全民医保:海市蜃楼还是可及目标?

作为一种合作共济形式,全民医保的达成尤其需要一个要件,那就是"可操作,,。务院发展研究中心的一份报告在得出"中国卫生医疗体制改革基本不成功"结论的同时,建议应该"建立覆盖全民的一体化医疗     

小切口股骨近端解剖钢板治疗股骨转子间骨折

目的 探讨股骨转子间骨折的治疗方法和疗效。方法小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折17例。结果 随访时间8个月～3年，平均1.6年，优良16例，占94%（16/17）。结论 小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折具有切口小、出血少等优点，是一种微创手术。     

纵隔支气管囊肿CT误诊1例

患者男性,29岁。因体检发现纵隔肿物17天入院。无胸、背痛及胸闷、气促、呼吸困难,无咳嗽、咳痰及咯血。查体:生命体征平稳,双肺呼吸音清晰、未闻及干湿性罗音及胸膜摩擦音。胸透及胸部CT:右后下纵隔类圆形占位,密度较均匀,CT值20~22HU,肿物不随呼吸运动活动。CT诊断:右后下纵隔神经源性良性肿瘤(图1,2)。于全麻下行右后下纵隔肿瘤切除术,病理诊断:(右后下纵隔)支气管源性囊肿。讨论:纵隔支气管囊肿属先天性异常,为前肠囊肿的一种,多见于儿童和青年人。大部分位于气管、支气管周围,多在隆突下和右气管旁。最常见的临床症状是胸痛,无症状…     

内窥镜下手术在眼科的应用

近年来，内窥镜下手术在眼科的应用有了很大进展，并且逐渐展现出其创伤小、并发症少、直视下操作、安全有效的优点。眼内窥镜联合激光可应用于青光眼前房角手术、青光眼睫状体光凝术、周边部视网膜玻璃体手术等等；另外泪道内窥镜在泪器疾病中的应用、鼻内窥镜在鼻眼相关手术中的应用也有很大的发展。眼内窥镜的应用开创了眼科微创手术时代。本文就眼用内窥镜的基本工作原理、应用现状和发展前景进行综述。     

Analysis of the Surface Ozone During Summer and Autumn at a Coastal Site in East China

The levels and temporal variations of surface ozone at a coastal site in East China during summer and autumn were analyzed and the influences of meteorological parameters on ozone were investigated. An inland city was chosen as a comparison site. The main results and conclusions of this study are: (1) ozone pollution, with a maximum 1 h concentration of 150.98 ppbv, was severe during summer and autumn at the coastal site; (2) the ozone level was obviously higher at the coastal site than that at the inland site in September; (3) besides temperature and solar radiation, sea-land breeze circulation is an important factor influencing the ozone level at the coastal site, and sea breeze often induce high ozone levels (the average ozone concentration for sea breeze was about 13 ppbv higher than that for land breeze).     

三氧化二砷对CO2气腹下小鼠肿瘤腹壁戳口种植影响的实验研究

目的 研究腹腔内注射三氧化二砷(arsenic trioxide,As2O3)对小鼠CO2气腹下肝癌H22转移的影响. 方法 昆明鼠40只(清洁级),中腹部穿刺置入1 mm套管针,自套管针注入1×106肿瘤细胞后,建立CO2气腹,压力8 mm Hg,时间30 min.术后随机分4组,每组10只,分别腹腔内注入生理盐水,1 ml;As2O3(2 mg/kg),1 ml;As2O3(4 mg/kg),1 ml;As2O3(4mg/kg)+肝素(10 U/ml),共1 ml.气腹后第3、7天测量肿瘤黏附因子(CD44)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的变化;比较各组生存状态、腹围、体重变化及转移瘤直径.结果 气腹后第3、7天,与对照组相比,各As2O3组CD44、VEGF表达均明显降低(P＜0.05).2个高剂量组的气腹后第3天VEGF、第7天CD44比低剂量组降低明显(P＜0.05).4组戳口种植率分别为9/10、8/10、7/10、6/10,差异无显著性(x2=2.667,P=0.446). 结论 As2O3对CO2气腹腹腔镜肿瘤生长转移有抑制作用.     

Uncooked rice of relatively low gelatinization degree resulted in lower metabolic glucose and insulin responses compared with cooked rice in female college students

Cooking processes that gelatinize granules or disrupt structure might increase the glucose and insulin responses because a disruption of the structure of starch by gelatinization increases its availability for digestion and absorption in the small intestine. We hypothesized that the uncooked form of rice, which has a relatively low degree of gelatinization even though in powder form, would result in lower metabolic glucose and insulin responses compared with cooked rice (CR). To assess the effects of the gelatinization of rice on metabolic response of glucose and insulin, we investigated the glucose and insulin responses to 3 rice meals of different gelatinization degree in female college students (n = 12): CR (76.9% gelatinized), uncooked rice powder (UP; 3.5% gelatinized), and uncooked freeze-dried rice powder (UFP; 5.4% gelatinized). Uncooked rice powders (UP and UFP) induced lower glucose and insulin responses compared with CR. The relatively low gelatinization degree of UPs resulted in low metabolic responses in terms of the glycemic index (CR: 72.4% vs UP: 49.7%, UFP: 59.8%) and insulin index (CR: 94.8% vs UP: 74.4%, UFP: 68.0%). In summary, UPs that were less gelatinized than CR induced low postprandial glucose and insulin responses.     

CT在外伤性胃肠道穿孔急诊中的价值

目的:探讨急诊外伤性胃肠穿孔的CT征象及诊断价值。方法:收集18例经手术证实的外伤性胃肠道穿孔的临床资料及CT征象,分析与总结胃肠道破裂穿孔CT扫描的各种有价值的表现。结果:18例外伤急诊患者中,胃、十二指肠、空回肠与结肠穿孔各1,2,12,3例,其中空回肠为多处破裂,CT主要征象为腹腔散在积液征、游离气腹征、肠系膜与肠壁增厚模糊征、造影剂外溢征。结论:CT扫描在外伤性胃肠道穿孔急诊患者的检查中有定性诊断价值,综合分析各种征象,会明显提高CT的诊断正确率。