NLR在AECOPD合并肺动脉高压患者中的临床意义

目的:探讨中性粒细胞/淋巴细胞比值(NLR)在评估慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压患者病情严重程度中的价值。方法:选取2014年9月-2016年12月于甘肃省人民医院呼吸科就诊的AECOPD患者78例、COPD稳定期患者23例。根据肺动脉压力将AECOPD患者分为AECOPD组合并肺动脉高压组47例(A组)、单纯AECOPD组31例(B组);COPD稳定期患者为C组。同时将A组细分为合并轻度肺动脉高压组14例(A1组)、中度肺动脉高压组18例(A2组)以及重度肺动脉高压组15例(A3组)。比较A、B、C组间NLR、PaO_2、PaCO_2的差异,比较A1、A2、A3组间NLR、PaO_2、PaCO_2水平的差异,并分析NLR水平与肺动脉压、PaO_2、PaCO_2的相关性。结果:A组NLR、PaCO_2水平均明显高于B、C组,B组NLR、PaCO_2水平均高于C组,比较差异均有统计学意义(P<0.05);A组PaO_2水平均明显低于B、C组,B组PaO_2水平高于C组,比较差异均有统计学意义(P<0.05);A3组NLR、PaCO_2明显高于A2、A1组,比较差异均有统计学意义(P<0.05);A3组PaO_2明显低于A1、A2组,比较差异均有统计学意义(P<0.05);A2组PaO_2水平低于A1组,A2组PaCO_2水平高于A1组,比较差异均无统计学意义(P>0.05)。AECOPD合并肺动脉高压患者NLR水平随着肺动脉压力的增加而增高,NLR水平与肺动脉压、PaCO_2呈正相关(r=0.589,0.682),与PaO_2呈负相关(r=-0.447)。结论:NLR可成为反映AECOPD合并肺动脉高压患者病情严重程度的重要指标,NLR水平有助于判断患者病情的变化。     

不同临床类型慢性阻塞性肺疾病患者营养状态及炎症因子差异分析

目的:观察和分析不同临床类型慢性阻塞性肺疾病患者营养状态以及炎症因子的差异。方法:选取2012年1月-2015年12月本院呼吸科收治的肺气肿型慢性阻塞性肺疾病患者80例(急性期40例,稳定期40例)设为A组;支气管炎型慢性阻塞性肺疾病患者76例(急性期38例,稳定期38例)设为B组;同时选取本院健康体检者60例作为对照组。测定三组患者营养状态的各项指标:三头肌皮褶厚度、白蛋白、淋巴细胞计数、上臂中部臂围;采用放射免疫方法检测三组患者的血清瘦素、趋化素细胞因子(IL-8)以及肿瘤坏死因子(TNF-α)水平;采用全自动化分析仪测定C反应蛋白(CRP)水平,比较三组患者各项指标的差异。结果:B组患者营养状态的各项检测指标均明显高于A组,差异均有统计学意义(P<0.05)。A组、B组稳定期的血清瘦素水平均明显低于对照组,差异均有统计学意义(P<0.05)。A组患者急性期与稳定期的TNF-α水平均明显高于B组和对照组,差异均有统计学意义(P<0.05)。A组、B组急性期与稳定期的IL-8水平均显著高于对照组,差异均有统计学意义(P<0.05);但A组和B组比较差异均无统计学意义(P>0.05)。A组、B组患者急性期及稳定期的CRP水平均显著高于对照组,差异均有统计学意义(P<0.05);A组和B组急性期的CRP水平均高于稳定期,差异均有统计学意义(P<0.05);A组急性期的CRP水平显著低于B组急性期,差异有统计学意义(P<0.05)。结论:在两种不同类型的慢性阻塞性肺疾病患者中营养状态、血清瘦素、TNF-α、CRP水平具有显著性差异,而IL-8水平差异不大。     

