脱中性粒细胞温血心脏停搏液连续灌注在心脏手术中心肌保护的研究

目的 :研究体外循环期间常温血脱中性粒细胞心脏停搏液微流量连续灌注对心脏瓣膜置换术中心肌的保护作用。方法 :临床随机选取体外循环时间在 60min以上的风湿性心脏瓣膜病人 2 0例 ,随机分为实验组和对照组 (每组 10例 ) ,分别检测不同时间点血浆心肌肌钙蛋白I(cTnI)水平和血浆MDA水平的变化。结果 :①两组病人在CPB前cTnI含量组间差异无显著性 ,而在主动脉阻断后及主动脉开放后各时间点差异显著 ,对照组cTnI值高于实验组 (P <0 .0 5 ) ;②两组病人在体外循环前及主动脉阻断 3 0min时MDA的含量组间差异无显著性 ,而在主动脉开放各时间点组间差异具有显著性 (P <0 .0 5 ) ,对照组高于实验组。结论 :实验研究证实 ,脱除心脏停搏液中的中性粒细胞后 ,可减轻中性粒细胞介导的心肌损伤 ,有利于心肌保护     

Incest diagnosis by comparison of alleles of mother and offspring at highly heterozygous loci

BACKGROUND: Methods that detect a child's homozygosity by examination of allelic products are insensitive for diagnosing incest because, at a given locus, a homozygous state is expected with a frequency of only 0.25 when parents are first-degree relatives. Furthermore, these methods are not specific if the population contains many homozygous individuals or silent alleles that cause apparent homozygosity. STUDY DESIGN AND METHODS: Use of highly heterozygous loci improves specificity, but not sensitivity. Sensitivity may be increased by observing for two kinds of mother-offspring similarities: an offspring of incest tends to be homozygous or heterozygous-identical with respect to its mother's phenotype. At each locus, two conditional probabilities may be calculated for a genetic observation, using allele frequencies expected under a state of incestuous mating versus mating within a specified population. The conditional probabilities at each locus are compared in a likelihood ratio to express a relative probability of incest. RESULTS: In a case of known sibling incest, three likelihood ratios were derived from variable number of tandem repeat phenotypes at five loci. When only offspring homozygosity was observed, the likelihood ratio was 75.3:1. When both homozygous- and heterozygous- identical phenotype similarities of offspring and mother were noted, the likelihood ratio was 130.4:1. When maternal obligatory alleles of the offspring were considered, the likelihood ratio was 262.4:1. CONCLUSION: Comparison of maternal and offspring phenotypes at highly heterozygous loci increases both sensitivity and specificity of genetic tests in cases of suspected incest.     

Schizophrenia in Malaysian families: A study on factors associated with quality of life of primary family caregivers

Background

Schizophrenia is a chronic illness which brings detrimental effects in the caregivers' health. This study was aimed at highlighting the socio-demographic, clinical and psychosocial factors associated with the subjective Quality of Life (QOL) of Malaysian of primary family caregivers of subjects with schizophrenia attending an urban tertiary care outpatient clinic in Malaysia.

Methods

A cross-sectional study was performed to study patient, caregiver and illness factors associated with the QOL among 117 individuals involved with caregiving for schizophrenia patients. The study used WHOQOL-BREF to assess caregivers' QOL and Brief Psychiatric Rating Scale (BPRS) to assess the severity of patients' symptoms. Social Readjustment Rating Scale (SRRS) assessed the stress level due to life events.

Results

The mean scores of WHOQOL-BREF in physical, psychological, social and environmental domains were 66.62 (14.36), 61.32 (15.52), 62.77 (17.33), 64.02 (14.86) consecutively. From multiple regression analysis, factors found to be significantly associated with higher QOL were higher educational level among caregivers in social and environmental domains; caregivers not having medical problem/s in physical and psychological domains; later onset and longer illness duration of illness in social domains; patients not attending day care program in environmental domain; lower BPRS score in physical and environmental domains. SRRS score of caregivers was also found to have a significant negative correlation with QOL in environmental and psychological domains. Other factors were not significantly associated with QOL.

Conclusion

Caregivers with more social advantages such as higher educational level and physically healthier and dealing with less severe illness had significantly higher QOL in various aspects. Supporting the caregivers in some of these modifiable factors in clinical practice is important to achieve their higher level QOL.     

探析张永华教授运用情志辨证理论体系辨治脾胃病思路

[目的]探究张永华教授运用情志辨证理论体系辨治脾胃病思路。[方法]通过门诊跟师学习、导师讲以及相关文献研究等方法,归纳总结张永华教授情志辨证理论体系的主要内涵及其辨治脾胃病的思路。[结论]情志辨证理论体系是张永华教授首创的一种新型辨证体系,该理论体系在形神合一指导下,重视辨识患者情志特点,以“烦-郁-虑-惊”为纲,与辨体质、辨病相结合,三位一体,整体辨证论治。脾胃病与情志密切相关,情志失调不仅是脾胃病的诱发因素,同时也是伴随症状,从情志辨证入手,协调心身关系,充分发挥中医整体论治的优势以提高疗效。[结论]情志辨证理论体系作为一种新型辨证体系,能够为脾胃病的辨证提供新的思路与方法,提高临床疗效。     

