丹鹿通督片联合柳氮磺吡啶治疗强直性脊柱炎的临床研究

目的探讨丹鹿通督片联合柳氮磺吡啶治疗强直性脊柱炎的临床疗效。方法选取2015年7月—2016年9在河南省直第三人民医院接受治疗的强直性脊柱炎患者90例,随机分为对照组(45例)和治疗组(45例)。对照组患者口服柳氮磺吡啶肠溶片,第1周2片/次,第2周3片/次,第3周及以后4片/次,均为2次/d。治疗组在对照组的基础上口服丹鹿通督片,4片/次,3次/d。两组患者均连续治疗2个月。评价两组患者临床疗效,同时比较两组患者治疗前后BASDAI、BASFI和临床症状评分以及血清C反应蛋白(CRP)、白介素-1β(IL-1β)、IL-4、IL-10和IL-17等血清学指标变化。结果治疗后,对照组和治疗组总有效率分别为77.78%、95.56%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组BASDAI、BASFI评分均明显下降(P0.05);且治疗组这些指标降低水平优于对照组(P0.05)。治疗后,两组下腰背疼痛、外周关节疼痛、外周关节肿胀等症状评分均显著降低(P0.05);且治疗组上述临床症状评分降低更显著(P0.05)。治疗后,两组CRP、IL-1β、IL-17均显著降低,而IL-4、IL-10均显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组上述血清学指标改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论丹鹿通督片联合柳氮磺吡啶治疗强直性脊柱炎的临床效果显著,有利于临床症状的改善及降低机体炎症反应,具有一定的临床推广应用价值。     

妇可靖胶囊联合奥硝唑分散片治疗慢性盆腔炎的临床研究

目的探讨妇可靖胶囊联合奥硝唑分散片治疗慢性盆腔炎的临床疗效。方法以2015年9月—2016年9月在商丘市妇幼保健院进行治疗的86例慢性盆腔炎患者为研究对象,根据治疗方案的差别分为对照组和治疗组,每组各43例。对照组口服奥硝唑分散片,1片/次,2次/d。治疗组在对照组治疗的基础上口服妇可靖胶囊,3粒/次,3次/d。两组患者均连续治疗3周。观察两组临床疗效,比较两组治疗前后血清学指标、临床症状评分的变化。结果治疗后,对照组、治疗组总有效率分别为79.07%、97.67%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组血清白细胞介素-4(IL-4)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、转化生长因子β1(TGF-β1)、血管内皮生长因子(VEGF)水平均较同组治疗前明显改善(P0.05);且治疗组改善得更明显(P0.05)。治疗后,两组患者临床症状评分均较治疗前明显降低(P0.05);且治疗组降低得更明显(P0.05)。两组不良反应发生率的比较没有明显差别。结论妇可靖胶囊联合奥硝唑分散片治疗慢性盆腔炎的临床效果显著,可明显改善患者临床症状,减轻机体炎症反应,值得临床推广应用。     

Vaccinations,response, and controls before and after intestinal transplantation in children

Vaccination is an effective strategy to decrease infections in transplant recipients. Children after intestinal transplantation carry a high risk of infection due to increased immunosuppression. In a series of 22 children after intestinal transplantation, we studied the vaccination schedules and the antibodies against vaccine‐preventable diseases before transplantation, and at one and five yr after transplantation. We reviewed whether the vaccination schedules were complete, and we analysed the factors that may influence serological immunity and the incidence of disease in patients with deficient immunity. All patients completed the recommended vaccination schedules for DTaP‐IPV and HBV. After transplantation, the negative antibodies against vaccine‐preventable diseases were mostly related to an antirejection therapy: for DTaP‐IPV: four of four patients with no antibody had been treated for rejection, for HBV: two of five, HAV: three of four, MMR: three of seven, and VZV: three of four. A post‐transplantation varicella infection was followed by acute rejection, with probability for a relationship between both events. We observed 50% of varicella cases in unvaccinated children, highlighting the importance of pretransplant vaccination. Waning immunogenicity mediated by antibodies against vaccine‐preventable disease after transplantation indicated a need for boosters. The recommendations should be regularly enforced, as the reliance on routine immunizations schedules is not adequate in immunocompromised patients.     

