临河地区乡村医生结核感染调查分析

目的为了了解乡村医生的结核菌感染及结核病患病率情况,为我国结核防控政策提供科学的依据,对临河地区乡村医生中实施结核感染检测。方法美国CDC工作人员自行设计调查表,对我们临河区的卫生行政部门注册的乡村医生进行了调查。结果通过本次调查的229名乡医中,9例X光异常,其中有2例确诊为结核,其余为气管炎或肺感染,PPD测试共226人,横径≥15mm的有42人,痰检15人,阳性2例。血相测试226人,其中阳性92人,阴性132人,不确定2人。结论本次调查不仅通过调查,基本掌握了临河地区乡村医生结核菌的感染率、结核病患病率;了解乡村医生的结核病对于呼吸感染控制的知晓情况,调查结果将为国家级结核防控政策提供科学的依据。     

Assessing immunization rates in an ambulatory care setting

Members of the Collaborative Immunization Initiatives determined the immunization coverage rates for two groups of children in our clinic: those 7 to 12 months old and those 18 to 23 months old. The Clinic Assessment Software Application from the Centers for Disease Control and Prevention was used. The immunization rates determined by this method appeared to significantly underestimate the vaccination coverage rates in our clinic. A review of available charts included in the original sample was done excluding patients no longer attending our clinic. We found a higher rate of coverage in the same sample and a low rate of missed opportunities for administering immunizations. The major reason for this discrepancy is overly stringent Clinic Assessment Software Application inclusion criteria. Additional factors include failure to take into account the wide range of acceptable ages for administering immunizations and different dosages for different brands of vaccines. Different methods of calculation may cause as much as a 20% difference in immunization rates for the same or similar population groups. Such large differences may lead to vastly different responses and interventions. We believe that a central registry is the most accurate method of determining immunization rates. Until this is widely available and applied, a more accurate measure of a facility’s immunization effectiveness is the number of missed opportunities for administering immunizations.     

绵阳市涪城区农村育龄妇女生殖系统疾病普查情况分析

目的：探讨绵阳市涪城区农村妇女生殖系统常见病患病率,主要病种及相关因素。方法：由医务人员按照统一制定的生殖系统疾病调查问卷,询问每名普查对象,常规进行妇科检查及辅助检查。结果：对2010年涪城区育龄妇女62255例进行普查,患病人数16996例,患病率27.30%。妇女常见妇科病发病率,阴道炎占首位,其次是宫颈炎、尖锐湿疣;查出宫颈癌14例。36～45岁组的农村妇女生殖系统疾病检出率高于其他两个年龄组（P〈0.05）。通过logistic回归发现,影响生殖系统感染的影响因素有年龄、婚姻状况、是否参加妇科检查。结论：加强妇女保健知识的宣传力度,多学科协作,努力提高妇科病普查率,降低患病率。     

Surgical procedures for urethral diverticula in women in the United States, 1979–1997

The objective of this study was to describe national rates of surgery for urethral diverticula in women. Data from the National Hospital Discharge Survey (NHDS), a federal database that samples inpatient hospitals in the United States, were analyzed from 1979 to 1997 for diagnosis and procedure codes using the ICD-9-CM classification system. The difference between the median age-adjusted rates from 1979 to 1988 and 1989 to 1997 were evaluated using the Mann-Whitney U test since the yearly rates fluctuated in a nonlinear fashion. Data from the National Statistics for Ambulatory Surgery (NSAS) database were analyzed from 1994 to 1996 in a similar fashion. The average age of women undergoing surgery for urethral diverticula increased from 41.6±15.1 years from 1979 to 1988 to 49.4±14.8 years from 1989 to 1997 (p=0.02). The average length of hospital stay decreased from 8.4±5.0 days in 1979 to 3.2±1.7 days in 1997 (p=0.007). Approximately 27,000 inpatient procedures were performed for the repair of urethral diverticula in the United States over a 19-year period, ranging from an estimated 500 to 3400 cases per year. The median age-adjusted rate of procedures decreased from 14.2 per 1 million women from 1979 to 1988 to 6.4 per 1 million women from 1989 to 1997 (p=0.009). Data from the NSAS indicated that an average of 6.7 surgeries per 1 million women per year were performed in the outpatient setting from 1994 to 1996. Age-adjusted rates of inpatient surgery for urethral diverticula were threefold higher for black compared to white women. Inpatient surgical repair of urethral diverticula is three times as high in black as compared to white women. These procedures are infrequent and rates appear to have decreased over time.This research has been presented in abstract form in March 2003 at the Annual Meeting of the Society of Gynecologic Surgeons     

Evidence for redistribution of filtrate among nephrons after beta-adrenergic stimulation and blockade

Summary Renal excretion of fluid and electrolytes, total kidney GFR and superficial nephron GFR were determined in 42 Sprague Dawley rats after beta-adrenergic stimulation with isoprenaline and beta-adrenergic blockade with propranolol. Isoprenaline (0.3 g/kg · min i. v.) decreased urine volume, sodium and potassium excretion and increased urinary sodium and potassium concentration and urine osmolarity. These effects were reversed by injection of propranolol (2.2 mg/kg i.v.). Propranolol alone increased renal sodium and potassium excretion and urinary sodium concentration. Total kidney GFR did not change after both substances, whereas superficial nephron GFR increased after propranolol by 35% and decreased after isoprenaline by 35%. A redistribution of glomerular filtration rates among nephrons therefore must have occured with a shift of the GFR to deep nephrons after isoprenaline and to superficial nephrons after propranolol. The redistribution of glomerular filtration rates is thought to the related to the changes in urinary excretion of electrolytes. Additionally, isoprenaline increased fractional fluid reabsorption of superficial proximal convoluted tubules by 12.3%.     

