双水平气道正压通气治疗中晚期妊娠重度哮喘的临床研究

目的研究无创通气在中晚期妊娠重度哮喘治疗中对胎儿、动脉血气指标（pH、PaO2、PaCO2、SaO2）、心率（HR）和呼吸频率（RR）的影响。方法将30例中晚期妊娠重度支气管哮喘患者随机分为无创通气（双水平鼻/面罩NIPPV）＋药物治疗组（实验组15例）和对照组（15例）。比较治疗后两组动脉血气指标（pH、PaO2、PaCO2、SaO2）变化以及对胎儿发育的影响,观察患者临床症状、HR和RR。结果实验组血气指标的改善以及监测HR、RR下降均优于对照组（P〈0.01）。结论在常规药物治疗的基础上,采用双水平鼻/面罩NIPPV用于妊娠期重度哮喘的治疗,安全有效,可减少气管插管率,减少对胎儿的不良影响。     

不同妊娠期孕妇甲状腺功能指标参考范围建立

目的:探讨不同妊娠期甲状腺功能指标参考范围,为本地区妊娠期甲状腺疾病提供可靠的诊断依据。方法:选择首次来本院进行甲状腺功能检测的不同妊娠期妇女为研究对象,分为妊娠早期(孕1~12周)、妊娠中期(孕13~27周)、妊娠晚期(孕28~40周),同期非妊娠妇女为对照组,各组220例,行促甲状腺激素(TSH)和游离甲状腺素(FT4)筛查。结果:检测中位数TSH分别为妊娠早期0.02~4.27mIU/L,妊娠中期0.08~5.07mIU/L,妊娠晚期期0.48~5.08mIU/L;FT4分别为妊娠早期12.08~24.80pmol/L,妊娠中期9.76~17.82pmol/L,妊娠晚期9.27~16.10pmol/L。与其他妊娠期及对照组比较,妊娠早期TSH水平最低,FT4最高(P<0.05)。结论:建立本地区不同妊娠期甲状腺功能指标参考值,有利于妊娠期甲状腺疾病的筛查及诊治。     

孕妇清火丸口服和肤舒止痒膏外洗治疗妊娠期肝内胆汁淤积症30例

目的:探讨口服孕妇清火丸和肤舒止痒膏外洗在妊娠期肝内胆汁淤积症治疗中的临床应用。方法:选取ICP患者60例,将其随机分为治疗组与对照组,每组30例。其中对照组给予思美泰静脉滴注治疗,治疗组给予口服孕妇清火丸和肤舒止痒膏外洗联合应用治疗,疗程为14 d。观察并比较两组患者瘙痒症状改善情况、孕周、肝功能指标的改善情况及妊娠结局等,并观察两组患者的不良反应。结果:两组患者治疗后,皮肤瘙痒症状出现明显好转,与治疗前比较,差异具有统计学意义(P<0.05);治疗后,治疗组患者瘙痒症状评分较对照组低,差异有统计学意义(P<0.05);治疗后,治疗组患者孕周为(37.1±0.12)周,与对照组患者(34.3±0.19)周比较,差异有统计学意义(P<0.05);治疗后,两组患者的总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)及胆汁酸(TBA)水平都明显降低,与治疗前比较,差异有统计学意义(P<0.05);并且与对照组比较,治疗组治疗后TBIL、ALT及TBA水平下降更显著,有统计学意义(P<0.05);对照组在治疗过程中出现恶心、头痛、面色潮红等不良反应,而治疗组无不良反应发生。结论:口服孕妇清火丸和肤舒止痒膏外洗治疗妊娠期肝内胆汁淤积症具有明显的治疗效果,同时无明显的不良反应发生,值得在临床上大力的推广与应用。     

新冠疫情期间上海市基层医务人员职业倦怠现况调查

目的：调查新冠疫情期间基层医务人员职业倦怠情况,为医院管理决策的改进和减轻医务人员职业倦怠提供参考。方法：2021年1—12月,采用问卷调查的方法,对上海市4家社区卫生服务中心医务人员进行现况调查。结果：162名调查对象中,有103人（63.6%）存在职业倦怠,有132人（81.5%）经常参与或每天参与疫情防控一线工作。多因素logistic回归分析结果显示,学历、喜欢社区医生这个职业、防疫工作中常遇到无理取闹情况、家人对工作非常理解和支持、工作时很少得到支持和帮助等因素是基层医务人员职业倦怠的影响因素。结论：新冠疫情期间,基层医务人员职业倦怠发生率较高,应采取合理安排工作、协调可利用资源提供支持、加强心理韧性水平并进行早期心理疏导介入干预等措施,改善医务人员职业倦怠状况。     

