基于PSM法的真实世界中国产与原研注射用盐酸万古霉素疗效和安全性一致性评价的队列研究

目的：比较国产与原研注射用盐酸万古霉素疗效和安全性的一致性,为医生选择原研和仿制提供依据,进一步促进合理用药。方法：回顾性分析2016年7月1日-2018年6月30日中国人民解放军南部战区总医院使用国产（浙江医药生产,商品名来可信）和原研（美国礼来生产,商品名稳可信）注射用盐酸万古霉素的1 602例患者资料,经排除后纳入644例有效患者,其中来可信组147例,稳可信组497例,采用1：3最邻近匹配法对2组患者行倾向性评分匹配（propensity score matching,PSM）,获得组间协变量均衡样本,以临床有效率和细菌学清除率评估疗效。匹配后的样本采用卡方检验评估2种药物的疗效差别。本研究是做病例分析,而且论文不涉及患者信息和隐私,豁免伦理审批。结果：倾向性评分匹配后,来可信组和稳可信组的疗效比较差异无显著性（P>0.05）。但由于所搜集的不良反应例数太少,安全性评价无法做统计学评估。结论：PSM法可有效均衡非随机研究组间协变量。国产与原研注射用盐酸万古霉素的疗效具有一致性。     

Malignant potential and specific characteristics of pure main duct type intraductal papillary mucinous neoplasm

BackgroundAs the malignant potential of main duct (MD-) type intraductal papillary mucinous neoplasm (IPMN) has been discussed together with Mixed-type in most previous studies, the malignant potential of pure MD-type IPMN remains unclear. This study evaluated the specific characteristics and predictors of high-grade dysplasia (HGD) and invasive intraductal papillary mucinous carcinoma (IPMC) for pure MD-type IPMN.MethodsFrom 1,100 patients with IPMN, this study includes 387 patients that underwent surgery. We evaluated the specific characteristics of pure MD-type IPMN by comparing clinicopathological factors between MD-type (n = 79) and branch duct (BD-) type (n = 146) or Mixed-type IPMN (n = 162), and predictors of HGD/invasive IPMC in pure MD-type IPMN.ResultsThe rate of HGD/invasive IPMC was significantly higher in MD-type than in BD-type (70.9 vs. 48.6%, P = 0.001), although there was no difference between MD-type and Mixed-type IPMNs (P = 0.343). Recurrence-free survival (RFS) and disease-specific survival (DSS) of patients with MD-type were better than those of patients with Mixed-type (P = 0.008 and P = 0.009, respectively). There were no significant differences in RFS, overall survival, and DSS between patients with MD-type and patients with BD-type IPMNs. Multivariate analysis showed two independent predictors of HGD/invasive IPMC in MD-type IPMN; mural nodule height ≥5 mm (P = 0.025, odds ratio [OR]; 16.949) and carcinoembryonic antigen (CEA) level in the pancreatic juice obtained by preoperative endoscopic retrograde pancreatography ≥50 ng/ml (P = 0.039, OR; 9.091).ConclusionsMeasurement of mural nodule height and CEA in the pancreatic juice might be useful in determining surgical indication for pure MD-type IPMN, although further studies for confirmation are essential.     

Antibodies to Mycobacterium tuberculosis-specific epitopes in lepromatous leprosy.

Sera from patients with leprosy or tuberculosis and healthy subjects have been analysed for the presence of antibodies to four species-specific mycobacterial epitopes, four different viruses and five autoantigens. Antibodies to the Mycobacterium leprae-specific 35-kD protein and phenolic glycolipid I epitopes were not present in patients with active pulmonary tuberculosis. In contrast, antibody levels to species-specific epitopes of the 38-kD and 14-kD antigens M. tuberculosis were significantly elevated in patients with lepromatous leprosy. Neither of the two antigens is cross-reactive with M. leprae at the B cell level. However, it was considered that cross-reactive helper T cells could recall the response of M. tuberculosis-specific memory B cells, which had been primed through prior self-healing tuberculous infection. As an alternative explanation, the possible role of polyclonal B cell stimulation was considered. This seemed unlikely, however, since: (i) antibody levels to autoantigens, except anti-smooth muscle, were not elevated, and (ii) antibody levels to four distinct viruses, unlike those to all mycobacterial epitopes, showed no correlation with titres, to M. tuberculosis-specific epitopes.     

