目的 探讨不同甲状腺结节手术治疗方案的合理性及临床效果。方法 选取本院2018年1月—2019年1月收治的120例患有甲状腺结节患者为研究对象,将其随机分为A组和B组各60例,A组患者未进行甲状腺细针抽吸细胞学检查直接进行甲状腺结节切除手术,B组患者接受超声负压引导甲状腺细针抽吸细胞学检查后给予手术治疗方案,比较两组患者手术前、后良恶性结节患者变化、术后复发率、并发症发生率及手术疗效。结果 术后A组残余恶性结节患者比例高于B组(P=0.001),A组健康无结节病变患者占比低于B组(P=0.002),A组患者恶性结节复发率高于B组患者(P<0.05);两组术后并发症发生率无差异(P>0.05),A组手术治疗总有效率低于B组(P<0.05)。结论 甲状腺结节患者术前有效超声穿刺诊断、术中超声引导手术及术后抗癌化疗治疗方案可以提高甲状腺结节患者手术有效率,B组方案具有重要临床推广价值。

Objective To investigate the rationality and clinical effect of different thyroid nodules surgical treatment. Methods A total of 120 patients with thyroid nodules admitted to our hospital from January 2018 to January 2019 were randomly divided into group A and group B, respectively. Group A patients did not undergo fine needle extraction. Aspiration cytology was performed directly for thyroid nodule resection. Group B patients underwent ultrasound negative pressure guided thyroid fine needle aspiration cytology and were given surgical treatment. The changes of benign and malignant nodules before and after surgery were compared between the two groups including postoperative recurrence rate, complication rate and surgical outcome. Results The proportion of patients with residual malignant nodules in group A was higher than that in group B (P=0.001). The proportion of patients with healthy no-nodular lesions in group A was lower than that in group B (P=0.002). The recurred rate of malignant nodules in group A was higher than that of group B (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The total effective rate of group A was lower than that of group B (P<0.05). Conclusion Preoperative effective ultrasound puncture diagnosis, intraoperative ultrasound guided surgery and postoperative anticancer chemotherapy treatment may improve the efficiency of thyroid nodules in patients with thyroid nodules. Group B has important clinical value.

目的 基于网络药理学方法预测银杏叶治疗心肌缺血的潜在靶点及信号通路。方法 利用 TCMSP 平台筛选生物利用度(OB)≥ 30% 和类药性(DL)≥ 0.18 的活性成分及作用靶点。利用GeneCards和OMIM数据库检索心肌缺血疾病相关靶点,并提取药物成分和心肌缺血疾病的共有靶点作为关键靶点。通过在线TRING平台构建PPI网络,并采用Cytoscape 软件构建可视化的“化合物-靶点-通路”网络,进一步进行GO 功能富集分析和KEGG通路富集分析。结果 筛选得到 27种潜在的药效成分,2 164个化合物靶点,531个心肌缺血相关靶基因。两者取交集后获得疾病-类药活性成分40个共同靶点,PPI 蛋白互作网络自由度较高的节点依次为:IL6、VEGFA、CASP3、MAPK8、MYC、NOS3。GO 功能富集分析得到42个 GO 条目,KEGG 通路富集分析得到42条信号通路。结论 银杏叶治疗心肌缺血主要GO 能力富集在半胱氨酸肽链内切酶活性,内肽酶活力,激活转录因子结合,DNA结合转录激活剂活性,RNA聚合酶II特异性等功能,调控TNF信号通路,糖尿病并发症的年龄愤怒信号, 细胞凋亡,PI3K-Akt信号通路等信号,进一步达到对心肌缺血疾病的治疗。

