三种结防“管理模式”肺结核菌阳检出率的变化

目的:研究肺结核病人痰菌检出率的影响因素,探寻提高肺结核病人痰菌检出率的有效措施。方法:分析结防“归口管理”、“卫生部加强结核病控制项目”、“CIDA-WHO结核病控制项目”三种管理模式中痰检结果资料。结果:实施“项目”管理菌阳检出率与“归口管理”模式菌阳检出率有显著性差异,前者显著高于后者;痰涂片结果分布有显著性差异。结论:提高肺结核病人痰菌检出率须采取综合措施,方能取得良好结果。     

结核病控制项目工作中实施可疑肺结核症状者转诊发现肺结核病人效果分析

高发现率是结核病控制项目（以下称项目）工作的主要目标之一。为了实现这一目标，从1992年实施结核病控制项目，加强可疑肺结核症状者转诊，实施结核病归口管理问），提高了病人的发现率。现将项目实施五年（1992～1996年）转诊的可疑肺结核症状者发现肺结核病人进行分析。1资料和方法1．1资料来源：本文资料来源于我站结防科门诊登记的肺结核病人或可疑肺结核患者。1992～1996年共登记可疑肺结核患者2855人，发现活动性肺结核555例，其中徐阳病人335例，初冶徐明病人220例。在涂阳病人中初治徐阳229例，复治徐阳106例。1．2发现方法1，2．…     

达县加强结核病归口管理的探索

本文对我县2004—2005年实施结核病归口管理工作中接诊7934人，是实施前两年接诊数（5649人）的140.45％，确诊为活动性肺结核2226例，其中发现新发涂阳1078例，治疗覆盖率100％，治愈1062例，治愈率98．52％，2月末痰检阴转率97.25％；复活涂阳198例，治愈189例，治愈率95.46％。涂阳病人督导化疗管理率达98.15％，督导化疗总体规则治疗率达98．40％，保证了涂阳病人化疗效果。全部达到“项目”规划要求。我县开展“项目”，全面实施DOTS，涂阳肺结核治愈率明显提高，因此是控制结核病传染源的最佳措施。实践证明，要搞好归口管理工作必须通过行政干预，发布地方法规或政令性文件，协调好预防和医疗部门的配合、加强结防专业机构队伍建设。并不断提高业务技术水平。同时以确保归口管理工作的顺利实施。     

结核病医院诊疗疾控中心管理模式推广

目的：对结核病医院负责诊疗、疾控中心负责结核病管理和督导的运作模式运行情况进行研究探讨。方法：选择2011年、2012年、2013年3个年度进行诊治的结核病患者为研究对象,对3个年度结核病人发现数、新发涂阳数、复发涂阳病人发现数及结核病工作“五率”等进行分析比较。结果：随着结核病诊疗疾控中心管理模式的推广,到2013年度结核病人新发涂阴数、复发涂阳数均显著提高（P＜0.05）,新发涂阳数显著下降（P＜0.05）。结核病“五率“也呈现逐年增高的趋势（P＜0.05）。结论：在结核病医院负责诊疗、疾控中心负责结核病管理和督导的运作模式下,结核病临床治疗及病人的管理情况均有一定提高,医防合作是结核病控制的必然趋势,结核病医院诊疗疾控中心管理模式是科学的,应予以推广。     

开封市城区实施DOTS治疗菌阳肺结核效果分析

痰涂片抗酸杆菌阳性 (菌阳 )肺结核病人是结核病控制的重点对象 ,实施ＤＯＴＳ(全程面视下短程化疗 )治管方式在县、乡、村结防网络健全的农村和大城市已取得明显效果 ,为评价我市城区实施ＤＯＴＳ治管菌阳肺结核的效果 ,特分析了 1996年 3月实施卫生结核病控制项目以来治疗的 4 38例初治菌阳肺结核病人的临床资料 ,报道如下。1　资料和方法1.1　资料来源及一般情况1.1.1　资料来源　 1996年 3月至 1999年 12月间我所登记管理的 4 38例初治菌阳肺结核病人中 ,有督导条件的 314例病人采取ＤＯＴＳ方式管理 ,余 12 4例因无督导条件采取全程管…     

