MRI技术对高原人群颅脑脱髓鞘疾病回顾性研究

目的研究高原地区,脱髓鞘疾病与中老年人疾病等因素的关系。方法对我院所有接受过磁共振头部扫描的病人进行评估,确诊出40位脱髓鞘疾病患者,并对大脑7个部位的脱髓鞘疾病按严重性分4级打分,统计临床数据,最后运用统计学方法分析其相关性。结果在40例患者中,出现在大脑半球、放射冠、半卵圆中心和脑室前后角的脑白质损伤频率最多,分别占总量的50%、67.5%、77.5%和87.5%。脑白质损伤患者的平均年龄为47.1岁,这比世界其他地区都有明显的提前。男性患者将近是女性患者的3倍(29∶11)。年龄、慢性高原红细胞增多症、收缩压、脑梗塞与脑白质损伤正相关(P<0.05)。结论对于高海拔地区,有效控制高原心血管疾病的发生对于减少颅脑脱髓鞘疾病的发生具有重要意义。     

乳腺良恶性肿块的高频彩色多普勒超声分析

目的:探讨彩色多普勒多参数分析对乳腺良、恶性肿块鉴别诊断的价值。材料和方法:应用高频彩色多普勒对96例104个乳腺实质肿块进行扫查,观察肿块的彩色多普勒血流信号及多普勒血流频谱形态,与手术病理结果对照分析。结果:64.4%的良性肿块可检出血流信号,血流信号多为Ⅰ~Ⅱ级,良性肿块中血流频谱以低阻力搏动型及静脉型多见,91.1%的乳腺恶性肿块可检出血流信号,血流信号多为Ⅱ~Ⅲ级,恶性肿块的血流频谱形态较多样化,即同时有多种血流频谱,且以高阻力搏动型和湍流型为多见。结论:高频彩色多普勒超声多参数综合分析有助于临床对乳腺肿块的诊断及鉴别诊断。     

The current role of photodynamic therapy in oesophageal dysplasia and cancer

Over the last 15 years photodynamic therapy (PDT) has become a viable treatment for pre-malignant and malignant disease of the oesophagus. Its initial use was in the palliation of oesophageal malignant obstruction bringing improved swallowing hence increasing nutritional intake and improving general quality of life. As the therapeutic boundaries of PDT have stretched, current studies look at the role of PDT in the treatment of pre-malignant dysplastic Barrett's epithelium and early malignancy as a curative mucosal ablative technique. As a curative treatment in early oesophageal cancer, PDT provides an alternative treatment to oesophagectomy for those more elderly or less medically fit patients.This paper reviews the uses of photodynamic therapy in oesophageal cancer with reference to the available publications on its use in the palliation of oesophageal cancer and treatment of early cancer and high grade dysplasia in Barrett's mucosa.     

Abdominal aortic aneurysm repair and colonic infarction: a risk factor appraisal

OBJECTIVE: Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients. METHOD: Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6-year period. RESULTS: A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross-clamp time, intra-operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients. CONCLUSION: In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality.     

Peritoneal dialysis patient survival: a comparison between a Swedish and a Korean centre.

BACKGROUND: Dialysis patient mortality remains high, and this high mortality may be due to many factors. In peritoneal dialysis (PD) patients, old age, co-morbid diseases, malnutrition, low residual renal function (RRF) and a high peritoneal transport rate have been shown to influence survival, but the relative importance of these factors may differ between different patient populations. Besides, centre practice patterns may differ between centres and may influence patient survival. In addition, the literature suggests that dialysis patient survival may be better in Asian than in Caucasian patients. METHODS: The influence of centre and patient characteristics on patient survival was investigated in 132 Korean and 106 Swedish incident PD patients, who underwent initial biochemical measurements and assessment of adequacy of dialysis, nutritional status, RRF and peritoneal transport characteristics. RESULTS: At the start of PD, Korean patients had a higher prevalence of diabetes, peritoneal Kt/V(urea), peritoneal creatinine clearance and peritoneal fluid removal, and lower body mass index, RRF and dialysate to plasma creatinine concentration ratio (D/P Cr) compared with Swedish patients. Significantly more patients from Korea were placed on temporary haemodialysis before PD (100 out of 132) when compared with Swedish patients (21 out of 106). During the follow-up, there was a significantly higher rate of transfer to other units in Korea and a significantly higher rate of kidney transplantation in Sweden. On Kaplan-Meier analysis, overall patient survival did not differ and relative risk for death was also not different between the two centres even after adjustment for age, diabetes, cardiovascular disease, RRF and D/P Cr. On Cox proportional hazards multivariate analysis, age, diabetes, RRF and D/P Cr were found to be independent predictors of mortality in the combined cohort of patients. While age, diabetes and D/P Cr were independent predictors of mortality in Korean patients, age and RRF independently predicted mortality in Swedish patients. CONCLUSION: Although there were significant differences in centre and patient characteristics, we were unable to confirm a survival advantage for Korean over Swedish PD patients. The results of this study suggest that the reported difference in survival between Asian and Caucasian dialysis patients may have been due, in part, to differences in centre and patient characteristics rather than to race as such. The genetic influence on patient characteristics remains, however, to be elucidated.     

