Background: Few studies have examined the relationship between nutritional status, as assessed by the Prognostic Nutrition Index (PNI), and incident cardiovascular mortality and all-cause mortality, particularly in hypertensive patients. This study aimed to examine the association between PNI and cardiovascular mortality and all-cause mortality in Americans with hypertension. Methods: Data from this retrospective cohort study were obtained from the National Health and Nutrition Examination (NHANES) 1999-2016. Using data of The NHANES Public-Use Linked Mortality Files to assess all-cause mortality (ACM) and cardiovascular mortality (CVM). After excluding participants younger than 18 years, without hypertension, and with missing follow-up data, a total of 18,189 cases were included in this study. Persons with hypertension were divided by PNI into 4 groups: Q1 (PNI < 49.0), Q2 (PNI: 49.0-52.5), Q3 (PNI: 52.5-55.5), and Q4 (PNI > 55.5). We used the Cox proportional hazard regression model to explore the predictive role of PNI on ACM and CVM in American adults with hypertension. Restricted cubic spline (RCS) curves to investigate the existence of a dose-response linear relationship between them. Result: During a median follow-up period of 89 months, a total of 1,444 (7.94%) cardiovascular deaths occurred and 5,171 (28.43%) all-cause deaths occurred. Multifactorial COX regression analysis showed all-cause mortality [hazard ratio (HR): 0.584, 95% CI: 0.523-0.652, p < 0.001] and cardiovascular mortality (HR: 0.435, 95% CI: 0.349-0.541, p < 0.001) associated with Q4 group risk of malnutrition in PNI compared to Q1 group. RCS curves showed a nonlinear relationship between PNI and all-cause mortality and cardiovascular mortality (both non-linear p < 0.001). Conclusions: Lower PNI levels are associated with mortality in patients with hypertension. PNI may be a predictor of all-cause mortality and cardiovascular mortality risk in patients with hypertension.

目的 观察分析髌上入路胫骨髓内钉治疗胫骨骨折的临床疗效.方法 选取收治的 42 例胫骨骨折患者,分为髌下入路组与髌上入路组各 21 例.髌下入路组患者采用传统髌下入路髓内钉固定术治疗,而髌上入路组患者则采用髌上入路髓内钉固定术治疗,观察与比较两组患者胫骨骨折临床治疗疗效、术前术后膝关节功能(采用膝关节吕斯霍尔姆Lysholm量表评估)、膝关节伸屈活动度(ROM)、膝关节疼痛程度(采用视觉模拟评分法VAS评估)及并发症发生率情况.结果 (1)髌上入路组患者治疗总优良率 95.24%(20/21)高于髌下入路组 66.67%(14/21),组间数据差异比较明显(P<0.05);(2)与治疗前相较,两组Lysholm评分、ROM均升高,而VAS评分则降低,且髌上入路组患者Lysholm评分、ROM均高于髌下入路组,而VAS评分则低于髌下入路组,组内、组间数据比较差异明显(P均＜0.05);(3)髌下入路组与髌上入路组患者并发症发生率分别为 14.29%(3/21)、4.76%(1/21),两组组间数据比较差异不明显(P>0.05).结论 与髌下入路方式相较,髌上入路胫骨髓内钉治疗胫骨骨折疗效更具优势,可促进患者膝关节功能恢复,减轻术后疼痛感,且并发症发生率较低,值得临床上推广应用.

Brucellosis in sheep is an infectious disease caused by Brucella melitensis in sheep. The current conventional serological methods for screening Brucella-infected sheep have the disadvantage of time consuming and low accuracy, so a simple, rapid and highly accurate screening method is needed. The aim of this study was to evaluate the feasibility of diagnosing Brucella-infected sheep by serum samples based on the Fourier transform infrared (FTIR) spectroscopy. In this study, FTIR spectroscopy of serum from Brucella-infected sheep (n = 102) and healthy sheep (n = 125) revealed abnormal protein and lipid metabolism in serum from Brucella-infected sheep compared to healthy sheep. Principal component analysis-Linear discriminant analysis (PCA-LDA) method was used to differentiate the FTIR spectra of serum from Brucella-infected sheep and healthy sheep in the protein band (3700-3090 cm-1) and lipid band (3000-2800 cm-1), and its overall diagnostic accuracy was 100% (sensitivity 100%, specificity 100%). In conclusion, our results suggest that serum FTIR spectroscopy combined with PCA-LDA algorithm has great potential for brucellosis in sheep screening.

