基诺族自杀和自杀未遂的10年随访调查

目的 调查云南省基诺山基诺族近10年内(1999年至2009年)的自杀死亡及自杀未遂的发生率及其发生特点.方法 采取整群随机抽样的方法,对云南省基诺山44个基诺族自然村共10 610人采取线索与入户调查相结合的方法,收集其自杀死亡和自杀未遂者的人口学资料.结果 基诺山基诺族近10年的年平均自杀死亡的发生率为30.16/10万,年平均自杀未遂的发生率为4.71/10万.结论 基诺族的自杀死亡率高于全国总人口的平均水平;自杀未遂的发生率低于全国总人口的平均水平.

Abstract：

Objective To investigate the recent decade (1999 to 2009) incidence of committed suicide and attempted suicide of the Jinuo nationality in Jinuo Mountain and study the clinical characteristics of it. Methods 10 610 subjects at 44 Jinuo villagers committees were investigated by the method of door-to-door inquiry under the help of clues and collected the data of larithmics and medical history. Results 32 committed suicide patients were found in total, and the average incidence rate per year in the recent decade was 30. 16/100 000. 5 attempted suicide patients were found and the average incidence rate per year in the recent decade was 4.71/100 000. Conclusion The Jinuo committed suicide incidence rate is higher than nationwide level. The attempted suicide incidence rate is lower than nationwide level.     

Prognosis of the short-term efficacy of thymectomy for myasthenia gravis with serum protein profiles

Background The extended thymectomy for myasthenia gravis （MG） is currently available, but in 20%-40% of the patients the results were not satisfactory. There are no ideal indicators forecasting surgical results before operation. The surface enhanced laser desorption ionization-time of flight-mass spectroscopy （SELDI-TOF-MS） is a currently new technique for detection of protein profiles, and some progresses have been made in cancer diagnosis and efficacy evaluation, but there is no report on efficacy forecasting of MG surgery. This study aimed to establish an efficacy prognosis model for forecasting the efficacy of surgery for MG by analysis of serum protein profiles of MG patients before surgery. Methods Fifty-six MG patients 6 months after extended thymectomy were enrolled in the study. They were classified into effective or non-effective groups according to symptoms and medication. Their pre-operative blood samples were analyzed for protein profiles by the SELDI-TOF MS technique, and protein peaks were identified for establishment of the efficacy prognosis model of MG surgery. Additional 100 MG patients were subjected to model validation and their pre-operation protein profiles reviewed for post-operative results. The results were compared with those of the post-operative follow-up so as to validate the prognosis model. Results For the model establishment, symptoms were improved in 33 patients and not improved in 18 patients, with an effective rate of 64.7%. Five （8.9%） patients were lost to follow-up. Within the molecular weight range of 1 000 to 20 000, 3 specific protein peaks were found to be significantly different between the effective and non-effective groups, ie M4110-76, M3394-58, and M1258-55. Using the efficacy prognosis model constructed with these data, the accuracy rate of classification was 87.9% for the effective group, and 83.3% for the non-effective group, with a total accuracy rate of 86.3%. For the model evaluation, 2 （8.9%） patients were lost to follow-up, 62 patients were effective and 36 were non- effective. By comparing with the real results of follow-up with 65 effective and 33 non-effective patients with an effective rate of 66.3%, the accuracy rate of prediction by the prognosis model was 86.2% for the effective group, and was 81.8% for the non-effective group with a total accuracy rate of 84.5%. Conclusions By protein profiles analysis of pre-operative blood samples taken from MG patients with the SELDI-TOF MS technique, protein peaks correlated with surgery efficacy in MG patients can be found for primary forecasting short-term efficacy of surgery for MG patients.     

