Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria

BACKGROUND Multidrug-resistant Gram-negative bacteria,exacerbated by excessive use of antimicrobials and immunosuppressants,are a major health threat.AIM To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia,and to provide theoretical reference for clinical diagnosis and treatment.METHODS This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022.After bacteriological culture,the patients'airway secretions were collected to confirm the presence of Gram-negative bacilli.The patients were divided into the experimental and control groups according to the medication used.The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous,nebulization,or intravenous combined with nebulization,with a daily dosage of 1.5–3.0 million units.The control group consisted of 26 patients who received standard dosages of other antibiotics(including sulbactam sodium for injection,cefoperazone sodium sulbactam for injection,tigecycline,meropenem,or vaborbactam).RESULTS Of the 28 patients included in the research group,26 patients showed improvement,treatment was ineffective for two patients,and one patient died,with the treatment efficacy rate of 92.82%.Of the 26 patients in the control group,18 patients improved,treatment was ineffective for eight patients,and two patients died,with the treatment efficacy rate of 54.9%;significant difference was observed between the two groups(P<0.05).The levels of white blood cell(WBC),procalcitonin(PCT),and C-reactive protein(CRP)in both groups were significantly lower after treatment than before treatment(P<0.05),and the levels of WBC,PCT,and CRP in the research group were significantly lower than those in the control group(P<0.05).Compared with before treatment,there were no significant changes in aspartate aminotransferase,creatinine,and glomerular filtration rate in both groups,while total bilirubin and alanine aminotransferase decreased after treatment(P<0.05)with no difference between the groups.In patients with good clinical outcomes,the sequential organ failure assessment(SOFA)score was low when treated with inhaled polymyxin sulfate,and specific antibiotic treatment did not improve the outcome.Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.CONCLUSION Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable.Moreover,the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions,providing new ideas for clinical administration.

Climate change impacts the distribution of Quercus section Cyclobalanopsis(Fagaceae),a keystone lineage in East Asian evergreen broadleaved forests

East Asian evergreen broadleaved forests(EBFLs) harbor high species richness,but these ecosystems are severely impacted by global climate change and deforestation.Conserving and managing EBLFs requires understanding dominant tree distribution dynamics.In this study,we used 29 species in Quercus section Cyclobalanopsis-a keystone lineage in East Asian EBLFs-as proxies to predict EBLF distribution dynamics using species distribution models(SDMs).We examined climatic niche overlap,similarity,and equivalency among seven biogeographical regions’ species using’ecospat’.We also estimated the effectiveness of protected areas in the predicted range to elucidate priority conservation regions.Our results showed that the climatic niches of most geographical groups differ.The western species under the Indian summer monsoon regime were mainly impacted by temperature factors,whereas precipitation impacted the eastern species under the East Asian summer monsoon regime.Our simulation predicted a northward range expansion of section Cyclobalanopsis between 2081 and 2100,except for the ranges of the three Himalayan species analyzed,which might shrink significantly.The greatest shift of highly suitable areas was predicted for the species in the South Pacific,with a centroid shift of over 300 km.Remarkably,only 7.56% of suitable habitat is currently inside protected areas,and the percentage is predicted to continue declining in the future.To better conserve Asian EBLFs,establishing nature reserves in their northern distribution ranges,and transplanting the populations with predicted decreasing numbers and degraded habitats to their future highly suitable areas,should be high-priority objectives.

