卵巢未成熟畸胎瘤临床特征及分析

目的;探讨未成熟畸胎瘤的临床特征,方法：对1979年8月至1999年7月收治的49例卵巢未成熟畸胎瘤进行回顾性分析。结果：49例卵巢未成熟畸胎瘤患者30岁以下者占75．49％,临床分期I期26例,II期6例,III期13例,IV期4例,其中实行保守性手术的5年生存率较根治性手术5年生存率稍低但无统计学差异,49例中发生于单仙卵巢的占88．2％,其中左侧占53．6％,结论：卵巢未成熟畸台瘤主要发生在青少年,单侧尤其左侧卵巢好发,临床分期与预后有关,手术方式与生存率无必然规律,对年轻患者要求生育者,可考虑保行留生育功能的手术方式。     

Seminal cell-free DNA and sperm characteristic’s: An added biomarker for male infertility investigation

Cell-free DNA (Cf-DNA) fragments may constitute an easy-to-measure molecular tool for guiding the choice of care provided to infertile couples who benefit assisted reproductive technology (ART) programmes. Data on Cf-DNA levels in the seminal plasma of men with sperm alterations are scarce. The objective of the present study was to quantify the presence of Cf-DNA in semen by using a quantitative real-time PCR. We compared men with abnormal sperm characteristics (n = 21) with normospermic controls (n = 21). The PCR assay evidenced significantly higher mean Cf-DNA levels in patients with sperm abnormalities than in controls (2.09 versus 1.18 µg/ml, respectively; p = .0003). The Cf-DNA levels were notably higher in men with azoospermia (3.65 µg/ml, versus 1.34 µg/ml in matched controls; p = .03) and men with teratozoospermia (1.80 µg/ml, versus 1.29 µg/ml in matched controls; p = .008). Our data report a significant association between elevated Cf-DNA levels and sperm abnormalities. These results may open up new diagnostic and prognostic perspectives in male infertility.     

基于Apriori算法的含丹参-当归药对的方剂用药特点与规律分析

目的 通过挖掘整理含丹参-当归的方剂,利用统计软件系统分析其用药规律。方法 检索筛选《中医方剂大辞典》中含丹参-当归药对的方剂,利用Excel软件分析中药使用频次、频率及丹参-当归配伍特征和主治中医病证频次,运用SPSS Modeler 18.0软件关联规则Apriori算法进行数据挖掘。结果 通过统计共筛选出含丹参-当归药对的方剂390首,频次统计分析发现涉及中药504味,使用频次≥60的中药共22味,除丹参、当归外,核心高频药物为川芎、甘草、白芍、肉桂、地黄、牛膝6味。通过组方规律分析得到常用中药组合有丹参-当归-川芎、丹参-当归-甘草、丹参-当归-白芍。主治病证涉及105种,频次≥10的中医病证10种,以瘀血疼痛病症、妇科病症为主。通过网络可视化得到治疗月经病的核心中药组合为丹参-当归-川芎-白芍-香附,治疗痹证的核心中药组合为丹参-当归-川芎-肉桂,治疗虚劳病核心中药组合为丹参-当归-牛膝-肉桂-防风。结论 与丹参-当归配伍的高频中药为白芍、川芎、肉桂等,优势病证为月经病、痹证和虚劳病,揭示了丹参-当归药对的用药规律,为该药对在临床合理用药及深入研究与开发提供科学依据。     

霍山石斛多糖的结构分析、生物活性研究进展及与不同种间多糖成分差异性分析

霍山石斛Dendrobium huoshanense作为一种名贵的滋补类中药,收载于《中国药典》2020年版。多糖为其主要活性成分之一,具有免疫调节、保肝、抗肿瘤、抗氧化和抗炎等药理活性。通过查阅国内外文献,基于中国知网及PubMed等中英文文献数据库分析当前研究现状及研究热点;总结霍山石斛多糖（Dendrobium huoshanense polysaccharide,DHP）的提取分离、结构解析及其生物活性;分析其多糖成分与其他常用石斛品种的差异性。以期更好地开发利用DHP,为DHP产品的深入开发与研究及质量标准完善提供参考和思路。     

