Clinical patterns and complications of diabetes mellitus in India

The records of 274 diabetics attending an outpatient clinic in New Delhi have been reviewed and the patients classified into four main types.     

Epidemiological study of the victims of vehicular accidents in Delhi.

The mortality and morbidity connected with road traffic accidents are increasing at an alarming rate throughout the world as a direct result of the rapid industrialization and increase of fast moving vehicles combined with lack of traffic sense of road users of this country. Epidemiological aspects manifested in vehicular accidents in New Delhi during the year 1983-84 are illustrated here.     

Contraception vaccine stimulates antibody to chorionic gonadotropin

A contraception vaccine which stimulates antibody to chorionic gonadotropin is showing promise in preliminary studies carried out by G.P. Talwar, M.D. et al. at the All-India Institute of Medical Sciences, New Delhi. S.J. Segal, PhD of the Population Council at Rockefeller University of New York has outlined several problems the Indian researchers had to overcome. Since the women in the preliminary tests had undergone tubal ligation, whether the antibody will neutralize the biologic function of the hormone has not been tested. Animal studies would be necessary to clear this up. Some tests with rhesus monkeys suggest that the vaccine can, indeed, prevent pregnancy, however many tests remain to be done.     

印度药物政策研究—以德里模式为案例

本文首先对印度医疗卫生服务体系概况进行描述，结合印度药物政策大背景，对印度最具有特色的基本药物模式——德里模式进行案例式介绍，重点对德里模式的实施步骤进行剖析，实施步骤包括：遴选基本药品目录用药；建立集中招标采购系统；引进质量保证系统；合理处方培训；为医生以及患者提供药品信息；开发标准治疗指南；监测与评价。     

rhBMP-2/SH复合物对微种植体支抗稳定性作用的实验研究

[摘要] 目的：评价 rhBMP-2/SH复合物对微种植体支抗稳定性的作用。方法：实验选用新西兰大白兔12只,分为2、4、8周组,每组4只。每只动物每侧胫骨植入rhBMP－2/SH/微种植体、微种植体各1枚;术后2、4、8周处死动物进行：（1）微种植体周围骨组织形态学观察。（2）微种植体-骨界面剪切力的测量。结果：在2、4、8周时, rhBMP－2/SH/微种植体周围胫骨表面周围有新骨生成,4周、8周时 rhBMP－2/SH/微种植体骨质附着量多于单纯微种植体。rhBMP－2/SH/微种植体组的剪切力分别为：(121.52±20.32) N、(213.78±25.30) N 和 (252.15±36.96) N;微种植体组的剪切力分别为：(124.32±18.25) N、(175.63±23.45) N 和 (201.07 ±33.49) N;术后4和8周时rhBMP－2/SH/微种植体组的剪切力要明显大于微种植体组,两者间差异有统计学意义（P<0.05）。 结论： rhBMP－2/SH复合物可以促进微种植体周围新骨形成,增加骨皮质厚度、骨结合率,从而增加微种植体的稳定性。     

保留骨膜的兔桡骨缺损性骨不连动物模型的制备

目的:制备新西兰大白兔保留骨膜的桡骨缺损性骨不连动物模型。方法:将20只成年新西兰大白兔随机分成两组,分别制成桡骨缺损长度为15mm及30mm组实验兔,每组10只,分别在4、8、12、16周时摄X线片,16周后不愈合兔标本再行组织病理学检查。结果:在保留骨膜的情况下截取兔桡骨中远段骨质长度15mm组,16周时均可见断端骨性愈合,在30mm组16周时,大体标本均见桡骨缺损处无骨性连接,骨折断端封闭,有硬化骨形成并见缺损区纤维组织充填,病理切片证实断端为纤维组织生长。结论:成功制备了新西兰大白兔保留骨膜的桡骨缺损性骨不连动物模型。     

功能负荷改变对兔髁突软骨中骨形成蛋白-2表达的影响

目的：探讨功能负荷改变对兔髁突软骨中骨形成蛋白-2（BMP-2）表达的影响。方法：24只青春发育期（约2月龄）新西兰白兔随机分为实验组和对照组4个实验点。实验组用手机均匀磨除兔上下切牙各2 mm（每周2次）建立兔功能负荷改变的动物模型,实验2、4、6、8周处死,应用免疫组织化学SABC方法检测髁突软骨中BMP-2的表达,并通过计算阳性细胞数目来探讨BMP-2在不同实验时间点的表达变化情况。结果：对照组兔髁突软骨中从2周到8周BMP-2的表达逐渐增强,实验组4、6、8周髁突软骨中部BMP-2较同龄对照组高表达（P〈0.05）;第2周髁突软骨后部表达高于同龄对照组（P〈0.05）,第4周组髁突软骨后部与同龄对照组之间无差异（P〉0.05）,第6、8周髁突软骨后部较同龄对照组低表达（P〈0.05）。结论：BMP-2参与了功能负荷改变所导致的髁突软骨适应性改建活动,中部和后部尤为明显。     

