影响早期老年性黄斑变性黄斑光敏度多因素逐步回归分析

运用多因素逐步回归方法，对６４例（８２眼）早期老年性黄斑变性（ＡＭＤ）的黄斑光敏度（ＭＬＳ）进行分析。结果显示黄斑玻璃疣数量、分布及融合程度和对侧眼晚期ＡＭＤ对ＭＬＳ有影响，其中以黄斑玻璃疣最为显著。揭示玻璃疣可能是早期ＡＭＤ视网膜光敏感性损害的危险因素，可能与ＡＭＤ的发生发展有着密切关系。     

孔源性视网膜脱离患者黄斑光敏感度的研究

目的：研究孔源性视网膜脱离患者的黄斑功能。方法：采用Ｈｕｍｐｈｒｅｙ自动视野分析仪（８５５型）对孔源性视网膜脱离患者（ＲＲＤ）３０例３０眼进行黄斑区５°光敏感度（ＭＬＳ）测定。结果：ＲＲＤ患者ＭＬＳ明显低于对照组和对侧眼，仅相当于对照组的３０％，视网膜复位后也仅相当于正常人的４３％。ＲＲＤ患者病程＞１个月、高度近视、多孔网脱、脱离范围≥Ⅱ个象限和裂孔位于赤道后，或伴有黄斑部脱离者ＭＬＳ下降更为明显，多呈不可逆性下降，术后黄斑功能恢复不佳。结论：ＲＲＤ患者ＭＬＳ明显低于正常人，其下降程度与年龄、病程、裂孔数目及位置、视网膜脱离范围等有关。     

Enzyme replacement therapy for mucopolysaccharidosis VI (Maroteaux-Lamy syndrome): experience in Hong Kong

Mucopolysaccharidosis VI (Maroteaux-Lamy syndrome) is a very rare inherited lysosomal storage disease. We evaluated the efficacy and safety of weekly infusions of recombinant human arylsulfatase B as enzyme replacement therapy for two patients in whom this condition was advanced. The primary outcome variables were the distance walked in a 6-minute walk test, forced vital capacity, and ejection fraction. The secondary outcome variables were the number of stairs climbed in a 3-minute stair climbing test, joint mobility, urinary glycosaminoglycan excretion, auto-continuous positive airway pressure study and liver size. After 24 weeks of treatment, patient A walked 40 m (36%) and patient B walked 66 m (58%) more in the walk test than at baseline. After 48 weeks, in patient A the corresponding improvements were 142 m (129%) in the walk test and 33 stairs (60%) in the 3-minute stair climbing test, and in patient B the respective improvements were 198 m (174%) and 77 stairs (140%). There was a significant decline in urinary glycosaminoglycan excretion and improvement in range of motion of joints in both patients. The auto-continuous positive airway pressure study revealed improvements in patient A, while other efficacy variables remained static. There were no drug-related adverse events or allergic reactions reported during and after the infusions of recombinant human arylsulfatase B. Recombinant human arylsulfatase B significantly improves endurance and reduces urinary glycosaminoglycan excretion. The drug is generally safe and well tolerated.     

A cross-sectional study of the knowledge and attitude of medical laboratory personnel regarding continuing professional development

Background:

Continuing professional development (CPD) in Medical Laboratory Scientists (MLS) is aimed at equipping laboratory professionals with the necessary skills to enhance practice. The laboratory scientists are usually the first contact between the patient and health care system in aspects of diagnosis and monitory of diseases. As such, it becomes imperative to assess the knowledge of laboratory personnel regarding CPD.

Materials and Methods:

Self-administered questionnaires were distributed to 200 laboratory personnel''s attending the maiden CPD workshop organized by the Association of MLS in Jos the Plateau state capital.

