反义导向分子a在单一延长应激模型大鼠皮质中的表达及意义

目的探讨反义导向分子a(Repulsive guidance molecule a,RGMa)在创伤后应激障碍模型单一延长应激模型大鼠皮质中的表达及意义。方法随机将30只Wistar大鼠分为对照组(con)、单一延长应激模型组(model)。建模后第7d观察两组大鼠行为学改变,并采用免疫荧光、逆转录PCR检测两组大鼠皮质RGMa的表达改变。结果与正常对照组比较,模型组大鼠僵立行为明显增加(0.01),皮质RGMa蛋白及m RNA表达水平均显著增多(0.01)。结论单一延长刺激诱导大鼠皮质RGMa蛋白及转录水平上调,可能是引起PTSD皮质体积缩小的重要分子机制之一。     

探讨中西医护理改善老年高血压患者生活质量的效果

目的探讨中西医结合护理改善老年高血压患者心理状态及生活质量的效果。方法在医院2018年1月—2018年6月就诊的老年高血压患者中选出60例,按照随机数字法的原则,分成研究组(n=30)和参考组(n=30)。参考组采用单一西医护理,研究组在此之外联合中医护理,比较两组患者的临床疗效。结果入院时研究组与参考组SAS、SDS、SF-6评分差异不显著(P>0.05),护理后1月、3月与参考组相比,研究组SAS、SDS评分显著降低(P<0.05),SF-6评分显著升高(P<0.05);研究组患者对中西结合护理满意度为96.67%,参考组患者对西医护理满意度为73.33%,研究组满意度较参考组高,差异显著(P<0.05)。结论中西医结合护理能够有效改善老年高血压患者的心理状态,提高生活质量。     

提高选题策划质量 提升行业期刊品牌影响力——以金属加工杂志社实践为例

【目的】 探讨行业期刊进行选题策划的方法,提升选题策划的质量。【方法】 利用互联网技术及新媒体资源,结合金属加工杂志社选题策划实例,归纳出几种选题策划的途径及方法。【结果】 结合行业热点进行选题策划,注重实效性和内容深度,提升期刊内容的可读性,可使期刊获得更多读者的关注和认可,提升期刊的行业影响力。【结论】 提高选题策划质量,可有效提升期刊内容的可读性,从而进一步提升期刊在行业的影响力。     

Influence of Fine Grains on the Bending Fatigue Behavior of Two Implant Titanium Alloys

By means of the ultrasonic surface impact (amplitude of 30 μm, strike number of 48,000 times/mm²), nanograins have been achieved in the surfaces of both Ti6Al4V(TC4) and Ti3Zr2Sn3Mo25Nb(TLM) titanium alloys, mainly because of the dislocation motion. Many mechanical properties are improved, such as hardness, residual stress, and roughness. The rotating–bending fatigue limits of TC4 and TLM subjected to ultrasonic impact are improved by 13.1% and 23.7%, separately. Because of the bending fatigue behavior, which is sensitive to the surface condition, cracks usually initiate from the surface defects under high stress amplitude. By means of an ultrasonic impact tip with the size of 8 mm, most of the inner cracks present at the zone with a depth range of 100~250 μm in the high life region. The inner crack core to TC4 usually appears as a deformed long and narrow α-phase, while the cracks in TLM specimens prefer to initiate at the triple grain boundary junctions. This zone crosses the grain refined layer and the deformed coarse grain layer. With the gradient change of elastic parameters, the model shows an increase of normal stress at this zone. Combined with the loss of plasticity and toughness, it is easy to understand these fatigue behaviors.     

晚期肺癌化疗患者医院感染的病原学与危险因素分析

目的研究晚期肺癌化疗患者发生医院感染的病原学特点,分析其危险因素,降低晚期肺癌化疗患者医院感染率。方法选择2012年1月-2015年12月收治的532例晚期肺癌化疗患者为研究对象,采集患者痰液或呼吸道分泌物标本进行细菌培养,应用SAS 9.3软件进行统计分析,并分析晚期肺癌化疗患者发生医院感染的危险因素。结果 125例晚期肺癌化疗患者发生医院感染,感染率为23.50%,其主要感染部位为呼吸道、胃肠道、口腔黏膜,分别占52.00%、15.20%、14.40%;共分离病原菌104株,其中革兰阴性菌51株占49.04%、革兰阳性菌30株占28.85%、真菌23株占22.11%;logistics回归显示,住院时间长、接受侵入性操作、使用抗菌药物是晚期肺癌化疗患者发生医院感染的危险因素。结论晚期肺癌化疗患者医院感染率较高,主要病原菌以革兰阴性菌为主,通过缩短患者住院时间、减少侵入性操作、合理使用抗菌药物等措施,降低晚期肺癌化疗患者医院感染的发生。     

Clinical analysis of peritoneal dialysis in the treatment of rapidly progressive glomerulonephritis

