替奈普酶是一种重组组织纤溶酶原激活剂基因修饰后的产物,因其给药时间短、半衰期长、特异性高等优点,有人提出在急性缺血性卒中治疗中使用替奈普酶代替阿替普酶.本文就替奈普酶在治疗急性缺血性卒中中的研究进展作一综述,以期提供规范的使用依据.

探讨妊娠相关血浆蛋白A(PAPP-A)的妇产科临床价值研究进展,为科学使用PAPP-A开展相关疾病的临床诊断提供新见解.分析PAPP-A在妇产科的应用,归纳、整理PAPP-A的生理功能及临床意义,总结PAPP-A与妊娠疾病的相关性.现有研究结果提示,PAPP-A与胎儿染色体异常、低出生体重儿、早产、妊娠期糖尿病、先兆子痫、流产、异位妊娠等相关.PAPP-A在上述妊娠相关疾病中有显著改变,临床可将PAPP-A作为辅助诊断指标之一,具有良好的预测价值.

对微信功能及其在学科信息精准服务中的实践进行了介绍,希望人们对智能技术在图书馆的应用有一个新的了解与思索.

手术部位感染(SSI)是较为常见的脊柱手术并发症之一,可造成严重后果.其主要致病菌是以葡萄球菌为代表的革兰阳性球菌,术前应用头孢类抗生素为最常用的预防措施,可取得良好效果.但随着广谱抗生素的广泛应用,耐甲氧西林的金黄色葡萄球菌(MRSA)及凝固酶阴性的葡萄球菌(CNS)逐渐成为脊柱手术后SSI最主要的病原菌,普通头孢类抗生素对其无效.脊柱手术中局部应用万古霉素可明显降低革兰阳性球菌所致的SSI风险,并具有操作简单、价格低廉等优势,值得临床推广.然而,其有效性、使用剂量与方法、不良反应及潜在风险仍需进一步研究.该文将对脊柱手术中局部应用万古霉素预防SSI的研究进展作一综述.

Jishou University School of Medicine has actively explored the application and effect of online teaching of "ideological and political education" in nursing courses under the COVID-19 epidemic. Taking 135 undergraduates majoring in nursing in batch 2017 as research objects, this study introduces the implementation scheme of online teaching of "ideological and political education". The results show that the online teaching of "ideological and political education" can help nursing undergraduates to establish the professional identity and cultivate medical ethics during the epidemic, to enhance the awareness of the prevention and control of the epidemic, to strengthen the understanding of relevant nursing professional knowledge, and improve students' learning attitude, worthy of reference and promotion.

Objective:To investigate the value of rate-pressure product (RPP) in predicating the prognosis of postural tachycardia syndrome (POTS) in children.Methods:Fifty-three children (26 males and 27 females) aged 5 to 15 who had syncope of unknown reasons or presyncope and were diagnosed with POTS by head-up tilt test (HUTT) at the Children′s Syncope Specialist Clinic, the Second Xiangya Hospital, Central South University from April 2012 to May 2019 were selected as the POTS group.Thirty-eight children aged 5 to 16 (19 males and 19 females) who underwent medical examinations at the Children′s Health Specialist Clinic of the Second Xiangya Hospital, Central South University over the same period were enrolled as controls (control group). POTS children were followed up after intervention and they were divided into the response group ( n=40) and the non-response group ( n=13) according to the follow-up results.The products (RPP0, RPP5, RPP10) of the heart rate (HR0, HR5, HR10) and systolic blood pressure (SBP0, SBP5, SBP10) at baseline (HUTT 0 min), HUTT 5 min and HUTT 10 min were calculated.Statistical analysis was performed using SPSS 22.0 software and EmpowerStats software. Results:(1) There was no statistical difference in age and gender between the POTS group and the control group (all P> 0.05). (2) HR5 [(115.45±14.50) times/min vs.(95.79±13.89) times/min], HR10 [(120.57±16.13) times/min vs.(96.05±12.43) times/min], RPP5 (12 814.55±2 304.56 vs.10 371.42±1 910.20), and RPP10 (13 449.17±2 360.40 vs.10 523.18±1 771.48) in the POTS group were significantly higher than those in the control group( t=0.799, 7.842, 5.747, 6.446, all P<0.01). No statistical difference of HR0 and RPP0 was observed between the 2 groups (all P>0.05). (3) In the POTS group: HR5 [(98.73±12.43) times/min vs.(113.77±17.65) times/min], HR10 [(96.90±13.96) times/min vs.(119.08±13.52) times/min], RPP5 (11 125.45±1 952.35 vs.12 914.69±3 192.12) and RPP10 (10 819.58± 2 144.26 vs.13 375.46±2 807.01) in the response group were significantly lower than those in the non-response group( t=3.406, 5.012, 2.432, 3.455, all P<0.01). HR0 and RPP0 were no significantly different between the 2 groups(all P>0.05). (4) When SBP10<114 mmHg(1 mmHg= 0.133 kPa), the probability of response after POTS intervention increased by 10% with every 1 mmHg increase in SBP10, and there was a non-linear relationship between the 2 group ( P<0.05). (5) The receiver operating characteristic curve suggested that when RPP5 was 11 548.50, the sensitivity and specificity to predict the response after POTS intervention were 81.82% and 61.70%, respectively.When RPP10 was 10 988.00, the sensitivity and specificity were 77.78% and 86.21%, respectively. Conclusions:RPP is closely related to the intervention effect of POTS in children.RPP5 and RPP10 can predict the prognosis of POTS in children.There is a non-linear relationship between SBP10 and the intervention effect of POTS in children.

