高压氧和甲强龙联合治疗脂肪栓塞综合征

对急诊9例骨折后脂肪栓塞综合征病人行高压氧,大剂量甲强龙冲击治疗。5次高压氧治疗后,所有病人症状消失、神志清醒,10~20次后痊愈出院,所有病人未遗留神经缺损症状。急诊高压氧配合甲强龙大剂量冲击治疗脂肪栓塞综合征是一种起效快、安全和有效的方法。     

中西医结合防治慢性肾功能衰竭的系列临床报告及分子生物学机制研究

根据临床经验提出中医、西医治疗慢性肾功能衰竭(CRF)的长处,为发挥中西医结合治疗CRF的长处提供了依据.并总结了江苏省中医院全国中医肾病医疗中心防治CRF的系列临床经验,介绍了中医中药对CRF的三级防治新方法,既有大样本的临床总结、随访,又有独特的诊治经验,防中有治,治中寓防,防治结合.最后以摘要形式报告了3类中药保肾片治疗CRF的作用机制可能与降低肾脏中的内皮氧化LDL受体、细胞增殖因子TGF-β、细胞外基质主要成分Ⅰ、Ⅳ型胶原的mRNA表达,抑制系膜细胞增殖及促进其凋亡有关.     

Randomized,comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial

BACKGROUND: Interferon beta (IFNbeta) reduces relapses and MRI activity in relapsing-remitting MS (RRMS), with variable effects on disability. The most effective dose regimen remains controversial. METHODS: This randomized, controlled, multicenter trial compared the efficacy and safety of IFNbeta-1a (Rebif) 44 micro g subcutaneously three times weekly (tiw), and IFNbeta-1a (Avonex) 30 micro g IM once weekly (qw) in 677 patients with RRMS. Assessors blinded to treatment performed neurologic and MRI evaluations. The primary endpoint was the proportion of patients who were relapse free at 24 weeks; the principal MRI endpoint was the number of active lesions per patient per scan at 24 weeks. RESULTS: After 24 weeks, 74.9% (254/339) of patients receiving IFNbeta-1a 44 micro g tiw remained relapse free compared with 63.3% (214/338) of those given 30 micro g qw. The odds ratio for remaining relapse free was 1.9 (95% CI, 1.3 to 2.6; p = 0.0005) at 24 weeks and 1.5 (95% CI, 1.1 to 2.1; p = 0.009) at 48 weeks, favoring 44 micro g tiw. Patients receiving 44 micro g tiw had fewer active MRI lesions (p < 0.001 at 24 and 48 weeks) compared with those receiving 30 micro g qw. Injection-site reactions were more frequent with 44 micro g tiw (83% vs 28%, p < 0.001), as were asymptomatic abnormalities of liver enzymes (18% vs 9%, p = 0.002) and altered leukocyte counts (11% vs 5%, p = 0.003) compared with the 30 micro g qw dosage. Neutralizing antibodies developed in 25% of 44 micro g tiw patients and in 2% of patients receiving 30 micro g qw. CONCLUSIONS: IFNbeta-1a 44 micro g subcutaneously tiw was more effective than IFNbeta-1a 30 micro g IM qw on all primary and secondary outcomes investigated after 24 and 48 weeks of treatment.     

Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs

OBJECTIVE: To compare service utilization and cost profiles of people with schizophrenia living in Europe in order to understand differences in treatment and care costs. METHOD: Cross-sectional samples were taken of people with schizophrenia in five European locations. Sociodemographic, clinical and service use data were collected via interviewer-administered questionnaires. Site-specific unit costs were obtained, transformed subsequently into a single currency (UK pound). Multiple regression analyses were conducted. RESULTS: There were widespread and considerable differences between sites in service utilization patterns and associated costs. Higher needs, greater symptom severity and longer psychiatric history are associated with higher costs: quality of life and service satisfaction are not. Few differences were found between sites in patterns of association with cost. CONCLUSION: Comparative analyses of the use and cost of mental health services can highlight existing variations helpfully in service provision and uptake. Methodological consistency is required if meaningful conclusions are to be drawn from such comparative data.     

Systemic lupus erythematosus in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis

