Objective The aim of this study was to investigate the efficacy of switching from entecavir（ETV） or tenofovir（TDF） to other different antiviral therapy in ETV-or TDF-treated chronic hepatitis B（CHB） patients with low-level viraemia（LLV）. Methods A total of 197 patients with CHB who had been treated with ETV or TDF were enrolled in this study and were divided into group A（n=74） continuing ETV or TDF treatment, group B（ n=63） switching to TAF therapy and group C（n= 60） switching to ETV or TDF and peg-IFNα-2 b combination therapy. The regimen lasted for（48±2） weeks. Results At the end of 48 week treatment, the complete virologic response and serum HBeAg negative rates in group C were 90.0% and 41.7%, significantly higher than 16.2% and 5.4%（P＜0.05） in group A or 66.7% and 9.5%（P＜0.05） in group B, and serum ALT normalization rates in group B and group C were 20.6% and 23.3%, significantly higher than 8.1%（P＜0.05） in group A; serum HBsAg level in group C was 3.0（2.8, 3.4）lgIU/ml, significantly lower than [3.3（2.9, 3.9）lgIU/ml, P＜0.05] in group A or [3.4（3.3, 3.8）lgIU/ml, P＜0.05] in group B, serum HBeAg level was 0.1（-0.7, 0.0）lgIU/ml, significantly lower than [0.6（-0.6, 1.8） lgIU/ml, P＜0.05] in group A or [0.6（-0.3, 1.8）lgIU/ml, P＜0.05] in group B, and serum HBV DNA load was 1.3（1.3, 1.3）lgIU/ml, significantly lower than [1.7（1.3, 2.0）lgIU/ml, P＜0.05] in group A or [1.6（1.3, 1.4）lgIU/ml, P＜0.05] in group B; the LSMs in group B and group C were 6.4（4.3, 8.4） kPa and 6.2（4.2, 7.7） kPa, both significantly lower than [8.6（5.2, 10.7） kPa, P＜0.05] in group A, and serum ALT levels in the three groups were not significantly different（P＞0.05）. Conclusion The switch to TAF or combined with peg-IFNα-2 b therapy in ETV-or TDF-treated patients with LLV might benefit for further virologic and even serologic response, and warrants clinical investigation.

宫颈癌(CC)居于女性恶性肿瘤第二位,严重危害女性健康和生命,成为全球关注的健康问题.人工智能(AI)是利用计算机程序模拟、延伸和拓展人的智能行为的科学;以AI为核心技术的智能医学是医学未来发展的重要方向.深度学习(DL)为AI新领域,在图像分析领域展示出巨大应用潜力,用于诊断及鉴别诊断肿瘤、指导治疗及预测预后等具有特有优势.本文对DL用于筛查和诊断CC、指导治疗及判断预后的现状、问题及前景进行综述.

目的 回顾性分析索磷布韦维帕他韦(SOF/VEL)联合利巴韦林(RBV)治疗慢性丙型肝炎(CHC)患者真实世界研究(RWS)的疗效和安全.方法 2018年5月～2020年4月初治/PR经治的CHC患者32例和代偿期丙型肝炎肝硬化(CHC-CLC)患者36例,接受SOF/VEL治疗12 w,失代偿期丙型肝炎肝硬化(CHC-DLC)或合并肝细胞癌(HCC)患者31例,接受SOF/VEL联合利巴韦林(RBV)治疗12 w.部分患者合并存在高血压、糖尿病、肿瘤和慢性乙型肝炎.采用RT-PCR法检测HCV基因型(GTs).结果 本组HCV感染患者以GT 2a(55.6％)和GT1b(34.3％)为主;CHC、CHC-CLC和CHC-DLC患者早期病毒学应答(EVR4)分别为90.6％、86.1％、83.9％,治疗结束病毒学应答(EOT)均为100.0％,CHC组和CHC-CLC组SVR12和SVR24均为100.0％,CHC-DLC组SVR12和SVR24均为93.5％,三组间EVR4、EOT、SVR12、SVR24均无显著性差异(P>0.05);所有患者SVR12和SVR24均为97.8％,除GT3b型外其他GTs感染患者SVR12和SVR24均为100.0％;三组血生化学应答率分别为87.5％、83.3％和74.2％;本组总体不良反应(AE)发生率为12.1％,无严重AE或因AE停药和死亡事件发生.结论 应用SOF/VEL或联合RBV治疗CHC或相关的肝硬化患者,无论何种基因型感染,均有良好的效果,且安全.

