去迷走腹腔支联合PDTC对兔重症急性胰腺炎心功能保护作用的超声研究

目的 探讨去迷走腹腔支联合吡咯烷二硫氨基甲酸酯(pyrolidine dithiocarbonate PDTC)对兔重症急性胰腺炎(SAP)心功能的保护作用.方法 用15只日本纯种长耳白兔(平均体质量2kg)随机分成3组.分别为SAP造模组,采用开腹自体胆汁胰管内逆行注射制作SAP模型.实验组,开腹制作SAP模型后切断迷走神经腹腔支及PDTC 20 mg/kg静脉注射.空白对照组.术后24 h检测各组心率(HR),射血分数(EF),二尖瓣频谱E/A值及Tei指数.结果 和造模组相比,(1)实验组HR、Tei指数显著降低,P＜0.01;(2)实验组EF明显升高,P＜0.05;(3)实验组E/A明显降低,P＜0.05.空白对照组及实验组各测值之间无明显差异,P＞0.05.结论 去迷走腹腔支联合PDTC对兔重症急性胰腺炎心功能具有明显保护作用,减轻胰腺炎症,提高治疗效果.     

Interpretation of semen analysis using WHO 1999 and WHO 2010 reference values: Abnormal becoming normal

Reference values of WHO 1999 manual were used for the interpretation of semen analysis until 2010 when new reference values were introduced which have lower cut‐off compared to WHO 1999. Therefore, several men who previously were diagnosed abnormal based on their semen analysis have now become normal using new reference values. This study was conducted on semen analyses of 661 men from Middle East region and Pakistan. All semen analyses were reviewed using WHO 1999 and WHO 2010 criteria. Results showed that based on new criteria, 19% of the population changed classification from abnormal to normal when all normal semen parameters were considered. When at least one or more abnormal semen parameters were considered, of the total 661, 44% (288) of the population changed its classification from abnormal to normal with shift from WHO 1999 to 2010 criteria. These findings show that using new cut‐off values, many more men are considered normal, but using old criteria (WHO 1999), the same men would be classified as abnormal. This warrants further discussion over the investigations and management plans for patients whose semen analyses fall below WHO 1999 but above WHO 2010 cut‐offs.     

QALYs without bias? Nonparametric correction of time trade‐off and standard gamble weights based on prospect theory

Common health state valuation methodologies, such as standard gamble (SG) and time trade‐off (TTO), typically produce different weights for identical health states. We attempt to alleviate these differences by correcting the confounding influences modeled in prospect theory: loss aversion and probability weighting. Furthermore, we correct for nonlinear utility of life duration. In contrast to earlier attempts at correcting TTO and SG weights, we measure and correct all these tenets simultaneously, using newly developed nonparametric methodology. These corrections were applied to three less‐than‐perfect health states, measured with TTO and SG. We found considerable loss aversion and probability weighting for both gains and losses in life years, and we observe concave utility for gains and convex utility for losses in life years. After correction, the initially significant differences in weights between TTO and SG disappeared for all health states. Our findings suggest new opportunities to account for bias in health state valuations but also the need for further validation of resulting weights.     

关节镜下Aesculap尼仑线治疗胫骨髁间隆突撕脱骨折

目的：探讨关节镜下应用Aesculap尼仑线治疗胫骨髁间隆突撕脱骨折的临床应用效果。方法：本院38例胫骨髁间隆突撕脱骨折患者,其中18例为实验组,在关节镜下进行Aesculap不吸收尼仑线对于骨折位行内固定术,并在术后进行康复治疗。20例为对照组,为本院按传统方法治疗的患者。对比两组治疗结果。结果：实验组优10例,良7例,总优良率为94.4%;对照组优5例,良7例,总优良率为60.0%,两组比较有明显差异性（P〈0.05）。结论：关节镜下治疗胫骨髁间隆突撕脱骨折,手术创伤小,切口瘢痕小,骨折块复位准确,并能同时处理关节内其他病变,术后功能恢复快,疗效佳,固定牢靠且手术操作简便,具有较大的临床应用及推广价值。     

复杂性肛瘘手术82例疗效观察

目的对比观察切缝挂线术与传统切开挂线术治疗复杂性肛瘘的临床疗效。方法将复杂性肛瘘患者164例,随机分为2组,治疗组82例采用切缝挂线术,对照组82例采用传统切开挂线法。结果①两组患者临床疗效比较,治疗组治愈率（89.0%）明显优于对照组（75.0%）,P〈0.05。②两组创面愈合时间比较,治疗组（20.71±8.06）d与对照组（21.14±8.57）d比较无统计学意义,P〉0.05。③两组术后并发症比较,治疗组并发症发生率（10.98%）明显低于对照组（34.15%）,P〈0.05。结论治疗组在治愈和术后并发症方面明显优于对照组,切缝挂线术是治疗复杂性肛瘘的理想方法。     

