目的 了解疫情期间医护人员代谢综合征(MS)、高同型半胱氨酸血症(HHcy)的患病率、二者关系及靶器官损害。方法 选取2020年1月—2021年11月在天津市某三级综合医院的1 544名医护人员作为研究对象。测量人体指标,测定血液生化、免疫等指标。分析MS及其组分的患病率、HHcy的患病率及靶器官损害。采用χ²检验,比较MS组、HHcy组与对照组靶器官损害的差异。采用Logistic回归模型分析MS与HHcy的关系。结果 三级综合医院医护人员疫情期间MS患病率为23.7%,MS组分:中心性肥胖、高血压/高血压病、高甘油三酯、低高密度脂蛋白和高空腹葡萄糖/糖尿病的患病率分别为49.4%、19.3%、24.3%、0.5%和37%。HHcy的患病率为29.7%。MS组、HHcy组与对照组靶器官损害程度差异有统计学意义(P<0.001)。HHcy与MS无直接相关性。结论 疫情期间医护人员MS和HHcy患病率较高,与对照组相比有明显的靶器官损害,HHcy不是MS的独立危险因素。

Objective To explore the prevalence of metabolic syndrome (MS) and hyperhomocysteinemia (HHcy), their relationship and target organ damage among medical staff during the pandemic. Methods A total of 1 544 medical staff in a third-class general hospital in Tianjin from January 2020 to November 2021 were selected as the object of study. The indexes of human body were measured, and the indexes of blood biochemistry and immunity were detected. The prevalence of MS and its components, the prevalence of HHcy and target organ damage were analyzed. χ² test was used to analyze the difference of target organ damage among MS group, HHcy group and control group. The relationship between HHcy and MS was analyzed by Logistic regression model. Results The prevalence of MS among medical staff in the third-class general hospital during the pandemic was 23.7%. The prevalence of central obesity, hypertension / hypertension disease, high triglyceride, low high density lipoprotein cholesterol and high fasting plasma glucose/diabetes were 49.4%, 19.3%, 24.3%, 0.5% and 37%, respectively. The prevalence of HHcy was 29.7%. There was significant difference in target organ damage among MS group, HHcy group and control group (P<0.001). There was no direct correlation between HHcy and MS. Conclusions During the pandemic period, the prevalence of MS and HHcy in medical staff were high, and there was obvious target organ damage in those staff compared with the control staff. HHcy is not an independent risk factor of MS.

慢性肾脏病是一类具有高发病率、高死亡率的慢性疾病群。临床上一般采用血液透析和肾脏移植治疗终末期的慢性肾脏病。研究表明,小分子药物或核酸类药物在慢性肾脏病治疗中极具潜力,但是缺乏特异性导致肾脏纤维化治疗效果有限,亟需开发新的治疗策略。纳米载体因具有良好的理化性质,被广泛应用于生物医学领域。本文综述了近年来纳米载体递送小分子或核酸类药物在慢性肾脏病中的研究进展。

Chronic kidney disease (CKD) is a series of chronic disease groups associated with high morbidity and mortality. Hemodialysis and kidney transplantation are the only choices for end-stage renal disease. According to the literature report, it is shown that small molecule and nucleic acid drugs have great potential in CKD treatments with an unsatisfied therapeutic efficacy because of the lack of specific targeting. Thus, it is necessary to develop a new strategy. Nanocarriers have been widely used in biomedical fields due to their excellent physical and chemical properties. In this review, we have summarized the recent advances in applying functional nanocarriers to deliver the small molecules and nucleic acid drugs in the treatment of CKD.