环境电离辐射体源表面剂量率的MC模拟计算及实验比较

目的　对核工业地质勘查计量站的 8个圆柱型环境电离辐射体源和两个本底模型上方不同高度处的空气吸收剂量率进行较为准确的定值。方法　采用蒙特卡罗软件MCNP ,对上述环境电离辐射体源和本底模型上方的空气吸收剂量率进行了模拟计算 ,采用 1台高气压电离室剂量率仪对各环境电离辐射体源和本底模型上方不同高度处的空气吸收剂量率进行了实测 ,模拟计算结果与实测结果以及其他工作者过去所作的剂量率测量和计算结果进行了比较。结果　MC模拟计算值与其他工作者得到的空气吸收剂量率理论值吻合较好 ,最大偏差小于 10 % ,一般偏差小于±5 %。结论　只要各种输入参数准确 ,采用MC模拟计算 ,可以得到辐射体源和本底模型上方不同高度处较准确 (3%不确定度 )的空气吸收剂量率模拟计算值。     

"分段切开,多重挂线术"治疗高位复杂性肛瘘临床研究

目的:观察"分段切开,多重挂线术"治疗高位复杂性肛瘘的临床疗效。方法:将60例高位复杂性肛瘘随机分为治疗组40例,采用"分段切开,多重挂线术";对照组20例,采用传统切开挂线术进行对比观察。结果:显示治疗组与对照组显愈率分别为95%和90%,无明显差异(P>0.05),但两组间的术后疼痛程度、创口愈合时间、肛门功能情况存在显著差异(P<0.05)。结论:在治疗高位复杂性肛瘘时,"分段切开,多重挂线术"与传统切开挂线术相比,具有手术操作简单,对组织损伤小,痛苦小、疗程短、肛门功能保护好等优点,该术式的应用,使得高位复杂性肛瘘治疗更加安全、有效。     

社区人群痛风危险因素的病例对照研究

目的 探讨社区人群(20岁以上)痛风的危险因素。方法 采用1：3病例对照研究方法，进行单因素与多因素与多因素logistic回归分析。结果 经单因素筛选和多因素分析，在P=0．05水平，高尿酸(OR=8．601)、肥胖(OR=2．910)、伴有高血压病史(OR=2．330)是痛风的独立危险因素。结论 痛风是一种在遗传基础上的与环境和生活方式有关的疾病，改变生活方式、控制相关疾病可能预防或减少高尿酸血症的发生，进而减少痛风的发生。     

多器官功能障碍小鼠高迁移率族蛋白1释放对单个核细胞免疫相关指标的影响

目的 分析多器官功能障碍综合征(MODS)小鼠血清高迁移率族蛋白B1(HMGB1)含量的变化与外周血中单个核细胞免疫相关指标变化的关系,观察MODS发生、发展中HMGB1释放的规律及其对细胞免疫功能的影响.方法 腹腔注射酵母多糖复制小鼠MODS模型,用Westernblot法检测病程不同阶段血清HMGB1含量、流式细胞术测定外周血单核细胞表面组织相容性复合体-Ⅱ类分子(MHC-Ⅱ类分子,IAb)的表达量及T淋巴细胞亚群的比值(CD4+/CD8+).结果 在酵母多糖所致小鼠MODS模型中,当血清HMGB1含量升高时,外周血单核细胞IAb表达量及CD4+/CD8+比值下降;当血清HMGB1含量回复接近正常时,单核细胞IAb表达量及CIM4+/CD8+比值也趋于恢复正常.结论 在MODS的发生、发展过程中,HMGB1可能通过影响血中单个核细胞MHC-Ⅱ类分子(IAb)表达及T淋巴细胞的活性参与免疫调节过程,导致免疫失衡或免疫抑制.     

保留盆腔植物神经对老年男性患者术后性功能及排尿功能的影响

目的:探讨保留盆腔植物神经的直肠癌手术对老年男性患者性功能及排尿功能的影响。方法:1999~2005年因直肠癌手术的170例老年男性患者分为PANP组(含规范的TME手术方法)和非PANP(TME规范情况不详),对两组术后性功能、排尿功能和局部复发率进行回顾性总结、比较。结果:PANP组性功能与排尿功能明显优于非PANP组,但统计学无显著差异(P<0.05)。而PANP组局部复发率低于非PANP组(P>0.05)。结论:老年直肠癌患者应重视性功能和排尿功能的保护。