目的 探讨川崎病(KD)病理进程中患儿血清热休克蛋白27(HSP27)和热休克蛋白70(HSP70)的表达水平,分析其与KD病理机制及冠状动脉病变的关系.方法 收集2017年1月至2019年12月陕西省人民医院儿童病院收治的住院KD患儿30例为KD组,另选取同期体检健康儿童为对照组(30例).根据是否合并冠状动脉损伤,将KD组患儿分为KD冠状动脉损伤(KD-CAL)组(12例)与KD非冠状动脉损伤(KD-NCAL)组(18例);根据KD病理变化,将KD组患儿分为病程在1～9天时的KD急性期组与病程在10～31天时的KD缓和期组.应用酶联免疫吸附法(ELISA)检测各组儿童血清中HSP27和HSP70水平,并进行统计分析.结果 KD急性期组、KD缓和期组及对照组的血清HSP27和HSP70水平比较差异均有统计学意义(F值分别为5.47、7.65,P<0.05);KD急性期组分别与KD缓和期组及对照组的血清HSP27和HSP70水平比较差异均有统计学意义(t值分别为15.23、14.32、16.72、13.75,P<0.05);KD缓和期组与对照组的血清HSP27和HSP70水平比较差异均有统计学意义(t值分别为12.36、13.75,P<0.05).KD-CAL组急性期与KD-NCAL组急性期的血清HSP27和HSP70水平比较差异均有统计学意义(t值分别为13.34、14.65,P<0.05);KD-CAL组缓和期与KD-NCAL组缓和期的血清HSP27和HSP70水平比较差异均有统计学意义(t值分别为12.53、13.72,P<0.05).结论 KD急性期患儿血清中HSP27和HSP70水平显著增高,其均在KD急性期抑制了血管炎性反应;KD缓和期患儿血清HSP27和HSP70水平持续较高,其对血管炎性反应的抑制作用可以维持至病程的缓和期.KD-NCAL组患儿血清HSP27和HSP70水平较KD-CAL组明显升高,其在KD冠状动脉病变中可能起保护作用.

目的:观察TP53、KRAS、KDR、APC、MLH1及PIK3CA等56个基因在消化道恶性肿瘤中的突变情况,探讨驱动基因的诊疗意义.方法:选择胃食管癌15例、结直肠癌21例患者组织石蜡标本,运用高通量基因测序技术检测56个肿瘤突变高频基因,并进行生物统计分析.结果:36例标本检出34例有已知基因突变,突变基因为TP53、KRAS、MLH1、PIK3CA、KDR、APC、SMARCB1、KIT、EGFR、NRAS、STK11、SMO、SMAD4、CDH1、ERBB2、JAK2和RET共17种.其突变率由高到低依次为:TP53(75.00％),KRAS(33.33％),MLH1、PIK3CA、KDR(均为13.89％),APC(11.76％),SMARCB1(8.82％),KIT、EGFR及NRAS(均为2.78％).KRAS在结直肠癌中的突变率(47.62％)显著高于在胃食管癌中的突变率(13.33％).TP53的突变率明显高于其他突变基因.在结直肠癌中KRAS的突变率显著高于KDR、APC、MLH1,未发现有统计学关联.结论:消化道恶性肿瘤TP53突变率较高,可能与病理组织分化程度低及淋巴结转移有关.KRAS在结直肠癌中较在胃食管癌中更易发生突变,存在部位差异.同时KRAS与KDR、APC、MLH1,在结直肠癌患者中存在共突变现象,提示结直肠癌的酪氨酸激酶通路和血管内皮生长因子受体基因在致癌过程中可能存在协同作用,导致肿瘤在结直肠中更易发生发展,选择靶向药物治疗时需考虑协同作用,以便科学精准用药.

新型冠状病毒肺炎(COVID-19)事件是首发于中国的一起大规模突发公共卫生事件,对我国人民的经济、生活造成了显著影响.在此次事件中,儿童作为特殊群体因机体各系统发育不完善,免疫力较差,更需要受到特别关注.根据COVID-19最新诊疗标准,儿童COVID-19在流行病学、发病特点、临床表现、诊治方面与成人有所不同.该文主要从流行病学、临床诊治方面阐述儿童COVID-19的特点,从而对儿童COVID-19的早期预防及诊治提供参考.

Objective To improve the work efficiency of triage methods and work flow by applying the critical path method. Methods The characteristics of the patients and the operation characteristics of the nuclear magnetic equipment were analyzed. Then the historical data of the patients with nuclear magnetic treatment was recorded. Based on this, the critical path method was used to adjust the magnetic scan work, and to explore, improve and perfect each link. Results The data of the patients who visited the clinic before and after the implementation of the scheme was recorded and compared, which proved that the method was effective. Conclusion The diagnostic capacity of MR and the utilization rate of equipment were improved when the critical path method was used in nuclear magnetic resonance examination, which alleviated the doctor — patient relationship to a certain extent. This study provides a reliable management method and reference basis for the management of nuclear magnetic chamber optimization services and nuclear magnetic equipment.

