基于MRI的成人正常膝关节软骨形态学测量

目的：了解正常膝关节软骨分布及股骨髁承重区的软骨厚度特点,为膝关节病变早期诊断和动态观察提供依据。方法：选取100名成人志愿者,男、女各50名,年龄20—30岁,平均25．3岁,膝关节均行MRI扫描。应用MIMICS软件对图像进行处理,在矢状位窗面上测量膝关节各部位软骨最大厚度。选择膝关节正常运动时的承重区,测量承重区域软骨的最大厚度并与其他区域进行比较。基于MRI图像行膝关节软骨三维重建,观察膝关节软骨的三维形态特征。结果：膝关节各部位的最大软骨厚度如下。胫骨外侧平台3．19mm,胫骨内侧平台3．07mm,股骨外侧髁2．93mm,股骨内侧髁3．19mm,股骨滑车软骨3．57mm,髌软骨3．75mm。不同性别与左右侧之间的软骨厚度差异无统计学意义（P〉0．05）。胫股关节承重区软骨厚度大于其他区域,有统计学差异（P〈0．05）。结论：成人正常膝关节各区域软骨厚度不同,胫股关节承重区软骨厚度大于非承重区域。基于MRI可以准确地测量膝关节各部软骨的厚度及重建膝关节软骨的三维形态。     

颅内电极置入与脑功能区定位技术在功能区难治性癫疒间手术的应用

目的探讨颅内电极埋藏与脑功能区定位技术在功能区起始的难治性癫疒间手术的评估价值。方法回顾性分析7例难治性癫疒间的临床资料,头皮视频脑电图长程监测均考虑致疒间灶可能累及功能区,故行颅内电极置入术,再行皮质电极视频脑电图长程监测,记录发作间期和发作期脑电图,以判断致疒间皮质,并采用皮质电刺激行脑功能区定位,在指导术中尽可能切除致疒间皮质的同时,最大限度保护脑功能。结果癫疒间发作起始区切除2例,癫疒间起始区部分切除加周围皮质热灼5例。随访6个月~1年,术后运动及语言功能均保护良好6例,对侧肢体出现短暂运动障碍后恢复1例。结论颅内电极埋藏与脑功能区定位技术是功能区难治性癫疒间手术必要评估手段,有助于术前明确脑功能区和皮质放电区域,以及两者之间的关系,指导设计手术方式,最大限度提高病人术后生活质量。     

中国东、中、西部地区农村老人健康状况及影响因素分析

目的通过对中国东、中、西部地区农村老人健康状况差异调查及相关影响因素分析,为国家平衡推进不同地区健康老龄化提供参考。方法于2014年3—5月采取立意抽样方法对江苏省海安县、河南省南乐县、青海省大通县抽取的3 053名≥60岁农村老人进行问卷调查。结果东、中、西部地区农村老人在经济水平、养老需求、患病情况、医疗服务利用等多方面存在差异;农村老人最常见的慢性病患病率依次为高血压38.78%(1 184/3 053)、关节炎29.97%(915/3 053)、心脏病16.80%(513/3 053);高血压中部患病率48.73%(497/1 020)>东部34.33%(344/1 002)>西部33.27%(343/1 031),关节炎西部患病率42.48%(438/1 031)>中部24.61%(251/1 020)>东部22.55%(226/1 002),心脏病西部患病率25.90%(267/1 031)>中部13.53%(138/1 020)>东部10.78%(108/1 002),糖尿病东部患病率8.68%(87/1 002)>西部6.30%(65/1 031)>中部5.49%(56/1 020);中、西部地区患有≥2种慢性病的老人明显高于东部地区,差异有统计学意义(P<0.01)。结论农村老人健康状况存在地区差异,东部地区老人健康状况好于中、西部地区;地区、年龄、性别、家庭结构及平时的生活方式与老人健康状况相关。     

Does hospital ownership influence hospital referral region health rankings in the United States

Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value‐Based Purchasing dataset are utilized to conduct a cross‐sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value‐based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not‐for‐profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for‐profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.     

