3D打印Dry Lab模型在腹腔镜胃底折叠手术教学中的应用

3D打印模型的腹腔镜下手术培训寻是一种新颖、教学成本低、效果好的教学方法，一定程度上弥补传统教育和实践操作教育之间的不足。利用3D抗反流手术模型在腹腔镜下完成胃底折叠手术学习曲线，对于外科医师手术技术的提高将有极大的帮助，同时也可以弥补由于手术量不足及患者个体解剖变异所带来的手术难度及风险的提升，有利于规避患者术中和术后并发症的发生，为手术规范化标准化提供保证。     

Treatment adherence among sputum smear-positive pulmonary tuberculosis patients in Xinjiang,China: a prospective study

Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance. The present study assessed anti-TB treatment adherence in sputum smear-positive TB patients and examined the risk factors for poor patient adherence to identify targets for intervention. Methods: We monitored and followed up TB patients who were diagnosed between July 2014 and June 2015 in Xinjiang, China. A total of 8289 sputum smear-positive TB patients were included in this study. All patients registered their information during the first hospital visit or with the Centers for Disease Control, had regular follow-up visits, and accepted the anti-TB treatment. Insufficient re-examination adherence was defined as undergoing fewer than the recommended three sputum smear examinations during the treatment course. Results: Among 8289 patients, 3827 men (84.4% of male patients) and 3220 women (85.7% of female patients) had good adherence during treatment follow-up. 1242 patients (15.0%) did not complete regular follow-up. 332 (4.0%) patients lost contact. An adjusted logistic regression model showed that ethnicity, household address, treatment classification, patient source, and the actual management were significantly associated with non-adherence. Conclusion: The Xinjiang TB epidemic situation remains grim. Smear-positive patients had a higher proportion of non-adherence, which increased treatment difficulties and the risk of death from TB. Relevant medical departments should strengthen their supervision and interventions during the TB treatment process to improve patient adherence to anti-TB treatment.

Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance.     

超声引导下骶管阻滞麻醉在肛肠手术中的应用

 目的 探讨超声引导下骶管阻滞麻醉在肛肠手术中应用效果。方法 选取2017-01至2018-03医院行肛肠手术患者208例,随机分为超声组和对照组,每组104例。 超声组予以超声引导定位骶管阻滞麻醉,对照组以传统解剖定位骶管阻滞麻醉。分别记录两组患者的穿刺情况(穿刺时间、穿刺针调整次数、麻醉起效时间和痛觉消失时间)、麻醉成功率及患者满意度和麻醉后并发症情况。结果 超声组穿剌针调整(2.50±0.50)次,明显少于对照组的(5.00±1.00)次,差异有统计学意义(P<0.05);麻醉起效时间(2.85±1.30)min,明显短于对照组的(4.88±0.92)min;痛觉消失时间(4.85±1.24)min,明显短于对照组的(7.86±2.12)min,差异均有统计学意义(P<0.05);超声组麻醉Ⅰ级比率及麻醉成功率均明显高于对照组(P<0.05)。超声组麻醉Ⅲ级比率明显低于对照组,差异有统计学意义(P<0.05)。超声组出现血肿、出血和神经损伤相关并发症明显少于对照组,差异均有统计学意义(P<0.05)。结论 超声引导下骶管阻滞麻醉在肛肠手术中可准确定位,提高阻滞麻醉成功率,减少并发症,提高患者满意度。     

