Amorphous solid dispersion (ASD) technology is increasingly employed to address the limitations of poorly water-soluble drugs, which are characterized by low and variable oral bioavailability due to inadequate dissolution in gastrointestinal fluids. In ASD formulations, the polymer inhibits drug crystallization during dissolution, thereby generating and stabilizing supersaturation, often described as spring and parachute effect. This finally results in enhanced absorption and bioavailability. Mucus, synthesized by goblet cells, forms a natural protective barrier that coats the mucosal surface. This study aims to investigate whether intestinal mucin, as a natural stabilizer of supersaturation, affects the dissolution and permeation characteristics of ASDs of poorly watersoluble drugs and to elucidate the underlying mechanisms. The solubilities of naproxen, nifedipine, and itraconazole were evaluated in different buffers without and with mucin. Supersaturation stability experiments were conducted using the solvent-shift method. Cellular transport experiment was performed using coculture monolayers. Dissolution testing of naproxen, nifedipine, and itraconazole ASDs was carried out under non-sink conditions according to USP II guidelines. Statistical significance was assessed using ANOVA with Tukey's HSD or ttest as appropriate. The results show that mucin stabilized the supersaturation of poorly water-soluble drugs in a concentration- and pH-dependent manner, without altering their solubility, due to the molecular state of mucin. This phenomenon enhanced the permeation of poorly water-soluble drugs. The dissolution medium containing mucin extended the parachute effect for the ASDs of poorly water-soluble drugs, providing more biorelevant dissolution results and parameters compared to dissolution media alone. The optimal equation for the ASDs of poorly water-soluble drugs best fit a first-order kinetic model. This research recommends improving the evaluation method of formulation dissolution by incorporating mucin into the dissolution medium as a more biorelevant approach.

BACKGROUND:The standard laparoscopic hiatoplasty with Toupet fundoplication is widely regarded as a safe treatment for giant hiatal hernia; however, it is often associated with a high incidence of posterior mediastinal seroma. To address this issue, a modified approach combining sac excision and negative pressure posterior mediastinal drainage has recently been introduced. This study compares clinical outcomes between the conventional and modified techniques to identify the optimal surgical strategy for managing giant hiatal hernia. METHODS:Patients who underwent laparoscopic hiatoplasty with sac excision and posterior mediastinal drainage between January 2013 and September 2020 were included. Demographic information, operative time, intraoperative blood loss, complication rates, length of hospital stay, and treatment outcomes were prospectively collected and assessed during follow-up. RESULTS:A total of 68 patients with giant hiatal hernia underwent the modified procedure without any conversions to open surgery or intraoperative complications. Compared with a historical cohort of 66 patients treated with the conventional approach (laparoscopic hiatoplasty with Toupet fundoplication), the modified group had significantly lower rates of postoperative posterior mediastinal seroma, as well as shorter overall and postoperative hospital stays. No significant differences were observed between the 2 groups regarding operative time, blood loss, ICU transfers, or incidence of postoperative pulmonary atelectasis. Median duration of long-term follow-up was comparable between the groups. There were no significant differences in the rates of early satiety, anatomic recurrence, diarrhea, acid regurgitation, or proton pump inhibitor (PPI) usage. In addition, no cases of dysphagia or reoperation occurred in either group. CONCLUSIONS:Laparoscopic hiatoplasty with sac excision and posterior mediastinal drainage is a safe and effective minimally invasive technique for treating giant hiatal hernia. This approach significantly reduces the risk of mediastinal seroma without increasing complication rates.

