异基因造血干细胞移植后慢性移植物抗宿主病危险因素分析

目的探讨异基因造血干细胞移植后慢性移植物抗宿主病(cGVHD)的发生及其危险因素。方法总结1997年11月至2005年1月治疗的96例患者临床资料,分析了受者年龄、供受者性别、疾病种类、状态、病程、干细胞来源、HLA配型、预处理方案(是否全身照射)、回输细胞数量、移植早期感染、是否发生过急性移植物抗宿主病(aGVHD)等因素与cGVHD发生的关系。结果36例患者发生了cGVHD,发生率为44.4%。发生局限型cGVHD的19例患者的5年生存率为18/19(94.7%),发生广泛型cGVHD的17例患者5年生存率为8/17(47.1%)。两者比较差别有统计学意义(P<0.01)。单因素分析显示:供受者性别、疾病种类、状态、病程,干细胞来源、预处理方案(是否全身照射)、回输细胞数量、移植早期感染均与cGVHD的发生无显著相关性(P>0.05)。多因素分析(logistic回归)确定HLA配型不合(RR=2.17,P<0.01)、发生过aGVHD(RR=2.91,P<0.01)是发生cGVHD的主要危险因素。单因素分析显示:受者年龄越大,cGVHD发病危险性越高(P<0.05)。结论HLA配型不合及发生过aGVHD、受者年龄较大是与cGVHD发生相关的危险因素。     

抗GSTAl单克隆抗体的制备与鉴定

目的:制备鼠抗人谷胱甘肽S转移酶A1(GSTAI)的单克隆抗体(mAb),并进行特性鉴定。方法:用纯化后的GSTAl融合蛋白作为抗原免疫BALB/c小鼠,采用常规的细胞融合技术制备抗GSTAl的单克隆抗体(mAb)。用ELISA法测定鼠抗人GSTA1血清的效价;用Western blot方法鉴定抗血清的特异性。结果:筛选到l株可稳定分泌抗人GSTAlmAb的细胞株。腹水效价为12 800。Western blot显示在相对分子量(Mr)约25KD处出现特异性条带。说明制备的mAb可特异地识别成人肝细胞中相对分子量(Mr)约25KD的GST-GSTA1。结论:获得一株能特异性识别抗人GSTAI的单克隆抗体,可用于肝损伤性疾病的诊断。     

中耳类癌一例

患者女，43岁，右耳反复流脓伴听力减退5年，2004年11月1日入院。查体：右外耳道几乎完全被一肿物堵塞，其质地柔韧，四周光滑，与外耳道各壁无粘连。表面呈乳头状生长，颈淋巴结无肿大。纯音测听呈重度传导性聋。颞骨CT示右外耳道软组织影，鼓室呈含气腔，听骨链周围见有软组织影，但听骨链及鼓室骨质无破坏，乳突气化好，无炎症表现（图1）。肿物活组织检查为慢性炎症。     

浅析社区医院的预算编制管理

医院预算管理主要指预算编制、执行与调整，本文就社区医院财务收支预算的编制，谈谈自已在实际管理中的体会。     

上海市闵行区民营医院执业情况及监管对策

闵行区作为人口导入区，人口流动性大，民营医疗机构数量较多。完善对民营医疗机构监督管理，更好地保护人民群众的身体健康，对构建和谐社会有重要意义。为了解区内民营医院的执业和经营情况，为完善民营医院规划、准入和日常监管提供政策依据，我区开展了民营医院执业情况调查，并针对目前民营医院发展过程中出现的问题，提出一些监管的政策建议。     

Cyclic mechanical strain decreases the DNA synthesis of vascular smooth muscle cells

