目的:了解杭州市艾滋病病毒感染者/艾滋病患者(PLWH)的抑郁和焦虑情绪现状及其相关因素.方法:收集2017年1月1日至2019年12月31日在杭州市西溪医院就诊并自愿参加的PLWH951例,采用病人健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)评估抑郁和焦虑情绪,采用logis-tic回归分析探讨抑郁和焦虑情绪的相关因素.结果:存在抑郁情绪192例,存在焦虑情绪104例.Logistic回归分析结果显示,少数民族、无业状态是PLWH抑郁情绪(OR=2.27、1.45)和焦虑情绪(OR=2.45、1.47)的危险因素,大学(含大专)及以上受教育程度是PLWH抑郁情绪(OR=0.78)和焦虑情绪(OR=0.78)的保护因素.结论:杭州市艾滋病病毒感染者/艾滋病患者(PLWH)的抑郁和焦虑情绪问题需要重视,特别关注无业、少数民族、中学及以下程度PLWH的情绪问题.

目的 评价中药敷脐治疗难治性肝硬化腹水的疗效.方法 在中文数据库:中国知网、维普、万方数据库、中国生物医学文献数据库以及外文数据库:Cochrane?Library、EM-BASE、Pubmed中检索2009年1月至2021年8月发表的有关中药敷脐治疗难治性肝硬化腹水的文献,纳入中药敷脐联合西医综合治疗对比单纯西医综合治疗的随机对照试验(RCTs).结果 符合纳入标准的文献共8篇,对其中的随机对照试验进行荟萃分析,中药敷脐治疗与对照组比较,腹水缓解率更高(RR=1.49,95％CI:1.30～1.70,P<0.001),尿量增多(P<0.001),腹围变小(P<0.007),门静脉血流量减少(OR=-323.72,95％CI:-451.66～-195.79,P<0.001);而血清白蛋白两组差异无统计学意义(P>0.05).结论 中药敷脐治疗能促进腹水缓解,可能与增加24?h尿量、降低门静脉血流量有关,可能不引起血清白蛋白的改变.

Objective To investigate the expression ofβ-arrestin gene in rats with severe acute pancreatitis. Methods Experimental severe acute pancreatitis (SAP) was induced in SD rats. The expression ofβ-arrestin mRNA in splenic tissue was detected by real-time RT-PCR, the TRAF6 protein in liver tissue and NF-κBp65 protein in pancreatic tissue were assessed by Western blot and immunohistochemistry respectively. Results The expression ofβ-arrestin mRNA in splenic tissue was signif-icantly inhibited;the expression of TRAF6 protein in liver tissue was decreased;and the transcriptional activity of NF-κB was in-creased in SAP rats. Conclusion Results indicate that the TLR-IL-1R signaling system may be involved in the pathological pro-cess of severe acute pancreatitis.

Objective: To investigate the rhubarb and salvia increasing β-arrestin gene expression,thereby affecting the mechanism of the process of rats with experimental severe acute pancreatitis. Methods: SD rats with experimental severe acute pancreatitis models were divided into normal group( SO),the experimental control group( SAP),rhubarb and salvia intervention group( DD). β-arrestin mRNA expression of spleen tissue,liver tissue TRAF6 protein content levels,the level of NF-κB p65 protein expression in the pancreatic tissue were tested. Results: The SAP group's β-arrestin mRNA expression was inhibited significantly. The DD group showed β-arrestin mRNA expression out of inhibition.TRAF6 protein content level downwardly changed in the SAP group. The DD group's TRAF6 protein content levels were decreased more significantly. The SAP group's NF-κB transcription activity was enhanced while the DD group's NF-κB activity was inhibited. Conclusion: Rhubarb and salvia can block the process of severe acute pancreatitis. The mechanism may be related to increasing β-arrestin gene expression and weakening TLR-IL-1R signaling system.

目的:研究非编织立体定位补片在腹腔镜经腹腹膜前腹股沟疝修补术中的安全性和有效性。方法:对56例(64侧)腹腔镜经腹腹膜前腹股沟疝修补术采用非编织立体定位补片治疗。结果:56例手术均成功,手术时间(55.8±12.6)min,术后平均住院时间(2.8±1.2)d,平均随访15.6月无复发。结论:采用免钉合技术,利用三维立体的非编织立体定位补片进行腹腔镜经腹腹膜前腹股沟疝修补术是安全而有效的。

Objective:To study lifestyle of health/sub-health status and the effect to Chinese constitution in Hangzhou residents by community health assessment,lifestyle surveys and Chinese constitution identification.Method:There are 880 cases aged 18～70 assessed as healthy or sub-healthy residents in seven community of Hangzhou into study by random sampling.All of them were study by community health assessment,lifestyle surveys and Chinese constitution identification.Results:①Residents of Hangzhou are good health in generally.②Women in alcohol and drugs,stress control and security and the overall lifestyle are better than men,but the health condition of male is better than women.③There are corresponding relationship between eating habits,alcohol and drugs,stress and control,security and the status of Chinese medicine.Conclusion:①Men should pay attention to alcohol and drugs,stress control and improve safety awareness of life,women should strengthen the physical exercise.②Even better way of life,there is also biased in Chinese constitution and Chinese medicine need to adjust accordingly.