Cholelithiasis is a common and frequently occurring disease worldwide that belongs to the category of jaundice in traditional Chinese medicine. Yinchenhao decoction (YD) consists of Artemisia capillaris Thunb., Gardenia jasminoides J.Ellis, and Rheum palmatum L., and is traditionally used to treat jaundice, which has a significant therapeutic effect on cholelithiasis. Our study aimed to investigate the pathological mechanism of cholelithiasis and the therapeutic mechanism of YD via mucin in the gallbladder and intestine. YD was prepared and analyzed using HPLC. The supersaturation stability experiment was designed by the solvent-shift method. The cell transport experiment was conducted by coculture monolayers. The animal experiment was performed using a cholelithiasis model with a high-cholesterol diet. The related indicators were detected by automatic biochemical analyzer, PCR, western blot, or ELISA. Statistics were analyzed using χ2-tests and t-tests. As the results, in cholelithiasis, MUC5AC highly expressed in the gallbladder shortened cholesterol supersaturation and promoted cholesterol crystallization via the inflammatory cytokine signaling pathway; MUC2 highly expressed in the small intestine prolonged cholesterol supersaturation and promoted cholesterol absorption via the inflammatory cytokine signaling pathway. YD inhibited mucin expression in the gallbladder and intestine in a concentration-dependent manner for cholelithiasis treatment by inhibiting the inflammatory cytokine signaling pathway, which was attributed to the active components, including chlorogenic acid, geniposide, and rhein.

Background Immune checkpoint inhibitor (ICI) has become a major breakthrough in the field of tumor therapy, leading to improved survival. This study evaluated the clinical and electrocardiographic characteristics of patients with ICI-related myocarditis. Methods Patients with ICI-related myocarditis were enrolled from 4 centers in China until September 2023. Demographic data (age, sex, comorbidity), types of ICI, clinical manifestations, electrocardiogram (ECG) and treatment were analyzed retrospectively. Arrhythmia and characteristics of ECG were compared according to prognosis and grading. Results A total of 29 participants (13 females with a median age of 63.25 years) with ICI-related myocarditis were enrolled. Lung cancer was the most, with a proportion of 31.03 % (9/29). The median time from the first administration of ICI to the diagnosis of myocarditis was 50 days. Camrelizumab was the main type of ICI (9/29). Most patients had non-specific symptoms, dyspnea (n = 16) and palpitation (n = 9) were common. The overall mortality rate was 37.93 % (11/29) with a median follow-up of 9(4,11) days. Compared with the survivors, P-wave abnormality was more common in participants who were dead (24.14 %vs6.90 %, p = 0.010). A total of 19 patients with severe ICI-related myocarditis were included in this study. The proportions of sinus tachycardia (34.48 %vs0.00 %, p = 0.005), premature ventricular complex (27.59 %vs0.00 %, p = 0.027) and atrioventricular block (34.48 %vs3.45 %, p = 0.044) were higher in severe ICI-related myocarditis. Conclusions Clinical manifestations of ICI-related myocarditis usually lacked specificity. ECGs can be manifested as new-onset arrhythmias, ST-T segment changes, fragmented QRS complex, abnormal P wave, prolonged QTc interval and multi‑lead low voltage.

BACKGROUND:Venous thromboembolism (VTE) significantly affects the prognosis of surgical patients with inguinal hernia. The complex Caprini score, commonly used for postoperative VTE risk assessment, poses practical challenges for surgeons in clinical settings. METHODS:The CHAT-3 trial, a prospective, multicenter, randomized controlled trial, compared a simple three-factor model to assess VTE risk against routine practices in postinguinal hernia surgery (IHS) patients. The patients were randomly assigned (1:1) to the intervention or control arm. The intervention group used the three-factor model to identify patients at moderate or high risk of VTE for subsequent prophylaxis according to clinical guidelines. Both groups were followed for 4 weeks, with randomization implemented using computer-generated sequences. The primary outcome measured was the rate of VTE prophylaxis. Secondary outcomes included time spent on VTE risk assessment (surgeon self-reported), postoperative D-dimer trends, perioperative VTE occurrence, bleeding events, and the net clinical benefit. RESULTS:Of the 1109 participants, 508 in the experimental group and 601 in the control group completed follow-up. The three-factor model showed higher VTE prophylaxis rates in all patients (pharmacologic prophylaxis: 26.2 vs. 6.00%, P <0.001) and particularly in those at high risk (pharmacologic prophylaxis: 57.3 vs. 9.50%, P <0.001). The experimental group significantly reduced VTE risk assessment time compared to the Caprini score (1.39±0.55 min vs. 5.73±1.35 min, P <0.001). The experimental group had lower D-dimer levels (0.26±0.73 mg/l vs. 0.35±0.55 mg/l, P =0.028). In the experimental group, the patients did not experience an increased risk of VTE (0 vs. 1.66%, P =0.268) and bleeding (1.18 vs. 0.67%, P =0.558) compared to the controls. There was no significant difference in net clinical benefit, which combined VTE and bleeding events, between the experimental and control groups (1.18 vs. 0.83%, P =0.559). CONCLUSION:Applying the simple three-factor model in perioperative VTE management could quickly identify the patient with a high risk of VTE and improve the prophylaxis rate of perioperative VTE.