目的 探讨妊娠中期孕妇静脉血镍(Ni)、砷(As)水平与新生儿脐带血心血管疾病生物标志物相关性.方法 收集A地(n=57)、B地(n=79)孕妇和新生儿基线资料及妊娠中期孕妇静脉血和分娩时新生儿脐带血;电感耦合等离子体质谱法测定孕妇Ni、As水平;酶联免疫吸附法测定脐带血血浆白介素-6(IL-6),全自动生化分析仪测定脐带血血浆C反应蛋白(CRP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平.Spearman秩相关及多重线性回归分析孕妇Ni、As水平与新生儿脐带血生物标志物水平的相关性.结果 妊娠中期A地孕妇静脉血Ni、As水平均高于B地(Z值分别为-5.98、-4.17,P<0.05).A地新生儿CRP、TG水平高于B地(Z值分别为-4.75、-2.28,P<0.05);A、B两地新生儿IL-6、TC、HDL-C、LDL-C水平差异均无统计学意义(P>0.05).Spearman秩相关显示,妊娠中期孕妇静脉血Ni、As与新生儿CRP呈正相关(rs值分别为0.238、0.183,P<0.05);孕妇静脉血Ni与新生儿TG呈正相关(rs值为0.175,P<0.05).多重线性回归分析显示,新生儿CRP水平与孕妇静脉血Ni呈正相关[β=1.458,95％CI:1.144～1.859],新生儿TG水平与孕妇静脉血As呈正相关[β=1.140,95％CI:1.090～1.191].结论 妊娠中期Ni、As暴露与新生儿脐带血生物标志物水平升高有关,孕妇妊娠期间应避免或减少Ni、As暴露接触.

目的 通过调查孕妇生活居住环境情况,了解母体血镍、砷水平对胎儿生长发育的影响,为阐明镍、砷对胎儿生长发育的影响提供依据.方法 选择甘肃省某重金属污染地区及其毗邻、位于其上风侧的另一地区作为研究地区(污染区空气PM2.5中镍、砷水平高于对照区),通过问卷调查收集孕妇的基本情况,利用B型超声检测孕中期胎儿双顶径、头围、股骨长度、腹围、胎心率大小,采用电感耦合等离子质谱仪测定孕中期孕妇静脉血镍(Ni)、砷(As)水平.分别以对照区及污染区共计82名研究对象的母血镍、砷水平中位数为截点,将孕妇及宫内胎儿按孕妇静脉血镍、砷水平分为低、高金属暴露组.结果 高砷暴露组来自于污染区的孕妇多于低砷暴露组(χ2=14.07,P<0.01).高镍组胎儿头围(201 mm)、腹围(168 mm)中位数低于低镍组头围(210 mm)和腹围(182 mm)(Z值分别为-2.53、-3.25;P<0.05);高砷组胎儿头围(204 mm)、股骨长度(38 mm)中位数小于低砷组头围(210 mm)和股骨长度(39 mm)(Z值分别为-2.03、-2.18;P<0.05).胎儿头围、腹围与孕妇静脉血镍水平存在负相关关系(t值分别为-4.76、-5.45,P<0.05).结论 孕妇暴露于镍、砷污染的空气环境可以影响宫内胎儿的生长发育,孕中期孕妇静脉血镍含量与孕中期胎儿头围和腹围存在负相关.

目的 探讨孕中期、孕晚期、分娩时孕妇镍(Ni)、砷(As)暴露与新生儿氧化应激指标关系及其密切程度.方法 于2013—2016年选取甲地(有矿开采)和乙地(无矿开采)孕中期(71对)、孕晚期(171对)、分娩时(206对)孕妇和新生儿作为研究对象.收集孕妇基本资料并在孕中期、孕晚期、分娩时采集孕妇静脉血和新生儿脐带血.以电感耦合等离子质谱法(ICP-MS)测定孕妇静脉血Ni、As水平,酶联免疫吸附法(ELISA)检测新生儿脐带血氧化应激指标8-异构前列腺素2α(8-epi-PGF2α)、3-硝基酪氨酸(3-NT)及8-羟基脱氧鸟苷(8-OHdG)含量.多重线性回归分析孕期孕妇静脉血Ni、As暴露水平与新生儿脐带血氧化应激指标关系.结果 除孕晚期Ni外,孕中期、分娩时甲地孕妇静脉血Ni、As水平显著高于乙地(P<0.05);除孕中、晚期8-epi-PGF2α外,孕中期、孕晚期、分娩时甲地新生儿脐带血3-NT、8-OHdG、8-epi-PGF2α高于乙地(P<0.05).多重线性回归分析显示,孕中期孕妇静脉血Ni[β:0.110(95％CI:0.019～0.202)]、As[β:0.290(95％CI:0.115～0.466)]与3-NT呈正相关;分娩时孕妇静脉血Ni与3-NT无相关性[β:0.044(95％CI:-0.004～0.092)];孕中期、孕晚期、分娩时孕妇静脉血Ni、As与8-epi-PGF2α、8-OHdG均无相关性(P>0.05).结论 孕期镍、砷暴露与新生儿脐带血氧化应激指标有一定关联,可能导致氧化应激,孕中期金属暴露更适合作为胎儿内暴露生物标志.