脉血康胶囊对PCI术后急性冠脉综合症患者长期预后的改善作用

Objective:To study the changes of adenosine diphosphate(ADP)-induced platelet aggregation rate,and evaluate the effects of Maixuekang Capsule(脉血康胶囊,MKC) on platelet aggregation rate and long-term prognosis of patients with acute coronary syndrome after percutaneous coronary intervention(PCI).Methods:A total of 236 patients with acute coronary syndrome,who received successful PCI,were randomly assigned to a trial group(116 cases) and a control group(120 cases) according to random numbers;treatment allocation occurred when the participants met the inclusion criteria and signed the informed consent forms.In the trial group,the patients were treated with MKC combined with routine medication,and in the control group the patients were treated with routine medication.The therapeutic course for the two groups was 12 months and the follow-up was 12 months.The levels of ADP-induced platelet aggregation rate and serum high-sensitive C-reactive protein(hs-CRP) were determined before PCI,12 h and 30 days after PCI.In the meantime,the incidence of cardio-/cerebrovascular events was recorded during the 12-month follow-up.Results:Compared with before PCI,the levels of ADP-induced platelet aggregation rate and serum hs-CRP were significantly higher at 12 h after PCI(P0.05).They were significantly reduced after 30-day-treatment of MKC,showing statistical differences when compared with those in the control group(P0.05).During the 12-month follow-up,the incidence of cardio-/cerebrovascular events was significantly lower in the trial group than in the control group(6.9%vs.12.5%,P0.01).Conclusions:ADP-induced platelet aggregation function was significantly elevated after PCI.MKC improved the prognosis of patients with acute coronary syndrome,possibly through inhibiting the platelet aggregation,fighting against inflammation,and protecting the vascular endothelial function.     

Chronic HBV Carrier’s Acceptance of Regular Surveilling Program in China

Long-term compliance with regular surveillance is important for the prevention and timely management of chronic hepatitis B (CHB). However, there are no researches focusing on the compliance of hepatitis B virus infected patients in regular surveillance so far. The purpose of our study was to investigate the outpatient compliance with long-term regular surveillance in China. Data of 3257 CHB outpatients was pooled and analyzed to assess the outpatient’s compliance with the long-term regular surveillance plan. In all outpatients, the non-follow-up and the follow-up group accounted for 73.2% and 26.8%, respectively. Among the follow-up outpatient’s, only 48.9% received ongoing-follow-up and 51.1% were finally lost to follow-up; the median length of visiting duration was 25 months; and the predictive 1-, 2-, 3-, 4and 5-year ongoing follow-up rate was 72.7%, 52.5%, 42.4%, 33.8%, and 26.3%, respectively. In conclusion, our survey proved that the regular long-term surveillance on Chinese chronic HBV carrier is difficult to be fully implemented. A large proportion of outpatients do not receive routine follow-up and are at risk of treatment delay due to various social reasons.     

FACTORS RELATED TO LONG-TERM EFFEGTS OF THYMECTOMY ON MY ASTHENIA GRAVIS

The authors report the results of long-term follow-up after thymectomy on 92 cases with myasthenia gravis (MG), including 22 cases of thymomatous MG. These patients were followed up for 6-73 months with an average of 23 months. The surgically effective rate was 88.0% and the late mortality, 6.5%. The sex of the patients and the durations of disease were not obviously related to the prognosis, however the effect of thymectomy was much better in patients aged 10-39 years than in other age groups. The modified Osserman's clinical classification, acetylcholine receptor (AchR) antibodies and citric acid extract (CAE) antibodies titers in plasma and pathological patterns of the surgical specimens of thymus including immunohistochemical observation play an important role among larious factors related to the long-term effects.     

43例胃神经内分泌癌的临床特征及根治性手术术后的预后因素分析

Background Gastric neuroendocrine carcinomas （g-NECs） are rare tumors that have aggressive biological behaviors and poor prognosis,but the prognostic factors of postoperative patients with g-NEC are still unclear.Our aim was to study and explore the clinical characteristics and prognostic factors of patients with g-NEC treated with radical surgery.Methods The clinical data of 43 g-NEC patients who underwent surgery from January 2002 to January 2011 at the Zhongshan Hospital of Fudan University were analyzed.Follow-up was conducted by telephone,mail,or returning visit survey.Results The sizes of the 43 neuroendocrine carcinomas （G3） were 1.5 cm × 1.5 cm × 0.5 cm to 7 cm × 8 cm × 1.5 cm.Eight NECs were localized,and 35 had lymph node involvement,of which 1 also had hepatic metastasis.At the end of the follow-up,the follow-up rate was 97.7％ （42/43）,and the median follow-up time was 22.2 months.The median overall survival of g-NEC patients was 36.5 months,and the 1-,3-,and 5-year overall survival rates were 86.0％,51.6％,and 36.7％,respectively.Sex （P ＜0.05） and lymph node involvement （P ＜0.05） were prognostic factors of postoperative g-NEC patients,among which sex was an independent prognostic factor （P ＜0.05）,as a survival advantage of female patients over male was observed.Conclusions Most of the g-NECs were diagnosed at an advanced stage.The prognosis of g-NECs was related with sex and lymph node involvement,of which sex was an independent prognostic factor,with female patients having a survival advantage.     