抗肿瘤治疗相关的心律失常是肿瘤心脏病学的重要领域之一，临床常见，各种抗肿瘤治疗使心律失常的识别和处理变得更加困难。然而，无论是临床实践还是科学研究，对抗肿瘤治疗相关心律失常的关注尚不足。本文对2021年美国心脏协会（AHA）发布的肿瘤患者心律失常和自主神经功能障碍的识别、预防和管理的科学声明进行解读。

总结1例急性非ST段抬高心肌梗死病人使用主动脉内球囊反搏(intra-aortic balloon pump,IABP)联合静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)、持续机械通气、血液净化支持治疗期间早期活动的护理经验.护理要点:准确进行镇痛、镇静评估,预防谵妄的发生,以让"病人参与自己照护"的活动形式进行早期活动.经过1周的治疗及护理,病人病情稳定,拔除气管插管及体外膜肺氧合管路,转至专科继续治疗.VA-ECMO救治过程中早期活动有利于病人康复,安全护理和预防并发症的发生具有重要意义.

Objective:To explore the risk factors of postoperative delirium in patients undergoing cardiac surgery through Meta-analysis, so as to provide a scientific basis for early clinical identification of postoperative delirium.Methods:The Chinese and English databases were searched by computer, and the retrieval time limit was from the establishment of the database to May 28, 2021. The articles on the risk factors of delirium in adult patients after cardiac surgery was collected and Meta-analysis was conducted with RevMan 5.4 software.Results:A total of 19 articles were included, including 10 731 subjects, including 1 901 cases in the case group and 8 830 cases in the control group, involving 14 risk factors. Meta-analysis showed that the risk factors with statistical differences included age ≥ 65 years ( OR=3.39) , history of cerebrovascular disease ( OR=2.00) , history of diabetes ( OR=1.88) , history of cognitive impairment ( OR=3.88) , history of depression ( OR=3.65) , history of atrial fibrillation ( OR=2.90) , preoperative Mini Mental State Examination (MMSE) score≤27 ( OR=3.96) , prolonged operation time ( OR=1.29) , postoperative mechanical ventilation time>24 hours ( OR=3.44) , postoperative cardiac insufficiency ( OR=2.56) and poor sleep quality ( OR=4.43) . Conclusions:Age≥65 years, cerebrovascular disease history, diabetes history, cognitive impairment history, depression history, atrial fibrillation history, MMSE≤27, prolonged operation time, postoperative mechanical ventilation time>24 hours, postoperative cardiac insufficiency, poor sleep quality are the risk factors of delirium after cardiac surgery in adults.

针刺辅助麻醉作为复合麻醉技术一部分,具有术前可以减轻患者焦虑、紧张的情绪,术中可以减少麻醉药剂量,术后可以镇痛、减轻术后恶心、呕吐等麻醉反应,使患者得以快速康复等优势.近年来,针刺辅助麻醉在围手术期的应用范围越来越广泛,该文主要围绕针刺麻醉在外科手术中的最新临床应用进行综述.

