老年脑出血昏迷患者继发多器官功能障碍综合征 （ＭＯＤＳ）危险因素的多元ｌｏｇｉｓｔｉｃ分析

分析老年脑出血（Ｃｅｒｅｂｒａｌｈｅｍｏｒｒｈａｇｅ,ＣＨ）昏迷患者继发多器官功能障碍综合征（ＭＯＤＳ）危险因 素,为ＣＨ的治疗提供依据。方法　选取我院２０１２年１月—至２０１４年１月期间收治的老年ＣＨ昏迷患者１２５ 例,按照是否继发ＭＯＤＳ进行分组,将４３继发ＭＯＤＳ患者作为观察组,８２例未继发ＭＯＤＳ患者作为对照组。选 择格拉斯哥昏迷指数（ＧＣＳ）评分、血糖、ＣＨ体积等７个因素对老年ＣＨ昏迷患者继发ＭＯＤＳ的情况实施单因素 分析,并进行Ｌｏｇｉｓｔｉｃ回归性分析。结果　观察组４３例患者死亡率４６５１％,显著高于对照组死亡率７３２％（Ｐ ＜００５）。且２个器官受累１８例,死亡６例,３个及３个以上器官受累２５例,死亡１４例。观察组格拉斯哥昏迷 指数（ＧＣＳ）评分显著低于对照组。血糖、ＣＨ体积、急性生理与慢性健康－Ⅱ（ＡＰＡＣＨＥ－Ⅱ）评分、ＩＬ－１及ＩＬ －１０水平均显著高于对照组。差异均有统计学意义（Ｐ＜００５）。Ｌｏｇｉｓｔｉｃ回归性分析显示ＧＣＳ评分、血糖、ＣＨ 体积、ＡＰＡＣＨＥ－Ⅱ评分、ＩＬ－１、ＩＬ－１０共计６个危险因素（Ｐ＜００５）。结论　ＧＣＳ评分、血糖、ＣＨ体积、Ａ ＰＡＣＨＥ－Ⅱ评分、ＩＬ－１、ＩＬ－１０为老年ＣＨ昏迷患者继发ＭＯＤＳ的危险因素,临床治疗中需给于高度关注。     

联合应用反义核酸对慢性粒细胞性白血病骨髓及外周血的净化的 …

目的：比较单独及联合应用ＢＣＲ－ＡＢＬ反义寡核苷酸（Ａｎｔｉｓｅｎｓｅ ｏｌｉｇｏｄｅｏｘｙｎｕｃｌｅｏｔｉｄｅ,ＡＳ ＯＤＮ）及Ｃ－ＭＹＢ ＡＳ ＯＤＮ对慢性粒细胞性细胞白血病（Ｃｈｒｏｎｉｃ ｍｙｅｌｏｇｅｎｏｕｓ ｌｅｕｋｅｍｉａ,ＣＭＬ）细胞及正常造血细胞的抑制作用。方法：用ＢＣＲ－ＡＢＬ ＡＳ ＯＤＮ、Ｃ－ＭＹＢ ＡＳ ＯＤＮ及错配ＯＤＮ,分别对１０例ＣＭＬ骨髓和外周血单个核细胞（Ｍｏｎ     

慢性功能性疼痛与心理社会因素的相关性研究

研究哪些心理社会因素与慢性功能性疼痛（ＣＰ）有关，并探讨ＣＰ的诊断归属。方法采用ＳＣＬ－９０、ＬＥＳ、ＳＳＲＳ、ＤＳＱ、ＨＡＭＤ、ＨＡＭＡ、ＭＭＰＩ等多个量表对５９例ＣＰ患者和３０例器质性疼痛（ＯＰ）患者进行调查，用ｔ检验、χ２检验、多元逐步回归分析等方法对数据进行统计分析。结果ＣＰ组的ＳＣＬ－９０症状评分、负性事件刺激量、不成熟防御方式因子均分、ＨＡＭＤ抑郁分、ＨＡＭＡ焦虑分均明显高于ＯＰ组（Ｐ＜０．０５～０．００１）），社会支持总分显著低于ＯＰ组（Ｐ＜０．００１）。ＭＭＰＩ的廓图表现为１、２、３、７型。结论心理社会因素在ＣＰ的发生、发展中起着重要作用，认为ＣＰ是神经症的一个亚型。     