中重度僵硬型颈椎后凸畸形的形态特点与手术效果

【摘要】 目的：评估中重度僵硬型颈椎后凸的矢状位形态特征与手术效果,并分析影响手术矫形效果及神经功能转归的相关因素。方法：回顾性分析2014年1月~2021年3月在我院接受手术治疗的34例中重度僵硬型颈椎后凸畸形患者临床资料,中重度后凸定义为局部后凸角≥20°,僵硬型后凸定义为过伸位X线片示后凸柔韧性＜30%或颈椎CT示后凸节段骨性强直。患者接受手术时年龄为50.1±17.6岁（14~83岁）,其中男性21例,女性13例。致畸因素包括退变性后凸18例,先天畸形5例,医源性后凸5例,强直性脊柱炎3例,创伤性后凸3例。行前路、后路或前后路联合手术分别为24例、5例及5例;其中5例行三柱截骨矫形手术。收集所有患者术前一般资料、围手术期参数和随访信息,并利用疼痛视觉模拟评分（visual analogue scale,VAS）、颈椎功能障碍指数（neck disability index,NDI）及日本骨科协会改良颈椎评分（modified Japanese Orthopaedic Association scale,mJOA）评估患者颈部疼痛和神经功能状态。通过颈椎侧位X线片测量患者术前、术后即刻及末次随访时的局部后凸角、T1倾斜角、颈椎矢状面垂直轴及颌眉垂线角,并定义畸形成角系数为局部后凸角/后凸累及节段数。根据数据分布情况选用独立样本或配对样本t检验、Mann-Whitney U检验、Wilcoxon signed-rank检验、卡方检验或Fisher精确概率检验比较上述影像学参数与评分指标在不同时间点或不同患者亚组间的分布。结果：患者局部后凸角中位数为25°（20°~100°）,畸形成角系数中位数为7.5°（5°~25°）。根据mJOA评分将患者分为两组,重度颈脊髓病组患者的畸形成角系数显著大于轻中度颈脊髓病组[9.3°（5.0°~25.0°） vs 7.0°（5.3°~10.0°）,P=0.016];手术时长277±140min,中位失血量150（20~2000）ml。局部后凸角与畸形成角系数分别由术前的31.6°±19.5°与8.8°±4.2°矫正至术后2.8°±5.7°与0.9°±1.9°,差异有统计学意义（P<0.001）;经过1.0±0.8（0.3~3.1）年的影像学随访,末次随访时局部后凸角与畸形成角系数与术后即刻相比差异均无统计学意义（P>0.05）;经过3.0±1.5年的临床随访,末次随访时患者VAS、NDI及mJOA评分分别由术前的5.3±1.8分、（27.7±16.5）%及11.9±4.3分改善至1.3±1.2分、（7.7±7.1）%及14.8±2.2分,差异有统计学意义（P<0.001）。畸形成角系数的矫形幅度与mJOA评分的改善幅度呈正相关（Spearman r=0.417,P=0.018）。共有14例患者（41.2%）术后出现早期并发症,包括10例（29.4%）神经系统并发症;共有8例患者（23.5%）出现远期并发症。发生术后早期并发症的患者病程更长,最高截骨等级>2级的比例更高,手术出血量更大（P<0.05）。结论：选择恰当的手术方式治疗中重度僵硬型颈椎后凸畸形可以获得满意的临床疗效。畸形成角系数可以作为形态学评估的重要参数,并在一定程度上预测术后神经功能改善情况。     

COVID-19 in solid organ transplant recipients: A national cohort study from Sweden

Solid organ transplant (SOT) recipients run a high risk for adverse outcomes from COVID-19, with reported mortality around 19%. We retrospectively reviewed all known Swedish SOT recipients with RT-PCR confirmed COVID-19 between March 1 and November 20, 2020 and analyzed patient characteristics, management, and outcome. We identified 230 patients with a median age of 54.0 years (13.2), who were predominantly male (64%). Most patients were hospitalized (64%), but 36% remained outpatients. Age >50 and male sex were among predictors of transition from outpatient to inpatient status. National early warning Score 2 (NEWS2) at presentation was higher in non-survivors. Thirty-day all-cause mortality was 9.6% (15.0% for inpatients), increased with age and BMI, and was higher in men. Renal function decreased during COVID-19 but recovered in most patients. SARS-CoV-2 antibodies were identified in 78% of patients at 1–2 months post-infection. Nucleocapsid-specific antibodies decreased to 38% after 6–7 months, while spike-specific antibody responses were more durable. Seroprevalence in 559 asymptomatic patients was 1.4%. Many patients can be managed on an outpatient basis aided by risk stratification with age, sex, and NEWS2 score. Factors associated with adverse outcomes include older age, male sex, greater BMI, and a higher NEWS2 score.     