目的 实施目标管理方案降低导尿管相关性尿路感染发生率,通过制订目标、实施目标、完成目标,推进质量改善.方法 对某三级甲等综合医院2020年4月—9月留置导尿管的住院患者,应用目标管理方案,依次制订质量改善目标、质量改善计划,实施计划并对过程进行质量评价,通过评估结果的反馈改进行动,实现质量改善.设定1个月为1个质量周期,首个周期的质量为基线,之后各周期质量与之比较,同时与前1周期质量比较.结果 12个过程指标与基线质量比较,6个指标在第2个周期得以改善(P<0.05),此后凡优于第2周期和基线质量的指标,较基线质量比较,差异均具有统计学意义(均P<0.001).5个过程指标基线完成率已达到较高水平,与后续测量数据持平.结果 指标导尿管相关性尿路感染发生率项目末期较基线显著降低(P<0.05).过程指标10项措施执行完成率≥95％,2项措施执行率≥91％,达成目标.结论 应用目标管理方案进行质量改善,实现目标导向指标具体化管理,对护理质量进行客观测量,科学比较,切实降低了留置导尿管住院患者的导尿管相关性尿路感染发生率,促进护理质量提升.

Objective:To construct a pressure injury risk prediction model for critical patients and verify its prediction effect.Methods:A cohort study was conducted to collect relevant data of critical patients hospitalized in the Intensive Care Unit from February 2019 to September 2019. The occurrence of pressure injuries was used as a dependent variable to conduct a single factor and multiple factor analyses of relevant data and establish predictive models. The risk stratification and predictive effect tests were also performed.Results:There were 329 critical patients and 48 cases of pressure injuries. The single factor analysis of 11 factors showed that blood lactate, body temperature, ICU hospitalization days, Braden score, consciousness state, age and booster drug treatment were the suspicious factors of stress injury, and the difference was statistically significant ( Z value was 2.575-3.694, χ 2 values were 6.800, 30.510, 6.344, P<0.05 or 0.01); The results of the binary Logistic regression analysis showed that the independent influencing factors for the occurrence of pressure injuries included the patient′s body temperature within 24 hours after entering the ICU, the Braden score, state of consciousness, age and ICU hospitalization duration ( P<0.05 or 0.01). A prediction model was established. The likelihood ratio chi-square proved that the model was statistically significant and fitted well. The sensitivity was 66.7% and the specificity was 72.2%. The risk stratification of the model was performed. The difference between the high-risk group and the low-risk group was statistically significant ( t value was -33.371, P<0.01); the validation set was used to test the prediction effect, and the area under the ROC curve was 0.758. Conclusions:The constructed prediction model is a scientific combination of objective indicators of the clinical characteristics of critical patients, which is statistically significant; the model can predict critical patients’ risks of pressure injuries; it also has a good degree of discrimination, which can provide a theoretical basis for the risk management of critical patients with great clinical application value.

目的:比较TAPP术中三种不同方式处理直疝缺损的临床效果及安全性.方法:回顾性分析自2018年6月—2019年12月行腹腔镜经腹腹膜前单侧腹股沟直疝修补术的116例患者的临床资料,按处理直疝缺损的不同方式分为圈套器组、缝合组及疝钉组,比较三组的直疝缺损大小、术中操作时间、术后第一天疼痛评分及术后并发症的发生率.结果:圈套器组的直疝缺损大小与缝合组间比较无显著统计学差异(P=0.08),圈套器组和缝合组的直疝缺损小于疝钉组,差异存在显著统计学差异(P<0.001);圈套器组的术中操作时间与疝钉组无明显统计学差异(P=0.84),圈套器组和疝钉组的术中操作时间小于缝合组,差异存在显著统计学差异(P<0.001).三组患者术后第一天疼痛评分无明显统计学差异(P=0.23).对于术后并发症的发生,三组患者术后血清肿的发生率无显著统计学差异(χ2=0.78,P=0.89);三组患者术后复发的发生率无明显统计学差异(χ2=0.64,P=0.91),三组患者无术后慢性疼痛及补片感染病例.结论:在腹腔镜腹股沟疝修补术中三种关闭直疝缺损的方式均具有临床有效性及安全性,如何选择关闭直疝缺损的方式应根据患者及术者的具体情况制定个体化治疗方案.

