甲状腺机能亢进危象：附14例临床分析

本文报道14例甲亢危象,其发病率为4.5％,其发病与感染、劳累、情绪激动及同位素治疗有关。指出同位素治疗甲亢初期应服用抗甲状腺药物,讨论了淡漠型危象的有关问题。     

PGA指数和透明质酸在诊断慢性乙肝肝纤维化中的价值

目的：寻找一种简便实用的诊断慢性乙型肝炎纤维化的方法。方法：以78例经肝穿刺病理证实的慢性乙型肝炎为对象，测定并比较了由PT、GGT、ApoA1组成的PGA指数和HA、LN、PⅢP、C－IV与肝内纤维化程度(S)和炎症活动度（G）的关系。结果：（1）LN、PⅢP、C－IV在轻度慢性乙肝时无明显升高，在中度慢性乙肝时明显高于正常，但与轻度慢性乙肝无差异，而PGA指数和HA不仅在轻度慢性乙肝时显著升高，而且在轻中度间差异明显.因重度慢性乙肝和活动性肝硬化时，五项指标均显著增高。（2）在G2－4期，HA、LN、PⅢP、C－IV均明显高升，但在G1期，只有PGA指数高于正常，且各期间差异显著。（3）在S1－2期，只有PGA指数、HA、C－IV明显上升，但C－IV的上升幅度远低于PGA指数和HA。（4）加以PGA＞4．5或HA＞200μg／L作为判断临界值，则两者判断肝纤维化的敏感性均＞94％，精确性＞91％，特异性＞86％，如两者结合，则分别达到98．3％、95．2％和96．4％。结论：PGA指数和HA均是反映慢性乙型肝炎患者肝内纤维化程度的良好指标，两者联合检测则可达到最大的价值效益比。     

异丙酚静脉全麻复合硬膜外腔阻滞麻醉期间CO2气腹对血流动力学和氧耗的影响

OBJECTIVE: To investigate the effects of intraperitoneal CO2 insufflation on the hemodynamics, oxygen consumption (VO2) and carbon dioxide production (VCO2) during intravenous anesthesia with propofol in combination with epidural block. METHODS: Intratracheal intubation was performed after rapid induction of anesthesia and mechanical ventilation was given. Maintenance of anesthesia was achieved using continuous intravenous propofol infusion (2 mg/kg/h) ?N2O inhalation and intermittent epidural administration. Indices of hemodynamics and respiratory function were collected 5 min before induction, 1 min before CO2 insufflation, and 5, 10, 20, 30, 40, 50, 60 min after the start of insufflation and 5 min after the termination of insufflation. RESULTS: The mean arterial pressure (MAP), heart rate (HR), end-tidal PCO2 (P(ET)CO2), VO2 and VCO2 1 min before insufflation were markedly reduced(P<0.01), compared with those recorded before induction. MAP and HR did not undergo any conspicuous changes during CO2 insufflation and 5 min after insufflation termination. Compared with that 1 min before insufflation, PETCO2 was significantly increased 20 min after the start of insufflation (P<0.01), and subsequently carried on the increase though of a lesser scale. VO2 and VCO2 gradually rose after the start of insufflation, and VO2 presented a significantly elevation (P<0.01) 10 min after the insufflation while VCO2 did not show this marked increase(P<0.05) till 20 min after the insufflation in comparison with the levels before insufflation. Subsequently, VO2 continued to rise and VCO2 also retained the increase but of smaller magnitude. CONCLUSION: Intravenous propofol anesthesia combined with epidural block assisted by well-managed excessive ventilation before insufflation can alleviate the adverse effects of CO2 insufflation on respiratory and circulatory systems.     

成人成骨细胞与珊瑚羟基磷灰石的体外生物相容性

目的：研究成人骨髓成骨细胞与珊瑚羟基磷灰石（carolline hydroxyapatite,CHA)在体外培养条件下的生物相容性。方法：抽取健康成人骨髓组织，置于含体积分数为10％胎牛血清的DMEM培养基中培养，传代后改用含地塞米松、β-甘油磷酸钠和维生素C的条件培养基培养，分为CHA复合细胞组和单纯细胞组，不同时间用倒置相关显微镜，HE染色光镜及扫描电镜观察，MTT法进行细胞增殖测定，并进行细胞微量蛋白含量和碱性磷酸酶的定量检测，结果：成人骨髓成骨细胞体外培养时复合或不复合CHA均生长良好，表现出典型成骨细胞的形态特征和生物学特性，CHA利于细胞的贴附，生长与增殖，并对细胞的功能无不良影响，结论：CHA是较理想的骨组织工程支架材料，成骨细胞复合CHA用于骨缺损的修复，具有广阔的临床应用前景。     