为了使医院主体经营者了解实施《患者安全目标》的必要性及重要性,文章分析了影响患者安全的因素与《患者安全目标》的相关内容。指出实施《患者安全目标》管理,可以预防医院不安全事件的发生,保证患者的安全,强化医院的管理。并建议将患者安全目标管理纳入全面质量管理体系中,使之成为医院质量管理的重中之重,从而促进医院可持续发展。

Objective:To observe the protective effects of Chinese medicine mixture AA-3 on pancreatic structure and function of sever acute pancreatitis.Methods:SD rats were randomly divided into three groups,sham group,model and Chinese medicine AA-3 groups.Sever acute pancreatitis models were copied by Aho's method.Fluorescent microscope speed test system was established to observe the microvascular changes of pancreas after modeling 24h,serum and ascites amylase,pathological changes of the pancreas and its ultrastructure were determined.Results:There was different blood flow rate in the pancreas microcirculation arteries and veins in the same rat with sever acute pancreatitis,the blood flow rate in the pancreas microcirculation arteries and veins was uniforms in AA-3 group rats.Pancreatic structure was damaged obviuosly in sever acute pancreatitis rats,the damage was significantly improved in AA-3 group.Conclusion:Chinese medicine mixture AA-3 can obviuosly protect pancreatic structure and function of rats with sever acute pancreatitis.

病案作为患者的原始诊疗档案,医教研的宝贵资料,医疗纠纷判定法律责任的事实依据,其规范化建设尤为重要和必要,必须充分体现并坚持客观性、完整性、系统性、科学性和法律性,才能适应社会发展的需要。

为适应新的医学模式,医患沟通在医疗活动中已愈来愈体现出其重要性。近年来,因医患沟通不当,而引起的医患纠纷已呈上升趋势,一些医患纠纷严重扰乱了医院的正常工作秩序,甚至威胁到医护人员的人身安全,成为困扰医院管理者的重大问题,医患沟通在当今医学模式中所起的作用已愈来愈广。

目的评价保健食品辅助改善人记忆作用。方法以50~60岁某工厂的工人为对象进行某保健品人体试食试验,用修改韦氏记忆量表测试其记忆商(MQ)。结果试验组MQ由试验前的79·28±13·85上升至试验后的84·74±12·10,试验组试验后MQ高于试验前(P<0·01),差异有统计学意义,而对照组差异无统计学意义。结论该保健食品对人体具有辅助改善记忆功能。

Mirizzi综合征是指胆囊颈部结石或胆囊管结石压迫肝总管引起的肝总管炎症性狭窄[1].临床主要表现为阻塞性黄疸、胆绞痛、胆管炎,是胆囊结石引起的一种少见的并发症.术前不能明确诊断,增加了术中胆管损伤的风险[2].作者自1990年7月至2003年6月对手术治疗32例Mirizzi综合征进行分析,报告如下.

随着人类平均寿命的延长,老年人大肠癌的发病率逐年增加,而此类患者多伴有营养不良,因此围术期营养支持显得格外重要.现将近2a来本院收治的24例60岁以上大肠癌患者围术期营养支持的情况分析如下.

嗜酸性细胞性胃肠炎(Eosmophilic Gastroentertis,EG ) 属于少见病,临床报道少,易误诊.2004年1月本院发现1例,现报道如下,并结合文献进行讨论.

目的:观察中药合剂对实验性急性胰腺炎大鼠肠系膜微循环的影响.方法:将实验大鼠分成正常组、对照组和治疗组,测定血清淀粉酶和腹水淀粉酶,应用荧光显微流速测试系统对实验性急性胰腺炎大鼠胰腺微循环进行观察,并与病理情况作对比.结果:与对照组比较,灌注中药合剂的治疗组的血清淀粉酶和腹水淀粉酶明显下降(P＜0.01),实验大鼠肠系膜微循环处于修复状态.结论:中药合剂对急性胰腺炎大鼠肠系膜微循环有改善作用.

