重组人促红素联合蔗糖铁用于妇科围手术期红细胞动员的疗效观察

目的观察重组人促红素(rhEPO)联合蔗糖铁用于妇科围手术期红细胞动员的效果。方法选取2012年5-12月我科收治的中度贫血患者156例,随机分为对照组与观察组,每组78例。对照组按照患者血红蛋白(Hb)情况,给予口服铁剂、饮食补充。观察组于手术前一日开始给予rhEPO 20 000 IU皮下注射,同时静脉补充蔗糖铁100 mg,每周2次。手术日开始,给予rhEPO 10 000 IU/支,每日皮下注射,连续7 d。分别于注射后1、3、5、7 d观察两组患者的Hb的变化情况。结果手术后,观察组患者的Hb未受手术影响;对照组患者的Hb与手术前比较,均有不同程度下降;治疗组患者的Hb值明显高于对照组,两组比较,差异有统计学意义(P<0.05)。结论 rhEPO联合蔗糖铁应用于妇科围手术期红细胞动员效果满意,既能缓解目前血液紧张的状态,又可以避免异体输血的隐患。     

自体骨髓干细胞动员移植联合神经营养因子和综合康复治疗持续植物状态

目的观察自体骨髓干细胞（bone marrow stem cells,BMSCs）动员联合神经营养因子及综合康复治疗持续植物状态（persistent vegetative state,PVS）患者的疗效及安全性。方法 60例PVS患者根据治疗方案分为对照组与观察组各30例,对照组给予神经营养因子及综合康复治疗,观察组在对照组治疗基础上行BMSCs动员治疗,比较2组治疗前、后PVS评分。结果治疗前观察组与对照组PVS评分分别为（0.92±0.67）和（0.91±0.75）分,差异无统计学意义（P〈0.05）;治疗后3,6个月、1a观察组PVS评分分别为（12.92±3.55）,（13.58±3.53）,（14.42±3.68）分,对照组分别为（10.45±4.58）,（11.82±5.06）,（12.27±5.06）分,2组比较差异均有统计学意义（P均〈0.05）;治疗后1a,观察组与对照组治愈率分别为80.0%,56.7%,差异有统计学意义（P〈0.05）;治疗过程中2组均未出现明显不良反应。结论 BMSCs动员联合神经营养因子及综合康复治疗PVS安全、疗效满意。     

Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial

Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops, shorten its duration. We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach (EMSMTA) in a subgroup of subjects with frozen shoulder syndrome (FSS). Based on the kinematics criteria from a prediction method, 34 subjects with FSS were recruited. Eleven subjects were assigned to the control group, and 23 subjects who met the criteria were randomly assigned to the criteria-control group with a standardized physical therapy program or to the EMSMTA group. Subjects attended treatment sessions twice a week for 8 weeks. Range of motion (ROM), disability score, and shoulder complex kinematics were obtained at the beginning, 4 weeks, and 8 weeks. Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria-control group at 4 weeks (mean difference = 0.2 of normalized hand-behind-back reach) and 8 weeks (mean difference = 22.4 degrees humeral external rotation, 0.31 of normalized hand-behind-back reach, 7.5 disability, 5 degrees tipping and 0.32 rhythm ratio). Similar improvements were found between the EMSMTA group and control group. The EMSMTA was more effective than a standardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method.     

初诊2型糖尿病患者胰腺脂质沉积程度与脂代谢紊乱的相关性

目的探讨初诊2型糖尿病(T2DM)患者胰腺脂质沉积与脂代谢紊乱的关系。方法收集T2DM患者64例和对照组60例,均接受上腹部CT平扫,计算脾胰CT差值,评估胰腺脂质沉积程度;设定脾脏CT值-胰腺CT值差值>5 HU为脂肪胰组,≤5 HU为非脂肪胰组。将T2DM患者再分为单纯T2DM组(20例),合并脂肪胰组(44例)。测定各组血浆三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)含量评估脂代谢状况。结果脾胰CT差值T2DM组为(11.7±8.9)Hu较对照组的(8.9±6.9)Hu有所增加;两组TG、HDL差异有统计学意义(P<0.05)。偏相关分析表明,脾胰CT差值与TG正相关(r=0.525),与HDL负相关(r=-0.575)。结论胰腺脂质沉积程度与脂代谢密切相关,可能参与T2DM患者代谢紊乱的发生、发展。     

