痔上粘膜环切钉合术后脱出的危险因素分析

目的分析痔上粘膜环切钉合术(PPH)后痔复发脱出的危险因素。方法回顾性分析2005-01/2012-02的178例PPH患者临床资料。结果本组患者随访时间2～87月,术后复发脱出48例(26.97%)。Ⅳ度内痔患者复发脱出率(45.16%)明显高于Ⅱ、Ⅲ度内痔患者;术后时间3年者脱出发生率(41.46%)明显高于≤3年者(14.58%),差异有统计学意义(P0.05)。性别、年龄、有无合并直肠粘膜脱垂及慢性便秘、单双荷包缝合、荷包距齿状线距离、吻合口距齿状线距离的脱出发生率间的差异无统计学意义(P0.05)。Logistic回归分析提示术后时间、痔分度、吻合口距齿状线距离是复发脱出的危险因素。结论术后时间、痔分度是PPH后痔复发脱出的独立危险因素。     

Magnetic resonance imaging of a temporal lobe cerebral amyloidoma

Amyloidomas are focal solitary amyloid masses without systemic involvement that have been observed to occur in various body locations. When presenting intracranially, they pose a challenging diagnostic and therapeutic course given their location and rarity. We report a case of a 62-year-old man with a 4-year history of seizure and headaches. Magnetic resonance imaging was initially inconclusive but revealed an ill-defined right temporal lobe lesion. Biopsy later confirmed a cerebral amyloidoma. We also review the current literature on the pathogenesis, imaging findings, prognosis, and treatment of cerebral amyloidomas.     

Efficacy of a spatial repellent for control of Aedes-borne virus transmission: A cluster-randomized trial in Iquitos,Peru

Over half the world’s population is at risk for viruses transmitted by Aedes mosquitoes, such as dengue and Zika. The primary vector, Aedes aegypti, thrives in urban environments. Despite decades of effort, cases and geographic range of Aedes-borne viruses (ABVs) continue to expand. Rigorously proven vector control interventions that measure protective efficacy against ABV diseases are limited to Wolbachia in a single trial in Indonesia and do not include any chemical intervention. Spatial repellents, a new option for efficient deployment, are designed to decrease human exposure to ABVs by releasing active ingredients into the air that disrupt mosquito–human contact. A parallel, cluster-randomized controlled trial was conducted in Iquitos, Peru, to quantify the impact of a transfluthrin-based spatial repellent on human ABV infection. From 2,907 households across 26 clusters (13 per arm), 1,578 participants were assessed for seroconversion (primary endpoint) by survival analysis. Incidence of acute disease was calculated among 16,683 participants (secondary endpoint). Adult mosquito collections were conducted to compare Ae. aegypti abundance, blood-fed rate, and parity status through mixed-effect difference-in-difference analyses. The spatial repellent significantly reduced ABV infection by 34.1% (one-sided 95% CI lower limit, 6.9%; one-sided P value = 0.0236, z = 1.98). Aedes aegypti abundance and blood-fed rates were significantly reduced by 28.6 (95% CI 24.1%, ∞); z = −9.11) and 12.4% (95% CI 4.2%, ∞); z = −2.43), respectively. Our trial provides conclusive statistical evidence from an appropriately powered, preplanned cluster-randomized controlled clinical trial of the impact of a chemical intervention, in this case a spatial repellent, to reduce the risk of ABV transmission compared to a placebo.

