2019年重庆市30岁及以上人群归因于被动吸烟的肺癌疾病负担研究

目的 分析重庆市肺癌发病死亡和疾病负担归因于被动吸烟的情况,为开展肺癌防治提供建议。 方法 肺癌死亡个案数据来源于2019年重庆市肿瘤登记报告系统,被动吸烟率来自2013年重庆市慢性病及危险因素监测。计算人群归因危险度百分比(population attributable risk percent, PAR%)、被动吸烟导致的肺癌发病、死亡和疾病负担。采用Excel 2010与SPSS 25.0进行统计分析,率的比较采用χ²检验。 结果 2013年30岁及以上成年人被动吸烟率为52.37%。2019年重庆市30岁及以上人群肺癌发病率与标化发病率分别为118.44/10万与80.83/10万,死亡率与标化死亡率分别为96.51/10万、63.58/10万。肺癌发病率和死亡率归因于被动吸烟的PAR%分别为19.76和19.04,归因发病率与归因标化发病率分别为23.41/10万和16.34/10万,归因死亡率与归因标化死亡率分别为18.38/10万和12.40/10万。2019年重庆市30岁及以上肺癌早死所致寿命损失年率(years of life lost,YLL)、残疾所致寿命损失年率(years lived with disability,YLD)、调整伤残寿命损失年率(disability adjusted life year,DALY)分别为21.16‰、0.31‰、21.47‰,YLL率、YLD率、DALY率归因于被动吸烟的PAR%分别为21.16、19.76和20.49,归因YLL率为4.34‰,归因YLD率为0.06‰,归因DALY率为4.40‰。 结论 2019年重庆市30岁及以上人群肺癌发病率、死亡率、YLL率、DALY率高,被动吸烟率高,肺癌归因于被动吸烟的疾病负担重,应加强落实控烟工作。     

Efficacy and safety of herbal medicines for idiopathic Parkinson's disease: a systematic review.

The objective of this study is to assess the efficacy and safety of herbal medicines (HMs), as a monotherapy or adjunct therapy, compared to placebo or conventional approaches in the treatment of idiopathic Parkinson's disease (PD). We conducted a systematic review of randomized controlled trials from both conventional and alternative medicine sources. Outcome measures were overall improvement, quality of life, reduction of levodopa dose, and adverse events. Nine studies were included, each testing a different HM. Six of the trials had limited internal validity due to major flaws in design, including the lack of proper randomization; insufficient blinding; unclear inclusive criteria in terms of diagnostic criteria, baseline staging, and duration of disease; lack of proper sample size calculation; and insufficient data analysis. Imbalances in gender and ethnicity among the patients in the included trials were observed. No major adverse events emerged, and no specific pattern was detected from the trials describing such data. In addition to major methodological defects, heterogeneity in (1) HM tested, (2) control treatment, and (3) outcome measure hindered in-depth data analysis and synthesis. Current evidence is insufficient to evaluate the efficacy and safety of various HMs. Further studies with improved trial design and reporting, with assessment on cost-effectiveness, quality of life, and qualitative data are warranted.     

现代医学教育创新的思考与对策

随着科技进步的加速,现代医学教育创新势在必行.本文针对这一现状,阐述了现代医学教育创新的内涵,分析了现代医学教育创新面临的问题,探讨了医学院校如何进行创新教育,介绍了山西医科大学对实施现代医学教育创新的一些具体措施.     

Coping with economic crisis: policy development in China and India

This paper explores health policy options in response to economiccrises in developing countries. The paper is based upon thepremise that policy is best pursued within a broad understandingof the determinants of health of populations. To provide anempirical base for analysis, the health status and health caresystems of China and India are compared. A conceptual frameworkon the determinants of the health status of populations is thendeveloped, incorporating both the performance of health caresystems and non-medical factors which influence health. Usingthe China and India experiences, the paper reviews the strengthsand weaknesses of traditional tools used in the analysis ofhealth policy. Significant policy change, it is argued, is bestimplemented through structural change of several health caresystem components simultaneously. Health policy analysis, itis further argued, must consider the broader political economyof the society. Moreover, there remain many imperfectly understoodsociocultural aspects of behaviour which enable some familiesto produce good health despite economic constraints. The paperconcludes that economic crisis presents an opportunity for astructural review of a society's health systems. Health policyoptions in response to economic crisis cannot be confined tothe health care sector. Rather, health policy should be viewedas only one, perhaps important, element of a package of socioeconomicpolicy options. Critical to policy choices are reliable informationon the condition of the poor and high political priority tominimize the adverse impact of economic crisis on the health,nutrition and social welfare of disadvantaged groups.     

