新疆南疆三地州卫生人力资源配置适宜性研究

新疆卫生人力资源存在着数量不足、素质不高、结构不合理及配置不平衡等问题,尤其新疆南疆三地州卫生人力资源的匮乏急待解决。根据卫生事业发展需与国民经济发展相协调的实际,满足全体人民基本卫生服务需要的目标,按照基本卫生服务均等化原则,建议增加当地卫生人力资源数量、提高基本卫生人力素质与能力、不断调整优化卫生人力资源结构和布局等。     

外源性p53对Wnt通路抑制因子Dickkopf-1的表达作用

目的研究外源性p53对W nt通路抑制因子D ickkopf-1(DKK-1)的表达作用。方法将携带p53基因的复制缺陷型腺病毒载体(Adp53)导入到p53完全缺失的人肝癌细胞株Hep3B中,并以p53反以寡核苷酸阻断p53阳性细胞p53的表达,以W nt通路的关键因子-βcaten in的改变为功能指标评价W nt通路的变化。以RT-PCR技术检测W nt通路抑制因子DKK-1表达的调节作用,以流式细胞术检测Adp53的转基因情况,肝癌细胞中p53和β-caten in的表达。结果DKK-1mRNA水平在转染Adp53 20 h后即有明显升高,32 h达最高水平,随后逐渐降低。β-caten in表达水平随着转染时间和转染剂量的增加,阳性细胞百分比强度和平均荧光量强度表达水平逐渐下降。以p53反以寡核苷酸阻断p53阳性细胞p53表达后,抑制剂DKK-1的表达逐渐降低,-βcaten in表达水平逐渐增加。结论外源性p53能明显诱导W nt通路抑制剂DKK-1的表达,进而产生抑制W nt通路的作用。     

Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography

Direct sagittal computed tomographic scanning (DSCT) of the shoulder was performed in 42 symptomatic patients, six healthy volunteers, and two cadaver shoulders. Axial CT scanning and double-contrast arthrography with plain radiographs were performed in 41 patients for comparison. DSCT enabled correct identification of 27 of 29 lesions in 24 patients. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions.     

The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders

Summary No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19–57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5‐week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain‐free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre‐intervention, 48 h after the last treatment (post‐intervention) and at 12‐week follow‐up period. Mixed‐model anovas were used to examine the effects of the intervention on each outcome measure. Within‐group effect sizes were calculated in order to assess clinical effect. The 2 × 3 mixed model anova revealed significant effect for time (F = 77·8; P < 0·001) but not for side (F = 0·2; P = 0·7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66·8; P < 0·001; side: F = 0·07; P = 0·8). Post hoc revealed significant differences between pre‐intervention and both post‐intervention and follow‐up periods (P < 0·001) but not between post‐intervention and follow‐up period (P = 0·9) for both muscles. Within‐group effect sizes were large (d > 1·0) for both follow‐up periods in both muscles. The anova found a significant effect for time (F = 78·6; P < 0·001) for changes in pain intensity and active pain‐free mouth opening (F = 17·1; P < 0·001). Significant differences were found between pre‐intervention and both post‐intervention and follow‐up periods (P < 0·001) but not between the post‐intervention and follow‐up period (P > 0·7). Within‐group effect sizes were large (d > 0·8) for both post‐intervention and follow‐up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain‐free mouth opening in patients with myofascial TMD.     

White-matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis

Patchy white-matter lesions occur in the magnetic resonance (MR) imaging brain studies of 20%-30% of neurologically healthy elderly subjects. To determine the frequency of histologically verifiable white-matter lesions at autopsy in such subjects the authors examined serial, microscopic, whole brain sections from 15 clinically healthy subjects aged 52-72 years. Small white-matter lesions were found in 12. In these 12, zones of atrophic perivascular demyelination were present in eight brains. These are not the familiar thrombotic, embolic, or ischemic vascular lesions that produce acute necrosis. This mild vascular insufficiency produces atrophy, which has been recognized in the pathology literature but whose clinical significance remains unknown. Other lesions seen were small vascular malformations in the centrum ovale in four brains, diverticula of the lateral ventricle extending into the white matter in three, and an isolated central white-matter infarction in one. All of these lesions are probably the basis of the patchy white-matter lesions seen on MR imaging studies in the neurologically healthy elderly population.