剖宫产术后晚期产后出血11例分析

1临床资料1991-01/2004-10我院发生剖宫产术后晚期产后出血7例,外院转入4例,患者年龄25~34(平均26.6)岁.初产妇8例,经产妇3例,均为子宫下段剖宫产.出血发生在产后8~35(18±6)d(产后2~3wk多见),表现为突然发生阴道出血,鲜红色,出血量500~2500(平均1000)mL.患者均有头晕、心慌,合并出血性休克者6例.B超检查10例提示子宫下段切口有暗区,1例提示有胎盘残留.本组11例均用宫缩剂和广谱抗生素治疗,出血多或伴有休克者予输血,最多者输血2500mL,1例在B超监测下行清宫术,刮出物经病理证实为胎盘胎膜残留,7例行子宫次全切除术,3例行全子宫切除术.行子…     

TRIPS,the Doha Declaration and increasing access to medicines: policy options for Ghana

There are acute disparities in pharmaceutical access between developing and industrialized countries. Developing countries make up approximately 80% of the world's population but only represent approximately 20% of global pharmaceutical consumption. Among the many barriers to drug access are the potential consequences of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Many developing countries have recently modified their patent laws to conform to the TRIPS standards, given the 2005 deadline for developing countries. Safeguards to protect public health have been incorporated into the TRIPS Agreement; however, in practice governments may be reluctant to exercise such rights given concern about the international trade and political ramifications. The Doha Declaration and the recent Decision on the Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health may provide more freedom for developing countries in using these safeguards. This paper focuses on Ghana, a developing country that recently changed its patent laws to conform to TRIPS standards. We examine Ghana's patent law changes in the context of the Doha Declaration and assess their meaning for access to drugs of its population. We discuss new and existing barriers, as well as possible solutions, to provide policy-makers with lessons learned from the Ghanaian experience.     

常染色体16三体胎鼠和正常同窝鼠肠神经系发育

目的 研究Ｄｏｗｎ综合征动物模型常染色体１６三体胎鼠及其正常同窝鼠肠神经系发育状况。方法 （１）将ＮＭＲ－１雌鼠与携带有两个Ｒｏｂｅｒｔｓｏｎｉａｎ（Ｒｂ）易位（１１,１６）,Ｒｂ（１６,１７）８Ｌｕｂｔ＾ＷＬｕｂ３雄鼠进行交配,繁殖常染色体１６三体胎鼠。（２）采用细胞遗传学分析,以检出两条Ｒｂ染色体和４１条染色体者定为常染色体１６三体胎鼠。（３）采用高度特异的神经标记物蛋白基因产物９．５抗体进行     

转小鼠TNFα基因大鼠脑缺血时TNFα表达对小胶质细胞激活的影响

目的：观察转小鼠TNFα基因大鼠脑缺血再灌流不同时间TNFα表达的动态变化及其对小胶质细胞激活的影响。方法：采用线栓法制作大鼠大脑中动脉闭塞模型,用TNFα、整合素QM(OX42)免疫组化染色观察转小鼠TNFα基因大鼠未缺血脑组织及缺血1h再灌注3h、12h、24h、72h、7d时的TNFα表达及小胶质细胞激活状态。结果：转小鼠TNFα基因大鼠缺血1h再灌注3hTNFα表达较未缺血脑组织明显增加,并达峰值,缺血1h再灌注12～72h,TNFα表达仍较显著,但随时间的延长逐渐减少,再灌注7d时,TNFα表达接近缺血前水平。转小鼠TNFα基因大鼠脑组织小胶质细胞缺血1h再灌注3h小胶质细胞极显著地被激活,并达峰值;缺血1h再灌注12h、24h、72h、7d时脑组织小胶质细胞与未缺血脑组织比较显著被激活,但随时间的延长,小胶质细胞激活状态逐渐接近缺血前的水平。结论：脑缺血再灌注后TNFα表达的动态变化与小胶质细胞激活的动态变化完全一致,提示脑缺血再灌注后小胶质细胞的激活主要与TNFα的过度表达有关。     

The International Headache Society (IHS) Headache Classification as applied to a headache clinic population

Four hundred patients attending a headache clinic were classified using the IHS criteria. The majority required more than two, often three or four, diagnoses. Even though migraine was the most common diagnosis, only 1/4 of those with a migraine diagnosis had it as the only diagnosis. Seventy-five percent of migraine patients had coexistent chronic tension-type headache (CTTH), drug-induced headache or both. Ninety-six percent of patients diagnosed as having migraine with aura also suffered from migraine without aura. More than 1/3 of patients (37.7%) attending the clinic suffered from chronic daily headache (CDH) (chronic cluster headache excluded), which is not included as a separate entity in the IHS classification. Pure CTTH formed only a small minority of CDH, whereas 86.6% of CDH had migraine as one of the diagnoses. Drug-induced headache was a prominent second or third diagnosis. The advantages and disadvantages of multiple verses single diagnosis in CDH and the need to recognize the natural history of headache disorders in the classification are discussed.