四种手术方式治疗痔病的网状Meta分析

目的利用网状Meta分析系统评价传统外剥内扎术（MMH）、吻合器痔上黏膜环切术（PPH）、选择性痔上黏膜切除术（TST）和多普勒超声引导下痔动脉结扎术（DG-HAL）治疗痔病的手术方式的疗效和安全性,为临床提供参考。 方法检索中国知网、万方数据、中国生物医学网,Pubmed、Cochrane Library、Embase数据库,收集建库至2020年12月关于MMH、PPH、TST和DG-HAL治疗痔病的随机对照试验,提取的资料采用GeMTC 0.14.3软件进行网状Meta分析。 结果最终纳入45项研究,包括43篇两臂实验,2篇三臂实验;共5 847例患者,其中MMH组1 777例,PPH组1 971例,TST组1 205例,DG-HAL组894例。与MMH相比,DG-HAL（MD=-4.16,95% CI：-6.49~ -1.82,P<0.05）和PPH（MD=2.28,95% CI：0.64~3.89,P<0.05）可以显著降低术后疼痛程度,差异均有统计学意义;TST术后尿潴留发生率明显低于MMH（OR=2.08,95% CI：1.23~4.09,P<0.05）;相比于MMH（OR=0.01,95% CI：0~0.15,P<0.05）和PPH（OR=0.08,95% CI：0~0.78,P<0.05）,DG-HAL术后肛门狭窄发生率低;而PPH（OR=6.56,95% CI：1.20~57.74,P<0.05）和TST（OR=58.25,95% CI：4.37~2 605.94,P<0.05）的术后肛门狭窄发生率均比MMH低,TST优于PPH（OR=8.50,95% CI：1.23~150.91,P<0.05）,差异均有统计学意义。术后24 h疼痛评分排序为MMH>PPH>TST>DG-HAL;术后出血发生率排序为MMH>PPH>TST>DA-HAL;尿潴留发生率排序为MMH>PPH>DA-HAL>TST;肛门狭窄发生率排序为MMH>PPH>TST>DG-HAL;复发率排序为DA-HAL>PPH>MMH>TST。 结论四种手术方式治疗痔病的作用机制各有优势,DG-HAL和TST术后疼痛、出血、尿潴留、肛门狭窄等并发症发生率低,术后舒适度和安全性方面有明显优势。术后复发率方面TST最优,DG-HAL最差。     

角膜接触镜经营企业质量管理现况及监管对策思考

目的通过系统调查,了解角膜接触镜经营企业质量管理现况,探索进一步有效监管的方向。方法对上海市徐汇区62家角膜接触镜经营企业质量管理指标进行系统调查,并对不同经营模式企业进行数据对比与统计分析。结果角膜接触镜批发企业、零售连锁企业各项质量管理指标明显好于非连锁角膜接触镜零售企业。结论提高许可门槛,鼓励角膜接触镜零售连锁经营模式,加强对角膜接触镜经营企业的监管,重点是加强对单体零售企业的监管。     

HPLC法测定灵仙跌打片中齐墩果酸的含量

目的:建立灵仙跌打片中齐墩果酸的高效液相色谱测定方法。方法:采用高效液相色谱法测定,Hypersil ODS-C18(200 mm×4.6 mm,5μm)色谱柱,甲醇-0.5%的冰乙酸溶液(84∶16)为流动相,检测波长210 nm,流速:1.0 mL.min-1,柱温:室温,进样量10μL。结果:齐墩果酸在0.3506-2.1036μg具有良好的线性关系,r=0.9998;平均加样回收率为98.77﹪,RSD%为1.02﹪(n=6)。结论:该方法操作简单,重现性好,适用于灵仙跌打片中的齐墩果酸含量测定。     

护理人员语言与护患关系

随着现代医学的发展,生物医学模式已转变为生物、心理、社会医学模式,相应地,护患模式也发生了改变。新的护患模式要求护士对患者实施全方位的身心护理,而不再是简单的“打针”、“送药”等技能性动作,其中建立良好的护患关系是至关重要的。建立良好的护患关系,必须一切以病人为中心,根据患者的不同情况,以有声语言和体态性语言(仪表、着装、姿态、情绪等)与患者进行沟通,增加病人对护士的信赖感,使消极情绪转变为积极情绪,配合治疗和护理,以达到早日康复的效果。为此,必须明确语言在护患关系中的重要性,护士在护患沟通中应具有的语言素质和运用技巧。     

步长稳心颗粒治疗慢-快综合征95例疗效观察

目的:观察步长稳心颗粒对慢一快综合征的临床疗效。方法:95例慢-快综合征患者随机分为治疗组和对照组两组,治疗组给步长稳心颗粒,9克/次,每天3次,共4周。对照组给胺碘酮,0.2肷,每天3次,7天后改为每天1次,共4周。用药前后做常规心电图和动态心电图。结果:稳心颗粒对快速心律失常显效15例,有效28例,总有效率为86％;对照组显效20例,有效19例,总有效率为87％,两组比较差异无显著性(P>0.05)。稳心颗粒对缓慢心律失常显效20例,有效22例,总有效率为88％;而对照组有效8例,总有率为18％,两组比较差异显著(P<0.01)。结论:步长稳心颗粒是治疗慢-快综合征的理想药物之一。     

