外直肌超常量后徙固定在知觉性外斜视手术中的应用

目的 观察外直肌超常量后徙固定在知觉性外斜视手术中的远期疗效,分析其应用价值.方法 回顾性分析我科2012年5月至2013年9月行外直肌超常量后徙固定的知觉性外斜视病例12例.外斜视度数均＞50△,患眼固视功能差.在斜视眼行外直肌超常量后徙固定(缝合于原肌止点后12.0 mm)联合内直肌缩短术(4.0～7.0 mm),观察术后眼位、眼球运动、眼面外观及视功能远期疗效.结果 随访13 ～ 27个月后,12例患者术后眼位正位,眼球外转稍有受限;眼面外观良好;均获得较稳定的患眼固视能力,但未建立明确的双眼视功能.结论 外直肌超常量后徙固定稳定了后徙外直肌的位置,减少了手术肌肉条数,具有安全可行、远期疗效稳定等优点.     

急性深静脉血栓患者早期下床活动与卧床休息的系统评价

目的：评价与卧床休息相比,早期下床活动对急性深静脉血栓患者继发肺栓塞率的有效性。方法运用计算机检索Cochrane、JBI、Medline、EMbase、CINAHL、Web of Knowledge、CBM、万方和CNKI数据库,查找关于对比早期下床活动和卧床休息处理急性深静脉血栓患者继发肺栓塞问题的相关研究文献。检索时间均从建库至2015年1月1日。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5．3软件进行M eta分析。结果共纳入9项研究,共847例患者。M eta分析结果显示：与卧床休息相比,早期下床活动对急性深静脉血栓患者继发肺栓塞率[RR＝0．42,95％ CI（0．16,1．09）,P＝0．08]差异无统计学意义。结论现有证据表明：早期下床活动不会增加深静脉血栓患者继发肺栓塞率。鉴于纳入研究数量有限,上述结论尚需开展更多研究予以验证。     

吸烟与慢性阻塞性肺疾病

布伦特兰博士于１９９８年５月１３日在第５１届世界卫生大会上当选为新的总干事,她宣布,上任后首先要抓控制吸烟和防治疟疾。烟草引起全球每年死亡人数达３００万。若目前对吸烟情况不加抑制,到２０２５年每年死于烟草危害者将增至１０００万。在我国,目前死于烟草危害者已达６０～７０万,到２０２５年将达２００万。烟草雾首先进入呼吸道,故呼吸系统最大程度受到危害。在工业发达国家,肺癌是吸烟造成死亡的首要疾病;而在我国,大规模、高水平的流行病学调查结果［１,２］显示,慢性阻塞性肺疾病（简称慢阻肺）是人们吸烟造成死亡…     

Plasma carboxyl ester lipase activity modulates apolipoprotein B-containing lipoprotein metabolism in a transgenic mouse model

Pancreatic carboxyl ester lipase (CEL) is in the plasma of many mammals, including humans and rats, but not mice. In vitro, CEL hydrolyzes cholesterol esters of apolipoprotein B-containing lipoproteins (apo B-Lp). To study the effect of CEL on metabolism of apo B-Lp and atherosclerosis in vivo, apo E-knockout (EKO) mice, which have high plasma levels of apo B-Lp and are prone to atherosclerosis, were made to secrete CEL into plasma by introducing a transgene containing a liver-specific promoter and rat CEL complementary DNA. Plasma CEL activity in EKO-CEL mice was comparable with that found in rats. Evidence of modification of apo B-Lp by plasma CEL in vivo was an increase in the free cholesterol to cholesterol ester ratio of apo B-Lp from mice on chow or a Western-type diet. In addition, plasma total cholesterol levels were elevated in EKO-CEL mice, with the elevation found exclusively in the apo B-Lp fraction. Associated with the increase in steady-state apo B-Lp levels was an increase in the plasma half-life of very low-density lipoproteins (VLDL) in EKO-CEL mice, measured by the clearance rate of injected VLDL. Interestingly, despite the increase of apo B-Lp, the atherosclerotic lesion did not differ between EKO and EKO-CEL mice on a Western-type diet. In summary, our results demonstrate that plasma CEL modulates apo B-Lp metabolism in vivo, resulting in reduced VLDL clearance and elevated plasma cholesterol levels.     

应用搏动性体外循环患者血浆丙二醛和超氧化物歧化酶的动态变化

对２０例心脏直视手术病人分别应用搏动性与非搏动性体外循环，动态观察体内丙二醛（ＭＤＡ）和超氧化物歧化酶（ＳＯＤ）变化。结果显示搏动组患者体外循环期间主动脉阻断及开放后血中ＳＯＤ升高，而ＭＤＡ无明显变化。提示搏动性灌注可能通过提高机体的抗氧自由基能力而改善组织的氧代谢。     

坦度螺酮治疗2型糖尿病伴发焦虑抑郁情绪患者疗效及对血糖的影响

目的：探讨坦度螺酮治疗2型糖尿病伴发焦虑抑郁情绪患者的疗效和安全性以及对血糖的影响。方法将80例2型糖尿病伴焦虑抑郁患者随机分为两组,均予以糖尿病常规治疗,实验组联合坦度螺酮治疗,观察6周。治疗前后采用汉密顿焦虑量表及汉密顿抑郁量表评定焦虑抑郁状况,副反应量表评定不良反应;检测空腹血糖、餐后2h血糖、糖化血红蛋白、三酰甘油水平的变化。结果治疗第2周末起两组汉密顿焦虑量表及汉密顿抑郁量表评分均较治疗前显著下降（P＜0．01）,治疗各时点实验组评分较对照组下降更显著（P＜0．01）。治疗6周末两组空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油水平均较治疗前显著下降（P＜0．01）,实验组空腹血糖、餐后2 h血糖、三酰甘油水平较对照组下降更显著（P＜0．01）。两组不良反应较轻微,治疗各时点两组副反应量表评分比较无显著性差异（P＞0．05）。结论坦度螺酮能显著改善2型糖尿病患者伴发的焦虑抑郁情绪,安全性高,有利于控制血糖水平。     

