支氣管哮喘( 簡稱哮喘) 是由多種細胞包括氣道的炎性細胞和結構細胞( 如嗜酸粒細胞、肥大細胞、T 淋巴細胞、中性粒細胞、平滑肌細胞、氣道上皮細胞等) 和細胞組分參與的氣道慢性炎癥性疾病。近年來其患病率在全球范圍內呈逐年增長趨勢, 雖然90% ~95% 的哮喘患者應用吸入β2 激動劑和糖皮質激素治療能夠控制癥狀, 但停藥后癥狀可能再次出現, 部分患者對激素治療抵抗。隨著對哮喘發病機制的深入認識, 探索了多種新的靶向治療, 但目前還處于研發和臨床試驗過程中。現簡要概述免疫調節劑相關的哮喘靶向治療的作用機制、效應及與之相關的不良事件。
Objective To analyze the reason of tumor treatment-related premature ovarian failure, and to review the progress of ovarian functional reconstruction. Methods The l iterature about the effects of radiotherapy and chemotherapy on ovarian function and reconstruct ovarian function was reviewed, analysed and summarized. Results Radiotherapy and chemotherapy can both affect ovarian function. The ovarian function reconstruction included fresh ovarian transplantation and ovarian cryopreservation and transplantation. Frequent ovarian cryopreservation was procedure slow-freezing protocols and vitrification protocols. Some laboratory and animal models of ovarian function reconstruction have come to gratifying results. Conclusion Ovarian function reconstruction has a potential cl inical value and provides a promising future.
Objective To investigate the effects of component blood transfusion combined with heparin therapy on coagulation function and clinical outcomes in pregnant women with acute disseminated intravascular coagulation (DIC). Methods A retrospective analysis was conducted on the clinical data of 65 pregnant women with acute DIC who were treated in Obstetrics Department of Luzhou People’ s Hospital between March 2020 and March 2022. Pregnant women treated with component blood transfusion were included in the control group, while those treated with component blood transfusion combined with heparin were included in the observation group. Before and after treatment, the DIC scoring system was used for score evaluation. Coagulation function indicators and routine blood indicators were compared between the two groups of pregnant women. Adverse clinical outcomes and adverse reactions were observed in both groups of pregnant women. Results The study enrolled 65 pregnant women, comprising 30 in the observation group and 35 in the control group. Before treatment, there was no statistical difference in DIC score, coagulation function indicators, or routine blood indicators between the two groups (P>0.05). After treatment, the DIC score, prothrombin time, activated partial thromboplastin time, thrombin time, and D-dimer significantly decreased in both groups (P<0.05), and the above indicators in the observation group [3.39±0.48, (13.28±2.28) s, (24.68±2.06) s, (14.27±1.82) s, and (2.23±0.88) mg/L, respectively] were lower than those in the control group [4.11±1.56, (15.02±2.45) s, (26.79±3.18) s, (15.61±1.91) s, and (2.87±0.74) mg/L, respectively] (P<0.05). The levels of fibrinogen, platelet count, hemoglobin, and hematocrit significantly increased in both groups (P<0.05), and the levels in the observation group [(4.29±1.05) g/L, (175.36±20.46)×109/L, (84.09±7.27) g/L, and (25.49±3.13)%, respectively] were higher than those in the control group [(3.44±1.27) g/L, (145.77±21.12)×109/L, (76.58±7.13) g/L, and (23.03±3.05)%, respectively] (P<0.05). The observation group had a lower incidence rate of adverse clinical outcomes compared to the control group (33.3% vs. 74.3%, P<0.05). The incidence rates of adverse reactions were not statistically different between the two groups (P>0.05). Conclusions Component blood transfusion combined with heparin therapy for pregnant women with acute DIC can effectively improve their coagulation function, reduce the risk of bleeding, and further improve adverse clinical outcomes such as postpartum hemorrhage and hysterectomy. Additionally, this treatment approach demonstrates a high safety profile.