Factors related to long-term effects of thymectomy on myasthenia gravis.

The authors report the results of long-term follow-up after thymectomy on 92 cases with myasthenia gravis (MG), including 22 cases of thymomatous MG. These patients were followed up for 6-73 months with an average of 23 months. The surgically effective rate was 88.0% and the late mortality, 6.5%. The sex of the patients and the durations of disease were not obviously related to the prognosis, however the effect of thymectomy was much better in patients aged 10-39 years than in other age groups. The modified Osserman's clinical classification, acetylcholine receptor (AchR) antibodies and citric acid extract (CAE) antibodies titers in plasma and pathological patterns of the surgical specimens of thymus including immunohistochemical observation play an important role among various factors related to the long-term effects.

     

~rognostic value of baseline C-reactive protein levels in patients mdergoing coronary revascularization

Background C-reactive protein （CRP） is a lowly expressed marker for inflammatory response. This study aimed to evaluate the prognostic value of baseline CRP levels in patients undergoing coronary revascularization in the context of modern medical treatment. Methods This was a retrospective study in a single center. Four hundred and fourteen patients were enrolled, who underwent coronary revascularization and received adequate medication for secondary prevention of coronary heart disease. The study compared the follow-up clinical outcomes between high level CRP group （CRP 〉5 mg/L） and low level one. The median follow-up time was 551 days. Results Compared with low CRP group, the relative risk （RR） of the major adverse cardiovascular and cerebral events （MACCE） in high CRP group was 5.131 （95% CI： 1.864-14.123, P=0.002）. There were no significant differences in death myocardial infarction and stroke during the follow-up between two groups, but a higher risk of re-revascularization was found in high CRP group （RR 6.008, 95% CI： 1.667-21.665, P=0.006）. Cox regression analysis showed that only CRP level could contribute to MACCE during the follow-up. MACCE-free rate was much lower in high CRP group （Kaplan-Meier log-rank P 〈0.001）. Conclusion In the context of modern medical treatment, the baseline level of CRP is an independent predictor for long-term prognosis in patients with coronary revascularization.     

Urodynamic analysis and treatment of male Parkinson’s disease patients with voiding dysfunction

Background Parkinson＇s disease （PD） is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence significantly impact the patient＇s quality of life.We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction.Appropriate treatments were given to subgroups that were divided based on test results,and the changes in urodynamic parameters as well as the treatment efficacy were observed.Results Detrusor hyperreflexia without bladder outlet obstruction （BOO） was observed in 35 patients,who exhibited significant improvements in the international prostate symptom score （IPSS）,maximum flow rate （Qmax）,bladder volume at the first desire to void,post-void residual （PVR）,and bladder compliance.Detrusor hyperreflexia associated with BOO was observed in 59 patients.The patients exhibited significant improvements in IPSS,Qmax,PVR,and bladder compliance.Detrusor dysfunction without BOO was observed in 19 patients,for whom the IPSS and the bladder volume at the first desire to void were improved after treatment.Detrusor dysfunction with BOO was found in 28 patients,with no significant improvement in the urodynamic parameters after the treatment.Conclusions Urodynamic examination is recommended for male Parkinson＇s disease patients with voiding dysfunction.Early and effective treatment can improve the bladder function and quality of life of these patients.     

