不同手术方式治疗慢性肛裂疗效评价的网状Meta分析

目的评价不同手术方式治疗慢性肛裂的效果。 方法通过计算机检索传统肛裂切除术、纵切横缝法、改良纵切横缝术、肛裂切除术+外括约肌切开术、肛裂切除术+内括约肌切开术5种手术治疗慢性肛裂的国内外临床研究，采用Stata13及GeMTC软件对其治愈率和并发症发生率进行传统Meta分析和网状Meta分析。 结果共纳入21项临床研究2 430例患者。网状Meta分析显示肛裂切除术+内括约肌切开术和肛裂切除术+外括约肌切开术的治愈率均高于传统肛裂切除术，OR值分别为2.27（95%CI=1.14~4.36）、3.26（95%CI=1.67~6.75）。在并发症的发生率方面，纵切横缝术、传统肛裂切除术排前两位，肛裂切除术+内括约肌切开术最低。 结论在5种常见的慢性肛裂手术方式中，肛裂切除术+内括约肌切开术的疗效和并发症发生均优于传统肛裂切除术、纵切横缝法、改良纵切横缝术、肛裂切除术+外括约肌切开术。     

Double‐chambered left ventricle diagnosis by 2D and 3D echocardiography: From fetus to birth

Double‐chambered left ventricle (DCLV) is a rare cardiac anomaly and is characterized by the division of the left ventricle by abnormal muscle and/or fiber bundles into two chambers. We hereby report a fetus which was diagnosed with DCLV in utero by 2D and 3D Fetal echocardiography and the findings were confirmed after birth.     

手术室医辅人员任务智能分配的抢单模式管理

目的研发适用于手术室医辅人员任务分配管理的智能软件信息系统,并探讨其运行效果。方法将2018年3月试运行抢单信息系统的509台次手术设为实验组,对医辅人员运用抢单模式进行管理;对同期未实施的486台次同类手术设为对照组,运用常规管理模式;比较两组的运行效果。结果实验组应答时间和完成任务时间显著短于对照组,护士满意率显著提升(均P0.01)。结论抢单信息系统精准记录了医辅人员的工作量和时间节点,提高了工作效率和护理人员满意率,促进了后勤医辅人员的科学化、精细化管理。     

糖尿病足溃疡复发因素及预防策略的研究进展

综述糖尿病足溃疡复发的影响因素包括足底压力、周围神经病变、周围血管病变、足部外伤、血糖控制不佳及其他(吸烟、日常活动负重、C-反应蛋白水平升高),预防复发的措施包括识别和筛查高危因素、卸载足部压力、选择合适的治疗鞋和鞋垫、手术卸载、自我护理、健康教育、信息化管理、依从性管理等,提出采取多种预防措施的综合性护理干预有助于减少糖尿病足溃疡的复发率。     

Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.     

In vitro dissolution and oral bioavailability study of fenofibrate nanomatrix system prepared by hot-melt extrusion

Solvent evaporation method for preparation of nanomatrix has the disadvantages, such as residual organic solvent, environmental pollution, explosion-proofing and so on. To overcome these shortcomings, a series of fenofibrate nanomatrix drug delivery system (NDDS) consisting of nano-porous silica Sylysia^®350 (S350) and pH sensitive material Eudragit^® L100-55 (EL100-55) were prepared using hot-melt extrusion (HME), and their in vitro dissolution and in vivo bioavailability were compared. Finally, the formulation with the highest in vivo bioavailability was selected as the optimized formulation for DSC and PXRD characterization. The results showed that the optimized NDDS showed a higher bioavailability than the reference formulation, although there was crystalline form drug remaining in NDDS. The relative bioavailability of the optimized formulation was 157.1% compared with the commercial product Lipanthyl^®. In addition, the relative bioavailability of the optimized formulation was 124.8% in comparison with the formulation prepared by solvent evaporation method, showing that the NDDS prepared by the HME method was effective in improving the bioavailability of fenofibrate. In conclusion, HME was a promising method to prepare NDDS.     

Association between PPARG genetic polymorphisms and ischemic stroke risk in a northern Chinese Han population: a case-control study

