择时针刺治疗糖尿病的临床研究

本文将５０例非胰岛素依赖型糖尿病患者分为不择时针刺组、胰岛素分泌高峰时针刺组、胰岛素分泌低谷时针刺组和药物Ｄ８６０组，进行治疗比较研究。结果表明：胰岛素分泌高峰时针刺组治疗后的空腹血糖、餐后２小时血糖、２４小时尿糖定量、糖化血红蛋白均有明显改善（Ｐ＜０．０１），改善程度较不择时针刺组及胰岛素分泌低谷时针刺组为优（Ｐ＜０．０１，）与西药Ｄ８６０组疗效相近。     

Psychosocial Factors and 2-Year Outcome Following Bariatric Surgery for Weight Loss

Background: How psychosocial factors may impact on weight loss after bariatric surgery is not well understood. This lack of knowledge is problematic, because there is a high prevalence of psychosocial distress in patients seeking treatment for obesity in hospital-based programs. The purpose of this study was to examine the relationship between preoperative psychosocial factors and eventual weight loss. Method: Between 1987 and 1998, all individuals undergoing Roux-en-Y gastric bypass for weight loss in our institution had psychologic preoperative evaluations. Patients who were followed prospectively were studied. The relation of having received mental health treatment to percentage of excess weight loss at 2 years is examined using t-tests. Results: 62 women and 18 men completed a 2-year follow-up. Patients who had received treatment for either substance abuse (n=10) or psychiatric co-morbidity (n=39) lost more weight compared with those without such histories (P<0.05, P <0.001 respectively). Conclusion: Given these results, it is plausible that a history of having received either psychiatric treatment for a disorder or counseling for substance abuse should not be a contraindication to bariatric surgery, and, in fact, may be prognostic of favorable outcome. Further research examining psychosocial factors and outcome from bariatric surgery is clearly warranted.     

Downhill skiing injuries: associated factors and prevention strategies

Abstract

Downhill skiing is a unique sport with respect to its technique and equipment. A variety of injuries have been reported, which include tears of the anterior cruciate and medial collateral ligaments of the knee, tear of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb, ankle sprain, fracture of the lower leg, soft tissue injury of the shoulder, tear of the medial meniscus of the knee, muscle strains, and lumbar spine strain. The findings from research into factors associated with injury are often equivocal. The main findings reported include: beginner–intermediate level of skiing ability, between one and four days of skiing, between two and three hours of skiing on the day of injury, fine weather, slow speed of skiing, slopes classified as 'easy', lack of professional instruction, and failure of bindings to release prior to injury. Further research into pre-season training and pre-skiing warm-up is required. General injury prevention recommendations have been made, however, thorough injury prevention strategies are yet to be developed. Recommendations include: equipment modifications, skiing specific pre-season training and pre-skiing warm-up with attention to a wide variety of body areas, professional instruction, and current information regarding risk factors and injury prevention to be made available to appropriate health professionals and the skiing public.     

A Case-Control Assessment of Risk Factors for Gallbladder Carcinoma

Gallbladder carcinoma is an uncommon, but highlyfatal disease. Its symptoms frequently mirror those ofgallstone disease, and in most instances, diagnosis isan incidental finding at surgery. While risk factors have been suggested for this cancer,many may in reality simply be a consequence of the olderage of the population. This study is one of the few toapproach this question by using a case-control study design comparing gallbladder carcinomapatients with a gallstone population, coupled withmultivariate analysis to determine age-independent riskfactors. Univariate analyses showed gallbladdercarcinoma patients to be older than gallstone patientsand to have many age-associated diseases. Followingmultiple regression adjustment for age, this disease wasassociated with female gender and with a previous history of gallstone symptoms. Carcinomapatients were less likely to have cholesterol gallstonesin their gallbladders at surgery. A previous history ofsmoking was a substantial risk but of borderline statistical significance. Previous studiesreport associations that may be due to the older age ofthe gallbladder carcinoma patient. Our results show thatafter adjusting for age with multivariate analysis, gallbladder cancer subjects were predominantlyfemale, more likely to report previous gallstonesymptomology, and to smoke. While gallstones were notuniversally isolated from carcinoma patients atcholecystectomy, when present, they were less frequentlyclassified as cholesterol gallstones based on visualinspection. Further cohort studies which target thesepopulations will allow us to gain a more solid consensus on the risk factors for this disease.     

老年性肺部真菌感染60例临床分析

【目的】探讨老年人肺部真菌感染的相关因素。【方法】对我们收治的60例老年性肺部真菌感染患者的资料进行回顾分析,寻找其感染菌群的病原体及可能与真菌感染相关的因素。【结果】老年性肺部真菌感染主要菌群为白色念珠茵,其发生可能与下列因素密切相关：基础疾病、抗生素的应用、低蛋白血症、糖皮质激素的应用。【结论】老年性肺部真菌感染主要茵群为白色念珠菌,基础疾病、抗生素的应用、低蛋白血症、糖皮质激素的应用可能是肺部真菌感染的相关危险因素,而中医药在治疗该病方面有独特的优势：     

