预防肺泡胸膜漏临床分析（附110例恶性肺肿瘤肺叶切除）

目的 探讨恶性肺肿瘤行肺叶切除后影响住院时间的因素。方法 研究分析1995年11月至2002年10月我科收治的110例恶性肺肿瘤行肺叶切除患者的临床病理资料，相关因素数值化后，以Logistic回归分析得到对住院时间影响较大的因素。结果 术后并发症气胸和术前肺功能指标第一秒用力呼气量(FEVl)是较大的影响住院时间因素。结论 提高术前肺功能储备及预防术后气胸的发生是缩短住院时间的关键。     

Dibenzo[a,l]pyrene-induced DNA adduction, tumorigenicity, and Ki-ras oncogene mutations in strain A/J mouse lung

Dibenzo[a,l]pyrene (DB[a,l]P), an environmental polycyclic aromatic hydrocarbon, is the most potent carcinogen ever tested in mouse skin and rat mammary gland. In this study, DB[a,l]P was examined for DNA adduction, tumorigenicity, and induction of Ki-ras oncogene mutations in tumor DNA in strain A/J mouse lung. Groups of mice received a single i.p. injection of 0.3, 1.5, 3.0, or 6.0 mg/kg DB[a,l]P in tricaprylin. Following treatment, DNA adducts were measured at times between 1 and 28 days, while tumors were counted at 250 days and analyzed for the occurrence of point mutations in codons 12 and 61 of the Ki-ras oncogene. DB[a,l]P in strain A/J mouse lung induced six major and four minor DNA adducts. Maximal levels of adduction occurred between 5 and 10 days after injection followed by a gradual decrease. DB[a,l]P-DNA adducts in lung tissue were derived from both anti- and syn-11,12- dihydroxy-13,14-epoxy- 11,12,13,14-tetrahydrodibenzo[a,l]pyrene (DB[a,l]PDE) and both deoxyadenosine (dAdo) and deoxyguanosine (dGuo) residues in DNA as revealed by cochromatography. The major adduct was identified as a product of the reaction of an anti-DB[a,l]PDE with dAdo in DNA. DB[a,l]P induced significant numbers of lung adenomas in a dose- dependent manner, with the highest dose (6.0 mg/kg) yielding 16.1 adenomas/mouse. In tricaprylin-treated control animals, there were 0.67 adenomas/mouse. Based on the administered dose, DB[a,l]P was more active than other environmental carcinogens including benzo[a]pyrene. As a function of time-integrated DNA adduct levels, DB[a,l]P induced lung adenomas with about the same potency as other PAHs, suggesting that the adducts formed by DB[a,l]P are similar in carcinogenic potency to other PAHs in the strain A/J mouse lung model. Analysis of the Ki- ras mutation spectrum in DB[a,l]P-induced lung tumors revealed the predominant mutations to be G-->T transversions in the first base of codon 12, A-->G transitions in the second base of codon 12, and A-->T transversions in the second or third base of codon 61, concordant with the DNA adduct profile.      

Comparison of the morphological transforming activities of dibenzo[a,l]pyrene and benzo[a]pyrene in C3H10T1/2CL8 cells and characterization of the dibenzo[a,l]pyrene-DNA adducts

C3H10T1/2CL8 (C3H10T1/2) mouse embryo fibroblasts were used to study the in vitro carcinogenic activities of dibenzo[a,l]pyrene (DB[a,l]P) and benzo[a]pyrene (B[a]P). The morphological transforming activities of these rodent carcinogens were compared using replicate concentration- response studies. In concentration ranges where both polycyclic aromatic hydrocarbons (PAHs) were active, DB[a,l]P proved to be four to 12 times as potent as B[a]P based on concentration. At lower concentrations DB[a,l]P was active at 0.10 and 0.20 microM, concentrations where B[a]P was inactive. This makes DB[a,l]P the most potent non-methylated PAH evaluated to date in C3H10T1/2 cells. DNA adducts of DB[a,l]P in C3H10T1/2 cells were analyzed by both TLC and TLC/HPLC 32P-postlabeling methods using mononucleotide 3'-phosphate adduct standards derived from the reactions of anti-DB[a,l]P-11,12-diol- 13,14-epoxide (anti-DB[a,l]PDE) and syn-DB[a,l]P-11,12-diol-13,14- epoxide (syn-DB[a,l]PDE) with deoxyadenosine 3'-monophosphate and deoxyguanosine 3'-monophosphate. All of the DNA adducts observed in C3H10T1/2 cells treated with DB[a,l]P were identified as being derived from the metabolism of DB[a,l]P to its fjord region diol epoxides through DB[a,l]P-11,12-diol. The predominant adduct was identified as an anti-DB[a,l]PDE-deoxyadenosine adduct. Other major adducts were anti- DB[a,l]PDE-deoxyguanosine and syn-DB[a,l]PDE-deoxyadenosine adducts with minor amounts of syn-DB[a,l]PDE-deoxyguanosine adducts. These DNA adduct data are consistent with similar findings of DB[a,l]PDE- deoxyadenosine adducts in mouse skin studies and human mammary cells in culture.      