原发性进行性失语(primary progressive aphasia,PPA)是一组以语言障碍为早期显著特征的综合征,包括非流利型(nonfluent/agrammatic variant PPA, nfvPPA)、语义型(semantic variant PPA,svPPA)和语素减少型(logopenic variant PPA,lvPPA)3种主要类型[1].nfvPPA表现为语言表达费力(言语失用)或语法缺失,可能存在对较复杂句子的理解障碍;svPPA表现为对单个词理解障碍和命名障碍,可伴有客观知识损伤,以及表层失读或失写;lvPPA表现为自发言语和命名中的单个词语提取受损(找词困难),以及句子和短语的复述障碍,自发言语中可存在语音错误[2].PPA早期的语言障碍不易被准确识别,除了病史以及语言和其他认知功能评估,诊断更多依赖于头颅MRI、单光子发射计算机断层成像(SPECT)和正电子发射断层成像(PET)等影像学支持.本综述采用以上影像学技术进行系统回顾和分析,比较不同亚型PPA的结构、功能和分子影像学特点及其诊断价值,以阐述PPA的脑功能改变和分子病理机制.

Objective To explore the effect of berberine (BBR) on steatotic liver ischemia reperfusion injury and analyze the role of endoplasmic reticulum stress and autophagy .Methods Thirty-four Wistar rats were fed with a high-fat diet for 12 weeks and 2 rats were randomly selected after 8 weeks to observe pathological changes and confirm the model of steatotic liver successfully .Then before opening and closing abdominal cavity ,32 rats were divided into I/R group (normal saline was intragastrically 4 weeks before performing cold I/R treatment) ,BBR group (normal saline was replaced by BBR ,BBR was intragastrically at a dose of 300 mg·kg-1 ·d-1 weeks and others were the same as I/R group) and TG group (TG was intraperitoneally at a dose of 0 .2 mg·kg-124h pre-operation and others were the same as BBR group ) .Then the rats were sacrificed at 6h post-reperfusion .Blood samples were collected from inferior vena cava and hepatic tissues harvested .The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected ,histopathologic changes observed by Hematoxylin & Eosin (HE) staining ,oxidative stress and inflammation determined by ELISA kit and the expressions of p-PERK ,CHOP ,Bip ,LC3 ,Beclin-1 and p62 detected by Western blot .Results As compared with Sham group ,the serum levels of ALT and AST were significantly higher in I/R ,BBR and TG groups (P < 0 .05) .And hepatic histological changes were severe and oxidative stress increased in parallel with the enhancement of pro-inflammation (P< 0 .05) .In BBR group ,the level of hepatic enzymes declined ,liver injury was milder ,oxidative stress decreased and pro-inflammation was lesser compared with I/R and TG groups (P< 0 .05) .Additionally ,as compared with sham group ,the expressions of p-PERK ,CHOP ,Bip ,LC3 ,Beclin-1 and p62 were up-regulated in I/R and BBR groups (P < 0 .05) .TG group increased the levels of LC3 ,Beclin-1 and p62 (P< 0 .05) .Interestingly ,compared with I/R group ,BBR pretreatment down-regulated the expressions of p-PERK ,CHOP ,Bip ,LC3 ,Beclin-1 and p62 (P< 0 .05) .TG group had the higher expressions of LC3 ,Beclin-1 and p62 than those of BBR group (P< 0 .05) .Conclusions BBR pretreatment can protect steatotic liver ischemia reperfusion injury .And the mechanisms may be attributed to the inhibitions of endoplasmic reticulum stress and autophagy .