喉癌患者PAC-1、CD62P表达与临床病理特征和复发的关系

目的探讨喉癌患者血小板表面血小板膜糖蛋白Ⅱb/Ⅲa纤维蛋白原受体(PAC-1)、血小板P-选择素(CD62P)阳性表达率以及与患者临床病理特征和复发的关系。方法选取2014年1月~2015年12月间在我院耳鼻喉科手术治疗的116例喉癌患者,随访≥2年,并选取同期在我院体检的健康人群60例为对照组,采用流式细胞仪检测法检测外周血PAC-1和CD62P阳性率,并分析与临床病理特征、复发的关系。结果喉癌患者PAC-1和CD62P阳性表达率分别为(17.82±1.76)%和(22.87±3.13)%,明显高于健康人群(P<0.05);而且在喉癌患者PAC-1表达和CD62P表达呈正相关性(r=0.238,P<0.05)。T3-T4分期或N2-N3分期患者PAC-1和CD62P阳性表达率高于T1-T2分期或N0-N1分期患者(P<0.05)。另外远处转移组PAC-1和CD62P阳性表达率高于未发生转移组(P<0.05);随访期间有24例患者复发,复发率为20.69%。复发喉癌患者PAC-1、CD62P阳性表达率分别为(17.02±0.85)%和(21.84±1.17)%,明显高于未复发的喉癌患者(P<0.05)。经Logistics回归分析,PAC-1和CD62P是喉癌患者复发的独立危险因素(P<0.05)。结论PAC-1和CD62P阳性表达率与喉癌患者T分期、淋巴结转移和远处转移密切相关,同时可作为喉癌局部复发、区域淋巴结转移、远处转移的预测指标。     

谈科普类视听教材的设计与制作

结合《农村饮水卫生》电视教材的制作,介绍了科普类视听教材在开发、制作过程中要依据受众广泛的特点,遵循专业知识通俗化、素材摄制与收集多样化、实景拍摄原生态化、编辑要素生活化的原则,并注重与外景地主管部门的沟通协调,同时处理好宣传和隐私的关系.     

降钙素原水平检测对鉴别重症监护病房血流感染患者菌种的作用

目的:探讨PCT水平对鉴别重症监护病房血流感染患者菌种的价值。方法:选择2011年3月-2014年1月本院ICU患者131例作为研究对象,按照其菌种将其分为G-组、G+组及真菌组,比较各组PCT水平差异,并根据其ROC曲线判断血清PCT的诊断性能。结果:三组血清PCT中位数水平差异具有统计学意义(P0.05);血清PCT水平对G-菌与G+菌及真菌所致的血流感染鉴别诊断性能较高。结论:血清PCT水平对于鉴别G-菌与G+菌或真菌引起的血流感染有一定的临床鉴别价值,但是对于G+菌与真菌引起的感染鉴别意义尚不明确。     

原生家庭亲密度与适应性对产妇产后抑郁的影响

目的：调查产妇产后3年内产后抑郁（PPD）的现状,并探讨原生家庭亲密度与适应性对产妇PPD的影响。方法：采用便利抽样法于2020年7月至8月利用爱丁堡产后抑郁量表、家庭亲密度与适应性量表对211例产后0～3年的产妇进行线上调查。结果：34.1%的产妇在产后3年内存在PPD。原生家庭的家庭亲密度为松散型、家庭适应性为僵硬型以及家庭类型为极端型的产妇其PPD的得分较高。在控制人口学变量后,多元线性回归分析发现原生家庭亲密度可负向预测产妇PPD程度（β=-0.175,P=0.013）,而极端型原生家庭可正向预测PPD程度（β=0.178,P=0.033）。结论：产后3年内产妇PPD的患病率较高,原生家庭亲密度及原生家庭类型是PPD的重要影响因素,临床医护人员可从原生家庭角度开展PPD的预防和干预。     

山区应用改良班氏试剂检测粪便还原糖的意义

目的为探讨改良班氏试剂测定粪便还原糖的意义。方法对112例感染性腹泻患儿同时应用改良班氏试剂法及Clintest Tabl。还原糖检测法检查粪便还原糖。结果两者相比差异无显著性。结论改良班氏试剂可以替代试纸法检测粪便还原糖。对粪便还原糖阳性者，采用去乳糖喂养，取得良好疗效。     

纪青山教授从脏腑辨证结合原穴治疗原发性痛经

“五脏有疾当取之十二原。”纪青山教授从脏腑辨证出发,通过针刺与痛经相关的肝、脾、肾三脏原气留止部位,即：足厥阴肝经原穴太冲,足太阴脾经原穴太白,足少阴肾经原穴太溪,3穴配合以疏理气机,调养气血,滋补肝肾,使气血化生有源,经血充足,运行畅通。缓解及根治由肝、脾、肾三脏病变所导致“不荣则痛”及其经络病变所引起“不通则痛”的痛经,加之配合局部取穴,使周围经络气血运行通畅。二者相合,治疗原发性痛经,收效满意。