肿瘤患者医院感染流行病学分析

目的了解肿瘤患者医院感染的临床流行病学特征.方法于2003～2005年对18 368例肿瘤住院患者进行临床流行病学调查分析.结果住院患者平均感染率为5.0%,不同年度感染率差异无统计学意义（P＞0.05）;平均漏报率为6.9%,不同年度漏报率差异有统计学意义（P＜0.05）;化疗科医院感染率最高为7.5%,占全院医院感染的63.20%;外科医院感染率为2.5%,占19.82%;放疗科医院感染率为4.4%,占16.98%.感染部位主要为呼吸道（45.2%）,口腔（18.3%）,胃肠道（13.1%）,手术部位（11.4%）;病原体送检率为57.5%,抗菌药物使用率为51.3%.结论呼吸道感染、口腔真菌感染、胃肠道感染和手术部位感染是今后监控重点.     

Prevalence and risk factors of restless legs syndrome in peritoneal dialysis patients

Objective To investigate the prevalence of restless legs syndrome (RLS) in peritoneal dialysis patients and analyze the related risk factors. Methods This study was a cross-sectional study. The patients receiving maintenance peritoneal dialysis from January 2017 to December 2017 in the Peritoneal Dialysis Center of the Second Hospital Affiliated to Soochow University were selected as the study subjects. RLS was screened for peritoneal dialysis patients by epidemiological field investigation based on the RLS diagnostic criteria of the International Restless Leg Syndrome Research Group in 2014. Clinical data and laboratory examinations of selected patients were collected and the differences of clinical indicators between RLS and non-RLS patients were compared. The risk factors related to RLS were analyzed by logistic regression. Results Seventy-six cases of RLS were screened out from 396 PD patients. The prevalence of RLS was 19.2%. Compared with non-RLS group, RLS group patients had longer dialysis age, less 24 hours urine volume, and elevated blood intact Parathormone (iPTH) and alkaline phosphatase (AKP) (all P﹤0.05). There was no significant difference in primary disease ratio, sex, age, body mass index, blood pressure, hemoglobin, creatinine, urea nitrogen, uric acid, ferritin, serum iron, transferrin saturation, blood calcium, blood phosphorus, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, eGFR, Kt/V, Ccr between RLS and non-RLS group patients (all P﹥0.05). Multivariate logistic regression analysis showed that long dialysis age (OR=1.010, 95%CI 1.001-1.018, P=0.022) and high blood AKP (OR=1.005, 95%CI 1.001-1.010, P=0.021) were independent risk factors for RLS in peritoneal dialysis patients (both P﹤0.05). Conclusions The prevalence of RLS is high in peritoneal dialysis patients. Long dialysis age and high blood AKP are independent risk factors for RLS.     

The Prevalence of Post-Traumatic Stress Disorder in the General Population during the COVID-19 Pandemic: A Systematic Review and Single-Arm Meta-Analysis

ObjectiveTo investigate the prevalence of post-traumatic stress disorder (PTSD) in the general population during the COVID-19 pandemic by a systematic review and single-arm meta-analysis. MethodsCNKI, PubMed, EMBASE, and MEDLINE were searched to collect literature on the prevalence of PTSD in the general population during the epidemic. The retrieval time is from the database construction to 31/08/2020. Meta-analysis was performed on the included articles by using Review Manger 5.3 and Stata 16.0 software. ResultsThe prevalence of PTSD in the general population during the COVID-19 pandemic was 15% (95% CI: 11–21%, p<0.001). ConclusionThe COVID-19 pandemic brought certain mental pain to general population, leading to a rise in the incidence of PTSD in a short time.     

DWI及DCE-MRI评价新辅助化疗对不同分子分型乳腺癌的疗效

目的探讨MRI功能成像评价乳腺癌新辅助化疗疗效的价值。方法回顾性分析本院38例经手术病理证实为浸润性乳腺癌行术前新辅助化疗的患者资料。依据化疗前后组织病理学改变进行疗效评价,将病例资料分为病理完全缓解组(pCR)和病理非完全缓解组(NpCR);对比分析两组免疫组化差异及化疗前后MRI检查指标数值变化的差异,以病理反应性标准分组为金标准,对其中有统计学意义的参数进行ROC曲线分析,并计算曲线下面积(AUC),评价其对NAC疗效的预测效能;最后应用相关分析结果建立乳腺癌新辅助化疗疗效预测模型logistP。结果38例中pCR13例,NpCR25例。两组免疫组化参数(ER/PR、HER-2、ki-67)及分子分型、ΔADC%差异均无统计学意义,化疗前后两组ΔD%、ΔV%、ΔS%、ΔSmax%、ΔTIC差异有统计学意义(P<0.05);ΔD%、ΔV%、ΔS%、ΔSmax%、ΔTIC的AUC分别为0.748、0.822、0.708、0.828、0.700,灵敏度/特异度分别为0.769/0.68、0.846/0.72、0.538/0.84、0.769/0.80、0.692/0.64,其logistP与病理组织学疗效的AUC为0.846(95%CI0.708~0.984)。结论乳腺癌新辅助化疗早期动态增强MRI参数变化能预测NAC疗效。     

