MRCP与ERCP对低位梗阻性黄疸诊断价值的比较

目的 评价磁共振胰胆管造影术(MRCP)和内窥镜逆行胰胆管造影(ERCP)在低位梗阻性黄疸中的诊断价值.方法 将78例经B型超声证实为低位梗阻性黄疸的病人随机分为2组(均无禁忌证),其中1组40例行MRCP检查,另1组38例行ERCP检查.通过对比检查后并发症、淀粉酶、脂肪酶以及诊断准确度来比较两者的诊断价值.结果 ERCP术后病人的并发症发病率明显高于行MRCP检查的病人(P＜0.01),ERCP检查后病人的淀粉酶和脂肪酶水平高于MRCP术后的病人(P＜0.05),两者诊断准确度经比较无差异(P＞0.05).结论 对低位梗阻性黄疸病人的诊断应首选MRCP,需作进一步确诊时再选用ERCP.     

乙状结肠两种造口方式术后排便功能及并发症的观察和对比

目的对两种乙状结肠造口术后造口功能及并发症进行观察对比。方法回顾性分析我们自1996年～2006年行Miles手术腹壁永久性造口512例的临床资料。结果经腹膜外结肠造口288例,发生造口并发症23例,并发症发生率为7.99%;经腹膜内结肠造口224例,发生造口并发症76例,并发症发生率为33.93%。经腹膜外结肠造口者术后2年造口功能优良率为56.25%,经腹膜内结肠造口者为30.80%(P<0.01)。结论经腹膜外结肠造口功能恢复及术后并发症发生率均优于经腹膜内结肠造口。     

Variations in the use of diagnostic procedures after acute stroke in Europe: results from the BIOMED II study of stroke care

Valid classification of stroke is essential to initiate effective acute management and early secondary prevention strategies. To accurately evaluate stroke subtype a number of diagnostic procedures have to be performed. This study sought to investigate variations in use of diagnostic procedures across selected European hospitals. First-ever stroke patients were sampled over a 1-year period through 11 hospital-based registers across 10 European countries. We defined a diagnostic standard for valid aetiological classification of ischemic stroke including brain imaging, vascular imaging and echocardiography. The impact of socio-demographic, clinical and structural characteristics on performance of the diagnostic standard was assessed using multivariate logistic regression analyses. A total of 1721 patients were included in the study. 83.1% received brain imaging, ranging from 32.8% to 100%. The diagnostic standard was performed in 40.4% of stroke patients, ranging from 0% to 77.2%. Patients with increasing age ( P  < 0.001) and with more severe strokes ( P  = 0.001) were less probably to receive the diagnostic standard. Patients treated in stroke units and neurological departments were more frequently investigated with the diagnostic standard ( P  < 0.001). Less than half of hospitalized stroke patients across Europe underwent diagnostic procedures to allow for aetiological classification of stroke, which may hamper the initiation of effective early management and secondary prevention.     

脑梗死OCSP分型和预后

目的了解脑梗死患者OCSP临床分型的构成及不同亚型与预后及复发的关系。方法采用回顾性队列研究,登记2002年1月~2005年6月第四军医大学西京医院神经内科确诊的617例脑梗死患者,按照OCSP标准分型并进行随访,分析各亚型与预后及复发的关系。结果OCSP各亚型构成比分变为:TACI占7.3%,PACI23.3%,POCI6.0%,LACI63.4%,分型与预后明显相关,TACI的预后最差,POCI和LACI预后相对较好,PACI次之,卒中复发与分型无明显相关。结论OCSP分型作为一种脑梗死临床分型方法,可以为脑梗死的预后判断提供参考依据。     

Association analysis of genes in the renin‐angiotensin system with subclinical cardiovascular disease in families with Type 2 diabetes mellitus: The Diabetes Heart Study