兔股骨头缺血坏死模型的建立研究及比较

目的：为研究股骨头坏死治疗建立理想的动物模型．方法：采用健康的成年新西兰兔24只,随机分为3组,A组：注射马血清及地塞米松（n=10）;B组：用液氮将股骨头冷冻坏死（n=10）;C组：正常对照组（n=4）．术后定期行X线检查,并取股骨头行组织切片,通过计算空骨陷窝率比较股骨头坏死情况．结果：光镜下A,B两组均股骨头均出现缺血性坏死表现,空骨陷窝率比C组均有升高（P〈0．05,P〈0．01）,A组8wk时的模型复制成功率小于55％;B组8wk后的成功率大于95％．结论：通过异种血清加激素或液氮冷冻股骨头均可建立兔的股骨头缺血坏死动物模型,但异种血清加激素的方法并非一定能引起股骨头坏死;通过液氮冷冻方法建立的兔股骨头缺血坏死模型方法简便、坏死明显,可作为研究股骨头缺血坏死治疗的理想动物模型．     

Introduction of emergency contraception in India

Emergency contraception is a safe and effective method for preventing unwanted pregnancy following unprotected sexual exposure. The method had not been included in the National Family Programme of India. A Consortium on National Consensus for Emergency Contraception met in New Delhi in January 2001, to reach a consensus on strategies for introduction of emergency contraception in India. During the consortium experts from different walks of life deliberated on issues related to emergency contraception introduction and formulated national consensus statements and guidelines. This paper describes highlights of consortium activity which has led to introduction of emergency contraception in India.     

兔下颌骨放疗后牵张成骨的组织学观察

目的观察兔下颌骨放疗后牵张成骨的组织学特征.方法将24只成年新西兰大白兔随机分为放疗组和未放疗组,每组12只.放疗组用60Co机照射大白兔下颌骨,5.4G y/次,隔日1次,共5次,总剂量为27 Gy.3个月后在两组动物下颌骨的双侧截骨处安装牵张器,经5 d延迟期后开始牵张,速率为1 mm/d,0.5 mm/次,2次/d,连续7 d,共延长下颌骨7㎜.分别在固定期的第4、6周处死动物12只, 取下颌骨双侧新生骨痂行组织学检查,观察其成骨特征. 结果组织学观察显示,牵张区以膜内成骨为主,放疗组有更多的软骨形成,但无统计学意义(P》0.05),放疗组较未放疗组新骨骨小梁细小,稀疏.结论放射损伤区牵张成骨是可行的,但成骨质量较差,成骨方式以膜内成骨为主,放射线促进了软骨成骨.     

宁夏腹泻病人群携带NDM-1基因菌株的初步研究

目的掌握宁夏携带I型新德里金属β-内酰胺酶(blaNDM-1)细菌的流行现状。方法用聚合酶链反应(PCR)检测以腹泻病分离保存的菌株,对blaNDM-1检测为阳性的菌株进行生化鉴定、药物敏感性试验,检测blaNDM-1基因测序和16SrRNA序列。结果 2株blaNDM-1基因阳性的菌株均为屎肠球菌,是多重耐药株;blaNDM-1测序结果与国外基因序列比对,同源性为100%。结论宁夏存在携带blaNDM-1基因的革兰氏阳性屎肠球菌。     

Tetanus in adults--a continuing problem: an analysis of 217 patients over 3 years from Delhi, India, with special emphasis on predictors of mortality

Tetanus is still widely prevalent in many parts of the world especially in the developing countries. This study was conducted to assess the demographic and clinical features, treatment and outcome of tetanus in adults with a special emphasis on identification of predictors of mortality. This was a retrospective study of all adult patients admitted with tetanus over a three-year period from 1998 to 2000 at Lok Nayak Hospital, New Delhi, India. The demography, clinical features, treatment and complications of the patients were assessed and were evaluated against two possible outcomes- survival or death, to identify the predictors of mortality. There were 217 adults (148 males, 69 females) admitted with generalized tetanus during the study period. The mean age of the patients was 36.08 +/- 18.84 years. In most instances (63.5%), wounds / injuries served as the source of infection. Overall 31.8% had mild, 21.7% had moderate and 46.5% had severe disease at presentation. Respiratory failure and dysautonomia were the frequently observed complications. Of the 217 patients, 82 died - a mortality rate of 37.78%. Parameters that were significantly associated with increased mortality were: age (especially > 60 years); shorter duration of symptoms - trismus, rigidity and dysphagia; severe disease at presentation and shorter period of onset. Tetanus is a preventable disease associated with a high fatality rate. Universal coverage of immunization programme and appropriate wound prophylaxis is the corner stone of tetanus eradication. The treatment of tetanus is difficult and requires specialized and intensive care. The presence of parameters indicating an adverse outcome at the beginning in the patients will help identify the subset of patients that need more intensive management especially in resource poor nations.     