Objective To predict the potential targets and signal pathways of ginkgo leaf in the treatment of myocardial ischemia based on network pharmacology. Methods The active components and targets of bioavailability (OB) ≥ 30% and drug-like (DL) ≥ 0.18 were screened by TCMSP platform.The related targets of myocardial ischemic diseases were searched by GeneCards and OMIM database, the components and the common targets of myocardial ischemic diseases were extracted as the key targets. To build the PPI network through the online STRING platform, a visual “compound-target-pathway” network was constructed to further analyze the functional enrichment of GO and the enrichment of KEGG pathway. Results 27 potential active components, 2 164 compound targets and 531 myocardial ischemia related target genes were screened. After the intersection of the two, 40 common targets of disease-class active components were obtained. The nodes with higher degree of freedom of PPI protein interaction network were IL6、VEGFA、CASP3、MAPK8、MYC and NOS3.42 entries were obtained by GO functional enrichment analysis and 42 signal pathways were obtained by KEGG pathway enrichment analysis. Conclusion Ginkgo leaf may be a target of cysteine-type endopeptidase activity,endopeptidase activity,activating transcription factor binding,DNA-binding transcription activator activity, RNA polymerase II-specific function. TNF signaling pathway, AGE-RAGE signaling pathway in diabetic complications, apoptosis, PI3K-Akt signaling pathway were regualted to achieve the treatment of myocardial ischemia disease.

目的 探讨替诺福韦酯单药治疗在慢性乙型肝炎(CHB)后肝硬化失代偿期(DCC)治疗中的长期应用价值。方法 随机将84例CHB后DCC患者分为对照组及观察组,每组42例。对照组接受拉米夫定联合阿德福韦酯治疗,观察组接受替诺福韦酯治疗。对比两组12个月内治疗时间内的死亡率及肝癌发生率,并分析两组肝功能、肝硬化指标及Child-Pugh评分变化趋势,同时对比两组治疗过程中HBeAg转阴率、HBV-DNA转阴率及失代偿好转率。此外,对比两组治疗不良反应的发生率。结果 在12个月的治疗时间内,两组死亡率及肝癌发生率比较,差异无统计学意义(P>0.05)。而两组治疗过程中ALT、AST、HA、LN、PCⅢ及Child-Pugh评分呈降低趋势,ALB呈升高趋势(P<0.05);治疗6个月及12个月时,治疗组ALT、AST、HA、LN、PCⅢ及Child-Pugh评分低于对照组,ALB高于对照组(P<0.05)。而两组12个月治疗完成后,HBeAg转阴率比较差异无统计学意义,但观察组HBV-DNA转阴率高于对照组(P<0.05)。此外,两组治疗不良反应发生率比较差异无统计学意义(P>0.05)。结论 在CHB后DCC的治疗中,替诺福韦酯单药治疗方案具有良好的长期治疗效果。

Objective To evaluate the long-term value of tenofovir disoproxil monotherapy in the decompensated cirrhosis(DCC) after chronic hepatitis B(CHB). Methods Eighty-four patients with DCC after CHB were randomly divided into control group and observation group, 42 cases in each group. The control group received lamivudine combined with adefovir dipivoxil, and the observation group received tenofovir disoproxil. Mortality and incidence of liver cancer within 12 months of treatment between the two groups were compared, and the change trend of liver function, liver fibrosis index and child-pugh score in the two groups were analyzed. At the same time,we compared the conversion rate of HBeAg, HBV-DNA and decompensated positive rate between the two groups. In addition, the incidence of adverse reactions were compared between the two groups. Results Within 12 months of treatment, there were no statistically significant differences in mortality and liver cancer incidence between the two groups(P>0.05). And during the treatment, the ALT, AST, HA, LN, PC Ⅲ and Child-Pugh score showed a decrease trend, ALB showed a increase trend(P<0.05). After 6-month and 12-month treatment, ALT, AST, HA, LN, PC Ⅲ Child-Pugh score of treatment group were lower than that of control group, ALB was higher than that of control group(P<0.05). After 12 months of treatment, the negative conversion rate of HBV-DNA in the observation group was higher than that of control group(P<0.05). In addition, there was no statistically difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Tenofovir disoproxil monotherapy has a good long-term therapeutic effect in the treatment of DCC after CHB.

