两种微创治疗方法在盘源性腰痛治疗中的应用

目的比较水冷式双极射频纤维环成形术和椎间盘内电热疗法治疗盘源性腰痛的临床效果及其并发症。方法 80例盘源性腰痛患者,随机分为A、B两组,每组40例,分别采用水冷式双极射频纤维环成形术和椎间盘内电热疗法进行治疗,观察两组患者手术前后VAS疼痛评分、Oswestry功能障碍指数评定的功能状态以及手术并发症等情况变化。结果经两种微创方法治疗后,两组患者疼痛评分均明显降低,功能状态显著改善,无严重并发症发生。结论水冷式双极射频纤维环成形术和椎间盘内电热疗法均能快速缓解患者疼痛,显著改善患者功能状态,并发症少,两者都是治疗盘源性腰痛的安全、有效的方法。     

Guidelines for perioperative do-not-resuscitate policies

This paper reviews some of the difficulties in implementing perioperative reevaluation of do-not-resuscitate (DNR) orders and suggests several strategies for perioperative DNR policies. Policies should be written, designed and implemented at the level of the institution, and be sufficiently flexible to permit the tailoring of the perioperative DNR order to the individual patient. Policies should unambiguously state that reevaluation is required, delineate responsibilities for reevaluating the DNR order, state all the available options, define the necessary documentation, and list resources for help.     

2004-2009年广西靖西县淋病、梅毒、AIDS/HIV流行状况分析

目的了解位于中越边境的靖西县2004-2009年梅毒、淋病、艾滋病感染及发病情况,分析其流行特征和规律,为制订性病艾滋病防治策略和措施提供科学依据。方法收集该县2004-2009年的梅毒、淋病、AIDS/HIV病例疫情资料,采用Excel软件进行统计分析。结果全县人口数为61.7万,近6年报告梅毒、淋病、AIDS/HIV阳性病例共767例,人群发病率为21.68/10万,男性高于女性,其中淋病118例、梅毒595例、艾滋病11例(死亡6例)、HIV阳性43例(死亡10例)。以上3种疾病高发年龄在15～44岁年龄组,占总发病率的68.06%。农民发病人数占59.06%。梅毒病例数2007年后增多明显。自1997年发现HIV感染者后,2004-2009年AIDS/HIV患者每年有所增加,病死率呈逐年上升,平均病死率为29.63%。结论该县2004-2009年梅毒患者增加较快,AIDS/HIV阳性病例有所增多,防治工作应进一步加强。     

开通闭塞冠状动脉策略的全球性研究 GUSTO—Ⅱb（亚组研究）

病人资料 3 289例因急性冠脉综合征而接受溶栓治疗的患者,2274例接受t－PA治疗,1015例接受链激酶治疗。     

Do differences in the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists positions on the ethics of maternal-fetal interventions reflect subtly divergent professional sensitivities to pregnant women and fetuses?

As therapeutic interventions that are designed for the direct benefit of the fetus have evolved, pediatric specialists along with obstetricians have become increasingly engaged in the management of pregnancies that are complicated by fetal disorders. Do the 2 groups of medical specialists hold differing "world views" on the nature of the maternal-fetal relationship that could have an impact on decision-making? A direct comparison of the positions of the ethics committees of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists concerning maternal-fetal conflicts and fetal therapy reveals subtle but telling differences. Compared with the American College of Obstetricians and Gynecologists policy, the American Academy of Pediatrics statement accords somewhat less weight to maternal decision-making and is more tolerant of overriding maternal refusal of interventions that are recommended for fetal benefit. In doing so, it may oblige pregnant patients to assume greater risk and tolerate diminished autonomy. We urge leaders from both disciplines to meet and seek consensus so that a common approach and language can guide treatment of the patients whom we share.     