早年父亲去世的心理创伤研究——1例男大学生的深入访谈分析

目的 探讨男孩8岁时父亲去世对其带来的创伤影响。方法 运用质的研究方法，对一名在8岁时经历父亲去世的男大学生进行深入访谈，采用主要概念或主题突出分类的方法进行编码分析。结果 父亲去世使个体产生了强烈的不安全感，严重的自卑感和神经症性的防御机制。结论 父亲去世后，家庭氛围是影响孩子心理健康的重要因素。     

2005～2006年江西省血吸虫病疫情监测点螺情调查结果分析

目的分析2005～2006年江西省12个国家级血吸虫病疫情监测点螺情调查结果,掌握各监测点钉螺消长情况。方法依据《全国血吸虫病疫情监测点方案》,对各监测点钉螺孳生环境与可疑环境进行调查,比较两年的各项螺情指标。结果2006年12个监测点的有螺面积较2005年下降17.27%,但各监测点有螺面积下降幅度不相一致,有10个监测点查出有阳性钉螺分布;另外各监测点活螺密度、阳性螺密度也有较大波动。结论各监测点螺情依然严重,应加强控制钉螺的防治力度。     

骨细胞的功能：生物学研究和机理探讨

骨细胞（osteocyte）是在矿化骨基质内名副其实的骨的细胞（bonecell）。通过细胞突触，骨细胞彼此相连，很可能也与骨髓中某些细胞相接，从而形成三维细胞网络。从骨的超微结构看，骨细胞处于很理想的位置，可以担当骨生理的重要调节因子。然而，由于骨细胞处于矿化骨基质深层，对其功能了解甚少。但随着新技术方法的应用，就有可能对这种成骨细胞系中的终末分化细胞进行深入研究，人们也由此对骨细胞的兴趣大增。骨细胞被认为是骨的机械应力感受器，它有可能参与骨重建。骨细胞能分泌具有调节成骨细胞功能的硬骨素（sclerostin）。一种能降低肾脏磷回吸收的激素——调磷因子FGF23也主要源白骨细胞。随着我们对骨细胞了解的深入，清楚显示，骨细胞不仅能影响局部骨转换活性，而且对全身矿物质的体内平衡也有多种功能。因此，对骨细胞的研究，可以为代谢性骨病的治疗探索新的途径。     

美国的医保"强制险"——美国立法打通医保资金瓶颈

美国作为世界上经济最发达的国家,2005年其医疗卫生的总支出已占GDP的16%,高居全球之首,但是美国迄今尚有15.2%的人群没有医疗保险。如何解决这个问题,最近,马萨诸塞州出台了新措施:通过立法强制未参保人群参保。这种做法或许会对中国当前正在进行的医疗卫生体制改革有所启发。     

Bayesian estimation of a random effects heteroscedastic probit model

Summary Bayesian analysis is given of a random effects binary probit model that allows for heteroscedasticity. Real and simulated examples illustrate the approach and show that ignoring heteroscedasticity when it exists may lead to biased estimates and poor prediction. The computation is carried out by an efficient Markov chain Monte Carlo sampling scheme that generates the parameters in blocks. We use the Bayes factor, cross‐validation of the predictive density, the deviance information criterion and Receiver Operating Characteristic (ROC) curves for model comparison.     

Induction of apoptosis in human hepatocarcinoma SMMC-7721 cells in vitro by flavonoids from Astragalus complanatus

Aim of the study

Flavonoids extracted from the seeds of Astragalus complanatus R.Br. reduce the proliferation of many cancer cells. The present study was carried out to evaluate the effects of these flavonoids from Astragalus complanatus (FAC) on human hepatocarcinoma cell viability and apoptosis and to investigate its mechanisms of action in SMMC-7721 cells.

Materials and methods

Cell viability was measured using the MTT assay. To detect apoptotic cells, SMMC-7721 cells treated with FAC were stained with Hoechst 33258 and subjected to agarose gel electrophoresis. Quantitative detection of apoptotic cells was performed by flow cytometry. The effects of FAC on apoptosis and cell cycle regulatory genes and proteins in SMMC-7721 cells were examined using an S series apoptosis and cell cycle gene array and Western blot analysis.

Results

The growth of SMMC-7721 and HepG2 cells was inhibited by treatment with FAC. Cell death induced by FAC was characterized by nuclear condensation and DNA fragmentation. Moreover, the cell cycle was arrested in the G0/G1 and S phases in FAC-treated SMMC-7721 cells. A sub-G1 peak with reduced DNA content was also formed. The activity of caspase-3 was significantly increased following FAC treatment. Microarray data indicated that the expression levels of 76 genes were changed in SMMC-7721 cells treated with FAC: 35 genes were up-regulated and 41 were down-regulated. Western blot analysis showed that caspase-3, caspase-8, Bax, P21, and P27 protein levels in SMMC-7721 cells were increased after 48 h of FAC treatment, while cyclinB1, cyclinD1, CDK1, and CDK4 protein levels were decreased.

Conclusions

These results suggest that FAC may play an important role in tumor growth suppression by inducing apoptosis in human hepatocarcinoma cells via mitochondria-dependent and death receptor-dependent apoptotic pathways.