Early stage nasopharyngeal carcinoma: radiotherapy dose and time factors in tumor control

OBJECTIVE: To evaluate radiotherapy dose and length of treatment in the control of early stage nasopharyngeal carcinoma (NPC) treated with a combination of external radiotherapy and brachytherapy, MATERIALS & METHODS: We reviewed the records of 133 patients with early stage nasopharyngeal carcinoma (stage I or II, AJC/UICC staging system) who received definitive radiotherapy in Chang Gung Memorial Hospital from 1979 to 1991. The median follow-up time was 7.1 years with a minimum of 2 years. All patients were treated with megavoltage external radiotherapy to the nasopharynx area (63-72 Gy) followed by high dose rate intracavitary brachytherapy (5-16.5 Gy in one to three fractions, spaced 1-2 weeks apart). The median total dose and time of irradiation was 75 Gy (69.8-81.4 Gy) and 11.6 weeks (7.8-20 weeks) respectively. Survival analysis was used to examine the effect of several variables on prognosis. RESULTS: The 5-year rates were 86.4% for local control, 84.7% for disease free survival, 88.5% for actuarial survival and 84.2% for overall survival. The treatment group (combination of time and dose of irradiation) was the most important prognostic factor according to Cox's proportional hazard model. Patients receiving radiation at a total dose of < or = 75 Gy completed in < 12 weeks showed the best prognosis. CONCLUSION: Treatment time and total treatment dose are both important factors in treating early stage NPC. Decreasing the total radiation time to < 12 weeks and not exceeding a radiation dose of 75 Gy gave the best results.      

中、西药2种方案治疗精索静脉曲张不育症的成本-效果分析

目的 :评价中、西药2种方案治疗精索静脉曲张不育症的成本 -效果。方法 :165例精索静脉曲张不育症患者随机分成2组 ,中药组110例给予张氏精索静脉曲张方 ;西药组55例给予人绒毛膜促性腺激素、枸橼酸氯米芬、葡萄糖酸锌、三磷酸腺苷及维生素AD、维生素E、维生素C。治疗3个月～9个月后观察2组治疗效果和不良反应 ,并运用药物经济学成本 -效果分析法进行评价。结果 :中药组与西药组总有效率分别为81 .82 %、50. 91 % ,成本分别为3688 2元、2399. 2元 ,成本 -效果比分别为45 08、47. 13 ;中药组相对于西药组的增量成本 -效果比为41. 7。结论 :张氏精索静脉曲张方治疗方案较佳。     

