要重视瘢痕子宫剖宫产的麻醉处理

我国孕妇剖宫产率高达30％以上,其原因除社会、经济因素外,主要是宫内胎儿窘迫指征放宽和择期反复剖宫产,还有治疗因素,曾有1例第二次剖宫产的女孩患白血病,     

趋化因子受体6基因与陕西汉中地区类风湿关节炎汉族人群相关性

目的探讨趋化因子受体6基因单核苷酸多态性位点与中国陕西汉中地区类风湿关节炎汉族人群的相关性。 方法采用病例-对照研究方法,收集768例RA患者和960例正常对照DNA样本;用聚合酶链反应（PCR）法扩增目的条带,使用单碱基延伸法（SnapShot）对rs1331301、rs1556413、rs3093024、rs1854853和rs3093023位点基因分型,分析与RA的相关性。 结果CCR6基因5个标签SNP位点均符合哈迪温伯格平衡（HWE）,RA组和对照组基因型差异均无统计学意义（P > 0.05）。rs3093024位点A等位基因（OR = 1.22、P = 0.003）,显性模式（OR = 1.33、P = 0.0048）RA组与对照组差异具有统计学意义。rs1854853位点A等位基因（OR = 1.20、P = 0.0067）,显性模式（OR = 1.35、P = 0.0063）,RA组与对照组差异具有统计学意义。rs3093023位点T等位基因（OR = 1.26、P = 0.0009）,显性模式（OR = 1.38、P = 0.0015）,隐性模式（OR = 1.33、P = 0.025）,RA组与对照组差异有统计学意义。rs1331301和rs1556413两个SNP位点等位基因和显性、隐性模式,RA组与对照组差异均无统计学意义。 结论CCR6基因rs3093023、rs3093024和rs1854853三个单核苷酸多态性位点,可能是陕西汉中地区汉族人类风湿关节炎的易感基因位点。     

大剂量乌司他丁对大面积烧伤患者凝血功能的影响及意义

目的：观察大剂量乌司他丁对大面积烧伤患者凝血功能的影响。方法：4例大面积烧伤患者入院后第3天起每天给予大剂量乌司他丁(60万U,4次/d),用药前及用药后1d、3d、7d、10d、14d,抽血观察血浆纤维蛋白原含量(Fib-c)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)及血浆D-二聚体含量的变化。结果：用药前血浆D-二聚体及纤维蛋白原含量明显升高,PT时间显著延长;给予大剂量乌司他丁1d后,血浆D-二聚体及纤维蛋白原含量明显减低,PT时间迅速恢复。结论：大面积烧伤患者早期应用大剂量乌司他丁可显著改善凝血功能,预防播散性血管内凝血的发生。     

Prognostic impact of stress echocardiography with discordant stress electrocardiography in patients with suspected coronary artery disease

INTRODUCTIONDuring stress echocardiography, the echocardiologist routinely collects both echocardiographic images and stress electrocardiogram (ECG) concurrently. The managing physician faces a dilemma when the stress ECG and stress echocardiography results are discordant; for example, when a patient has negative stress echocardiography but positive stress ECG. We therefore sought to evaluate the prognostic value of stress echocardiography in relation to concordant or discordant stress ECG findings in our local Singapore setting, which has a well-defined Southeast Asian population.METHODSThis was a retrospective observational study of all patients who underwent stress echocardiography in 2012 at Changi General Hospital, Singapore. All study patients were followed up for 18 months via electronic medical records.RESULTSThere was no difference in the major adverse cardiovascular events (MACE) outcome of patients with normal stress echocardiography and normal stress ECG (reference group) as compared with patients with normal stress echocardiography but positive (discordant) stress ECG (odds ratio 2.02, 95% confidence interval 0.82‑4.98; p = 0.125).CONCLUSIONThis study will help to reassure cardiologists that discordant results (negative stress echocardiography but positive stress ECG) do not portend a higher risk of MACE when compared to concordant results (i.e. both stress echocardiography and stress ECG are negative).     

活血化瘀法在慢性肝病治疗中的应用体会

慢性肝病顽固难愈,包括慢性乙型肝炎、肝纤维化及肝硬化等疾病,往往出现"久病必瘀"的病理机转,所以治疗慢性肝病常在辨证论治的基础上配合活血化瘀法。活血化瘀同时与清热解毒、疏肝理气、健脾益气、补肾益气、软坚散结等法相配伍应用,在慢性肝病的治疗中取得一定疗效。     

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

也谈中医与中西医结合

通过深入剖析中西医在思维方式上的差别,阐述了中西医结合是历史必然的思想,认为中西医之间的差别是医学发展的动力,未来医学既不同于现在的中医也不同于现在的西医,中西医结合必然酝酿新的医学产生。未来医学是以中医思维模式为主,结合现代医学手段的新医学。     

带蒂胸脐皮瓣修复肢体各种软组织缺损

目的探讨胸脐皮瓣在各种软组织缺损创面修复中的应用。方法以腹壁下动脉及其脐旁穿支为营养血管，沿脐与同侧肩胛下角连线方向设计腹部及侧胸皮瓣，带蒂转移修复腹部、上肢、会阴及下肢软组织缺损创面。必要时可将皮瓣携带的感觉神经与受区皮神经吻合，以利皮瓣感觉的恢复。也可同时切取双侧皮瓣，提高了皮瓣的修复效果。结果临床应用16例，1例皮瓣出现远端1／2坏死，2例边缘起泡、表皮坏死，其余全部成活。吻合神经皮瓣3个月后感觉建立。结论胸脐皮瓣血供可靠，转移方便，用途广泛，可用于各种软组织缺损的修复，效果满意。     

先天性单纯性腋毛缺失与桥本甲状腺炎的相关性分析

目的：探讨先天性单纯性腋毛缺失与桥本甲状腺炎（Hashimoto’s thyroiditis,HT）之间的关系。方法：选取116例甲状腺疾病患者,根据是否伴有先天性单纯性腋毛缺失分为2组,其中伴有先天性腋毛缺失的A组52例,男5人,女47人,平均年龄（35.3±11.5）岁,其中HT 46例,Graves病（GD）2例,甲状腺癌（thyroid carcinoma,TC）4例;对照（B）组64例,男26人,女38人,平均年龄（41.4±12.6）岁,其中GD 25例,HT 2例,TC 19例,结节性甲状腺肿（nodular goiter,NG）13例,亚急性甲状腺炎（suba－cute thyroiditis,ST）5例,对所有患者均进行性毛和甲状腺查体、甲状腺功能和甲状腺自身抗体检测以及甲状腺超声检查。结果：A组伴发HT的概率高达98.06%,而对照组仅为3.13%（P=0.000）,且A组55.77%的患者有先天性单纯性腋毛缺失家族史（P=0.000）,44.23%的患者有甲状腺疾病家族史（P=0.029）,26.54%的患者目前为甲状腺功能减退（P=0.000）,94.21%的患者TPOAb和TGAb阳性（均P=0.000）。结论：先天性单纯性腋毛缺失可能作为HT的遗传标志,为早期识别HT患者并及时干预提供临床依据。