目的了解急性胰腺炎早期胰腺微循环的改变情况,探讨其在疾病发生发展中的作用,同时观察中药合剂AA-3对胰腺微循环的影响.方法健康SD大鼠随机分成3组,Aho法复制成急性胰腺炎模型.正常组、对照组灌水,治疗组灌中药合剂AA-3,1ml/100g;建立荧光显微流速测试系统,观察造模后4h的胰腺微血管的变化.结果同一只大鼠的胰腺微循环动、静脉存在着不同的血流速度,治疗组血流速度则相对一致.结论微循环障碍是急性胰腺炎的发病原因之一,或者是急性胰腺炎向重症急性胰腺炎进展的重要因素,在急性胰腺炎时胰腺水肿与坏死并存,坏死往往是局灶性的.中药合剂AA-3有改善急性胰腺炎大鼠胰腺微循环的作用.

目的:观察中药大黄丹参治疗重症急性胰腺炎大鼠肝胰组织TNF-α mRNA和IL-10 mRNA表达的影响 .方法:SD大鼠30只,随机平均分成假手术组、重症急性胰腺炎对照组及大黄丹参治疗组.造模后6 h后用荧光PCR方法测定各组大鼠肝脏及胰腺组织TNF-α mRNA和IL-10 mRNA.结果:肝脏组织中,重症急性胰腺炎组大鼠TNF-α mRNA和IL-10 mRNA的表达均较假手术组有明显升高(P<0.05);中药治疗后TNF-α mRNA的表达下降(P<0.05),IL-10 mRNA的表达升高(P<0.05).胰腺组织中,重症急性胰腺炎组TNF-α mRNA和IL-10 mRNA表达同样升高(P<0.05),中药治疗后TNF-α mRNA的表达降低(P<0.05),但IL-10 mRNA表达与急性胰腺炎组比较无统计学差异.结论:SAP大鼠在肝脏和胰腺组织中,TNF-α mRNA和IL-10 mRNA均有明显升高,两者呈同一化的进程.大黄丹参治疗能够使肝胰组织的TNF-α mRNA表达下降,使肝IL-10 mRNA升高,显示了中药的调节作用.

急性胰腺炎发病机理的研究,已成为外科领域中的热点,近几年来大量实验研究证实,其发病机制除自身消化学说外,还有肿瘤坏死因子和白介素-1等细胞因子的瀑布反应[1]、胰酶和弹力酶的组织溶解作用[2-4]、多核嗜中性粒细胞激活及对内皮细胞的损害及共对细胞凋亡调节机制的障碍等因素,胰腺微循环障碍在本病发病中的作用越来越受到重视[5,6].微循环系指大循环中的游离血管进入每一器官之后的循环部部分[7],它由微动脉、前毛细血管、真毛细血管网、后毛细血管及微静脉组成,它的主要功能之一是能够为适应组织中实质细胞代谢活动的增加而增加血流量.与大循环有关的调节作用受神经系统支配,以保持中心血压,而对于微循环系统则通过控制组织灌注来满足代谢活动时需要.虽然两种方式的作用于一身,其作用方向却不尽相同,甚至在疾病状态下是相互冲突的.由于观察方法的限制,微循环发展比较缓慢,直到上世纪70和80年代电子显微镜的应用,人体活体显微镜及计算机图像控制分析系统的应用,才使人体的微循环系统研究进入了新的纪元.

目的探讨老年胆囊切除术后并发症的特点及预防.方法回顾1999年1月至2001年12月老年胆囊切除103例,与同期非老年胆囊切除294例进行比较,分析术后并发症发生率及并发症的特点,提出预防措施.结果老年组并发症发生率为34.95%,对照组为17.35%,(P＜0.01);直接手术并发症老年组为20.39%,对照组为12.93%,(P＞0.05);间接手术并发症老年组为22.33%,对照组为6.12%,(P＜0.05);老年组间接手术并发症主要为肺部感染(10.68%)和心血管系统并发症(7.77%).结论老年患者胆囊切除术后并发症发生率明显高于非老年患者,且主要为呼吸系统、心血管系统等间接手术并发症,因此加强老年患者围手术期的心肺功能管理对于减少并发症尤为重要.

目的:研究雷公藤(Tripterygium,TⅡ)治疗盆腔子宫内膜异位症(Endometrosis,EM以下简称EM)、子宫肌腺症的机理和疗效.方法:本研究将病例分为2组,每组40例.治疗组口服复方雷公藤制剂1mg/kg/d.对照组口服炔诺酮5mg/kg/d.两组分别用药治疗3个月.结果:2组患者治疗后临床症状、子宫形态、卵巢、垂体功能、血清CA125有明显差异.2组病例血常规、生化全套药物副反应观察结果无明显差异.结论:TⅡ使血清FSH升高、LH升高、E2下降、子宫内膜萎缩、血清CA125下降,临床症状缓解或消失,月经改变或闭经.雷公藤是治疗子宫内膜异位症较有前途的药物.