Applications of survival model in the prognostic research of orthostatic intolerance in children

Abstract Background: Orthostatic intolerance (OI) is a common disease at pediatric period which has a serious impact on physical and mental health of children. The purpose of this study was to investigate the effect of related factors on the prognosis of children with OI. Methods: The subjects are 170 children with OI, including 71 males (41.8%) and 99 females (58.2%) at the age from 6 to 17 (12.0±2.6) years old. The effect of related factors on the prognosis of children was studied by using univariate analysis. Then, the impact of children's age, symptom score, duration, disease subtype and treatment on patient’s prognosis was studied via analysis of COX proportional conversion model. Results: Among 170 cases, 48 were diagnosed with vasovagal syncope (VVS), including 28 cases of vasoinhibitory type, 16 cases of mixed type and 4 cases of cardioinhibitory; 115 cases were diagnosed with postural tachycardia syndrome (POTS) and 7 cases were diagnosed with orthostatic hypotension (OH). By using univariate analysis of Cox regression, the results showed that symptom score had a marked impact on the time of symptoms improvement of children after taking medication (P<0.05), while other univariate had not (P>0.05). Multivariate analysis by using Cox proportional hazards regression model showed that the symptom score at diagnosis had a significant effect on holding time of symptoms improvement of children after taking medication treatment (p<0.05). Kaplan-Meier curve showed that the symptom-free survival was higher in children with symptom score equal to 1 than that of children with symptom score equal to or greater than 2 during follow-up (p<0.05). Conclusions: Symptom score is an important factor to affect the time of symptom improvement after treatment for children with OI.     

强迫症患者人格特征与临床症状的关系

目的 探讨强迫症患者的人格特征及其与临床症状的相关性.方法 采用耶鲁-布朗强迫量表(Y-BOCS)和明尼苏达多相人格测定问卷(MMPI)对105例强迫症患者进行测试,并与中国常模对照.结果 强迫症患者的D、Hy、Pd、Pt因子标准分及男性Hs和女性Pa因子标准分均显著高于常模.强迫症患者明尼苏达多相人格测定的D、Pd与强迫思维分呈正相关;Pa、Sc、Si与强迫思维及强迫行为分均成正相关;Pt与强迫思维分、强迫行为分及强迫总分均呈正相关.结论 强迫症患者可能存在病态心理状态;强迫症患者的人格特征与其临床症状可能存在一定的相关性. Abstract： Objective To study the personality of obsessive-compulsive disorder(OCD) patients, and the relationship between the clinical symptoms and the personality of OCD patients. Methods One hundred and five OCD patients were tested with Y-BOCS and MMPI, the result was compared with the chinese normals. Results The MMPI scores of D,Hy,Pd,and Pt of OCD patients,Hs of male OCD patients and Pa of OCD female patients were significantly higher than that of the chinese normals (P<0.01). The scores of Dand Pd of OCD patients had positive correlation with the severity of obsessive thinking. The scores of Pa,Sc and Si of OCD patients had positive correlation with the severity of obsessive thinking and symptoms. Pt scores of OCD patients had positive correlation with the severity of obsessive thinking,compulsive behavior and symptoms.Conclusions OCD patients may have morbid psychology.The personality charaeteristics of the OCD patients may have positive correlation with clinical symptoms.     

