妊娠期糖尿病孕前体质指数对围产期母婴结局的影响

目的探讨妊娠期糖尿病孕前体质指数(body mass indes,BMI)对围产期母婴结局的影响。方法选取2012年4月—2013年3月在海军总医院正规产检、分娩的238例妊娠期糖尿病孕妇,按照孕前BMI分组,BMI＜185 kg/m2为低体质量组、185 kg/m2≤BMI＜250 kg/m2为正常组、250 kg/m2≤BMI＜280 kg/m2为超重组、BMI≥280 kg/m2为肥胖组,分析各组间早产率、巨大儿发生率、剖宫产率、新生儿出生体质量、新生儿血糖水平等围产结局,分析各组间未接受正规治疗的比例。结果各组间巨大儿发生率、剖宫产率以及未接受正规治疗的比例差异有统计学意义,其中超重组和肥胖组巨大儿发生率与正常组比较明显升高（P＜005）,但与低体质量组比较差异无统计学意义（P＞005）。超重组剖宫产比例以及未接受正规治疗的比例与低体质量和正常组比较明显升高（P＜005）,但与肥胖组比较差异无统计学意义（P＞005）。肥胖组孕期体质量增加以及BMI增加与其余3组分别比较均明显减少（P＜005）。超重组新生儿血糖水平与低体质量组比较明显降低（P＜001）。4组之间早产率、新生儿体质量差异无统计学意义（P＞005）。结论妊娠期糖尿病孕前BMI与围产期母婴结局有明显相关性,孕前将BMI控制在185~250 kg/m2为宜。孕期应重点加强对孕前超重组和肥胖组的管理,控制孕期体质量增加,减少不良妊娠结局发生。     

MEBO治疗犬咬伤创面的临床观察

目的:总结MEBO(湿润烧伤膏)治疗犬咬伤创面的临床疗效。方法:将52例犬咬伤创面患者随机分为MEBO治疗组和对照组,MEBO组用MEBO治疗,对照组采用雷佛奴尔纱条治疗。结果:MEBO能控制犬咬伤创面感染,改善创面血液及淋巴循环,促进创面肉芽组织和上皮再生。MEBO组创面较对照组创面的炎性渗出要少(P＜0．05),MEBO组犬咬伤创面的平均痊愈时间12．3±3．2 d明显短于对照组18．5±3．9 d(P＜0．05)。结论:MEBO治疗犬咬伤创面的临床疗效好,应用方便。     

67例长期腹膜透析患者转归分析

[摘要]目的分析长期腹膜透析患者的临床资料,探讨其临床特点及临床转归。 方法对本院腹透龄超过1年的67例腹膜透析患者进行回顾性分析,根据其临床转归分为维持腹透组、转向血透组、转向移植组及死亡组。分析各组间近期血清白蛋白、透析充分性指标、水清除指标、血压水平及残肾功能。结果死亡组血清白蛋白及尿素清除指数（Kt/V）水平低于其余3组（P＜005）。维持腹透组水清除指标高于其余3组（P ＜005）。维持腹透组及转向移植组残肾功能高于其余2组（P＜005）。死亡组患者死亡前3个月Kt/V及肌酐清除率均低于死亡前1年（P＜005及P＜001）。死亡组24例中有10例死于心脑血管疾病。结论心脑血管疾病是死亡的首位病因,透析不充分、营养不良以及血压控制不佳都是死亡的重要原因,残肾功能可影响预后。     