乳腺癌患者PICC护理质量敏感性指标的建立与实施

目的探讨乳腺癌患者PICC护理质量敏感性指标的建立与实施效果。方法将实施PICC护理质量敏感性指标前(2014年)行PICC置管的203例患者作为对照组,实施后(2015年)231例患者作为研究组。对照组实施常规护理,研究组采用自行研制的PICC护理质量敏感性指标监测管理,比较实施前后PICC相关并发症发生率、PICC专科护理质量及患者满意率。结果实施前后患者PICC相关并发症发生率、PICC维护护理质量评分比较,差异有统计学意义(P0.05,P0.01);实施后患者对护理工作满意率明显提高。结论建立并实施PICC专科护理质量敏感性指标监测与控制,能有效降低PICC相关并发症发生率,提高PICC专科护理质量,提高患者满意率。     

Serological and structural characterization of the O-antigens of the unclassified <Emphasis Type="Italic">Proteus mirabilis</Emphasis> strains TG 83, TG 319, and CCUG 10700 (OA)

INTRODUCTION: Lipopolysaccharide (endotoxin, LPS) is an important potential virulence factor of Proteus rods. The serological specificity of the bacteria is defined by the structure of the O-polysaccharide chain (O-antigen) of the LPS. Until now, 76 O-serogroups have been differentiated among Proteus strains. MATERIALS AND METHODS: LPSs were isolated from Proteus mirabilis TG 83, TG 319, and CCUG 10700 (OA) strains by phenol/water extraction. Antisera were raised by immunization of rabbits with heat-killed bacteria. Serological investigations were performed using enzyme immunosorbent assay, passive immunohemolysis, inhibition of both assays, absorption of antisera, and Western blot. RESULTS: The cross-reactive epitope shared by these strains and P. penner O72a,O72b is located on the O-polysaccharide and is most likely associated with an alpha-D-Glcp-(1-->6)-beta-D-GalpNAc disaccharide fragment. The serological data indicated the occurrence of two core types in the LPSs studied, one characteristic for P. mirabilis TG 319 and CCUG 10700 (OA) and the other for P. mirabilis TG 83 and O57. CONCLUSIONS: The serological and structural data showed that P. mirabilis TG 83, TG 319, CCUG 10700 (OA), and O57 have the same O-antigen structure and could be qualified to the Proteus O57 serogroup.     

Using leading and lagging indicators to select safe contractors at the prequalification stage of construction projects

The contractor-selection decision at the prequalification stage is critical to the project success. An insufficient prediction of contractors’ safety capacities using only lagging indicators may hinder the continuous improvement of safety performance in the construction industry. This research enhanced construction management and practices by proposing a comprehensive safe contractor selection model which integrated both leading and lagging indicators. First, a set of leading and lagging safety indicators were identified based on literature review and expert opinions. Then, the grey correlation analysis (GCA) was utilized to assign weights to individual indicators. We found that management commitment, safety training and education, safety risk management, and safety rules and procedures were four most influential factors to the safety performance of contractors. In addition, the fuzzy technique of ordering preference by similarity to ideal solution (Fuzzy TOPSIS) was used to condense individual indicators and create a composite safety performance indicator (c-SPI). Finally, the feasibility of the decision support tool for safe contractor selection was verified using a real-case railway construction project.     

成都市双流区3~6岁学龄前儿童体质状况调查分析

目的 分析成都市双流区学龄前儿童体质现状,了解学龄前儿童体质水平的年龄性别差异及发展特点。方法 2017年5月采用分层整群抽样方法抽取1 130名3~6岁儿童为研究对象,并依据 《国民体质测定标准手册》( 幼儿部分) 进行体质测试,实际检测儿童1 077名,采用方差分析对不同年龄组儿童的体质总分进行比较,采用成组设计t检验对不同性别儿童的体质总分进行比较,采用χ²检验对不同年龄组及不同性别的综合评级分布进行比较。结果 研究共对双流区5所公立幼儿园的1 077名 3 ～ 6 岁学龄前儿童进行体质测量,学龄前儿童体质测试总体合格率为 87.16% 。体质总分方面,男童及女童不同年龄组间的总分差异有统计学意义(P<0.05);3.5岁组、4岁组及4.5岁组的男女童体质总分存在差异,且均为女童优于男童。体质评级方面,男童及女童优秀率最高的年龄组分别为5.5岁组(7.69%)与4.5岁组(12.06%);各年龄组的女童的优秀率均高于男童,但仅有4.5岁组男女童的差异有统计学意义(P<0.05)。结论 成都市双流区 3 ～ 6 岁学龄前儿童体质水平较低;应针对不同年龄、不同性别制定个性化的干预策略,以增强学龄前儿童的体质发展水平。     