四种抗体联合检测在SLE患者中的诊断价值

目的 探讨抗双链DNA(dsDNA)抗体、抗Smith(Sm)抗体、抗核小体抗体(AnuA)、抗组蛋白抗体联合检测在系统性红斑狼疮(SLE)患者中的诊断价值.方法 抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体均采用欧蒙斑点法测定98例SLE患者(分为活动期和稳定期)、90例其他结缔组织病患者及40例健康人血清中的四种自身抗体.结果 98例SLE患者中抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体阳性率分别为45.9%、 29.6%、 57.1%、33.6%,特异性分别为100%、99.2%、98.5%、89.2%;抗dsDNA抗体和AnuA在活动期SLE中的敏感性与稳定期相比差异有统计学意义(P<0.05);抗dsDNA抗体和AnuA以及四种抗体联合检测时阳性率分别为70.4%和79.6%,明显高于其中任何单项检测的阳性率,且明显高于疾病对照组,差异有统计学意义(P<0.05).结论 所检测的四种抗体在SLE中都具有很高的特异性和敏感性,其中抗dsDNA抗体和AnuA对活动期SLE具有很好的诊断价值,抗体的联合检测可较大程度提高SLE检测阳性率,四种抗体有明显的互补作用,尤其抗dsDNA抗体和AnuA的联合检测具有很好的组合价值. Abstract： Objective To investigate the diagnostic significance of combined detection of anti-double stranded DNA antibody(anti-dsDNA),anti-Smith antibody(anti-Sm)and antinuclesome antibody(AnuA) and anti-histone antibody in systemic lupus erythematosus(SLE),and evaluate the significance of combined detection of these autoantibodies in the diagnosis of SLE. Methods Ninety-eight cases of SLE patients who were divided into active and stable stage group and 90 disease controls and 40 healthy people were detected with Euro immunoblot assay.Results In the assays mentioned above. The serum positive rates of anti-dsDNA,anti-Sm, AnuA and anti-histone antibody were 45.9%,29.6%,57.1% and 33.1% in SLE, and the specificities were 100%,99.2%,98.5% and 89.2% respectively in patients with SLE.The positive rates of anti-dsDNA and AnuA in active SLE group were 57.5%,65.1%,which was apparently higher than that in the stable stage group;The sensibility of combined detection of anti-dsDNA and AnuA was 70.4%, four autoantibodies combined detection in SLE was 79.6%, which was apparently higher than any single autoantibodies, the difference had statistical significance. Conclusions These four autoantibodies have very high sensibility and specificity respectively, combined detection of four autoantibodies can markedly raise the relevance ratio in SLE, while their specificity didn't have a visual reduction. Especially, the sensibility of combined detection of anti-dsDNA and AnuA can markedly increased in active SLE patients. This compose can raise effectively the diagnosis of active SLE.So the detections of the four antibodies are complementary for the diagnosis of SLE.     

骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响

目的 探讨骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响.方法 择期下腹部、会阴部或下肢手术小儿60例,ASA I或II级.随机分为单纯气管插管组(T组),骶管阻滞复合气管插管组(CT组),骶管阻滞复合喉罩通气组(CL组),每组20例.分别于诱导前(T0)、插管即刻(T1)、手术开始(T2)、手术开始后30 min(T3)、手术开始后60 min(T4)监测心率(HR)、血压、脉搏氧饱和度、呼气末CO2分压,记录平均动脉压(MAP),中心静脉压,丙泊酚、瑞芬太尼的用量及术后不良反应的发生情况.结果 T组、CT组在T1时点MAP、HR明显高于CL组(P<0.05);CL组、CT组丙泊酚及瑞芬太尼的用量明显少于T组;CL组术后不良反应最少.结论 骶管阻滞复合全麻喉罩通气对小儿的血液动力学影响最小,不良反应少. Abstract： Objective To investigate the effects of caudal block with laryngeal mask airway(LMA) ventilation on the hemodynamics of children undergoing elective surgery under general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ children undergoing selective lower abdominal surgery were randomly divided into 3 groups (n=20):Group T:endotracheal intubation. Group CT:caudal block and endotracheal intubatio. Group CL:caudal block and laryngeal mask airway(LMA) ventilation. HR,BP,MAP,CVP,SpO2,PetCO2 were monitored during anesthesia.HR,MAP,CVP were recorded at proinduction (T0),intubation(T1),operation(T2),30 min after operation(T3) and 60 min after operation (T4).Recording the dosage of propofol,remifentanil and adverse reactions of postoperation. Results MAP,HR at T1 were significantly higher in group T and group CT than that in group CL.The dosage of propofol and remifentanil were significantly less in group CT and group CL than that in group T. Conclusions Caudal block with LMA ventilation have little side effects on hemodynamics of the children undergoing slective surgery with general anesthesia.     

