原发性肝癌患者外周血IL-2,sIL-2R,TNFa水平及NK细胞活性检测

目的 :检测原发性肝癌患者外周血IL -2,sIL -2R,TNFa水平及NK细胞活性 ,并探讨患者细胞免疫功能低下的原因。方法 :采用MTT法检测30例原发性肝癌患者外周血单个核细胞白细胞介素2(IL -2)的诱生水平 ;采用ELISA法检测血清可溶性白细胞介素2受体 (sIL -2R) ,肿瘤坏死因子a(TNFa)水平 ;自然杀伤细胞活性 (NK -A)检测采用MTT法。结果 :原发性肝癌患者外周血TNFa水平降低 (P<0.01) ;IL -2、NK -A活性水平低于对照组 (P<0.05) ;sIL -2R水平高于对照组 (P<0.01)。结论 :原发性肝癌患者Th1细胞因子及NK -A活性有所降低 ,检测该指标有助于了解患者机体细胞免疫功能及预后评估。     

支气管肺癌伴其它部位多原发癌的影像诊断(附25例报告)

经病理确诊的527例原发性支气管肺癌(PBC)(1972～1987)中,PBC伴其它部位多原发癌(MPC)25例(4.7％)。其中双原发肺癌(DPBC)、12例(2.3％),PBC伴消化道癌6例(1.14％)。25例中共有原发癌灶52个,其中2例为3原发癌;同期组6例(其中DPBC 4例),后期组19例(其中14例间隔3年以上,内2例分别间隔14年及25年)。组织类型相同者8例,不同者4例。 25例MPC特点如下:1.55岁以上20例(80％);2.24例(96％)第2原发癌为1980年后发现;3.第2原发癌为肺癌者23例(92％);4.双原发肺癌12例(48％)。上述特点说明80年代老年人中MPC,尤其是肺癌发病率增高。 本文着重对第2原发肺癌的影像学表现和鉴别诊断进行讨论。     

胎膜早破并发胎盘早剥的临床分析

目的　探讨妊娠晚期胎膜早破并发胎盘早剥的发生率、早期诊断和处理要点。方法　回顾分析2 0 0 1年～2 0 0 4年郑州大学第三附属医院产科分娩的胎膜早破病例,其中并发胎盘早期剥离者8例,与非胎膜早破发生胎盘早剥者进行比较。分析早期诊断和母婴结局。结果　3年分娩总数为4 12 4例,胎膜早破并发胎盘早剥者占全部胎盘早剥的2 8 6 % ,胎膜早破是胎盘早剥的首位发病诱因。胎膜早破并发胎盘早剥的发生率为2 77% ,而非胎膜早破者为0 5 2 % ,两者相比差异有显著性(P <0 0 1)。间断腰痛、血性羊水、胎心异常为常见的临床表现。胎膜早破并发胎盘早剥时围产儿的死亡率为12 5‰,无孕产妇死亡。结论　胎膜早破是胎盘早剥的诱因之一,重视临床表现,并结合B超和胎心监护有助于早期诊断,以降低母儿并发症。     

Disability,depression and somatization in a low back pain population

Objective: The aim of this study was to determine the prevalence of low back pain (LBP) in a primary care setting population and examine its association with the symptoms of depression and somatization. Methods: This is a cross‐sectional study, utilising a survey carried out in primary health care clinics (PHCs) in Al‐Ain, United Arab Emirates (UAE). A multistage stratified sampling design was used and a representative sample of 1304 UAE nationals aged 18–65 years who attended PHC clinics for any reason were included and 1103 (84.5%) subjects agreed to participate and responded to the questionnaire during a period from June 2001 to January 2002. A specially designed questionnaire with three parts was used for the data collection: socio‐demographic information of the studied subjects, modified version of the Roland‐Morris scale for evaluating back‐related functional disability and SCL‐90 R for depression and somatization subscales was used to assess depressive and somatic symptoms. Results: Of the total number of subjects surveyed (1103), 586 (53.1%) were men and 517 (46.9%) women. The mean age was 34.9 ± 13.4 years for men and 33.5 ± 11.8 years for women. The prevalence of LBP in the studied subjects was 64.7% (95% CI, 60.7–68.5] with 46.7% among men and 53.3% among women. There were a significant differences between the subjects with LBP and without LBP with respect to gender (P < 0.001), body mass index (BMI) (P < 0.001), occupational status (P < 0.001) and living environment (P = 0.016). Functional disability was higher in patients with LBP. Young patients in aged 15–34 years, patients with preparatory/secondary educational level and students showed higher depressive symptoms. A similar pattern was found in patients with somatic symptoms. Factor analysis revealed a strong association between depression and somatization in LBP patients. Conclusions: Functional disability was higher in with LBP. Furthermore, symptoms of depression and somatization are prevalent among LBP patients.     