目的 利用网络药理学技术,分析黄甲软肝颗粒治疗肝纤维化的作用网络,以及黄甲软肝颗粒治疗肝纤维化的潜在作用机制,并在体内动物实验进行初步验证。方法 采用中药系统药理学分析平台中寻找黄甲软肝颗粒中10味中药相关的化学成分和作用靶点,通过GeneCards等数据库筛选肝纤维化疾病相关的靶标;对药物与疾病靶点相映射得到黄甲软肝颗粒治疗肝纤维化的作用靶点,运用cytoscape将疾病靶点与复方活性成分靶点的交集-交集部分对应的活性成分”构建“C(成分)-T(靶点)”作用网络。将交集靶点利用 DAVID数据库进行GO富集分析和KEGG富集分析,以获得其潜在作用机制。最后,通过黄甲软肝颗粒防治CCl₄导致SD大鼠肝纤维化的体内实验进行初步验证,考察末次给药后大鼠体质量和肝脏指数,采用微板法检测SD大鼠血清中天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平,苏木精-伊红染色观察肝脏病理学变化。结果 预测筛选得到黄甲软肝颗粒共有117个潜在活性成分,266个活性成分对应靶点,161个交集靶点,关键成分有槲皮素、山奈酚、丹参酮IIA、芒柄花黄素等,关键靶点有PTGS2、PTGS1、NCOA1、ACHE、HTR、RXRA、ADRB2、IL1B等。GO 分析共包含 960条富集结果,其中生物过程845 条,分子功能 63条,细胞组成 52 条;KEGG 分析共得出68条通路,与本次研究较相关的通路主要包括TNF信号通路、Toll样受体信号通路、Rap1信号通路、胞质DNA传感途径、ErbB信号通路、VEGF信号通路等。体内动物实验研究表明,黄甲软肝颗粒能显著降低大鼠的肝脏指数和血清ALT、AST,改善肝组织病理学指标。结论 黄甲软肝颗粒可通过多成分、多途径、多靶点协同发挥治疗肝纤维化的作用,本研究为黄甲软肝颗粒治疗肝纤维化疾病的物质基础、作用机制及临床应用的进一步研究奠定基础。

Objective To analyze the effective network of Huangjia Ruangan Granules in treating liver fibrosis and its potential mechanism by using network pharmacology, and preliminary verify by animal in vivo experiments. Methods From the Chinese Medicine System Pharmacology Analysis Platform, we searched for the chemical constituents and targets of 10 Chinese herbs in Huangjia Ruangan Granules, and screened the targets related to liver fibrosis diseases through GeneCards and other databases. The drug and disease target were mapped to the target of Huangjia Ruangan Granules for the treatment of liver fibrosis, and the active component corresponding to the intersection of the disease target and the compound active component target was constructed using cytoscape “C (component)-T (target)” action network. The intersection target was used for GO enrichment analysis and KEGG enrichment analysis with DAVID database to obtain its potential mechanism of action. Finally, through the in vivo experiment of using Huangjia Ruangan Granules to prevent and treat CCl₄ leaded liver fibrosis in SD rats, the rats' body weight and liver index after the last dose were recorded, and the levels of aminotransferase (AST) and alanine aminotransferase (ALT) in the serum of SD rats were detected by the microplate method, hematoxylin-eosin staining were used to observe liver pathological changes. Results Predictive screening showed that Huangjia Ruangan Granules had 117 potential active ingredients, 266 active ingredients corresponded to targets, and 161 intersection targets. The key ingredients was quercetin, kaempferol, tanshinone IIA, formononetin, etc. The key targets were PTGS2, PTGS1 NCOA1, ACHE, HTR, RXRA, ADRB2, IL1B, etc. GO analysis showed a total of 960 enrichment results, including 845 biological processes, 63 molecular functions, and 52 cell compositions; KEGG analysis revealed a total of 68 pathways, the related pathways included TNF signaling pathway, Toll-like receptor signaling pathway, Rap1 signaling pathway, cytoplasmic DNA sensing pathway, ErbB signaling pathway and VEGF signaling pathway, etc. In vivo animal experiments had shown that Huangjia Ruangan Granules could significantly reduce the liver index and serum ALT and AST levels of rats, and improve liver histopathological indicators. Conclusions Huangjia Ruangan Granules treated liver fibrosis through multi-component, multi-pathway and multi-target synergy. This research laid the groundwork for the material basis, mechanism and clinical application of Huangjia Ruangan Granules in treating liver fibrosis diseases.

