目的 通过无创的微血管血液黏度与低切血液黏度之间的相关性,探究基于指脉的血液黏度无创检测的可行性.方法 首先采集被测者的静脉血、指尖光电容积脉搏波及生理信息;然后使用指脉波形面积拟合微血管半径,通过泊肃叶定律公式计算无创的微血管血液黏度;最后用SPSS软件分析微血管血液黏度计算值与全血黏度的相关性以及血液黏度与基础生理因素、血液生化因素之间的相关性.结果 微血管血液黏度计算值与低切血液黏度呈正相关.体重、腰围、体表面积、总胆固醇与微血管血液黏度计算值、低切血液黏度呈正相关;高密度脂蛋白与微血管血液黏度计算值、低切血液黏度呈负相关.结论 通过指脉无创检测出来的微血管血液黏度,与有创检测出来的低切血液黏度之间的正相关性以及二者状态变化规律的一致性表明,基于指脉的血液黏度无创检测具有一定的可行性.

目的 了解医联体全科医学基层实践基地师资现状,为更好地发挥牵头医院的优势及带头作用,以期切实地不断加强基层师资建设.方法 2021年4月对北部医联体基层实践基地师资进行调查,内容包括一般情况、职业素养、临床工作能力、带教能力和可持续发展能力.共发放调查问卷16份,收回16份,回收率100％.结果 在职业素养中,基层师资对自身职业道德评分较高(9.15±0.99),对全科医学的热爱程度评分为8.69±1.11分,对教学工作的热爱评分为8.23±1.09分;在临床工作能力中,对急危重症初步处置和转诊评分较低(7.92±1.26);在带教能力中,教案书写、教学方法与技巧、门诊带教和基本技能带教评分较低,分别为7.69±1.38、7.69±1.44、7.77±1.24和7.77±1.30;在可持续发展能力中,科研意识和论文撰写评分较低,分别为7.23±1.54和6.77±1.59.结论 北部医联体全科医学基层实践基地师资较为缺乏,带教能力需要进一步提升,可持续发展能力有待不断提高.

Objective To investigate and analyze the appearance of keratic precipitate changing during the course of Posner Schlossman syndrome. Methods Retrospectively analyze 17 patients who were diagnosed of Posner Schlossman syndrome referred to from affiliated Hospital of Xuzhou Medical College from 2013 to 2015, the appearance of KP was finely recorded when the patients were diagnosed and their follow-up visit after corresponding treatment. Results If patients visit our clinic in 12 hours after their eye discom-fort, keratic precipitates are hyaline , few in number and fine in appearance on the area of pupil or below the horizontal midline. If lon-ger than 12 hours, we can observe more accumulated KP with medium size and mutton-fat appearance. After treatment, keratic precipi-tates clear away gradually. The appearance turns from fresh and pinguid to wizened and stale. Some of them stay for a long peri-od. Conclusions On early stage of Posner Schlossman syndrome, keratic precipitates are hyaline , few in number and fine in appear-ance on the area of pupil or below the horizontal midline, then they increase and accumulated to medium size and mutton-fat appear-ance. Knowing the appearance of keratic precipitate changing during the course of Posner Schlossman syndrome can help the diagnosis to be made correctly and timely.