2011-2018年中国手足口病发病的时空特征及影响因素研究

目的 分析我国手足口病的时空特征,探讨社会、经济、人口和卫生服务等因素对我国手足口病发病的影响,为手足口病疫情防控提供参考依据。方法 采用贝叶斯时空模型对手足口病数据进行拟合,评估手足口病的时空变化,并识别手足口病发病风险与社会、经济、人口和卫生服务等因素的潜在关联。结果 2011-2018年,我国共报告手足口病例17 118 050例,死亡2 283例,2011-2014年报告发病率呈波动上升趋势,2014-2018年报告发病率呈波动下降趋势,报告死亡率一直呈波动下降趋势。手足口病的发病具有空间聚集性,报告发病率最高的地区为华南地区且为热点区域及高风险区域,报告发病率最低的为西北地区,冷点区域及低风险区域也集中在其部分区域。手足口病发病风险与人均地区生产总值（RR=3.54）、每万人规模以上工业企业单位数（RR=1.61）、城市化率（RR=3.00）、人口出生率（RR=2.36）、每万人医疗机构床位数（RR=3.40）和人均公园绿地面积（RR=0.57）有关。结论 2011-2018年我国手足口病防控重点区域为东南沿海地区,在加快城市化进程的同时需考虑增加人均公园绿地面积,以降低手足口病的发病率。     

Clinical Characteristics and Controllable Risk Factors of Osteoporosis in Elderly Men with Diabetes Mellitus

ObjectiveTo analyze the clinical characteristics and controllable risk factors of osteoporosis in elderly men with type‐2 diabetes mellitus (T2DM).MethodsA total of 250 elderly OP patients with T2DM were included in the present study. Patients with one or more common chronic diseases (including hypertension, coronary heart disease, heart failure, chronic bronchitis, chronic nephrosis, and cirrhosis), and a course of more than 3 years were defined as complicated with chronic diseases. Blood glucose, cholesterol, triglyceride, low‐density lipoprotein, high‐density lipoprotein, calcium, phosphorus, glycosylated hemoglobin, urea nitrogen, creatinine, fasting insulin, liver function, and 25‐hydroxy vitamin D3 levels were measured. Bone mineral density was also measured.ResultsA total of 16 patients (6.4%) had severe osteoporosis. Furthermore, 66 patients (26.4%) had blood glucose control that reached the standard, while 176 patients (70.4%) used more than two anti‐diabetic drugs. The serum testosterone level was lower than the median in 87 patients (34.8%) and in 56 smokers (22.4%). Furthermore, 138 patients (55.2%) were overweight and obese, six patients (2.4%) were underweight, 197 patients (78.8%) had chronic diseases, 88 patients (35.2%) were sticking to exercise, and 117 patients (46.8%) had less exercise. In addition, 92 patients (36.8%) were treated with osteotrophy‐protective agents, and 24 patients (9.6%) received anti‐osteoporosis therapy. Smoking, poor glycemic control, low testosterone levels, less exercise, and complications with chronic diseases were the most relevant controllable risk factors.ConclusionFor elderly male osteoporosis patients with type‐2 diabetes, smoking cessation, blood sugar control up to the standard, regular exercise, active prevention and treatment of complications, and appropriate testosterone supplementation are necessary for preventing and curing osteoporosis.     

To what extent do community characteristics drive health facility delivery? Findings among Women who had recent live births in Nigeria

Existing studies have established several individual drivers of health facility delivery in many developing countries. However, the community characteristics that drive health facility delivery have been less studied across developing countries. This study thus examines the extent to which community characteristics drives health facility delivery among women who had recent live births in Nigeria based on data from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample size of 7,342 women was analysed. The outcome variable was health facility delivery. The explanatory variables were selected individual and community characteristics. Results show 39.7% prevalence of health facility delivery among the women. Findings further reveals that the community characteristics have significant effects on the variations in health facility delivery across the communities. Community characteristics significantly drive health facility delivery in Nigeria. More community-based priority actions are required to improve demand for health facility delivery in the country.