奥拉西坦联合尼莫地平治疗重症脑挫裂伤的临床观察

目的观察奥拉西坦联合尼莫地平治疗重症脑挫裂伤的临床疗效。方法选取新疆医科大学第二附属医院2010年11月—2014年10月收治的重症颅脑损伤患者130例,随机分为对照组(68例)和治疗组(62例)。两组患者术后均转入ICU监护并给予等常规治疗,对照组给予尼莫地平注射液4 mg/次,加入到250 m L生理盐水中静脉滴注,1次/d。治疗组在对照组基础上加用注射用奥拉西坦,4 g/次,加入到250 m L生理盐水中缓慢静滴,1次/d。两组均连续治疗14 d。比较两组的临床疗效,同时比较两组治疗前,治疗第3、7、14天神经功能缺损(NIHSS)评分、颅内压、GCS评分、脑电图快慢波比值、大脑中动脉(Mc A)平均血流速度、双侧平均肌力的变化。结果对照组和治疗组总有效率分别为61.76%、80.65%,两组比较差异有统计学意义(P0.05)。对照组NIHSS评分从治疗第7天,治疗组从治疗第3天开始显著下降,同组比较差异有统计学意义(P0.01)。从治疗第3天开始治疗组NIHSS评分显著低于对照组,两组比较差异有统计学意义(P0.05、0.01)。两组颅内压均从治疗第3天开始降低,GCS评分、Mc A平均血流速度、双侧平均肌力从治疗第3天开始升高,同组治疗前后差异有统计学意义(P0.01)。治疗组从治疗第3天开始,GCS评分、Mc A平均血流速度高于对照组,治疗组在治疗第3、7天颅内压低于对照组,在治疗第7天快慢波比值低于对照组,在治疗第3、14天双侧平均肌力高于对照组,两组比较差异有统计学意义(P0.05、0.01)。结论奥拉西坦联和尼莫地平治疗重症脑挫裂伤术后患者具有较好的临床疗效,可促进患者神经功能恢复,提高患者生存质量,为进一步探索和治疗重症脑挫裂伤患者提供明确的思路。     

Olanzapine ameliorates neuropathological changes and increases IGF-1 expression in frontal cortex of C57BL/6 mice exposed to cuprizone

Cuprizone (CPZ) induced demyelinating mouse has been used as an animal model to examine the assumed roles of altered oligodendrocytes in the pathophysiology and treatment of schizophrenia. The objectives of this study were to examine the effect of olanzapine, an atypical antipsychotic, on cuprizone-induced neuropathological changes in the frontal cortex of C57BL/6 mice, and to explore the underlying mechanism for the possible protective effects. The effects of six-week olanzapine (10 mg/kg/day) treatments on neuropathological changes were examined by immunohistochemistry and Western-blot analyses. Olanzapine treatment for six weeks effectively decreased the breakdown of myelin and oligodendrocytes loss of cuprizone-fed mice. Reactive cellular changes, including astrocyte gliosis, microglia accumulation and increased activation of oligodendrocyte progenitor cells, were also attenuated by olanzapine. However, the cortical expression level of insulin-like growth factor 1 (IGF-1) was significantly increased by olanzapine treatment in cuprizone-fed mice as measured by the quantitative real-time polymerase chain reaction (PCR) method. Olanzapine treatment in control mice consuming normal food had no effect on all above measures. These results provide the first in vivo evidence for the protective effects of olanzapine on cuprizone-induced neuropathological changes and suggest that up-regulated insulin-like growth factor 1 may contribute to the protective effects of this antipsychotic.     

人乳头瘤病毒及bcl-2的表达与维吾尔族外阴癌发病关系的研究

目的:探讨人乳头瘤病毒(human papilloma virus,HPV)感染及bcl-2蛋白的表达在维吾尔族妇女外阴癌发生发展中的作用及其相互关系。方法:应用原位杂交及免疫组化SP法对67份维吾尔族妇女外阴手术切除存档蜡块(其中外阴癌57份,癌旁正常外阴组织10份)进行HPV16/18型及bcl-2蛋白的检测。结果:(1)57份外阴癌及10份癌旁正常外阴组织中,无一例HPV16/18型阳性表达;bcl-2蛋白在外阴癌组织中阳性表达率为70.18%(40/57),在10份癌旁组织中表达均阴性。(2)bcl-2在Ⅰ期、Ⅱ期及Ⅲ~IV期外阴癌中分别为70.18%,75.0%及50.0%,其在各期别之间无显著性差异(P=0.302),bcl-2蛋白表达在外阴癌淋巴结阳性组(88.88%)明显高于淋巴结阴性组(51.62%),两者之间有显著性差异(P=0.044)。结论:维吾尔族外阴角化型鳞状上皮癌的发生可能与HPV感染无关。bcl-2的表达与维吾尔族外阴角化型鳞状上皮癌密切相关。bcl-2的表达与外阴癌临床分期及组织学分级无明显相关,但与淋巴结转移有关。     