目的 探讨孕晚期七氟烷暴露对子代大鼠脑组织单胺类神经递质含量的影响.方法 18只SD孕大鼠,随机分为3组,对照组、低浓度暴露组和高浓度暴露组,每组6只.孕14 d行麻醉干预,低浓度和高浓度暴露组孕鼠于麻醉箱内分别吸入混有2.5％和4.5％七氟烷的空气2h,对照组吸入空气2h.测定5周龄子鼠体重、脑重,计算脑脏器系数;水迷宫测试5周龄子鼠学习记忆能力;高效液相色谱-荧光检测法测定5周龄子鼠大脑皮质和海马去甲肾上腺素(norepinephrine,NE)、多巴胺(dopamine,DA)和五羟色胺(5-hydroxytryptamine,5-HT)含量.结果 高浓度暴露组子鼠脑脏器系数(1.51±0.08)显著低于对照组(1.63 ±0.12),P＜0.05;定向航行实验训练第1天,各组子鼠游泳速度无明显差异(P＞0.05);从训练第2天起,随暴露浓度增加,子鼠逃避潜伏期逐渐延长(P＜0.05);空间探索实验中,子鼠在目标象限停留时间随暴露浓度增加逐渐缩短(P＜0.05);子鼠大脑皮层NE和5-HT含量随染毒剂量增加逐渐下降(P＜0.05);高浓度暴露组子鼠大脑皮层DA含量也显著低于对照组和低浓度暴露组(P＜0.05);子鼠海马NE和DA含量随染毒剂量增加逐渐下降(P＜0.05);高浓度暴露组子鼠海马5-HT含量也显著低于对照组(P＜0.05).结论 孕晚期七氟烷暴露可导致子代生后成年早期学习记忆能力下降;对脑形态和不同脑区单胺类神经递质含量的影响可能参与其导致的神经发育毒性过程.

目的：探讨全麻下行胰腺癌高强度聚焦超声（HIFU）治疗中应用右美托咪啶的临床价值。<br>　　方法：选取2014年4月—2015年12月行HIFU手术治疗的87例胰腺癌患者采用抽签法随机分为观察组43例和对照组44例，两组均采用芬太尼2~3μg/kg、顺阿曲库铵0.2 mg/kg、丙泊酚1.5~2.0 mg/kg进行麻醉诱导，采用丙泊酚、雷米芬太尼、顺阿曲库铵、七氟烷进行维持麻醉，观察组于麻醉诱导前15 min静脉输注右美托咪啶负荷量0.7μg/kg，之后以0.2μg/（kg·h）静脉输注至术毕，对照组麻醉诱导前给予等量生理盐水。比较两组患者麻醉诱导完毕（T0）、麻醉30 min（T1）、麻醉90 min（T2）、麻醉180 min（T3）时刻的平均动脉压（MAP）、心率（HR）、动脉血氧饱和度（SpO2）水平，以及麻醉前、手术后90 min的血清炎症因子的变化。<br>　　结果：观察组的丙泊酚用量、七氟烷用量、雷米芬太尼用量均明显低于对照组（均P<0.05）；观察组和对照组的手术时间、麻醉时间、拔管时间差异均无统计学意义（均P>0.05）；在T0~T3时刻，两组患者的MAP值差异均无统计学意义（P>0.05）；在T1~T3时刻，观察组的HR值明显低于对照组，而SpO2值明显高于对照组（均P<0.05）；术前两组各炎症因子水平差异均无统计学意义（均P>0.05）；术毕90 min，观察组各炎症因子水平均明显低于对照组（均P<0.05）。<br>　　结论：全麻下行胰腺癌HIFU治疗中应用右美托咪啶可以减少麻醉药物的用量、稳定术中心率、降低炎症因子水平。

目的：探讨经鼻持续气道正压通气（nasal continuous positive airway pressure，NCPAP）治疗小儿重症肺炎合并呼吸衰竭早期的临床疗效。方法筛选2014年1月至2015年12月本院收治的小儿重症肺部感染合并呼吸衰竭患儿96例作为研究对象。所有患儿均处于呼吸衰竭早期（病程＜3小时），采用随机数字表法将其分为观察组与对照组，每组患儿48例，其中观察组采用NCPAP治疗，对照组接受常规经鼻导管吸氧治疗，比较两组患者治疗效果、症状改善及免疫功能指标。结果观察组患儿心率恢复正常时间、呼吸困难缓解时间、肺部啰音消失时间、发绀时间明显短于对照组（P＜0.05）；两组患儿肺通气功能治疗后均明显改善，但观察组患儿治疗后1小时、12小时血氧分压（partial pressure of oxygen，PaO2）、二氧化碳分压（partial pressure of carbon dioxide in artery，PaCO2）、血氧饱和度（arterial oxygen saturation，SaO2）水平较对照组改善更为显著（P＜0.05）；治疗后72小时观察组患儿IgA、IgG、IgM、白细胞介素（interleukin，IL）-2、IL-6、IL-8、肿瘤坏死因子-α改善效果明显优于对照组（P＜0.05）。结论经鼻持续气道正压通气对小儿重症肺炎致呼吸衰竭早期临床疗效显著，可快速缓解患儿临床症状，明显增强患儿免疫功能及改善炎症状态，具有临床应用价值。