中年知识分子心理健康状况调查

[目的]探讨中年知识分子心理健康状况及影响因素。[方法]采用整群抽样方法,应用症状自评量表SCL-90对1474名中年知识分子进行心理状况测评,运用尺度分析、主成分因子分析和方差分析。[结果]女性中年知识分子躯体化(somatization)因子得分高于男性(P<0.001),且男女躯体化因子高于全国常模(P<0.001); 未婚的中年知识分子各项因子得分均高于已婚者,丧偶的中年知识分子躯体化、抑郁因子得分高于已婚、未婚和离婚者。[结论]中年知识分子不同婚姻状况的心理影响因子存在差异,躯体化症状对女性中年知识分子影响比男性大,未婚的中年知识分子心理健康状况有待改善,丧偶的中年知识分子比较突出的心理问题表现为躯体化症状和抑郁。     

FRAX underestimates fracture risk in patients with diabetes

The study objective was to determine whether diabetes is a risk factor for incident hip or major osteoporotic fractures independent of the WHO fracture risk assessment tool (FRAX). Men and women with diabetes (n = 3518) and nondiabetics (n = 36,085) aged ≥50 years at the time of bone mineral density (BMD) testing (1990 to 2007) were identified in a large clinical database from Manitoba, Canada. FRAX probabilities were calculated, and fracture outcomes to 2008 were established via linkage with a population-based data repository. Multivariable Cox proportional hazards models were used to determine if diabetes was associated with incident hip fractures or major osteoporotic fractures after controlling for FRAX risk factors. Mean 10-year probabilities of fracture were similar between groups for major fractures (diabetic 11.1 ± 7.2 versus nondiabetic 10.9 ± 7.3, p = 0.116) and hip fractures (diabetic 2.9 ± 4.4 versus nondiabetic 2.8 ± 4.4, p = 0.400). Diabetes was a significant predictor of subsequent major osteoporotic fracture (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.42-1.83) after controlling for age, sex, medication use, and FRAX risk factors including BMD. Similar results were seen after adjusting for FRAX probability directly (HR = 1.59, 95% CI 1.40-1.79). Diabetes was also associated with significantly higher risk for hip fractures (p < 0.001). Higher mortality from diabetes attenuated but did not eliminate the excess fracture risk. FRAX underestimated observed major osteoporotic and hip fracture risk in diabetics (adjusted for competing mortality) but demonstrated good concordance with observed fractures for nondiabetics. We conclude that diabetes confers an increased risk of fracture that is independent of FRAX derived with BMD. This suggests that diabetes might be considered for inclusion in future iterations of FRAX.     

广州市门诊就诊人数与气候关系研究

【目的】探讨广州市门诊就诊人数与气候的关系。【方法】对广州市3所医院1993～2001年各科室月门诊人数与同期月气象数据进行相关回归分析。【结果】影响广州市月门诊人数的主要气象因素为：月平均气压、月最低气温、月总日照时数、月降雨量、月均相对湿度、月平均风速。平均气压、最低气温、相对湿度、平均风速与月门诊人数呈负相关；日照时数、降雨量与月门诊人数呈正相关。并建立相应的多元线性回归方程。结果表明影响广州市疾病发生的气象因素为平均气压、最低气温、相对湿度、平均风速、日照时数、降雨量。【结论】根据气象因素建立起来的多元线性回归方程可用来预测所在地区的疾病流行趋势，对预测疾病的发生与流行有较大参考价值。     

气温与节气对上消化道出血影响的临床再分析

【目的】深入调查、分析、总结上消化道出血(UGB)发病与节气和气温的相关性,为上消化道出血未病先防提供依据。【方法】回顾性调查分析近10年来闽西地区2 166例UGB患者的发病节气,作圆形统计分析,计算此期间各节气UGB的发病例数,观察其发病的节气规律;应用双变量相关的统计方法分析UGB发病数与不同节气中的气象因子,包括最高气温、最低气温、平均气温、气温较差、雨日、降水量之间的相关性。【结果】2 166例UGB患者的发病在节气上存在集中性,发病高峰日处于大雪节气,高峰期为上年的处暑至当年的春分。UGB与气温较差呈正相关(相关系数r为0.799,P﹤0.01);与最低气温、平均气温、最高气温、降水量呈负相关(相关系数r分别为-0.832、-0.823、-0.758、-0.600,均P﹤0.01);与雨日呈负相关(相关系数r为-0.503,P﹤0.05)。【结论】UGB在平均气温较低、气温较差大时段,尤其是大雪节气较容易发病,预防重点应放在此期间。     

Regulation of Mammary Gland Growth and Morphogenesis by the Mammary Fat Pad: A Species Comparison

The growth and morphogenesis of mammaryparenchyma varies substantially between species and isregulated by an array of systemic and local factors.Central to this regulation is the mammary fat pad, amatrix of adipose and connective tissue capable ofmediating hormone action and synthesizing an array ofgrowth regulatory molecules. In this article wehighlight differences between the morphologicaldevelopment of the mammary parenchyma in rodents, humans,and ruminant dairy animals, placing emphasis ondifferences in the cellular composition and structure ofthe mammary fat pad. While a great deal remains to be understood about the ability of stroma tolocally regulate mammary development, the significanceof its contribution is becoming increasingly apparent.The actions of several steroid and peptide hormones appear to be mediated by an array of growthfactors, proteases and extracellular matrix componentssynthesized by constituents of the mammary fat pad.Further, mammary adipose tissue represents a significant store of lipid which, by itself and through itsderivatives, could influence the growth of mammaryepithelium in diverse ways. This review describes theintegral role of the mammary fat pad duringmammogenesis, emphasizing the point that species differencesmust be addressed if local growth and morphogenicmechanisms within the mammary gland are to beresolved.