目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.

       目的   探讨非肌层浸润性膀胱癌患者初次经尿道膀胱肿瘤电切术的复发情况及危险因素。方法   以93例非肌层浸润性膀胱癌患者进行研究，2018年1月至2022年1月西藏自治区人民政府驻成都办事处医院泌尿外科医院收治采取经尿道膀胱肿瘤电切术，术后随访24个月，复发22例，未复发71例，比较复发与未复发基础情况、不同肿瘤直径、不同肿瘤分期、分级、数量、是否带蒂、灌注化疗方式等特征患者的复发情况，对具有统计学意义的因素，采取非条件Logistic多因素回归分析，明确术后复发的危险因素。结果   肿瘤分期T1期者的复发率为32.08%，高于Ta期者15.50%，肿瘤分级为高级别者的复发率为53.33%，高于低级别者17.95%，肿瘤多发者的复发率为35.71%，高于单发者的13.73%，肿瘤不带蒂者的复发率为38.71%，高于肿瘤带蒂者的16.13%，常规灌注化疗患者的复发率为29.85%，高于术后即刻+灌注化疗患者的7.69%，比较差异均有统计学意义（χ ² 分别为6.648、4.836、6.872、6.166、5.834、5.902，P分别为0.010、0.027、0.008、0.013、0.015、0.024）。肿瘤分期T1期、肿瘤分级为高级别、肿瘤多发、常规灌注化疗为非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发的危险因素（P＜0.05）。结论   非肌层浸润性膀胱癌患者初次采取经尿道膀胱肿瘤电切术容易因为临床分期为T1期、肿瘤分级为高级别、肿瘤多发及常规灌注等出现复发，应采取针对性干预措施，改进灌注化疗方式，降低复发率。

       Objective  To investigate the  relapse and  risk factors of non-muscular invasive bladder cancer after primary transurethral resection．Methods  A total of 93 patients with non-muscular invasive bladder cancer were selected for study．They were received by the hospital from January 2018 to January 2022 and underwent transurethral resection．After 24 months of follow-up，22 patients recurred，and 71 patients did not recur．The recurrence of patients with different tumor diameter，tumor stage，grade，numbers，pedicel or not，and infusion chemotherapy methods were compared．For the statistically significant factors，unconditional logistic regression analysis was used to determine the independent risk factors for recurrence．Results  The recurrence rate in T1 stage of tumor was 32.08% higher than that in Ta stage，which was 15.50%．The recurrence rate in high stage was 53.33% higher than that in low stage，which was 17.95%．The recurrence rate in multiple tumor patients was 35.71% higher than that in single tumor patients，which was 13.73%．The no-pedicle tumor recurrence rate was 38.71% higher than that with pedicle，which was 16.13%．The recurrence rate in patients receiving conventional infusion chemotherapy was 29.85% higher than that in patients receiving immediate postoperative infusion chemotherapy，which was 7.69%．The differences were statistically significant（χ ² =6.648、4.836、6.872、6.166、5.834、5.902，P=0.010、0.027、0.008、0.013、0.015、0.024）．The independent  risk factors of recurrence after primary transurethral resection were tumor stage T1，high grade tumors，multiple tumors，routine perfusion chemotherapy as non-muscular invasive bladder cancer（P＜0.05）．Conclusions  The  patients with  non-muscular invasive bladder cancer taking transurethral resection for the first time are prone to recurrence because of the clinical stage of T1，tumor grade of high grade，multiple tumors and routine perfusion．Targeted intervention measures  should be taken to improve the perfusion chemotherapy method to reduce the recurrence rate．

      近视是一种常见的屈光不正状态，也是全球范围内普遍存在的视觉健康问题，其特征是在眼部调节放松的状态下，平行光线经眼的屈光系统折射后聚焦在视网膜前，导致视远模糊。近视通常在儿童期发生和发展，但在成年期仍可继续发生和发展。本综述对已发表的关于成年人近视发生和进展的文献进行总结，描述成年人近视的流行病学特征，包括近视率、近视发病率、近视进展率及其近视特征（屈光度及眼轴），总结成年人近视发病和进展的危险因素。了解成年人近视的发展特点和管理方式对于近视防控实践具有重要意义。

   Myopia is a common refractive error and a universal visual health problem in the world. It is characterized by the fact that parallel light rays refract through the refractive system of the eye and focus in front of the retina when the eye accommodatior is relaxed, resulting in distant blurred vision. Myopia usually occurs and develops in childhood, but can continue to occur and develop in adulthood. This review summarizes the published literature on the occurrence and progression of myopia in adults, describes the epidemiological characteristics of myopia in adults, including myopia rate, myopia incidence rate, myopia progression rate, and myopia characteristics（diopter and ocular axis） ; and summarizes the  risk factors for the occurrence and progression of myopia in adults. Understanding the developmental characteristics and management methods of adult myopia is of great significance for myopia prevention and control practice.