血清胆红素与冠脉病变程度及血脂的相关性分析

目的分析血清胆红素与冠脉病变程度及血脂的关系。方法对冠状动脉造影术确诊的冠心病者和非冠心病者进行病例-对照研究。结果冠心病组血清胆红素水平低于非冠心病组,差异有显著性(P＜0.05)。多元逐步回归分析血清直接胆红素进入回归方程,提示血清直接胆红素与冠脉病变程度呈独立负相关,其相关强度与甘油三脂(TG)和空腹血糖(FBS)相似。血清胆红素与血脂直线相关分析提示血清胆红素与甘油三脂、总胆固醇(TCHO)和低密度脂蛋白胆固醇(LDL-C)呈显著负相关。结论血清直接胆红素水平与冠脉病变程度呈独立负相关,低血清胆红素是冠状动脉粥样硬化的危险因素,血清胆红素与甘油三脂、总胆固醇和低密度脂蛋白胆固醇呈负相关。     

施普瑞对冠心病患者胰岛素敏感性的影响

目的观察施普瑞对冠心病患者胰岛素敏感性的影响.方法40例血压正常、非糖尿病的冠心病患者,施普瑞治疗前及1.2g/d治疗10周后,分别检测空腹血糖、空腹血浆胰岛素、血胆固醇、甘油三酯、高密度脂蛋白-胆固醇,计算胰岛素敏感指数,并以38例性别、年龄、体重指数相当的正常人为对照组.结果2组空腹血糖差异无显著性(P＞0.05),冠心病组空腹血浆胰岛素显著升高,胰岛素敏感性指数显著降低(P＜0.01),施普瑞治疗10周后,空腹血浆胰岛素水平明显下降(P＜0.01),胰岛素敏感性指数显著增高(P＜0.05),血脂代谢明显改善.结论施普瑞在纠正冠心病患者血脂代谢异常的同时,对其胰岛素敏感性也有明显的改善.     

海南省性罪错妇女11年性病感染情况调查分析

目的 通过对11年来性罪错人员性病感染情况的调查分析,掌握性病在性罪错妇女中流行的特点,为政府部门对性病防治政策的制定提供科学依据。方法 对1990年元月至2000年12月海南省妇女收容教育所被收教的性罪错妇女进行性病检查,统计其各种性病的发病人数,然后进行分析。结果 11年中共收教4780人,其中感染淋病、非淋菌性尿道炎(宫颈炎)、尖锐湿疣、梅毒、生殖器疱疹、HIV共2967例,阳性率为62．07％,其中非淋菌性尿道炎(宫颈炎)1826例(38．20％)、淋病469例(9、81％)、梅毒414例(8．7％)、尖锐湿疣246例(5．14％)、生殖器疱疹11例(0．23％)、HIV阳性1例(0．02%)。结论 性罪错妇女六种性病的患病率很高,达62．07％,其中非淋菌性尿道炎(宫颈炎)为其主要病种,淋病的患病率逐年下降,梅毒的患病率逐年上升,尖锐湿疣基本稳定,其流行特点值得我们重视。     

伤病比在医院维权中的运用

为了保证民法的公平原则,避免医疗纠纷赔偿案件审理中忽视患者本身病情所致的不良后果的情况,对损伤与疾病对患者预后的影响进行了研究.介绍了伤病比的来源,论述了伤病比在医疗纠纷处理中的适用 范围,伤病比的级别与医院承担的赔偿额度.指出应增强伤病比意识,促进医与法的完美结合.     

洛赛克治疗症状性胃食管反流病95例临床观察

目的了解洛赛克强力抑酸作用对胃食管反流病(GERD)患者临床症状改善及胃镜下食管炎症改善情况.方法将95例GERD病人随机分为两组,用洛赛克(20mg qd)50例,雷尼替丁(150mg Bid)45例,疗程4周,停药2周后胃镜复查,观察临床症状及食管炎症改善情况.结果治疗组临床症状改善有效率为91.6%,对照组为50.4%.治疗组胃镜下食管炎症改善有效率为70%,对照组为29.2%.治疗组明显优于对照组.结论对GERD病人抑制胃酸分泌,减轻其对食管粘膜的损伤和改善临床症状洛赛克有较好的疗效,其作用已被公认,但在食管炎症愈合方面疗效不太满意,如与促动力药物合用,可望更高疗效.     

A simple scoring system to estimate perioperative mortality following liver resection for primary liver malignancy—the Hepatectomy Risk Score (HeRS)

BackgroundSelection of the optimal treatment modality for primary liver cancers remains complex, balancing patient condition, liver function, and extent of disease. In individuals with preserved liver function, liver resection remains the primary approach for treatment with curative intent but may be associated with significant mortality. The purpose of this study was to establish a simple scoring system based on Model for End-stage Liver Disease (MELD) and extent of resection to guide risk assessment for liver resections.MethodsThe 2005–2015 NSQIP database was queried for patients undergoing liver resection for primary liver malignancy. We first developed a model that incorporated the extent of resection (1 point for major hepatectomy) and a MELD-Na score category of low (MELD-Na =6, 1 point), medium (MELD-Na =7–10, 2 points) or high (MELD-Na >10, 3 points) with a score range of 1–4, called the Hepatic Resection Risk Score (HeRS). We tested the predictive value of this model on the dataset using logistic regression. We next developed an optimal multivariable model using backwards sequential selection of variables under logistic regression. We performed K-fold cross validation on both models. Receiver operating characteristics were plotted and the optimal sensitivity and specificity for each model were calculated to obtain positive and negative predictive values.ResultsA total of 4,510 patients were included. HeRS was associated with increased odds of 30-day mortality [HeRS =2: OR =3.23 (1.16–8.99), P=0.025; HeRS =3: OR =6.54 (2.39–17.90), P<0.001; HeRS =4: OR =13.69 (4.90–38.22), P<0.001]. The AUC for this model was 0.66. The AUC for the optimal multivariable model was higher at 0.76. Under K-fold cross validation, the positive predictive value (PPV) and negative predictive value (NPV) of these two models were similar at PPV =6.4% and NPV =97.7% for the HeRS only model and PPV =8.4% and NPV =98.1% for the optimal multivariable model.ConclusionsThe HeRS offers a simple heuristic for estimating 30-day mortality after resection of primary liver malignancy. More complicated models offer better performance but at the expense of being more difficult to integrate into clinical practice.     

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach

ObjectiveTo assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach.MethodsA scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 “overall” indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 “equity-related” indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach.ResultsOverall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, “D”) than that for equity-related indicators (average score of 17%, “F”). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients’ immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors.ConclusionOne year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several “best practices” in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00496-6.