目的 总结分析Fuchs综合征早期的临床特点.方法 回顾分析我院2008~2014年门诊初诊诊断为青睫综合症的病人,均按照青睫综合症的诊断标准予以诊断并给予相应治疗.其中5例病人在局部激素眼水减量后病情反复,病程大于3个月,呈慢性化改变.对该5例病人进行分析,总结,查阅相关资料,修正诊断:Fuch综合征,并予相应治疗.结果 所有患者按Fuch综合征治疗方案治疗后病情逐渐稳定,随访时间最长7年,仅1例病人于确诊5年后出现较对侧眼可明显辨别的虹膜脱色素,所有病人均未见明显并发性白内障.结论 Fuch综合征发病早期症状与青睫综合症相似,无法明确鉴别诊断,但Fuch综合征在治疗过程中呈慢性化改变,局部激素点眼反应差,随病程迁延,患眼眼压可轻度升高,出现虹膜脱色素,但需与对侧眼仔细鉴别.及时明确诊断及正确治疗病人预后较好.虹膜脱色素及并发性白内障不是早期Fuch综合征的临床特征.

Objective To explore the surgery and conservative treatment for obstructive sleep apnea hypop -nea syndrome of PSG parameters .Methods According to the treatment method , 60 cases of obstructive sleep apnea syndrome patients for the study were divided into observation group and control group ,the control group were used for non-surgical treatment ,the research group were treated by surgery .PSG monitoring equipment were used to detect the AHI,AHTI,AHT,SAT90%,minimum and average SaO2 so SaO2.Results After treatment,patients were significant-ly lower SAT90%were (38.4 ±13.4)%,(17.5 ±12.5)%,the lowest Sa(O2) were(79.6 ±12.4)%,(83.7 ± 11.2)%,significantly higher average SaO 2 were (85.4 ±16.3)%,(90.8 ±12.4)%,increased significantly com-pared with before treatment difference was statistically significant (t=10.13,22.42,4.76,9.76,3.65,6.65,all P<0.05).And the control group improved more significantly (t=17.32,3.76,3.76,all P<0.05).After treatment,pa-tients were AHI,AHT and AHTI were (22.4 ±3.4)times/h,(14.5 ±2.5)times/h,(9.6 ±2.4)min,(5.7 ±1.2) min,(1.4 ±0.3)min,(0.8 ±0.4)min,significantly reduced compared with before treatment difference was statisti-cally significant(t=9.63,12.12,7.51,19.27,21.42,10.63,all P<0.05).And the control group decreased more significantly,the difference was statistically significant (t=8.97,9.76,6.57,all P<0.05).Conclusion Obstructive sleep apnea syndrome treated by surgery ,each of PSG parameters improved significantly superior to conservative treat-ment,which should be used as their preferred method of treatment .

目的：探讨脊髓室管膜瘤的诊断和显微手术技巧。方法回顾性分析16例病理证实的脊髓室管膜瘤患者的临床特征，影像学诊断，均行显微外科手术切除肿瘤。结果肿瘤全切除14例，近全切除2例，术后短时间内症状改善10例，无变化4例，短期内加重2例，无手术死亡病例。随访6~36个月，无肿瘤复发。结论MRI对脊髓髓内室管膜瘤的诊断是必要的，熟练的显微外科手术技术和肿瘤全切是取得良好临床疗效和降低复发率的关键。

Objective To study the curative effect and safety of ligation therapy with CRH O′ Regan disposable bander for internal hemorrhoids. Methods 414 patients with grade Ⅰ- Ⅲ internal hemorrhoids were performed with superior hemorrhoidal mucosa ligation with CRH O′Regan disposable bander. The curative effects were observed and analyzed 15 days after the treatment. Results Internal hemorrhoids were cured in 385 cases(93%), were effective in 22 cases(5.3%) and were invalid in 7 cases(1.7%), with total efficiency of 98.3%.Complications of anal spasm was occurred in 47 cases(11.3%) and minor bleeding in 23 cases(5.6%), no significant pain, major bleeding, infection and other severe complications was occurred. Conclusions CRH O′Regan ligation therapy was an effective treatment for gradeⅠ-Ⅲ internal hemorrhoids, with high security, minimal invasion, painlessness, and was easy to operate.