敲低lincRNA-COX2抑制单核细胞增生李斯特菌感染相关的巨噬细胞的凋亡和M1型极化

目的探讨长链基因间非编码RNA环加氧酶2(lincRNA-COX2)在单核细胞增生李斯特菌(Lm)感染所致RAW264.7细胞凋亡和细胞极化中的作用.方法体外培养RAW264.7细胞,分为未感染对照组、Lm感染组、小干扰RNA阴性对照(si-NC)组、si-NC联合Lm组、lincRNA-COX2小干扰RNA(si-lincRNA-COX2)组、si-lincRNA-COX2联合Lm组.Lm感染复数(MOI)=10感染RAW264.7细胞,细菌感染6 h后收集细胞,倒置荧光显微镜和实时定量PCR检测siRNA转染抑制效率,Western blot法检测细胞中裂解型胱天蛋白酶3(c-caspase-3)、caspase-3、B细胞淋巴瘤因子2(Bcl2)、Bcl2相关X蛋白(BAX)、精氨酸酶1(Arg1)和诱导型一氧化氮合酶(iNOS)蛋白水平.结果Lm感染RAW264.7细胞后,c-caspase-3/caspase-3、BAX/Bcl2比值、iNOS蛋白水平较对照组显著上调,而Arg1水平较对照组下调.敲低lincRNA-COX2可抑制Lm感染引起的RAW264.7细胞中BAX/Bcl2、c-caspase-3/caspase-3及iNOS蛋白的升高,上调Lm感染后RAW264.7细胞中的Arg1蛋白.结论敲低lincRNA-COX2抑制Lm感染引起的RAW264.7细胞凋亡并抑制其向M1型极化.

mok E基因过表达对红曲霉Monacolin K产量、菌丝及孢子形态的影响

红曲霉中mok E基因是红曲霉次级代谢产物Monacolin K生物合成的一个相关基因,mok E基因表达量与Monacolin K产量呈正相关。以mok E基因为目的基因,构建红曲霉mok E基因过表达工程菌株,通过逆转录实时荧光定量聚合酶链式反应(reverse transcription-quantitative real-time polymerase chain reaction,RT-q PCR)确定mok E基因过表达转化子,对转化子Monacolin K产量进行测定,同时利用扫描电镜,对野生型红曲霉M1及转化子菌丝、孢子进行观察。结果表明:以潮霉素抗性基因为筛选标记,成功得到240个转化子,对其中9个转化子进行mok E基因表达量测定,有3株转化子mok E基因表达量增加,分别为T2、T8、T9转化子,确定其为mok E基因过表达转化子;T2、T8、T9转化子内酯型Monacolin K产量分别为2 159.7、4 177.6、3 365.7μg/g,与野生型红曲霉Monacolin K产量(1 447.8μg/g)相比,分别提高了49.2%、188.5%及132.5%。扫描电镜结果显示,mok E基因过表达,对红曲霉的菌丝体、孢子形态及生殖方式均有影响。

PCOS患者和肽素、Ghrelin、DHEA-S水平及与胰岛素抵抗的相关性研究

目的探究和肽素、生长激素释放肽(Ghrelin)、硫酸脱氢表雄酮(DHEA-S)在多囊卵巢综合征(PCOS)中的水平及与胰岛素抵抗的相关性。方法选取2019年4月至2021年4月在秦皇岛市第一医院生殖医学科就诊治疗的PCOS患者130例作为研究对象(PCOS组),选择同期在该院接受体检的健康女性100例作为健康对照组。又根据体质量指数(BMI)不同将PCOS组分为肥胖型组(50例)和非肥胖型组(80例)。PCOS患者接受炔雌醇环丙孕酮和二甲双胍治疗。采用血糖仪测量所有参与研究人员的空腹血糖水平,化学发光法测量DHEA-S水平、酶联免疫吸附法检测和肽素和Ghrelin水平。比较PCOS组、健康对照组的基线资料及PCOS肥胖型组、非肥胖型组治疗前后与健康对照组的和肽素、Ghrelin、DHEA-S及胰岛素抵抗指数(HOMA-IR)水平,并分析PCOS患者和肽素、Ghrelin、DHEA-S水平与HOMA-IR的相关性。结果PCOS组、健康对照组的年龄、BMI分布、血脂水平、血压水平等比较均无显著性差异(P>0.05)。PCOS肥胖型组患者治疗前和肽素、DHEA-S及HOMA-IR水平显著高于健康对照组和PCOS非肥胖型组(P<0.05),而Ghrelin水平显著低于健康对照组和PCOS非肥胖型组(P<0.05)。PCOS组患者治疗后和肽素、DHEA-S与HOMA-IR水平显著低于治疗前,而Ghrelin水平显著高于治疗前(P<0.05),且PCOS非肥胖型组患者各指标改善情况显著优于PCOS肥胖型组(P<0.05)。Pearson相关性分析显示,PCOS患者治疗前和肽素、DHEA-S水平与HOMA-IR呈显著正相关(P<0.05),Ghrelin水平与HOMA-IR呈显著负相关(P<0.05)。结论PCOS患者和肽素、DHEA-S高表达,Ghrelin低表达,且与HOMA-IR显著相关,可能为临床PCOS的诊断和治疗提供参考。