OBJECTIVE:To evaluate the ability of heart rate (HR) and HR difference during head-up tilt test (HUTT) and to predict clinical improvement related to metoprolol treatment in children and adolescents with postural tachycardia syndrome (POTS). STUDY DESIGN:This was a retrospective cohort study. A total of 53 subjects (27 male, aged 6-12 years old, mean age 11.79 ± 1.50 years old) with POTS treated with metoprolol were involved from July 2012 to September 2019. In total, 52 subjects who underwent health examination during the same period were matched as the control group. Subjects in both groups underwent HUTT. The HR distance between 5 minutes and 0 minutes (HR difference 5) and between 10 minutes and 0 minutes (HR difference 10) during HUTT was calculated. RESULTS:The POTS group was significantly greater than the control group in HR 5, HR 10, HR difference 5, and HR difference 10 (P < .01). There was no statistical difference in HR 0 between the 2 groups (P > .05). In total, 53 subjects with POTS were followed up for 96.0 (IQR, 40.5, 134.5) days during treatment with metoprolol. HUTT results demonstrated that 58.49% of subjects with POTS had a response and symptom scores were reduced after intervention. HR and HR difference were useful in predicting the efficacy of metoprolol on POTS. When HR 5, HR 10, HR difference 5, and HR difference 10, respectively, were ≥110, 112, 34, and 37 beats/min, the sensitivity and specificity were 82.50% and 69.23%, 84.62% and 69.70%, 85.29% and 89.47%, and 97.56% and 64.86%, respectively. CONCLUSIONS:HR and HR difference are helpful to predict the efficacy of metoprolol on POTS in children and adolescents.

目的 比较神经内镜与开颅手术对高血压脑出血(HICH)患者的有效性和安全性.方法 检索中国知网全文数据库、中国维普全文数据库(VIP)、万方数据库、Pubmed、The Cochrane Library和EMbase等数据库,检索关于神经内镜与开颅手术治疗高血压脑出血的研究.提取文献的相关原始数据,通过Meta分析神经内镜与开颅手术治疗高血压脑出血的有效性及安全性,采用敏感性分析评估结果的稳定性,采用用漏斗图评估文献的发表偏倚.结果 对符合纳入标准的9项研究分析显示,与开颅手术相比,神经内镜手术降低了死亡率(RR=0.47,95％CI:0.28～0.77;P=0.003).再出血的分析结果表明,神经内镜手术与开颅手术无明显差异(RR=0.60,95％CI:0.28～1.28;P=0.19).结论 我们的结果显示经神经内镜与开颅血肿清除术后再出血无明显差异,但经神经内镜手术患者死亡风险明显降低.