目的 分析闽西南地区在院炎症性肠病患者流行病学资料,从而加强对炎症性肠病的认识。方法 回顾性研究炎症性肠病患者临床特点及用药情况。结果 纳入317例炎症性肠病,克罗恩病占212例,男女之比 2.07:1,溃疡性结肠炎占105例,男女比例1.84:1。克罗恩病患者确诊平均年龄29岁,以患A2型为主,溃疡性结肠炎者确诊平均年龄44岁。女性B2型比例明显高于男性。溃疡性结肠炎患者的病变部位主要为E3型(44.8%)。结论 炎症性肠病患者临床表现多样。克罗恩病确诊年龄主要是A2型, L3型是主要病变部位分型,B2型是疾病行为主要分型。E3型是溃疡性结肠炎患者的主要病变部位。克罗恩病多以免疫抑制剂和生物制剂治疗,糖皮质激素和5-ASA类制剂是轻中度的UC患者主要治疗措施。生物制剂、糖皮质激素治疗多用于重度UC患者。

Objective To analyze the epidemiological data of inflammatory bowel disease (IBD)patients in southwest Fujian Province, so as to improve the understanding of IBD. Methods To retrospectively study the clinical characteristics and medication of inflammatory bowel disease patients. Results A total of 317 IBD patients were included.Crohn's disease accounted for 212 cases, with a male-to-female ratio of 2.07:1, and ulcerative colitis accounted for 105 cases, with a male-to-female ratio of 1.84:1.Patients with Crohn's disease were diagnosed at an average age of 29, mainly with type A2, while patients with ulcerative colitis were diagnosed at an average age of 44. The proportion of female with type B2 was significantly higher than that of male.The lesions of ulcerative colitis patients were mainly type E3 (44.8%).Conclusions Patients with IBD had diverse clinical manifestations.The age of diagnosis of Crohn's disease was mainly type A2, type L3 was the main lesion, type B2 was the main disease classification.Crohn's disease was mainly treated with immunosuppressive and biological therapy. Glucocorticoids and 5-ASA were the main treatment for patients with mild-to-moderate ulcerative colitis. Biological agents and glucocorticoid therapy were mostly used in severe patients.

目的 研究麻醉恢复室(PACU)全麻患者气管内吸痰的最佳时机与按需吸痰的可行性。方法 选取2021年6月—2021年10月行经口气管插管静吸复合全身麻醉的择期手术患者240例,随机分为A组(拔管前吸痰组)、B组(入室吸痰组)、C组(入室按需吸痰组)3组,每组80例。A组苏醒时拔除导管前常规气道内及口腔吸痰;B组入PACU时提前气道内及口腔吸痰,苏醒时拔除导管,拔管后清理口腔;C组入室后参考吸痰指征评估患者气道分泌物,有吸痰指征患者吸痰,无吸痰指征者不吸痰,苏醒时拔除导管后清理口腔。分别记录患者术后入PACU时、吸痰及拔管后1 min患者的心率、血压、患者因气管刺激引起的呛咳、恶心呕吐及气道痉挛等发生例数,记录躁动评分、术后咽喉痛评分并进行评估。结果 A组与B组比较,每位患者均有吸痰,A组患者心率、血压、血氧饱和度,在吸痰后及拔管后较B组变化幅度大,差异均有统计学意义(P <0.05),气道应激反应方面,C组有20例患者按需吸痰,3组患者均未出现气道痉挛患者,A组有2例患者因拔管时剧烈呛咳引起呕吐,C组呛咳例数低于A组和B组,差异有统计学意义(P <0.05),气道刺激引起的躁动及术后咽喉疼痛C组低于A组,差异有统计学意义(P <0.05)。结论 患者在入室时按需吸痰,拔管时不再吸痰,可减少患者的心血管及气道应激反应,减少术后咽痛。

Objective To investigate the best time for endotracheal suction and the feasibility of on-demand suction in general anesthesia patients of post anesthesia care unit (PACU).Methods A total of 240 selective surgical patients who underwent oral endotracheal intubation with general anesthesia from June 2021 to October 2021 were selected.They were randomly divided into group A (sputum suction before extubation),group B (sputum suction in the room),and group C (in-room sputum suction on demand),80 cases in each group.In group A,routine airway and oral sputum suction was performed before removing the catheter when the patients were waking up.Group B had sputum sucked in the airway and mouth before entering the PACU,removed the catheter when waking up,and cleaned the oral cavity after extubation.In group C,the patients were assessed with reference of suction indications after entering the room.Sputum suction was performed for those with indications,but not for those without indications,and the mouth was cleaned after removing the catheter when awaken.Patient's heart rate,blood pressure,coughing,nausea and vomiting and airway spasm caused by tracheal irritation in 1 minute after suction and extubation were recorded after the patients entered the PACU.The tremor score and sore throat score were recorded and analyzed.Results Comparing group A with group B,each patient had sputum suction.The heart rate,blood pressure,and oxygen saturation of group A changed more significantly than group B after sputum suction and extubation (P<0.05).In terms of airway stress response,20 patients in group C needed suction,none in the three groups had airway spasm.Two patients in group A had vomiting due to severe coughing during extubation.The patients of coughing in group C were significantly less than that of group A and group B,respectively (P<0.05).The dysphoria caused by airway stimulation and postoperative throat pain in group C was significantly lower than that of group A (P<0.05).Conclusions The patient on-demand suction when enter the room,and no suction when extubation,can reduce the patient's cardiovascular and airway stress response and reduce postoperative sore throat.