Clinical Aspects of Uterine SarcomasKlinik der Uterussarkome

Uterine sarcomas constitute 1 % to 3 % of all uterine cancers. There are three main histological varieties: endometrial stromal sarcoma, leiomyosarcoma, and mixed mesodermal (Müllerian) sarcoma. The tumors are characterized by local aggressiveness and early dissemination. According to the literature, 5 year survival rates range from 3 to 75% (!).This wide range reflects great prognostic differences in the various histologic types. On the other hand it may be due to discrepancies in histopathological evaluation.Radical surgery is the most effective therapy. In early stages it leads to 5 year survival rates of up to 88%. Adjuvant irradiation may increase the control of disease in the pelvis but has proven to be of little influence on the final outcome. The histologic variants show great differences in radiosensitivity. In endometrial stromal sarcomas adjuvant radiation therapy apparently can improve the treatment results. By contrast mixed mesodermal sarcomas are highly radioresisteft.There is poor knowledge on the effectiveness of cytotoxic agents on uterine sarcomas. Objective remission of distant metastasis has been observed following treatment with cytotoxic antibiotics (Adriamycin).     

The effects of chronic administration and withdrawal of (+)-amphetamine on seizure threshold and endogenous catecholamine concentrations and their rates of biosynthesis in mice

The i.v. pentylenetetrazol seizure threshold was increased by 2.5 mg/kg and decreased by 15 mg/kg of a single (+)-amphetamine dose. After 7 consecutive days of amphetamine administration, tolerance developed to the decrease but not to the increase in seizure threshold. At 12–48 h after the last dose of 2.5 mg/kg seizure threshold was decreased, and at 36–48 h after the last dose of 15 mg/kg seizure threshold was increased. After acute and chronic administration of (+)-amphetamine (2.5 mg/kg) endogenous concentrations of whole brain dopamine (DA) were increased and returned to normal levels during the withdrawal period (12–48 h); endogenous norepinephrine (NE) levels were unchanged by acute and chronic drug treatment and during withdrawal. The rates of DA and NE synthesis were increased by chronic amphetamine administration at 24–48 h after drug withdrawal. An acute dose of (+)-amphetamine (15 mg/kg) decreased endogenous levels of DA and NE; normal levels of DA were detected with chronic drug treatment and during withdrawal, with NE remaining slightly depressed. The rates of synthesis of DA and NE were increased by acute and chronic amphetamine treatment and returned to normal 24–48 h after withdrawal. The rebound reversal in seizure threshold after (+)-amphetamine withdrawal suggests an abstinence syndrome that may be interpreted as evidence for the development of physical dependence to (+)-amphetamine after chronic drug administration.     

Black-white differences in sentinel causes of death: Counties in large metropolitan areas

The black/white ratio of death rates (before 65 years of age) in 1994–1996 for a group of “sentinel” cause, regarded as preventable by medical treatment and as useful in assessing overal quality of health care, was examined for 60 US counties located in large metropolitan areas. Counties with the highest black/white death rate ratios (>3.5) and the highest death rates for blacks included the District of Columbia; Essex (Newark), New Jersey; Cook (Chicago), Illinois; Wayne (Detroit) Michigan; and Dade (Miami), Florida. In these five counties, in contrast to the US, the death rate from the sentinel causes for blacks had not declined from 1979–1981 to 1994–1996. The findings suggest that racial inequities in health care may be unusually great in certain counties in large metropolitan areas, and that further studies are needed to explain the variation among counties in the black-white ratio of mortality from the sentinel causes.     

晚期喉声门上型癌的手术治疗

目的探讨晚期喉声门上型癌手术治疗的方法及疗效。方法对64例晚期喉声门上型癌进行手术治疗,其中Ⅲ期35例,Ⅳ期29例,行喉全切除术40例,喉垂直部分切除术4例,喉声门上水平部分切除术15例,会厌切除术5例,所有病例均经5年随访。结果35例Ⅲ期喉声门上型癌患者中,行喉部分切除术和行喉全切除术者5年生存率分别为54.55%和56.72%,两者间无显著性差异(P>0.05);29例Ⅳ期喉声门上型癌患者中,行喉部分切除术和喉全切除术者5年生存率分别为46.88%和33.93%,两者间无显著性差异(P>0.05)。结论晚期喉声门上型癌行喉部分切除术是可行的,正确选择手术适应证,熟练掌握多种修复方法,可以提高晚期喉声门上型癌患者的生活质量。