Effect of endogenous insulin-like growth factor and stem cell factor on diabetic colonic dysmotility

AIM: To investigate whether the reduction of stem cell factor (SCF) is mediated by decreased endogenous insulin-like growth factor (IGF)-1 in diabetic rat colon smooth muscle. METHODS: Sixteen Sprague-Dawley rats were randomly divided into two groups: control group and streptozotocin-induced diabetic group. After 8 wk of streptozotocin administration, colonic motility function and contractility of circular muscle strips were measured. The expression of endogenous IGF-1 and SCF was tested in colonic tissues. Colonic smooth muscle cells were cultured from normal adult rats. IGF-1 siRNA transfection was used to investigate whether SCF expression was affected by endogenous IGF-1 expression in smooth muscle cells, and IGF-1 induced SCF expression effects were studied. The effect of high glucose on the expression of endogenous IGF-1 and SCF was also investigated. RESULTS: Diabetic rats showed prolonged colonic transit time (252 ± 16 min vs 168 ± 9 min, P < 0.01) and weakness of circular muscle contraction (0.81 ± 0.09 g vs 2.48 ± 0.23 g, P < 0.01) compared with the control group. Endogenous IGF-1 and SCF protein expression was significantly reduced in the diabetic colonic muscle tissues. IGF-1 and SCF mRNA expression also showed a paralleled reduction in diabetic rats. In the IGF-1 siRNA transfected smooth muscle cells, SCF mRNA and protein expression was significantly decreased. IGF-1 could induce SCF expression in a concentration and time-dependent manner, mainly through the extracellular-signal-regulated kinase 1/2 signal pathway. High glucose inhibited endogenous IGF-1 and SCF expression and the addition of IGF-1 to the medium reversed the SCF expression. CONCLUSION: Myopathy may resolve in colonic motility dysfunction in diabetic rats. Deficiency of endogenous IGF-1 in colonic smooth muscle cells leads to reduction of SCF expression.

Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes

Objective To examine the association between serum uric acid levels and cardiovascular disease risk among individuals without diabetes.Methods We investigated the association between serum uric acid levels and the risk of prevalent cardiometabolic diseases, 10-year Framingham risk for coronary heart disease, and 10-year risk for atherosclerotic cardiovascular diseases （ASCVD） among 8,252 participants aged 〉 40 years without diabetes from Jiading district, Shanghai, China.Results Body mass index, waist circumference, blood glucose, glycated hemoglobin, blood pressure, and serum lipids increased progressively across the sex-specific quartiles of uric acid （all P trend 〈 0.05）. Compared with individuals in the lowest quartile, those in the higher quartiles had a significantly higher prevalence of obesity, hypertension, and dyslipidemia （all P trend 〈 0.05）. A fully adjusted logistic regression analysis revealed that individuals in the highest quartile had an increased risk of predicted cardiovascular disease compared with those in the lowest quartile of uric acid. The multivariate adjusted odds ratios （ORs） [95% confidence intervals （C/s）] for the highest quartiles for high Framingham risk were 3.00 （2.00-4.50） in men and 2.95 （1.08-8.43） in women. The multivariate adjusted ORs （95% C/s） for the highest quartile for high ASCVD risk were 1.93 [1.17-3.17） in men and 4.53 （2.57-7.98） in women.Conclusion Serum uric acid level is associated with an increased risk of prevalent obesity, hypertension, dystipidemia, 10-year Framingham risk for coronary heart disease, and lO-year risk for ASCVD among Chinese adults without diabetes.