[背景]孕期重金属环境暴露可以影响不同孕期胎儿生长发育情况,重金属暴露对哪一孕期影响最大以及综合评判孕期胎儿生长发育情况与脐带血重金属水平之间的相关关系的研究较为少见.[目的]了解重金属暴露状态下,不同孕期胎儿生长发育情况及与脐带血重金属水平之间的相关关系.[方法]2013年1月至2016年12月期间,选择甘肃省某重金属污染地区(污染区)及其毗邻的位于污染地区上风侧的另一地区(对照区)作为研究地区,经知情同意后,纳入自愿配合且年龄在22～35周岁、在研究地点连续居住两年以上的单胎妊娠孕产妇.通过问卷调查收集孕妇的基本情况,利用B型超声检查不同时期胎儿双顶径、股骨长度、胎心率等,采用电感耦合等离子质谱仪测定所有孕妇分娩时新生儿脐带血镍、铜、砷水平,采用典型相关分析胎儿双顶径、股骨长度、胎心率与脐带血镍、铜、砷水平两组指标间的相关性.[结果]孕中、晚期和分娩时分别纳入研究对象42、58、71名(污染区)和58、91、169名(对照区).两地区孕妇的基本情况除了孕晚期、分娩时的被动吸烟情况[污染区(84.5％、85.9％)高于对照区(44.0％、47.3％)(均P＜0.001)]和孕中期、分娩时的孕妇妊娠期合并症[污染区(40.5％、38.0％)高于对照区(19.0％、17.8％) (P=-0.018,=-0.001)]及分娩时孕妇居住地距马路≤300m者和孕妇服用药物的比例[污染区(60.6％、29.6％)高于对照区(45.0％、12.4％) (P=0.027,P=0.001)]差异存在统计学意义外,其他方面差异均无统计学意义.孕中期、孕晚期、分娩时入选的污染区新生儿脐带血砷水平(0.77、0.75、0.73μg·L-1)高于对照区(0.29、0.34、0.35 μg·L-1)(P＜0.001);孕中期、孕晚期、分娩时污染区胎儿股骨长度(35.0、60.0、70.0 mm)小于对照区(41.5、63.0、72.0 mm) (P＜0.01).孕中期胎儿生长发育与新生儿脐带血重金属水平存在典型相关关系,其典型相关关系式为:U1=0.617X1+0.349X2-0.430X3 (X1-3分别为双顶径、股骨长度、胎心率);W1=-0.545Y-0.109Y2-0.897Y3(y1-3分别为镍、铜、砷水平).即胎儿双顶径、股骨长度与新生儿脐带血镍、铜、砷水平为负相关,胎儿胎心率与新生儿脐带血镍、铜、砷水平为正相关;胎儿双顶径、股骨长度与新生儿脐带血砷水平的相关性最密切.[结论]脐带血的重金属水平作为内暴露剂量与孕中期胎儿双顶径、股骨长度存在负相关,孕期重金属暴露对孕中期胎儿的不良影响较大.

通过动物实验来探讨高温热浪与臭氧交互作用对动脉粥样硬化(AS)小鼠的毒性影响.利用人工气候环境暴露仓(Shanghai-METAS)模拟一次实际热浪和重度臭氧污染的天气过程,将16只AS小鼠按体重随机分成对照组和暴露组(热浪+臭氧组),每组8只.两组小鼠分别放入对照仓和暴露舱内,使暴露组小鼠接受热浪与臭氧协同作用刺激,模拟结束后处死小鼠,采用试剂盒法测定各组小鼠相应组织生物标志物含量.结果表明受热浪与臭氧协同暴露影响,AS小鼠体温明显升高、心率和血压显著下降(P＜0.05);并可诱导HSP-60、TNF-α、IFN-γ、IL-6、sICAM-1、HIF-1α、MDA、NO的表达水平均显著上升(P＜0.05).此外,还造成小鼠血浆SOD活性下降,加速血脂异常.说明高温热浪与臭氧协同暴露能加剧AS小鼠的心脏毒性,使其促进炎症发生、抑制心肌组织抗氧化能力、破坏血管内皮结构,导致血脂异常的发生增加.

Objective:To evaluate the clinical value assessing left ventricular function in patients with complex congenital heart disease (CCHD) using dual-source computed tomography (DSCT) with transthoracic echocardiography (TTE) as standard of reference. Methods:27 patients with complex congenital heart disease (CCHD) were diagnosed by clinic and TTE.Measured and compared parameters of left ventricular function of the patients using DSCT and TTE. And two radiologists measured left ventricular function parameters of DSCT. Compared the parameters measured by two radiologists. Results:The end diastolic vol-ume (EDV),end systolic volume (ESV),stroke volume (SV),ejection fraction (EF) measured by DSCT were higher than those by TTE,no significant difference was found among the measurements between DSCT and TTE. No significant difference was found among the measurements between different measurer (P>0.05). Conclusions:DSCT is an accurate,feasible and good re-peatability method to assess the left ventricular function of CCHD. It has great value for DSCT to estimate before surgery,de-cide surgical strategy and evaluate the effectiveness of the therapy.

