Responsabilidad por pérdida de oportunidad asistencial en patología oncológica maligna en la medicina pública española

ObjectiveThe loss of chance in healthcare has been forcibly introduced in the adjudications pronounced in recent years. Our objective was to analyse the verdicts of guilt resulting from the loss of chance ordered by the Contentious-Administrative Court (i.e., in the public healthcare system), in which both the origin of the disease to be treated and the sequelae were oncological processes.MethodWe analysed 137 cancer-related court judgments from the Contentious-Administrative Court, which referred to the concept of loss of chance, issued in Spain up to May 2014.ResultsOf the 137 sentences, 119 (86.9%), were pronounced due to diagnostic error and 14 (10.2%) due to inadequate treatment. Since 2010, 100 sentences have been passed (73.0%), representing an increase of more than 170% with respect to the 37 (27.0%) ordered in the first six years of the study (from 2004 to 2009). Most of the patients (68.6%) died, predominantly from breast cancer and gynaecological cancer (24.1%), and gastrointestinal cancers (21.1%). These malignancies were the ones most often involved in the sentences.ConclusionsThe litigant activity due to loss of chance in oncological processes in the public health care has significantly increased in the last years. The judgments were mainly given because of diagnostic error or inadequate treatment.     

早年父亲去世的心理创伤研究——1例男大学生的深入访谈分析

目的 探讨男孩8岁时父亲去世对其带来的创伤影响。方法 运用质的研究方法，对一名在8岁时经历父亲去世的男大学生进行深入访谈，采用主要概念或主题突出分类的方法进行编码分析。结果 父亲去世使个体产生了强烈的不安全感，严重的自卑感和神经症性的防御机制。结论 父亲去世后，家庭氛围是影响孩子心理健康的重要因素。     

尿微卫星不稳定性研究对膀胱肿瘤诊断的探讨

目的：探讨尿微卫星不稳定性改变(MSI)与膀胱移行细胞癌(TCC)临床病理特征的关系及其在早期诊断中的价值。方法：选择36例TCC患者5个微卫星位点,应用聚合酶链反应-变性聚丙烯酰胺凝胶银染法分析尿微卫星的改变。结果：36例中有22例(61．11%)出现微卫星不稳定性改变(LOH/MSI),并与肿瘤的分期、分级无关(P＞0．05)；尿脱落细胞学检查的阳性率为22．22%(8/36),两者相比差异有统计学意义(P＜0．05)。结论：尿沉渣微卫星不稳定性分析对膀胱癌的早期诊断有一定的意义,是尿脱落细胞学检查的重要补充。所选微卫星位点为本地区膀胱癌的进一步研究奠定了基础。     

Obesity and postmenopausal bone loss: The influence of obesity on vertebral density and bone turnover in postmenopausal women

This study was undertaken to evaluate the effect of obesity on the postmenopausal bone mass. Bone mineral density, measured by dual photon absorptiometry of the lumbar spine, serum osteocalcin (OC), fasting urinary calcium to creatinine (Ca:Cr), serum estradiol (E2) dehydroepiandrosterone (DHA) and testosterone (T) were measured in 176 women aged 45–71 years. Women were divided into four groups according to their menopausal status and their weight: 49 perimenopausal, 28 obese perimenopausal, 49 obese postmenopausal. Within each population (perimenopausal and postmenopausal), mean age was the same, only weight was significantly different (p < 0.0001). For the two groups of postmenopausal women mean interval since menopause (YSM) was the same (5.8 ± 3 and 5.4 ± 5 yr). Comparison between groups revealed a significant effect of menopausal status and obesity on BMD and bone turnover. As compared to perimenopausal women, BMD was lower, OC and Ca: Cr higher only in nonobese-postmenopausal women. E2, T, DHA did not differ between the two groups of postmenopausal women. The results of this study suggest that even moderate obesity can play a protective role on postmenopausal bone loss.     

庆大霉素中毒性耳聋

庆大霉素目前仍是主要的致聋抗生素，庆大霉素中毒性耳聋的发病机制包括自由基损伤学说、内耳微循环障碍学说、毛细胞线粒体功能失常学说、细胞凋亡等，并发现一些与耳聋相关的基因。聚DL-天冬氨酸（PAA）、表皮生长因子（EGF）表皮生长因子（EGF）、碱性成纤维细胞生长因子（bFGF）、神经营养凼子3（NT3）、高压氧等对庆大霉素的耳毒性有一定的拈抗作用。中医药丹参、天鼓冲剂、复聪片、耳聋左慈丸等也可减轻庆大霉素的耳毒性。庆大霉素中毒性耳聋基因治疗具有良好的前景。制造一种由病毒DNA序列和非病毒载体结构共同组成的复合型载体，也许是未来基因治疗载体得到完善、基因治疗得到突破性进展的着手点之一。     

