Facteurs associés aux perdus de vue des patients sous traitement antirétroviral dans un centre de traitement ambulatoire du VIH à Conakry,Guinée

Background

Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry.

α-葡萄糖苷酶抑制剂治疗2型糖尿病的系统评价

目的评价α-葡萄糖苷酶抑制剂治疗2型糖尿病患者的效果。方法检索Cochrane图书馆、MEDLINE、EMBASE、CurrentContents、LILACS在研试验数据库,主题为α-葡萄糖苷酶抑制剂的综述的参考文献,并联系纳入试验的专家与实施者。最近检索日期为2003年月12月(CurrentContents)和2003年4月(其他数据库)。纳入α-葡萄糖苷酶抑制剂单一疗法与其它干预比较,治疗2型糖尿病疗程至少12周的随机对照试验,并且试验至少包括以下结局之一:病死率、患病率、生活质量、血糖控制、血脂、胰岛素水平、体重、不良事件。两名评价者独立阅读所有摘要,评价质量并提取数据,分歧通过协商解决或由第三位评价者裁决。由一位统计学家在对提取数据输入数据库时进行检查。我们尽量联系所有作者以核实数据。结果共纳入41个试验、8130例受试者,其中30个针对阿卡波糖,7个针对米格列醇,1个针对优格列波糖,还有3个为不同α-葡萄糖苷酶抑制剂间的比较。绝大多数研究疗程为24周,仅有2个研究超过1年。与安慰剂相比,阿卡波糖血糖控制效果更好:糖化血红蛋白–0.8%[95%CI(–0.9,–0.7)],空腹血糖–1.1mmol/L[95%CI(–1.4,–0.9)],负荷血糖–2.3mmol/L[95%CI(–2.7,–1.9)],阿卡波糖对糖化血红蛋白的作用呈非剂量依赖。我们发现其可降低负荷胰岛素,但对血脂和体重未见临床相关的作用。不良反应主要来自胃肠道且与剂量相关。相对于磺脲,阿卡波糖将空腹和负荷胰岛素水平分别降低至–24.8pmol/L[95%CI(–43.3,–6.3)]和–133.2pmol/L[95%CI(–184.5,–81.8)],但阿卡波糖引起的不良反应更多。结论关于α-葡萄糖苷酶抑制剂是否影响2型糖尿病患者的病死率和患病率仍不清楚。相反,其对血糖控制或胰岛素水平作用明显,对血脂和体重的作用差异无统计学意义。α-葡萄糖苷酶抑制剂更长疗程的效果仍不确定。阿卡波糖剂量超过50mg(TID)时不能进一步影响糖化血红蛋白水平,不良反应反而更多,与磺脲相比,α-葡萄糖苷酶抑制剂降低了空腹和负荷胰岛素水平,但在血糖控制和不良反应方面存在不利影响。     

内镜下切开术治疗难治性食管癌术后吻合口狭窄的疗效

目的 探究食管支架置入术(ESP)和内镜下切开术(EIM)在难治性食管癌术后吻合口狭窄治疗中的应用效果.方法 将70例难治性食管癌术后吻合口狭窄患者按照手术方式不同分为ESP组(n=41)与EIM组(n=29).对比两组患者临床疗效、吞咽困难评分及并发症发生情况.结果 两组患者总有效率比较,差异无统计学意义(P>0.05).术前,两组患者Stooler评分比较,差异无统计学意义(P>0.05);术后1个月,两组患者Stooler评分均较术前降低(P<0.05),且EIM组患者Stooler评分明显低于ESP组(P<0.01).ESP组患者术后并发症总发生率高于EIM组(P<0.05).结论 EIM和ESP治疗难治性食管癌吻合口狭窄的临床疗效相当,EIM短期内对患者吞咽困难症状改善作用明显,且具有术后并发症少等优点.     