In vivo, smooth muscle cells of the vascular wall are rhythmically stretched by the arterial pulse. Here, we test the hypothesis that rhythmical stretch is important for suppressing the growth of vascular smooth muscle (vsm) cells. DNA-synthesis rate, cell number, metabolic activity, and cell death were compared between rhythmically stretched and non-stretched vsm cells from the rat embryonic aortic A10 cell line. Rhythmical stretch (0.5 Hz, 5% elongation, 48 h) did not induce vsm cell proliferation, that is the vsm cell number was constant. Cell damage or necrosis was excluded because the release of lactate dehydrogenase (LDH) was identical. The low rate of apoptosis (0.2%) was not different between stretched cells and control cells. Stretch significantly reduced the DNA-synthesis rate [measured as incorporation of 5-bromo-2'-deoxyuridine (BrdU)] in a time-dependent manner. BrdU incorporation was decreased by 32% after 24 h of cyclic stretching and was further diminished to 50% after 48 h of strain. Metabolic activity (measured by Wst-1 cleavage) was only modestly influenced. The stretch-induced decrease in DNA synthesis was independent of the extracellular matrix. No differences were detected when laminin- or pronectin-coated membranes were used instead of collagen-coated membranes. The effect of stretch was unlikely to be mediated by secretion of an unknown "factor", because vsm cells incubated with medium conditioned by stretched cells did not show a significant decrease in BrdU uptake. The results support the idea that rhythmical stretch is important to keep the rate of DNA synthesis and thereby the proliferation of vsm cells at a low level.     

上海市社区卫生服务中心中医药人力资源现状与对策研究

目的：了解上海市社区卫生服务中心中医药人力资源的现状，为合理配置中医药人力资源提供依据。方法：采用统一设计的调查表进行调查。结果：上海市社区卫生服务中心共计227所，中医执业医师1050人，占执业医师总数的11．21％，平均每中心4．62人。高级职称占中医师的6．61％，中级职称占41．26％，初级职称占52．13％。结论：上海市社区卫生服务中心中医药人力资源仍存在城乡差距，且中医师的学历、职称水平偏低，应加强中医药人才素质建设。     

无症状女性患者泌尿生殖道标本沙眼衣原体基因型研究

目的了解沙眼衣原体引起的泌尿生殖道感染的无症状患者的临床表现与其分离株的基因型的关系。方法应用聚合酶链反应和限制性片段长度多态性分析,对来自妇产科和皮肤性病门诊病例的泌尿生殖道感染沙眼衣原体病人的102份沙眼衣原体检测为阳性的标本进行了基因分型,并分析其临床表现特点与基因分型的关系。结果被调查人群中以E型、D型、F型、G型感染为主。在不同年龄段中,以21～30岁为最多。结论无症状泌尿生殖道沙眼衣原体感染与多种基因型感染有关。     

The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey

BACKGROUND: Lower reimbursements for endoscopic procedures and increasing demand for screening endoscopy over the past decade have spurred efforts to increase efficiency in the performance of endoscopic procedures. Two dichotomous approaches have emerged: (1) unsedated endoscopy and (2) propofol sedation. The aim was to determine national practice patterns of unsedated endoscopy and propofol sedation, and to assess endoscopists' attitudes toward unsedated screening with an electronic survey. METHODS: A short survey was developed and then was converted to a Web-based format. All national members of the American Society for Gastrointestinal Endoscopy (ASGE) were invited via electronic mail (e-mail) to participate. Survey data were collected electronically. RESULTS: Two e-mails elicited responses to the Web survey from 18% (724) of national ASGE members contacted, within 2 weeks. Of the respondents, 45% do not routinely offer unsedated EGD and colonoscopy, and only 15% of those respondents plan to incorporate unsedated endoscopy into their practice in the next year. Of the 55% who currently perform unsedated endoscopy, 85% do no more than 25 unsedated procedures per year. Lack of patient acceptance was the most common reason cited for not offering unsedated endoscopy. Most endoscopists felt that the availability of unsedated esophagoscopy or colonoscopy would not significantly increase screening for Barrett's esophagus or colonic polyps/colorectal cancer, respectively. Routine use of propofol sedation for EGD, colonoscopy, and ERCP/EUS was reported by 19%, 22%, and 19%, respectively. Community practitioners were more likely to use propofol than those at academic centers (p < 0.0002 for all). Of those not currently using propofol, 43% plan to incorporate it into their practice within the next year. Over 70% of respondents would themselves choose to be sedated for routine endoscopic procedures. CONCLUSIONS: Electronic surveys allow for rapid distribution and data collection but suffer from a limited response rate. The survey suggests that unsedated endoscopy has limited acceptance in the United States, and, without a major intervention that affects endoscopists' attitudes, its use is not likely to increase significantly. Unsedated endoscopy will not have a great impact on endoscopic screening. In contrast, propofol sedation has already gained acceptance in the community, and the routine use of propofol in endoscopy units will likely increase in the future.