Genetics of Bone Mass in Childhood and Adolescence: Effects of Sex and Maturation Interactions

We aimed to determine if adult bone mineral density (BMD) susceptibility loci were associated with pediatric bone mass and density, and if sex and pubertal stage influenced any association. We analyzed prospective areal BMD (aBMD) and bone mineral content (BMC) data from the Bone Mineral Density in Childhood Study (n = 603, European ancestry, 54% female). Linear mixed models were used to assess if 77 single‐nucleotide polymorphisms (SNPs) near known adult BMD susceptibility loci interacted with sex and pubertal stage to influence the aBMD/BMC; adjusting for age, BMI, physical activity, and dietary calcium. The strongest main association was observed between an SNP near C7orf58 and distal radius aBMD. However, this association had a significant sex?SNP interaction, revealing a significant association only in females (b = –0.32, p = 1.8 × 10^–6). Furthermore, the C12orf23 locus had significant interactions with both sex and pubertal stage, revealing associations in females during Tanner stage I for total hip aBMD (b = 0.24, p = 0.001) and femoral neck aBMD (b = 0.27, p = 3.0 × 10^–5). In contrast, the sex?SNP interactions for loci near LRP5 and WNT16 uncovered associations that were only in males for total body less head BMC (b = 0.22, p = 4.4 × 10^–4) and distal radius aBMD (b = 0.27, p = 0.001), respectively. Furthermore, the LRP5 locus interacted with both sex and pubertal stage, demonstrating associations that were exclusively in males during Tanner V for total hip aBMD (b = 0.29, p = 0.003). In total, significant sex?SNP interactions were found at 15 loci; pubertal stage?SNP interactions at 23 loci and 19 loci interacted with both sex and pubertal stage. In conclusion, variants originally associated with adult BMD influence bone mass in children of European ancestry, highlighting the fact that many of these loci operate early in life. However, the direction and magnitude of associations for a large number of SNPs only became evident when accounting for sex and maturation. © 2015 American Society for Bone and Mineral Research.     

Peritoneal inclusion cysts: ovarian fluid in peritoneal adhesions

In four women pelvic peritoneal inclusion cysts were diagnosed with ultrasound or computed tomography. Three patients had a history of multiple surgical procedures, whereas the fourth had prior severe abdominal trauma. Imaging studies showed large cystic structures contiguous with the adnexa. The normal ovarian appearance was distorted in two women. Pathologic confirmation was obtained in all cases. When large adnexal cystic structures are identified in young women with a history of surgery or trauma, the diagnosis of peritoneal inclusion cysts should be entertained. Recognition should result in conservative therapy rather than salpingo-oophorectomy.     

Salmon calcitonin nasal spray in the prevention of corticosteroid- induced osteoporosis

The objectives were to determine the efficacy and safety of nasal salmon calcitonin 200 IU daily in the prevention of corticosteroid- induced osteoporosis. A minimized, double-blind, placebo-controlled trial was carried out in corticosteroid-treated patients with polymyalgia rheumatica. The setting was a tertiary care university- affiliated hospital and a total of 31 patients were enrolled. The primary outcome measure was the percentage change in bone mineral density of the lumbar spine in the two treatment groups from baseline to 1 yr of follow-up. The mean +/- S.D. bone mineral density of the lumbar spine in the calcitonin-treated group decreased by 1.29 +/- 6.76% and in the placebo group by 4.95 +/- 3.50% after 12 months. The observed difference of 3.65 +/- 2.10% between groups is statistically significant (P < 0.05). Nasal salmon calcitonin prevented loss of bone in the lumbar spine as measured by dual-energy X-ray absorptiometry.      

肺栓塞孕产妇死亡病例56例临床分析

[目的]探讨孕产妇发生肺栓塞的诱因、诊治和预防。[方法]回顾性分析湖南省2006年10月1日至2012年9月30日56例因肺栓塞引起的孕产妇死亡病例资料。[结果]因肺栓塞所致孕产妇死亡人数占孕产妇死亡总数的4．71％（56/1190）;发生在产前7例,产时2例,产后43例。另外,发生在宫腔镜下清宫术中2例,剖宫流产术中1例,早孕人流术后1例。其中24例发生在产后48 h内,占产后死亡总数的55．8％（24/43）;产时及产后死亡病例中剖宫产39例,阴道产6例;依据临床表现联合C T 诊断肺栓塞4例,尸检确诊1例,余均依据临床表现死后推断;在抢救措施方面,仅3例给予了抗凝治疗。[结论]重视孕妇肺栓塞高危因素的筛查,严格控制剖宫产指征,规范肺栓塞的诊断并掌握急救方法,重视深静脉血栓的预防和筛查,是预防和降低因肺栓塞所致孕产妇死亡的关键。     

AsC不同中医体质人群“伏邪”之探析

无症状慢性乙肝病毒携带者(AsC)在临床上没有明显的症状和体征,然其在感染乙型肝炎病毒(HBV)后患者可长期无症状携带,并伴随不同程度的肝损伤.因此从“伏邪”学说出发对不同体质AsC人群的邪气藏伏和发病机理进行理论探讨,对临床预防AsC人群发病具有理论指导意义.