多普勒超声心肌作功指数评价氯沙坦钾对老年高血压患者左室功能的作用

目的 :应用多普勒超声指标心肌作功指数 (MPI)评价氯沙坦钾对老年原发性高血压 (EH)患者左室功能的作用。方法 :38例老年EH患者 ,按照超声心动图左室肥厚 (LVH)的诊断标准分成无LVH(2 8例 )和LVH(10例 )两组 ,给予氯沙坦钾 5 0mg每日 1次口服 ,疗程 2 4周。治疗前后多普勒超声心动图测定左室室壁厚度和收缩、舒张功能 ,根据等容舒张期时间 (IRT)和等容收缩期时间 (ICT)之和与射血时间 (ET)的比值计算MPI。结果 :LVH组患者经氯沙坦钾治疗后左室重量指数 (LVMI)降低 ,但差异无统计学意义。两组患者射血分数 (EF)治疗前后均在正常范围 ,经氯沙坦钾治疗后IRT均显著缩短 [(12 0 .4 6± 2 3.84 )ms∶(96 .4 6± 2 3.19)ms;(12 5 .4 0± 2 5 .81)ms∶(92 .5 6± 2 9.98)ms,P <0 .0 1],MPI降低 [(0 .6 1± 0 .14 )∶(0 .4 4± 0 .12 ) ,P <0 .0 1;(0 .6 0± 0 .14 )∶(0 .4 7± 0 .13) ,P <0 .0 5 ]。MPI与IRT呈正相关 (r =0 .80 ,P <0 .0 1) ,与LVMI不相关 (r =- 0 .0 95 ,P >0 .0 5 )。结论 :氯沙坦钾能提高老年EH患者的左室功能。MPI综合反映心脏的收缩和舒张功能 ,其不受左室构型的影响 ,在高血压患者收缩功能正常的情况下是反映早期左心功能不全的指标。     

耳穴贴压加膈神经按摩治疗卒中后顽固性呃逆疗效观察

目的 探讨耳穴贴压配合膈神经按摩治疗卒中后顽固性呃逆的效果.方法 将64例卒中后顽固性呃逆患者分为对照组和观察组各32例.观察组采用耳穴贴压配合膈神经按摩方法治疗卒中后顽固性呃逆,对照组采用传统方法治疗.结果 两组呃逆缓解率比较,差异有显著性意义(P＜0.01).结论 耳穴贴压配合膈神经按摩治疗卒中后顽固性呃逆效果好,且简便易行.     

细胞因子TNF-α和血管内皮细胞功能标志物与多器官功能衰竭综合征的关系

目的探讨在多器官功能衰竭综合征(MODS)患者中细胞因子TNF-α和血管内皮细胞功能标志物的变化。方法动态观察MODS及非MODS患者一氧化氮(NO)、内皮素(ET-1)、组织纤溶酶原激活物(t-Pa)、纤溶酶原激活物抑制物-1(PAI-1)、循环内皮细胞(CEC)、肿瘤坏死因子(TNF-α)的浓度,同时给予Marshall评分。结果与非MODS组相比,MODS组、死亡组的TNF-α、ET- 1、PAI-1、CEC、Marshall评分显著升高(P＜0．05),而NO、t-Pa显著降低(P＜0．05)。结论TNF-α作为炎性因子在MODS的进展中起重要作用;在MODS时内皮细胞的损伤表现为ET-1、PAI-1、CEC增加,NO、t-PA减少,Marshall评分对于危重症患者的评估是敏感指标。     

糖尿病患者心功能减退及其机制探讨

目的：探讨糖尿病（DM）患者心功能减退的机制。方法：用超声方法测量60例DM患者的心功能，并与其临床，生化指标进行相关性研究。结果：DM病人的LVEF低于正常对照组，但尚处于正常范围，二尖瓣舒张期血流频谱的E／A值，EI／AI值和Ta/Td值显著降低，并与年龄及血糖呈显著负相关。结论：DM病人存在不同程度的心脏舒张功能的减退，血糖的显著升高是舒张功能明显减退的主要危险因素。     

实验性急性心肌梗塞左室功能与细胞结构改变及其相关性

通过结扎羊心冠状动脉左前降支(LAD)制成AMI模型,观察结扎前、结扎后即刻及1、2、3小时血液动力学、血清酶学、超声心动图及活检心肌的光、电镜结构变化,探讨AMI后左室功能及结构的改变。结果:结扎后显示LAP、LVEDP明显升高,-dp/dtmax显著下降。超微结构有明显的变化。超声指标E峰明显下降,A峰明显上升,EF和AC显著下降。提示AMI后左室收缩及主动脉性松弛下降,在血液动力学、心功能及细胞结构上有相应变化。