Objective To evaluate the efficacy of berberine in preventing brain injury induced by hepatic ischemia-reperfusion ( I∕R) and the relationship with glycogen synthase kinase 3 beta ( GSK-3β) activity in mice. Methods Forty-eight healthy clean-grade male C57BL∕6 mice, weighing 20-25 g, were randomized into 3 groups (n=16 each) using a random number table method: sham operation group (S group), hepatic I∕R group (I∕R group) and berberine group (B group). The model of 70％ liver I∕R injury was established by clamping the portal vein and hepatic artery supplying left and middle lobes of the liver in mice anesthetized with 2％ pentobarbital sodium 40 mg∕kg. In B group, berberine 50 mg∕kg was adminis-tered through a gastric tube once a day for 7 consecutive days starting from 7 days before operation. The e-qual volume of normal saline was given instead in S group and I∕R group. The mice were sacrificed at 6 h af-ter reperfusion, brains were removed and hippocampal tissues were harvested for microscopic examination of pathological changes ( with a light microscope) and for determination of cell apoptosis ( by TUNEL) , super-oxide dismutase ( SOD ) activity ( by xanthine oxidase method ) , malondialdehyde ( MDA ) content ( by thiobarbituric acid colorimetric method) , expression of phosphorylated GSK-3β ( p-GSK-3β) and GSK-3β(by Western blot), and opening of mitochondrial permeability transition pore (mPTP). The apoptosis in-dex and p-GSK-3β∕GSK-3β ratio were calculated. Results Compared with S group, the apoptosis index and MDA content were significantly increased, SOD activity and p-GSK-3β∕GSK-3β ratio were decreased, and mPTP opening was increased in I∕R and B groups ( P<0. 05) . Compared with group I∕R, the apoptosis index and MDA content were significantly decreased, SOD activity and p-GSK-3β∕GSK-3β ratio were in-creased, mPTP opening was decreased (P<0. 05), and the pathological changes of hippocampal tissues were significantly attenuated in B group. Conclusion Berberine can prevent the brain injury induced by he-patic I∕R, and the mechanism may be related to inhibiting GSK-3βactivity and thus inhibiting mPTP open-ing in mice.

Objective To evaluate the effect of berberine on fatty liver ischemia-repeffusion (I/R) injury and the relationship with endoplasmic reticulum stress in liver tissues.Methods Thirty-two male Wistar rats,aged 4 weeks,weighing 100-150 g,were divided into 4 groups (n=8 each) using a random number table method:control group (group C),fatty liver group (group FL),I/R group and berberine group (group BBR).Rats were fed a normal fat diet for 12 weeks,normal saline 3.5 ml was given intragastrically for 4 weeks starting from 9th week,and rats only underwent simple laparotomy in group C.Rats were fed a high-fat diet (45％ energy originating from fat) for 12 weeks,and the other treatments were similar to those previously described in group C.Rats were fed a high-fat diet (45％ energy originating from fat) for 12 weeks,normal saline 3.5 ml was given intragastrically for 4 weeks starting from 9th week,and then the model of liver I/R injury was established in group I/R.Rats were fed a high-fat diet (45％ energy originating from fat) for 12 weeks,berberine solution (300 mg/kg) 3.5 ml was given intragastrically for 4 weeks starting from 9th week,and then the model of liver I/R injury was established in group BBR.Hepatic ischemia was induced by clamping the portal vein,hepatic artery,right gastric vein,and supra-and inferior-hepatic vena cava to perform cold perfusion with 4 ℃ lactated Ringer's solution lasting for 30 min,followed by reperfusion.The serum triglyceride (TG) concentrations were determined after 4,8 and 12 weeks of diet.Blood samples were collected at 6 h of reperfusion for measurement of serum aspartate transminase (AST) and alanine transaminase (ALT) concentrations.Livers were removed after blood sampling at 6 h of reperfusion and liver tissues were obtained and stained with oil red O and haematoxylin and eosin for examination of pathological changes and for determination of the expression of Bip,CCAAT/enhancer-binding protein homologous protein (CHOP),protein kinase RNA-like endoplasmic reticulum kinase (PERK) and phosphorylated PERK (p-PERK) (by Western blot).p-PERK/PERK ratio was calculated.Results Compared with group C,the serum TG,ALT and AST concentrations were significantly increased,the expression of Bip and CHOP was up-regulated,p-PERK/PERK ratio was increased (P＜0.05),lipid deposition was increased,and liver steatosis was found in group FL.Compared with group FL,the serum AST and ALT concentrations were significantly increased,the expression of Bip and CHOP was up-regulated,pPERK/PERK ratio was increased (P＜0.05),and the pathological changes of liver tissues were accentuated in group I/R.Compared with group I/R,the serum TG,ALT and AST concentrations were significantly decreased,the expression of Bip and CHOP was down-regulated,p-PERK/PERK ratio was decreased (P＜ 0.05),lipid deposition was reduced,and the pathological changes of liver tissues were significantly attenuated in group BBR.Conclusion Berberine can ameliorate fatty liver I/R injury,and the mechanism may be related to inhibiting endoplasmic reticulum stress in liver tissues of rats.

