关于河南中医学院设置健康保险专业的思考

目的：探讨河南中医学院设置健康保险专业的论证。方法：从我国健康保险业的发展实际出发，集中分析河南中医学院设置健康保险专业的必要性，论证了河南中医学院在师资、设施、生源与就业等方面的可行性，以培养目标、课程设置和实习基地建设为轴线，提出了设置健康保险专业的建议。结果与结论：河南中医学院设置健康保险专业有必要、有可行性、有优势。     

63例扩张型心肌病的长期随访分析

目的:评价扩张型心肌病的远期预后。方法:扩张型心肌病患者63例,给予强心、利尿、β受体阻滞剂、血管紧张素转化酶抑制剂及中药生脉(参麦)复方制剂治疗,定期随访,随访时间3～13年。随访项目包括:心功能改善情况、体力活动适应程度、院外服药治疗、再次入院次数,死亡,了解并登记死亡原因。结果:63例中随访3～5年16例,5～10年35例,10年以上12例,平均随访时间6.1年。随访期间死亡18例(病死率28.6%);存活45例,存活者患病时间2～15年,其中28例能从事一般正常劳动及工作(62.2%),生活可自理者10例(22.2%)。结论:由于治疗方案的改进,特别是中西医结合药物的应用,使扩张型心肌病患者的预后改善,平均存活时间延长,多数患者的生存质量提高。     

Site-independent prognostic value of chromosome 9q loss in primary gastrointestinal stromal tumours

Although the significance of tumour site for estimating malignant potential in gastrointestinal stromal tumours (GISTs) has recently been recognized, site-specific genetic patterns have not to date been defined. This study examined 52 c-kit-positive primary GISTs (with a mean follow-up of 42.3 months in 51 cases) from three different locations (35 gastric, 12 small intestinal, and five colorectal) using comparative genomic hybridization (CGH). In general, tumour site correlated with key prognostic factors, including tumour size, mitotic rate, proliferative activity, and probable malignant potential. Furthermore, several DNA copy number changes showed a site-dependent pattern. These included losses at 14q (gastric 83%, intestinal 35%; p = 0.001), losses at 22q (gastric 46%, intestinal 82%; p = 0.02), losses at 1p (gastric 23%, intestinal 88%; p = 1 x 10(-5)), losses at 15q (gastric 14%, intestinal 59%; p = 0.002), losses at 9q (gastric 14%, intestinal 53%; p = 0.006), and gains at 5p (gastric 11%, intestinal 53%; p = 0.002). These data demonstrate strong site-dependent genetic heterogeneity in GISTs that may form a basis for subclassification. Prognostic evaluation of DNA copy number changes identified losses at 9q as a site-independent prognostic marker associated with shorter disease-free survival (p = 0.03) and overall survival (p = 0.002). Furthermore, 9q loss also appeared to carry prognostic value in predicting overall survival for patients with advanced or progressive GISTs (p = 0.003).     

脑卒中后抑郁及其对神经功能康复的影响

目的:观察脑卒中后抑郁(Post-Stroke Depression,PSD)的发生率和相关因素;探讨选择性5-HT抑制剂对脑卒中后抑郁神经功能康复的影响.方法:选取急性脑脑卒中患者132例(脑梗死78例,脑出血54例),分别在病程2周、1,3,6,12月时给每一位入组患者行PSD诊断、神经功能缺损评分、日常生活能力评分(Activity of Daily Living Scale,ADL)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分;同时完成Zung's抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS).结果:①脑卒中患者中约44.70%出现抑郁症状;②脑卒中类型和性别与PSD发生率无相关性(P＞0.05);③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④PSD与病变部位、病灶大小、病灶单侧性均无明显相关(P＞0.05);⑤氟西汀抗抑郁治疗能明显改善病程3、6个月时的神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著.结论:脑卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者功能康复的速度和程度.抗抑郁剂治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.     