氨氯地平联合厄贝沙坦对糖尿病合并高血压的疗效及对QT离散度的影响

目的:探讨氨氯地平联合厄贝沙坦对糖尿病合并高血压的疗效,并分析其对QT离散度的影响。方法:回顾性分析2015年2月-2017年2月本院门诊收治的104例糖尿病合并高血压患者的临床资料,其中单纯接受厄贝沙坦治疗的34例为A组,单纯接受氨氯地平治疗的34例为B组,氨氯地平联合厄贝沙坦治疗的36例为C组。治疗结束后评价三组的疗效,观察治疗前后三组患者血糖、血压的变化情况,同时比较三组患者治疗前后QT离散度的变化。结果:A、B、C三组临床治疗总有效率分别为82.35%、88.24%、100%,C组显著高于A、B两组,差异均有统计学意义(P<0.05),A、B两组比较差异无统计学意义(P>0.05)。三组治疗后血糖、血压各项指标较治疗前均有显著改善,C组改善情况均显著优于A、B两组,B组降压效果显著优于A组,差异均有统计学意义(P<0.05)。治疗前,三组QT间期、校正QT间期、QT间期离散度比较,差异均无统计学意义(P>0.05),治疗后C组低于A、B两组,差异均有统计学意义(P<0.05)。结论:氨氯地平联合厄贝沙坦治疗糖尿病合并高血压的效果较好,不但能维持稳定的血糖水平,有效降压,更能帮助改善患者左心室肥厚情况,值得推广。     

中药联合经直肠超声导入抗生素治疗老年慢性细菌性前列腺炎的临床研究

目的:探讨中药联合经直肠超声导入抗生素治疗老年慢性细菌性前列腺炎的疗效。方法:选取2015年1月-2018年1月在本院住院治疗的老年慢性细菌性前列腺炎患者189例。按照随机数字表法将其分为A、B、C组,各63例。A组口服抗生素+坦索罗辛,B组行经直肠超声导入抗生素+口服坦索罗辛,C组行经直肠超声导入抗生素+口服中药,三组均2周为一个疗程,共2个疗程。比较三组临床疗效、慢性前列腺炎症状(NIH-CPSI)总评分、中医辨证总评分及前列腺液(EPS)中白细胞计数。结果:B、C组总有效率分别为72.13%和90.32%,均高于A组的54.10%,且C组总有效率高于B组,差异均有统计学意义(P<0.05);治疗后,B、C组中医辨证总评分、NIH-CPSI评分、EPS白细胞计数均低于A组,且C组上述指标均低于B组,差异均有统计学意义(P<0.05)。结论:中药联合经直肠超声导入抗生素治疗老年慢性细菌性前列腺炎,效果确切,值得推广运用。     

原发性高血压并糖尿病老年患者血压与靶器官损害的关联性研究

目的:探讨原发性高血压合并糖尿病老年患者血压与靶器官损害的关联性。方法:将本院收治的70例高血压合并糖尿病患者纳入A组,68例单纯高血压患者纳入B组,52例单纯糖尿病患者纳入C组,并将同时期的46例健康体检志愿者纳入D组。对四组患者的临床指标进行统计学分析。结果:A组患者的TC、LDL-C以及IMT水平均显著高于B、C两组;与B组比较,A组患者的24 h SBP、n SBP水平显著增高,同时24 h DBP、d DBP显著降低;A组患者的靶器官损害比例也显著高于其他组,比较差异均有统计学意义(P<0.05)。结论:原发性高血压合并糖尿病能够显著加重患者的血压变异性以及靶器官的损害程度。     

