瑞格列奈(孚来迪)的疗效及安全性进行评价.方法共观察30例2型糖尿病患者,开放性研究,治疗前后自身对照;进行2周清洗期后予国产瑞格列奈1.0 mg,每日3次,为期12周,观察空腹、餐后血糖、糖化血红蛋白、肝肾功能、体重、血脂等的变化.结果与治疗前相比,空腹和餐后血糖及糖化血红蛋白水平均有显著下降(P<0.01),体重增加,肌酐水平升高,但均未超过正常值,肝功能正常.结论国产瑞格列奈有明确的降低空腹、餐后血糖及糖化血红蛋白的效果,不良反应少,是一种安全、有效、价廉的降糖药物.     

“中气不足,溲便为之变”在肾系疾病中的应用

“中气不足,溲便为之变”这一理论在治疗肾系疾病中具有很大的指导意义,本文通过医案举例、分析,强调“中气不足,溲便为之变”这一理论在实际指导临床中的重大意义,强调该理论在病因分析、疾病治疗方面取得的良好效果,理论指导临床,为治疗疾病,研究病因,开阔了思路。     

五加生化胶囊治疗对药物流产早孕妇女血常规指标的影响

目的：探究五加生化胶囊治疗对药物流产早孕妇女血常规指标的影响。方法：选取2019年7月至2020年1月皖南医学院第二附属医院收治的药物流产早孕患者60例作为研究对象,按照随机数字表法分为对照组和观察组,每组30例。对照组给予米索前列醇+米非司酮,观察组在米索前列醇+米非司酮药物流产基础上给予五加生化胶囊,比较2组治疗效果、出血情况（出血量、出血持续时间）、尿量、脉搏、舒张压、收缩压、血常规指标。结果：观察组治疗有效率较对照组高,（96.67%比80.00%,χ2=4.043,P=0.044＜0.05）。2组脉搏比较差异无统计学意义（P>0.05）,观察组出血量少于对照组,出血持续时间短于对照组,舒张压、收缩压高于对照组（P<0.05）。治疗前,2组患者血小板计数、血红蛋白水平、白细胞计数水平比较差异无统计学意义（P>0.05）,治疗9 d后,观察组血小板计数、血红蛋白水平、白细胞计数水平优于对照组（P<0.05）。治疗前,2组患者孕酮（P）、卵泡刺激素（FSH）和黄体生成素（LH）、雌二醇（E2）水平比较差异无统计学意义（P>0.05）,治疗9 d后,2组患者FSH、P、E2水平均较治疗前下降,LH水平较治疗前提高（P<0.05）,而且观察组FSH、P、E2低于对照组,LH水平高于对照组,（P<0.05）。结论：五加生化胶囊治疗应用于药物流产早孕妇女中,能够有效止血,改善血常规指标,改善性激素水平,疗效确切,值得在临床中应用。     

不同评价方法对标准物质互换性评价结果的影响

目的观察不同评价方法对标准物质互换性评价结果的影响。方法以A、B、C 3个血清总胆红素候选标准物质、甲厂家校准品D的互换性评价为例,采用血清总胆红素参考方法和甲常规方法同时测量A、B、C、D 4个待评价样本和无溶血、乳糜的26份单人份血清样本的总胆红素含量。分别采用EP30-A、EP14-A3和国际临床化学和检验医学联合会(IFCC)互换性评价更新方案3个互换性评价方法评价待评价样本的互换性,EP30-A和EP14-A3方法的互换性评价判断依据为标准物质应落在Y预测值的±95%置信区间内,IFCC互换性评价更新方案中的互换性评价判断依据为标准物质的偏移/差±不确定度应落在医学允许偏移的固定范围内(该研究设定为5%)。比较采用3个不同判断依据对标准物质互换性评价结果的影响。结果A、B、C、D 4个样品参考方法和常规方法的测量结果分别为108.10、44.60、53.16、200.70μmol/L和94.93、38.27、48.70、189.50μmol/L;26份人血清样本的总胆红素浓度范围分别为4.69~679.73μmol/L和4.2~684.17μmol/L;A、B、C、D 4个样品采用EP30-A、EP14-A3方法评价时均具有互换性,但采用IFCC互换性评价更新方案评价时仅有A和C 2个样品具有互换性。结论评价方法不同,相同样品的互换性评价结果有可能不同,IFCC互换性评价更新方案的评价结果更符合医学预期需求。     

时辰化疗毒副反应的临床观察与护理对策

[目的]比较时辰化疗与常规化疗不良反应出现的类型及程度。[方法]经组织病理学证实需化疗的中晚期恶性肿瘤病人560例,随机分为对照组与时辰组,每组病例各280例。对照组采用常规时间化疗,时辰组则根据抗肿瘤药物血药浓度高峰制定用药时间,观察两组化疗后出现不良反应类型及程度。[结果]时辰组各种类型毒副反应的程度较对照组轻(P<0.001)。[结论]时辰化疗可以降低化疗毒副反应的发生率,增强病人对化疗的耐受性。     

Z径路肌内注射法与常规肌内注射法临床效果的Meta分析

目的 对Z径路（Z—track）肌内注射法和国内常规肌内注射法进行比较研究。方法 采用Meta分析方法，通过计算机检索国内有关两种注射法的病例对照研究，将纳入的7篇文献中有关两种注射法研究对象的特征、研究结果等内容用RevMan4．2软件进行分析。结果 Z径路肌内注射法和国内常规肌内注射法临床效果差异有统计学意义：前者药（血）液渗出率低（RR=0．38，95％CI为0．29～0．50，P〈0．05）、皮肤变色率低（RR=0．34，95％CI为0．22～0．52，P〈0．05）、组织变形率低（RR=0．39，95％CI为0．21～0．72，P〈0．05）、疼痛发生率低（RR=0．40，95％CI为0．33～0．50，P〈0．05）。结论 Z径路肌内注射法较常规肌内注射法所致局部不良反应的发生率低，相关并发症少，药物利用度高，适合在临床上推广应用。     

一次性气管套管在置管期间的护理问题及对策

目的 分析一次性气管套管置管期间的护理问题，探讨更好的有效的处理方法。方法 对15例气管套管出现的护理问题进行观察、分析。结果 发现气管置管期间出现的护理问题主要是痰液黏稠结痂粘附阻塞气管套管，其中气管套管阻塞13例，气管套管脱落1例，1例未形成窦道拔管重插。结论 护士正确掌握痰液黏稠度和气道湿化标准，是防止气管套管阻塞，维持呼吸道正常生理功能，确保和提高置管病人护理质量的关键。