Aedes-borne viral diseases (ABVDs) [e.g., dengue (DENV), chikungunya, Zika (ZIKV), and yellow fever] are devastating, expanding global public health threats that disproportionally affect low- and middle-income countries. DENV, one of the most rapidly increasing vector-borne infectious diseases, results in ∼400 million infections each year (1, 2), with 4 billion people at risk for infection annually (3). Currently, the primary means for ABVD prevention is controlling the primary mosquito vector, Aedes aegypti. Existing vector control interventions, however, have failed to prevent ABV transmission and epidemics (4–6).There is an urgent need to develop evidence-based guidance for the use of new and existing ABV vector control tools. The evidence base for vector control against ABVs is weak, despite considerable government investments in World Health Organization (WHO)-recommended control of larval habitats (larviciding, container removal) and ultra-low-volume insecticide spraying (4, 5, 7–9). These strategies continue to be implemented despite the lack of rigorously generated data from controlled clinical trials demonstrating they reduce ABV infection or disease (6). The only ABV intervention with a proven epidemiological impact in a cluster-randomized control trial (cRCT) assessed community mobilization to reduce mosquito larval habitats (10). A recent test-negative trial with Wolbachia-infected mosquitoes reported a significant reduction of DENV illness in Indonesia (11).Spatial repellents (SRs) are devices that contain volatile active ingredients that disperse in air. The active ingredients can repel mosquitoes from entering a treated space, inhibit attraction to human host cues, or disrupt mosquito biting and blood-feeding behavior and, thus, interfere with mosquito–human contact (12–14). Any of these outcomes reduce the probability of pathogen transmission. Pyrethroid-based SRs have shown efficacy in reducing malaria infections in China (15) and Indonesia (16). There have, however, been no clinical trials evaluating the protective efficacy (PE) of SRs against ABV infection or disease.To generate evidence for public health consideration, we conducted a double-blinded, parallel cRCT to demonstrate and quantify the PE of a transfluthrin-based SR to reduce ABV infection incidence over 2 y in a human cohort in Iquitos, Peru.     

Significance of anti-lymphocyte antibodies in systemic lupus erythematosus

Sera from patients with SLE frequently contain IgM and IgG antibodies with multiple specificities for lymphocyte surface determinants, including autologous antigens. The IgM antibodies are of relatively low binding avidity and exhibit broad reactivity with B and T lymphocytes from most individuals. IgG antibodies are reactive selectively with PBL from different individuals and appear to be more specific for B cell and a minor proportion of T cells. The molecular nature of the surface determinants involved and their relationship with known antigens and receptors remain largely undefined. Interest in anti-lymphocyte antibodies in SLE relates in part to data suggesting a causal role in the abnormal immune system function in this disorder. In this regard, possible mechanisms that are supported by indirect data include: a) antibody-mediated lymphocyte depletion in vivo, perhaps involving functional subsets specifically; b) antibody blockade of surface receptors operant in cell-cell and in cell-soluble antigen interactions. Certain data have raised the possibility that anti-lymphocyte antibodies represent serum markers for infection with virus as etiologic in SLE, but this question is controversial. Nevertheless, further investigation may yet reveal viral or genetically determined “SLE-specific” lymphocyte surface antigens. Clinically, anti-lymphocyte antibodies may have potential for mediating tissue injury in SLE, either directly or indirectly as circulating complexes in association with “shed” lymphocyte surface antigen. Direct evidence in support of such a role in the natural history of this disorder has not been forthcoming.     

两种职业健康风险评估方法在某啤酒制造企业噪声评估中的应用

目的 研究两种不同职业健康风险评估方法在某啤酒制造企业噪声岗位的适用性。方法 对武汉市某啤酒制造企业的工作场所进行职业卫生学调查和职业病危害因素检测,以噪声暴露岗位L_EX,8h≥80dB(A)的工人为研究对象,使用《噪声职业病危害风险管理指南》法和职业危害风险指数法对某啤酒制造企业噪声作业岗位进行风险评估,并比较两种方法的评估结果。结果 该企业噪声暴露水平在81.2～91.2dB(A)之间;指南法预测瓶装生产线灌酒工及贴标工在接触噪声35年后发生高频听损和噪声聋的风险为高风险,洗瓶、验瓶、装箱及听装生产线上瓶、灌酒工为中等风险,瓶装生产线做箱、堆垛及听装生产线装箱堆垛为低风险,职业危害风险指数法评估结果显示,瓶装生产线上瓶工、灌酒工、验酒工、贴标工及装箱工风险等级为中等风险,其他岗位为低风险。结论 职业危害风险指数法对影响健康风险的各要素考虑较为全面,评估结果与指南法较为接近;指南法能定量预测高频听损与噪声聋的风险,发生听力损失的风险随暴露年数增加而升高。     

