培哚普利抗高血压及对左室肥厚的逆转作用

目的观察培哚普利降压疗效及对原发性高血压(EH)左室肥厚(LVH)的逆转作用。方法120例患者予培哚普利4mg，po.qd，治疗32wk，观察EH患者的降压疗效，用超声心动图(UCG)测量患者LVH的改善情况。结果治疗后SBP、DBP均较治疗前明显降低。舒张早期流速峰值增加、A／E明显下降。室间隔舒张末期厚度、左室后壁舒张末期厚度均明显下降，舒张功能改善。结论培哚普利能有效降低BP，对EH的LVH有逆转作用。     

人工智能技术在辅助耳鼻咽喉科医师了解过敏性鼻炎患者需求中的应用

利用人工智能技术分析近年中国互联网用户对于过敏性鼻炎（allergic rhinitis,AR）的网上检索信息,以帮助耳鼻咽喉科医师更好地了解AR患者的实际需求,从而在临床实践中更加合理地对患者进行管理。     

人性化护理干预对膀胱癌围术期患者治疗依从性和生活质量的影响

目的探讨人性化护理干预对膀胱癌围术期患者治疗依从性和生活质量的影响。方法选择2011年1月~2014年1月来我院泌尿外科行手术治疗的60例膀胱癌患者为研究对象,根据护理方法不同随机分为干预组和对照组各30例,对照组采取随机对症护理,干预组着重实施围术期护理,尤其是心理护理干预,比较两组患者的依从率、生活质量FACT各项评分、护理满意度。结果干预组患者的治疗依从率达93.3%,对照组患者的治疗依从率达73.3%,两组比较,差异有统计学意义(χ2=6.378,P<0.05)。干预组患者FACT评价中的生理状况、社会/家庭状况、情感状况、功能状况评分显著高于对照组,差异存在统计学意义(P<0.05)。干预组的护理满意度达93.3%,显著高于对照组(70.0%),组间比较,差异具有统计学意义(P<0.05)。结论对膀胱癌手术患者实施人性化护理干预,有利于提高患者治疗的依从性,改善患者术后的生活质量,提高患者对医院护理人员的护理满意度。     

2014—2018年度国家自然科学基金中医肿瘤领域资助项目情况分析

通过对2014-2018年度国家自然科学基金中医肿瘤领域面上、青年、地区基金项目资助情况进行分析,以期对本领域研究者提供参考。分析结果显示,中医肿瘤领域获资助情况与中医学科整体获资助情况基本一致。获得资助数目的依托单位以中医药研究机构为主,获资助项目的主要特点为：从临床实际需求出发,紧扣研究前沿,使用新技术及新方法。     

心电图与超声心动图在原发性高血压左心室肥厚诊断中的应用价值对比

目的探讨心电图（ECG）与超声心动图（UCG）在原发性高血压左心室肥厚（LVH）诊断中的应用价值。方法回顾性分析了2007年7月～2012年7月入住我院的200例原发性高血压患者的ECG与UCG的资料,对其进行统计学分析。结果 ECG检出LVH49例（24.5%）,UCG检出LVH 146例（73.0%）,二者检出率存在显著性差异（P〈0.01）。其中Ⅰ级高血压28例,ECG与UCG检出LVH比率分别为7.14%（2/28）、32.14%（9/28）;Ⅱ级高血压69例,ECG与UCG检出LVH比率分别为13.04%（9/69）、62.32%（43/69）;Ⅲ级高血压103例,ECG与UCG检出LVH比率分别为36.89%（38/103）、91.26%（94/103）。结论 ECG与UCG在原发性高血压左心室肥厚检测中存在互补关系,应综合性地运用两种方法才能提高原发性高血压LVH的检出率,从而降低原发性高血压患者的致残率及病死率。     

Evaluation of the Chinese Adult Strabismus-20 （CAS-20） questionnaire using Rasch analysis

ObjectiveTo further refine the Chinese Adult Strabismus-20 （CAS-20） health-related quality of life（HRQOL） questionnaire using Rasch analysis. MethodsIn this cross-sectional study, the CAS-20 questionnaire was independently completed by 246 adult strabismus patients. Based on the score for each item, Rasch analysis was performed on the original CAS-20 using the following aspects： dimensionality, response order, local dependence, infit and outfit analysis, differential item function, subject targeting and confirmatory dimensionality. ResultsThe original CAS-20 was divided into 4 subscales, which were labeled ″self-perception″, ″interaction″, ″reading function″, and ″general function″. Response ordering was appropriate for all of the 4 subscales. As a result of infit and outfit analysis, 3 items were removed, one each from ″self-perception″, ″reading function″, and ″general function″. No significant differential item function was found for sex or age. Compared with the ability of the patients and item difficulty, the 3 subscales matched well except for ″reading function″. ConclusionThe original CAS-20 was reduced to 17 items, and divided into 4 subscales, which were ″self-perception″, ″interaction″, ″reading function″, and ″general function″. Subject response choices saved 5 test options. The refined CAS-20 may prove to be more responsive to HRQOL changes in adult strabismus patients.     