语文教学中教师在小组合作学习中的角色定位

目的:探讨慢性乙型病毒性肝炎湿热症患者的临床量化规律。方法:选取2012年1月-2013年12月高要市人民医院消化内科住院部西医诊断慢性乙型病毒性肝炎,中医辨证属于湿热证患者101例,将患者分为两组,其中慢性乙型病毒性肝炎湿偏重证者作为A组(50例),慢性乙型病毒性肝炎热偏重证者作为B组(51例),同期选取肝功能正常,未合并肝脏疾病和湿热证的健康人群作为正常组(50例),酶联免疫吸附测定法(ELISA法)检测尿液水通道蛋白2(AQP-2)、血清热休克蛋白70(HSP70)水平,同时用流式细胞仪检测外周血T淋巴细胞亚群的变化。结果:A、B组AQP-2均明显高于对照组,比较差异均具有统计学意义(P<0.05),其中A组AQP-2明显高于B组,两组比较差异具有统计学意义(P<0.05);A、B组HSP70均明显高于对照组,比较差异具有统计学意义(P<0.05),其中B组HSP70明显高于A组,两组比较差异具有统计学意义(P<0.05);A、B组CD4+、CD4+/CD8+均明显低于对照组,CD8+均明显高于对照组,比较差异具有统计学意义(P<0.05),A组和B组CD4+、CD8+、CD4+/CD8+比较差异均无统计学意义(P>0.05)。结论:慢性乙型病毒性肝炎湿热证存在AQP-2、HSP70和CD8+等指标显著增加现象,同时存在CD4+、CD4+/CD8+等指标显著降低现象,其中慢性乙型病毒性肝炎湿偏重证者AQP-2增加程度更明显,热偏重证者HSP70增加程度更明显。     

不同消化道重建方式对远端胃癌合并2型糖尿病患者术后血糖的影响

目的:探讨不同消化道重建方式对远端胃癌合并2型糖尿病患者术后血糖的影响。方法:选取本院79例远端胃癌合并2型糖尿病的患者,对其行根治性远端胃大部切除术,按消化道重建方式的不同分为三组,A组19例:毕Ⅰ式吻合;B组38例:单纯毕Ⅱ式吻合;C组22例:毕Ⅱ式吻合+空肠侧侧吻合。比较三组患者术后血糖的变化情况。结果:A组血糖治疗有效率为26.3%,B组为81.6%,C组为86.4%。B、C组术后对血糖控制的有效率均高于A组(P<0.05),而B、C组之间比较差异无统计学意义(P>0.05)。B、C组术后1、6、12个月的FPG、2 h PG、Hb Alc与A组比较差异均有统计学意义(P<0.05);而B、C组之间比较差异无统计学意义(P>0.05)。结论:毕Ⅱ式吻合能够有效控制术后的血糖,并推测前肠短路导致肠激素分泌减少可能是手术治疗糖尿病的主要原因。     

玻璃离子水门汀、光固化复合树脂、流动树脂修复牙体浅型楔状缺损的疗效性

目的:对玻璃离子水门汀、光固化复合树脂、流动树脂三种材料修复牙体浅型楔状缺损的临床疗效进行对比,并做出评价。方法:选取2010年1月-2014年5月本院口腔科门诊收治的牙体浅型楔状缺损患者90例为研究对象,将患者随机分成三组,每组各30例,分别以玻璃离子水门汀(A组)、光固化复合树脂(B组)、流动树脂(C组)作为充填材料。三组均进行1年随访,比较三组的修复成功率、材料脱落率、牙髓组织刺激症状发生率及继发龋发生率。结果:A组1年内发生材料脱落6例,B组发生4例,C组为1例,A组显著高于C组,两组比较差异有统计学意义(P<0.05),A、B组比较差异无统计学意义(P>0.05)。三组1年内牙髓组织刺激症状的发生率分别为10.0%、40.0%、3.3%,A组与C组比较差异无统计学意义(P>0.05);B组显著高于其他两组,差异有统计学意义(P<0.05)。A、B两组1年内继发龋的发生率分别为13.3%、16.7%,C组未见继发龋发生,A、B组继发龋的发生率均显著高于C组,与C组比较差异有统计学意义(P<0.05)。三组的修复成功率分别为63.3%、23.3%、86.7%,C组成功率显著高于其他两组,差异有统计学意义(P<0.05)。修复后1周三组的各项牙周指标均有明显上升,组间比较差异无统计学意义(P>0.05);修复后3个月后与修复后1周相比,B组与C组牙周指标均有明显的回落,差异有统计学意义(P<0.05);修复后6个月与3个月比较,三组的牙周指标有所上升,A组上升明显,差异有统计学意义(P<0.05),而其他两组上升幅度不明显,差异无统计学意义(P>0.05)。结论:流动树脂具有粘结度好、刺激性小、可充填牙体边缘、降低微渗率、对牙周组织损伤小等优点,修复成功率高,可在临床治疗中推广应用。     