Investigation of scale efect for the computation of turbulent flow around a circular cylinder

In order to investigate the scale effect of turbulent flow around a circular cylinder, two similarity numbers （criteria） based on turbulent kinetic and dissipation rates associ- ated with the fluctuation characteristics of turbulence wake are deduced by analyzing the Reynolds averaged NavierStokes equations （RANS）. The RNG k-s models and finite volume method are used to solve the governing equations and the second-order implicit time and upwind space discretization algorithms are used to discrete the governing equations. A numerical computation of flow parameters around a two-dimensional circular cylinder with Reynolds numbers ranging from 102 to l07 is accomplished and the result indicates that the fluctuation of turbulence flow along the center line in the wake of circular cylinder can never be changed with increasing Reynolds numbers when Re ≥ 3 × 10^6. This conclusion is useful for controlling the scale of numerical calculations and for applying model test data to engineering practice.

Unusual tunability of multiferroicity in GdMn_2O_5 by electric field poling far above multiferroic ordering point

The multiferroicity in the RMn_2O_5 family remains unclear, and less attention has been paid to its dependence on high-temperature(high-T) polarized configuration. Moreover, no consensus on the high-T space group symmetry has been reached so far. In view of this consideration, one may argue that the multiferroicity of RMn_2O_5 in the low-T range depends on the poling sequence starting far above the multiferroic ordering temperature. In this work, we investigate in detail the variation of magnetically induced electric polarization in GdMn_2O_5 and its dependence on electric field poling routine in the high-T range. It is revealed that the multiferroicity does exhibit qualitatively different behaviors if the high-T poling routine changes, indicating the close correlation with the possible high-T polarized state. These emergent phenomena may be qualitatively explained by the co-existence of two low-T polarization components, a scenario that was proposed earlier.One is the component associated with the Mn^(3+)–Mn^(4+)–Mn^(3+) exchange striction that seems to be tightly clamped by the high-T polarized state, and the other is the component associated with the Gd Mn^(3+)–Mn^(4+)–Mn^(3+) exchange striction that is free of the clamping. The present findings may offer a different scheme for the electric control of the multiferroicity in RMn_2O_5.

The Ultraviolet Detection of Corona Discharge in Power Transmission Lines

Corona discharge is a common phenomenon in power transmission lines external insulation, and it may cause serious defect if without effective detection. The ultraviolet (UV) imagery technology has been widely used to detect the corona discharge in industry in recent years, but some influence factors’ functions are not definite. In this paper, the fracture aluminum strands which is common in power transmission lines were used as the electrode model while a SuperB ultraviolet imager were utilized to detect, the photon count rate was detected with different detect distance, electric field, aluminum strands length and UV gain were applied. Then the multivariate regression analysis (MRA) was taken to calculate the function between the photon count and the factors.

省域国土空间生态修复规划体系构建的逻辑与实践——基于“规划—设计—治理”的视角

国土空间生态修复是推进国土空间治理的重要手段,厘清其规划体系的构建逻辑对于国土空间生态修复规划的编制实施和作用发挥至关重要。从需求层次出发,阐明国土空间生态修复规划体系构建的基本逻辑,以浙江省为例,探索建立省域国土空间生态修复规划体系构建的理论。研究表明:(1)国土空间生态修复规划在需求层面上可体现为“功能修复—韧性提升—价值实现”3个层次。(2)围绕着“整体规划—深化设计—系统治理”的逻辑,提出国土空间生态修复规划作为专项规划的体系构建逻辑。(3)基于构建逻辑,将省域国土空间生态修复规划梳理形成“编制—实施—支撑”3个体系。国土空间生态修复规划要从需求层次变化的认识入手,以维护生态安全、提升空间价值为目标,在省域范围内通过纵向传导、横向深化及全流程支撑3个维度构建规划体系,为系统化开展国土空间生态修复工作探索实施路径。

