改良Sugiura术治疗门静脉脉高压症20例报告

目的：探讨改良Sugiura术治疗门静脉高压症的疗效。方法：对20例门静脉高压症行改良Sugirua术者进行临床分析。结果：20例术后近期止血效果确切,随访观察发现19例食管静脉曲张消失或明显减轻。1例出现吻合口瘘及狭窄,经非手术治疗而愈。1例因肝肾功能衰竭死亡。结论：改良Sugiura术是治疗门静脉高压症的一种合理可取的术式。     

~(89)Sr治疗骨转移癌疼痛研究

 目的　评价放射性核素89锶 (89Sr)对骨转移癌的止痛疗效和不良反应 ,并探讨其在癌性骨痛治疗中的应用范围。方法　观察 35例骨转移癌患者使用89Sr治疗后的止痛疗效、肿瘤标记物水平的变化、不良反应及血液学毒副反应。结果　89Sr止痛总有效率为 71 .4 % ,其中来源于前列腺癌和乳腺癌的骨转移癌患者有效率达到 80 .0 %。少数肿瘤标记物水平有下降。副反应主要为轻度可逆性的骨髓造血功能损害。89Sr对血生化无明显不良影响。结论　89Sr是治疗骨转移癌疼痛的一种安全有效的方法     

己酮可可碱在高机械通气诱导大白鼠肺损伤炎性反应中的作用

目的探讨己酮可可碱(pentoxifylline,PTX)在大容量机械通气诱导的大白鼠肺损伤炎性反应中的作用。方法大白鼠在接受4h大容量机械通气时,治疗组(8只)静脉给予PTX,对照组(15只)静脉给予生理盐水,比较通气前后气道灌洗液中血栓烷B2(thromboxane B2,TXB2)、肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)、血小板活性因子(platelet activating factor,PAF)、肺组织髓过氧化物酶(myeloperoxidase,MPO)水平和肺组织湿干重量比。结果气道灌洗液中TXB2治疗组通气前为(17±4)ng/L,通气后为(13±1)ng/L,对照组通气前为(15±2)ng/L,通气后为(21±2)ng/L,两组通气后比较差异有统计学意义(P<0.01);TNF-α治疗组通气前为(39±19)ng/L,通气后为(245±76)ng/L,对照组通气前为(29±16)ng/L通气后为(620±112)ng/L,两组通气后比较差异有统计学意义(P<0.01);PAF两组通气后比较差异无统计学意义。治疗组肺组织MPO为(0.6±0.1)OD/g,对照组为(1.4±0.7)OD/g(P<0.01);治疗组肺组织湿干重量比为(6.3±0.3)g/g,对照组为(7.3±0.4)g/g(P<0.01)。结论PTX在抑制大容量机械通气诱导大白鼠肺损伤的炎性反应中有一定的积极作用。     

化疗增敏剂影响 P-糖蛋白依赖多药耐药性肿瘤细胞~(99)Tc~m-MIBI 摄取的实验研究(英文)

目的观察化疔增敏剂对多药耐药性(Multi-drug resistance,MDR)肿瘤细胞 P-糖蛋白(P-glycoprotein,P-gp)的影响及伴随~(99)Tc~m-MI-BI 摄取动力学的变化,以建立用~(99)Tc~m-MIBI 来评价化疗增敏剂效果的方法。方法 MDR 人乳腺癌细胞 MCF-7/Adr 37℃培养。(1)实验组和对照组细胞培养基中分别加入化疗增敏剂维拉帕米(10 μmol/L)和等体积培养液 DMEM。~(99)Tc~m-MIBI 与细胞共同孵育2 h 后收集细胞,测定放射性活度和 P-gp 表达水平。(2)维拉帕米(10 μmol/L)加入细胞培养基中,与细胞孵育若干时间后~(99)Tc~m-MIBI 加入细胞培养基中,与细胞一起培养2 h 后收集细胞。测定放射性活度和P-gp 表达水平。结果 (1)维拉帕米作用2h 后,细胞摄取~(99)Tc~m-MIBI 较对照组显著增加(t=2.33,P<0.05),但 P-gp 表达水平差异无显著性(P>0.05)。(2)肿瘤细胞摄取~(99)Tc~m-MIBI 随维拉帕米作用时间的延长而增加,各时间点 UR 差异有显著性(F=58.2,P<0.05),并且,VRP 作用时间在80 min 内时,肿瘤细胞摄取~(99)Tc~m-MIBI 与 P-gp 的表达水平无相关性(r=0.16,P>0.05),VRP 作用时间大于8 h时,肿瘤细胞摄取~(99)Tc~m-MIBI 与 P-gp 的表达水平呈负相关(r=-0.73,P<0.01)。结论化疗增敏剂能够影响 P-gp 过度表达所致 MDR 肿瘤细胞对~(99)Tc~m-MIBI 的摄取。     

武汉市新型冠状病毒肺炎定点医院护士 焦虑抑郁情绪现状分析

目的:了解武汉市新型冠状病毒肺炎定点医院护士焦虑抑郁情绪现状。方法:采用横断面调查的研究设计,使用患者健康问卷(PHQ-9)和广泛性焦虑障碍量表(GAD-7),了解武汉某定点医院护士的焦虑抑郁情绪现状。结果:定点医院护士抑郁检出率为35.4%,焦虑检出率为33.6%。一线护士和非一线护士焦虑抑郁情绪检出率差异无统计学意义(P0.05);护士焦虑抑郁情绪受性别、年龄、婚姻状态、与新冠肺炎患者接触、同事感染和自身相关症状等因素的影响。讨论:武汉市新型冠状病毒肺炎定点医院包括一线和非一线护士均存在明显焦虑抑郁情绪。     