慢性乙型肝炎(CHB)已成为全球最关注的疾病之一,每年导致约100万人死于慢性乙型肝炎相关的肝硬化和肝细胞癌,抗病毒则成为慢性乙型肝炎治疗的关键.对于CHB患者,抗病毒治疗首先要实现对HBV的免疫学控制,进而阻止疾病的的进展.对于HBeAg阳性患者CHB患者,获得HBeAg血清学转换意味着达到免疫控制.近年来,干扰素(IFN)、核苷(酸)类似物(NUC)的抗病毒疗效已得到全球公认,同时不可避免地尤其是HBeAg阳性慢性乙型病毒感染患者,可能存在一些治疗过早或过于积极的问题.正确评估HBeAg阳性慢性乙型病毒感染的疾病阶段,选择最佳治疗时期,最好地运用这些药物,单独或联合或序贯治疗,最大程度地发挥它们的作用,从而保证高效、持久的应答,仍是值得关注与探讨的话题.

Objective To analyze the value of dual-source computed tomography (DSCT)in the diagnosis of complex congenital heart disease(CCHD).Methods DSCT angiography and transthoracic echocardiography (TTE)were retrospectively assessed in 46 patients who were confirmed by surgery with 107 deformities.Results There were 49 intracardiac deformities and 58 extracardiac deformities.The diagnostic accuracies in detection of intracardiac malformation were 81.63%(40/49)on DSCT and 93.88%(46/49) on TTE,those in detection of extracardiac malformation were 94.83%(55/58)on DSCT and 58.62%(34/58)on TTE,and the overall accuracies of cardiovascular malformations were 88.79%(95/107)on DSCT and 74.77%(80/107)on TTE,respectively,exhibting statistical differences.The diagnostic accuracy of DSCT in combination with TTE in detection of intracardiac and extracardiac malformation was 94.39%(101/107),which was higher than DSCT or TTE with statistical differences.Conclusion The combination of TTE and DSCT is helpful to improve the diagnostic accuracy of CCHD.

Objective:To explore the roles of quality control circle (QCC) in reducing preparation residue rate of reduced glutathione (GSH). Methods:QCC was established according to PDCA cycle method, current state was investigated by taking"reducing preparation residue rate of GSH"as the topic, the goal was set up, the reason was analyzed, the countermeasure was established and the effects were analyzed. Results: QCC activity could make preparation GSH residue rate 28.84%before the improvement decrease to 7.59%after improving (P=0.000). Conclu-sion:QCC activity could effectively reduce residual percentage of GSH in the course of GSH preparation.

目的探讨医生和护士对优质护理认知的异同,为护理管理者制定护理质量标准提供一定的理论依据。方法制定开放式调查问卷并对我院优质护理病房的医生和护士进行测试。结果随机抽取84名医师和84名护士作为研究对象。护士认为最能代表优质护理的项目为认真负责(4.98±0.05)分、技术好(4.97±0.13)分、帮病人进行生活护理(4.96±0.04)分、病人满意(4.96±0.17)分和与病人沟通多(4.96±0.44)分;医师认为最能代表优质护理的项目为病人满意(4.98±0.27)分、认真负责(4.96±0.09)分、技术好(4.95±0.16)分、与病人沟通多(4.95±0.32)分和经常巡视(4.95±0.06)分;在知识丰富、不怕脏、主动讲解知识、帮病人进行生活护理4项中,护士和医师的观点有显著性差异(P<0.05)。结论医师和护士优质护理认识基本一致,认真负责、技术好、病人满意和与病人沟通多被认为是最重要的内容,但个别项目有不同见解,可能与职业特性有关。

Objective To investigate the value of vein assessment in the chemotherapy of leukemia.Methods Select the appropriate blood vessel,the puncture site and puncture tool according to the patient's age,peripheral vascular,coagulation mechanism,stimulant medication and so on,and evaluate the rates of drug extravasation and phlebitis.Results Among the 180 patients,ordinary steel needle was adopted for 52 patients,intravenous catheter was adopted for 69 patients,peripherally inserted central catheter was adopted for 17 patients,and central venous catheter was selected for 42 patients.Drug extravasation occurred in 4 patients and phlebitis occurred in 5 patients;the incidence rates were significantly less than that of control group(P<0.05).Conclusion Venous assessment is important to reduce the incidence of drug extravasation and phlebitis.