Alterations in apoptotic caspases and antioxidant enzymes in arsenic exposed rat brain regions: Reversal effect of essential metals and a chelating agent

Arsenic (As) widely studied for its effects as a neurotoxicant. The present study was designed to evaluate the protective effect of calcium, zinc or monoisoamyl dimercaptosuccinic acid (MiADMSA), either individually or in combination on As induced oxidative stress and apoptosis in brain regions (cerebral cortex, hippocampus and cerebellum) of postnatal day (PND) 21, 28 and 3 months old rats. Arsenic exposure significantly decreased the activities of superoxide dismutase (SOD) isoforms, catalase (CAT), glutathione peroxidase (GPx) and glutathione reductase (GR) with increase in glutathione s transferase (GST) while lipid peroxidation (LPx), arsenic levels, mRNA expression of caspase 3 and 9 were significantly increased in different brain regions. Arsenic induced alterations in these parameters were greater in PND 28 and more pronounced in cerebral cortex. From the results it is evident that combined supplementation of calcium and zinc along with MiADMSA would be most effective compared to individual administration in reducing arsenic induced neurotoxicity.     

急性呼吸窘迫综合征患者下呼吸道重力依赖区气道关闭数值模拟

为了研究急性呼吸窘迫综合征（ARDS）患者下呼吸道重力依赖区气流特性的变化情况,基于CT影像建立真实人体下呼吸道三维模型,确定重力依赖区气道关闭位置,利用CFD技术对下呼吸道内气体进行瞬态数值模拟,得到了部分气道关闭后下呼吸道内空气流速、表面压力、壁面剪切应力等参数的变化趋势,理解了ARDS发生发展的病理生理变化,从而指导机械通气策略,避免呼吸机相关肺损伤的发生。     

Enzymatic cytochemistry,DNA ploidy and AgNOR quantitation in hepatocellular nodules of uncertain malignant potential in liver cirrhosis

Conventional histological examination of echo-guided biopsy specimens can be inconclusive in small nodular lesions in cirrhotic livers. We investigated the diagnostic potential of cytochemical analysis of dipeptidyl-peptidase IV (DPP IV), of image analysis of nuclear DNA content, and of interphase silver-stained nucleolar organizer regions (AgNORs) in 12 cases of small (13- to 29-mm in diameter) hepatic nodules visualized in cirrhotic patients by ultrasonography. All cases underwent an echo-guided liver biopsy at the time of detection and in none of them were histological signs of malignancy found. Characterization with the above-mentioned techniques was always done at the time of histological examination. These patients underwent a mean (±sd) follow-up of 27.0 (±11.2) months after biopsy, with repeated ultrasound (US) examinations. In the seven patients with subsequent neoplastic growth, DPP IV score was altered in five of six; the fraction of mononucleated polyploid cells was altered in six of seven; and the AgNOR quantity exceeded the cutoff value of 4 m² in five of five cases. Among the five lesions whose US appearance remained unchanged during the follow-up, only one abnormality (AgNORs) was found in one case. The combined cytochemical analysis of DPP IV, nuclear DNA content, and quantitative evaluation of interphase AgNORs in biopsy samples may contribute to the differential diagnosis of hepatocellular nodules of uncertain type in the cirrhotic liver.This work was supported by grants from the Ministero per l'Università e la Ricerca Scientifica (fondi 40% e 60%) andA.I.R.C. (Milano).     

一种新的HBeAg阴性慢性乙型肝炎病毒变异机制

Objective To investigate mutation patterns in core promoter(CP)region of hepatitis B virus(HBV).Methods HBV DNA was extracted from sera of patients with chronic HBV infection.The CP sequence was amplified by polymerase chain reaction(PCR)and cloned into pMD19 T vector.The positive clones were then sequenced.The sequences were compared with known HBV genome in GenBank to identify the mutation sites and patterns of patients with chronic HBV infection.Results There were 74 clones from 21 patients with chronic HBV infection which were sequenced.The sequence comparisons showed that there was a 234-nucleotide deletion in CP region of HBV genome in 54 clones and a 245-nucleotide deletion in one clone.These deletion regions included CP,HBeAg initiation codon and direct repeat sequence(DR)Ⅰ regions,which named CP deletion(CPD).A1585T replacement mutation was also found in HBV strain with CPD,which indicated that there was linkage between these two mutations.Conclusions A novel mechanism of HBeAg negative chronic hepatitis B is observed,which includes deletions of CP and HBeAg initiation codon.Meanwhile,a simple and useful PCR method is developed to detect CPD.