慢性阻塞性肺疾病是一种常见的慢性呼吸系统疾病,其发生进展与气道慢性炎症有关.呼吸道感染引发急性加重,死亡率较高.现阶段,慢性阻塞性肺疾病急性加重期诊断主要依据临床症状,缺乏统一标准实验室指标,诊断的主观性强,容易造成漏诊或误诊,部分患者因综合治疗效果差而死亡.新型炎性标志物对慢性阻塞性肺疾病急性期患者的辅助诊断、病情与预后评估、用药指导及病情监测可起到指导作用,可作为新的治疗靶点进行深度研究.本文讨论慢性阻塞性肺疾病急性加重期患者炎性标志物的研究进展,旨在为进一步改善慢性阻塞性肺疾病急性加重期患者的存活率和生存质量提供依据.

Jishou University promotes the education reform for postgraduate students majoring in clinical medicine with the guidance of "Serving the Local Demand for Professional and Improving the Training Quality of Professional":moral education first,strengthening the thought of serving people wholeheartedly and developing good style of study;focusing on the development of clinical skills and clinical research competency;scientifically setting up curriculums and actively carrying out teaching innovation on the basis of the plan;attaching importance to supervision by innovating guidance mode and perfecting quality supervision mechanism.It has achieved remarkable results and laid a solid foundation for the postgraduate education to achieve the "connotative development of meeting the service demand and improving the teaching quality".

慢性心力衰竭(chronic heart failure,CHF)伴慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)普遍存在于老年患者中,两者共存严重影响患者的生活质量,而且预后较差.目前对于慢性心力衰竭或慢性阻塞性肺疾病单独存在诊治的研究已经很深入,并制定了很多诊治指南,但对于CHF合并COPD的诊治尚无统一认识.本文就相关研究进展进行文献梳理和分析,期望可为CHF合并COPD的诊治提供有益的参考.

克罗恩病(CD)是一种非特异性肠道慢性炎症性疾病,多见于末端回肠和邻近结肠,从口腔至粘连肛门各段消化道均可受累.由于CD的临床表现、内镜下特征及影像学特点均缺乏特异性,甚至活检标本病理学也难以确诊,加之临床医生对克CD的认识不足,极易引起漏诊和误诊.本例患者在10余年的诊治过程中,除有消化道及全身表现外还出现了严重并发症,经历了三次手术治疗.现将1例CD 10余年的诊治过程进行报道,以提高临床医师对该病的认识.

目的 目的探讨儿童青少年体位性心动过速综合征(POTS)体质量指数(BMI)的变化.方法 回顾性分析2009年8月至2018年6月因不明原因晕厥或晕厥先兆在中南大学湘雅二医院儿童晕厥专科门诊就诊、并诊断为POTS的4～17岁儿童青少年的临床资料.POTS组127例,男63例,女64例,平均年龄(11.31±2.53)岁.将同期在该院儿童保健专科门诊进行健康检查的127例7～17岁儿童青少年作为对照组,男64例,女63例,平均年龄(11.60±3.27)岁.测量两组儿童身长、体质量,计算BMI.采用SPSS 22.0软件进行数据统计分析.结果 (1)病程和晕厥频次:POTS组病程为(8.13±13.76)个月,晕厥频次为(1.45±4.43)次.(2)BMI组间比较:POTS组与对照组比较,年龄、身长、体质量差异无统计学意义(P＞0.05),BMI明显降低[(17.32±2.65) kg/m2 vs.(18.17±2.42)kg/m2,t=2.655,P＜0.01].(3)BMI分类:体质量过低在POTS组(69.29％,88/127)高于对照组(56.69％,72/127),体质量正常在POTS组(29.13％,37/127)低于对照组(41.73％,53/127),组间比较x2=4.444,P＜0.05.结论 儿童青少年POTS组BMI明显降低,且女性低于男性.

心力衰竭和多种生物标志物相关,近年来,一些新的生物标志物被陆续发现并在心力衰竭的诊断和预后方面起到了重要的作用,本文对新发现的标志物进行综述.