Neuropsychological performance in advanced age: influences of demographic factors and Apolipoprotein E: findings from the Cache County Memory Study

The Cache County Study of Memory in Aging (CCMS) is an epidemiological study of Alzheimer's disease (AD), mild cognitive disorders, and aging in a population of exceptionally long-lived individuals (7th to 11th decade). Observation of population members without dementia provides an opportunity for establishing the range of normal neurocognitive performance in a representative sample of the very old. We examined neurocognitive performance of the normal participants undergoing full clinical evaluations (n = 507) and we tested the potential modifying effects of apolipoprotein E (APOE) genotype, a known genetic risk factor for the later development of AD. The results indicate that advanced age and low education are related to lower test scores across nearly all of the neurocognitive measures. Gender and APOE epsilon4 both had negligible and inconsistent influences, affecting only isolated measures of memory and expressive speech (in case of gender). The gender and APOE effects disappeared once age and education were controlled. The study of this exceptionally long-lived population provides useful normative information regarding the broad range of "normal" cognition seen in advanced age. Among elderly without dementia or other cognitive impairment, APOE does not appear to exert any major effects on cognition once other demographic influences are controlled.     

益气活血法治疗慢性萎缩性胃炎

本文采用益气活血法,使用自拟益气化瘀汤(处方:党参、白术、当归、甘草、佛手、川芎、木香、五灵脂、红花、陈皮、丝瓜络)加减治疗慢性萎缩性胃炎260例,治愈221例,好转28例,无效11例.     

Homeostatic adaptations in brain energy metabolism in mouse models of Huntington disease

Impairment of energy metabolism is a key feature of Huntington disease (HD). Recently, we reported longitudinal neurochemical changes in R6/2 mice measured by in-vivo proton magnetic resonance spectroscopy (¹H MRS; Zacharoff et al, 2012). Here, we present similar ¹H MRS measurements at an early stage in the milder Q111 mouse model. In addition, we measured the concentration of ATP and inorganic phosphate (P_i), key energy metabolites not accessible with ¹H MRS, using ³¹P MRS both in Q111 and in R6/2 mice. Significant changes in striatal creatine and phosphocreatine were observed in Q111 mice at 6 weeks relative to control, and these changes were largely reversed at 13 weeks. No significant change was detected in ATP concentration, in either HD mouse, compared with control. Calculated values of [ADP], phosphorylation potential, relative rate of ATP synthase (v/V_max(ATP)), and relative rate of creatine kinase (v/V_max(CK)) were calculated from the measured data. ADP concentration and v/V_max(ATP) were increased in Q111 mice at 6 weeks, and returned close to normal at 13 weeks. In contrast, these parameters were normal in R6/2 mice. These results suggest that early changes in brain energy metabolism are followed by compensatory shifts to maintain energetic homeostasis from early ages through manifest disease.     

血清尿酸水平评估慢性阻塞性肺疾病急性加重者病情的临床价值

目的探讨血清尿酸水平评估慢性阻塞性肺疾病急性加重（AECOPD）者病情的临床价值。方法收集2014年4月至2015年4月在呼吸科住院治疗的111例经肺功能检测确诊的AECOPD患者的临床资料。以血清尿酸值416μg/L为临界点，分成血清尿酸＞416μg/L组，血清尿酸＜416μg/L组，进行临床资料分析。结果血清尿酸＞416μg/L组以男性为主，年龄更大，吸烟率更高，肺功能更差，D级患者构成比更多，在首次住院床日、1年内机械通气发生率、1年内病死率、1年内住院次数均显著高于血清尿酸＜416μg/L组（P＜0.05或0.01）。血清尿酸＞416μg/L组呼吸衰竭更严重，更多合并有冠心病、充血性心力衰竭、心律失常、糖尿病、恶性肿瘤、意外骨折和褥疮（P＜0.05或0.01）。结论测定AECOPD患者血清尿酸水平有助于对其病情及预后作出评估。     

High acetone sensing properties of In2O3–NiO one-dimensional heterogeneous nanofibers based on electrospinning

Pure NiO nanofibers and the In₂O₃–NiO one-dimensional heterogeneous nanofibers were prepared by electrospinning, and the gas sensing properties to acetone were also investigated. Material characterization proved that the heterogeneous nanofibers were composed of In₂O₃ and NiO, and the nanofibers exhibited an enhanced sensitivity to acetone. At the optimal working temperature, the response of In₂O₃–NiO nanofibers to 50 ppm acetone was more than 10 times higher than that of pure NiO nanofibers. The minimum detection limit of the heterogeneous nanofibers reached 10 ppb, while the pure NiO nanofibers only reached 100 ppb. Among acetone and the comparison gases (methanol, ethanol, triethylamine, ethyl acetate, and benzene), the heterogeneous nanofibers achieved the highest response to acetone. In addition, the heterogeneous nanofibers exhibited an improved response–recovery rate and good long-term stability. These results indicated that the In₂O₃–NiO one-dimensional heterogeneous nanofibers have great potential in low-concentration acetone detection. Combined with the material properties, the mechanism of the enhanced sensing properties was discussed in detail for the In₂O₃–NiO heterogeneous nanofibers.

The In₂O₃–NiO nanofiber with p–n heterojunctions exhibited an enhanced acetone sensing performance, and the detection limit reached 10 ppb.