17β-雌二醇对子宫内膜异位症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响

目的研究17β-雌二醇(17β-E2)对子宫内膜异位症(内异症)患者在位子宫内膜间质细胞β-catenin mRNA和蛋白表达的影响,探讨Wnt/β-catenin信号通路在介导雌激素促进内异症发生发展的作用。方法体外分离培养内异症患者在位子宫内膜间质细胞。用不同浓度17β-E2处理子宫内膜间质细胞48 h;此后选用10-10mol/L 17β-E2处理子宫内膜间质细胞12、24和48 h,逆转录聚合酶链反应(RT-PCR)和免疫印迹法(Western blotting)检测17β-E2处理前后子宫内膜间质细胞β-catenin mRNA和蛋白的表达水平。同法分析雌激素受体拮抗剂ICI182,780(10-6mol/L)对17β-E2促进β-catenin mRNA和蛋白表达的影响。免疫组织化学染色观察17β-E2作用后β-catenin在子宫内膜间质细胞中的定位。结果17β-E2能明显促进内异症患者在位子宫内膜间质细胞β-catenin mRNA和蛋白的表达,并呈剂量和时间依赖性,于10-10mol/L作用48 h最明显。雌激素受体拮抗剂ICI182,780能明显抑制17β-E2对子宫内膜间质细胞β-catenin mRNA和蛋白的表达。免疫组织化学染色发现17β-E2能促进β-catenin在子宫内膜间质细胞核内的表达。结论雌激素可能通过激活Wnt/β-catenin信号通路促进内异症在位子宫内膜的异位种植。     

《野叟曝言》创作人格批判

《野叟曝言》的“文格”与夏敬渠的创作人格有一致性，但存在明显的、不可忽视的矛盾，这种矛盾对《野叟曝言》的文本价值产生了极复杂的影响。导致夏敬渠“人格”与《野叟曝言》“文格”矛盾的原因是多方面的，研究视角不能简单化、绝对化。     

泸州市473例新报告50岁及以上男性艾滋病患者性途径感染原因分析

目的调查泸州市中老年男性艾滋病疫情高发的原因,为制订有针对性的干预策略提供依据。方法采用整群抽样的方法,2019年对473例新报告的泸州市50岁及以上中老年男性艾滋病感染者/病人展开性伴、安全套使用及商业性行为等主要内容的问卷调查,采用卡方检验进行差异性分析,检验水准α=0.05。结果分别有81.6%、62.8%和10.1%的人有商业性行为、固定性伴/配偶和临时性伴,除固定性伴比例随年龄增长呈下降趋势(χ²_趋势=6.934,P=0.008)外,其余性伴类型没有统计学差异。与不同性伴发生性关系,近1年从未使用安全套比例均超过90%。无配偶(35.8%)、配偶不在身边(30.8%)、诱惑/好玩(22.4%)是寻找商业性伴的前3位原因;性交易对象以本地为主,本乡镇占56.0%。固定场所(46.3%)和接头拉客(43.7%)是最主要的寻找商业性伴方式。多数性交易价格低于50元,年龄越大,<50元的占比越大(50岁~59岁、60岁~69岁、≥70岁分别为52.1%、78.0%和80.0%),差异有统计学意义(χ²=22.061,P<0.001)。结论中老年男性通过寻找商业性伴满足其性需求,交易价格偏低。该群体存在多性伴行为、基本不使用安全套行为等现象,是其艾滋病疫情快速增长的重要原因。     

7003例儿童意外损伤住院病例分析

目的以1993～1999年武汉市儿童医院意外损伤住院病例为研究对象，对不同年龄、性别住院儿童的损伤类型和损伤原冈进行分析比较。方法采用描述性研究，以1993～1999年儿童医院意外损伤住院病例为研究对象（ICD9-800～959），根据ICD9划分意外损伤类型，Ecode标准区别损伤的外部原因，并运用SAS分析软件分析数据。结果7003例意外损伤住院儿童中，前网位损伤的是骨折、开放性损伤、软组织损伤和异物，分别占42．1％、14．5％、13．1％和11．0％。前网位损伤外部原因是跌落、交通运输、呼吸道梗阻和挤压／撞击，分别占50．9％、11．8％、10．4％和9．8％。意外损伤住院儿童性别比为2．1：1。骨折、开放性损伤和挫伤／挤压多发生于3岁以上年龄组，异物和烧伤多发生于1～3岁年龄组；交通运输、跌落造成的损伤多发生于6岁以上组，挤压／撞击造成的损伤多发生于3岁以上儿童，呼吸道梗阻、火灾／爆炸造成的损伤多发生于1～3岁组。结论意外损伤住院的数量逐年增加，男孩比女孩吏容易受伤。发生意外的数量、损伤的类型和损伤外部原因根据儿童年龄组的不同而不同。     