目的:探讨术前外周血中性粒细胞计数与淋巴细胞计数比值(NLR)、血小板计数与淋巴细胞计数比值(PLR)对行结直肠癌根治术后患者预后的预测价值.方法:回顾性分析2007年至2012年就诊于湖南省常德市第一人民医院普外科行根治性手术且术后,随访资料完整的237例结直肠癌患者的临床资料.用ROC曲线确定NLR和PLR的Cut-off值后,分为高NLR/PLR组和低NLR/PLR组,比较两组患者的术后总体生存期.结果:NLR和PLR的Cut-off值分别是5.26和169.18;与低NLR水平患者相比较,高NLR水平患者的总体生存期明显低于低NLR水平患者(x2=34.252,P<0.001);与低PLR水平患者相比较,高PLR水平患者的总体生存期明显低于低PLR水平患者(x2=28.698,P<0.001);COX单因素回归分析或多因素回归分析均支持NLR(HR=5.493,95％CI:2.891～10.437,P<0.001;HR=3.508,95％CI:1.675～7.345,P=0.001)或PLR(HR=5.094,95％CI:2.624～9.887,P<0.001;HR=2.092,95％CI:1.006～4.348,P=0.048)可能是评判结直肠癌预后的独立风险因素.结论:NLR和PLR可用于评估结直肠癌患者的预后,NLR≥5.26或PLR≥169.18提示预后差.

椎弓根螺钉固定系统是脊柱外科常用的固定方式,生物力学稳定性良好,固定效果可靠.然而对于骨质疏松症患者,骨质量降低将导致椎弓根螺钉稳定性下降,置钉过程中难以避免相关并发症的发生.2009年Santoni等首次提出皮质骨钉道(CBT)螺钉技术,可增加螺钉的抗拔出力及稳定性,应用前景广阔.本文就脊柱皮质骨生物力学以及胸椎、腰椎、骶椎CBT螺钉置钉技术、螺钉参数等基础研究进行文献综述,以期为CBT螺钉的临床置钉提供参考依据.

白细胞介素-1作为先天免疫系统的关键细胞因子在心血管疾病中的作用逐渐显现.阻断白细胞介素-1已被证明在其他心血管疾病中有效,如心肌炎、心律失常和心力衰竭.本综述旨在总结白细胞介素-1阻滞剂在心血管疾病中的作用,简要描述其发病机理及相关的临床研究.阻断白细胞介素-1通路可能是一种新的治疗策略,可能成为许多急慢性心血管疾病的治疗方法.

目的 探讨儿童青少年体质量指数(body mass index,BMI)与洗澡诱发晕厥的关系.方法 回顾性分析2003年7月至2019年2月因洗澡过程中出现晕厥在中南大学湘雅二医院儿童晕厥专科门诊就诊的8～18岁儿童青少年25例,男10例,女15例,平均年龄(12. 92 ± 2. 94)岁(晕厥组);匹配同期在该院儿童保健专科门诊进行健康检查的9 ～18 岁儿童青少年25 例为对照组,男10例,女15例,平均年龄(13. 28 ± 2. 81)岁.晕厥患儿经详细询问病史、体格检查,血液生化(空腹血糖、心肌酶)、常规12导联心电图、24 h动态心电图、胸部X线检查、超声心动图、脑电图及头部CT/MRI等检查,排除器质性心脑血管疾病及心因性疾病等引起的晕厥症状,在取得受试者或监护人书面知情同意后进行直立倾斜试验(head﹣up tilt test,HUTT),测量身长、体质量,计算BMI.结果 晕厥组与对照组比较,年龄、身长、体质量未见统计学差异(P>0. 05),BMI明显降低,差异有统计学意义(P<0. 05).晕厥组血流动力学类型:HUTT阳性16例(64. 00%),其中血管迷走性晕厥血管抑制型62. 50%(10/16),血管迷走性晕厥混合型31. 25%(5/16),体位性心动过速综合征6. 25%(1/16).用受试者工作特征(receiver oper﹣ating characteristic,ROC)曲线评价BMI预测洗澡诱发晕厥的灵敏度和特异度,当BMI为19. 45 kg/m2时洗澡诱发晕厥的灵敏度72. 22%,特异度62. 50%.结论 低 BMI儿童青少年容易出现洗澡诱发晕厥.