Testing GSTP1 genotypes and haplotypes interactions in Slovenian post-/pre-menopausal women: novel involvement of glutathione S-transferases in bone remodeling process

Objectives

Osteoporosis (OP) is an age-related disease associated with increased production of reactive oxygen species (ROS) and a reduction in antioxidant defense system, such as low activity of glutathione S-transferase (GST) family. The enzyme activity of the member of GSTs, GSTP1, depends on gene polymorphisms such as: Ala114Val and Ile105Val. The aim of this study was to evaluate the association between genetic polymorphisms of the GSTP1 gene and BMD variation and biochemical bone remodeling markers in 523 Slovenian pre- and post-menopausal women.

Study design

Observational pilot study in a representative cohort of Slovenian patients with adjustment for potential confounders (age, height, weight, years since menopause, smoking status and glucocorticoid use) using univariate one-way and two-way analyses.

Main outcome measures

Ala114Val and Ile105Val polymorphisms genotypes of GSTP1 gene, bone mineral density (BMD) values of total hip (_th), femoral neck (_fn) and lumbar spine (_ls), plasma osteocalcin (OC), serum bone alkaline phosphatase (BALP), free soluble RANKL and serum osteoprotegerin (sOPG) concentrations were determined.

Results

Our results show that the Ala114Val heterozygotes are (borderline) significantly associated with higher concentrations of pOC (p = 0.052) and decreased BMD_fn values (p = 0.053) and the same trend is shown for BMD_th and BMD_ls values in osteopenic postmenopausal women. Furthermore, significantly higher concentrations of pOC were determined among Val allele carriers of Ile105Val gene polymorphism (p = 0.037) and in carriers with the absent 114Ala–105Ile haplotype combination, again in osteopenic post-menopausal women.In addition, in pre-menopausal women the significant associations between sOPG and Ala114Val genotypes subgroups and between sBALP and Ile105Val genotypes subgroups, alone or in combination with Ala114Val, were determined (0.032, 0.026 and 0.008, respectively).

Conclusions

Since significant associations existed in Ala114Val genotype and 114Ala–105Ile haplotype subgroups, these variations can be useful for determining low BMD and high pOC risk in postmenopausal women.     

动态关节松动术治疗桡骨远端骨折后关节僵硬的初步研究

目的初步研究动态关节松动术对桡骨远端骨折后关节僵硬的疗效及应用价值。方法将18例桡骨远端骨折后关节僵硬的患者分为动态关节松动术组10例和对照组8例。动态关节松动术组采用动态关节松动术治疗,对照组采用Kaltenborn关节松动术治疗,3周后对两组治疗前后的腕部关节活动度和关节功能进行比较。结果动态关节松动术组与对照组治疗后的腕关节活动度及关节功能均优于康复治疗前(P<0.05)。治疗后两组患者之间的关节活动度和功能无明显差异(P>0.05)。结论动态关节松动术是一种治疗桡骨远端骨折后关节僵硬的有效手段,可作为该类患者的康复方法之一。     

The more, the less: age and chemotherapy load are predictive of poor stem cell mobilization in patients with hematologic malignanciesThe more, the less: age and chemotherapy load are predictive of poor stem cell mobilization in patients with hematologic malignancies

Background  Intensive treatment such as autologous peripheral blood stem cell (PBSC) transplantation is an important therapeutic strategy in many hematologic malignancies. A number of factors have been reported to impact PBSC mobilization, but the predictive factors varied from one study to another. This retrospective study assessed our current mobilization and collection protocols, and explored the factors predictive of PBSC mobilization in patients with hematologic malignancies.

Methods  Data of 64 consecutive patients with hematologic malignancies (multiple myeloma, n=22; acute leukemia, n=27; lymphoma, n=15) who underwent PBSC mobilization for over 1 year were analyzed. Four patients with response to treatment of near complete remission or better were administered granulocyte colony-stimulating factor (G-CSF) to mobilize PBSCs. Sixty patients received G-CSF followed by chemotherapy mobilizing regimens. Poor mobilization (PM) was defined as when ≤2.0´10⁶ CD34⁺ cells/kg body weight were collected within three leukapheresis procedures.