Lung cancer has the highest mortality rate of all cancers, and LUAD's survival rate is particularly poor. Erythropoietin receptor (EPOR) can be detected in lung adenocarcinoma (LUAD), however, the expression levels and prognostic value of EPOR in LUAD are still unclear. In our study, clinicopathological data of 92 LUAD patients between January 2008 and June 2016, multiple bioinformatics databases and immunohistochemistry were used to explore the EPOR expression, the mutant genes affecting EPOR expression, and the correlation of EPOR expression with oxidative stress - related genes, prognosis, immune microenvironment. All statistical analyses were performed in the R version 4.1.1. The study found that EPOR expression might be down-regulated at the mRNA levels and significantly up-regulated at the protein levels in LUAD, which indicates that the mRNA and protein levels of EPOR are inconsistent. The muTarget showed that the expression of EPOR was significantly different between the mutant group and the wild group of 15 genes, including DDX60L and C1orf168. Importantly, we found that EPOR was associated with VEGF and HIF family members, and had significant positive correlation with oxidative stress - related genes such as CCS, EPX and TXNRD2. This suggests that EPOR may be involved in the regulation of oxidative stress. The Kaplan-Meier Plotter and PrognoScan databases consistently concluded that EPOR was associated with prognosis in LUAD patients. Our clinicopathological data showed that high EPOR expression was associated with poorer overall survival (29.5 vs 46 months) and had a good predictive ability for 4-year and 5-year survival probability. EPOR is expected to be a potential new prognostic marker for LUAD.

目的 通过生物信息学方法筛选多发性骨髓瘤(multiple myeloma,MM)潜在的关键基因,并分析其免疫浸润模式.方法 从基因表达综合数据库(gene expression omnibus,GEO)获取与多发性骨髓瘤相关的基因表达谱GSE118985,(GSE133346和GSE146649),采用生物信息学方法筛选与多发性骨髓瘤相关的差异表达基因(DEGs)并进行基因本体(GO)功能注释和京都基因与基因组百科全书(KEGG)富集分析、免疫细胞浸润分析.通过蛋白质-蛋白质相互作用网络筛选出多发性骨髓瘤潜在的关键基因,利用数据GSE7116 验证关键基因在多发性骨髓瘤中的诊断价值并绘制受试者工作特征(receiver operator characteristic,ROC)曲线.结果 共筛选出101个DEGs.GO功能注释和KEGG富集分析显示,DEGs主要富集在免疫反应过程中,细胞因子受体相互作用、细胞外基质受体相互作用、粘着斑和Hedgehog信号通路等,单核细胞是多发性骨髓瘤最主要的免疫浸润细胞.最终筛选出5 个关键基因,分别为SDC1,IRF4,CD38,TNFRSF17和CCND1,核心基因对验证模型联合诊断的AUC为 0.933.结论 SDC1,IRF4,CD38,TNFRSF17 和CCND1 在多发性骨髓瘤中均上调,联合诊断的效能较高,可能是多发性骨髓瘤潜在的生物标志物,可为以后治疗提供新的思路.

目的 分析改良Hardinge入路骨水泥型假体人工股骨头置换术的临床疗效.方法 回顾性分析2016年1月至2019年1月因股骨颈骨折在扬州市江都人民医院骨科行人工股骨头置换的108例老年患者的临床资料,按照手术方式分为观察组(45例)与对照组(63例).观察组患者采用改良Hardinge入路骨水泥假体,对照组患者采用后外侧入路非骨水泥假体,比较两组患者的切口长度、手术时间、术前及术后血红蛋白量(Hb)、输血率、术后并发症及Harris髋关节功能评分.结果 观察组切口长度短于对照组,手术时间长于对照组,差异有统计学意义(P<0.05).术后1个月,观察组Harris髋关节功能评分高于对照组,差异有统计学意义(P<0.05).两组的手术前后Hb、输血率、各并发症发生率、术后6个月Harris髋关节功能评分比较,差异无统计学意义(P>0.05).结论 改良Hardinge入路骨水泥型假体人工股骨头置换术具有手术切口小,髋关节功能早期改善快等优点,能够为老年股骨颈骨折的治疗提供新的选择.