Two common polymorphisms of the peroxisome proliferator-activated receptor gamma(PPARG) gene, rs1801282 and rs3856806, may be important candidate gene loci affecting the susceptibility to ischemic stroke. This case-control study sought to identify the relationship between these two single-nucleotide polymorphisms and ischemic stroke risk in a northern Chinese Han population. A total of 910 ischemic stroke participants were recruited from the First Hospital of China Medical University, Shenyang, China as a case group, of whom 895 completed the study. The 883 healthy controls were recruited from the Health Check Center of the First Hospital of China Medical University, Shenyang, China. All participants or family members provided informed consent. The study protocol was approved by the Ethics Committee of the First Hospital of China Medical University, China on February 20, 2012(approval No. 2012-38-1). The protocol was registered with the Chinese Clinical Trial Registry(registration number: ChiCTR-COC-17013559). Plasma genomic DNA was extracted from all participants and analyzed for rs1801282 and rs3856806 single nucleotide polymorphisms using a SNaPshot Multiplex sequencing assay. Odds ratios(ORs) and 95% confidence intervals(CIs) were calculated using unconditional logistic regression to estimate the association between ischemic stroke and a particular genotype. Results demonstrated that the G allele frequency of the PPARG gene rs1801282 locus was significantly higher in the case group than in the control group(P 0.001). Individuals carrying the G allele had a 1.844 fold increased risk of ischemic stroke(OR = 1.844, 95% CI: 1.286–2.645, P 0.001). Individuals carrying the rs3856806 T allele had a 1.366 fold increased risk of ischemic stroke(OR = 1.366, 95% CI: 1.077–1.733, P = 0.010). The distribution frequencies of the PPARG gene haplotypes rs1801282-rs3856806 in the control and case groups were determined. The frequency of distribution in the G-T haplotype case group was significantly higher than that in the control group. The risk of ischemic stroke increased to 2.953 times in individuals carrying the G-T haplotype(OR = 2.953, 95% CI: 2.082–4.190, P 0.001). The rs1801282 G allele and rs3856806 T allele had a multiplicative interaction(OR = 3.404, 95% CI: 1.631–7.102, P 0.001) and additive interaction(RERI = 41.705, 95% CI: 14.586–68.824, AP = 0.860; 95% CI: 0.779–0.940; S = 8.170, 95% CI: 3.772–17.697) on ischemic stroke risk, showing a synergistic effect. Of all ischemic stroke cases, 86% were attributed to the interaction of the G allele of rs1801282 and the T allele of rs3856806. The effect of the PPARG rs1801282 G allele on ischemic stroke risk was enhanced in the presence of the rs3856806 T allele(OR = 8.001 vs. 1.844). The effect of the rs3856806 T allele on ischemic stroke risk was also enhanced in the presence of the rs1801282 G allele(OR = 2.546 vs. 1.366). Our results confirmed that the G allele of the PPARG gene rs1801282 locus and the T allele of the rs3856806 locus may be independent risk factors for ischemic stroke in the Han population of northern China, with a synergistic effect between the two alleles.     

Peritoneal dialysis improves lung function in rats with lung injury induced by shock wave

Objective To prove the efficacy of peritoneal dialysis on shock wave-induced acute lung injury of rats, and analyze its mechanisms. Methods Forty-five adult Sprague-Dawley rats were randomly divided into three groups: control group, sham operation (Sham) group and peritoneal dialysis (PD) group. Sham group and PD group did abdominal catheterization before blast injury. The 55 kg shock wave (bst-I) was used to induce lung blast injury. After one hour of blast injury, PD group was given 2.5% peritoneal dialysate 20 ml to stay abdomen, which was released 30 min posted, repeated 12 cycles. After 6 hours of peritoneal dialysis, all of the rats were sacrificed. Partial damaged tissues in lung were used to evaluate the pathomorphologic changes by HE staining, and the remnants were used to measure the lung water content. Lung function was detected by blood gas analyzer and small animal detector from the arterial blood gas. The levels of serum inflammatory factors, such as tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and monocyte chemoattractant protein-1 (MCP-1) were tested by ELISA. Results The relative integrity of alveolar structure, interstitial edema and inflammatory cell infiltration in PD group were significantly improved than those in control group. The lung water content of PD group was significantly lower than that of control group (P＜0.05). The levels of TNF-α, IL-1β, IL-6 and MCP-1 in serum of PD group were significantly lower than those in control group (all P＜0.05). The blood oxygen saturation, oxygen partial pressure, oxygenation index, vital capacity, functional residual volume and maximum mid-expiratory flow rate in PD group were significantly higher than those in control group (all P＜0.05). Conclusions Through reducing pulmonary edema and inflammatory factors, peritoneal dialysis can improve lung function in shock wave -induced acute lung injury of rats.     

冠心病血瘀证基因组学研究进展＊

目的 系统综述冠心病血瘀证基因组学研究的方法和内容。方法 计算机检索Medline、Cochrane Central Register of Controlled Trials、中国知网、万方数据库，查找冠心病血瘀证基因组学的临床研究，按照制定的纳入排除标准，由2名研究人员独立筛选文献，任何分歧通过协商一致或通过第3名研究人员来解决。结果 最终纳入34项研究，其中与冠心病血瘀证密切相关的基因组学研究类型包括基因多态性、差异基因的表达、基因的甲基化修饰，涉及的生物学功能有血管内皮损伤、血液流变学改变、炎症反应与免疫调节、血管平滑肌增殖、血脂水平等，采用的技术方法有聚合酶链式反应（Polymerase chain reaction，PCR）、飞行时间质谱技术（Time-of-flight mass spectrometry，TOF-MS）、基因芯片杂交测序（Gene Chip）等。结论 基因组学研究可阐明冠心病血瘀证的生物学基础，为冠心病血瘀证的病机演变提供更好的依据，更有助于从分子水平实现个体化治疗，从而进一步提高临床疗效。