积极老龄化视角下老年人心理服务体系建设路径研究

随着我国人口老龄化进程的逐步加快,老年人的心理健康状况被广泛关注,推进老年心理健康服务体系研究与建设,有助于实现积极老龄化。近年来,我国高度重视社会心理服务体系建设,但在实际推进中遇到了种种难题和瓶颈,且缺乏针对老年人等特殊群体的服务制度体系建设。根据我国老年人心理服务体系建设过程中存在的问题以及路径进行探析,提出未来应从明确责任主体和权责分工、健全运行机制、明确定位、创新服务模式、建设专业化人才队伍、建立健全评估和激励机制等方面进行进一步探索,以期为积极老龄化视角下建立符合我国实际的老年人心理服务体系建设路径提供新思路。

田耀洲教授辨治慢性萎缩性胃炎经验采撷

慢性萎缩性胃炎(CAG)是消化系统常见病,具有病情反复、缠绵难愈的特点。病理主要以胃腺体的萎缩、伴或不伴有肠上皮化生或异型增生为特征。肠上皮化生和异型增生属于癌前病变,与胃癌的发生关系密切,积极控制CAG患者的临床症状,延缓其病理进展或逆转其病理变化,有利于改善患者的生活质量、减轻经济负担及预防胃癌发生。田耀洲教授认为此病属本虚标实,脾胃虚弱是本,气滞、湿郁、瘀血为标,虚、滞、湿、瘀相互胶结推动着疾病的进展,在辨证上推崇微观与宏观相结合,用药上推崇中西医结合,并擅用经方与药对,精准辨治与用药。田教授开创的自拟方剂芪芝方,疗效显著,可有效改善脾胃湿热型CAG的临床症状。今将田教授辨治CAG之经验及自拟方剂分享给大家,以期为临床辨治CAG提供参考借鉴。

吐哈盆地台北凹陷中侏罗统西山窑组深层煤岩气地质特征与勘探潜力

深层煤岩气是吐哈盆地油气勘探的新领域,但研究程度相对较低。基于煤岩测试与基础资料,系统研究了吐哈盆地台北凹陷中侏罗统西山窑组煤层分布、煤岩煤质、储层物性、宏微观煤岩、煤储层气源及煤岩等温吸附特征,揭示了煤岩储层含气性及其影响因素,提出了深层煤岩气形成富集条件,建立了深层煤岩气富集成藏模式,预测了台北凹陷煤岩气勘探潜力。结果表明:(1)台北凹陷深层侏罗系西山窑组煤层分布广、厚度大,为中低阶、原生结构、割理发育的低灰、低水、富镜质组煤层;(2)煤储层孔渗较高且受埋深影响不明显,煤层段气测异常普遍且储层吸附性能中等—好,具有游离气与吸附气共存、试采快速见气、气组分齐全等特征;(3)台北凹陷煤岩气的油气供给充注,可以形成正向构造带“调整型”和斜坡及洼陷区“自生自储型”两种成藏模式;(4)台北凹陷煤岩气资源丰富,西山窑组主煤层煤岩气资源量近3×10^(12)m^(3)。根据煤岩气资源丰度、煤层厚度、含气量、保存条件等综合评价优选出温吉桑构造带、小草湖南斜坡为深层煤岩气勘探有利目标区。