益气活血补肾汤治疗慢性阻塞性肺疾病合并肺动脉高压气虚证

目的:探讨益气活血补肾汤干预慢性阻塞性肺疾病合并肺动脉高压气虚型老年患者的临床效果。方法:将76例慢性阻塞性肺疾病合并肺动脉高压气虚型老年患者随机分为两组,各38例,对照组予吸氧、扩张支气管、改善肺功能和肺通气、抗感染等治疗。观察组在对照组基础上加用益气活血补肾汤治疗,2个疗程(8周)后对比两组临床疗效、临床症状评分、肺功能、肺动脉压、呼吸困难指数、肝肾功能主要指标、不良反应及再次入院率。结果:治疗2个疗程(8周)后,观察组有效率为86.84%,明显高于对照组的68.42%,差异具有统计学意义(P<0.05);临床症状评分比较,观察组改善情况优于对照组,差异具有统计学意义(P<0.05);肺功能指标升高幅度、肺动脉收缩压和呼吸困难评分降低幅度,观察组均优于对照组,差异具有统计学意义(P<0.05);再次入院率情况比较,观察组明显优于对照组,差异具有统计学意义(P<0.05)。结论:益气活血补肾汤干预慢性阻塞性肺疾病合并肺动脉高压气虚型老年患者,疗效显著,能有效改善患者不适症状,提高患者肺功能,降低患者肺动脉高压和呼吸困难程度,减少复发和入院次数,提高生存质量,安全性良好。     

全科医学管理模式对老年高血压患者血压及心血管事件的应用研究

目的:探讨全科医学管理模式在控制老年高血压患者血压及减少心血管事件发生中的效果。方法:选择本院2010年1月-2013年1月收治的老年高血压患者2000例作为研究对象,采用随机数字表法将所选患者分成全科医学管理组(A组)、常规药物管理组(B组)及对照组(C组),比较干预前后三组患者血压改善情况及心血管事件发生情况。结果:干预后,三组患者的收缩压均较干预前降低,A组舒张压较干预前降低,A组血压改善情况优于B组及C组,B组收缩压改善情况优于C组,以上各项比较差异均有统计学意义(P<0.05);随访1年后三组心血管事件发生情况比较差异有统计学意义(P<0.05)。结论:全科医学管理模式可以较好的控制老年高血压患者的血压,同时可以减少心血管事件的发生。     

蓝领英雄颂

在共和国即将迎来华诞的日子里,送爽的金风送来了一个好消息耀华的熔化工技师曹宝成荣膺了第八届中华技能大奖这是整个建材行业第一次获此殊荣,这个大奖的意义非同凡响这样的评选来自人才辈出的新时代这样的表彰是全国行业工人的最高奖项在熔铸晶莹玻璃的璀璨炉火旁在锻造坚硬水泥的熊熊炉火旁在烧制建卫陶瓷的绚烂炉火旁曹宝成是万千建材工人的一个杰出代表“掌握精湛的技能,制造一流的产品,是一个技术工人对国家对现代化建材产业永远不变的承诺。”这是曹宝成的获奖感言,也是无数建材工人的心声在全世界都惊羡不已的眼神里在中国人从容自…     

有机无机结合施肥制度研究进展

笔者综述了有机肥、无机肥以及有机无机结合施肥对作物产量与品质、土壤肥力以及农田氮损失的影响以及机理,重申了有机无机结合施肥制度的优越性。认为有机无机配施过程中提供的速效养分数量和强度是影响有机物配施效果的关键因素,理想的有机无机配施是使得速效养分的数量和强度既能满足作物生长的需求,又不会引起因速效养分的流失导致的环境风险。指出在生产实践中科学的有机无机配施比例应该考虑以下几个因素,主要包括土壤基础地力水平,施肥水平,有机肥类型,气候条件等;有机无机结合施肥过程中,在保证作物需求的前提下,降低化肥的施用比例是降低活性氮损失,减轻环境负面影响的关键措施。     