Aims Cardiovascular disease (CVD) is a major complication of Type 2 diabetes mellitus. The renin‐angiotensin system (RAS) and nitric oxide production are both important regulators of vascular function and blood pressure. Genes encoding proteins involved in these pathways are candidates for a contribution to CVD in diabetic patients. We have investigated variants of the angiotensinogen (AGT), angiotensin converting enzyme (ACE), angiotensin type 1 receptor (AT1R) and endothelial nitric oxide synthase (NOS3) genes for association with subclinical measures of CVD in families with Type 2 diabetes mellitus (T2DM). Methods Atherosclerosis was measured by carotid intima‐media thickness and calcification of the carotid and coronary arteries in 620 European Americans and 117 African Americans in the Diabetes Heart Study. Because of the role of these systems in blood pressure regulation, blood pressure was also investigated. Results Compelling evidence of association was not detected with any of the SNPs with any outcome measures after adjustments for covariates despite sufficient power to detect relatively small differences in traits for specific genotype combinations. Conclusions Genetic variation of the RAS and NOS3 genes do not appear to strongly influence subclinical cardiovascular disease or blood pressure in this diabetic population.     

肝脏扩散加权成像方法研究

目的探讨肝脏扩散加权成像(DWI)的方法。资料与方法将头部DWI序列的参数修正后用于肝脏成像,并以此序列对机器校准纯水水模对32名正常人行b值为0~1000s/mm2的DWI,测量纯水的表观扩散系数(ADC)值与正常人肝脏信号强度的ADC值。结果纯水ADC值约为2.30×10-3mm2/s。对于正常人,随b值增大肝脏信号强度与ADC值降低,存在负相关性(信号强度与ADC值的相关性分别为r=-0.903,P=0.00;r=-0.795,P=0.00);b值为50~250s/mm2时得到的ADC值与变异程度均偏大;b值为300~1000s/mm2,ADC值变得稳定,变异性减小;但b值为1000s/mm2时,肝脏信号强度减低,解剖结构显示不清。结论本研究所用的肝脏DWI方法能准确反映水分子的扩散状态,用b值300~800s/mm2范围,能得到清晰的DWI图像与稳定的ADC值。     

成人护理专科教育护理学基础课堂教学设计的探讨

本文以“健康与疾病”为例，介绍了成人护理专科的护理学基础课堂教学设计。主要包括学生的情况分析、授课计划的制定、教学方法的选择、课程内容的优化、教学媒体和教学案例的运用等。同时，提出了调动学生的学习积极性、学生终身学习意识教育及医德教育等问题，从而使学生既能真正获得有用知识，又尽可能地通过考试取得学历文凭。     

Periodontal conditions in insulin-dependent diabetes mellitus.

In the present investigation, the frequency and severity of periodontal disease was assessed in a group of 71 patients with a mean duration of 16.5 years of insulin-dependent diabetes mellitus (IDD). The diabetics, aged 17-63 years, were under treatment at the diabetic outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at two clinics of the Helsinki Health Centre. Based upon their long-term medical records, 44 individuals were assessed to have a poorly controlled insulin-dependent diabetes mellitus (PIDD). At baseline of the present study, the PIDD group had a mean blood glucose level of 11.8 mmol/l and a mean glycosylated hemoglobin (HBA1) level of 10.7%. 27 subjects were classified as having a controlled insulin-dependent diabetes mellitus (CIDD). For each individual, site-specific recordings were made for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession and radiographic loss of alveolar bone. Under similar plaque conditions, adult subjects with a long-term PIDD were found to have lost more approximal attachment and bone than subjects with a CIDD (P = 0.046, P = 0.019). These differences were not equally obvious when the subjects were classified according to the history of medical complications, such as retinopathies, neuropathies and nephropathies.     

腓骨支撑术在粉碎性胫腓骨折中的应用研究

目的：研究腓骨支撑术在粉碎性胫腓骨折中的应用价值。方法：回顾性分析1986年以来我院收治的粉碎性胫腓骨折55例临床资料。结果：全部病例均骨性愈合，总优良率95％。结论：腓骨支撑术在治疗粉碎性胫腓骨折中，损伤小，方法简单，易于操作，疗效好。