目的 观察和评价重症毒蕈中毒(PMP)患者的临床资料,探讨血液灌流(HP)联合血液滤过(HF)与单独血液滤过治疗的疗效比较。方法 收集本院2016年8月—2018年10月救治的32例重症急性毒蕈中毒并发中毒性肝损伤、急性肾衰竭、中毒性心肌炎、消化道出血、中毒性脑病、急性血管内溶血等患者的临床资料,将32例患者分为治疗组和对照组,治疗组14例,采用持续静脉-静脉血液滤过24 h串联灌流2 h;对照组18例,采用单独血液滤过24 h,疗程2～3 d。两组患者内科常规治疗基本相同。结果 14例治疗组在内科常规治疗基础上联合血液灌流+血液滤过,好转率为92.9%(13/14);18例对照组在内科常规治疗基础上单用血液滤过,好转率为61.1%(11/18),两组好转率比较,差异有统计学意义(P<0.05)。治疗组患者黄疸、少尿、黑便、意识障碍等症状减轻,优于对照组;血清AST、ALT、TBil、DBil、PT、APTT水平较治疗前改善,优于对照组,差异有统计学意义(P均<0.05)。结论 毒蕈中毒患者常合并多脏器功能障碍(MODS),及早进行血液灌流联合血液滤过治疗较单独血液滤过能更有效的清除蛋白结合毒素和血清炎症因子,从而减轻内脏器官损害,改善肝、肾和凝血功能,治疗效果显著。

Objective To compare the clinical effect differences between hemoperfusion combined with hemofiltration with simple hemofiltration in treatment of severe mushroom poisoning patients. Methods 32 patients with toxic hepatitis,toxic myocarditis,toxic encephalopathy and acute renal failure due to poisonous mushroom were divided into two groups: treating group(n=14) and control group(n=18).Patients of treating group received continuous veno-venous hemofiltration for 24 hours combined with hemoperfusion for 2 hours.The cases of control group only received hemofiltration for 24 hours. Results After the treatment,the improvement rate in treating group were higher than that in control group(P<0.05).The disturbance of consciousness,jaundice,oliguria,melena in treating group were improved obviously and serum levels of AST、ALT、TBil、DBil、PT、APTT were reduced than those in controls(P<0.05). Conclusion Compared with simple hemofiltration,early hemoperfusion combined with hemofiltration for patients with severe toadstool poisoned can not only remove protein binding toxin and serum inflammatory factors,but also improve liver,kidney and coagulation function.

介绍我院应对新型冠状病毒感染防控工作的护理管理措施,包括发热病区的组建,护理应急队伍的建设,工作流程指引的修订和完善,院感防护措施的严格落实,后勤保障的严密管理等,并进行护理质量控制与持续改进,为其他医院的防控工作提供借鉴。

It introduces nursing management measures of novel coronavirus infection prevention and control in our hospital, including the establishment of fever ward, the construction of nursing emergency team, the revision and improvement of working process guidelines, the strict implementation of hospital sensory protection measures, tight management of logistical support, and quality control and continuous improvement of nursing. It offers experiences for other hospitals.

目的 观察应用济川煎加减结合贴穴治疗帕金森病患者便秘的临床疗效。方法 选取帕金森病合并便秘患者64例,随机分为对照组和观察组,各32例。入选患者均进行帕金森病常规治疗,对照组服用莫沙必利;观察组在对照组治疗基础上加服济川煎加减,并选穴敷贴。疗程结束后对两组患者便秘改善程度、生活活动能力、中医证候积分等项目进行比较。结果 观察组患者便秘改善程度、生活活动能力、中医证候改善均优于对照组,两者比较差异有统计学意义(P<0.05)。结论 应用济川煎加减结合贴穴能有效治疗帕金森病患者便秘,并对帕金森病其他症状有正向调节作用,能提高该类患者生存质量。

Objective To investigate the clinical effect of Jichuanjian decoction and acupoint application on the treatment of constipation in Parkinson's disease. Methods 64 patients with constipation in Parkinson's disease were randomly divided into two groups. 32 patients were treated with Mosapride in control group. 32 patients were treated with Jichuanjian decoction and acupoint application in treatment group.The clinical effects were compared in the two groups. Results The clinical effects of the treatment group were better and the differences were statistical significance (P<0.05). Conclusion The treatment of constipation in Parkinson's disease with Jichuanjian decoction and acupoint application had a significant effect.