目的:評價奈達鉑聯合氟脲嘧啶/四氫葉酸治療晚期復發耐藥食管癌的療效及不良反應。方法:30例晚期復發耐藥食管癌均經病理學或細胞學確診。奈達鉑100mg/㎡,靜脈滴注,第1天;氟脲嘧啶500mg/㎡,靜脈滴注,維持6~8小時,第1~5天; 四氫葉酸200mg,靜脈滴注,第1~5天,21天為一周期,連續用2周期后評價療效及不良反應。結果:30例均完成2個周期以上化療,共接受86周期化療,全部病例均可評價療效及不良反應。無CR病例,PR 13例(43.3%),SD 7例(23.3%),PD 10例(33.3%),有效率為43.3%,TTP 4.0月,MST8.3月。不良反應主要是骨髓抑制,惡心、嘔吐,全組無IV度不良反應。結論:奈達鉑聯合氟脲嘧啶/四氫葉酸治療晚期復發耐藥食管癌有確切療效,不良反應輕,耐受性好,值得臨床進一步推廣應用。
ObjectiveTo systematically review the comprehensive evaluation methods applied to estimate the medical service performance based on diagnosis-related groups (DRGs) in China and to provide suggestions for the promotion of methods in further studies.MethodsLiterature published before May 2019 were searched in China National Knowledge Infrastructure, WanFang Data, CQVIP and PubMed for studies about DRGs-based comprehensive evaluation. After literature screening and information extracting by two reviewers independently, qualitative approaches were used to describe the application of DRGs-based comprehensive evaluation methods in the performance evaluation of medical services.ResultsA total of 24 articles were included in the systematic review. Different indexes were used to evaluate the medical service performance. Delphi Method, expert discussion, Saaty’s Method and some other means were applied to determine the weights of indexes in 8 articles. Rank-sum ratio method, Technique for Order Preference by Similarity to an Ideal Solution and synthetic index method were proposed for the comprehensive evaluation in 9, 7 and 9 articles, respectively; besides, analytic hierarchy process and combination evaluation were also used.ConclusionsBased on DRGs, the choose of indicators, weighting approaches, and calculation methods of comprehensive values vary richly in different studies. More attention should be paid to weight using and combination of comprehensive evaluation methods in further studies. Meanwhile, the quality of information source used for estimation and the rationality of results application are supposed to be emphasized.
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation. MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%, and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula, biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.
Objective To investigate the application of risk assessment in the control of nosocomial infections in surgical departments of infectious disease hospitals so as to provide references for the regulation of prevention and control measures. Methods Nosocomial infection risks in surgical departments of infectious disease hospitals were identified by the method of brainstorming. Based on risk assessment and planning of American children's national medical center in Washington for epidemic and infectious diseases control, the matrix method was used for risk assessment. The three highest risks were controlled, and then we compared the incidence of nosocomial infections before and after the risk assessment. Results The major risk factors in surgical departments existed in the process of diagnosis and treatment. By matrix scoring, excluding high readiness items, we found that the top three risks were airborne diseases, prevention and nursing of hematogenous infections and air disinfection. Nosocomial infection rate in the surgical departments dropped to 2.03% after carrying out risk assessment and taking correspondent measures (χ2=5.480,P=0.019). Conclusion Evaluation of nosocomial infection risk in surgical departments of infectious disease hospitals can discover major potential risks and reduce the incidence of nosocomial infections, which can provide references for management and control of nosocomial infections.
Objective To explore the feasibility, operation method, and clinical application value of transumbilical single-port laparoscopic cholecystectomy (TUSP-LC) in treatment for children patients with benign gallbladder diseases. Methods The clinical data of 64 patients with benign gallbladder diseases from June 2009 to June 2011 were analyzed retrospectively. The patients were divided into TUSP-LC group (n=41) and convention three-port LC (CTP-LC group, n=23). The operative time, intraoperative blood loss, conversion to CTP-LC or laparotomy, operative complications, and hospital stay were recorded. The pains were registered at 3,6,12,24,48, and 72h postoperatively using visual analog scale (VAS). The patients were given satisfaction questionnaires with surgery at 6 time points (1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months) during a 12 months follow-up. Results A total of 64 pediatric LCs were performed successfully, no patients were converted to laparotomy. Except for one case of incision infection in the CTP-LC group 〔4.35%(1/23)〕 and one case of incision infection and one case of ecchymoma in the TUSP-LC group 〔4.88% (2/41)〕, no other complications such as bile duct injury, bile leakage, and incision hernia happened, the total complication rate was not significant difference in two groups (P>0.05). The operative time 〔(47.54±18.71) min versus(45.33±10.58) min〕, intraoperative blood loss 〔(18.56±13.34) ml versus (17.28±12.53) ml〕, and hospital stay 〔(1.67±0.36) d versus (1.81±0.38) d〕were not significant differences in two groups (P>0.05). The VAS score was not statisticly significant within 24h in two groups (P>0.05), but which in the TUSP-LC group was significantly lower than that in the CTP-LC group after 24h postoperatively (P<0.05). During a 12 months follow-up, the score of satisfaction in the TUSP-LC group was significantly higher than that in the CTP-LC group (P<0.05). Conclusions TUSP-LC is a safe and feasible method in the children patients with benign gallbladder diseases. It can be performed with the same technical exposure and outcomes as multi-port laparoscopy, with the added benefit of relieving postoperative pain and little no scarring.