The purpose of this study was to determine the cumulative incidence of lupus nephritis (LN) and the factors predictive of its occurrence in a multiethnic systemic lupus erythematosus (SLE) cohort. We studied 353 SLE patients as defined by the American College of Rheumatology (ACR) criteria (65 Hispanics, 93 African-Americans and 91 Caucasians). First, we determined the cumulative incidence of LN in all patients. Next, we determined the predictors for LN in those with nephritis occurring after diagnosis. The dependent variable, LN, was defined by: (1) A renal biopsy demonstrating World Health Organization (WHO), class II-V histopathology; and/or (2) proteinuria > or = 0.5 g/24 h or 3+ proteinuria attributable to SLE; and/or (3) one of the following features also attributable to SLE and present on two or more visits, which were performed at least 6 months apart--proteinuria > or = 2+, serum creatinine > or = 1.4 mg/dl, creatinine clearance < or = 79 ml/min, > or = 10 RBCs or WBCs per high power field (hpf), or > or = 3 granular or cellular casts per hpf. Independent variables assessed at diagnosis, and if absent, at baseline, were from four domains: sociodemographic, clinical, immunologic and immunogenetic (including the complete antibody profile and MHC class II alleles), and health habits. Variables with P < 0.05 by chi square analyses were entered into domain-specific stepwise logistic regression analyses controlling for disease duration, with LN as the dependent variable. Significant domain-specific regression variables (P < or = 0.1) were then entered into an overall model. The cumulative incidence of LN was 54.3% in all patients, and 35.3% for those developing LN after diagnosis. LN after diagnosis occurred in 43.1% of 65 Hispanics, 50.5% of 93 African-Americans, and 14.3% of 91 Caucasians, P < 0.0001. The duration of follow-up for those with LN after diagnosis was 5.5+/-2.4 vs 4.0+/-2.9 years for those without LN. Hispanic (odds ratio (OR) = 2.71, 95% confidence limits (CL) = 1.07-6.87, P < 0.04) and African-American ethnicities (OR = 3.13, 95% CL = 1.21-8.09, P < 0.02), not married or living together (OR = 3.45, 95% CL = 1.69-7.69, P < 0.0003), higher SLAM score (OR = 1.11, 95% CL = 1.02-1.19, P < 0.007), anti-dsDNA (OR = 3.14, 95% CL = 1.50-6.57, P < 0.0001) and anti-RNP (OR = 4.24, CL = 1.98-9.07, P < 0.0001) antibodies were shown to be significant predictors of the occurrence of LN. Repeated analyses excluding the patients with missing HLA data showed that absence of HLA-DQB1*0201 was also a significant predictor for the occurrence of LN (OR = 2.34, CL = 1.13-5.26, P < 0.04). In conclusion, LN occurred significantly more often in Hispanics and African-Americans with SLE. Sociodemographic, clinical and immunologic/immunogenetic factors seem to be predictive of LN occurring after the diagnosis of SLE has been made.     

甲强龙对出血性休克大白鼠的影响

目的研究甲强龙(甲泼尼龙)对出血性休克大白鼠的影响并探讨其机制.方法大白鼠经动脉放血,造成失血性休克模型,随后用自体血和生理盐水从静脉回输,进行复苏.复苏前大白鼠随机分成三组假休克组,休克组和甲强龙治疗组.结果复苏后72 h,休克组的生存率降至20%,而甲强龙治疗组的生存率达80%,差异显著(P＜0.01).复苏后18h器官病理取材,H-E染色,光镜下显示休克组大白鼠的心、肺、肾、肝组织出现不同程度水肿、细胞变性、间质炎性细胞浸润等.甲强龙治疗组大白鼠的上述脏器的病理改变明显减轻.复苏后18 h,CK、Cr、ALT、AST、ALKP检测,休克组明显升高,而甲强龙治疗组只有轻度增高,差异非常显著(P＜0.01).复苏后2 h,肝脏枯否细胞用LPS刺激后,休克组的细胞内Ca2+浓度和TNF-α产量明显增高,而甲强龙治疗组轻度增高,差异显著(P＜0.01).结论甲强龙可以通过抑制kupffer细胞内Ca2+升高和激活,阻止TNF-α的过度产生,降低机体系统性炎症反应程度,最终减轻出血性休克大白鼠脏器的损伤和降低死亡率.     

经阴道后壁修补术治疗Ⅱ度Ⅲ度直肠前突症的临床观察

目的探讨经阴道后壁修补术治疗中度及中度以上直肠前突症（rectocele）的临床价值。方法采用经阴道后壁直肠前突修补术，并辅助直肠前壁粘膜下硬化注射结扎治疗共40例。结果手术均一次成功，平均手术时间25min，平均住院5d，无严重并发症，有效缓解便秘症状。结论经阴道后壁修补术是在临床上治疗直肠前突症的一种具有很好疗效的方法。     

论慢性肾衰"毒"之特征与分类

慢性肾衰是多种慢性肾脏疾病发展到最后阶段出现的一种临床综合征,以肾功能进行性减退,代谢废物潴留,内环境失衡为病理生理特征,临床表现可以多种多样。中医与“肾劳”、“癃闭”、“关格”、“肾风”、“溺毒”等相类似,乃脾肾衰败,湿浊瘀血内阻的本虚标实之证。笔者认为就其病因及病机而言,离不开毒邪,临床治疗常从排毒解毒法[1]入手,取得较好疗效,本文拟从其特征与分类,阐述慢性肾衰之毒。内科病证之毒,尤其是在慢性肾功能衰竭中的毒,笔者认为是指病程日久,肾元虚衰,邪气至盛且蕴蓄不解之谓。与外感六淫不正之气、传染性之疫毒、外科之火…