沈阳市961名老年干部牙健康状况调查

目的了解并分析沈阳市老年干部牙健康状况。方法按第二次全国口腔健康流行病学抽样调查标准,对沈阳市961名60岁以上的老年干部进行口腔健康调查,结果用SPSS软件处理。结果患龋率为67.12%,患龋者的龋均随着年龄的增长而逐渐增高(P<0.05),龋齿全部充填率为33.18%。缺牙率为80.65%,人均失牙7.38颗,人均保留牙的数目与年龄呈负相关(P<0.01)。无牙牙合率为10.20%,无牙牙合与牙列缺损的修复率分别为98.98%和36.04%。牙周健康状况与年龄呈负相关(P<0.01)。结论牙列缺失及缺损是老年人常见的口腔疾患,龋病和牙周病是其主要原因。加强老年人的口腔保健意识,是提高口腔疾病治疗成功率的重要环节,进而增进老年人的全身健康。     

染色体1pter-p36.21杂合性缺失与瘢痕疙瘩的关系

目的寻找瘢痕疙瘩1pter-36.21中可能存在的肿瘤抑制基因的杂合性丢失(LOH)区域,为发现和定位瘢痕抑制基因提供线索和依据。方法采用聚合酶链反应(PCR)-变性聚丙烯酰胺凝胶电泳技术,对25例瘢痕疙瘩组织和外周静脉血标本进行微卫星分析。结果瘢痕疙瘩组织在所选的位点上的LOH发生率为60%(15/25),明显高于正常对照组织的4%(1/25,P<0.05),在所选的位点上均未发现微卫星不稳定性(MSI)。D1S243位点、D1S468位点、D1S507位点、D1S199位点的LOH发生率分别为28%(7/25)、40%(10/25)、52%(13/25)、12%(3/25),其中D1S243、D1S468、D1S507的LOH发生率比较具有统计学意义(P<0.05)。结论发生在D1S243-D1S468-D1S507位点的LOH存在与瘢痕疙瘩有关的潜在瘢痕抑制基因(SSG),而1pter-36.21上LOH微卫星不稳定性与瘢痕疙瘩发生的关系不大。     

The development of addiction to d-amphetamine in an animal model: same principles as for alcohol and opiate

We have established a rat model that reflects the course of development of alcohol and opiate addiction. The present study with d-amphetamine aimed to define general principles in the development of an addiction. Male rats had a continuous free choice between d-amphetamine solutions (100, 200 and 400 mg/l) and water for 47 weeks. An initial intake of high doses of d-amphetamine during the first weeks of drug choice was followed by an individually stable pattern of drug consumption of moderate drug doses. During this period of controlled consumption (from week 10 to week 40), the voluntary intake of d-amphetamine depended on individual factors (dominant rats: 0.37 ± 0.02 mg/kg per day, subordinate rats: 0.57 ± 0.05 mg/kg per day) and environmental variables (group housing: 0.21 ± 0.02 mg/kg per day, single housing: 0.41 ± 0.03 mg/kg per day). Beginning with week 41, voluntary d-amphetamine consumption progressively increased (1.9 ± 0.2 mg/kg per day in week 47), although the experimental conditions remained unchanged. Drug intake during a retest (free choice as before) after 6 months of drug deprivation revealed that the rats had persistently lost their control over drug intake and were no longer able to adjust drug taking to internal and external conditions. These addicted rats took very high drug doses, even when all d-amphetamine solutions but not water were adulterated with bitter tasting quinine (6.6 ± 0.6 mg/kg per day; age-matched controls: 0.37 ± 0.04 mg/kg per day). Forced intake of d-amphetamine for 47 weeks (7.1 ± 0.3 mg/kg per day) via the drinking fluid caused physical dependence (hyperreactivity during withdrawal) but did not lead to drug addiction (voluntary intake in the retest with adulteration: 0.42 ± 0.04 mg/kg per day). Both the temporal development and the prerequisites of psychostimulant addiction were in principle the same as for alcohol and opiates. Received: 3 April 1998/Final version: 26 August 1998     

Loss of heterozygosity on chromosomes 3p,8p,9p and 17p in the progression of squamous cell carcinoma of the larynx

Previous molecular genetic studies of laryngeal squamous cell carcinoma (SCC)have shown certain chromosomal regions with recurring alterations. But studies of sequential molecular alterations and genetic progression model of laryngeal SCC have not been clearly defined. To identify the chromosomal alterations associated with the carcinogenesis of laryngeal SCC, we analyzed genomic DNA from microdissected squamous metaplasia, squamous dysplasia, invasive SCC, and metastatic carcinoma samples from 22 laryngeal SCC patients for loss of heterozygosity (LOH) at microsatellite loci. Ten microsatellite markers on chromosome 3p, 8p, 9p, and 17p were used. LOH at 9p21 was observed in the all stages including squamous metaplasia, squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 17p13.1, 3p25 and 3p14.2 was observed from the squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 8p21.3-p22 was observed mainly from the invasive SCC and metastatic carcinoma. The results suggest that 9p21 in the early event, 17p13.1, 3p25 and 3p14.2 in the intermediate event and 8p21.3- p22 in the late event may be involved in the laryngeal carcinogenesis.