运用反应时探究小学生情绪认知发展特点

目的：探究小学儿童情绪认知的发展特点。方法：采用计算机实验方法和反应时评价指标，运用80对情绪词汇推测小学儿童对四个不同类别情绪（基本积极情绪、基本消极情绪、积极自我意识情绪、消极自我意识情绪）的认知发展差异，以及对引发情绪的原因、情绪的外在行为反应、情绪的后继调节三个维度的认知发展差异。结果：小学儿童对引发情绪的原因、外在行为反应、后继调节三个维度的反应时差异有统计学意义（1289．5、1164．6、1295．7，F=13．535，P〈0．001），且三个维度认知反应时2年级学生均长于4、6年级（P〈0．01），对四个不同类别情绪认知的反应时差异无显著性（1237．1、1269．8、1222．8、1305．2，F=1．520，P=0．220），四个类别的情绪认知反应时2年级均长于4、6年级（P〈0．01）。结论：儿童对情绪行为认知的加工速度最快，对消极自我意识认知的发展相对较慢，且均在2—4年级间发展迅速。     

Obstetrician-gynecologists as primary care physicians: The Oregon experience—Early perceptions regarding the effects of legislative action

OBJECTIVE: Our purpose was to assess whether legislative action influenced the role of obstetrician-gynecologists as primary care physicians. STUDY DESIGN: An observational study was performed on the basis of a questionnaire sent to 410 obstetrician-gynecologists and 27 medical directors of managed-care organizations. RESULTS: Of 67% of obstetrician-gynecologists and 96% of medical directors who responded, there was agreement as to the content of primary care, but a minority (38%) of obstetrician-gynecologists identified themselves as primary care providers. A minority of medical directors (35%) felt that obstetrician-gynecologists should serve in that role. Both obstetrician-gynecologists and medical directors felt that legislation had little impact. CONCLUSION: The reticence of obstetrician-gynecologists to assume a major role in primary care appears to be the result of an uneasiness with accepting a more comprehensive role in patient management and gatekeeping. They appear comfortable with the more traditional roles but feel that training and experience has not prepared them well for the management of more complex medical problems. (Am J Obstet Gynecol 1998;178:1222-8.)     

Synchronous growth of triple lung cancer

The case of a 75-year-old man with three synchronous carcinomas of the lung (large cell carcinoma, adenocarcinoma, and small cell carcinoma) is reported. This is the eighth well-documented case report in the literature; however, our case is the first to be reported with the newly described histological combination.     

Pleiotropy in Coffin-Lowry syndrome: Sensorineural hearing deficit and premature tooth loss as early manifestations

We report on 7 patients (6 M, 1 F) with Coffin-Lowry syndrome who have a sensorineural hearing deficit in addition to developmental delay and characteristic facial changes. One of the patients also had a history of premature exfoliation of primary teeth. These are previously unappreciated clinical signs that may aid in the early diagnosis of Coffin-Lowry syndrome. Early diagnosis and recognition of a hearing deficit in the patient can lead to the use of hearing aids to help the patient achieve his or her full potential. These “;new”; clinical manifestations expand the phenotype of Coffin-Lowry syndrome and constitute an additional indication of pleiotropy. © 1993 Wiley-Liss, Inc.     

原发性淀粉样变性的临床病理及电镜观察

淀粉样变性是指淀粉样蛋白在皮肤，粘膜或内脏器官的细胞外沉积引起的一种少见疾病。口腔粘膜中舌粘膜是本病的好发部位。本组４例典型地发生于口腔颌面部的原发性淀粉样变性病例，３例病变部位为舌，１例为皮肤和口腔粘膜同时受累，临床提示有必要进行全身系统检查及追踪随访。并就基临床表现，常规病理，组织化学及电镜进行研究，同时讨论了淀粉样蛋白的光镜，电镜特点，组织学类型生化组成及来源。     

现阶段县级卫校在初级卫生保健中的作用探析

依据乡村医生人力结构现状调查结果,就现阶段县级卫校在初级卫生保健中的作用及今后面向乡村医生办学的可行性作了具体的分析和探讨。结论是:提高质量,加强对在岗乡医进行系统化正规中专层次的职后复训,应是县级卫校今后1O年的最主要的任务。