压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期35例疗效观察

目的 探讨压缩雾化吸入可必特对慢性阻塞性肺疾病急性加重期的疗效和不良反应.方法 将75例患者随机分为两组,对照组30例采用常规治疗,治疗组35例在常规治疗基础上加用雾化治疗,观察两组治疗效果和解除主要症状、体征的时间和住院时间.结果 治疗组住院时间和喘憋、肺部喘鸣音的持续时间均明显短于对照组(P＜0.05).结论 压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期疗效确切,方法简便,不良反应小,值得推广. Abstract： Objective To explore the effect of compressed nebulized inhalation combivent on chronic obstructive pulmonary disease with acute exacerbation. Mehods Seventy-five patients were randomly divided into two groups,the control group(30 cases) with conventional treatment, the treatment group (35 cases) on the basis of conventional therapy plus treatment with the spray were observed lifting of the main symptoms and signs of the time and hospital stay.Results The treatment group hospitalization time and asthmatic lungs duration of wheezing were significantly shorter than the control group (P<0.01). Conclusions Compression combivent aerosol inhalation treatment of chronic obstructive pulmonary disease with acute exacerbation is simple, side effects are little and are worth promoting.     

超声引导下酒精硬化治疗肝、肾囊肿的并发症及处理方法

目的 探讨超声引导下酒精硬化治疗肝、肾囊肿所发生的并发症及处理方法.方法 回顾性分析近年所施行的肝、肾囊肿介入性酒精硬化治疗患者202例(均以无水酒精为治疗药物),其中出现并发症23例,包括出血、酒精不耐受、注入无水乙醇后无法顺利抽出、术中出现明显疼痛、操作过程中针尖脱出等.结果 22例均经对症处理,成功治疗,1例因针尖脱出,未行酒精硬化治疗,仅抽出囊液.结论 超声引导下酒精硬化治疗肝、肾囊肿是普遍采用的有效方法,但可发生少数并发症,如经早期发现并正确处理均能予以治愈. Abstract： Objective To explore the causes and treatment of the complications of alcohol sclerotherapy for hepatic and renal cysts with ultrasound-guided. Methods In recent 4 years, 202 cases of hepatic and renal cysts were treated by alcohol sclerotherapy with ultrasound-guided,among which complications were found in 23 cases by retrospective analysis. Results 22 cases were treated successfully. In 1 case, the needle was falling off from the cyst cavity, the liquid of cyst was drained out. Conclusions Alcohol sclerotherapy is a generally applied and efficient method for hepatic and renal cysts. But a few complications might occur due to different factors, which could be treated successfully if you found them early.     

低分子量肝素在胸部肿瘤合并高凝血状态病人围术期的临床应用

目的 使用低分子量肝素(LMWH)预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生.方法 对2006年1月至2007年10月我科收治的合并高凝血状态的食管癌、贲门癌、肺癌病人,在围术期皮下注射低分子量肝素,每日1次,从术前3～5 d开始直至病人下床,观察术中出血量及术后胸液量,并统计血栓性疾病发生率.结果 该组病人围术期血栓性疾病发生率得到了明显控制.结论 低分子量肝素对预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生有明显效果,安全可靠. Abstract： Objective To evaluate the efficacy of low molecular weight heparin for preventing thromboembolism disease in perioperative of thoracic tumor with blood hypercoagulabale state. Methods From January 2006 to October 2007, we diagnosed and treated 72 patients with lung cancer and carcinoma of esophagus and cardia. All the patients were treated with LMWH qd from the 3 -5 days before operation until ambulation after operation. To observe the postoperative total amount effusion and to statistic of incidence of thromboembolism disease. Results Incidence of thromboembolism disease decreased more significantly of this group than usual. Conclusions Application of LMWH for preventing thromboembolism disease in periopetive of thoracic tumor with blood hypercoagulabale state is an effective, safe and reliable treatment.     