2021-09期目录

Objective To investigate the predictive effect of thyroglobulin antibody (TgAb) level after operation and the trend of TgAb change after 131I treatment on the curative effect of 131I treatment in patients with differentiated thyroid carcinoma (DTC). Methods A total of 95 patients with DTC who were positive for TgAb and who underwent total thyroidectomy and 131I treatment in the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from December 2016 to May 2018 were retrospectively analyzed. The patients included 16 males and 79 females, aged 11?63 (37.74±11.27) years old. 131I treatment was administered 2–6 months after surgery. Based on the response to therapy assessment system of DTC in the American Thyroid Association Management Guidelines and according to the images, the curative effect was divided into three groups, namely, structural excellent response group (A group, 54 cases), structural incomplete response group (B group, 19 cases), and structural indeterminate response group (C group, 22 cases). The following parameters were observed among the three groups: TgAb level before 131I treatment; percentage change at 1.5 months, 3–6 months, and 6–12 months; and rate of change of TgAb. The factors that might affect the curative effect were analyzed. Receiver operating characteristic (ROC) curves were drawn with the following: the TgAb level before 131I treatment; percentage change of TgAb at 1.5 months after treatment; and percentage change of TgAb at 3–6 months after treatment. The best critical value for predicting therapeutic effect was determined, and the diagnostic efficiency was calculated. The measurement data were compared through variance analysis or Kruskal-Wallis rank sum test. Chi-square test or Fisher's exact text were used to compare the count data among the groups. The multivariate Logistic regression analysis was used to analyze the factors that may affect the curative effect. Results The univariate regression analysis results showed that the mean age (F=3.48, P=0.03), lymph node metastasis rate (χ2=10.28, P<0.01), TgAb level before 131I treatment (χ2=16.03, P<0.01), 131I dose (Fisher's exact text, P=0.002), percentage changeand and rate of change of TgAb (except percentage change at 6?12 months) at 1.5 months, 3?6 months, and 6?12 months were significantly different among the three groups (χ2=8.55–22.79, all P<0.05). The multivariate Logistic regression analysis result showed that TgAb levels before 131I treatment were significantly different among the three groups (β=?0.006, OR=0.994; P<0.01), percentage change of TgAb at 1.5 months (β=0.327, OR=1.387; P=0.046), and percentage change of TgAb at 3?6 months (β=2.521, OR=12.439; P=0.041) had statistical significance. The optimal cut-off value of TgAb level on ROC curve was 201.4 U/mL with a sensitivity of 74.1% and specificity of 68.3%. The area under ROC curve (AUC) was 0.740. The optimal cut-off values of the percentage change of TgAb in 1.5 months and for 3–6 months after treatment were 9.7% and 19.2%; the sensitivities were 72.2% and 61.0%; the specificities were 87.0% and 58.5%; and the AUCs were 0.660 and 0.752, respectively. Conclusions Postoperative TgAb level enabled the prediction of the therapeutic effect of 131I. Patients with lower TgAb level showed better therapeutic effect. The decrease of TgAb after treatment was more significant than before treatment, suggesting that the 131I therapeutic effect was satisfactory.     

基于ARIMA模型对海南某医院的医院感染发病率的预测研究

摘要 目的 探索ARIMA模型在预测医院感染发病率趋势中的应用价值,为进一步防控工作提供指导。方法 回顾性采集海南某医院2009-2018年住院患者的医院感染发病率数据,构建ARIMA模型并评价模型精度,预测2019年7月至2020年6月的医院感染月发病率。结果 本次研究最终确定ARIMA(0,1,1)模型为最优模型(BIC=-2.068,MAPE=10.574),残差序列Ljung-Box检验为白噪声(Q=9.864,P=0.909),模型拟合精度良好,预测2019年7月-2020年6月的月平均发病率为2.79%。结论 ARIMA(0,1,1)模型拟合该院医院感染发病率效果较好,可用于短期预测发病趋势和早期预警,有助于指导医院感染宏观防控决策的制定。     

右美托咪定与艾司洛尔在肩关节镜术中控制性降压时对脑氧饱和度和认知功能的影响研究

目的 比较在肩关节镜手术中应用右美托咪定与艾司洛尔进行控制性降压时局部脑氧饱和度的变化。方法 选取2022年3-6月在宁波市医疗中心李惠利医院全身麻醉下行侧卧位肩关节镜择期手术的患者60例,美国麻醉医师协会(ASA)分级I～II级,采用随机数字表法入组右美托咪定组或艾司洛尔组,每组30例。分别使用右美托咪定或艾司洛尔进行控制性降压。观察记录两组在术前吸氧5 min(T0,基础值)、改侧卧位5 min(T1)、降压15 min(T2)、降压30 min(T3)、降压45 min(T4)、降压结束并改平卧位5 min(T5)、拔管10 min(T6)的平均动脉压(MAP)、心率(HR)和局部脑氧饱和度(rScO₂)。记录rScO₂较基础值下降的最大百分比和脑去饱和事件(CDEs)的发生情况,以及术前1 d和术后3 d的简易智能精神状态检查(MMSE)评分。结果 与T0时比较,两组rScO₂值在T1～T5时显著降低。其中,右美托咪定组术中rScO₂最低值(71.83%±4.80%)高于艾司洛尔组(67.5...