目的 研究我院自拟肿痛消方中药离子导入联合关节镜手术治疗膝骨性关节炎的疗效。方法 将76 例膝骨性关节炎患者分为2组,即肿痛消方离子导入联合关节镜组和单纯关节镜组,在治疗前、后分别对两组患者进行Lysholm膝关节功能评分。结果 肿痛消方联合关节镜手术治疗对膝骨性关节炎的治疗效果有明显的提高,总有效率达到92.11%,高于对照组。结论 肿痛消方联合关节镜手术治疗对膝骨性关节炎具有良好的治疗效果。可明显降低患者的疼痛感,改善膝关节功能,促进骨关节的恢复。

Objective To study the effect of Zhongtongxiao formula combined with arthroscopy in the treatment of knee osteoarthritis. Methods 76 patients with knee osteoarthritis were divided into two groups, namely, the group of Zhongtongxiao square ion-implantation combined with arthroscopy and the group of arthroscopy alone. Lysholm knee function scores were performed on the two groups before and after treatment. Results The therapeutic effects of Zhongtongxiao formula combined with arthroscopic surgery on knee osteoarthritis were improved, the total effective rate was 92.11%, higher than the control group. Conclusion Zhongtongxiao formula combined with arthroscopy has good therapeutic effect on knee osteoarthritis.It can obviously reduce the pain of patients, improve the function of knee joint and promote the recovery of bone and joint.

目的 筛选九头狮子草治疗小鼠细菌性阴道炎的有效部位。方法 采用金黄色葡萄球菌、大肠埃希菌菌悬液注入小鼠阴道建立小鼠细菌性阴道炎动物模型,观察九头狮子草各极性部位对细菌性阴道炎的治疗作用。结果 九头狮子草水提液、石油醚提取部位和70%乙醇提取部位对病原菌转阴率和阴道黏膜炎症的治愈程度均有提高,其中,对金黄色葡萄球菌的转阴率分别为60%、50%、40%,对大肠埃希菌的转阴率分别为80%、70%、50%。结论 九头狮子草石油醚提取部位和70%乙醇提取部位为其治疗细菌性阴道炎的有效部位。

Objective To study the active parts of Peristrophe japonica of vaginitis treatment effect. Methods The bacterial vaginitis model was established by injecting the bacteria of Staphylococcus aureus and Escherichia coli into the vagina of the mice and the treatment effect of each extract of Peristrophe japonica was observed. Results Three drug administration groups (including water extract of Peristrophe japonica, ligarine fraction and 70% ethanol fraction) showed marked treatment effect on the vaginitis models. The effect of water extract of Peristrophe japonica group were stronger than that of the ligarine fraction and 70% ethanol fraction groups. The pathogens seroconversion rates in Staphylococcus aureus were orderly as follows: 60%, 50%, 40%. The pathogens seroconversion rates in Escherichia coli were orderly as follows: 80%, 70%, 50%. Conclusion The ligarine fraction and 70% ethanol fraction of Peristrophe japonica might be the active extracts of curing vaginitis.