Quality of primary health care in China: an analysis of data from a nationwide longitudinal survey

Background

China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.

魏氏鼻咽通气道在鼾症患者气管插管前经声门上喷射通气中的应用效果

目的 评价魏氏鼻咽通气道在鼾症患者气管插管前经声门上喷射通气应用的安全性与可行性。方法 选择2019年1～11月在解放军第九一○医院拟行全麻的鼾症患者50例,采用随机数字表法分为魏氏声门上喷射通气组（W组）与面罩通气组（M组）,每组25例。麻醉诱导后,W组经鼻插入魏氏鼻咽通道行声门上喷射通气,M组双手扣面罩通气。5 min后气管插管,记录在给氧去氮5 min自主呼吸时（T₀）、麻醉诱导后无自主呼吸1 min（T₁）、2 min（T₂）、3 min（T₃）、4 min（T₄）和5 min后插管后即刻（T₅）用超声测量的膈肌波动振幅均值、呼末二氧化碳分压（P_ETCO₂）,动脉血气[动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、血氧饱和度（SpO₂）];记录过程中SpO₂<90%、平均动脉压（MAP）和心率（HR）波动≥术前20%的发生情况,并记录通气相关并发症的发生情况。结果 两组患者膈肌呼吸运动振幅、PaO₂、PaCO₂和P_ETCO₂指标在T₀时差异无统计学意义（P>0.05）;W组患者膈肌呼吸运动振幅和PaO₂较高,W组患者PaCO₂和P_ETCO₂较低,差异有统计学意义（P<0.05）;与T₀时比较,两组患者T₁～T₅时膈肌呼吸运动振幅和PaO₂升高,PaCO₂和P_ETCO₂降低,差异有统计学意义（P<0.05）;分组与时间对各指标的差异存在交互作用,差异有统计学意义（P<0.05）。W组患者下颌角皮肤红肿淤青、胃肠胀气的发生率低于M组,差异有统计学意义（P<0.05）。结论 魏氏声门上喷射鼻咽通气道可为鼾症伴有肥胖患者气管插管提供满意的声门上通气效果,且安全性较好。     

DhhP,a Cyclic di-AMP Phosphodiesterase of Borrelia burgdorferi,Is Essential for Cell Growth and Virulence

Cyclic di-AMP (c-di-AMP) is a recently discovered second messenger in bacteria. Most of work on c-di-AMP signaling has been done in Gram-positive bacteria, firmicutes, and actinobacteria, where c-di-AMP signaling pathways affect potassium transport, cell wall structure, and antibiotic resistance. Little is known about c-di-AMP signaling in other bacteria. Borrelia burgdorferi, the causative agent of Lyme disease, is a spirochete that has a Gram-negative dual membrane. In this study, we demonstrated that B. burgdorferi BB0619, a DHH-DHHA1 domain protein (herein designated DhhP), functions as c-di-AMP phosphodiesterase. Recombinant DhhP hydrolyzed c-di-AMP to pApA in a Mn²⁺- or Mg²⁺-dependent manner. In contrast to c-di-AMP phosphodiesterases reported thus far, DhhP appears to be essential for B. burgdorferi growth both in vitro and in the mammalian host. Inactivation of the chromosomal dhhP gene could be achieved only in the presence of a plasmid-encoded inducible dhhP gene. The conditional dhhP mutant had a dramatic increase in intracellular c-di-AMP level in comparison to the isogenic wild-type strain. Unlike what has been observed in Gram-positive bacteria, elevated cellular c-di-AMP in B. burgdorferi did not result in an increased resistance to β-lactamase antibiotics, suggesting that c-di-AMP''s functions in spirochetes differ from those in Gram-positive bacteria. In addition, the dhhP mutant was defective in induction of the σ^S factor, RpoS, and the RpoS-dependent outer membrane virulence factor OspC, which uncovers an important role of c-di-AMP in B. burgdorferi virulence.     

冠心病患者冠状动脉旁路移植术近期预后的影响因素分析

目的 分析影响冠心病患者冠状动脉旁路移植术(CABG)近期预后的相关因素,旨在为改善CABG术的效果提供一些依据。方法 收集2019年6月—12月在广东省人民医院心血管外科接受初次CABG手术的65例患者的临床资料,分别比较纳入患者的术前、术中及术后临床指标及手术效果,筛选出可能影响CABG术近期预后的相关因素。结果 纳入接受体外循环CABG术患者55例,非体外循环CABG术(OPCABG)患者10例。年龄高导致CABG术后非正常(死亡和自动出院)出院率增加(P＝0.024);OPCABG(P＝0.009)、正高职称医师主刀(P＝0.027)可减少术后住院时间;同期处理心脏瓣膜可能增加术后并发症的发生(P＝0.012);吸烟者术后心功能恢复较慢(P＝0.017)。体外循环时间与重症监护病房时间呈正相关(r＝0.621,P＜0.001)。65例患者中院内死亡1例,死亡率1.54%。结论 年龄、OPCABG、同期处理瓣膜、吸烟、正高职称医师主刀、术前高密度脂蛋白水平和体外循环时间是可能影响冠心病患者CABG近期预后的因素。