1269例早期宫颈癌患者手术途径及卫生经济学初步分析

目的：分析腹腔镜宫颈癌根治术和开腹宫颈癌根治术的卫生经济学指标。方法对1269例早期宫颈癌患者进行分析。根据手术方式分为腹腔镜组和开腹手术组。分析两组患者的年龄、体质量指数、临床分期、住院天数及费用等。结果腹腔镜手术方式在治疗早期宫颈癌所占比例逐年增多。两组的总住院费用差异无统计学意义（P﹥0.05）,腹腔镜组较开腹手术组总住院天数及术后住院天数明显减少（P﹤0.01）,护理费、药费和组麻醉也均明显减少（P﹤0.01）。结论腹腔镜手术在治疗早期宫颈癌方面较开腹手术有更好的卫生经济效益,值得推广。     

生命网在冠心病择期介入手术中的作用

为了加强冠心病二级预防,1996年以来,国际上相继兴起了生命网活动,至2003年,全国有30多家医院相继开展了生命网项目.它有助于心脏康复治疗的进行,尤其是冠心病介入术后病人的康复[1].     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

目的 总结飞行人员甲状腺疾病的诊治和医学鉴定经验. 方法 收集我院2000年12月-2009年12月间住院飞行人员67例甲状腺疾病资料,将其归为:①无症状的良性甲状腺结节;②慢性淋巴细胞性甲状腺炎;③甲状腺功能异常类疾病(包括甲状腺机能亢进症和甲状腺机能减退症);④甲状腺恶性肿瘤.分析4类疾病的特点及飞行结论 情况. 结果 ①良性甲状腺结节36例(占53.73%),4例手术治疗(腺瘤3例,结节性甲状腺肿1例),除5例因其他原因停飞外,其余31例均飞行合格,定期复查;②慢性淋巴细胞性甲状腺炎5例(占7.46%),甲状腺功能正常,均飞行合格,定期复查;③甲状腺功能异常类疾病20例(占29.85%,甲状腺机能亢进18例,甲状腺机能减退2例),均行药物治疗,6例飞行合格,3例暂时飞行不合格,11例停飞;④甲状腺恶性肿瘤6例(占8.96%,4例为乳头状癌,2例为滤泡状癌),1例飞行合格,5例停飞.经统计学分析,甲状腺功能异常类疾病和甲状腺恶性肿瘤的停飞率均高于良性甲状腺结节和慢性淋巴细胞性甲状腺炎,且差异有统计学意义(P<0.01或P<0.05). 结论 飞行人员甲状腺疾病以无症状的良性结节常见,要重视功能异常类疾病和恶性肿瘤的早期诊断和治疗. Abstract： Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

下体负压训练提高歼击机飞行员加速度耐力二例

一、临床资料例1,男性,28岁,歼-7飞行员,飞行时间600 h,因改装体检入院.改装体检各项检查均正常.离心机检查:3.0 G持续10 s勉强通过,自觉周边灯消失;4.25 G持续6 s时耳水平脉搏消失,并出现G-LOC.患者本人强烈希望能改装合格.     

正常高值血压飞行人员心血管危险因素调查分析

Objective To investigate the epidemic features of cardiovascular risk factors in the flying personnel with high normal blood pressure(BP). Methods Three hundred and ninety-one flying personnel were divided into normal BP group and high normal BP group by judging if the systolic and diastolic BP was higher than 120 and 80 mm Hg respectively.Body mass index(BMI),serum total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL)and uric acid(UA)were compared.History of smoking and heredity of cardiovascular diseases were surveyed. Results Level of BMI,TG,LDL and prevalence rate of blood fat abnormality in high normal BP group were significantly higher than those in normal BP group (r=2.023,2.191,2.336,P＜0．05;χ2=7.535,P＜0.05),but no significant differences on UA,TC,HDL,smoking habit and familial inherited cardiovascular diseases were found between groups. Conclusions The flying personnel with high normal BP run higher risk of suffering cardiovascular diseases.Medical interventions for controllable risk factors are suggested.     