目的 系统评价手术与保守治疗无骨折脱位型颈脊髓损伤的疗效。方法 应用计算机检索 PubMed、Cochrane Library、EMbase、OVID、CNKI、维普及万方数据库,纳入关于手术及保守治疗无骨折脱位型颈脊髓损伤疗效比较的随机或非随机对照试验。由2名研究人员独立对文献进行筛选、提取和纳入文献评价,采用 Rev-Man 5.3软件对两种治疗的JOA评分、ASIA运动评分、神经功能恢复率、ASIA分级改善进行Meta分析。结果 ①共纳入13 篇研究,共598例患者,手术和保守治疗组分别371例和227例;②Meta分析显示,与保守治疗相比,手术治疗后的JOA评分更高[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01];神经功能恢复率更高[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01];ASIA分级改善更明显[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006];在ASIA运动评分方面,两者无差异[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]。结论 对于无骨折脱位型颈脊髓损伤的患者,手术治疗更有利于患者神经功能的改善。

Objective To systematically assess the clinical efficacy of surgical treatment versus conservative treatment for CSCIWFD from previously clinical investigations. Methods A systematic search of all the studies published was conducted on the PubMed, Cochrane Library, EMbase, OVID, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between surgical treatment and conservative treatment for CSCIWFD were identified. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the quality of included studies. Meta-analyses were performed to assess variables including Japanese Orthopaedic Association scores(JOA), Neurological function recovery rate, ASIA impairment scale grade, ASIA motor scores. Results ①A total of 13 articles were included, involving 598 patients, of which 371 and 227 patients received sugical or conservative treatment. ②The results of the meta-analysis indicated that, compared with conservative group, surgical group has higher JOA scores[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01], better Neurological function recovery rate[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01], better ASIA impairment scale grade improvement[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006], and there were no significant differences in the ASIA motor scores[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]. Conclusion These result suggests that surgical treatment can improve the neurological function more effectively for patients with cervical spinal cord injury without fracture and dislocation.

目的 通过分析孤立性蝶窦病变的临床特点,进一步提高早期诊断率及治疗疗效。方法 回顾性分析2019年1月—2019年8月在我科手术的孤立性蝶窦病变的9例患者临床资料,总结分析蝶窦病变的临床症状、鼻窦影像学表现及鼻内镜手术疗效。结果 蝶窦病变平均发病年龄约59.1岁,1例为双侧真菌性蝶窦炎,只有1例首诊于耳鼻喉科,8例患者就诊于神经内科,都以头痛为首发症状,1例鼻流清亮液体,鼻腔异味2例,鼻塞、脓涕1例,嗅觉功能减退1例。不同类型的蝶窦病变影像学表现不同,临床症状不同,绝大多数患者以头痛为首发症状。所有患者均在全身麻醉下行鼻内镜手术。术后随访至少3月以上,术后症状完全消失,无复发病例。结论 头痛是孤立性蝶窦病变最常见的临床特点,鼻窦影像学检查是重要的诊断手段,鼻内镜下经嗅裂蝶筛隐窝进路开放蝶窦是最有效的治疗手段。

Objective By analyzing the clinical characteristics of solitary sphenoid sinus disease,the early diagnosis rate and therapeutic effect can be further improved. Methods The clinical data of 9 patients with isolated sphenoid sinus lesions operated on in our department from January 2019 to August 2019 were retrospectively analyzed,and the clinical symptoms,imaging features of the sinuses and the efficacy of nasal endoscopic surgery were summarized and analyzed. Results The average age of onset of sphenoid sinus lesions was 59.1 years old,1 case was bilateral fungal sphenoid sinusitis,only 1 case was first diagnosed in the department of otolaryngology,8 cases were treated in the department of neurology,all with headache as the first symptom,1 case had clear rhinorrhea,2 cases had nasal odor,1 case had nasal obstruction,1 case had purulent nose,and 1 case had anosmia. The imaging manifestations and clinical symptoms of different types of sphenoid sinus lesions were different,and headache was the first symptom of most patients. All patients underwent nasal endoscopic surgery under general anesthesia. The patients were followed up for at least 3 months after the operation,and the symptoms completely disappeared without recurrence. Conclusion Headache is the most common clinical feature of isolated sphenoid sinus lesions. Imaging examination of the sinus is an important diagnostic method,and endoscopic opening of the sphenoid sinus through the sphenoidal cleft via sphenoidal recess is the most effective treatment method.