改进原位肛门整形重建术的临床研究

目的探讨采用改进的四联术原位肛门整形重建术的效果。方法38例低位直肠癌行Miles根治术后行一期改进的四联术原位肛门整形重建术,改进包括:①肛门内括约肌改进为双层双套环;②肛门外括约肌改进为肛门外括约肌浅部与深部重建;③直肠角改进为肛提肌切缘牢固地缝合于肛门括约肌外面与结肠前壁;④直肠瓣改进为三个人工直肠瓣。结果38例术后肛门外形、功能及远期生存率均更为优良,术后肛门功能测试的总优良率达94·73%,远期生存率高达76·32%。结论改进的四联术原位肛门重建术的效果良好,改进术式的设计也更符合正常解剖结构与生理功能。     

高血压病患者血压参数与尿微量蛋白的关系

目的:通过分析高血压病(EH)患者的5种血压参数(收缩压、舒张压、平均动脉压、脉压、夜间血压下降百分比)与尿敏感肾功能试验的常用指标尿微量白蛋白(MA)、转铁蛋白(TRF)和α1-微球蛋白(α1-MG)的关系,来寻找保护EH患者肾功能的途径。方法:对年龄在58岁~84(71.00(5.00))岁的240名EH患者进行24h动态血压检测和尿敏感肾功能检测,运用多元线性回归分析方法,从血压参数中筛选影响EH患者MA、TRF、α1-MG的影响因素。结果:EH患者MA的独立影响变量为24平均收缩压(β=1.135,P<0.001);TRF的独立影响变量是夜间脉压(β=0.117,P<0.001);α1-MG独立影响变量是夜间收缩压下降百分比(β=-0.140,P<0.01)。结论:在EH患者中,不同的血压参数对肾功能的影响不尽相同。积极采取有效措施,控制高血压,维持良好的脉压和血压昼夜变化节律,是保护EH患者肾功能的重要途径。     

The nephronophthisis complex

Summary The clinical and morphological findings are described in 27 children with nephronophthisis. Seventeen children were considered as sporadic cases. In 10 familial cases the presumed mode of inheritance was autosomal recessive. The clinical picture was rather uniform: polyuria-polydipsia, hyposthenuria, anemia, growth retardation, and azotemia with progressive renal failure. Six patients presented with tapeto-retinal degeneration. In a further seven children other ocular changes were detected. Two female siblings showed additional non-renal manifestations: mental retardation, pulmonary emphysema, skeletal anomalies, and congenital hepatic fibrosis.Renal histology displayed a chronic sclerosing tubulo-interstitial nephropathy with extensive tubular atrophy and dedifferentiation. Medullary cysts were frequently found in end-stage kidneys. Immunofluorescence was either non-specific or completely negative. On electron microscopy, the tubular basement membrane changes predominated: thickening, lamellation, splitting, and deposition of microfibrils within the increased basement membrane substance. Detailed light- and electron microscopic findings were non-specific but the overall morphologic picture was characteristic and even diagnostic in conjunction with the clinical presentation.A recurrence of nephronophthisis in transplanted kidneys has not been observed.The pathogenesis of nephronophthisis is obscure but with respect to the morphologic findings a primary or secondary tubular basement membrane defect seems very likely.Our experience suggests that nephronophthisis is a frequent cause of chronic renal failure in children and commonly associated with non-renal abnormalities. To avoid the separation of different syndromes presenting with a uniform renal disease but various non-renal manifestations, we suggest that the term nephronopthisis complex be used.Presented in part at the 63th Annual Meeting of the German Society of Pathology, Stuttgart 1979     

我国中老年人群骨关节炎罹患现状及其关联因素分析

目的 了解我国中老年人群罹患骨关节炎现状及其关联因素。方法 采用2015年和2018年中国健康养老追踪调查（CHARLS）数据,纳入中老年人群（≥45岁）作为研究对象,运用χ2检验和多因素logistic回归分析中老年人群骨关节炎的关联因素。结果 纳入7 050名中老年人,骨关节炎患病率为33.69％。多因素logistic回归结果表明,从个体社会人口学特征看,年龄≥60岁（OR = 2.254,95%CI:1.985～2.558）、女性（OR = 1.353,95%CI:1.200～1.527）是骨关节炎的危险因素;从慢性病患病情况看,患有高血压（OR = 1.228,95%CI:1.072～1.408）、心脏病（OR = 1.607,95%CI:1.361～1.897）、中风（OR = 2.303,95%CI:1.604～3.306）、肾脏疾病（OR = 2.147,95%CI:1.744～2.644）、胃部疾病或消化系统疾病（OR = 2.810,95%CI:2.487～3.175）是骨关节炎的危险因素;从居住环境看,居住在城市地区（OR = 0.637,95%CI:0.541～0.750）、住房有电梯（OR = 0.879,95%CI:0.785～0.985）、坐式厕所（OR = 0.669,95%CI:0.580～0.770）是骨关节炎的保护因素。结论 我国中老年人群骨关节炎患病状况不容乐观,其关联因素是多方面的,应从个体层面到环境层面重视对骨关节炎的防控。     

