目的:探讨芪独合剂改善缺血性脑卒中恢复期(气虚血瘀、络脉痹阻证)患者的临床效果,探讨其对患者神经缺损程度、颈动脉粥样硬化、血管内皮生长因子的影响.方法:将110例缺血性脑卒中恢复期患者采用随机数字表法分为对照组和观察组,每组55例.对照组患者给予常规西药治疗,观察组患者在对照组基础上加用芪独合剂口服,1个月为1个疗程,连续用药2个疗程.观察两组治疗的临床效果,评价神经功能缺损程度、运动功能、日常生活能力变化,检测颈动脉内膜中层厚度(IMT)、斑块面积、大脑中动脉血流速度,监测血管内皮生长因子(VEGF)水平变化.结果:观察组、对照组的有效率分别为90.91％(50/55)、76.36％(42/55),以观察组有效率明显升高(P<0.05);观察组患者治疗后的神经功能缺损程度较对照组明显减轻,治疗1个月、治疗2个月的NIHSS评分显著低于治疗前及对照组(P<0.05);观察组患者治疗后的运动功能、日常生活能力改善优于对照组,FMA评分、Barthel指数评分均显著高于对照组(P<0.05);观察组患者治疗后的颈动脉粥样硬化改善优于对照组,斑块IMT厚度、斑块面积均显著小于对照组(P<0.05);观察组患者治疗后的脑血流改善优于对照组,Vm、Vd、Vs均显著高于对照组(P<0.05);观察组患者治疗1个月、治疗2个月的VEGF水平显著高于治疗前及对照组(P<0.05).结论:芪独合剂能有效提高运动功能、日常生活能力,改善颈动脉粥样硬化程度,增加脑血流量,促进新生血管形成,从而促进受损神经功能的修复.

目的 观察超声引导下射频消融(RFA)联合无水乙醇注射(PEI)治疗良性甲状腺囊性结节的效果.方法 浙江省荣军医院2017年2月至2018年3月接诊并证实为良性甲状腺囊性结节的患者114例,结节病灶137个.按入院先后顺序对患者编号,单号为对照组57例(结节68个),双号为观察组57例(结节69个).对照组采取超声引导下RFA治疗,观察组实施超声引导下RFA联合PEI治疗.对比两组疗效、甲状腺激素水平变化、并发症发生率.结果 观察组治愈率51.5%,高于对照组的34.8%,差异有统计学意义(P＜0.05).两组治疗后血清促甲状腺素、游离三碘甲状腺原氨酸、游离甲状腺素水平及并发症发生率接近,差异均无统计学意义(P＞0.05).结论 超声引导下RFA联合PEI治疗良性甲状腺囊性结节效果满意,安全性较高,且不会影响甲状腺功能.

Objective To explore the clinical value and safety of radioactive 125 I combined with high-frequency hyperthermia in the treatment of patients with recurrent cervical cancer.Methods A total of 52 cases randomly divided into two groups,with 26 patients in each group,were collected.The observation group accepted 125I seeds combined with high-frequency hyperthermia in treatment,while the control group only received simple particle implantation.The control of tumor response,local control rate of pain relief and the adverse reactions were evaluated.A comparison between groups was done using Chi-square test.Results Two months after treatment,the response rate of the tumor was 96.2％ in the observation group,which was higher than that in the single treatment group(73.1％;x2 =8.35,P ＜ 0.05).Response rates of pain relief were 88.2％ and 38.9％ (x2 =5.33,P ＜ 0.05).One month after treatment,there was no significant difference in the prevalence of adverse effects between the two groups(x2 =2.79,P ＞ O.05).Conclusion Interstitial permanent implantation of 125I seeds combined with high-frequency hyperthermia for recurrent cervical cancer has a good short-term response and less adverse reactions.