Tolerance to ischemia and hypoxia is reduced in aged human myocardium

BACKGROUND: Recovery of cardiac function after cardiac surgery and other interventional cardiac procedures in elderly patients is inferior to that in younger patients, suggesting that the aged myocardium is more sensitive to ischemia and other stresses. Although convincing data from animal studies of senescence now exist, there is a dearth of controlled in vitro studies that examine the specific response of aged human myocardium to the stress of hypoxia or ischemia. OBJECTIVE: We sought to determine the effect of age on the capacity of human atrial trabeculae to recover contractile function after in vitro hypoxic or ischemic stress. METHODS: Atrial pectinate trabeculae were dissected from the tip of 58 right atrial appendages harvested during an operation in patients aged between 34 and 89 years and electrically stimulated at 1 Hz in oxygenated Ringer's solution at 37 degrees C. Tissues experienced 30 minutes of either hypoxia (N(2) and perfusate) or simulated ischemia (humidified N(2) without perfusate) and were returned to normoxia for recovery of function for 30 minutes. Developed force and other contractile variables were determined during each period. RESULTS: Under normoxic conditions, no significant age difference was observed for any contractile function variable. However, after hypoxia, the old (70-89 years) and intermediate age groups (60-69 years) showed reduced recovery of developed force (48.5% +/- 22.2% [n = 11] and 44.9% +/- 19% [n = 12], respectively) compared with that found (66.4% +/- 19.7% [n = 15]) in the younger (34-59 years) group (mean +/- SD, P =.02). Similarly, after simulated ischemia, the groups of 70- to 89-year-old and 60- to 69-year-old subjects showed reduced recovery of developed force (35.7% +/- 17% [n = 5] and 51.1% +/- 11.8% [n = 9], respectively) compared with that found (68.2% +/- 10.4% [n = 6]) in the group of 34- to 59-year-old subjects (P =.01). Multivariable analysis, comparing 20 factors of surgical patient characteristics and recovery of developed force, found that only age (P =.01) and hypertension (P =.01) were predictors of reduced recovery of developed force after either hypoxia or simulated ischemia. CONCLUSIONS: In aged human atrial myocardium, the capacity to recover contractile function after in vitro hypoxia or simulated ischemia is reduced compared with the younger myocardium of mature adults. These findings suggest that enhanced myocardial protective strategies may be indicated for elderly patients undergoing cardiac surgery.     

SARS与急性上呼吸道感染中医证候分型及指标数量化方法的探讨

目的 探讨早期SARS与急性上呼吸道感染患者中医证候及四诊指标数量化,为中医证候客观化研究提供方法 学参考.方法 应用自编急诊发热病例中医证候观察表,收集急诊SARS患者与急性上呼吸道感染患者中医临床四诊信息,建立数据库,运用样品聚类分析及频数归一化权重分析.结果 早期SARS患者的中医证型主要有两型;急性上呼吸道感染患者早期证候主要有三个证型.结论 样品聚类分析与频数归一化权重方法 可用于SARS患者与急性上呼吸道感染患者的中医证候客观化研究,也可用于其他病的中医证候客观化研究.     

福建省469例健康咨询热线电话记录分析

目的了解福建省接受健康咨询热线的主要对象的特征以及求询的主要内容,为今后开展健康教育和行为干预提供依据。方法选取2004年1月至2005年2月接受电话咨询者469例资料进行分析,按咨询内容(性病艾滋病、寻医问药、生殖生育和心理卫生)进行分类整理,数据采用SPSS 11.5统计软件包进行统计分析。结果求询者中,男性占66.74%,女性占33.26%;年龄以29岁以下青年人居多,占49.89%;职业以工人(打工族)居首位,占48.83%;文化程度主要是初中以下人员,占60.77%;咨询内容涉及性病艾滋病问题最多,占45.42%。结论本热线求询者以男性中青年为主,大部分文化程度偏低,且多数有高危行为。利用咨询热线,对求询者进行心理、行为等健康教育具有积极意义。     

医学生自杀态度及影响因素调查

目的了解医学生的自杀态度以及影响因素，为自杀预防的健康教育工作提供资料。方法以整群抽样方法抽取某医科大学一年级、三年级本科学生，应用自杀态度问卷（QSA）进行调查。结果医学生对自杀总的态度（F）、对自杀性质的认识（F1）持矛盾或中立的态度，对自杀者（F2）、自杀者家属（F3）以及安乐死（F4）持理解或宽容的态度。65．9％的医学生表示需要预防自杀的知识和技巧。结论对医学生进行系统的自杀干预知识和技巧的培训是很有必要的。     

公共娱乐场所服务小姐预防艾滋病健康教育的效果评价

目的探讨对娱乐场所服务小姐的健康教育方法和行为干预模式,为在该特殊人群中实施有效的健康教育提供依据。方法对重庆市北碚区200名娱乐场所服务小姐进行有关艾滋病防治的健康教育。采用问卷调查的方法,在教育前后分别进行问卷调查。结果健康教育后服务小姐有关艾滋病知识的知晓率明显提高,传播途径的知晓率从65.3%上升至91.8%,当前预防艾滋病的主要措施的知晓率从68.9%上升至91.3%,日常生活接触不会传染艾滋病病毒的知晓率从69.9%上升至88.3%(P<0.01)。有商业性性行为者,最近一次使用安全套的比例从教育前的65.8%上升到86.2%(P<0.01)。结论对服务小姐进行多种形式的健康教育,可以提高该人群艾滋病预防控制知识和有效改善相关行为。