Syngeneic B16-F1 cells are more efficient than allogeneic Cloudman cells as antigen source in DC-based vaccination in the B16-F1 murine melanoma model

A major obstacle to obtaining relevant results in cancer vaccination has been the lack of identification of immunogenic antigens. Dendritic cell (DC)-based cancer vaccines used preventively may afford protection against tumor inoculation, but the effect of antigen choice on anti-tumor protection is not clear. When using irradiated syngeneic tumor cells to load DCs, tumor self-antigens are provided, including tumor-associated antigens (TAAs) and neoantigens generated by tumor mutations. On the other hand, allogeneic tumor cells could only supply shared TAAs. To assess the advantages of each source in protective vaccination, we analyzed in C57BL/6 mice the effect of loading DCs with irradiated syngeneic B16-F1 or allogeneic Cloudman melanoma cells; both cell lines were characterized by whole exome sequencing and RNAseq. Tumor cell components from the two irradiated cell lines were efficiently internalized by DCs, and transported to MHC-class II positive tubulovesicular compartments (MIICs). DCs loaded with allogeneic irradiated Cloudman cells (DC-ApoNec_ALLO) induced a partially effective anti-melanoma protection, although Cloudman and B16-F1 cells share the expression of melanocyte differentiation antigens (MDAs), cancer-testis antigens (CTAs) and other TAAs. DCs loaded with syngeneic B16-F1 cells (DC-ApoNec_SYN) established a more potent and long-lasting protection and induced a humoral anti-B16F1 response, thus suggesting that neoepitopes are needed for inducing long-lasting protection.     

Residential mobility during pregnancy and the potential for ambient air pollution exposure misclassification

Studies of environmental exposures and adverse birth outcomes often rely on maternal address at birth obtained from the birth certificate to classify exposure. Although the gestational age of interest is often early pregnancy, maternal addresses are not available for women who move during pregnancy when using maternal addresses abstracted from birth certificates. The aim of this study was to explore the extent of ambient air pollutant exposure misclassification due to maternal residential mobility during pregnancy among the subgroup of a New York birth cohort. The authors obtained the maternal addresses at birth from the New York Birth Certificate, and the maternal addresses by gestational age from the National Birth Defect Prevention Study for New York participants for the study period 1997-2002. Among the 1324 mothers, 172 (13.0%) moved once during pregnancy and 46 (3.5%) moved at least twice. When accounting for multiple addresses among some individuals, of the 218 mothers who moved, 38 (2.9%) moved in the 3rd to 8th weeks after conception (critical period, not exclusive from the 1st trimester), 80 (6.0%) moved in the 1st trimester, 112 (8.5%) in the 2nd trimester, and 51 (3.9%) in the 3rd trimester. Air monitoring data from the New York Department of Environmental Conservation were used as surrogates to compute the ambient ozone and PM₁₀ exposures for mothers with complete residential data. This study estimates exposure using maternal address at birth obtained from birth certificates, compared to exposure estimates when using maternal addresses by gestational age obtained from maternal interview, the gold standard. Average exposures during pregnancy were similar when using interview based versus birth certificate addresses (0.035 vs. 0.035 ppm for ozone, and 20.11 vs. 20.09 μg/m³ for PM₁₀, respectively). Kappa statistics and percent agreement were calculated to measure the degree of agreement for dichotomous exposure measurements (<median vs.>=median) and weighted kappa for quartile exposure measurements by gestational age. All the statistics indicated a high agreement between the two measurements. For mothers who moved, the majority maintained their address in the same exposure region. Given the low mobility during pregnancy and the short distance moved, the exposure assignment did not change substantially when using the more accurate interview based addresses in this study. However, the level of observed agreement may decrease for studies that require smaller geographic zones for exposure assignments or with more mobile study populations.     