目的:探讨住院肝硬化患者的衰弱现状及其影响因素,为制定干预措施提供临床依据.方法:采用便利抽样的方法,应用卡罗来纳衰弱指数量表和步行测试对某三甲医院消化科住院的152例肝硬化患者进行横断面调查,并进行影响因素分析.结果:患者的衰弱指数为0.28±0.07,处于衰弱期38例(25.0％)、衰弱前期23例(15.1％)、健康状态91例(59.9％).不同性别、既往跌倒史、疾病严重程度、学历和病因的患者之间的衰弱指数差异有统计学意义(P＜0.05);相关性分析显示患者衰弱指数与年龄、中性粒细胞淋巴细胞比值呈正相关,与体质指数、血清白蛋白及步行速度呈负相关,且有统计学意义(P＜0.05);多元回归分析显示,年龄、既往跌倒史和中性粒细胞淋巴细胞比值是肝硬化患者衰弱的影响因素,可解释因变量全部变异的41.8％.结论:年龄越大、有既往跌倒史及中性粒细胞淋巴细胞比值越高的肝硬化患者,其衰弱程度越高,医护团队应加强此类患者的护理管理,及时给予护理干预,降低患者的衰弱水平,减少跌倒等不良事件发生.

原发性进行性失语(primary progressive aphasia,PPA)是一组以特定语言功能进行性丧失,而其他认知功能相对保留为特点的综合征.2010年提出的分类方法将PPA分为3种亚型:非流利型/语法缺失型、语义变异型和寡语型.其中寡语型PPA(logopenic primary progressive aphasia,LPA),也称为“LV-PPA”或“PPA-L”,是由Mesulam在1982年最早描述的,其核心特征为词语提取障碍和语句复述能力受损.目前,越来越多的研究关注LPA患者语言损害及机制,本综述将对LPA语言损害特点及其形成机制的最新研究进展进行讨论,希望能增进人们对LPA的认识和研究.

Objective To compare the applied signification of optical and ultrasonic biometry in observing the axial length of eyes with vitreous hemorrhage and retinal detachment. Methods This is a prospective clinical study. We randomly selected 57 cases (57 eyes) with vitreous hemorrhage and (or) retinal detachment from May 1, 2016 to May 31. Patients had not been performed eye surgery, also denied the history of ocular trauma and excluded other eye diseases. 25 eyes with vitreous hemorrhage, 24 eyes with retinal detachment, 8 eyes complicated with vitreous and retinal detachment hemorrhage. At 24 hours before surgery, we measured axial length using the Lenstar LS 900, immersion B-ultrasound (IB) and immersion A-ultrasound (IA). The differences between three methods were assessed with paired sample t-test. Results IB and IA data was collected from all 57 eyes, there was no statistical significance between measurements of IB and IA (P > 0.05). In the eyes with serious refractive medium opacity (36 eyes), the results showed no statistical significance difference between measurements of IB and IA (P > 0.05). The measurements of three groups can be obtained from the rest eyes (21 eyes): significant statistical difference of the measurements between IB and Lenstar was detected[(24.057±1.441)mm vs(23.470±1.775)mm],(t=3.099, P < 0.05) same results between IA and Lenstar was obtained [(23.962±1.443) mm vs (23.470±1.775) mm], difference was statistically significant (t=2.643, P < 0.05). But the measurements showed no statistical significance difference between the measurements of IB and IA (P > 0.05). Conclusions In the eyes with vitreous hemorrhage and (or) retinal detachment, the measurements of axial length could not be achieved or existed deviations on account of refractive medium opacity when using optical biometry. Under such circumstances, we should choose IA or IB as the optimization method to obtain measurements, in order to get much more accurate results.