Objective To investigate the infection of HPV subtypes in male urethra in Xi'an area.Methods The eighteen subtypes of HPV DNA were detected in 478 cases of male patients by PCR-reverse dot hybridization assay (RDB) including low risk subtypes (HPV6,11,43) and high risk subtypes (HPV16,18,31,33) during 2015～2016.Results The total infection rate of HPV subtypes in 478 subjects was 44.97％ (215/478).The percents of subjects infected by one subtype,two ones,three ones,four ones and five ones were 32.85％ (157/478),8.79％ (42/478),2.09％ (10/478),0.42％ (2/478) and 0.84％ (4/478),respectively.The detection rates of low risk subtypes and high risk ones were 40.17％ and 22.38％ in which the most common subtypes were HPV6 (24.69％),HPV11 (12.13％),HPV16 (5.65％),HPV43 (3.35％) and HPV52 (2.30％) and those of others were from 0％ to 2.09％.The infection pattern of HPV subtypes gave priority to one subtype infection in all age groups.There was statistically different between H PVs (6,11,16,43,52,66) in twenty years or older subjects (x2 =12.879～109.7,P=0.000～0.025).Conclusion The majority of HPV subtypes detected in male urethra were HPV6,HPV11,HPV16,HPV43 and HPV52 in Xi'an area which provided epidemiological data for HPV infection in males.

Objective To investigate the correlation between serum vascular endothelial growth factor(VEGF)and the fac-tors of depression in patients with primary liver cancer(HCC).Methods The retrospective analysis was about 43 cases of primary liver cancer patients of Shaanxi Provincial People's Hospital,from September 2015 to September 2016.The self-rat-ing depression scale was used to evaluate the patients with depression and non-depression group.By ELISA kits,test VEGF levels,analysis of depression,age,gender and serum VEGF concentration.Results The level of VEGF in patients with de-pression was 86.21±19.52 pg/ml,which was significantly higher than that in patients without depression(48.31±9.16 pg/ml)by t test(t=-2.968,P=0.005).The levels of serum VEGF in patients with different gender groups were meas-ured by t test(t=0.079,P=0.938).And the serum levels of VEGF were measured in patients with different age groups by multiple sets of variance analysis(F=0.618,P=0.655).For age and gender,there was no significant difference in serum VEGF level between HCC.Conclusion By HCC,it was related between depression and the level of serum VEGF,and it suggests that serum level of VEGF may become the prognosis of primary liver cancer detection index for these patients.Giv-ing psychological interventions earlier,may improve the prognosis of cancer patients with depression.

Objective:To compare the detective effect between color Doppler twinkling artifact and B-mode ultrasonography for kidney stones in order to develop an ultrasonic model that can more easily and more accurately detect kidney stone.Methods: 9 patients with kidney stone who were confirmed by CT scan in recently were selected to accepted two methods (color Doppler twinkling artifact and B-mode ultrasonography) to detect kidney stone. The video fragments of upper pole, interpolar and lower pole were created by three radiologists and the results were diagnosed by them.Results: In dual kidneys of the nine patients, 32 stones with average size of (8.9±7.5) mm were found. The sensitivity, specificity, positive predictive value and negative predictive value of the B-mode ultrasonography were 71%, 48%, 52% and 68%, respectively, while those of color Doppler twinkling artifact were 56%, 74%, 62% and 68%, respectively.Conclusions: In the detection of kidney stones, B-mode ultrasonography is more sensitive when is used alone, but color Doppler twinkling artifact has more high specificity. The color Doppler twinkling artifact should be applied in more clinical practices, and a new commercial ultrasonography mode that used basic acoustic difference and is special for detection of kidney stone should be researched and developed so as to improve the detection of kidney stone.

In order to adapt to the new health management localization requirements of the physical examination center and develop the scientific allocation strategy for hardware resources, this paper analyzed many kinds of functional requirements such as disease diagnosis and monitoring, risk early warning and intervention, health promotion and keep and so on. Then the allocation strategies of hardware resource that included the inspection, early warning type and the type 3 instruments and the information coordinating platform was clarified, which had an important guiding significance for the transformation of health care market orientation.

Objective To evaluate the impact of intravascular ultrasound imaging (IVUS) guidance on the final volume of contrast agent utilized in patients undergoing percutaneous coronary intervention (PCI).Methods A total of 83 patients were randomized grouped to angiography-guided PCI group and IVUS-guided PCI group. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months.Results The median total volume of contrast was 64.5 mL in angiography-guided group vs. 20.0 mL in IVUS-guided group (P<0.001). Similarly, the median volume of contrast/creatinine clearance ratio was significantly lower than patients who were treated with IVUS-guided PCI (P<0.001). The in-hospital and 4-month outcomes were not different between the two groups.Conclusion The tilization of IVUS as the primary imaging tool is safe to guide PCI, and markedly reduces the volume of iodine contrast, compared to angiography-alone guidance. The use of IVUS should be considered for patients at high risk for contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty.