丹红注射液联合多奈哌齐治疗阿尔茨海默病的临床研究

目的探讨应用丹红注射液联合多奈哌齐治疗阿尔茨海默病的临床效果。方法选取2015年6月—2017年6月中国人民解放军白求恩国际和平医院收治的阿尔茨海默病患者106例,随机分成对照组(53例)与治疗组(53例)。对照组睡前口服盐酸多奈哌齐片,5 mg/次,1次/d。治疗组在对照组基础上静脉滴注丹红注射液,40 m L加入250 m L生理盐水,1次/d。两组均连续治疗4周。评价两组患者临床疗效,同时比较治疗前后两组患者简易精神状态量表(MMSE)评分、脑血流动力学和血清学指标。结果治疗后,对照组临床有效率为77.4%,显著低于治疗组的92.5%,两组比较差异具有统计学意义(P0.05)。治疗后,两组MMSE评分较治疗前均显著增加(P0.05);且治疗组比对照组升高更显著(P0.05)。治疗后,治疗组基底动脉(BA)和双侧大脑中动脉(MCA)的平均血流速度(MFV)值均显著升高(P0.05),搏动指数(PI)值显著下降(P0.05);且治疗后治疗组BA和双侧MCA的MFV值和PI值比对照组改善更显著(P0.05)。治疗后,两组血清血清磷酸化tau蛋白(P-tau)、丙二醛(MDA)、白细胞介素(IL)-8和超敏C反应蛋白(hs-CRP)水平较治疗前均显著降低(P0.05),超氧化物歧化酶(SOD)水平均显著增加(P0.05);且治疗组上述血清学指标比对照组改善更显著(P0.05)。结论应用丹红注射液联合多奈哌齐治疗阿尔茨海默病可有效改善患者脑血流状态,减轻机体氧化应激与炎症损伤,提高认知功能,延缓病情进展。     

桂芍镇痫片联合卡马西平治疗癫痫的临床研究

目的探讨桂芍镇痫片联合卡马西平片治疗癫痫的临床疗效。方法选取2017年5月—2018年5月江汉大学附属医院收治的78例癫痫患者为研究对象,所有患者根据治疗方法的不同分为对照组和治疗组,每组各39例。对照组口服卡马西平片,起始剂量0.2 g/次,2次/d,用药7 d后调整剂量,根据病情每周增加0.1～0.4 g,2次/d;治疗组在对照组治疗的基础上口服桂芍镇痫片,6片/次,3次/d。两组患者均连续治疗8周。观察两组的临床疗效,比较两组的癫痫放电、导联数目、癫痫发作次数、血清学指标和认知障碍评分。结果治疗后,对照组和治疗组的总有效率分别为74.36%、92.31%,两组比较差异有统计学意义(P0.05)。治疗后,两组癫痫放电、导联数目、癫痫发作次数均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)和S100β蛋白(S100β)水平均明显降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组血清学指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组蒙特利尔认知评估量表法(MoCA)评分均显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组MoCA评分明显高于对照组,两组比较差异具有统计学意义(P0.05)。结论桂芍镇痫片联合卡马西平片治疗癫痫的临床疗效较好,能改善癫痫症状,提高认知水平,调节血清学指标,具有一定的临床推广应用价值。     

脑苷肌肽联合阿替普酶治疗急性脑梗死的临床研究

目的探讨脑苷肌肽注射液联合注射用阿替普酶治疗急性脑梗死的临床疗效。方法选取2015年8月—2017年10月海安市人民医院收治的90例急性脑梗死患者为研究对象。根据入院编号将所有患者分为对照组和治疗组,每组各45例。对照组给予注射用阿替普酶,0.9 mg/(kg·d),总剂量的10%于短时间内静脉推注,剩余90%在1 h内静脉滴注。治疗组在对照组治疗的基础上静脉滴注脑苷肌肽注射液,20 mL加入0.9%氯化钠注射液250 mL中,1次/d。两组均连续治疗14 d。观察两组临床疗效,比较两组患者的美国国立卫生院脑卒中量表(NIHSS)评分、Barthel指数、血液流变学指标和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为82.2%、95.6%,两组比较差异具有统计学意义(P0.05)。治疗7、14d后,两组NIHSS评分显著降低,Barthel指数显著升高,同组治疗前后比较差异具有统计学意义(P0.05)。治疗7、14d后,治疗组NIHSS评分、Barthel指数显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组全血高切黏度、全血低切黏度、血浆黏度和红细胞压积水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组血液流变学指标显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组S100β蛋白、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)和白细胞介素1β(IL-1β)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组血清指标水平显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗期间,治疗组不良反应发生率为6.7%,显著低于对照组的15.6%,两组比较差异具有统计学意义(P0.05)。结论脑苷肌肽注射液联合注射用阿替普酶治疗急性脑梗死具有较好的临床疗效,可显著改善患者的神经功能评分和生活质量,降低炎性指标和血液黏度,具有一定的临床推广应用价值。