阿托伐他汀对冠心病合并充血性心力衰竭患者血管内皮功能的影响

目的 研究阿托伐他汀对冠心病(CHD)合并充血性心力衰竭(CHF)患者血浆中一氧化氮(NO)、降钙素基因相关肽(CGRP)和内皮素(ET)的影响.方法 将68例CHD并CHF患者随机分为两组,常规治疗组(地高辛、氢氯噻嗪、硝酸异山梨酯)34例,联用组常规用药加阿托伐他汀34例,另选34例健康体健者为正常对照组.采用Greiss法测定NO水平,放射性免疫法测定治疗前后血中CGRP和ET的水平.结果 CHD并CHF患者中NO和CGRP水平明显低于正常组(P＜0.01),ET显著高于正常组(P＜0.01),治疗后均显著改善(P＜0.01),且以联用组改善更为显著,与常规组治疗后比较差异有统计学意义(P＜0.05).结论 常规用药加阿托伐他汀能显著改善CHD合并CHF患者的NO、CGRP和ET的代谢失衡. Abstract： Objective To study the effect on levels of plasma calcitonin gene-related peptide (CGRP) and endothelin(ET) of atorvastatin in patients with coronary artery heart disease(CHD) complicated with congestive heart failure(CHF). Methods Patients with CHD complicated with CHF were divided into two groups usual medicine group(usual medicine) and atorvastatin group. The plasma CGRP and ET levels were observed before and after treatment. Results The levels of CGRP in patients with CHF were lower than that in normal group before treatment (P＜0.05),and the level of ET was higher (P＜0.05),the improvement of CGRP and ET in atorvastatin group was better than that in the usual medicine group(P＜0.05). Conclusions Atorvastatin had the action of improving the imbalance of CGRP and ET in Patients with CHD complicated with CHF.     

股骨远端骨折的手术治疗

目的 观察各种内固定方法治疗股骨远端骨折的临床疗效.方法 对285例股骨远端骨折患者采用股骨髁钢板、逆行髓内钉、动力髁螺钉和单独拉力螺钉内固定治疗.结果 术后随访时间8～14个月,按Hohl评分标准判定膝关节功能活动情况.术后膝关节活动度基本恢复,无明显内外翻畸形,行走基本不受限,活动时无明显疼痛.结论 手术治疗股骨远端骨折可使骨折得到解剖复位、加强内固定,有利于关节早期活动,从而使膝关节功能得以改善,且各种内固定方法各有利弊,要根据骨折具体类型选择合适的内固定方法. Abstract： Objective To explore the value of internal fixations in the clinical treatment of distal femoral fractures.Methods Two hundred and eighty-five cases of distal femoral fractures were treated with of femoral condylar plate, retrograde intramedullary nail, dynamic condylar screw and single lag screw fixation.Results The patients were followed up for 8 to 14 months. Using Hohl scoring criteria to determine knee function activities, we found all cases regained knee activity, and there was no significant internal or external varus deformity and walking was not basically limited and there was no significant pain. Conclusions Surgical treatment can make the fractures of distal femur fractures anatomic reset and rigid fixated, so it is conducive for early ambulant of the joint and to improve the function of the knee. Each internal fixation method has its advantages and disadvantages, so we must select suitable fixation according to the type of fracture.     

曲美他嗪治疗不稳定型心绞痛

目的 探讨曲美他嗪治疗不稳定型心绞痛(UAP)的临床疗效及对内皮素(ET)、一氧化氮(NO)的表达影响.方法 随机选择UAP患者80例,入选患者被随机单盲分为曲美他嗪组40例和常规治疗组40例.观察统计两组治疗前1周和治疗结束后1周心绞痛发作次数、自拟的疼痛强度及持续时间记分值,检测治疗前后患者血浆ET和NO水平的变化.结果 曲美他嗪组和常规治疗组比较,治疗后患者疼痛发作频率、疼痛强度及持续时间记分均有明显减少,但曲美他嗪组的疗效比常规治疗组明显,差异有统计学意义(P<0.05). 两组治疗都可改善不稳定型心绞痛患者心电图ST段的偏移,但曲美他嗪组的疗效比常规治疗组显著, 差异有统计学意义(P<0.05).两组都可改善心绞痛患者心电图表现,但差异无统计学意义(P>0.05).两组患者治疗后血浆ET水平明显减低,NO水平明显升高,但曲美他嗪组比常规治疗组显著, 差异有统计学意义(P<0.01).结论 曲美他嗪组对不稳定型心绞痛患者疗效明显升高,这种疗效与改善血管内皮细胞功能有关. Abstract： Objective To observe the effects of trimetazidine on plasma concentration of endothelin(ET) and nitric oxide(NO) in patients with unstable angina pectoris(UAP).Methods Randomly selected 80 patients with unstable angina pectoris, patients were randomly divided into trimetazidine group with 40 patients, and conventional treatment group with 40 patients. The clinical effect was observed by the changes of the angina pectoris frequencies and pain period and intensity score per mean day at 1 week pro-treatment and 1 week post-treatment. Plasma concentrations of ET and NO were measured before and after the treatment.Results The frequency, intensity and duration of pain score was significantly reduced in both groups, and the effect of trimetazidine group was obvious than the conventional treatment group, the difference was statistically significant(P<0.05). The two groups can improve the treatment of unstable angina patients ECG ST section of the shift, and the effect of trimetazidine group was obvious than the conventional treatment group, the difference was statistically significant(P<0.05). Two groups of patients can improve angina and ECG, but the difference was not statistically significant(P>0.05). In the two groups, plasma ET was significantly reduced, and plasma NO was significantly elevated,the effect of trimetazidine group was obvious than the conventional treatment group, the difference was statistically significant(P<0.01).Conclusions The effects of trimetazidine on patients with unstable angina pectoris is significantly elevated, and is significantly beneficial to protect the endothelial function.     