Results:

One hundred and thirty-five (82 males and 53 females) of the 200 administered questionnaires were returned. Only 32 of them (23.7%) attended CPD program in the last 1 year with 10 (7.5%) engaging in online CPD. Five (3.7%) of the respondents had the privilege to attend an international CPD. Majority (95.2%) of the respondents identified CPD as an essential component of professional career development. Lack of sponsorship was identified as a major setback in CPD efficiency by 93.8% of respondents. About 58 (46.4%) noted that poor attendance in CPD workshops was due to unavailability of policy guideline for CPD. One hundred and twenty (95.2%) of respondents had an aim of improving their skills after attending CPD workshops.

Conclusion:

The overall attitude of Nigerian MLS toward attending CPD workshop is poor; however, the knowledge regarding the importance of CPD is adequate. There exists a gap between sponsorship for CPD by various institutions and MLS.     

斑点追踪技术定量评价尿毒症心肌病左室肥厚及形变对心功能的影响

目的：应用二维斑点追踪技术(two dimensional speckle tracking imaging,2D-STI)检测尿毒症心肌病(uremic cardiomyopathy,UCM)患者心肌生物力学参数,评价左室肥厚及左室形变对心功能的影响。方法：随机将67例UCM 患者分为临床心功能正常组(A亚组,32例)及心功能异常组(B亚组,35例),另选30例作为正常对照组。比较受检者 临床心功能分级积分NYHA-P、左室射血分数(left ventricular ejection fraction,LVEF)、左室重量指数(left ventricular mass index,LVMI)、左室球形指数(left ventricular spherical index,LVSI)以及心肌生物力学参数即左室平均径向应变(mean radial strain,MRS)、平均径向应变率(mean radial strain rate,MRSR)、平均纵向应变(mean longitudinal strain,MLS)、 组织运动瓣环位移(tissue motion annular displacement,TMAD)、左室心肌收缩期扭转角度(systolic twist angle,STA)。 结果：UCM组LVMI增大,而STA,MLS,MRS,MRSR,TMAD,LVSI减低(P<0.05)。UCM组中B亚组与A亚组 比较：LVMI差异无统计学意义(P>0.05),MLS,MRS,MRSR,STA,TMAD,LVSI减低(P<0.05)。正常对照组 和UCM组MLS绝对值与LVEF均呈正相关;UCM患者MLS绝对值与LVSI呈正相关,与LVMI呈负相关。以MLS –14.10% 为截断点判定患者NYHA-P>4分灵敏度为90.5%,特异度为71%,Yuedden指数最高0.585。UCM患者心肌收缩期STA 较对照组减低(P<0.05)。结论：用2D-STI技术检测心肌生物力学参数来评价UCM患者左室局部功能具有独特的优越 性,左室肥厚与心室形变无直接相关,临床心功能分级与左室肥厚及心室形变相关,与局部心功能参数相关性更明 显,局部心肌力学参数改变存在于心功能分级尚好及心室重构程度较轻的患者,局部心肌力学参数下降预示心功能 向异常化发展。     

Croatian population data for arylsulfatase a pseudodeficiency-associated mutations in healthy subjects,and in patients with Alzheimer-type dementia and Down syndrome

