肿瘤三项标记物在良性和恶性胸液鉴别诊断中的价值

作者测定了44例良恶性胸腔积液患者胸液及血清甲胎蛋白(AFP)、癌胚抗原(CEA)和铁蛋白(Ft)三项肿瘤标记物水平。结果表明:恶性胸腔积液患者的胸液和血清的CEA均明显高于良性胸腔积液。若胸液和血清的CEA以>15ng/ml为诊断界值,其敏感性为55.6％和43.8％,特异性均为100％。恶性胸腔积液患者胸液的Ft高于良性胸腔积液。若胸液的Ft分别以男>480 ng/ml、女>264 ng/ml为诊断界值,其敏感性为70％,特异性为66.7％。故可认为CEA及Ft在良恶性胸液的鉴别诊断中具有一定意义,而AFP在鉴别诊断中则无显著意义。     

彩色多普勒超声血流图在心脏手术中的应用(附19例病例分析)

在心脏手术中应用多普勒彩色超声心动仪直接探测和观察19例患者,其中风湿性心瓣膜病11例、先天性心脏病7例、左心房粘液瘤1例。风心病及左房粘液瘤患者手术前、中检查的结果基本一致;先心病术前诊断符合率为84.2％(5/7),术中诊断符合率为100％。本文对检查结果作了分析讨论,并提出符合我国情况的有关检查设想。     

医疗纠纷的非诉讼解决方式-医疗纠纷ADR

由于在纠纷解决方面所表现出来的简便，经济，快捷，专业性及保密性强等优点，非诉讼纠纷解决方式（又可译为代替性纠纷解决方式）ADR（Alternative Dispute Resolution）逐渐成为许多国家和地区解决民事纠纷的一大趋势，我国现行医疗纠纷解决机制存在着较多的问题，有待于进一步的改善与完善，根据我国所面临的现实情况，将ADR引入医疗纠纷领域是一条快速，有效地解决医疗纠纷的途径，医疗纠纷的非诉讼纠纷解决方式主要包括仲裁，调解与和解，这3种纠纷解决方式各具特点，适用于不同情况下医疗纠纷的解决。     

Electrocatalytic dehalogenation of organohalides on a nickel(II) tetraazamacrocyclic complex-modified graphite felt electrode

Electrocatalytic dehalogenation of organohalides was studied using a nickel(II) tetraazamacrocyclic complex-modified graphite felt electrode. The nickel(II) tetraazamacrocyclic complex-modified graphite felt electrode was prepared by attaching nickel(II) (6-(2′-hydroxyethyl)-1,4,8,11-tetraazacyclotetradecane)perchlorate chemically to the carboxyl groups of a thin poly(acrylic acid) layer coated on the graphite felt. The modified electrode gave a reversible electron transfer for the nickel(II)/nickel(I) redox couple in cyclic voltammetry at ?0.95 V versus Ag/AgCl. A preparative electrocatalytic dehalogenation of organohalides was successfully achieved on the modified electrode with an adequate current efficiency (55.6–94.8%), conversion (34.2–100%) and turnover number of the Ni catalyst (667–3333).     

Raman and UV–vis spectroscopic study of polyaniline membranes containing a bulky cationic additive

Electrically conducting soluble polyaniline (PANI), containing different amounts of a bulky lipophilic cationic additive, tridodecylmethylammonium chloride (TDMACl), was studied by Raman (λ_exc=780 nm) and UV–vis spectroscopy. PANI was made simultaneously electrically conducting and soluble with bis[4-(1,1,3,3-tetramethylbutyl)phenyl]phosphoric acid in dichloromethane. The PANI membranes were prepared by drop casting on glassy carbon or ITO substrates. Raman and UV–vis measurements were carried out in a 0.1 M CaCl₂ solution at potentials between 400 and ?600 mV (vs. SCE) at pH 6, or alternatively at the open circuit potential at pH 10. The results of Raman, UV–vis and cyclic voltammetric measurements confirm that the incorporation of TDMACl into the PANI membrane facilitates the oxidation and reduction of PANI.     

缺血性脑卒中急性期TCD,EEG,BEAM,CT的对比研究

目的 :对缺血性脑卒中急性期TCD动态观察 ,并与EEG ,BEAM ,CT等进行对比研究 ,以探讨TCD对缺血性脑卒中早期诊断、病情判断、治疗指导的价值 .方法 :发病 2 4h内首次发病的单侧MCA供血区缺血性脑卒中患者 2 3例 ,于入院即刻进行神经功能缺损评分及床旁TCD检查 ,在第 2 ,4 ,7d进行复查 ,入院当天进行EEG ,BEAM及CT检查 .门诊健康体检者 30人为对照组 .结果 :入院当天TCD异常率高于EEG ,BEAM及CT .入院当天病侧MCAVm降低 ,病侧ACAVm升高 ,分别与自身健侧及对照组比较差异有显著性(P <0 0 1) .MCA流速不对称指数 (AI)与神经功能缺损评分成正相关 (P <0 0 1) ,与BEAM慢波相对功率值成正相关 (P <0 0 5 ) ,与α波相对功率值成负相关 (P <0 0 1) .动态观察病侧MCAVm逐渐恢复并出现流速增高 ,而病侧ACAVm随之下降 .结论 :在缺血性脑卒中急性期TCD异常率高于BEAM ,EEG及CT ,异常程度与病情严重程度相关 ,动态观察可发现血管再通情况 ,具有较高的早期诊断、病情判断及治疗指导价值     