门静脉、肠系膜上静脉的解剖与临床应用的初步研究

目的 为提高肝门胆管癌和壶腹周围癌的手术切除率,使该区域受肿瘤浸润的血管能同时切除,血管直接重建提供解剖学依据.方法 在实施肝门胆管癌切除术及胰十二指肠切除术中,对病人的肝蒂内门静脉干、胰腺钩突内的肠系膜上静脉干进行解剖学定位并分段测量长度及可以纵向折叠的长度,以此估计可切除的静脉长度及重新再建血管的长度.结果 测量肝蒂内门静脉干104例,男性(5.8±1.99)cm,女性(5.5±O.81)cm,优势长度大于4.5cm者,男性56例占76.7%,女性25例占80.6%.胰腺钩突内段肠系膜上静脉干测量54例,男性(3.7±0.77)cm,女性(3.5±0.64)cm,优势长度大于3.0cm者,男性28例占77.6%,女性14例占77.8%.门静脉纵向折叠移动的范围在1.8～4.2cm,平均折叠2.2(1.8～2.4)cm者占66.3%,平均折叠2.8(2.5～4.2)cm者占33.7%.切除胰十二指肠后胰腺钩突内肠系膜上静脉段纵向折叠范围平均4.0cm,最长达5.2cm.结论 肝门胆管癌和壶腹周围癌切除术合并受浸血管切除在一定范围是可行的.     

“三热论”复方对四氧嘧啶性糖尿病小鼠血糖的影响

目的:研究"三热论"复方的降血糖作用。方法:以雄性KM小鼠尾静脉注射四氧嘧啶80mg/kg建立糖尿病动物模型。将不同剂量的复方水提物(30、20、10g生药/kg)灌胃给药,阳性对照组给予格列本脲(50mg/kg-1·d-1),连续给药5天,测定给药后的小鼠血糖值。结果:"三热论"复方高剂量组能显著降低四氧嘧啶致糖尿病小鼠的血糖(P0.01)。结论:"三热论"复方水提物对四氧嘧啶性糖尿病小鼠有一定的降血糖作用。     

三磷酸腺苷脂质体的研究进展

本文综述了近年来三磷酸腺苷(ATP)脂质体的研究进展.脂质体作为新载体可以提高ATP在体内的稳定性,并且能靶向于缺血的心肌和缺血的大脑,用于器官移植中能提高冷冻贮存器官的能级状态,提高移植的成活率,故制备稳定的ATP脂质体具有重要的意义.本文还综述了ATP脂质体的制备方法,探讨如何进一步提高脂质体的包裹率和靶向性,以用于临床.     

荞麦包联合红外线治疗肾性下肢水肿临床观察

【目的】观察荞麦壳药包（简称荞麦包）外敷联合红外线照射治疗肾性下肢水肿的临床疗效。【方法】将63例肾性下肢水肿患者随机分为对照组31例和治疗组32例。对照组给予西医常规治疗,治疗组在对照组基础上给予荞麦包外敷联合红外线照射治疗,疗程为15 d。观察2组患者治疗前后体质量指标和小腿围指标的变化情况,并评价2组患者的临床疗效。【结果】（1）治疗1个疗程后,治疗组的总有效率为81.25%(26/32),对照组为61.29%(19/31),组间比较,治疗组的疗效明显优于对照组,差异有统计学意义（P<0.05）。（2）治疗后,2组患者的体质量指标和小腿围指标均治疗前明显降低（P<0.05）,且治疗组对体质量指标和小腿围指标的降低作用均明显优于对照组,差异均有统计学意义（P<0.05）。【结论】在西医常规治疗的基础上应用荞麦包外敷联合红外线照射治疗肾性下肢水肿疗效确切,其疗效优于单纯西医常规治疗。     

心力衰竭患者左室峰值充盈率与左室心肌质量的相关性分析

目的探讨心力衰竭患者左室峰值充盈率与左室心肌质量的相关性。方法应用实时三维超声心动图(RT-3DE)测量并计算104例心力衰竭患者的左室峰值充盈率(LVPFR)、左室心肌质量(LVM)、左室心肌质量指数(LVMI),分析心力衰竭患者LVPFR与LVM、LVMI的相关性。结果心力衰竭患者LVPFR的减低与LVM和LVMI的增加呈良好负相关(r=-0.614,r=-0.557)。结论心力衰竭患者的LVPFR与LVM密切相关,能够较好的评价心力衰竭患者左室整体舒张受损程度。