急性非淋巴细胞白血病N－ras基因突变的研究

目的：探讨Ｎ－ｒａｓ基因突变在急性非淋巴细胞白血病（ＡＮＬＬ）中的作用及其意义。方法：用聚合酶链反应－单链构像多态（ＰＣＲ－ＳＳＣＮ）分析法检测３５例ＡＮＬＬ患者Ｎ－ｒａｓ基因突变。结果：初发ＡＮＬＬ４／１５例、复发ＡＮＬＬ３／１０例、缓解ＡＮＬＬ１／１０例有Ｎ－ｒａｓ基因突变。结论：Ｎ－ｒａｓ基因突变与ＡＮＬＬ发生和发展有一定相关性。初步随访表明Ｎ－ｒａｓ基因突变可作为一种分子生物学标志，用于ＡＮＬＬ患者疗效预测和微小残留病（ＭＲＤ）检测。     

溶栓药APSAC的制备和鉴定

重组链激酶（ｒ－ＳＫ）由工程菌提取液经ＳｅｐｈａｃｒｙｌＳ－２００柱纯化，比活性达１０５ＩＵ／ｍｇ，十二烷基硫酸钠－聚丙烯酰胺凝胶电泳（ＳＤＳ－ＰＡＧＥ）显示分子量为７８．０２４７×１０－２４ｋｇ的一条带。人新鲜血浆经Ｌｙｓｉｎｅ－Ｓｅｐｈａｒｏｓｅ４Ｂ亲和层析，ＳｅｐｈａｄｅｘＧ－２５凝胶过滤制备纤溶酶原（ｐｌｇ），比活性达２３．７ＩＵ／ｍｇ，活性回收率为１３．６％，ＳＤＳ－ＰＡＧＥ显示分子量为１４７．７４８９×１０－２４ｋｇ的一条带。对－茴香酸－对－脒基ｒ－ＳＫ和ｐｌｇ的混合物经苯酯盐酸盐（ＡＰＡＮ）修饰后制备茴香酰纤溶酶原链激酶激活剂复合物（ＡＰＳＡＣ），产物经Ｌ－ｌｙｓｉｎｅＳｅｐｈａｒｏｓｅ４Ｂ亲和层析，ＳＤＳ－ＰＡＧＥ显示分子量为７８．０２４７×１０－２４ｋｇ和１４７．７４８９×１０－２４ｋｇ两条带，其拟一级水解速率常数为１．２６×１０－４ｓｅｃ－１。体外溶栓实验证明其有溶栓活性。     

准分子激光原位角膜磨镶术治疗低,中,高度近视

目的：评价准分子激光原位角膜磨镶术（Ｌａｓｅｒ ｉｎ ｓｉｔｕ Ｋｅｒａｔｏｍｉｌｅｕｓｉｓ，ＬＡＳＩＫ）治疗低，中、高度近视的疗效。方法：年龄１８－５６岁３４３例（６８０只眼）近视患者（－１．００Ｄ－２３．００Ｄ）按屈光组分为４组：Ⅰ组１１６只眼，≤３．００Ｄ；Ⅱ组２５８只眼－３．２５－６．００Ｄ；Ⅲ组２１０只眼，－６．２５Ｄ－１０．００Ｄ；Ⅳ组９６只眼，－１０．２５Ｄ－２３．００Ｄ，行ＬＡＳＩ     

芸香苷的胃粘膜保护作用与抗氧化作用的关系

目的 探讨正常皮肤ＣＤ１ａ＾＋树突状细胞（ＣＤ１ａ＾＋ＤＣ）、Ｓｏｍａｔｏｓｔａｔｉｎ＾＋树突状细胞的免疫表达和分布特点。方法 应用免疫组化ＳＡＢＣ法检测１０例下沉人皮肤中ＣＤ１ａ＾＋ＤＣ、ＡＳｏｍａｔｏｓｔａｔｉｎ＾＋ＤＣ的定位定量情况,分别采取ＢＧＩＰ／ＮＢＴ、ＡＥＣ和双标法以;双标民研究包括ＣＤ１ａ、Ｓｏｍａｔｏｓｔａｔｉｎ、Ｓ－１００、ＨＬＡ－ＤＲ四种抗体,结果 ＣＤ１ａ＾＋ＤＣ主要分布于     