继发性肝癌的外科治疗

目的探讨继发性肝癌的手术适应证和方法。方法对52例继发性肝癌的临床病例资料进行回顾性分析。结果分别采用了左半肝切除、右半肝切除、左外叶切除、右前叶切除、右后叶切除和肝楔形切除术。术后1、3、5年的生存率分别为28.3%、19.4%和11.9%。结论对适合手术的继发性肝癌,行肝切除术可以获得满意的效果。     

1例系统性红斑狼疮患者视网膜中央动脉阻塞及脑出血的护理

对1例系统性红斑狼疮并发视网膜中央动脉阻塞及脑出血患者，给予糖皮质激素、免疫抑制剂、高压氧、改善微循环及对症支持治疗．同时予以密切观察病情、药物护理、高压氧治疗护理及健康教育等措施，结果患者恢复良好出院。提出该病虽然少见且后果严重，但及时采取综合性治疗护理措施，可以提高治疗效果。     

重症肌无力术后机械通气脱机方法的比较

目的:比较重症肌无力胸腺切除术后经验性脱机和程序化脱机在机械通气(MV)撤机的临床效果。方法:重症肌无力胸腺切除术后行机械通气的患者67例,根据脱机方式不同分为经验性脱机组和程序化脱机。比较两种脱机方法的MV时间、监护室住院时间、脱机成功率、呼吸机相关性肺炎(VAP)发生率和住院死亡率等差异。结果:两组重症肌无力术后机械通气患者比较,程序化脱机组比经验性脱机组MV时间、监护室住院时间和总住院时间均有明显缩短(P<0.05);VAP发生率和住院死亡率方面,程序化脱机组均明显低于经验性脱机组(均P<0.05)。结论:重症肌无力胸腺切除术后机械通气时采用程序化脱机能明显缩短MV时间和监护室住院时间,提高脱机成功率,降低VAP发生率和住院死亡率,值得临床推广。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

子宫内膜萎缩疗法治疗青春期功血362例临床研究

目的：探讨子宫内膜萎缩疗法治疗青春期功血（DUB）的止血效果。方法：将362例平均分为观察组（采用炔诺酮、戊酸雌二醇联合疗法止血）和对照组（单用炔诺酮子宫内膜萎缩疗法止血），两组各181例，比较两组的止血效果。结果：观察组和对照组止血有效率分别为96．13％（174／181）和92．27％（167／181），两组比较差异无统计学意义（踟105）；观察组和对照组控制出血时间分别为（28．69±14．87）h和（29．72±15．34）h，两组比较差异无统计学意义（踟．05）。观察组和对照组的完全止血时间分别为（32．80±19．10）h和（47．30±18．60）h，两组比较差异有统计学意义（／9〈0．05）。观察组和对照组的住院天数平均为（6．10±2．80）d和（6．9±2．60）d，观察组住院时间短于对照组（P〈0．01）。结论：炔诺酮止血疗法和炔诺酮、戊酸雌二醇联合疗法治疗青春期功血效果均较好，但炔诺酮、戊酸雌二醇联合疗法治疗效果更佳。     

内镜辅助肋骨-软骨移植重建髁突与同期正颌手术的临床研究

目的 探讨内镜辅助肋骨-软骨移植重建髁突与同期正颌手术治疗严重颞下颌关节病变及牙颌面畸形的效果. 方法 于术前对患者进行临床检查和治疗设计,术中行Le Fort Ⅰ型截骨术、下颌支矢状骨劈开术、髁突等关节区病变的处理、内镜辅助下肋骨-软骨移植和颏成形术,术后进行随访. 结果 2003年9月至2005年12月,于临床应用15例,所有患者同期手术均顺利完成.术中、术后均无严重出血、神经损伤、受区感染等严重并发症发生.术后随访29～52个月,平均31.8个月,所有患者面容均显著改善,关节功能良好,且无关节区疼痛等主观症状,患者对手术疗效满意.术后张口度平均为33.6 mm,侧向运动度为0～6 mm. 结论 选择合适的适应证、设计合理的手术方案,内镜辅助髁突重建同期正颌手术效果较好.