经食管超声心动图在心血管手术麻醉与监测中的应用

目的　评价经食管超声心动图 (TEE)在心血管手术麻醉中的价值。方法　本组共完成 1 2 2例TEE监测。主要观察指标 :(1 )对 4 1例瓣膜置换患者的瓣膜作返流和狭窄分级及评价机械或生物瓣的功能 ;(2 ) 4 8例不停跳冠状动脉搭桥 (CABG)患者手术前后心功能变化〔①面积减少分数(FAC) ;②E波与A波峰值流速比率 (E/A)和各自的流速时间积分比率 (VTIE/VTIA) ;③E波减速时间 (DT) ;④心脏指数 (CI)〕 ;(3)手术前后对 2 0例不停跳CABG患者左室室壁 (前壁、后壁、侧壁和室间隔 )运动分级 ;(4 )监测先心病矫正前后心脏结构变化。结果　TEE检测瓣膜病变与经胸超声结果一致 ,手术后瓣膜活动正常。术后FAC、CI和VTIE/VTIA分别为 (0 5 2± 0 0 8)、(2 6 4± 0 6 9)L·min 1 ·m 2 和 1 2 9± 0 1 8,与术前比较 (0 4 2± 0 0 9)、(2 0 5± 0 4 8)L·min 1 ·m 2 和 1 1 4± 0 1 6有显著性差异 (P <0 0 5 ) ;术后E/A 0 86± 0 2 1与术前 0 77± 0 1 8比较P <0 0 1。DT无显著性变化。术前节段性室壁运动异常大于 2级的占 1 0 % ,术后为 5 %。结论　在心血管手术中 ,TEE是一种新的有用的监测技术     

上海城市社区老年人生殖保健需求分析

目的:了解上海城市社区老年人生殖保健需求的特点。方法:对20个居民区35例老年人、20例服务人员进行访谈;对116例老年人进行结构式问卷调查。结果:31.9％的老年人自诉患有生殖系统疾病,23.3％担心患有生殖系统疾病,53.4％对性生活无兴趣,46.6％没有性生活,48.4％性生活中遇到困难。83.2％的老年人在遇到生殖系统问题时首选到医院就诊。表示会参加专门为老年人提供的生殖系统健康检查、有兴趣与异性老人结伴活动,以及希望社区提供有关老年人生殖保健方面的宣传、咨询服务的老年男性比例明显高于女性,分别为68.2％:32％、40.9％:24％、48.5％:38％。结论;老年人当中存在着大量潜在的生殖保健需求,而目前的老年生殖保健需求层次还较低,重点仍是生殖系统疾病的治疗;老年男性希望获得生殖保健服务的愿望比老年女性更为强烈。     

Effect of ACTH,adrenalectomy and the combination treatment on the density of 5-HT2 receptor binding sites in neocortex of rat forebrain and 5-HT2 receptor-mediated wet-dog shake behaviors

The effect of ACTH and/or adrenalectomy on serotonin (5-HT)₂ receptor binding sites was evaluated in the neocortex of rat forebrain. One day after the adrenalectomy or sham operation, ACTH (50 µg/day) was injected subcutaneously into adult male SD rats for 10 consecutive days. Saturation analysis showed that subchronic ACTH treatment significantly increased the B_max values for³H-ketanserin binding without any change in the K_d values. Moreover, this ACTH-induced increase in the B_max values was prevented by adrenalectomy. The concentrations of 5-HT and 5-hydroxyindole acetic acid (5-HIAA) measured by HPLC-ECD were not altered by these manipulations. Ten-day administration of corticosterone (20 and 50 mg/kg) also increased 5-HT₂ receptor density in the neocortex of rat forebrain. 5-HT₂ (and 5-HT_1C) receptor agonist, (±)DOI-induced wet-dog shakes in ACTH and/or adrenalectomy-treated rats were also examined. Ten-day administration of ACTH enhanced (±)DOI-induced wet-dog shakes and this increase was prevented by adrenalectomy. These results indicate that subchronic adrenocorticotropinadrenal axis activation of rats increases both the number of 5-HT₂ receptors in neocortex of forebrain and the wet-dog shake responses induced by (±)DOI.     

Differentiation of a primitive neuroectodermal tumor into a benign ganglioglioma

We describe a case of cerebellar neuroblastoma with histologic documentation of maturation into a ganglioglioma sixteen months later. Only chemotherapy was administered following the initial surgery and the child is well and disease-free three years following her final surgical procedure. The outcome of this patient supports previous hypotheses that the cerebellar neuroblastoma may be a less malignant tumor than its other primitive neuroectodermal posterior fossa counterparts. Furthermore, this case suggests a role for second-look surgery in the management of selected pediatric brain tumors.