Restricted Mobilities: Access to,and Activities in,Public and Private Spaces

Privatization of public spaces in the contemporary city has increased over the past few decades, but only a few studies have approached this trend from a mobility perspective. Therefore, this article seeks to make a contribution to the field by exploring two Australian examples of private spaces in the city, gated communities and shopping centres, through the ‘mobility’ lenses. The article illustrates how different mobility systems enable and/or restrict public access to private–public spaces, and it points out that proprietary communities create an unequal potential for human movement and access in the city. The main argument in the article is that many mobility systems enable specialization of places that are targeted at a special section of the population. This means that various forms of mobilities (e.g. automobility, virtual mobile communication technologies) not only create new opportunities for urban life, but also serve as one of the most critical components in the production of new exclusion and stratification. In conclusion, the article therefore suggests that future urban research and planning also need to apply the mobility perspective in order to understand the mechanisms between flows of movement and the understanding fixed spaces in the cities, and how different mobility systems play an important role in sustaining the exclusiveness that often characterizes private/public spaces. Likewise, from a mobility perspective, the specific consequences that the proprietary communities have on the surrounding communities seem to be an important further question for research and planning.     

Economics,ideology, and the creation and performance of state-owned electricity utilities in Australia, 1900 to 1950

This paper examines the factors that contributed to the evolving structure and ownership of the electricity industry in Australia in the inter-war and immediate post-World War II period. It details how the industry developed in the Australian states from the latter part of the 19th century through the first half of the 20th century. In examining the industry's transformation, network effects, generation plant scales, and the influence of the conflicting ideologies of socialism versus private ownership are considered. It then provides an assessment of the impact the changes in structure collectively had on the industry's performance during this period.     

Challenges and responses to agricultural practices in Gerado area,South Wello,Ethiopia

This paper presents the results of a study in rural areas of Ethiopia into the problems facing peasant farmers and ameliorating those problems so as to produce food security. The research, using both quantitative and qualitative research methods, identified a range of social, economic and natural problems for the agricultural activity of the area. Furthermore, the shortage of draught animals, nutrient depletion and food insecurity were serious for many households. Hence, the local people used various structural and biological land management techniques and they diversified their sources of income to minimise the constraints of land degradation and the impact of food insecurity.     

Ocular,nasal, dermal and respiratory symptoms in relation to heating,ventilation, energy conservation,and reconstruction of older multi-family houses

The aim was to study relationships between symptoms compatible with the sick building syndrome, type of heating and ventilation system, energy saving, and reconstruction in older dwellings. In Stockholm, 4815 inhabitants in 231 multi-family buildings built before 1961 were randomly selected, of whom 3241 participated (77%). Symptoms and personal factors were assessed by a postal questionnaire. Independent information on building characteristics, and energy saving measures was gathered from the building owners. Multiple logistic regression analysis was applied to calculate odds ratios (OR) adjusting for age, gender, hay fever, current smoking, population density, type of ventilation, type of heating system, and ownership of the building. Subjects in buildings with a mechanical ventilation system had less ocular and nasal symptoms (OR = 0.29-0.85). Heating by electric radiators, and wood heating was associated with an increase of most symptoms (OR = 1.18-1.74). In total, 48% lived in buildings that had gone through at least one type of reconstruction or energy saving remedies during the latest 10 years, including exchange of heating or ventilation system, and sealing measures (exchange of windows, sealing of window frames, roof/attic insulation, and phasade insulation). Energy saving was associated with both a decrease and increase of different symptoms. Major reconstruction of the interior of the building was associated with an increase of most symptoms (OR = 1.09-1.90), and buildings with more than one sealing measure had an increase of ocular, nasal symptoms, headache and tiredness (OR = 1.22-2.49). In conclusion, major reconstruction of the interior, direct heated electric radiators, wood heating, and multiple sealing of buildings were associated with an increase of some symptoms. The study supports the view that mechanical ventilation in dwellings is beneficial from a health point of view.     