中国人胰岛素依赖型糖尿病与HLA－DQ基因的相关性研究

本研究采用聚合酶链式反应（ＰＣＲ）和序列特异性寡核苷酸探针杂交（ＳＳＯＰＨ）方法（ＤＱＡｌ，共用９个探针，ＤＯＢ１，共１０个探针），对北京地区汉族４９例胰岛素依赖型糖尿病（ＩＤＤＭ）患者及４８名健康对照者ＨＬＡ－ＤＯＢｌ基因和２７例ＩＤＤＭ患者及２９名对照者ＨＬＡ－ＤＱＡｌ基因的研究提示：（１）ＨＬＡ－ＤＱＡｌ基因的Ａ４等位基因（ＲＲ＝１１．７，Ｐｃ＜０．０２）与ＩＤＤＭ易感性呈显著正相关。（２）ＨＬＡ－ＤＱＢ１基因的ＤＯＢ１＊０６０１（ＤＱＷ１．１２）等位基因与ＩＤＤＭ抵抗性相关（ＲＲ＝０．０３，Ｐｃ＜０．００２）。（３）ＨＬＡ－ＤＱ６５７天门冬氨酸［ＨＬＡ－ＤＱβ５７Ａｓｐ（＋）纯合子基因型与ＩＤＤＭ易感性降低有关，而ＨＬＡ－ＤＱβ５７非天门冬氨酸［ＨＬＡ－ＤＱＢ５７Ａｓｐ（－）］纯合子基因型与ＩＤＤＭ易感性增强有关，说明ＨＬＡ－ＤＱβ链第５７位氨基酸在决定ＩＤＤＭ易感性方面的重要作用。同其它人种相比，ＨＬＡ－ＤＱβ５７Ａｓｐ（－）纯合子基因型频率在中国人群中的减少及ＨＬＡ－ＤＱβ５７Ａｓｐ（＋）纯合子基因型频率在中国人群中的增多可能同中国人群ＩＤＤＭ发病率低有关。     

创伤多器官功能不全综合征与HLA—DRB1相关性研究

目的 研究创伤后ＭＯＤＳ与ＨＬＡ－ＤＲＢ１相关性。方法 对ＰＣＲ对３７例创伤对３７例创作后ＭＯＤＳ患者１８例对ＨＬＡ－ＤＲＢ１基因引物进行扩增,用ＥＬＩＳＡ进行ＩＬ－１０测定。结果 创作后ＭＯＤＳ患者ＤＲ２（ＤＲＢ１＊１５０１－ＤＲＢ１～１５０２）基因频率显著升高。ＤＲ２＾＋较ＤＲ２＾－的ＭＯＤＳ患者血浆ＩＬ－１０水平和病死率显著升高（Ｐ〈０．０１）。结论 创伤后ＭＤＤＳ与ＨＬＡ－ＤＲ２（ＤＲＢ１     

HLA-B27检测对强直性脊柱炎的诊断价值

为探讨强直性脊柱炎（ａｎｋｙｌｏｓｉｎｇ ｓｐｏｎｄｙｌｉｔｉｓ,ＡＳ）与ＨＬＡ－Ｂ２７抗原的关系,采用微量淋巴细胞毒实验检测２２０例,ＡＳ患者ＨＬＡ－Ｂ２７抗原,阳性检出率８５％,男女比例为５．５：１。其中ＨＬＡ－Ｂ２７抗原阳性病人１０例的一级亲属１０例,ＨＬＡ－Ｂ２７抗原阳性者８例。显示,ＨＬＡ－Ｂ２７抗原与ＡＳ呈明显相关性,ＨＬＡ－Ｂ２７检测对ＡＳ的早期诊断,鉴别诊断和及时治疗有重要价值。     

Lifestyle factors and risk of dementia: Dubbo Study of the elderly

OBJECTIVE: To identify risk factors for dementia in an elderly Australian cohort. DESIGN AND SETTING: A longitudinal cohort study conducted in Dubbo, NSW. PARTICIPANTS: 2805 men and women aged 60 years and older living in the community and initially free of cognitive impairment, first assessed in 1988 and followed for 16 years. MAIN OUTCOME MEASURE: Admission to hospital or nursing home with any kind of dementia. RESULTS: There were 115 cases of dementia in 1233 men (9.3/100) and 170 cases in 1572 women (10.8/100). In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. CONCLUSION: While excess alcohol intake is to be avoided, it appears safe and reasonable to recommend the continuation of moderate alcohol intake in those already imbibing, as well as the maintenance of physical activity, especially daily gardening, in the hope of reducing the incidence of dementia in future years.     

Prevalence study on dementia and Alzheimer disease

An epidemiological survey on dementia and Alzheimer disease (AD) was carried out in a community of 5055 persons over the age of 55 at Jingan district of Shanghai. Diagnoses were made according to the diagnostic criteria of dementia of DSM-III-R and of AD of NINCDS-ADRDA. It was found that dementia is not uncommon in the aged, and AD was the leading category of dementia. The age and sex adjusted prevalence rate of dementia was 2.57% in those over 55, 3.46% in those over 60, and 4.61% in those over 65, and that of AD was 1.50%, 2.05% and 2.90% respectively. Beside age, the other risk factors were female sex, bereavement of spouse, low education and unfavorable socio-economic status.     