正常及妊娠期高血压疾病胎盘组织中单胺类递质的相关研究

目的:通过对正常孕妇及妊娠期高血压疾病孕妇胎盘组织中去甲肾上腺素(NE)、5-羟色胺(5-HT)及多巴胺(DA)的测定,探讨其与妊娠期高血压疾病发病的关系。方法:应用免疫组织化学(免疫组化)链霉素抗生物素-过氧化物酶法,对31例正常早、中、晚孕妇女(正常孕妇组),及38例妊娠高血压、轻度子痫前期、重度子痫前期孕妇的胎盘组织进行NE和DA定位及定量。结果:①定位:正常孕妇组中,早期孕妇的胚胎绒毛滋养细胞NE、DA及5-HT免疫反应呈现强阳性,定位于细胞滋养细胞的细胞膜及细胞浆中;中、晚期孕妇为阳性,定位于合体滋养细胞的细胞膜及细胞浆,以及毛细血管内皮。妊娠期高血压疾病孕妇组定位同正常组。②定量:正常孕妇组NE由孕早期的1.595±0.018降至中、晚期的1.488±0.019和1.419±0.014(P<0.01);DA由孕早期的1.552±0.067,降至中、晚期的1.369±0.051和1.302±0.013(P<0.01),5-HT由孕早期的1.497±0.022升至中、晚期的1.538±0.017和1.554±0.013(P<0.01)。妊娠期高血压疾病组依据病情程度不同DA依次为1.378±0.029、1.305±0.023和1.237±0.024(P<0.01);NE依次为1.494±0.018、1.624±0.014和1.917±0.044(P<0.01),5-HT依次为1.411±0.034、1.374±0.017和1.324±0.014(P<0.01)。结论:正常孕妇组孕早期胎盘组织单胺类递质定位于绒毛滋养细胞中,于孕中、晚期则定位于合体滋养细胞中,正常孕妇组NE及DA含量随孕周增加而逐渐降低,5-HT逐渐升高。妊娠期高血压疾病孕妇组胎盘组织的定位同正常孕妇组的孕晚期相同,NE及5-HT含量随妊娠期高血压疾病病情加重而逐渐升高,DA含量则相反。     

中西医临床科室对插配合-中西医结合发展路线图

分析了中西医结合事业困境的根本原因,并且提出了中西医临床科室对插配合的策略和住院期中西医结合的概念.     

中国中西部8县母亲孕期贫血与儿童发育迟缓的关联性研究

目的 了解中国中西部8县的母亲孕期贫血状况,并探讨其与儿童发育迟缓的关联性,为相关干预措施提供依据。方法 2016年10月-2017年1月采用横断面研究和按容量比例概率抽样法,调查了中国中西部地区8个县的1 100名1~59月龄儿童母亲孕期贫血状况,使用年龄与发育进程问卷(ASQ)评价儿童发育状况。运用多因素Logistic回归分析,计算调整混杂因素后的比值比(OR)和95%置信区间(95%CI)。结果 被调查地区儿童母亲孕期贫血患病比例为38.1%。控制了儿童性别、月龄、孩次、分娩方式、出生胎龄、出生体重、营养不良、儿童贫血、家庭年人均纯收入及母亲文化程度等因素后,孕期贫血是儿童沟通能区(OR=2.02,95%CI:1.09~3.75,P=0.025)和ASQ总评分(OR=1.63,95%CI:1.12~2.38,P=0.011)的可疑发育迟缓的危险因素。结论 被调查地区儿童母亲孕期贫血与儿童可疑发育迟缓的发生存在关联。     

乳腺疏导推拿配合中药外敷治疗哺乳期急性乳腺炎的疗效观察

目的观察运用乳腺疏导推拿配合中药外敷治疗哺乳期急性乳腺炎患者的疗效。方法将符合标准的60例哺乳期急性乳腺炎患者,随机分成3组,推拿组、外敷组及观察组各20例。推拿组给予乳腺疏导推拿治疗,外敷组给予中药外敷治疗(乳香、香附、郁金、生白芷、青皮及皂角刺等),观察组给予乳腺疏导推拿配合中药外敷治疗。观察3组治疗1个疗程后的有效率、临床症状的恢复时间、白细胞(WBC)及C-反应蛋白(CRP)水平。结果 3组治疗前后的有效率、临床症状的恢复时间、WBC、CRP比较,差异均有统计学意义(均P<0.05),观察组明显优于推拿组及外敷组(P<0.05)。结论乳腺疏导推拿和中药外敷都可以改善哺乳期急性乳腺炎患者临床症状、WBC及CRP水平,但乳腺疏导推拿配合中药外敷的疗效更加显著。