情绪效价和动机强度对社会分享型提取诱发遗忘的影响

在互动提取过程中,说话者选择性地提取目标信息,会导致听者对非目标信息的遗忘,这被称为社会分享型提取诱发遗忘。本研究基于情绪、动机与记忆之间的密切联系,探索在互动提取范式中,情绪效价与情绪动机维度对社会分享型提取诱发遗忘的影响。实验1通过操纵情绪效价与项目类型,考察情绪效价对社会分享型提取诱发遗忘的影响;实验2通过操纵积极情绪效价下的动机维度与项目类型,考察积极情绪动机维度对社会分享型提取诱发遗忘的影响。结果发现,在积极情绪(和中性情绪)条件下会产生社会分享型提取诱发遗忘,消极情绪条件下则不会;且高趋近动机积极情绪条件下的社会分享型提取诱发遗忘效应量大于低趋近动机积极情绪。以上结果为了解情绪效价及相应的动机维度对社会分享型提取诱发遗忘的影响提供了实证依据,在社会互动任务中检验了情绪与动机影响记忆表现的关键作用。

2013—2021年山东省滕州市缺血性卒中死亡率时间趋势分析

目的分析2013—2021年山东省滕州市户籍居民在高血压防控期间缺血性卒中(IS)死亡率的时间趋势。方法2013年1月1日山东省滕州市开始高血压防控,采用2013年1月1日至2021年12月31日IS死亡病例监测数据统计IS死亡率,分析其在不同特征居民中的时间趋势。户籍人口来源于山东省滕州市公安局,以2020年全国第7次人口普查数据计算年龄和性别标化死亡率。采用χ2检验比较死亡率差异,采用Cochran-Armitage趋势检验比较死亡率的时间趋势和年龄趋势。结果滕州市2013—2021年IS总体粗死亡率和标化死亡率均呈现时间变化趋势(Z值分别为12.647、7.305,均P<0.001),2021年比2019年分别下降了23.77%和30.99%(Z值分别为-7.393、-9.975,均P<0.001)。男性IS粗死亡率2019年比2017年升高了13.27%,女性IS粗死亡率和标化死亡率2018年比2017年分别下降了16.39%和19.49%,差异均有统计学意义(χ2值分别为7.160、9.789和15.109,均P<0.05);除2013、2015年IS粗死亡率外,其余年份男性IS粗死亡率和各年份标化死亡率均高于女性,差异均有统计学意义(χ2值为25.816~124.040,均P<0.001)。各年份IS粗死亡率均随年龄段增加而升高(Z值为42.604~61.025,均P<0.001)。年龄≥65岁IS死亡比例为85.85%。男性45~54岁年龄别IS粗死亡率呈时间变化趋势(Z=3.035,P<0.01),而同年龄段女性未呈时间变化趋势(P>0.05)。城区IS死亡率由2013年的62.61/10万下降到2021年的54.00/10万(Z=-2.097,P<0.05)。农村IS死亡率2019年比2013年升高了213.15%,2021年比2019年下降了22.75%(Z值分别为19.074、-6.390,均P<0.001)。结论2013—2021年,山东省滕州市IS死亡率城区呈下降趋势,农村2019年后呈下降趋势;相较于女性,男性45~54岁年龄段死亡率有年轻化趋势。应对男性和农村IS患者给予重点关注。

一款紧凑型磁谱仪的特性参数分析与实验刻度研究

超短脉冲激光与靶相互作用可产生高能电子以及质子、离子、X/γ射线等次级粒子和射线,这些粒子和射线在惯性约束聚变、激光核物理、实验室天体物理、生物、医学以及材料科学等领域具有广泛的应用前景。高能电子的特征参数测量对理清激光等离子体相互作用过程、优化粒子参数和拓展其应用具有重要意义。本文研究设计了一款紧凑型矩形结构磁谱仪,在永磁铁均匀场中采用前、侧、后三面IP板布局,满足了几十keV到10 MeV的电子能谱测量需求,并对磁谱仪的特征参数如能量色散、能量色散梯度、能量分辨率、斜入射效应等进行详细分析。基于北京大学DC-SRF-Ⅱ射频超导光阴极电子枪开展了磁谱仪能量刻度实验,在真空条件下实验测量了0.7~1.8 MeV区间内多个能量的电子能谱,结果显示,磁谱仪的能量测量与监测系统结果基本符合。电子能谱的能量分辨率主要决定于磁谱仪自身分辨能力,为提高能量分辨率,需通过准直系统进一步减小入射孔径和电子发散角。