一种特殊类型的阴道斜隔综合征一例

患者26岁,未婚有性生活,孕0产0,痛经渐进性加重11年,腹部手术切口经期渗血2个月于2010年12月28日入院.患者15岁月经初潮,周期30 d,经期6～7 d,规律、量少;有痛经且渐进性加重,影响生活.     

人源化与鼠源CD19 CAR-T细胞疗法治疗复发/难治急性B淋巴细胞白血病的长期随访

目的探索人源化和鼠源CD19嵌合抗原受体T细胞(CAR-T细胞)治疗复发/难治急性B淋巴细胞白血病(B-ALL)安全性、短期及长期随访的疗效差异。方法分析2016年5月至2023年3月于华中科技大学同济医学院附属协和医院接受CD19 CAR-T细胞治疗的80例R/R B-ALL患者的有效性和安全性, 其中接受鼠源CAR-T治疗31例, 人源化CAR-T治疗49例。结果鼠源和人源化组患者发生细胞因子释放综合征(CRS)的比例分别为61.3%和65.3%, 其中接受鼠源CAR-T的患者发生重症CRS的比例高于人源化CAR-T(19.4%对8.2%, P=0.174), 两组中分别有1例患者死于严重CRS。1～2级免疫效应细胞相关神经毒性综合征(ICANS)的发生率为12.9%和6.1%, 无患者发生高级别ICANS。鼠源组和人源化组中白血病患者的总体反应率分别为74.2%和87.8%。在中位时间为10.5个月的随访期中, 两组患者中位无复发生存(RFS)期均为12个月, 中位总生存(OS)期均未达到。在45例基线骨髓白血病细胞负荷>20%的患者中, 接受人源化CAR-T治疗的患者1年...     

中性粒细胞/淋巴细胞比值在外阴鳞癌和外阴上皮内瘤变筛查中的预测价值

目的 本研究旨在探讨中性粒细胞/淋巴细胞比值(NLR)与外阴病变活检病理的关系,并探讨NLR能否作为鉴别外阴鳞癌与其癌前病变外阴上皮内瘤变的炎症标志物的可行性.方法 回顾分析2012年12月—2020年6月386例因外阴病变进行活检的患者,评估术前NLR与外阴病变的病理结果的相关性.结果 外阴鳞癌组的平均NLR明显高于...     

雷公藤多甙对雌性小鼠生殖功能影响的实验研究

目的:探讨雷公藤多甙(GTW)对雌性育龄期小鼠生殖功能损伤的药理作用机理。方法:将7~8 w龄雌性成熟昆明种小鼠随机分为GTW A组[60 mg/(kg.d))、B组[40 mg/(kg.d)]、C组[30 mg/(kg.d)]、D组[20 mg/(kg.d)]、E组[15 mg/(kg.d)]5组及正常对照组。观察给药后小鼠动情周期,分别在以下3个时段分批处死小鼠:①各组部分小鼠动情周期延长时;②各组小鼠动情周期均延长、不规则时;③各组小鼠动情周期完全紊乱、甚至消失时;观察不同时段GTW对生殖功能的影响。检测血清E2、P水平,计算卵巢、子宫指数,卵巢、子宫作组织形态学观察,计数各级卵泡、黄体数,测量子宫内膜、肌层厚度。结果:分别在给药5,7,10 w时分批处死小鼠。给药10 w时,A、B、C组子宫指数明显降低,子宫内膜、肌层明显变薄,卵巢成熟卵泡数及黄体数减少;A、B组E2水平降低,各组P水平及卵巢指数无明显变化。结论:雷公藤多甙可损伤雌性小鼠生殖功能,给药10 w损伤明确,造成肾虚生殖功能低下状态。     

计数抽样检验程序及其在医疗器械领域的应用

计数抽样检验是医疗器械质量控制的常用手段之一,在生产和监管过程中得到了广泛应用。GB/T 2828系列标准给出了不同类型的计数抽样检验程序。介绍了GB/T 2828系列标准,以及在不同情景下计数抽样检验方案的设计与检索。同时,还对如何平衡准确性和经济性给出了建议,对于医疗器械生产企业和监管部门的使用具有指导作用。