This research mainly adopts the methods of literature,mathematical statistics,logic analysis method,using the combination of qualitative analysis and quantitative analysis methods,the various provinces and municipalities of China urban residents' income and ten games each provinces and erformance analysis of integral.The results show that: the urban residents of our country in the income situation of various index,general and competitive sports have great relevance.

<正>随着我国对外交流的日益扩大,教育国际化的趋势日益明显,外国医学生来我国接受医学教育的人数也逐年增加。有资料显示,来我国接受医学教育的外国学生的人数增加迅速,仅次于来我国接受汉语教学的外国学生。留学生医学教育已经成为我国医学教育的一个重要组成部分[1]。

BACKGROUND:Vascular smooth muscle cell proliferation is an important process in the development of atherosclerosis and is associated with other cellular processes in atherogenesis. Telmisartan is reported to have partial peroxisome proliferator-activated receptor (PPAR)-γ activating properties and has been referred to as selective PPAR modulators, but valsartan just blocks angiotensin II (AngII) type 1 (AT1) receptors. This study aimed to compare the different effects of telmisartan and valsartan on human aortic smooth muscle cells (HASMCs) proliferation. METHODS:Ability of telmisartan and valsartan to inhibit proliferation of HASMCs was evaluated by the Cell Counting Kit-8 (CCK-8) in continuous cell culture. Whether the antiproliferative effects of telmisartan and valsartan depend on their effects on AngII receptors or activating the peroxisome PPAR-γ was also investigated in this study. RESULTS:Telmisartan inhibited proliferation of HASMCs by 52.4% (P < 0.01) at the concentration of 25 µmol/L and the effect depended on the dose of telmisartan, but valsartan had little effect on HASMCs proliferation (P > 0.05) and no dose response. When tested in cells stimulated with AngII, telmisartan had the same inhibition of HASMCs by 59.2% (P < 0.05) and valsartan also inhibited it by 41.6% (P < 0.05). Telmisartan and valsartan had the same effect on down-regulating AT1 receptor expression and telmisartan was superior to valsartan up-regulating AngII type 2 (AT2) receptor expression. Antiproliferative effects of telmisartan were observed when HASMCs were treated with the PPAR-γ antagonist GW9662 but antiproliferative effects of the PPAR-γ activator pioglitazone were not observed. CONCLUSIONS:Telmisartan, but not valsartan, inhibits HASMCs proliferation and has dose-dependent response without stimulation of AngII. AT2 receptor up-regulation of telmisartan contributes to its greater antiproliferative effects than valsartan. Its PPAR-γ activation does not play a critical role in inhibiting HASMCs proliferation.

Objeetive:To observe the experience of management about the disease of mammary gland in old ladies during the epidural blockage.MethodsiPatients who suffer from the disease of mammary gland,more than 60yrs,ASAⅡ-Ⅲwere given epidural blockage,ECG,MAP,RR,HR,SpO_2 were recorded.Results:MAP、RR、HR after 15min and 45min was significant difference to the basic line(P<0.05).Conclusion:Suitable concentration and volume of local anesthesia,perfect monitory,reasonable use of assistant drug can result a safety.satisfied effection.

This research mainly adopts the methods of literature,mathematical statistics,logic analysis method,using the combination of qualitative analysis and quantitative analysis methods,on China's various provinces and cities of the consumption structure of urban residents and ten games each provinces and performance analysis of integral.The results show that : China's urban residents in consumption structure of various index,general and competitive sports have great relevance.Description of China's urban residents nsumption structure indexes are directly or indirectly to ten games achievement points have a profound effect.