OBJECTIVE:To observe clinical efficacy and safety of Brucea javanica oil combined with gemcitabine and cisplat-in in the treatment of advanced non small cell lung cancer(NSCLC). METHODS:Totally 131 advanced NSCLC patients selected from Huanggang Hospital of TCM during Feb. 2014 to Jan. 2016 were divided into observation group(71 cases)and control group (60 cases)according to random number table. Control group was given Gemcitabine for injection(1st and 8th day)+Cisplatin injec-tion (2nd day),every 21 days,twice as a treatment course. Observation group was additionally given Breucea javanica oil oral emulsion 20 mL,po,2-3 times/d,for consecutive 14 d (3 days before chemotherapy). Both groups received treatment for 87 d and followed up until Jul. 1,2016. Clinical efficacy,the levels of T cell subsets (CD3+,CD4+,CD8+),survival time were ob-served in 2 groups. Single factor and multiple factor analysis was conducted for survival time. The occurrence of ADR was record-ed. RESULTS:The total response rate of observation group (32.39%) was higher than that of control group (25.00%),without statistical significance(P>0.05). Before treatment,there was no statistical significance in the levels of CD3+,CD4+ and CD8+ be-tween 2 groups(P>0.05). After treatment,the levels of CD3+ and CD4+ in observation group were increased significantly,while CD8+ level was decreased significantly;there was statistical significance compared to control group at corresponding period (P<0.05). Four patients withdrew from the study in observation group and 3 patients in control group. The survival time of observation group [(14.02 ± 4.10) months] was longer than control group [(13.21 ± 5.22) months],without statistical significance (P>0.05). Single factor analysis showed that the survival time of patients aged <70 were significantly longer than those of patients aged ≥70;those of patients with pleural effusion were significantly shorter than those of patients without pleural effusion;there was statis-tical significance (P<0.05). Multiple factor analysis showed that with or without pleural effusion,age were influential fac-tors for survival time of patients with advanced NSCLC(OR=1.685 and 0.647,P=0.012 and 0.043). There was no statistical significance in the incidence of ADR between observation group (50.70%) and control group (53.33%)(P>0.05). CONCLU-SIONS:Brucea javanica oil combined with gemcitabine and cisplatin in the treatment of advanced NSCLC patients,although not significantly improve the therapeutic effect,but can significantly improve the cellular immune function. With or without pleural effu-sion and age are infuential facters for survival time of advanced NSCLC patients.

Objective:To explore the influence of ginsenoside monomer Rh2 on CNE-2S cell proliferation and apoptosis of human nasopharyngeal carcinoma.Methods:Human nasopharyngeal carcinoma CNE-2S cells growed in the logarithmic phase were divided into blank control group,negative control group and experimental group.The control group were cultured routinely,the negative control group were cultured with DMSO,and the experimental group were added ginsenoside monomer Rh2 on the basis of the control groups.MTT method was used to measure cell proliferation.PI single staining flow cytometry was used to analyze cell percentage in each period of the cell cycle.Effects of monomer Rh2 on CNE-2S cell proliferation of human nasopharyngeal carcinoma were observed.AnnexinV-PI double staining flow cytometry was used to detect cell apoptosis.Results:Compared with the negative control group,the experimental group and the levels of Rh2 in CNE-2S cells significantly inhibited the proliferation (P ＜ 0.05),and with the increase of Rh2 concentration and showed a increasing trend,the concentration of 12.5 mg ·L-1 Rh2 proliferation inhibition rate is lowest,the concentration of 100 mg·L-1 Rh2 added the highest inhibition rate.The distribution of single Rh2 G0/G1 cells with different concentrations of ginsenoside was significantly higher than that of the negative control group (P＜0.001),and G2/M,the percentage of cells in S phase was significantly lower than that of the negative control group (P＜0.01),and with ginsenoside Rh2 concentration increased has increased (P ＜ 0.05);The early and late apoptosis rate and total apoptosis rate of CNE-2S cells with different concentrations of 24h were significantly higher (P＜0.001) than that of negative control group,and the highest apoptosis rate was 100 mg·L-1 when the concentration of Rh2 was Rh2.Conclusion:Ginsenoside monomer Rh2 has significant influence on CNE-2S cell proliferation and apoptosis of human nasopharyngeal carcinoma,and may be lazy on concentration of monomer Rh2.