阻断软骨终板营养对终板软骨细胞影响的实验研究

目的:观察阻断新西兰白兔椎体软骨终板营养途径对终板内软骨细胞的影响。方法:30只新西兰白兔平均分为实验组、假手术组和对照组。实验组采用颈前路显露椎体,使用0.5mm钻头分别在C4、C5椎体上、下缘,C3椎体下缘,C6椎体上缘靠近软骨终板处钻孔,孔外缘位于终板软骨下缘,深度至椎体后缘(术中X线机透视确定),孔中用Stryker骨水泥填塞(0.5ml),假手术组仅切开皮肤后缝合,对照组不做处理。术后4周及8周切取软骨终板标本,用HE染色和原位脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL),观察终板软骨细胞密度和软骨细胞凋亡。结果:术后4周,实验组终板软骨细胞密度较假手术组及对照组下降明显,细胞凋亡增加(P<0.05);术后8周,实验组细胞密度下降及细胞凋亡增加较术后4周更为明显(P<0.05);实验组4周及8周细胞密度和细胞凋亡数比较,差别有显著意义(P<0.05)。结论:阻断软骨终板营养途径可导致终板软骨细胞密度下降,细胞凋亡增加。     

自体骨用于脊柱后路植骨融合中BMP-2、BMP-7的表达

目的:观察自体骨用于脊柱后路融合过程中骨形态发生蛋白2-7(BMP-2、BMP-7)的表达,并探讨其在脊柱融合过程中的作用机制。方法:成年雄性新西兰大白兔36只,随机分为2组,每组18只,在兔腰椎5、6横突植入自体骨(自体骨组)、异体骨(异体骨组)制作腰椎后路融合模型。分别于第2、4、7、14、27、35天处死兔,取其融合节段标本,显微镜下观察,并用图文分析软件计算软骨生成面积和BMP-2、BMP-7阳性细胞数。结果:在脊柱后路融合模型中自体骨组、异体骨组软骨生成面积分别为(51±4)%、(40±5)%,自体骨组明显大于异体骨组(P<0.05)。脊柱融合过程中,各时间点自体骨组BMP-2、BMP-7表达均高于异体骨组,差异有统计学意义(P<0.05)。第14~27天表达达到高峰。结论:在脊柱后路植骨融合中,自体骨植骨融合质量优于异体骨,在脊柱融合异位成骨的过程中,自体骨BMP-2、BMP-7起到关键性作用。     

纤维环穿刺法诱导兔椎间盘退变模型的组织学和影像学分析

目的探讨纤维环穿刺法诱导椎间盘退变模型的可行性和科学性。方法新西兰大白兔18只,经右侧腹膜外入路用弯血管钳夹持16G穿刺针准确刺入L3-4、L4-5、L5-6椎间盘的纤维环,深度控制在5 mm。于术前及术后4、8、12周对造模后的椎间盘及对照组的椎间盘（以L1-2、L2-3、L6-7为对照）行计算机X线摄影（computed radiography,CR）、MRI检查,并进行组织学观察。结果从手术后第4～12周,造模后的椎间盘高度指数（disc height index,DHI）呈递减趋势,MRI T2WI信号呈现持续减弱趋势（P〈0.01）;组织学观察发现4、8周造模组髓核细胞逐渐减少,12周组髓核细胞几乎被纤维软骨组织替代,纤维环排列不整齐,与髓核界限不清。结论纤维环穿刺法可以诱导兔椎间盘的缓慢退变,为临床深入研究椎间盘的退行性变提供了切实可行的动物模型。     

静脉留置针注射不同性质药物对血管损伤的实验观察

目的:探讨静脉留置针在输入不同性质药物时留置时间与血管损伤程度的相关性?方法:选取大耳新西兰白兔60只随机分为A?B?C 3组,每组20只,取其双耳外缘静脉作为实验血管,留置针穿刺置管?A组注射多柔比星,B组注射20%甘露醇,C组注射生理盐水,1次/天,用药后肝素盐水封管?各组于用药第2?4?6?8?10天分别取4只腹腔麻醉切取活体标本做切片,观察血管及周围组织的病理变化?结果:3组留置相同时间炎症反应比较:第2天 P > 0.05;第4?6天P < 0.05;第8?10天P > 0.05?血栓形成比较:第2?4天P > 0.05;第6?8?10天P < 0.05?同一组不同部位的炎症反应?血栓形成情况比较:P < 0.05?结论:应用静脉留置针注射不同药物时留置时间不应相同,强刺激性药物留置时间一般以2天为宜,最多不超过3天,弱刺激性药物时可适当延长留置时间,但以不超过7天为宜?     