[Objective] To analyze the effect of compound lidocaine cream used in pediatric circumcision and the difference from other anesthetic methods. [Method] Ninety cases undergoing selective operation were divided into three groups randomly,Ketamine with compound lidocaine cream was used n group A.Ketamine and penis root block were applied in group B.Ketamine only was in group C.The effect of anesthesia was observed during the operation.[Result] The effect of anesthesia in group A and B was significantly superior to group C(P0.01).The time of consciousness recovery in group A and B was less than that in group C(P0.01).The difficulty of operation in group B was significantly higher than that in group A and C(P0.01).[Conclusion] Compound lidocaine cream has apparently advantage to be used in pediatric circumcision.

Objective:Mechanical ventilation for respiratory medical factors in patients with nosocomial infection were analyzed. Methods:Chooses the patient 70 examples which my courtyard internal medicine department infects to divide into 2 groups stochastically,the control group 35 examples adopts the non-machinery to pass machine,the observation group 35 examples adopt the machinery ventilation,the contrastive analysis and study its nosocomial infection the characteristic..Results:The patients displayed the results of bacterial isolates,132 strains were isolated,including 107 for the G-strain,23 strains of G + bacteria.Control group patients showed the results of bacterial isolates, 90 strains were isolated,of which 72 for the G-strain,18 were G + strain.The distribution of the two groups for the bacteria,pathogens in the observation group was Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus,the control group bacteria Acinetobacter baumannii group,Haemophilus influenzae,Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella pneumoniae. Comparison with results on the different time segments of different strains appear in the observation group the number of lower respiratory tract was significantly higher disease-causing bacteria..Conclusion:Easy to cause respiratory infection in hospital medical patients include mechanical ventilation,disinfection and isolation take the appropriate measures to strengthen the ward management,improve the overall intensity of nursing interventions,can reduce the incidence of hospital infections and improve the quality of life of patients..

目的探讨人脑胶质瘤干细胞的培养和分离方法。方法取脑胶质瘤手术标本,制成单细胞悬液用无血清培养基培养,加入表皮生长因子(EGF)、碱性成纤维细胞生长因子(bFGF)进行诱导分化;用免疫组化法检测巢蛋白(Nestin)和胶质原性纤维酸蛋白(GFAP);用免疫磁珠分选系统进行细胞分离,流式细胞仪检测分化前后CD133阳性细胞的比率。结果培养出悬浮生长的人脑胶质瘤干细胞球,Nestin表达呈阳性,分化后GFAP表达呈阳性;分离前CD133阳性细胞百分比为4.66%±0.55%,分离后为87.21%±6.17%,P<0.05。结论无血清培养法、免疫磁珠分选系统可成功培养和分离人脑胶质瘤干细胞。

目的观察三线化疗药物(紫杉醇、长春瑞滨、吉西他滨)小剂量单药化疗联合胸腔闭式引流及IL-2注入治疗老年恶性胸腔积液的疗效。方法 34例对老年晚期非小细胞肺癌合并恶性胸腔积液患者,随机分为局部组18例和联合组16例。均行胸腔内置管闭式引流胸腔积液。局部组胸腔内注入IL-2,每周2次;联合组在此基础上给予紫杉醇、长春瑞滨或吉西他滨单药小剂量单药化疗。结果局部组有效率为55.6%,联合组为87.5%,两组相比P<0.05。局部组发生发热3例、胸痛8例、恶心呕吐11例、骨髓抑制0例、肝损害1例、肾损害0例,联合组分别为3、7、12、9、4、2例。不良反应均为Ⅰ~Ⅱ度,经对症治疗后均缓解。结论 紫杉醇、长春瑞滨、吉西他滨小剂量单药化疗联合胸腔闭式引流及IL-2注入治疗老年恶性胸腔积液疗效满意。

乳牙根尖周炎是儿童齿科的常见多发病.根管治疗是治疗乳牙根尖周炎最有效的方法.而根管充填材料则直接影响根管治疗的效果.笔者将Vitapex糊剂充填患有根尖周炎的乳牙根管,取得肯定疗效,现报告如下.