Objective To study the accurate and effective method for the extraction of influenza a H1N1 influenza virus.Methods A total of 40 pharyngeal swab points from patients with influenza A (H1N1) from December 2014 to December 2015 in our hospital were selected as the research object.The obtained specimens were 10-1 ～ 10-4 series dilution,obtained with different concentrations of influenza virus samples preparation of inspection.This research mainly uses three kinds of reagent box to carry on the experiment.A was Maxwell16 Promega automatic nucleic acid extraction apparatus and the extractor kit,as group A;B was the Qiagen RNeasy Mini Kit;C was domestic H company RNA extraction kit.The nucleic acid extraction of the three methods was compared.Results The total RNA concentration of A group was the highest,followed by B group,in C group was the lowest.The concentration of extraction rate in Group A at each dilution were highest and the difference was statistically significant (P ＜ 0.05).With increase of concentration,the influenza virus extraction rate decreased gradually in Group B and group C,especially in group C,when diluted to 10-4,influenza virus couldnt be extracted.Conclusion The effect of Automatic nucleic acid extraction apparatus for nucleic acid extraction is better,even under high dilution conditions,it can also achieve high nucleic acid extraction rate.It is a rapid and effective detection method to avoid the error of the manual extraction,which is worthy of promotion and application in clinical.

目的 探讨高效抗逆转录病毒联合免疫调节对艾滋病患者炎性因子及免疫功能的影响.方法 选择2011年8月至2014年12月湖北省黄冈市疾病预防控制中心收治的艾滋病患者38例为研究对象,根据入院时间先后顺序随机分为观察组(n=19)和对照组(n=19).对照组患者接受HAART治疗(齐多夫定300 mg、拉米夫定150 mg、奈韦拉平200 mg口服,2次/d),观察组患者在接受HAART治疗的基础上联合胸腺五肽治疗,两组均连续治疗24周.比较两组患者炎性因子、免疫功能、生活质量.结果 治疗前两组患者炎性因子、免疫功能及生活质量等方面比较差异无统计学意义;治疗后均有不同程度的改善,与治疗前比较差异均有统计学意义,且观察组患者血清白细胞介素-17 (IL-17)、白细胞介素-23 (IL-23)含量明显高于对照组,C反应蛋白(CRP)含量明显低于对照组(P＜0.05);CD4+T细胞、Th17细胞含量明显高于对照组,CD8+T细胞含量、Treg细胞明显低于对照组(P＜0.05);生活质量:观察组心理、独立等评分明显高于对照组(t=2.078～3.359,P＜0.05).结论 高效抗逆转录病毒联合免疫调节能够增强免疫功能,减轻炎症反应,改善生活质量.

目的 了解黄冈市娱乐场所从业人员HIV、丙肝和梅毒感染现状,探讨娱乐场所人群艾滋病防控行为认知干预效果.方法 采用横断面调查方法对被调查对象进行HIV、HCV和梅毒血清学监测,对从业人员进行行为学调查,对培训前后从业人员艾滋病认知率的变化频数进行统计学分析.结果 21家娱乐场所共594名女性从业人员中,梅毒阳性5例,阳性率为0.84％,40名男性从业人员梅毒未能检出;女性HCV抗体阳性3例,阳性率为0.51％,男性HCV抗体阳性1例,阳性率为2.5％;全部被调查者HIV抗体均为阴性.培训干预前从业人员艾滋病认知率为55.04％,培训后其认知率提高至62.05％(P＜0.01),其中,“性接触传播”、“经血液传播”和“HIV感染初期无症状,外表看不出”培训后认知率与培训前比较,差异有统计学意义(P＜0.01).结论 娱乐场所女性从业人员是梅毒和丙肝感染的高危险人群,对这一场所职业人群开展培训干预可明显提高其对预防艾滋病的认知能力.

目的探讨尿胰蛋白酶抑制剂对严重脓毒症患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）和白细胞介素-10（IL-10）水平的影响。方法选取86例重度脓毒症患者为研究对象,采用随机数字表法将其分为实验组（43例）,对照组（43例）,2组患者均给予对症治疗,实验组在此基础上给予尿胰蛋白酶抑制剂静脉注射,比较2组患者治疗前后血清TNF-α、IL-8和IL-10水平的变化。结果治疗前2组患者血清TNF-α、IL-8和IL-10水平差异无统计学意义,治疗后2组患者TNF-α、IL-8水平均显著降低（P＜0.05）,IL-10水平显著升高（P＜0.05）,实验组改善水平高于对照组（P＜0.05）;实验组患者总有效率为86.05%显著高于对照组65.12%（P＜0.05）;治疗前2组患者的APACHE-II评分与认知功能评分差异无统计学意义,治疗后APACHE-Ⅱ评分显著降低（P＜0.05）,实验组显著低于对照组（P＜0.05）,治疗后认知功能评分显著升高（P＜0.05）,实验组显著高于对照组（P＜0.05）;实验组不良反应发生率2.33%,显著低于对照组20.93%（P＜0.05）。结论尿胰蛋白酶抑制剂可以有效地改善重度脓毒症患者炎症因子水平,提高总有效率,降低APACHE-II评分,改善认知功能,减少不良反应。