结防机构与综合医院合作开展肺结核病人转诊及追踪工作模式初探

目的 依法开展结核病归口管理工作,由结防机构与综合医院合作开展肺结核病人转诊及追踪工作.方法 从2003年起,按照全球基金结核病控制项目要求:县慢性病防治所对推荐和转诊的单位或个人每推荐或转诊1例由县慢性病防治所确诊的肺结核病例发给转诊劳务费12元,以激励转诊者的积极性.利用综合医院的人力、物力资源和结防机构公共卫生管理职能及三级防痨网的作用,从5个方面探讨合作模式以加强对肺结核病的管理.结果 肺结核病人的发现率及转诊率逐年提高,到县结防所登记管理的病人转诊率为:2003年18.80%,2004年54.21%,2005年56.53%,2006年65.14%.网络追踪工作的开展有效提高了病人到位率.结论 对传染性肺结核病人免费检查和免费治疗是结核病控制项目成功的核心;健全的服务体系和激励机制是项目成功的条件;对综合医院相关科室的医生进行结核病知识培训,进一步提高综合医院结核病诊断水平,特别是对不典型结核病的诊断和耐药肺结核病人的治疗,重视胸片及查痰工作.对肺结核病人实施归口管理是执行DOTS的基础,结防机构与综合医院加强合作、开展双向转诊工作能有效提高肺结核病人的发现率和治愈率.病人转诊的具体措施是:将疫情报告率、转诊率和转诊到位率、病人督导管理纳入医院工作目标考核内容,与奖惩挂钩,有效地推动了我县结核病控制工作的全面开展.     

中山市加强结核病人和可疑者转诊的实施性研究

医药产业资讯MEDICINEINDUSTRYINFORMATION1项目描述1.1目的、意义加强结核病人和可疑者的转诊,是国家级结核病控制的实施性研究项目,我市是广东省12个项目实施地之一。按照《广东省结核病归口管理暂行办法》规定“凡已健全结防机构的市县,结核病的门诊诊断,治疗管理和技术指导,由结防机构负责,各医疗单位门诊发现的结核患者及可疑者均应归口到结防机构管治”。根据我市2003年病人发现资料统计显示,结核病人和可疑者来源于市属三间综合医院的占23.02%,来源于镇区医院和卫生站的占72.37%,主动到结防所就诊的只占4.59%,由此可见95.…     

专业医疗点与非专业医疗点肺结核病人管理的探讨

目的了解结核病防治专业医疗点(下称专业点)与非专业医疗点(下称网点)在结核病诊断、治疗方案、治愈率及管理等方面的差距。方法对兰州市城乡交接处的伏龙坪辖区,由省结防所设立的结防专业点与网点1996～2000年期间因症就诊治疗的198名活动性肺结核病人,在治愈率、病人管理等方面进行了全面的比较分析。结果专业点接诊肺结核病人107例,完成治疗103例(96.3%),治愈102例(95.3%);网点接诊肺结核病人91例,完成治疗63例(69.2%),治愈54例(59.3%)。其相关资料比较结果有明显差异(P<0.01)。结论专业点管理水平明显高于网点,而网点仍有不少就诊治疗的肺结核病人也是不争的事实。只有进一步加强和完善结核病的归口管理工作,加大现代结核病防治策略的宣传力度,充分发挥社区医疗和个体医疗资源在结核病控制中的作用,才能真正有效地促进结核病控制的可持续发展。     

南阳市卧龙区肺结核病人不同转诊方式的效果评价

肺结核病归口管理是结核病控制的一项重要措施。南阳市卧龙区从1995年开始实施结核病归口管理，所有医务人员发现可疑肺结核病人要进行登记、报告并及时转诊到当地结核病防治机构进行确诊、治疗和管理。2000年2月南阳市在一般转诊的基础上，开始在全市范围内推行综合医疗单位“放射科转诊”模式。本文通过对实施“放射科转诊”前后5年可疑肺结核病人转诊到位率、活动性肺结核病人新登记率等动态指标进行观察比较，评价两种不同转诊方式的实际效果，为更有效的落实结核病归口管理及结核病控制工作提供依据。     

嘉兴市实施结核病控制项目效果评价

目的了解执行浙江省“结核病控制项目”后的效果。方法通过实施政府承诺、增加专项经费投入、签订工作目标责任、落实结核病人归口管理、定诊单位实行免费规则查治、非定诊单位不诊治肺结核病人、疑似病人转诊、外来流动人员病人通过网络在国内追踪管理、治愈者和追踪者给予奖励和所有病人实行全程督导管理等措施。结果全市新登涂阳病人发现率从2001年12．83／10万上升到2006年的32．41／10万；治愈率从83．61％上升到88．26％。结论实施结核病控制项目管理后效果显著。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.