目的:探讨轮状病毒肠炎患儿肠道外各系统损害发生情况以及心肌酶水平.方法:将轮状病毒感染患儿60例作为观察组,同期住院非轮状病毒感染患儿60例作为对照组.观察比较两组患儿肠道外各系统损害发生情况以及心肌酶水平.结果:观察组与对照组发生心肌损害分别为34例(56.67%)和17例(28.33%);肝功损害分别为23例(38.33%)和12例(20.00%);小儿良性惊厥分别为7例和2例(3.33%),差异均有统计学意义(P<0.05).观察组患儿CK、CK-MB、LDH较对照组显著增高(P<0.01).结论:轮状病毒肠炎患儿肠道外各系统损害以心肌损害发生率最高,其心肌酶各项指标较非轮状病毒感染患儿水平明显增高,临床上应引起重视并做到早发现、早治疗,早期控制病情,以减少对患儿的身心损害.

Objective:The miRNA-140 expression level in patients with gastric antrum cancer was studied.And its relationship with clinical pathology of gastric antrum cancer was explored.Methods:To select 47 patients with gas-tric antrum carcinoma and by RT-PCR method to detect serum miR-140.Results:The expression of miR-140 lev-el and the degree of gastric antrum carcinoma differentiation ,clinical stage ,lymph node metastasis was related (P<0.05),while in gender and age,had no correlation (P>0.05).Conclusion:The lower expression of miR-140 in patients with gastric antrum cnacer may be related with gastric antrum cancer occurrence and development.

介绍了医疗App的发展现状,指出了医疗App的应用对传统的医疗服务模式转变产生了重要的推动作用.分析了医疗App发展的瓶颈问题,提出了坚持政府主导、调动医疗机构积极性、倡议医药分离、强化商业保险以及完善信息技术等建议,展望了医疗App的发展前景.

目的：分析不完全川崎病（IKD ）的临床特征和实验室检查，旨在提高IKD的早期诊断率。方法：对28例IKD患儿和98例典型KD患儿的性别、年龄、临床表现与实验室特点及心脏超声等相关临床资料进行比较、分析。结果：两组发病比较无性别差异，但IKD组发病年龄偏小；IKD组发热持续时间偏长；IKD组在发病急性期球结膜充血、口腔黏膜病变等典型症状少于典型KD组，而卡疤再现红肿、肛周脱屑则高于典型KD组；IKD组WBC、CRP升高较典型KD组明显；IKD组发生冠状动脉病变（CAL）高于典型KD组。结论：IKD患儿发病年龄小、发热时间较长、卡疤再现红肿及肛周脱屑发生率高、WBC及CRP升高明显、CAL发生率高。

Objective: To study the effect of Tongluo Pingchuan Decoction combined Montelukast Soudium Tablets and salbutamol sulfate aerosol in the children with cough variant asthma. Methods: Between January 2013 to January 2014 in our hospital,100 cases were randomly divided into observation group and control group,50 cases in each. Control group adopted Montelukast Soudium Tablets and salbutamol sulfate aerosol therapy and observation group used Tongluo Pingchuan Decoction combined Montelukast Soudium Tablets and salbutamol sulfate aerosol. Before and after treatment,two groups pulmonary function improvement and recurrent situation were compared. Results: Treatment groupu0027s cough cough relief time and disappear time were significantly lower than those of the control group and the difference was statistically significant( P 0. 05). There was no statistically significant difference of recurrence rates between two groups( P 0. 05).After treatment,two groupsu0027 FVC,FEV1,FEV1. 0 and PEF were statistically significant compared with those before treatment( P 0. 05). All children within the treatment scheme did not appear serious adverse reactions and the security had no significant difference between two groups( P 0. 05). Conclusion: Tongluo Pingchuan Decoction combined Montelukast Soudium Tablets and salbutamol sulfate aerosol in the children with cough variant asthma has remarkable effect and it is safe and reliable and can be used in clinic.

Emergency medicine is a newly rising composite subject, including the whole process of the pr-hospital first aid, emergency in hospital and critical care. With the rapid development of economy and science technology, a large number of advanced emergency medical devices have been equipped in the hospital of al levels. The medical equipments play a decisive role in the rescue work. They strengthened the safe, rapid, effective, continuous medical services in emergency department and helped a lot of critical y il patients out of danger.

Reevaluation of medical device quality is an important part of the medical equipment quality control system. In this paper, the authors introduced the methods for the reevaluation based on the situation of low quality of medical devices used in medical institutions in China. Meanwhile, we explored the establishment of the system of the reevaluation through the angles of strengthening quality standards, constructing technical specifications and emphasizing monitoring of adverse events. It proved that the reevaluation of medical device quality in medical institutions is very important for quality control of the devices.