BACKGROUND: Arylsulfatase A (ASA) is a lysosomal enzyme involved in catabolism of cerebroside sulfate, whose deficiency causes metachromatic leukodystrophy, a rare autosomal recessive disorder characterized by storage of cerebroside sulfate, mainly in the nervous system. Low ASA activities have also been reported in healthy individuals and several neuropsychiatric disorders due to the condition termed ASA pseudodeficiency. The aim of this study was to establish frequency of two mutations associated with ASA pseudodeficiency in healthy individuals in the Croatian population as well as in persons with Alzheimer-type dementia and Down syndrome. METHODS: Presence of N350S and 1524+95 A-->G pseudodeficiency mutations was detected in genomic DNA extracted from leukocytes of healthy subjects (n = 125) and of patients with Alzheimer-type dementia (n = 18) and Down syndrome (n = 21). Arylsulfatase A activity was measured in leukocyte homogenates by spectrophotometry (lambda = 515 nm) using p-nitrocatechol sulfate as chromogenic substrate. RESULTS: Frequency of N350S mutation and mutation 1524+95 A-->G was estimated at 6.8 and 2.8% for healthy controls, 11 and 5.5% for Alzheimer-type dementia, and 12 and 9.5% for Down syndrome, respectively. Arylsulfatase A activity was slightly but not significantly decreased in leukocytes derived from subjects with dementia and Down syndrome in comparison with age-matched control samples. CONCLUSIONS: Frequency of two mutations associated with ASA pseudodeficiency in the Croatian population is slightly below the range reported for other populations. Additionally, despite the proposed role of arylsulfatase A pseudodeficiency as one of the predisposing factors for neuropsychiatric disorders, our preliminary results did not show significantly higher frequencies of either mutation in Alzheimer-type dementia or Down syndrome.     

红景天豆奶延缓衰老作用的实验研究

目的：确定红景天和豆奶是否具有延缓衰老协同作用,为其进一步开发利用提供依据。方法：用红景天的乙醇提取液和豆奶配制成不同浓度的红景天豆奶,进行果蝇生存试验和老龄小鼠肝脏中过氧化脂质（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）及谷光甘肽过氧化物酶（ＧＳＨ－Ｐｘ）活力测定。结果：实验组果蝇平均寿命、最高寿命和半数死亡时间均明显高于对照组（Ｐ＜ ０．０５～０．００１）;实验组老龄小鼠肝脏ＬＰＯ 含量降低,ＳＯＤ及ＧＳＨ－Ｐｘ 活力上升,且红景天豆奶高剂量组作用最显著。结论：豆奶、红景天及红景天豆奶均有抗氧化作用;豆奶以及红景天豆奶中、高剂量均具有延缓衰老作用;高剂量的红景天和豆奶具有延缓衰老协同作用     

腹膜后脂肪肉瘤的CT表现特征

目的:探讨腹膜后脂肪肉瘤的CT平扫和增强表现及鉴别诊断要点。方法:回顾12例经手术病理证实的腹膜后脂肪肉瘤的CT平扫和增强资料,12例均行CT平扫,7例加作增强。分析不同组织类型脂肪肉瘤的CT表现与病理的相关性。结果:与病理对照,脂肪瘤样脂肪肉瘤(LLS)1例。硬化性脂肪肉瘤(SLS)1例,黏液样脂肪肉瘤(MLS)1例,圆细胞性脂肪肉瘤(RCLS)1例,去分化脂肪肉瘤(DDLS)1例,混合成分7例。CT图像上,LLS表现为脂肪密度肿块,不均质,有分隔;MLS平扫表现为均匀的水样密度肿块,增强扫描可见网状、片状或岛状强化;RCLS表现为无脂肪的软组织肿块,与其他类型的软组织肿瘤难以鉴别;DDLS表现为明显强化的软组织肿块,常伴有分化良好的脂肪瘤样组织。结论:不同组织学亚型的脂肪内瘤其CT表现有所不同,CT表现的差异取决于病变内不同组织学亚型的比例、分布及混合的方式。本组中,腹膜后脂肪肉瘤多以混合形式存在,了解这些CT表现特点有助于脂肪内瘤的术前诊断及分型。     

尾核刺激镇痛时家兔中央灰质灌流液内源性吗啡样物质竞争率的变化

<正> 据报告刺激尾核头部可以提高痛阈,对于缓解晚期癌肿引起的恶痛有较为满意的效果,提示尾核具有镇痛作用。中央灰质是吗啡脑内微量注射发挥镇痛作用最有效的部位之一,尤其是中脑中央灰质的尾端腹外侧作用最突出。邹网等将微量吗啡注射在脑内第三脑室及中央灰质能明显镇痛,所需剂量仅为静脉注射有效量的1/500—1/1000,这与中央灰质具有密集的内啡肽受体——阿片受体有关。     