Lead,cadmium, and arsenic residues in animal tissues in relation to those in their surrounding habitat

The relationships of the residues of lead, cadmium, and arsenic in animal tissues to those in surrounding vegetation and soil were determined in a natural habitat representing a wide range of such residues. The samples studied were selected from 18 different locations. Analyses were performed on a total of 113 animals, 332 plant specimens (representing 33 species), and 408 soil samples (taken at different depths). For the purpose of evaluating relationships, the samples from each location were averaged and reported as parts per million on a dry weight basis. The average lead residues from different locations ranged from 1.4–9.2 ppm in the liver, 45–195 in bones, 4–283 in vegetation, and 15–1399 in soil samples. The cadmium contents ranged from 1–27 ppm in the liver, 3–77 in bones, 0.5–5 in vegetation, and 1–10 in soil. The arsenic contents in different components of the ecosystem varied with an average of 1–9 ppm in liver, 0.6–94 in vegetation, and 7–655 in soil samples. The soil residues varied considerably according to the depth of sampling. Little variation was noted in different species of vegetation or in soil and vegetation samples according to the time and year of sampling.Statistical analyses performed on the averages indicated a significant correlation between vegetation and soil residues for all three elements, and also between animal to vegetation and animal to soil cadmium residues. Multiple linear correlations for all elements in soil, vegetation, and animal tissues were determined. The results indicated a possibility of an increase in cadmium in animal tissues depending upon the increased residues of this metal in the environment.     

Diatom assemblages distribution in catalan rivers, NE Spain, in relation to chemical and physiographical factors

Distribution patterns of epilithic diatom assemblages in streams in northeastern Spain and their relation to different environmental gradients are presented. Thirty-five sites were sampled covering a wide range of fluvial typologies. Gradient analysis was used to analyze the community structure and the major ecological gradients underlying variation in species composition. Two major gradients were evident; the first was a complex gradient from oligotrophic, pristine, fast-flowing highland rivers to mainly eutrophic rivers of low elevation; and the second related to altitudinal and seasonal variation of temperature. Two sets of factors were evident; one was associated with water chemistry, and the other to seasonal and physiographical variation. Variance partitioning allowed the separation of the effects of the different sets of environmental parameters. The contribution of physiography and water chemistry to diatom distribution was more unclear when the level of disturbance was intermediate. Considering the relatively high proportion of variation explained by physiographical variables alone, we suggest that when using diatoms to evaluate water quality, ecoregional characteristics of river stretches should also be considered.     

Onset of mucosal, dermal, and general symptoms in relation to biomarkers and exposures in the dwelling: a cohort study from 1992 to 2002

We examined the associations between biomarkers of allergy and inflammation, indoor environment in dwellings, and incidence and remission of symptoms included in the sick building syndrome (SBS) and changes in the home environment of 452 adults who were followed from 1992 to 2002 within the Uppsala part of the European Community Respiratory Health Survey (ECRHS). The 10-year incidence (onset) of general, mucosal, and dermal symptoms was 8.5%, 12.7%, and 6.8%, respectively. Dampness or indoor molds at baseline was a predictor of incidence of general (relative risk [RR] = 1.98), mucosal (RR = 2.28), and dermal symptoms (RR = 1.91). Women had higher incidence of general (RR = 1.74) and mucosal symptoms (RR = 1.71). Indoor painting increased the incidence of general symptoms (RR = 1.62). Bronchial responsiveness (BR), eosinophil counts in blood, total IgE and eosinophilic cationic protein (ECP) in serum at baseline were predictors of incidence of SBS. At follow-up, BR, total IgE, and C-reactive protein (CRP ) were associated with increased incidence of SBS. Moreover, subjects with doctor-diagnosed asthma at baseline had a higher incidence of general (RR = 1.65) and mucosal symptoms (RR = 1.97). In conclusion, female gender, dampness or indoor molds, indoor painting, and biomarkers of allergy and inflammation were associated with a higher incidence of SBS symptoms, in particular mucosal symptoms. PRACTICAL IMPLICATIONS: The focus in Sweden on indoor environment issues over the last few decades has resulted in improvements in dwellings, and reduced tobacco smoking, which could be beneficial for public health. Reducing dampness and molds in the dwelling place is another important way of reducing occurrence of SBS symptoms in the general adult population. The association between the incidence of SBS symptoms and clinical biomarkers of allergy and inflammation suggests a common etiology between inflammatory diseases, including asthma, rhinitis, and SBS. Lastly, good agreement between self-reported and clinically diagnosed atopy indicates that questionnaire data on atopy can be used in epidemiological studies.