慢性阻塞性肺疾病患者血清瘦素水平与炎性反应相关性

目的 探讨慢性阻塞性肺疾病(COPD)患者血清瘦素水平变化及其与炎性反应的关系,了解瘦素在COPD患者炎症反应过程中的作用及其意义.方法 选择COPD患者共58例,COPD急性加重期(Ⅰ组)30例,COPD缓解期(Ⅱ组)28例,正常对照组28例.测定和计算各组的多项营养指标,包括身高、体重、体重指数(BMI)、理想体重百分比(NM%)、体脂百分比(fat%).用酶联免疫吸附试验法(ELISA)测定58例COPD患者和28例正常人的血清瘦素、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、超敏C-反应蛋白(hs-CRP)水平及肺功能,分析瘦素与各项参数的相关性.结果 ①COPD患者的各营养指标:BMI、NM%、fat%均显著低于正常对照组(P<0.01).②COPD I组血清瘦素、TNF-α、IL-8、hs-CRP均显著高于正常组与COPDⅡ组(P<0.01);COPDⅡ组血清瘦素低于正常组(P<0.01),TNF-α、IL-8、hs -CRP高于对照组(P<0.01);③COPD患者的瘦素含量与BMI、NM%、fat%、TNF-α、IL-8、hs -CRP水平显著正相关.结论 血清瘦素在COPD急性加重期明显高于缓解期,并与营养参数、TNF-α、IL-8、hs -CRP呈显著正相关,提示瘦素可能与COPD的疾病本身和全身炎症反应有关,可作为COPD急性加重期的炎症标志物. Abstract： Objective To investigate the expression and significance of serum leptin in patients with chronic obstructive pulmonary disease(COPD). Methods Thirty COPD patients in acute exacerbations phase (group I), 28 COPD patients in stationary phase(group Ⅱ) and 28 healthy controls were studied. Body height, body mass,body mass index (BMI), percentage of normal body mass (NM%), percentage of body fat(fat%) were determined.The serum leptin、TNF-α、IL-8、hs-CRP levels were examined by ELISA. The correlation between leptin and other parameters was analysed. Results ①BMI,NM% fat% in COPD patients significantly lower than those in healthy controls (P<0.01). ②Serum leptin、TNF-α、IL-8、hs-CRP level was significantly higher in group I than that in healthy controls and in group II (P<0.01); Serum leptin level was significantly lower in group II than that in healthy controls (P<0.01); Serum TNF-α、IL-8、hs-CRP level was higher in healthy controls (P<0.01). ③The leptin level was associated positively with BMI,NM%, fat%. TNF-α、IL-8、hs-CRP level of COPD. Conclusions The leptin level of COPD in acute is higher than that in stationary, and the levels were correlated to nutritional parameters,TNF-α,IL-8,hs-CRP.The result suggests that leptin may play a role in systemic inflamination of COPD, the leptin is an inflaming mark of the actue exacerbation phase in patients with COPD.