Arylsulfatase A levels in patients with chronic alcoholism

BACKGROUND: The goal of this study was to find the association between low arylsulfatase A (ASA) activity and psychiatric disorders in chronic alcoholic patients. METHODS: The study was carried out in 30 chronic alcoholic patients (27 male, 3 female); age range was 25-65 years. There were 20 normal controls (18 males, 2 females), and age range was 24-67 years. ASA and routine aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activity laboratory tests were measured in blood serum from all patients and control subjects. RESULTS: Alcoholic patients with psychiatric disorders have ASA average values of 68.25 nmol/mL/4 h. This is less than averages found in the alcoholics without psychiatric disorders group (82.48 nmol/mL/4 h) and the control group (90.8 nmol/mL/4 h). There were no statistically significant differences among the three groups studied. Alcoholic subjects with elevated activity of AST and ALT (n = 10) have ASA activity average values of 134.82 nmol/mL/4 h), which is 48.8% higher than the control group (90.6 nmol/mL/4 h). These means show statistically significant differences (p <0.05). CONCLUSIONS: Results indicate an association between low serum ASA activity and alcoholism. The appearance of psychiatric manifestations could be related to the low activity of this enzyme in chronic alcoholic patients. Alcoholic patients with elevated enzyme activity of AST and ALT in sera also have elevated sera arylsulfatase A (ASA) activity. We consider that these findings may be useful for evaluating the psychiatric state as a prognosis in chronic alcoholic patients, and should be a routine laboratory test in alcoholic patients.     

耐甲氧西林葡萄球菌对大环内酯类抗生素的耐药性分析

目的研究耐甲氧西林葡萄球(MRS)对大环内酯类(M)-林可酰胺类(L)-链阳菌素类(S)抗生素(MLS)的耐药性,以指导临床用药.方法采用K-B扩散法测定90株MRS临床分离株的MLS六种代表药物的药敏试验,分析其耐药率和药敏表型.结果MRS的红霉素、阿齐霉素耐药率一致,均达93.00%以上,麦迪霉素、乙酰螺旋霉素达71.00%以上,克林霉素达68.00%以上,未见奎奴普丁/达福普丁(QD)耐药.MRS对MLS有5种药敏表型,最主要的表型为ML耐药/S敏感(71.11%);MRSA和MRCNS的药敏表型分布不一样.结论MRS的红霉素、阿齐霉素耐药率一致,但其它MLS 4种代表药物耐药率不一致且较高;MRS对MLS有5种药敏表型,最主要的表型为ML耐药/S敏感;MRSA和MRCNS的药敏表型分布不一样.     

中医辨证分型与慢性乙型肝炎患者T淋巴细胞亚群及VCS参数的关系

目的探讨慢性乙型肝炎患者不同的中医辨证分型是否引起淋巴细胞亚群和淋巴细胞VCS（V volume C conductivity S scatter）相应的变化。方法对符合纳入条件116病例分成三组,分别为肝郁脾虚型43例,湿热中阻型38例,瘀血阻络型35例,同时选健康体检人员为健康对照组48例。对各组进行ALT、WBC、CD4^＋、CD8^＋、CD4^＋/CD8^＋、MLV、MLV-SD、MLC、MLC-SD、MLS、MLS-SD的检测,分析各组上述指标间的相互关系。结果与健康对照组比较,肝郁脾虚型、湿热中阻型、瘀血阻络型三组的ALT、CD8^＋、MLV、MLV-SD、MLC-SD、MLS-SD均升高,差异有统计学意义（P〈0.05）,WBC、CD4^＋、CD4^＋/CD8^＋、MLC、MLS均下降,差异有统计学意义（P〈0.05）,与湿热中阻型比较,肝郁脾虚型的CD8^＋、MLV-SD、MLC-SD、MLS、MLS-SD差异有统计学意义（P〈0.05）,瘀血阻络型ALT、CD4^＋、CD8^＋、CD4^＋/CD8^＋、MLV、MLV-SD、MLC-SD、MLS差异有统计学意义（P〈0.05）,与瘀血阻络型比较,ALT、CD4^＋、CD8^＋、CD4^＋/CD8^＋、MLV、MLV-SD、MLC-SD、MLC-SD、MLS、MLS-SD差异有统计学意义（P〈0.05）。结论慢性乙型肝炎患者证侯的变化,淋巴细胞的亚群表达及VCS参数的结果发生相应的变化,表明三者间存在密切的关系,可为中医辨证分型提供实验指标。     