老年性腹股沟巨大疝术后并发阴囊积液16例分析

目的：探讨老年性腹股沟巨大疝术后并发阴囊积液的原因、诊治及预防。方法：对16例老年性腹股沟巨大疝术后并发阴囊积液的临床资料进行回顾性分析。结果：根据阴囊积液量大小,采取穿刺抽吸,局部物理治疗,15例阴囊积液消失,1例阴囊感染,采取切开引流。结论：对腹股沟巨大疝修补术时,由于疝囊大,处理远端疝囊时尽量剥离完善彻底止血,因为残留疝囊具有分泌功能。     

B0 field inhomogeneity considerations in pseudo-continuous arterial spin labeling (pCASL): effects on tagging efficiency and correction strategy

Pseudo-continuous arterial spin labeling (pCASL) is a very powerful technique to measure cerebral perfusion, which circumvents the problems affecting other continuous arterial spin labeling schemes, such as magnetization transfer and duty cycle. However, some variability in the tagging efficiency of the pCASL technique has been reported. This article investigates the effect of B(0) field inhomogeneity on the tagging efficiency of the pCASL pulse sequence as a possible cause of this variability. Both theory and simulated data predict that the efficiency of pseudo-continuous labeling pulses can be degraded in the presence of off-resonance effects. These findings are corroborated by human in vivo measurements of tagging efficiency. On the basis of this theoretical framework, a method utilizing B(0) field map information is proposed to correct for the possible loss in tagging efficiency of the pCASL pulse sequence. The efficiency of the proposed correction method is evaluated using numerical simulations and in vivo implementation. The data show that the proposed method can effectively recover the lost tagging efficiency and signal-to-noise ratio of pCASL caused by off-resonance effects.     

体外循环和非体外循环冠状动脉旁路移植术后心肌梗死发生率的Meta分析

目的 使用Meta分析比较常规体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCAB)术后心肌梗死发生率的差异.方法 在 Medline、SCI、Cochrane图书馆临床对照试验注册库(CENTRAL)和中国生物医学文献光盘数据库(CBMdisc)检索中文和英文的相天随机对照临床试验,并检索相关文献的参考文献,检索时间截止至2009年1月.根据严格的纳入和排除标准,两名评价员独立地筛选文献,并按照Cochrane系统评价员手册5.0.0版所建议的评价方法 对纳入临床试验进行质量评价,最后将提取的资料用RevMan 5软件进行数据处理和分析.结果 共纳入22个试验进行Meta分析,OPCAB组共纳入1494例病人,心肌梗死总发生率为2.81%;CCABG组共1512例,心肌梗死总发生率为3.57%.Meta分析结果 显示OPCAB和CCABG术后心肌梗死发生率的差异尤统计学意义(OR=0.80,95%CI=0.54～1.20,P=0.28).结论 依据现有的随机对照试验进行Meta分析结果 显示,OPCAB和CCABG术后心肌梗死发生率的差异无统计学意义.     

苏北地区失地农民心理异常与社会保障多因素研究

目的了解失地农民心理健康状况、社会支持和社会保障现状,分析当前形势下,失地农民的身心健康状况、社会关系状况和对社会关怀的需求状况。为维护社会稳定、缓解社会矛盾提供决策依据。方法采用整群抽样的方法抽取徐州市两社区失地农民开展问卷调查,收回有效问卷1070份。结果失地农民心理健康问题严重,有近一半的失地农民心理异常。超过一半的农民认为自己身体状况一般或差。超过60%的人没有职业,超过65%的人没有医疗保险,超过80%的人没有养老保险,超过90%的没有失业保险。年龄低、无职业、健康状况差、无经济帮助、无社会保障措施成为心理异常的独立危险因素。结论失地农民心理健康问题严重,有近一半的失地农民心理异常。应尽快完善社会保障制度、医疗保险制度,开展社区医疗服务、心理咨询服务,加强失地的农民的社会支持。     

Off‐pump,minimally invasive and robotic coronary revascularization yield improved outcomes over traditional on‐pump CABG

Coronary artery disease is a global health concern, with increasing morbidity and mortality. Surgical coronary artery bypass grafting has been performed on cardiopulmonary bypass for nearly four decades, with excellent long‐term durability. Beating‐heart coronary surgery has been increasing in frequency in an attempt to decrease cardiopulmonary bypass‐related morbidity. Furthermore, with increasing expertise and technology, minimally invasive and robotic techniques have been developed to enhance post‐operative recovery, patient satisfaction and cosmesis. Several clinical trials have demonstrated decreased morbidity and more rapid recovery following off‐pump, minimally invasive and robotic procedures when compared to on‐pump coronary artery bypass grafts (CABGs). An equivalent extent of revascularization and medium‐term anastomotic patency has been demonstrated among all approaches. Furthermore, for a large number of patients who do not have anatomy amenable to traditional coronary revascularization, adjunctive molecular therapies may provide alternative myocardial micro‐revascularization. Copyright © 2008 John Wiley & Sons, Ltd.