An MRI study of spatial probability brain map differences between first-episode schizophrenia and normal controls

We created a spatial probability atlas of schizophrenia to provide information about the neuroanatomic variability of brain regions of patients with the disorder. Probability maps of 16 regions of interest (ROIs) were constructed by taking manually parcellated ROIs from subjects' magnetic resonance images (MRIs) and linearly transforming them into Talairach space using the Montreal Neurological Institute (MNI) template. ROIs included temporal, parietal, and prefrontal cortex subregions, with a principal focus on temporal lobe structures. Subject Ns ranged from 11 to 28 for the different ROIs. Our global measure of the spatial distribution of the transformed ROI was the sum of voxels with 50% overlap among subjects. The superior temporal gyrus (STG) and fusiform gyrus (FG) had lower values for schizophrenic subjects than for normal controls, suggestive of greater spatial variability for these ROIs in schizophrenic subjects. For the computation of statistical significance of group differences in portions of the ROI, we used voxel-wise comparisons and Fisher's exact test. First-episode schizophrenic patients compared with controls showed lower probability (P < 0.05) at dorso-posterior areas of planum temporale and Heschl's gyrus, lateral and anterior regions in the left hippocampus (HIPP), and dorsolateral regions of fusiform gyrus. Importantly, most ROIs of schizophrenic subjects showed a significantly lower spatial overlap than controls, even after nonlinear spatial normalization, suggesting a greater heterogeneity in the spatial distribution of ROIs. There is consequently a need for caution in neuroimaging studies where data from schizophrenic subjects are normalized to a particular stereotaxic coordinate system based on healthy controls. Apparent group differences in activation may simply reflect a greater heterogeneity of spatial distribution in schizophrenia.     

双切口套法预防开放性胃肠手术后切口感染的临床效果观察

目的：探讨双切口套法预防开放性胃肠手术后切口感染的临床效果。方法选取2013年3月~2014年8月在本院实施开放性胃肠手术的75例患者作为研究对象,随机分为观察组(38例)和对照组(37例)。观察组在开放性胃肠手术中采用双切口套法,对照组术中不使用任何切口保护套。比较两组的手术时间、术后首次排气时间、首次排便时间、住院时间及切口感染率。结果两组的手术时间比较,差异无统计学意义(P>0.05)。观察组的术后首次排气时间、首次排便时间及住院时间显著短于对照组,差异有统计学意义(P<0.05)。观察组的切口感染率为2.63%,显著低于对照组的16.22%,差异有统计学意义(P<0.05)。结论双切口套法可以明显降低开放性胃肠手术后的切口感染率,提高临床疗效。     

民办医学院校专科教学改革的探讨

该研究以山东万杰医学院为例,针对目前招生规模越来越大,生源质量不断下滑,大面积学生逃学、厌学、考试成绩不及格的严峻现实,提出有关教学方法、教学内容和考核方式的教学三项改革,这三项改革举措顺应了当前高校教育(特别是民办高校教育)形势的发展趋势。通过改革实践,已初见成效,进一步验证了只有坚定不移地搞好教学三项改革,才能保证和提高教学质量,从而使广大学生及其家长的利益得到充分保障;也只有大张旗鼓地继续搞好教学三项改革,学校才有生存和可持续发展的空间。     

Modulation of cerebellar activities by acupuncture stimulation: evidence from fMRI study

Recent neuroimaging studies have revealed that acupuncture stimulation modulates human central nervous system including cerebral limbic/paralimbic and subcortical structures. Due to the wide and intricate connections with cerebrum, we hypothesized that anatomically specific areas in human cerebellum are also modulated by acupuncture stimulation beyond classical involvement of cerebellum in motor coordination. Functional MRI (fMRI) was used to investigate neural substrates responding to the acupuncture stimulation of Pericardium 6 (PC6, Neiguan), an acupoint relevant for the management of nausea including vestibular-related motion sickness. Sham stimulation near the acupoint and tactile stimulation on the skin of the acupoint were given as separate conditions. Psychophysical scores as well as the heart and respiratory rates were measured during each condition. Acupuncture manipulation on PC6, in comparison to the sham acupuncture and tactile stimulation conditions, selectively activated left superior frontal gyrus, anterior cingulate gyrus, and dorsomedial nucleus of thalamus. Acupuncture-specific neural substrates in cerebellum were also evident in declive, nodulus, and uvula of vermis, quadrangular lobule, cerebellar tonsil, and superior semilunar lobule. Negative MR signal changes, often seen during the acupuncture of analgesic points, were not observed in the present study. Our data suggest that cerebellum serves as important activation loci during the acupuncture stimulation of PC6, and clinical efficacy of PC6 may be mediated by the cerebellar vestibular neuromatrix.