Objective:To investigate the risk factors of surgical site infection after Pilon fracture surgery.Methods:The clinical data of 309 patients who underwent surgical treatment for Pilon fracture in Yangzhou Jiangdu People′s Hospital from January 2015 to June 2020 were analyzed retrospectively, excluding patients with a history of infection before admission. They were divided into two groups according to whether postoperative surgical site infection occurred. The gender, age, body mass index (BMI), smoking history, hypertension, diabetes history, fracture type, tension blister, joint dislocation, fracture classification, injury to operation time, postoperative drainage, operative time, surgical approach, anesthesiologist's anesthesia level (ASA), number of internal fixation plates, and whether used external fixing bracket temporarily in the two groups were compared. Statistical analysis included independent sample t test, chi square test or Fisher exact test. The statistically significant single factors were taken as independent variable for logistic regression analysis.Results:A total of 309 patients were included in this retrospective study, including 25 cases of postoperative infection at the surgical site, with an infection rate of 8.1% (25/309). Twenty-two patients had positive results of incision secretion culture, with a positive rate of 88%. The most common pathogens were Staphylococcus aureus (7/22, 31.8%), Escherichia coli (6/22, 27.3%) and Staphylococcus epidermidis (4/22, 18.2%). Univariate analysis showed that there were significant differences in operation time, hypertension, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture and smoking history between the two groups (t=2.629, χ2=7.646, 12.184, 6.438, 14.268, all P<0.05). Multivariate logistic regression analysis showed that open fracture and smoking were independent risk factors for postoperative infection of Pilon fracture [odds ratio (OR)=3.770, 11.129, both P <0.05].Conclusion:Open fracture and smoking are independent risk factors of surgical site infection after open reduction and internal fixation of Pilon fracture.

目的 观察交锁髓内钉内固定联合阻挡钉技术治疗胫骨远端关节外骨折临床疗效.方法 回顾性分析自2016-01-2020-12采用交锁髓内钉内固定联合阻挡钉技术治疗的24例胫骨远端关节外骨折(观察组),并且与单纯交锁髓内钉内固定治疗的29例胫骨远端关节外骨折进行比较(对照组).比较两组手术时间、术中出血量、术后至开始完全负重时间、骨折愈合时间、并发症情况,末次随访时X线片上冠状面、矢状面成角,以及末次随访时Johner-Wruhs评分及踝与后足功能AOFAS评分.结果 53例均获得随访,随访时间平均16(12～24)个月.观察组与对照组手术时间、术中出血量、术后至开始完全负重时间、骨折愈合时间、感染发生率、骨折不愈合发生率、末次随访时AOFAS评分、矢状面成角、Johner-Wruhs评分差异无统计学意义(P＞0.05).观察组末次随访时冠状面成角小于对照组,骨折畸形愈合发生率低于对照组,差异有统计学意义(P＜0.05).结论 采用交锁髓内钉内固定治疗胫骨远端关节外骨折时,阻挡钉可作为辅助复位工具,同时减小了髓腔宽度使髓内钉主钉更加稳定,降低了骨折畸形愈合发生率.

目的 观察逆行股骨髓内钉和顺行股骨髓内钉治疗股骨干中段骨折的疗效和并发症.方法 选取股骨干中段骨折患者76例纳入本研究,根据主钉置入方式的不同,分为逆行组36例和顺行组40例.比较2组围术期、随访及并发症情况.结果 2组患者髓内钉直径、透视次数、骨折两端螺钉数量比较,差异无统计学意义(P＞0.05);逆行组手术时间短于顺行组,而出血量多于顺行组,差异有统计学意义(P＜0.05).末次随访时2组患者骨折愈合时间、Harris评分、Lysholm评分、骨折愈合率比较,差异无统计学意义(P＞0.05).顺行组膝关节屈曲度为(130.22±4.31)°,优于逆行组的(126.58±8.41)°,逆行组患者膝关节疼痛发生率(19.4％)高于顺行组(2.5％),差异有统计学意义(P＜0.05).结论 逆行髓内钉和顺行髓内钉治疗股骨干中段骨折均可取得较满意的临床疗效,逆行置钉无需牵引床,相对便捷,但逆行钉固定后膝关节并发症相对较多.

ABSTRACT:To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau.From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ± 3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee.All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ± 3.92°, a mean PA of 7.43 ± 2.68°, and a mean Rasmussen radiological score of 16.00 ± 2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ± 3.51°, a mean PA of 9.68 ± 4.01°, and a mean Rasmussen radiological score of 15.33 ± 2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly (P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ± 10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ± 10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found.The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.