2型糖尿病患者白细胞群落参数的改变及临床应用

目的:探讨白细胞群落参数(VCS)参数在2型糖尿病患者诊断中的临床价值.方法:使用血液分析仪检测2型糖尿病151例外周血白细胞各项参数并与对照组比较.用免疫浊度分析仪检测其中37例尿微量白蛋白(MA),并分析与VCS参数相关性.结果:与对照组比较,白细胞、单核细胞计数,单核细胞百分率和淋巴细胞平均激光率(MtS)变化差...     

Macrolide resistance among invasive Streptococcus pneumoniae isolates

CONTEXT: Macrolide antibiotics, including erythromycin, clarithromycin, and azithromycin, are the mainstays of empirical pneumonia therapy. Macrolide resistance among Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, is increasing in the United States. Whether resistance is a significant problem or whether macrolides remain useful for treatment of most resistant strains is unknown. OBJECTIVE: To examine the epidemiology of macrolide-resistant pneumococci in the United States. DESIGN AND SETTING: Analysis of 15 481 invasive isolates from 1995 to 1999 collected by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance system in 8 states. MAIN OUTCOME MEASURES: Trends in macrolide use (1993-1999) and resistance and factors associated with resistance, including examination of 2 subtypes, the M phenotype, associated with moderate minimum inhibitory concentrations (MICs), and the MLS(B) phenotype, associated with high MICs and clindamycin resistance. RESULTS: From 1993 to 1999, macrolide use increased 13%; macrolide use increased 320% among children younger than 5 years. Macrolide resistance increased from 10.6% in 1995 to 20.4% in 1999. M phenotype isolates increased from 7.4% to 16.5% (P<.001), while the proportion with the MLS(B) phenotype was stable (3%-4%). The median erythromycin MIC (MIC(50)) of M phenotype isolates increased from 4 microg/mL to 8 microg/mL. In 1999, M phenotype strains were more often from children than persons 5 years or older (25.2% vs 12.6%; P<.001) and from whites than blacks (19.3% vs 11.2%; P<.001). CONCLUSIONS: In the setting of increasing macrolide use, pneumococcal resistance has become common. Most resistant strains have MICs in the range in which treatment failures have been reported. Further study and surveillance are critical to understanding the clinical implications of our findings.     

基于MLS的药学技术经纪信息体系建立研究

信息系统的建立,对于我国药学技术经纪行业的发展至关重要。本文在借鉴房地产MLS（多重上市服务系统）系统的基础上,引入交易成本等理论,研究了我国药学技术经纪信息系统的构建思路。分析了该系统对于整合人员、信息,规范管理,保障权益等积极作用后,提出了构建思路和构建模式,对该系统的管理方式、交易运作、结构布局、界面设置以及优化措施等提出了建设性建议,对于日后我国药学技术经纪行业整体管理体系的建立与发展具有现实意义。     

加强收费环节控制 提高窗口服务质量

医院货币性资金的主要收入途径是通过收费处来实现的,医院应加强收费环节控制,堵塞资金管理漏洞,防止医院资金流失。同时,挂号、门诊、住院收费作为窗口服务单位,规范服务标准,提高服务质量,对有效保障医院各项业务活动有序进行有着非常重要的意义。     

