Nutritional iron deficiency anemia is a common disease to highlighted prevent and cure in China,it has highest morbility in infants,do harm to children.Recent reseach discovered that the occurance of nutritional iron deficiency anemia had close relationship with helicobacter pylori infection and the time when added complementary feed.In diagnosis,the ratio between serum soluble transferritin receptor(sTfR)and serum ferritin is very important to assess the body′s iron storage.Hypochromic red blood cell and reticulocyte hemoglobin quantity have the value on early diagnose of IDA.In treatment,it talks about the treatment to the helicobacter pylori infection besides the symptomatic treatment.
Objective:To investigate the clinical value of dynamic detection of lymphocyte subsets and blood cell counts in management of patients with lupus nephritis (LN).Methods:The clinical data of 65 patients with primary LN admitted in Affiliated Hospital of Qingdao University from January 2015 to April 2021 were retrospectively analyzed. According to the stage of disease progression and medications used,LN patients were classified into primary active phase,post-induction therapy phase,and maintenance therapy phase. The changes in lymphocyte subsets were monitored,and the relationship of lymphocyte subsets and blood cell count ratios with lupus activity and infection events was evaluated.Results:The decrease of CD4 +T lymphocyte and NK cell counts were negatively correlated with the activity of systemic lupus erythematosus (SLE)( r=-0.67,-0.33, P<0.01),while CD8 +T lymphocyte,B cell counts,neutrophil/lymphocyte ratio (NLR),platelet/lymphocyte ratio (PLR),and monocyte/lymphocyte ratio (MLR) were positively correlated with the SLE activity( r=0.38,0.26,0.34,0.26,0.29, P<0.05). The area under ROC curve (AUC) of CD4 +T lymphocyte count in predicting the occurrence of infection in LN patients was the highest (0.89); taking 247.50 cell/μl as cutoff value,the sensitivity and specificity were 81.25% and 87.50%,respectively. The combination of CD4 +T lymphocyte with CRP increased the predicting value for the occurrence of infection. Conclusion:Dynamic detection of blood lymphocyte subsets and blood cell counts can reflect SLE activity and the occurrence of infection in LN patients. Among these indicators the CD4 +T lymphocyte has the highest predictive value for the occurrence of infection,and the combination of the CD4 +T lymphocyte count with CRP level can further improve the predicting value.
Objective:To evaluate the effect of narrative medicine teaching in general practice residency training.Methods:Thirty-eight resident physicians who received standardized training in the Department of General Medicine in Shanghai Fifth People′s Hospital from November 2021 to November 2022 were randomly divided into trial group and control group with 19 individuals in each group. All residents received general medicine training according to the national standard curriculum, while narrative medicine was added to the teaching for the trial group. The teaching results were evaluated after 8 months of training. The indicators included mini-clinical evaluation exercise (Mini-CEX) assessment scores, academic assessment, narrative ability and empathy ability scores, self-assessment scores of learning effectiveness, and teaching satisfaction.Results:Among 38 residents, 15 were males and 23 were females with a mean age of (25.9±2.1) years. There were no significant differences in gender composition, age and education level of the two groups (all P>0.05). Mini-CEX results showed that the evaluation skills, physical examination, professionalism, clinical diagnosis, communication skills, organization and efficiency, and overall ability scores in the trial group were all significantly higher than those in the control group (all P<0.001). Examination results showed that there were no significant differences in knowledge test scores between the two groups ( P=0.208), however the skill manipulation performance in the trial group was significantly higher than that in the control group ( P=0.023). The narrative ability scores and empathy ability scores of the trial group were significantly higher than those in the control group (both P<0.001). In terms of learning effectiveness, the scores of stimulating interest in learning, scores of improving language expression ability, scores of learning good doctor-patient relationship, improving doctor-patient communication ability, and improving problem analysis ability in the trial group were significantly higher than those in the control group (all P<0.001). The teaching satisfaction rate of the trial group was 78.9% (15/19), which was higher than that of the control group (52.6%(10/19)). Conclusion:Adding narrative medicine teaching to the residency training can enhance the teaching effect of general practice residency training, especially in clinical practice ability, narrative ability and empathy ability.
原发性绒癌是一种罕见的高度恶性的肿瘤，多数病例发病时伴有脏器及淋巴结转移，初诊困难，通过报告1例经内科胸腔镜诊断的老年男性纵隔原发性绒癌伴有双肺及双侧胸膜转移患者的诊治过程，探讨内科胸腔镜在该病诊断中的作用及内科胸腔镜下表现，提高对该疾病的认识。
冠心病是临床上常见的心血管疾病之一，严重威胁人类健康，疾病负担较大 ［1］。心理问题不仅影响冠心病的发生、发展和治疗，同时还影响患者预后 ［2］。心脏疾病与心理疾病二者互为因果，互相影响，并可导致病情恶化 ［3］。该问题在基层临床实践中尤为突出。目前已有《稳定性冠心病基层诊疗指南（2020年）》 ［4］《稳定性冠心病基层合理用药指南》 ［5］和《冠心病心脏康复基层合理用药指南》 ［6］等可指导基层医师对冠心病进行规范诊疗，但尚缺乏稳定性冠心病（stable coronary artery disease，SCAD）合并心理问题诊疗的基层规范，为此中国医师协会心血管内科医师分会双心学组、北京医学会心脏心理分会组织相关专家，遵循《中华医学会心血管病分会关于心血管疾病指南或专家共识制定及文件撰写规范的建议》，参考中华医学会心血管病学分会2018年颁布的《稳定性冠心病诊断与治疗指南》 ［7］、欧洲心脏病学会（ESC）2019 年发布的《慢性冠状动脉综合征的诊断和管理指南》 ［8］和ESC2019年发布的《抑郁与冠心病立场文件》 ［9］等指导性文件，结合领域内最新的循证医学证据，经过心血管内科、精神心理科、全科以及中医科等多学科专家的多轮讨论，制订了本共识。本共识针对SCAD合并心理问题的流行病学、发病机制、诊断和治疗、基层随访及管理等内容进行了阐述，旨在为基层医疗卫生机构的全科医师、心血管内科医师接诊成年SCAD患者提供指导。