The investigation of glucose metabolism and insulin secretion in subjects of chronic hepatitis B with cirrhosis

Aims: To investigate the situations of abnormal glucose metabolism and dysfunction of pancreatic islet beta cells in subjects of chronic hepatitis B (CHB) with cirrhosis. Methods: 106 hepatitis B virus (HBV) positive subjects with liver cirrhosis as well as with different grade of Child-Pugh and 37 healthy subjects were included in this study. The oral glucose tolerance test (OGTT), C-peptide and insulin release test were detected. Plasma glucose and insulin levels were analyzed periodically for 2 h after oral glucose loading. Results: There was no significant difference in the level of fasting plasma glucose and C-peptide between cirrhosis group and control group (P>0.05). The levels of OGTT 2 h glucose, insulin and C peptide were significantly higher in cirrhosis group than control group (P<0.01). Peak plasma glucose levels were obtained at 60 min in normal group and cirrhosis group. The peak insulin and C-peptide response occurred at 60 min in normal group, whereas it was delayed to 120 min in cirrhosis group. There was a significant difference between two groups in the pattern of plasma glucose levels at corresponding time points (P<0.05). The OGTT 2 h glucose and insulin levels were positively correlated with Child-Pugh Score (r1 = 0.389, r2 = 0.508, P<0.01). Conclusion: These findings implied that there was a certain degree of insulin resistance and abnormal glucose metabolism in the patients with liver cirrhosis.     

血清 DKK1和 P53自身抗体联合检测对食管鳞状细胞癌的诊断价值

目的：探讨血清 DKK1（Dickkopf-1）和 P53自身抗体联合检测在食管鳞状细胞癌（ESCC）中的诊断意义。方法应用酶联免疫吸附试验检测126例 ESCC 患者和60例正常对照血清 DKK1和P53自身抗体的表达水平,采用受试者工作特征曲线（ROC）评价诊断效能。结果血清 DKK1水平和P53自身抗体在 ESCC 患者中的表达均明显高于正常对照[（673．09±343．82）pg／ml ∶（362．05±148．07）pg／ml,Z ＝6．158,P ＜0．0001;（0．398±0．546）∶（0．069±0．050）,Z ＝3．832,P ＜0．0001]。ROC 曲线显示,当血清 DKK1为最佳诊断临界值588．77 pg／ml 时,其在诊断 ESCC 的曲线下面积（AUC）为0．780（95％CI 为0．715～0．844,敏感性为61．9％,特异性为95．0％）。P53自身抗体诊断 ESCC 的AUC 为0．674（95％CI 为0．598～0．750,敏感性为45．3％,特异性为95．0％）。DKK1和 P53自身抗体联合检测诊断食管癌的 AUC 为0．843（95％CI 为0．788～0．897,敏感性为73．8％,特异性为95．0％）。在早期 ESCC,DKK1和 P53自身抗体联合检测具有更好的诊断效能,AUC 为0．903（95％CI 为0．845～0．961,敏感性为81．0％,特异性为95．0％）。结论血清 DKK1和 P53自身抗体可作为 ESCC 的血清诊断标志物,联合检测有助于 ESCC 的早期诊断。     

Patient Attitudes Regarding the Cost of Illness in Cancer Care

Background and Purpose.

The cost of illness in cancer care and the subsequent distress has attracted scrutiny. Guidelines recommend enhanced discussion of costs, assuming this will reduce both stress and costs. Little is known about patient attitudes about cost considerations influencing treatment decisions.

Methods.

A convenience-sample survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center was performed. Assessments included prevalence and extent of financial burden, level of financial distress, attitudes about using costs to influence treatment decisions, and frequency or desirability of cost discussions with oncologists.

Results.

A total of 132 participants (94%) responded. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their oncologists about cost. More than 71% of patients did not want either society’s or personal costs to influence treatment, and this result did not change based on degree of financial stress. Even when asked to assume that lower cost regimens were equally effective, only 28% would definitely want the lower cost regimen. Patients did not believe it was the oncologist’s duty to perform cost discussions.

Conclusion.

Even insured patients have a high degree of financial distress. Most, including those with the highest levels of distress, did not speak often with oncologists about costs and were strongly adverse to having cost considerations influence choice of regimen. The findings suggest that patients are not cost sensitive with regard to treatment decisions. Oncologists will require improved tools to have meaningful cost discussion, as recommended by the American Society of Clinical Oncology.

Implications for Practice:

This study raises important questions regarding optimal communication with patients about costs. If patients are not cost sensitive regarding treatment decisions, they will not be full partners in the desire to reduce financial burden and financial distress by lowering costs. Better patient educational tools are needed to help increase not just cost awareness but also awareness of value. To master this mode of discourse and to help ease patients’ financial toxicity, oncologists will need to master a new set of data and develop new skills. This new knowledge and proficiency are as vital to good oncology care as all other clinical acumen.