实体肿瘤物理和化学微环境异常阻碍了肿瘤与外界进行物质交换,降低了药物渗入肿瘤组织,是肿瘤对放化疗抵抗的重要原因。目前,已有多种针对肿瘤微环境各个组分的治疗方法,如使血管正常化、降低肿瘤间质液压、降解细胞外基质等,以达到增强药物等的渗出,从而增强肿瘤治疗效果。声学调控是改变肿瘤理化微环境的一种有效方法,本文对声学调控其中几个主要的机制和研究进展进行综述,以期为临床肿瘤治疗提供新思路。

目的 观察清化血浊中药对大动脉粥样硬化型(LAA)缺血性脑卒中患者的临床疗效。方法 将105例发病24 h内符合标准的大动脉粥样硬化型缺血性脑卒中患者,随机分为观察组52例和对照组53例,对照组予以西医综合治疗,观察组在西医综合治疗的基础上加用清化血浊中药(化浊和血颗粒),疗程为14 d。两组患者分别于治疗前及治疗后7 d、14 d评定NIHSS评分;治疗前及发病1个月后分别测定mRS评分,以判定临床转归;治疗前及治疗后14 d分别采集空腹血测定低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋浓度。结果 清化血浊中药可降低大动脉粥样硬化型缺血性脑卒中患者治疗后7 d及14 d的NIHSS评分(P<0.05)、增加好转率且不增加患者复发、死亡及出血性转化,并能降低患者血低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋白。结论 清化血浊中药可减低大动脉粥样硬化型缺血性脑卒中患者的神经功能缺损,促进神经功能恢复,提高临床良好转归, 且不增加出血性转化。

目的 探究词联导航训练法结合针灸、环喉按摩对脑卒中构音功能障碍的疗效。方法 将我院收治的200例脑卒中伴有构音障碍患者按照随机数字表法平均分为干预组与对照组。两组患者均接受临床基础治疗、常规PT、0T、理疗和中医药治疗,在此基础上干预组给予词联导航训练法结合针灸、环喉按摩等综合的康复方案进行康复护理和治疗,观察疗效以及不良反应发生情况。结果 干预组(90%)的临床疗效优于对照组(76%),差异有统计学意义(P＜0.05);生活质量评价干预组高于对照组,差异有统计学意义(P＜0.05);不良反应发生情况干预组(6%)与对照组(7%)接近,差异没有统计学意义(P＞0.05)。结论 词联导航训练法结合针灸、环喉按摩对脑卒中构音功能障碍方法安全、疗效显著,可以提升患者的生活质量。

目的 研究集体呼吸操对慢阻肺稳定期患者的执行率影响效果。方法 选取连州市人民医院呼吸内科、ICU 2019年6月—2020年6月收治的120例慢阻肺稳定期患者为研究对象,以随机数字表法分为试验组与对照组,每组各60例,对照组采取一对一训练,试验组采取集体呼吸操,对两组执行率、肺功能、六分钟步行距、圣乔治呼吸问卷(St. George's Respiratory Questionnaire Application,SGRQ)评分进行对比。结果 试验组执行率90.00%,与对照组75.00%相比较,差异有统计学意义(P＜0.05);护理前两组肺功能、六分钟步行距离、SGRQ评分相比较,差异无统计学意义(P＞0.05),护理后4周、护理后8周与护理前相比较,差异有统计学意义(P＜0.05); 试验组护理后4周、护理后8周肺功能、六分钟步行距、SGRQ评分与对照组相比较,差异有统计学意义(P＜0.05)。结论 集体呼吸操有助于提高慢阻肺稳定期患者执行率,进一步改善其肺功能以及运动耐力水平,值得在今后护理工作中推广使用。