Objective To observe the clinical characteristics and prognosis of patients with rapidly progressive glomerulonephritis (RPGN) caused by lupus nephritis, antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, or primary glomerulonephritis who were treated with peritoneal dialysis (PD) and then withdrew PD because of renal recovery. Methods Data of the above patients were retrospectively analyzed. The patients were diagnosed as RPGN and received PD therapy in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from February 2009 to August 2018. The patients were divided into early withdrawal group (PD time≤183 days, n=24) and late withdrawal group (PD time＞183 day, n=24). The differences of clinical characteristics between the two groups were compared. The cumulative incidence of adverse events in both groups was analyzed using Kaplan-Meier curves. Cox proportional hazards model was used to analyze the risk factors influencing the prognosis of patients. Results Forty-eight RPGN patients were included. The median time of maintaining PD was 178(76, 378) days. Compared with the late withdrawal group, the patients in early withdrawal group had lower levels of urine volume, serum albumin and parathyroid hormone, and lower rates of gross hematuria and hypertension at the beginning of PD, and received higher rates of methylprednisolone impulse, combined immunosuppressive agents, and hemodialysis or continuous renal replacement therapy (all P＜0.05). At the time of PD withdrawal, the levels of serum creatinine, serum calcium, serum albumin and parathyroid hormone in the early withdrawal group were significantly lower than those in the late withdrawal group (all P＜0.05). The Kaplan-Meier curves showed that there was no significant difference in the cumulative survival of patients in both groups (log-rank test χ2=3.485, P=0.062). Cox regression analysis revealed serum creatinine≥209 μmol/L at the time of PD withdrawal was an independent risk factor for poor prognosis (HR=5.253，95%CI 1.757-15.702, P=0.003). Conclusions PD can be used for RPGN patients caused by lupus nephritis, ANCA-associated vasculitis and primary nephritis. Serum creatinine≥209 μmol/L at the time of PD withdrawal is an independent risk factor for poor prognosis.     

慕课在医学生假期课前预习中的应用探讨

高校医学生会利用假期时间对将要学习的科目进行预习,力求提前了解或掌握,以利于日后对知识的充分理解。预习对于医学科目学习有一定必要性,然而传统的假期预习模式常存在缺乏引导、效率难以提升等问题。目前,慕课在医学教育领域的应用有所发展。对于医学生,其自主学习的模式、课程设计等契合医学课程的预习需求和假期学习的特点,有助于提升医学生的学习能力和假期预习效果。医学生将慕课作为假期预习资源可有多种学习模式选择。慕课平台的功能拓展和学校教师的辅助可以有效深入慕课在医学生假期预习中的应用,为医学生带来更合理的假期学习安排。     

逐瘀止血汤加减治疗慢性子宫内膜炎气虚血瘀证的疗效观察

目的 评价逐瘀止血汤加减对慢性子宫内膜炎（CE）气虚血瘀证患者妊娠结局的影响及对免疫炎症因子的调节作用。方法 将144例患者随机按数字表法分为观察组和对照组各72例。观察组脱落、失访4例，剔除2例，完成66例；对照组脱落、失访3例，剔除5例，完成65例。两组均给予抗感染治疗14 d。对照组口服妇科千金片，6片/次，3次/d。观察组内服逐瘀止血汤加减，1剂/d。两组疗程均为3个月，并随访6个月。记录治疗前后月经经量、经期和周期变化情况；进行治疗前后宫腔镜和阴道彩色多普勒超声检查，评价子宫内膜形态、子宫内膜容受性（CP）［子宫内膜厚度、阻力指数（RI），搏动指数（PI）和血流指数（FI）］等，并进行子宫内膜病理检查；进行治疗前后气虚血瘀证评分；检测治疗前后月经血白细胞介素-1β（IL-1β），IL-6和肿瘤坏死因子-α（TNF-α）水平和外周血测T淋巴亚群（CD3⁺，CD4⁺，CD8⁺）水平；随访记录妊娠情况和流产情况。进行安全性评价。结果 治疗后观察组经量、经期、周期和月经完全正常率均高于对照组（P<0.05）；观察组子宫内膜厚度和FI均高于对照组（P<0.01），RI和PI均低于对照组（P<0.01）；观察组月经血IL-1β，IL-6和TNF-α水平均低于对照组（P<0.01）；观察组CD3⁺，CD4⁺水平和CD4⁺/ CD8⁺均高于对照组（P<0.01），CD8⁺水平低于对照组（P<0.01）；在6个月随访期间，观察组妊娠率46.97%（31/66），高于对照组的27.69%（18/65）（χ²=5.197，P<0.05）；观察组子宫内膜形态疗效总有效率为96.97%（64/66），高于对照组的86.15%（56/65）（χ²=4.981，P<0.05）；观察组子宫内膜病理组织疗效总有效率为95.45%（63/66），高于对照组的84.62%（55/65）（χ²=4.304，P<0.05）；观察组综合临床疗效总有效率为93.94%（62/66），高于对照组的81.54%（55/65）（χ²=4.696，P<0.05）；两组治疗期间均未发现与中药相关不良反应。结论 逐瘀止血汤加减治疗CE气虚血瘀证患者，可调经月经、减轻临床症状，改善宫腔镜下内膜形态，调节全身和局部的免疫炎症反应，提高了CP，从而改善了妊娠结局，有着较好的综合疗效，且安全。