作为教育部认可的首批25所招收临床专业留学生(英语授课)的医科院校,提高来华留学生教学质量是很有必要的.借助社交软件微信的快捷交流功能实施PBL教学法作为提高留学生教学质量的重要方法之一,教师可以将PBL教案分享到微信群,同学提前预习,在教师组织讨论之前,学生自己查找文献、做报告、将许多不懂的问题编辑成文本然后进行讨论,教师实时进行解答.该方法是以问题为基础,借助微信平台,教师实时的通过微信对学生进行引导,学生主动学习,增加师生之间的互动,最大化的资源共享.从而提高来华留学生的学习效率和解决问题的能力,激发留学生的学习热情,调动其学习的积极性.

目的:探讨尿液核基质蛋白22(NMP22)、骨桥蛋白(OPN)及膀胱肿瘤抗原(BTA)检测在膀胱尿路上皮癌诊断和预后评估中的价值.方法:选取65例膀胱尿路上皮癌患者为观察组,49例泌尿系统良性疾病患者为良性组,45例健康体检者为健康组.检测三组患者尿液NMP22、OPN及BTA水平,并分析其检测结果对膀胱尿路上皮癌的诊断价值,探讨不同临床特征患者NMP22、OPN及BTA阳性率差异,对比不同NMP22、OPN及BTA表达情况患者3年生存情况.结果:观察组患者尿液NMP22、OPN及BTA水平均显著高于良性组和健康组(P<0.05).NMP22、OPN及BTA诊断膀胱尿路上皮癌的曲线下面积分别为0.898、0.887、0.878,联合检测的受试者工作特征曲线下面积为0.957,诊断敏感度为92.5％,特异度为87.2％.尿NMP22、OPN及BTA的表达与肿瘤直径、肿瘤数目、病理分级、临床分期、有无淋巴结转移有关(P<0.05);而与患者性别、年龄无关(P>0.05).NMP22、OPN及BTA表达阳性患者生存率均显著低于阴性患者(P<0.05).结论:NMP22、OPN及BTA对膀胱尿路上皮癌的诊断具有潜在价值,其表达情况与临床病理特征以及预后存在相关性.

目的 探讨PBL教学方法在《实验诊断学》中的应用与效果.方法 选择2019年3-9月就读于新疆医科大学五年制临床医学专业的150名本科生作为研究对象,随机分为实验组和对照组,各75名.实验组采用基于问题学习(problem-based learning,PBL)教学模式进行教学;对照组采用传统教学模式进行教学,比较2组学生的理论知识和病例分析考核成绩的差异,并进行问卷调查.结果 实验组与对照组病例分析考核成绩差异有统计学意义(P＜0.05),实验组与对照组学生在自主学习能力、理论知识记忆效果、学习效率、团队协作能力和临床思维能力方面的差异有统计学意义(P＜0.05).结论 采用PBL教学模式的学生在病例分析考核成绩、自主学习能力、理论知识记忆效果、学习效率、团队协作能力和临床思维能力方面的表现均优于传统教学的学生.

目的 评价4款品牌不同型号床边检测(POCT)血糖仪的准确度,为医院选购和使用POCT血糖仪提供参考.方法 收集20份抗凝全血标本,POCT血糖仪检测全血葡萄糖和贝克曼DXC800生化分析仪检测血浆葡萄糖,计算偏差,评价准确度.结果 当血糖浓度<4.2 mmol/L时,4款POCT血糖仪分别有100％、50％、100％和100％的测定结果与实验室测定结果的偏差范围在±0.83 mmol/L之内;当血糖浓度≥4.2mmol/L时,4款POCT血糖仪分别有88.89％、100.00％、100.00％和100.00％的测定结果与实验室测定结果的偏差范围在±20％之内,分别有44.44％、100.00％、76.47％和100.00％的测定结果与实验室测定结果的偏差范围在±10％之内.结论 4款POCT血糖仪中罗氏POCT血糖仪的准确度较高,医院应合理选择并正确使用POCT血糖仪,保证临床POCT血糖仪的结果准确性和可靠性.

目的 探讨POCT血糖仪网络化管理在临床诊疗中的应用与效果.方法 分别选取2015年和2018年新疆医科大学第一附属医院第四季度POCT血糖仪与生化分析仪比对结果各200例,采用SPSS 17.0进行统计分析.结果 在POCT血糖仪网络化管理的应用下,2018年网络化管理的优秀率为87.50％,合格率为10.00％,不合格率为2.50％.2015年有纸化管理的优秀率为66.50％,合格率为25.50％,不合格率为8.00％,采用网络化管理出现的不合格率较有纸化管理出现的不合格率明显降低,网络化管理的优秀率明显高于有纸化管理,且有统计学意义.结论 POCT网络化管理具有一定的优越性,为进一步实现规范化、准确化、高效化的临床诊疗服务打下基础,为临床诊疗提供了更更好、更快、更准、更优的服务,值得大力推广.