Objective To explore the possible anti-inflammatory mechanism of peroxisome proliferators-activated receptor(PPAR) gamma-agonists by investigating the effects of Rosiglitazone on the expression of phosphorylation of signal transducer and activator of transcription 6(p-STAT6) and the secretion of interleukin(IL)-4 in T-lymphocytes from patients with acute asthma.Methods Peripheral blood T-lymphocytes from 10 healthy volunteers(group A) and 10 patients with acute asthma were isolated,purificated and cultured.T-lymphocytes from the asthma patients were divided into a control group(group B) and a Rosiglitazone treated group(group C).Rosiglitazone was added with a single dose of 10-4 mol/L at 0 hour of cultrue.After cultured for 48 hours,the concentration of IL-4 in supernatant of each groups were detected by ELISA.The express of p-STAT6 in the T-lymphocytes were determined by Western blot and immunohistochemical techniques.Results The levels of IL-4 were increased markedly in group B than those in group A and group C[(170.34±9.05)pg/mL vs(76.82±7.06)pg/mL and(123.59±8.70)pg/mL,both Plt;0.01],and which in group C was significantly lower than group A(Plt;0.01).The levels of p-STAT6 in T lymphocytes were increased markedly in group B than in group A and C[Western blot:(6.28±0.19 vs 3.07±0.18 and 4.12±0.16;immunohistochemistry:(36.58%±7.41)% vs(11.39±4.02)% and(23.92±5.8)%,all Plt;0.01),and which in group C were significantly higher than that in group B(both Plt;0.01).There was a positive correlation between the level of p-STAT6 and IL-4(Plt;0.01).Conclusion The levels of p-STAT6 and IL-4 in T-lymphocytes of patients with acute asthma were suppressed by Rosiglitazone in vitro.
目的 通過分析環境空氣中二氧化硫與過敏原的關聯性,探討二氧化硫在評估過敏性疾患中的作用。 方法 收集2005年1月1日-2012年12月31日綿陽市4個監測點二氧化硫濃度,及2007年7月1日-2012年12月31日的過敏性疾病患者各種過敏原的陽性百分比,采用Pearson相關分析探討二氧化硫濃度變化對過敏原的影響。 結果 2005年-2012年綿陽市二氧化硫年平均濃度分別為(0.060 ± 0.022)、(0.054 ± 0.018)、(0.046 ± 0.012)、(0.030 ± 0.020)、(0.026 ± 0.010)、(0.035 ± 0.012)、(0.036 ± 0.008)、(0.030 ± 0.009) mg/m3。淡水魚組合(fs34),海魚組合(fs33),羊肉(f88),黃豆(f14),花生(f13),狗上皮(e2)與二氧化硫的Pearson相關系數分別為:0.144、0.186、0.209、0.150、0153、0.197。檢驗P值分別為:0.019、0.002、0.001、0.015、0.013、0.001。按α=0.05標準認為與二氧化硫存在正相關關系。而其余的塵螨組合(ds1)、普通豚草(w1)、律草(u80)、樹組合(ts20)、雷菌組合(ms1)、蟑螂(i6)、屋塵(h1)、牛肉(f27)、蝦(f24)、蟹(f23)、牛奶(f2)、雞蛋白(f1)、貓毛(e1)、艾蒿(w6),按α=0.05標準,不能認為與二氧化硫存在正相關關系。 結論 環境空氣二氧化硫與淡水魚、海鮮、羊肉、大豆、花生及狗皮屑具有明確的相關性,對樹組合、普通豚草、艾蒿、塵螨組合、屋塵、貓毛、蟑螂、霉菌組合、律草、雞蛋白、牛奶、牛肉、蝦、蟹等無明確的相關性。