Cholinergic markers in elderly patients with early signs of Alzheimer disease

CONTEXT: A central tenet of Alzheimer disease (AD) is the loss of cortical cholinergic function and cholinergic markers in postmortem brain specimens. Whether these profound deficits in cholinergic markers found in end-stage patients are also found in patients with much earlier disease is not known. OBJECTIVE: To determine whether cholinergic deficits in AD precede, follow, or occur in synchrony with the earliest signs of cognitive deterioration. DESIGN, SETTING, AND PATIENTS: Postmortem study of nursing home residents with Clinical Dementia Rating (CDR) Scale scores of 0.0 to 2.0 and 4.0 to 5.0 who underwent autopsy between 1986 and 1997, comparing the activity of the cholinergic marker enzymes in the cortices of 66 elderly subjects with no (CDR score = 0.0; n = 18), questionable (CDR score = 0.5; n = 11), mild (CDR score = 1.0; n = 22), or moderate (CDR score = 2.0; n = 15) dementia vs subjects with severe dementia (CDR score = 4.0-5.0; n = 15). MAIN OUTCOME MEASURES: Activity of the cholinergic marker enzymes choline acetyltransferase and acetylcholinesterase in 9 neocortical brain regions. RESULTS: The activity of choline acetyltransferase and acetylcholinesterase in 9 neocortical brain regions did not differ significantly in subjects with CDR scores of 0.0 to 2.0, but was significantly lower in subjects with severe dementia (CDR score = 4.0-5.0). Choline acetyltransferase levels were significantly correlated with severity of neuropathological lesions of AD, as measured by density of neuritic plaques and neurofibrillary tangles. CONCLUSIONS: Although neocortical cholinergic deficits are characteristic of severely demented AD patients, in this study, cholinergic deficits were not apparent in individuals with mild AD and were not present until relatively late in the course of the disease. These results suggest that patients with more severe disease should be a target for cholinergic treatment.     

老年性痴呆的危险因素和保护因素以及中医保健养生方法的可能作用

综述了近１５年来对老年性痴呆（阿尔茨海默病，Ａｌｚｈｅｉｍｅｒ’ｓ ｄｉｓｅａｓｅ，ＡＤ）的危险因素和保护因素的研究概况，认为ＡＤ公认的危险因素包括有年龄、性别、低教育程度、职业、痴呆家族史、头部外伤等，而早年接受教育或智力因素、抗衰老、预防头部外伤、雌激素替代治疗可能具有防止或延迟ＡＤ发生的保护作用。通过对中医保健养生方法可能作用的分析，提出中医保健养生方法可能对ＡＤ有保护作用的假说并就假说提供     

电针对老年性痴呆大鼠前额叶皮质nNOS阳性神经元表达的影响

目的：研究电针对老年性痴呆（AD）模型大鼠前额叶皮质（Prefrontal Cortex ,PFC）神经元型一氧化氮合酶（nNOS）阳性神经元表达的影响。方法：以D-半乳糖腹腔注射和Aβ1-40海马注射诱导形成的老年性痴呆模型大鼠为研究对象。电针“大椎”、“太溪”、“肾俞”三穴,以免疫组织化学法检测大鼠PFC中nNOS阳性神经元的表达。结果：与模型组相比,电针组nNOS阳性神经元数量明显增多,具有显著性差异。结论：电针可能通过上调大鼠PFC中nNOS阳性神经元的表达,进而发挥抗老年性痴呆的作用。     

Incidence of dementia and Alzheimer disease in 2 communities: Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana

CONTEXT: Alzheimer disease (AD) represents a major and increasing public health problem. If populations were identified with significantly lower or higher incidence rates of AD, the search for risk factors in the genesis of AD could be greatly enhanced. OBJECTIVE: To compare incidence rates of dementia and AD in 2 diverse, elderly community-dwelling populations. DESIGN: The Indianapolis-Ibadan Dementia Project, a longitudinal, prospective population-based study consisting of a baseline survey (1992-1993) and 2 subsequent follow-up waves after 2 years (1994-1995) and 5 years (1997-1998). Each wave followed a 2-stage design, with an in-home screening interview followed by a full diagnostic workup of a subsample of participants based on screening performance. SETTING AND PARTICIPANTS: A total of 2459 community-dwelling Yoruba residents of Ibadan, Nigeria, without dementia, and 2147 community-dwelling African American residents of Indianapolis, Ind, without dementia (all aged 65 years or older). The cohorts were followed up for a mean of 5.1 years and 4.7 years, respectively. MAIN OUTCOME MEASURES: Incident cases of dementia and AD in each of the 2 populations. RESULTS: The age-standardized annual incidence rates were significantly lower among Yoruba than among African Americans for dementia (Yoruba, 1.35% [95% confidence interval [CI], 1.13%-1.56%]; African Americans, 3.24% [95% CI, 2.11%-4.38%]) and for AD (Yoruba, 1.15% [95% CI, 0.96%-1.35%]; African Americans, 2.52% [95% CI, 1.40%-3.64%]). CONCLUSION: This is the first report of incidence rate differences for dementia and AD in studies of 2 populations from nonindustrialized and industrialized countries using identical methods and the same group of investigators in both sites. Further explorations of these population differences may identify potentially modifiable environmental or genetic factors to account for site differences in dementia and AD.     

电针对老年性痴呆大鼠斜角带核Nestin阳性神经元表达的影响

目的:研究电针对老年性痴呆(AD)模型大鼠斜角带核(DB)Nestin阳性神经元表达的影响。方法:以D-半乳糖腹腔注射和Aβ1-40海马注射诱导形成的老年性痴呆模型大鼠为研究对象。电针"大椎"、"太溪"、"肾俞"三穴,以免疫组织化学法检测大鼠DB中Nestin阳性神经元的表达。结果:与模型组相比,电针组Nestin阳性神经元数量明显增多,具有显著性差异。结论:电针可能通过增加大鼠DB中Nestin阳性神经元的表达,进而发挥抗老年性痴呆的作用。     

阿尔茨海默病患者痴呆程度与血浆同型半胱氨酸水平的研究

目的 研究阿尔茨海默病（AD）患者痴呆程度与血浆同型半胱氨酸（Hcy）水平的关系.方法 依据美国国立神经病语言障碍卒中研究所和阿尔茨海默病及相关疾病学会（NINCDS-ADRDA）诊断标准及Hachinski缺血量表,筛选我科门诊及住院AD患者45例,及健康对照组15例,分别进行MMSE量表评分,分为轻度痴呆组、中度痴呆组、重度痴呆组和健康对照组,每组15例,监测患者血浆Hcy浓度进行对比分析.结果 AD组患者血浆Hcy浓度较健康对照组明显增高;其中轻度痴呆组血浆Hcy浓度较中度痴呆组和重度痴呆组降低,各AD组患者与健康对照组相比较,中、重度痴呆组与轻度痴呆组相比较均具有统计学意义（P＜0.05）;MMSE量表评分与Hcy水平呈负相关（r=-0.843,P＜0.05）.结论 血浆Hcy水平是阿尔茨海默病的独立高危因素,与AD患者的痴呆程度密切相关.     

Repetitive strain injury

Pain in the forearm is relatively common in the community. In the workplace forearm pain is associated with work involving frequent repetition, high forces, and prolonged abnormal postures. Nevertheless, other factors are involved in the presentation and the continuation of the pain. Notable among these factors are psychosocial issues and the workplace environment-the attitude to workers and their welfare, the physical conditions, and design of the job. Primary prevention may be effective but active surveillance is important with early intervention and an active management approach. Physical treatments have not been extensively evaluated. In the established case, management should be multidisciplinary, addressing physical aspects of the job but also addressing the "yellow, blue, and black flags" which should be viewed as obstacles to recovery. For the worker "on sick" a dialogue should be established between the worker, the primary care physician, and the workplace. Return to work should be encouraged and facilitated by medical interventions and light duty options. Rehabilitation programmes may be of use in chronic cases.     

老年性痴呆危险因素的Iogistic回归分析

目的探讨老年性痴呆的危险因素,为制订防范对策提供依据。方法抽样调查南京市158名老年人健康状况及其影响因素,填写自我健康评估表、心理创伤量表、精神健康量表、幸福度量表、生活照料情况表、无望量表、老年性痴呆筛查量表等。资料用EPI和SAS系统作一元与多元分析。结果一元分析结果显示,年龄、性别、职业、婚姻、教育、中风史6个因子与老年性痴呆发生率均有密切关系;多元分析结果显示,年龄越高,老年性痴呆发生率越高,女性发生率高于男性,体力劳动者发生率高于脑力劳动者。结论老年性痴呆与社会心理因素有一定关系。