Interleukin 1 induces human marrow stromal cells in long-term culture to produce granulocyte colony-stimulating factor and macrophage colony- stimulating factor

Pure interleukin 1 (IL 1) was found to stimulate established human bone marrow stromal layers in long-term culture to produce colony- stimulating activity (CSA). Maximal concentrations in the culture medium were reached 24 hours after a single IL 1 pulse. The effect could be neutralized by a specific rabbit anti-IL 1 antiserum. Stromal layers, once stimulated by IL 1, continued to release CSA into the culture medium in the absence of exogenous IL 1. A second IL 1 pulse induced CSA release in an identical manner, as did the primary stimulation, indicating that the CSA released was actively produced. Using specific immunologic assays, both granulocyte colony-stimulating factor (G-CSF) and macrophage CSF (M-CSF) could be identified in the culture supernatants, and production of both factors was inducible by IL 1. Shortly after initiation of the long-term marrow cultures "spontaneous" G-CSF and M-CSF release occurred. The release of G-CSF diminished following addition of the anti-IL 1 antiserum, indicating that endogenous production of IL 1 by stromal cells had contributed to this effect. These results further support the role of IL 1 as an important modulator of CSF production by cells of the hematopoietic microenvironment.     

Die Beeinflussung der Organperfusion durch Kalziumblocker und Converting-Enzyminhibitor an der herzinsuffizienten,wachen Ratte

Summary The present study examined the regional vascular effects (radioactive microspheres) of converting-enzyme inhibition (captopril, 1mg/kg) and calcium-antagonism (diltiazem, 1 mg/kg) in a rat model of cardiac failure due to large myocardial infarction (n=18, infarct size 40% of the left ventricle) both at rest and during submaximal tread-mill exercise. Diltiazem increased renal, gastrointestinal, coronary and cutaneous blood flow at rest by 29%, 28%, 26% and 37% (p<0.05 each) and enhanced skeletal muscle blood flow during exercise by 16% (p<0.05). Captopril improved primarily renal and coronary blood flow at rest (by 59% and 23%, respectively,p<0.05) and reduced vascular resistance in the gastrointestinal bed by 25% (p<0.05) without significant effects in other circulatory beds. We conclude that the regional vascular effects elicited by converting-enzyme inhibition and calcium antagonism differ considerably in this animal model of congestive heart failure and may be clinically important. The favourable regional vascular profile of diltiazem deserves further clinical investigation.

Mit Unterstützung der Deutschen Forschungsgemeinschaft Dr 148/2-1     

Cyclosporine-A as prevention for graft-versus-host disease in pediatric patients undergoing bone marrow transplants

Cyclosporine-A is a drug commonly used in bone marrow transplantation (BMT) for the prevention of graft-versus-host disease. In the pediatric allogeneic BMT population at The Children's Hospital in Boston, a combination of Cyclosporine-A and Methotrexate is used for graft-versus-host prophylaxis. Graft-versus-host disease, whether acute or chronic, may be fatal. The increasing use of Cyclosporine-A in the pediatric BMT setting demands careful nursing assessment and intervention for Cyclosporine-A toxicity and related side effects.     

Interleukin-6 is not involved in the interleukin-1-induced production of colony-stimulating factors by human bone marrow stromal cells and fibroblasts

Interleukin-6 (IL-6) is a multifunctional cytokine that plays a role in regulation of hematopoiesis. Because IL-6 is coinduced with colony- stimulating factors (CSFs) by various cell types in response to stimulation with IL-1, we investigated whether IL-6 is involved in the IL-1-induced production of CSF by human bone marrow (BM) cells in long- term culture or human fibroblasts. We showed that IL-6 does not induce CSF production by these cells. Neither addition of exogenous IL-6 nor neutralization of endogenous production of IL-6 by an anti-IL-6 monoclonal antibody (MoAb) diminished the IL-1-induced colony- stimulating activity (CSA), indicating that IL-6 did not act synergistically with IL-1. Finally, IL-6 did not influence the kinetics of IL-1-induced CSA production by human fibroblasts. We conclude that IL-6, either alone or in combination with IL-1, does not induce CSF production by human BM stromal cells or fibroblasts.