准噶尔盆地鼠疫调查

目的 掌握准噶尔盆地鼠疫疫源地的分布、动物区系组成、宿主动物及其体外寄生蚤类的种群结构以及动物鼠疫的流行动态.方法 采用生态学研究方法、鼠疫血清学和病原学检验方法以及生物化学技术对准噶尔盆地进行鼠疫流行病学调查和研究.结果 准噶尔盆地共有小型哺乳动物7科11属17种,其中啮齿动物13种,啮齿动物体外寄生蚤类8科10属19种;大沙鼠洞群平均覆盖率22.5%,洞群平均密度15.9个/hm2,洞群平均栖息率为70.2%;在大沙鼠洞群鼠类群落中,大沙鼠占总捕获数的72.9%,子午沙鼠占24.5%;夜行鼠类群落中,子午沙鼠占总捕获数的64.0%,三趾跳鼠占15.1%.准噶尔荒漠鼠类群落中大沙鼠的染蚤率最高,为84.9%;染蚤种类有16种,总蚤指数为8.58,以簇鬃客蚤为优势种.准噶尔荒漠啮齿动物血清鼠疫F1抗体平均阳性率5.5%.其中,大沙鼠阳性率12.1%,占阳性总血清的94.3%,子午沙鼠和三趾跳鼠血清阳性率分别为0.7%和0.9%;自大沙鼠、子午沙鼠及其体外寄生蚤--臀突客蚤、同形客蚤指名亚种、长吻角头蚤和簇鬃客蚤共分离出鼠疫菌26株,其中自大沙鼠及其体外寄生蚤分离出鼠疫菌24株,占92.3%;该区域鼠疫菌的生化特性是麦芽糖、阿胶糖、甘油阳性,鼠李糖和脱氮阴性,对小白鼠强毒.结论 准噶尔盆地鼠疫疫源地涉及整个准噶尔区域,有12个县(市)发生了动物鼠疫流行,确定克拉玛依、博乐、吉木萨尔和奇台4个县(市)为鼠疫疫源县(市).疫源地动物、媒介组成复杂,生态系统稳定,主要宿主动物为大沙鼠,鼠疫菌生化型属中世纪型,为中国新类型的鼠疫自然疫源地.     

新疆4个地区240例HIV感染者直接经济负担研究

目的探讨新疆4个地区HIV感染者个人直接经济投入的差异。方法对新疆乌鲁木齐、哈密、伊犁、喀什4个地区240例HIV感染者家庭收入和医疗费用支付方式进行调查;分析各地区HIV感染者的门诊费用(诊疗费、交通费)、住院费用(住院费、交通费、食宿费、营养费)等存在的差异。结果乌鲁木齐与其他地区相比HIV门诊就诊率和住院率均比较高,且各项直接医疗费用与非直接医疗费用也较其他地区高。结论经济发达地区,交通业较为便利,医疗服务较为齐全,医疗服务投入较多。而经济发展较为缓慢地区,其各种医疗服务较为匮乏,人民获得各种医疗服务较为困难,并且由于个人收入较低,居民受教育程度也较低,HIV感染者各项医疗投入也较低。     

烟雾病外科治疗进展

烟雾病是一种慢性进行性闭塞性脑血管病。患者对象以婴幼儿和成人为主,婴幼儿主要表现为脑供血不足;成人主要表现为脑出血。手术治疗为主要的治疗方法,包括直接血管重建术、间接血管重建术及直接、间接联合手术方式。早期手术解除脑缺血症状的效果明显优与延迟手术。根据临床表现及年龄差别选择不同手术治疗方式等非常重要。     

新疆和田地区维吾尔族和汉族人群糖脂代谢的流行病学调查分析

目的:采用流行病学调查,比较和田地区维吾尔族和汉族的糖脂代谢特点.方法:采用整群抽样,按国际糖尿病联盟(IDF)MS的诊断标准,调查分析新疆和田地区维吾尔族和汉族人群糖脂代谢指标及代谢异常人群的百分数.40岁以上的健康人群糖尿病筛查总人数1 017例其中维吾尔族684例,汉族433例.结果:维吾尔族体重(WT),腰围(WC)、甘油三脂(TG)明显高于汉族组(P<0.01),维吾尔族组的平均体质指数(BMI)为(29.39±16.08)kg/m2.如按IDF的腹型肥胖的腰围标准.维吾尔族男性有78.8%,女性有74.6%腰围超标.而汉族易出现胆固醇(TC)的升高,维吾尔族组的空腹血糖(FPG)胆固醇低于汉族组,甘油三脂(TG)高密度脂蛋白胆固醇(HDL-C)高于汉族组,维吾尔族更须关注TG水平,本研究还发现汉族组如拟FPG≥5.6 mmol/L为糖代谢异常标准时有43.6%的异常,如拟FPG≥6.1 mmol/L为糖代谢异常标准时只有23.3%的异常,差异显著.结论:维吾尔族较汉族存在较严重的肥胖和代谢综合征.