Serum long acting thyroid stimulator protector in pregnancy complicated by Graves' disease

Activities of serum long acting thyroid stimulator protector were measured in a series of nine pregnancies in eight mothers who had Graves' disease, one of whom had been successfully treated by surgery. In all but two instances the activities tended to decline as pregnancy progressed. After delivery activities rose in three out of five patients in whom these had disappeared in pregnancy and, as this occurred, the patients relapsed. In the two patients whose activities did not decline thyrotoxicosis persisted throughout pregnancy and after delivery. None of the nine babies in this study suffered from neonatal thyrotoxicosis because maternal activities of the thyroid stimulator protector, though high enough to induce Graves' disease in adults, were not above the threshold for the induction of thyroid overactivity in neonates.     

Association between participation in sports club activities and decision-making preferences in end-of-life treatment among Japanese elderly people: a cross-sectional study

Introduction: Decision-making regarding treatment at the end-of-life stage is an important issue for the elderly and their families. Such decision-making may be influenced by activities that promote communication and physical health. The purpose of this study was to examine the association between participation in sports club activities and decision-making regarding life-prolonging treatment among the general community-dwelling Japanese elderly. Methods: In this cross-sectional study, which used stratified random sampling, 1,603 elderly people aged 65 years or older as of January 2016, living in Fukushima prefecture, Japan were enrolled. Data was collected by a self-completed questionnaire (effective response rate: 53.4%). The association of sports club activity participation with a preference for accepting or declining life-prolonging treatment was analyzed by multinomial logistic regression analysis. Results: Of those participating in sports club activities, the results revealed an odds ratios of 1.812 for participants declining life-prolonging treatment (95% CI=1.325 to 2.477) and 1.948 for those who preferred life-prolonging treatment (95% CI=1.160 to 3.271). Conclusions: The present study suggests that participation in sports club activities is associated with articulating decisions about life-prolonging treatment in end-of-life care. Consideration of patient involvement in daily activities in non-medical settings may enhance decision-making for end-of-life care planning.     

云南省鼠疫偶然宿主树鼩中鼠疫噬菌体的分离及流行病学意义

目的 调查云南省部分鼠疫疫源地鼠疫偶然宿主树鼢肠道中携带能裂解鼠疫菌的噬菌体的状况,并探讨其流行病学意义.方法 在云南省8个市/县(弥勒市、弥渡县、宜良县、梁河县、元江县、玉龙县、文山市及临沧市)捕获树鼩,采集其盲肠标本,以鼠疫菌疫苗株EV76为饲养菌,采用双层平板法分离噬菌体,电镜观察形态,并通过宿主谱检测其宿主特异...     

Presentation of the 2009 Morris F Collen Award to Betsy L Humphreys, with remarks from the recipient

The American College of Medical Informatics is an honorary society established to recognize those who have made sustained contributions to the field. Its highest award, for lifetime achievement and contributions to the discipline of medical informatics, is the Morris F Collen Award. Dr Collen''s own efforts as a pioneer in the field stand out as the embodiment of creativity, intellectual rigor, perseverance, and personal integrity. The Collen Award, given once a year, honors an individual whose attainments have, throughout a whole career, substantially advanced the science and art of biomedical informatics. In 2009, the college was proud to present the Collen Award to Betsy Humphreys, MLS, deputy director of the National Library of Medicine. Ms Humphreys has dedicated her career to enabling more effective integration and exchange of electronic information. Her work has involved new knowledge sources and innovative strategies for advancing health data standards to accomplish these goals. Ms Humphreys becomes the first librarian to receive the Collen Award. Dr Collen, on the occasion of his 96th birthday, personally presented the award to Ms Humphreys.

‘Betsy not only understands all the strengths and weaknesses of medical librarians but doctors and NIH scientists, plus the peculiar behavior of organizations… she handles all of them with grace and intelligence and that''s pretty hard to beat.’Donald AB Lindberg, MD, National Library of Medicine