Marfan syndrome: Evolving organ manifestations—A 10‐year follow‐up study

The age‐dependent penetrance of organ manifestations in Marfan syndrome (MFS) is not known. The aims of this follow‐up study were to explore how clinical features change over a 10‐year period in the same Norwegian MFS cohort. In 2003–2004, we investigated 105 adults for all manifestations in the 1996 Ghent nosology. Ten years later, we performed follow‐up investigations of the survivors (n = 48) who consented. Forty‐six fulfilled the revised Ghent criteria. Median age: females 51 years, range 32–80 years; males 45 years, range 30–67 years. New aortic root dilatation was detected in patients up to 70 years. Ascending aortic pathology was diagnosed in 93 versus 72% at baseline. Sixty‐five percent had undergone aortic surgery compared to 39% at baseline. Pulmonary trunk mean diameter had increased significantly compared to baseline. From inclusion to follow‐up, two patients (three eyes) developed ectopia lentis, four developed dural ectasia, four developed scoliosis, three developed incisional or recurrent herniae, and 14 developed hindfoot deformity. No changes were found regarding protrusio acetabuli, spontaneous pneumothorax, or striae atrophicae. The study confirms that knowledge of incidence and progression of organ manifestations throughout life is important for diagnosis, treatment, and follow‐up of patients with verified or suspected MFS.     

Plasma B Vitamers: Population Epidemiology and Parent-Child Concordance in Children and Adults

Scope: B vitamers are co-enzymes involved in key physiological processes including energy production, one-carbon, and macronutrient metabolism. Studies profiling B vitamers simultaneously in parent–child dyads are scarce. Profiling B vitamers in parent–child dyads enables an insightful determination of gene–environment contributions to their circulating concentrations. We aimed to characterise: (a) parent–child dyad concordance, (b) generation (children versus adults), (c) age (within the adult subgroup (age range 28–71 years)) and (d) sex differences in plasma B vitamer concentrations in the CheckPoint study of Australian children. Methods and Results: 1166 children (11 ± 0.5 years, 51% female) and 1324 parents (44 ± 5.1 years, 87% female) took part in a biomedical assessment of a population-derived longitudinal cohort study: The Growing Up in Australia’s Child Health CheckPoint. B vitamer levels were quantified by UHPLC/MS-MS. B vitamer levels were weakly concordant between parent–child pairs (10–31% of variability explained). All B vitamer concentrations exhibited generation-specificity, except for flavin mononucleotide (FMN). The levels of thiamine, pantothenic acid, and 4-pyridoxic acid were higher in male children, and those of pantothenic acid were higher in male adults compared to their female counterparts. Conclusion: Family, age, and sex contribute to variations in the concentrations of plasma B vitamers in Australian children and adults.     

16例交锁髓内钉＋植骨治疗胫骨骨折不愈合的疗效观察

目的 :观察交锁髓内钉 植骨治疗胫骨骨折不愈合的临床疗效。方法 :本组胫骨骨折不愈合 16例 ,男 11例 ,女 5例 :年龄 19— 76岁 ,平均 34岁 ,全部采用开放置入交锁髓内钉 植骨治疗。结果 :经 11到 2 4个月 (平均 16 .5个月 )随访 ,15例胫骨骨不连愈合。结论 :交锁髓内钉 植骨治疗胫骨骨折不愈合具有 :1、合理的生物力学设计 ;2、抗骨折旋转及短缩功能 :3、对局部血运破坏小 ;4、植骨的成骨作用等促进骨愈合 ,值得推荐使用     

直立倾斜试验加硝酸甘油含化诊断血管迷走性晕厥的临床研究

目的评价硝酸甘油(NTG)含化加异丙肾上腺素倾斜试验(ITTT)诊断血管迷走性晕厥(VS)的价值.方法将72例VS患者和36例正常对照组随机均分成ITTT和ITTT+NTG组.结果ITTT+NTG组敏感性高于ITTT(93.1%和76%,P＜0.05)有显著性差异.结论ITTT+NTG含化是一种安全、耐受性好、敏感性高,特异性强的诊断VS的方法.     

药品零加成政策对慢性心力衰竭患者次均住院费用变化影响结构分析

目的 分析药品零加成政策对于慢性心衰住院费用的影响和结构变动趋势,为推进医改的实施和加强医院内部管理提供依据。方法 收集上海某医院2016—2019年慢性心衰患者住院费用,采用结构变动度法和灰色关联度法分析各项费用的结构变动情况及其与总费用的关联程度。 结果 2016—2019年住院费用总结构变动度为24.49%;药费及耗材费呈下降趋势,诊断费及综合服务费上升;药费结构变动贡献率最大（34.75%）,其次是诊断费（31.24%）,两项累积贡献率达65.99%;与次均住院费用关联度从高到低前三项为诊断费（0.86）、药费（0.79）和耗材费（0.72）。 结论 样本医院药品零加成政策的实施取得显著的成效。今后医院应建立合理评估机制,进一步控制药费及耗材费,加强诊断费的监督管理,优化医疗费用结构。