微观探析"看病贵"的原因及对策

分析了药品定价过高、医疗服务价格体系不健全、社保体制僵化、教学经费不足挤占卫生经费及诸多摊派变相侵犯了病人利益是造成“看病贵”问题的根源。提出了应改革现行的药品定价体系和管理体制、健全医疗服务收费体系及社保监督机制、理顺医疗和教学经费关系及营造医院良好的外围空间等5个方面的对策,以解决“看病贵”问题。     

门诊西药房退药原因分析与应对策略

目的 通过对本院门诊西药房退药情况进行调查分析,提出应对策略,减少和规范退药。方法 对门诊退药处方进行统计分析,探讨应对策略。结果 退药原因排在前三位的分别是处方错误、患者拒用、不良反应,共110人次,占全部退药的61.7%。结论 退药现象不可避免,应针对原因,完善制度,减少和规范退药。     

不同冷冻原因FET周期移植结局的分析

目的 分析辅助生殖技术中不同冷冻原因的玻璃化冻融胚胎移植结局.方法 对2009年3月至2011年5月1 186个玻璃化冻融胚胎移植周期进行回顾性统计学分析,根据不同的冷冻原因分为预防卵巢过度刺激综合征(OHSS)全胚冷冻组(A组)、新鲜周期移植后剩余胚胎冷冻组(B组)、宫腔积液原因取消移植胚胎冷冻组(C组)和其他原因胚胎冷冻组(D组),分析各组的临床妊娠率.结果 A、B、C、D组的妊娠率分别为64.2％、45.5％、44.0％、51.5％,A组与B组、C组均有显著性差异(x2值分别为35.080、4.119,均P＜0.05).但与D组无显著性差异(x2=2.113,P＞0.05),B组与C组、D组间均无显著性差异(x2值分别为0.022、0.461,均P＞0.05).结论 对于有过激风险和宫腔积液的患者,进行冻融胚胎移植是一种有效的助孕方法.     

Patient and Provider-Identified Factors Contributing to Surgical Readmission After Colorectal Surgery

Purpose: Nearly one in seven surgical patients is readmitted to the hospital within 30 days of discharge. Few studies have identified patient-centric factors that raise the risk of both preventable and nonpreventable postoperative readmissions. Materials and Methods: Over 6 months in 2012, 48 colorectal surgical patients were identified on re-admission within 30 days of discharge. We prospectively obtained information on the patient's and primary surgeon's views on factors that contributed to readmission, and compiled data to produce an external list of contributing factors. A standard cost analysis was performed. Results: 48 colorectal surgery patients participated, and 47 were included in this patient-centric evaluation of factors leading to readmission. The three primary readmission diagnoses included dehydration, fever, and ileus or small bowel obstruction. Of all readmissions, 23% were considered to be preventable. 38% of patients had scheduled follow-up appointments that were documented in the medical record at the time of discharge. Providers identified several factors contributing to readmission including difficulty understanding discharge plan, medication management and premature discharge. Per patient, the cost of preventable readmission was $15,366 (±20%; $12,293–$18,439). Total preventable cost was $169,025 (±20%; $135,220–$202,829). Conclusions: The ability to obtain an outpatient postoperative appointment and the understanding of their own postoperative care were the most commonly identified barriers. Interventions to help reduce unnecessary readmissions include a standard discharge process and coordinator, and routine (<7 days) postdischarge outpatient appointments. Successful reduction of preventable readmissions would result in approximately $3.6 million in cost savings per 1,000 colorectal readmissions.     

Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Knee Arthroplasty: A Review of 3015 Cases

BackgroundA higher volume of primary total knee arthroplasty (TKA) is starting to be performed in the outpatient setting. However, data on appropriate patient selection in the current literature are scarce.MethodsPatients who underwent primary TKA were identified in the 2012-2017 National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days. The primary outcome was a readmission within the 30-day postoperative period. Reasons for and timing of readmission were identified. Risk factors for and effect of overnight hospital stay on 30-day readmission were evaluated.ResultsA total of 3015 outpatient TKA patients were identified. The incidence of 30-day readmission was 2.59% (95% confidence interval [CI] 2.02-3.15). The majority of readmissions were nonsurgical site related (64%), which included thromboembolic and gastrointestinal complications. Risk factors for 30-day readmission include dependent functional status prior to surgery (relative risk [RR] 6.4, 95% CI 1.91-21.67, P = .003), hypertension (RR 2.5, 95% CI 1.47-4.25, P = .001), chronic obstructive pulmonary disease (RR 2.4, 95% CI 1.01-5.62, P = .047), and operative time ≥91 minutes (≥70th percentile) (RR 1.9, 95% CI 1.17-2.98, P = .008). For patients who had some of these risk factors, their rate of 30-day readmission was significantly reduced if they had stayed at least 1 night at the hospital.ConclusionOverall, the rate of 30-day readmission after outpatient TKA was low. Patients who are at high risk for 30-day readmission after outpatient TKA include those with dependent functional status, hypertension, chronic obstructive pulmonary disease, and prolonged operative time. These patients had reduced readmissions after overnight admission and seem to benefit from an inpatient hospital stay.