Results  The incidence of PM at the first mobilization attempt was 19% (12/64). The PM group was older than the non-PM group (median age, 51 vs. 40 years; P=0.013). In univariate analysis, there were no significant differences in gender, diagnosis, and body weight between the PM and non-PM groups. A combination of chemotherapy and G-CSF was more effective than G-CSF alone as a mobilizing regimen (P=0.019). Grade III or IV hematopoietic toxicity of chemotherapy had no significant effect on the mobilization efficacy. Supportive care and the incidence of febrile neutropenia were not significantly different between the two groups. In multivariate analysis, age (odds ratio (OR), 9.536; P=0.002) and number of previous chemotherapy courses (OR 3.132; P=0.024) were two independent negative predictive factors for CD34⁺ cell yield. PM patients could be managed well by remobilization.

Conclusion  Older age and a heavy load of previous chemotherapy are the negative risk factors for PBSC mobilization.

     

水杨酸对白桦悬浮细胞中齐墩果酸积累及防御酶活性的影响

目的 研究水杨酸（SA）对白桦悬浮细胞生长、齐墩果酸积累及防御酶活性的影响。方法 在白桦悬浮培养第7、10、13、15天,分别添加不同质量浓度（10、25、50、100、250 mg/L）的SA,进行细胞生长、齐墩果酸量及抗逆酶活性分析。结果 添加低质量浓度SA（10～25 mg/L）对细胞活力和生长量影响不大,高质量浓度的SA（100～250 mg/L）处理可显著抑制细胞活力和生长,但可促进齐墩果酸的积累,在第7天添加250 mg/L SA后齐墩果酸量最高,达1.71 mg/g（干质量）,是对照的3.1倍;而第7天添加50 mg/L SA后齐墩果酸的产量为0.473 mg,比对照提高了42.04%。悬浮培养第7天添加50 mg/L SA,过氧化氢酶（CAT）和超氧化物歧化酶（SOD）两种酶活性分别在0～24 h和0～48 h比对照显著提高,而PAL活性在SA处理12 h后始终高于对照。结论 适宜浓度的SA可刺激白桦细胞防御酶活性提高,并促进白桦悬浮细胞中齐墩果酸的积累。     

Follow-up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non-adopters

Objectives  To verify reported construction of 22 385 household latrines in 2004, after community mobilization, as part of a trachoma control programme in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non-adopters.
Methods  We used a two-stage cluster sample survey design to randomly select eight sub-districts and 160 households listed as having built a latrine, and visited them to verify presence and use. Household heads were interviewed to determine latrine cost and knowledge, attitude and practice regarding latrines. Non-latrine adopting neighbours were interviewed for comparison. We estimated district latrine ownership and calculated adjusted odds ratios for factors associated with latrine use.
Results  Latrines were present in 87% (95% CI 77–97) of listed households; 90% (81–99) were in use. Among all district residents we estimated ownership as 50.2% (44–56) and use as 45.2% (36–55). Of latrine owners who had built in 2004, 69% (53/77) had spent nothing on their latrine, those who paid spent an average of US$4.0 [standard deviation (SD) US$3.6]; overall the median cost was US$0 and the mean US$0.80 (SD US$1.7). Household heads adopting latrines were 1.9 times (95% CI 1.3–2.8) more likely to have any education and 1.5 times (95% CI 1.1–2.0) more likely to have a larger family than non-adopting neighbours. Cleanliness (48%, 56/116) and health benefits (42%, 49/116) were the most frequently reported advantages of latrines.
Conclusion  The latrine promotion programme dramatically increased latrine access and use at very low cost. The method of community mobilization used could be an effective way of reaching millennium development sanitation targets.     

中医“治未病”理论在血液透析中的运用

目的:减少血液透析并发症,保证透析效果,提高患者生活质量。方法:在执行常规透析治疗的基础上,将"治未病"理论的"未病先防"、"既病防变"、"病后防复"三种理论体系,运用到血液透析的不同阶段。结果:通过"治未病"理论在血液透析中的运用,减少了并发症,保证了透析效果,提高了患者的生活质量。结论:"治未病"理论经过两千多年的医学实践,不断得到总结和完善,仍然可以指导和运用于现代医学治疗手段的血液透析中,对提高血液透析患者的治疗效果,有效降低血液透析各种并发症有重要意义。