Objective To investigate the current situation of enzyme production and drug resistance of nosocomial infection strains of Acinetobacter baumannii , and provide reference for clinical treatment and monitoring of hospital infection. Methods Bacteria strains were isolated and identified according to the clinical laboratory procedures. The Nitrocefin method was used to detect the beta-lactamase. Results 175 strains of Acinetobacter baumannii were isolated, 82.28% from the respiratory tract. 124 strains could produce beta-lactamase, with a positive rate of 70.9%. Among them, 52 strains (41.9%) produce extended spectrum beta-lactamase (ESBL); 70 stains (56.4%) produced AmPC enzyme; 2 strains (1.6%) produced metallo-beta-lactamase sand. The isolates were resistant to commonly using drugs. 37.7% was resistant to Cefoperazone/sulbactam (SCF), 1.1% to imipenem (only two strains of MBL resistance). Conclusions Respiratory tract was the main route of nosocomial infection of Acinetobacter baumannii; ESBL and AmPC production could be the main resistance mechanism of Acinetobacter baumannii.To reduce carbapenem-resistant Enterobacteriaceae infection should be the main strategy to combat drug-resistant bacteria.

为探索中医治未病理论和方法体系进行肛管直肠癌早期医学干预的可行性,应用自行设计的肛管直肠癌治未病技术方案,针对社区人群进行生活习惯调查、体质辨识、症候分析等治未病技术操作,结合粪便检验、肿瘤标志物检验、直肠镜检等方法,判断高危人群并进行中医医学干预.结果显示,2000名社区人群,饮食习惯不良者613人,有慢性肠道疾病史者36人;体质判定有偏颇体质者66.95％(1339例);偏颇体质者42.49％ (569)表现为湿热蕴结;全组检出直肠息肉(腺瘤)11例,直肠炎症及溃疡5例,发现早期直肠癌2例.开出治未病处方1 321份,转临床治疗18例.结果表明,运用中医治未病体系,能有效地确定肛管直肠癌的高危人群,及时发现早期癌变,指导进行防病调理养生,调整偏颇体质,远离患病危险因素,遏制肛管直肠癌的进程.

<正>城市建筑工人人口基数大、流动性强,较男性占绝大多数,大部分为青壮年,长期生活在单一性别的人群中,处于城市生活边缘,远离家庭,法制观念淡薄,文化水平较低,缺乏性病、传染病防治的常识,成为各类传染病感染的高危人群〔1-3〕。为了解黄冈建筑工地工人HBV、HCV、HIV和梅毒

血液检验已成为临床诊断和治疗最常见的辅助方法,因此检验结果的准确性和及时性显得尤为重要。做好检验分析前质量的控制、保证一次采集有效的血标本成为我们标本采集时的关注点,针对其原因采取了遵照医嘱,严格查对;健康宣教;正确采集;及时送检等措施,以保证送检标本的真实性和可靠性,为临床诊治提供可靠的依据。

临床生化检验结果的可靠性直接关系到患者的安危、医疗质量。由于影响分析结果可靠性的因素十分复杂,误差有时难免。应用科学管理方法-质量控制,医护、患者、检验科三维一体,密切配合,严格把关,以保证检验结果的完整、正确、有效、及时,给临床医生诊断治疗疾病提供可靠依据。

目的:提高输血安全性,评估乙型肝炎血清标志物与核酸联合检测的价值。方法:采用酶联免疫吸附试验(ELISA)和荧光定量聚合酶链反应(PCR)技术,分别对医院患者和献血员的标本进行乙型肝炎病毒标志物和DNA含量检测。结果:经ELISA法检测,346例医院患者中乙型肝炎病毒标志物阴性62份,其中呈HBV-DNA阳性1例(1.5%);在300份初筛合格的献血员标本中,6例呈HBV-DNA阳性(2%),其中78份HBsAg阴性三项抗体分别阳性的标本检出HBVDNA阳性4例(5.1%),222份ELISA法全阴性的标本检出HBVDNA阳性2例(0.9%)。结论:本地区人群存在HBsAg阴性的HBV感染;乙型肝炎病毒DNA和血清标志物的联合检测,对提高输血安全性有重要意义。