磁共振扩散加权成像在直肠肿瘤性病变诊断中的价值

目的：通过对不同类型直肠肿瘤病例DWI图像分析和ADC值的测量探讨扩散加权成像对直肠肿瘤性病变的诊断价值。方法比较8例直肠腺瘤,30例中分化腺癌,6例低分化腺癌,7例黏液腺癌,6例淋巴瘤及5例间质瘤的ADC值的差异。结果①直肠淋巴瘤的ADC值明显低于直肠癌、直肠腺瘤,差异有统计学意义（ P＜0．05）,淋巴瘤与间质瘤之间差异无统计学意义（ P ＞0．05）;②直肠腺瘤ADC值低于粘液腺癌（ P ＜0．05）,与间质瘤、腺癌之间差异无统计学意义（ P＞0．05）;③间质瘤 ADC值低于粘液腺癌（ P ＜0．05）,与淋巴瘤、腺癌、腺瘤之间差异无统计学意义（ P ＞0.05）;④粘液腺癌ADC值高于中分化腺癌（ P ＜0．05）,与低分化腺癌之间差异无统计学意义（ P ＞0．05）,中分化、低分化腺癌之间差异无统计学意义（ P ＞0．05）。结论扩散加权成像对不同类型直肠肿瘤、不同类别的直肠腺癌具有一定的鉴别诊断价值,联合MR常规扫描可提高诊断效能。     

绞股蓝对非酒精性脂肪肝和酒精性脂肪肝血清生化指标的疗效

目的比较分析绞股蓝皂苷对非酒精性脂肪肝（non alcoholic fatty liver disease,NAFLD）与酒精性脂肪肝（alcoholic fatty liver disease,AFLD）的疗效。方法对69例NAFLD患者和55例AFLD患者均给与绞股蓝总甙片60 mg 3 /d,口服,疗程均为9个月;分别检测各组治疗前后血脂和血清酶指标。结果绞股蓝皂苷均能显著降低NAFLD组及AFLD组的总胆固醇（total cholestrol,TC）、三酰甘油（triacylglycerol,TG）、低密度脂蛋白（low density lipoprotein,LDL）、谷丙转氨酶（alanine aminotransferase,ALT）水平,升高高密度脂蛋白（high density lipoprotein cholestrol,HDL）,与治疗前比较,差异有统计学意义（P＜005）;但对谷草转氨酶（aspartate transaminase,AST）及γ 谷氨酰转肽酶（γ glutamyl transferase,GGT）的影响不大,与治疗前比较,差异无统计学意义（P＞005）。绞股蓝皂苷对NAFLD组的疗效显著优于AFLD组（P＜005）。结论绞股蓝皂苷只对两类患者的血脂异常有效,对肝功能试验的改善不明显,需要结合调节饮食和增加运动来和配合其他保肝护肝药物使用解决。     

妇科千金片对慢性盆腔炎模型大鼠子宫组织辅助性T细胞1/2型细胞因子表达的影响

目的研究妇科千金片对慢性盆腔炎大鼠组织辅助性T细胞（helper T cell,Th）1/2型细胞因子表达的影响。方法采用金黄色葡萄球菌、大肠杆菌及解脲脲原体混合菌接种法建立慢性盆腔炎模型。模型成功后,随机分成妇科千金片低、中、高（052,104,208 g/kg）剂量组和假手术组、模型组、空白组6组。治疗21 d后,取子宫组织,采用酶联免疫吸附测定法检测白介素 1β（interleukin 1β,IL 1β）、IL 8、肿瘤坏死因子 α（tumor necrosis factor α,TNF α）和IL 10表达情况。结果与空白组比较,模型组IL 1β、IL 8、TNF α明显升高（P＜001）,IL 10明显降低（P＜001）。与模型组比较,妇科千金片高、中剂量组IL 1β,IL 8、TNF α均明显降低（P＜005）,IL 10明显升高（P＜001）;低剂量组IL 8和TNF α有所降低（P＜005）。结论妇科千金片治疗慢性盆腔炎的机制可能与抑制组织促炎症因子IL 1β、IL 8、TNF α的释放以及促进组织抗炎症因子IL 10表达、调节Th1/Th2平衡有关。     

142例老年患者医院感染的调查分析

目的 探讨老年患医院感染发生率及其相关因素。方法 对某院1998－2000年收治的老年患发生医院感染的142例进行了回顾性调查分析。结果 老年患的医院感染率为6．50％，明显高于医院同期平均感染率4．78％（P＜0．05），发生医院感染的老年患病死率为17．61％，也显高于未发生医院感染的老年患的病死率（P＜0．05）。结论 老年患的医院感染发生率及医院感染病死率明显高于同期平均感染率和平均病死率，应加大医院感染管理力度，改善医疗环境，合理使用抗生素，对老年患及时采取生理及心理治疗，降低发病率。     