三维超声研究兔乳腺VX2移植瘤放疗的血流变化

目的应用三维超声探讨兔乳腺VX2移植瘤放射治疗前后的血流变化,研究其与MVD、VEGF表达之间的关系。方法 20只兔建立40个乳腺VX2移植瘤模型,第2周对20个右侧兔乳腺VX2移植瘤进行放射治疗,应用三维超声监测肿瘤生长情况,于治疗前（第2周）、第3周及第4周利用VOCAL-Ⅱ功能量化肿瘤内部及周边的血供,并测量VI值、FI值及VFI值;4周后处死瘤兔,用免疫组化法检测左右侧肿瘤MVD及VEGF的表达,评价三维超声相关检测指标的价值。结果治疗前兔两侧乳腺VX2移植瘤VI值、FI值及VFI值基本一致,第3周及第4周右侧（治疗侧）较左侧（未治疗侧）VI、FI及VFI值减小（P〈0.01）,且第4周的三维血流参数与MVD及VEGF表达呈正相关。结论三维超声血流参数与MVD及VEGF的表达呈正相关,有助于评价乳腺肿瘤放射治疗的疗效。     

Non-health determinants of health and healthcare in Delhi

With only 0.05% of the total area of the country, Delhi is home to 1.34% of India's population. This creates enormous pressure on natural and man-made resources, and generates situations in which non-health determinants may take precedence over the conventional determinants directly associated with health and healthcare. With the rising advocacy on social determinants of health, several of these factors may rightly seem to be part of the broader territory of health-related variables, and in that context, they may be designated as conventional non-medical determinants. We discuss some more visible domains, such as demography, migration and floating population; the physical and biological environment; economic determinants; social determinants; legislation and enforcement, and underscore some less explored yet critical domains of the determinants related to culture, governance and politics. What emerges as a compelling reality is a wide differential in physical environment, urban planning and access to infrastructural inputs between the privileged and marginalized areas of Delhi. Inequities in physical quality of life are so gross that even a value-neutral, official narrative betrays them helplessly. We propose actionable areas to address some of the pressing non-health determinants of health and healthcare.     

红花对兔耳增生性瘢痕CTGF表达的影响

目的:观察红花对兔耳增生性瘢痕(HS)结缔组织生长因子(CTGF)表达的影响,探讨红花抑制兔耳HS可能的分子生物学机制.方法:27只新西兰大白兔耳腹侧建立HS模型,每耳2块.建模后45 d开始对HS行注射治疗,1次/wk,连续注射4次.设立阴性对照组、阳性对照组、生理盐水组、低浓度红花(125 g/L)组、高浓度红花(500 g/L)组.注射后第2,4,6周分别切取8只兔耳HS及皮肤,采用免疫组织化学方法(SP)检测每块组织CTGF蛋白的表达(CTGF蛋白面密度及平均吸光度),逆转录聚合酶链反应(RT-PCR)方法检测每块组织CTGF-mRNA的表达.结果:注射后第2,4,6周,两种浓度红花组CTGF蛋白面密度、平均吸光度及CTGF-mRNA的表达均低于阳性对照及生理盐水组,有统计学差异(P<0.05);其中高浓度红花组CTGF蛋白面密度、平均吸光度及CTGF-mRNA的表达为同时段所有HS组中最低(P<0.05).结论:高、低浓度红花均能抑制兔耳HS的CTGF的表达,高浓度红花的作用较低浓度红花强.     

牛骨形态发生蛋白复合煅烧骨治疗缺损的实验研究

目的：验证从牛皮质骨中提取的骨形态发生蛋白（bBMP)的异位诱导成骨能力,探讨煅桡骨（SB）作为某载体对骨缺损的治疗作用。方法：（1）将bBMP植入16只balb/c小鼠肌袋内,每周宰杀4只行细胞学检查,连续4周,（2）16只新西兰大白兔手术造成双侧桡骨1cm缺损,分别植入bBMP-SB和SB进行自身对照,分批宰杀后行X－线照片和组织学检查,结果：植入肌袋内的bBMP术后一周即可诱导软骨细胞形成,2周时可见编织骨,4周时可见小梁骨及骨髓成形,而骨缺损实验中,bBMP-SB组在软骨诱导,小梁骨的形成数量,骨折愈合等方面均明显优于单纯SB组,结论：（1）bBMP有强大的异位诱导成骨能力;（2）bBMP-SB复合骨可促进骨缺损愈合。