甲胎蛋白启动子调控表达p53基因的肝癌细胞靶向性基因治疗？…

目的 利用含有人甲胎蛋白启动子的腺相关病毒载体,构建能在人肝癌细胞株中特异表达目的的基因的质粒。方法 通过设计含有特定酶切点位点的引物,选择性地从人基因组中扩增出人甲胎蛋启动子（ＡＦＰ ｐｒｏｍｏｔｅｒ）主列并克琶含有绿色荧光蛋白（ＧＦＰ报基因的质粒,ｐＲＴ－ＵＦ５上,构建成含报告基因的重组腺相关病毒质粒ｒＡＡＶ－ＡＦＰ－ＧＦＰ转染表达ＡＦＰ的Ｈｅｐ Ｇ２细胞株和不表达ＡＦＰ的２９３因的质粒ｒＡＡ     

Differential control of in-phase and anti-phase coupling of rhythmic movements of ipsilateral hand and foot

Summary Rhythmic flexion-extensions of ipsilateral hand and foot are easily performed (easy association) when the two segments are moved in phase (isodirectionally), whereas great care and attention are required (difficult association) to move them in phase opposition. We searched for features distinguishing the two types of coupling by analyzing, on ten subjects: 1) the frequency limit in each association; and, 2) if coupling is modified by inertial or elastic loading of the hand. 1) Subjects were asked to oscillate hand and foot at various paced frequencies, in the easy or in the difficult association for one minute at least. In the easy coupling, the task was performed up to 2.0–2.5 Hz, the duration being thereafter shortened by muscular fatigue. In the difficult coupling when the frequency was increased above 0.7–1.7 Hz, the performance rapidly shortened, not because of fatigue but because of an inevitable reversal to the in-phase movement. The frequency-duration curve always followed a similar decay, although it covered different frequency ranges in the various subjects. 2) The effect of charging the hand with inertial or elastic loads was studied at the subject's preferred frequency, chosen when the hand was unloaded. Without loading, in the easy association the hand cycle slightly lagged the foot cycle while in the difficult one an almost perfect phase opposition was maintained. Under inertial load (inertial momentum: 9 gm²), in the easy association the hand lag was increased by 10° to 45°, despite a compensatory advanced activation of the forearm EMG; in the difficult association, instead, the hand lag was small (less than 10°), thanks to an even earlier onset of the forearm EMG. The elastic load (torque: 4 gm) had negligible effects on the phase relation between movements but improved the phase relation between EMGs. These findings show that coupling is tighter in the difficult than in the easy association, a feature that is emphasized by the effect of the load. This supports the idea that kinaesthetic afferences have more pronounced influences on control of the anti-phase than the in-phase coupling.     

粘膜相关淋巴组织淋巴瘤临床病理研究

目的：探讨粘膜相关淋巴组织(MALT)淋巴瘤临床病理特征。方法：对我院确诊和会诊的粘膜相关淋巴瘤18例，进行临床病理分析。按原发部位分为胃肠(GI)和非胃肠(NON-GI)两组，男性11例，女性7例，男女之比为1．6：1，平均年龄52岁(31岁-63岁)。结果：Gl组9例，临床表现无特异性，以腹部疼痛最常见，占本组78％(7／9)，其次是腹部包块，占33％(3／9)，内镜下表现多样；NON-GI组9例，以局部无痛性包块为主。手术后标本行免疫组化染色，结果均为B细胞恶性淋巴瘤。结论：粘膜相关淋巴组织(MALT)淋巴瘤是非霍奇金淋巴瘤的一种亚型，具有起病隐匿，病程长，进展慢及患病率低，好发于中老年男性，治疗和预后良好等特征。     

颅脑损伤合并伤临床分析

目的　探讨合并伤对颅脑损伤病死率的影响及其急救原则。方法　总结分析我院收治的 4 311例颅脑损伤病例合并伤资料。结果　颅脑损伤 4 311例中合并伤 1372例 ( 31 8% ) ,其中轻型组 13 7% ,中型组 2 7 9% ,重型及特重型组 5 3 9%。各部位合并伤在总体、<2 4h死亡 ( 16 4例 )组、>2 4h死亡 ( 2 2 9例 )组中的发生率依次为 :颌面部 12 2 %、14 6 %、12 6 % ;胸部 9 3%、32 9%、10 9% ;腹部 1 5 %、9 1%、3 4 % ;脊柱骨盆 3%、2 1 9%、4 8% ;四肢 17 3%、2 0 1%、19 2 %。结论　在颅脑损伤患者的院前、院内急救中要加强对胸部、腹部、脊柱骨盆合并伤的合理救治     

ASSOCIATION BETWEEN SMOKING,CRACK COCAINE ABUSE AND THE DISCONTINUATION OF COMBINATION ANTIRETROVIRAL THERAPY IN RECIFE,PERNAMBUCO, BRAZIL

Despite the effectiveness of combination antiretroviral therapy in the treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has become a major threat to its effectiveness. This study aimed to estimate the prevalence of self-reported irregular use of antiretroviral therapy and the factors associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who attended two referral centers in the city of Recife, in Northeastern Brazil, between June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors, social service support and personal habits associated with nonadherence to antiretroviral therapy, adjusted by multivariable logistic regression analysis. The prevalence of PLWHA who reported irregular use of combination antiretroviral therapy (cART) was 25.7%. In the final multivariate model, the irregular use of cART was associated with the following variables: being aged less than 40 years (OR = 1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR = 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each of the following groups: individuals aged less than 40 years, smokers, former smokers and crack cocaine users. Measures for giving up smoking and crack cocaine should be incorporated into HIV-control programs in order to promote greater adherence to antiretroviral drugs and thus improve the quality of life and prolong life expectancy.