幽门螺杆菌感染与肝硬化相关因素分析

目的探讨肝硬化患者幽门螺杆菌（Hp）感染与肝硬化相关因素关系。方法对46例肝硬化及30例浅表性胃炎Hp感染率、CagA阳性率进行研究。分析Hp感染与乙型肝炎病毒感染、门脉高压性胃病及血氨关系。结果肝硬化组与浅表性胃炎组Hp感染率及CagA阳性率两组无统计学差异（P〉0．05）。Hp感染率与乙肝病毒指标之间及门脉高压性胃病发生无相关性（P〉0．05）。结论Hp感染在肝硬化胃粘膜病变中起一定作用，但不是主要因素。Hp感染可致血氨升高，但与肝性脑病关系有待进一步研究。     

Lichtenstein无张力与开放式腹膜前间隙修补术治疗腹股沟疝的临床研究

目的：分析比较Lichtenstein无张力与开放式腹膜前间隙修补术治疗腹股沟疝的临床效果与安全性,以期为临床合理治疗腹股沟疝气提供选择依据。方法选取腹部外科2012年1月～2013年12月收治的196例腹股沟疝患者为研究对象。将采取腹膜前间隙修补术进行治疗的114例患者作为研究组,将采用Lichtenstein修补术进行治疗的82例患者作为对照组,比较分析两组患者的手术时间、术中出血量、术后下床活动时间、术后住院时间及术后并发症、疝复发的发生情况。结果与对照组比较,开放式腹膜前间隙修补术治疗腹股沟疝的患者手术时间短,术中出血少、下床时间早,住院时间短,差异均有统计学意义（ P＜0．05）;研究组患者术后并发症的总发生率明显低于对照组,差异有统计学意义（ P＜0．05）。但在切口感染和尿潴留方面比较,差异无统计学意义（P＞0．05）;两组患者术后复发比较差异有统计学差异（P＜0．05）。结论开放式腹膜前间隙修补术治疗腹股沟疝的手术时间更短、患者恢复得更快,疼痛更轻,且并发症的发生率与病情的复发率更低。     

4种下尿路感染药物治疗方案的转化医学研究

目的运用转化医学的研究方法进一步量化比较4种不同用药方案治疗下尿路感染的临床效果。方法临床研究：4种治疗方案（左氧氟沙星、阿奇霉素、左氧氟沙星+热淋清颗粒、阿奇霉素+热淋清颗粒）的临床观察由航空总医院泌尿外科完成;统计98例急性下尿路感染门诊病例的症状积分;采用疗效指数（efficacy index,EI）和成本（cost,C）/疗效指数（C/EI）对各方案进行药物经济学分析。实验室研究：将60只SD雌鼠随机分成6组（空白组、造模组、左氧氟沙星组、阿奇霉素组、左氧氟沙星+热淋清颗粒组、阿奇霉素+热淋清颗粒组）,经尿道插管注入大肠杆菌液,建立下尿路感染大鼠模型。各组分别于给药前和给药后进行尿培养,末次取尿后采用血清药理学方法进行血清药敏试验,最后收集膀胱组织行苏木素和伊红（hematoxylin and eosin,HE）染色和免疫组化。结果临床EI结果显示,4种治疗方案的疗效差异无统计学意义（P＞005）。左氧氟沙星方案药物经济学最好（C/EI=29242±2812,P＜005）,阿奇霉素+热淋清颗粒方案药物经济学最差（C/EI=58580±12936,P＜005）。实验室结果表明,4种治疗方案的疗效顺序为：左氧氟沙星+热淋清颗粒＞左氧氟沙星≥阿奇霉素＝阿奇霉素+热淋清颗粒,且差异有统计学意义（P＜005）。结论在临床上疗效差异无统计学意义的不同治疗方案,在实验室研究中差异却有统计学意义。提示转化医学的研究模式能把临床观察结果进一步定量化,从而具有更强的比较性,为临床常用治疗方案的选择提供更定量化的参考信息,具有单一的临床研究模式或单一的实验室研究模式所无法替代的作用。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.