Objective To study the effect of collective breathing exercises on the execution rate of patients with stable COPD. Methods A total of 120 patients with stable chronic obstructive pulmonary disease admitted to the department of respiratory medicine and ICU of Lianzhou People's Hospital from June 2019 to June 2020 were selected as the research objects. They were divided into the experimental group and the control group by a random number table. For 60 cases, the control group took one-to-one training, and the test group took collective breathing exercises. The performance rate, lung function, six-minute walk distance, and St. George's Respiratory Questionnaire Application (SGRQ) scores were compared between the two groups. Results The execution rate of the experimental group was 90.00%, compared with 75.00% of the control group, the difference was statistically significant (P<0.05); there was no statistically differences in lung function, six-minute walking distance, and SGRQ score between the two groups before nursing ( P>0.05), 4 weeks after nursing, 8 weeks after nursing, and before nursing, the difference was statistically significant (P<0.05); in the experimental group, 4 weeks after nursing, 8 weeks after nursing, lung function, six-minute walking distance, SGRQ score was compared with the control group, the difference was statistically significant (P<0.05). Conclusion Group breathing exercises may help improve the performance rate of patients with chronic obstructive pulmonary disease in stable phase, and further improve their lung function and exercise endurance. It is worth popularizing in future nursing work.

目的 探讨体外受精治疗中第3天(D3)不同质量卵裂期胚胎培养至囊胚的发育潜能,为囊胚培养提供实验室依据。方法 对2015年4月—2019年4月D3移植或冷冻后剩余行囊胚培养的5 510枚胚胎进行了回顾性分析。按D3胚胎质量、卵裂球数目、均一性及碎片率分组,比较囊胚形成率,优质囊胚形成率及可利用囊胚形成率,并分析各因素与可利用囊胚形成的相关性。结果 D3优质胚胎的囊胚形成率,优质囊胚形成率及可利用囊胚形成率与非优质胚胎组相比有统计学差异(P＜0.05);4-6细胞组及＜4细胞组与7-9细胞组相比有统计学差异(P＜0.05),但融合期胚胎(CP)组及＞ 9细胞组与7-9细胞组相比差异无统计学意义;卵裂球大小差异(+)组和(++/+++)组与卵裂球大小均匀(-)相比有统计学差异(P＜0.05); 10%～25%组及碎片＞25%组与碎片≤10%组相比有统计学差异(P＜0.05)。 Logistic分析结果表明,D3胚胎质量、卵裂球数目、均一性及胚胎碎片率与可利用囊胚形成显著相关(P＜0.05)。 结论 D3胚胎质量、卵裂球数目、均一性及胚胎碎片均会影响到囊胚的形成及质量,其中胚胎质量和卵裂球数目对可利用囊胚形成的影响较大。

Objective To explore the developmental potential of day 3(D3) different quality embryos cultured to blastocyst in vitro fertilization treatment, and to provide laboratory basis for blastocyst culture. Methods A total of 5 510 embryos with blastocyst culture remained after D3 transplantation or freezing from April 2015 to April 2019 were analyzed retrospectively. They were divided into groups according to embryo quality, blastomere number, blastomere homogeneity and fragment rate in D3. And the blastocyst formation rate, high quality blastocyst formation rate and available blastocyst formation rate were compared between the groups.The correlation within each factor and available blastocyst formation was analyzed. Results The blastocyst formation rate, high quality blastocyst formation rate and available blastocyst formation rate of D3 high quality embryo group were higher than those of non-high quality embryo group (P<0.05); compared with 7- 9 cell group, 4- 6 cell group and<4 cell group were lower (P<0.05), but there was no significant difference in CP group or >9 cell group. Compared with the normal size of the blastomere (-), the difference in the size of the blastomere (+) group and the (++/+++) group decreased (P<0.05); compared with the fragment ≤ 10%, the difference in the size of the blastomere between the 10%~25% group and the fragment>25% group decreased (P<0.05). The results of logistic analysis suggested that the embryo quality, blastomere number, homogeneity and fragment rate of D3 were correlated with available blastocyst formation (P<0.05). Conclusion D3 embryo quality, blastomere number, homogeneity and embryo fragment may affect the formation and quality of blastocyst, especially the embryo quality and blastomere number.