基于政策工具、政策目标和政策力度三维分析框架的我国大病保险政策文本分析

目的探讨我国大病保险政策内部结构的均衡性及各维度间的匹配性,为我国大病保障制度的编制与优化提供理论依据。方法基于政策工具、政策目标、政策力度三维分析框架,采用内容分析法和政策文献量化分析法,对我国2012—2022年颁布的大病保险相关政策文件文本进行多维分类和交叉分析。结果政策工具维度中,政策工具运用失衡,内部结构差异较大;政策目标维度中,政策目标有所侧重,但规范监管考核仍需进一步强化,且整体协同性不足;政策力度维度中,政策力度围绕着总体平均效力上下波动幅度不大,呈现波浪式前进的趋势。结论目前,我国大病保险政策在组织建设和人才培养方面的使用频率明显过低,规范监管考核的政策目标占比也较低,且多部门共治支撑各政策目标有效实现的格局尚未普遍形成,政策整体协同性有待进一步提高。建议统筹协调大病保险政策工具的运用,调整内部结构并完善政策目标的结构,加强监管考核的规范力度,以提高政策体系的协调性,优化实施效果。

超声介入治疗自体动静脉内瘘狭窄的效果评估与分析

目的研究超声引导下经皮腔内血管成形术(PTA)治疗自体动静脉内瘘(AVF)狭窄的临床效果。方法选取2020年9月至2023年9月赣州市人民医院收治的68例自体AVF狭窄患者作为研究对象,根据随机数字表法分为对照组(n=34)和观察组(n=34)。对照组予以数字减影血管造影(DSA)引导下PTA治疗,观察组采用超声引导下PTA治疗,比较两组的临床手术指标,比较两组治疗前后的AVF狭窄处超声测量指标[血管内径、横断面积、收缩期峰值流速(PSV)、自然血流量],比较两组治疗前后的炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]水平,并比较两组的并发症发生率。结果观察组的手术时间、住院时间均短于对照组,内瘘通畅率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的血管内径、横断面积及自然血流量均大于本组治疗前,PSV慢于本组治疗前,差异有统计学意义(P<0.05);且观察组治疗后的血管内径、横断面积及自然血流量大于对照组,PSV慢于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的hs-CRP及IL-6水平均低于本组治疗前,且观察组的hs-CRP及IL-6水平均低于对照组,差异有统计学意义(P<0.05)。观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论超声引导下PTA是自体AVF狭窄的首选治疗方式,可以术中直接评估疗效,更好地改善内瘘通畅率及自然血流量,调节炎症因子,降低并发症风险,还可以避免对比剂和射线伤害,较DSA引导下PTA疗效更佳,值得推广。

多媒体与翻转课堂联合教学模式在心血管内科临床见习教学中的应用研究

目的探讨多媒体与翻转课堂联合教学模式在心血管内科临床见习带教中的应用效果。方法选取2022—2023年西安交通大学第二附属医院心血管内科接收的临床见习生共计100名作为研究对象,随机分为实验组与对照组,其中对照组接受传统见习带教模式,实验组接受多媒体联合翻转课堂见习带教模式。选取出科考试成绩、综合能力水平、满意度作为观察指标,P<0.05表示差异具有统计学意义。结果与对照组比较,实验组的各项观察指标提示该模式的教学效果更加理想,差异具有统计学意义(P<0.05)。结论在心血管内科临床见习带教中应用多媒体联合翻转课堂教学模式,相比传统见习带教模式更有助于提升学生的考试成绩、综合能力及见习体验。