目的 本文采用基于问题的学习(PBL)方法在留学生临床实验诊断教学的应用效果.方法 以新疆医科大学国际教育学院2015级四年制临床专业82名留学生为研究对象,将其分成实验组和对照组各41人,实验组采用PBL教学模式,对照组采用传统教学模式,课程结束后通过试卷考核和问卷调查评价教学效果.结果 实验组留学生的学习兴趣、团队协作能力、实验操作技能、对教学模式的喜爱度5个方面均高于对照组,差异具有统计学意义(P＜0.05);实验组测试成绩明显高于对照组,差异具有统计学意义(P＜0.05).结论 PBL教学模式能激发留学生学习兴趣、启发实验思维、增强自主学习能力,学生更容易接受,这种教学模式更值得推荐,为留学生教学添彩.

目的 评价4款品牌不同型号床边检测(POCT)血糖仪的主要性能,为医院选购和使用POCT血糖仪提供参考.方法 2个水平的质控品,分别在POCT血糖仪上检测,计算批内变异系数、日间变异系数和总变异系数,评价精密度.收集20例抗凝全血标本,在POCT血糖仪检测全血葡萄糖和贝克曼DXC800生化分析仪检测血浆葡萄糖,计算偏差,评价准确度,并评价POCT血糖仪与全自动生化仪检测结果的相关性.结果 4款POCT血糖仪低浓度质控检测结果的批内精密度分别为2.65％、2.48％、3.73％和2.04％,日间精密度分别为0.74％、2.26％、4.00％和2.93％,总精密度分别为2.75％、3.36％、5.47％和3.57％;高浓度质控检测结果的批内精密度分别为2.66％、2.35％、2.04％和1.38％,日间精密度分别为2.61％、1.45％、3.31％和0.42％,总精密度分别为3.72％、2.76％、3.89％和1.44％.当血糖浓度<4.2mmol/L时,4款POCT血糖仪分别有100％、50％、100％和100％的测定结果与实验室测定结果的偏差范围在±0.83mmol/L之内;当血糖浓度≥4.2mmol/L时,4款POCT血糖仪分别有88.89％、100％、100％和100％的测定结果与实验室测定结果的偏差范围在±20％之内;分别有44.44％、100％、76.47％和100％的测定结果与实验室测定结果的偏差范围在±10％之内.4款POCT血糖仪与生化分析仪的相关系数分别为:0.976、0.993、0.993和0.997.结论 4款POCT血糖仪精密度均较好,罗氏POCT血糖仪的准确度较高,且与生化分析仪的检测结果有较好的相关性.医院应合理选择并正确使用POCT血糖仪,建立相对完善的质量管理体系,保证临床POCT血糖仪的结果准确性和可靠性.

目的:比较股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)治疗高龄股骨粗隆间不稳定骨折的临床疗效.方法:选取2013年6月—2016年12月在我院就诊的80例高龄股骨粗隆间不稳定骨折患者,随机分为观察组(PF-NA)和对照组(DHS),各40例.对比两组临床疗效.结果:观察组术中出血量、手术时间和术后引流量均显著少于对照组(P<0.05),但隐性失血量多于对照组(P<0.05).两组负重时间、卧床时间和术后髋关节疼痛评分比较,差异无统计学意义(P>0.05).观察组畸形评分、功能评分、活动范围评分和Harris总分均显著高于对照组(P<0.05).观察组总并发症发生率5.00％(2/40),与对照组总并发症发生率30.00％(12/40)比较,显著降低(P<0.05).结论:PFNA治疗高龄股骨粗隆间不稳定骨折疗效优于DHS,值得临床推广.

随着我国医疗卫生水平的提高,实验室检查成为临床评估病情发展的重要手段.为了及时向临床反馈实验结果,检验结果回报时间(turnaround time,TAT)成为目前反映临床实验室检测效率的最佳指标之一.TAT由3部分组成:开出医嘱到样本收集的时间、样本收集到样本接收的时间、样本接受到结果报告的时间.本研究对新疆医科大学第一附属医院检验科急诊检验组生化检验项目TAT超时标本进行分析,探究TAT超时原因,提出改进意见,合理规划相关流程,以使患者最大程度地获得及时诊疗.