借鸡生蛋:三九中原试水社区医院

去年8月20日,国家十一部委联合下发了《关于加快发展城市社区卫生服务的意见》,其中提出:打破部门垄断和所有制等界限,鼓励企业事业单位、社会团体、个人等社会力量多方举办社区卫生服务机构,健全社区卫生服务网络,并鼓励部分国有中、小型医疗机构转制为民办社区卫生服务机构,或实行国有民营。     

原发性输尿管癌31例临床分析

目的：提高原发性输尿管癌的术前诊断水平。方法：对南京医科大学第一附属医院1989-2002年间收治的31例原发性输尿管癌的临床资料进行回顾性分析。结果：31例中，肉眼血尿22例(71．0％)，腰痛11例(35，5％)。B超、静脉肾盂造影(IVU)、CT和逆行造影检查的阳性率分别为输尿管腔内占位4例(13．0％)、输尿管腔内占位3例(11．5％)、膀胱或合并膀胱占位8例(36．4％)，输尿管充盈缺损6例(40．0％)。29例患者经手术治疗，其中13例行患侧肾、输尿管、膀胱袖状切除。结论：老年患者反复发作的腰痛及血尿应考虑原发性输尿管癌的可能，造影诊断对本病有较高价值，应作CT及MRU无创检查。     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。     

三种颈前路钢板重建对维持颈椎曲度和高度的比较

目的对3种不同颈椎前路钢板系统重建并维持颈椎融合节段曲度和高度的作用进行比较.方法 2002年1月～2004年6月,行颈前路减压,自体髂骨植骨,钢板内固定术122例;男85例,女37例,年龄14～70岁.根据采用Orion、Zephir、Codman 3种颈椎前路钢板系统分为A组37例、B组39例及C组46例.于术前、术后1周和随访时摄颈椎侧位X线片,测量融合节段的曲度和高度,并比较其变化及3组间差异.结果术后患者均获随访6～35个月,平均17.3个月.术后6个月3组患者术段颈椎均获骨性融合.且术后1周时颈椎融合节段曲度和高度较术前明显改善(P＜0.05),但最后1次随访时和术后1周比较,差异无统计学意义(P＞0.05),3组间比较差异无统计学意义(P＞0.05).结论 3种钢板系统均能有效重建并维持颈椎融合节段曲度和高度,近期效果优良.     

Genome-wide scan identified QTLs underlying femoral neck cross-sectional geometry that are novel studied risk factors of osteoporosis.

A genome-wide screen was conducted using a large white sample to identify QTLs for FNCS geometry. We found significant linkage of FNCS parameters to 20q12 and Xq25, plus significant epistatic interactions and sex-specific QTLs influencing FNCS geometry variation. INTRODUCTION: Bone geometry, a highly heritable trait, is a critical component of bone strength that significantly determines osteoporotic fracture risk. Specifically, femoral neck cross-sectional (FNCS) geometry is significantly associated with hip fracture risk as well as genetic factors. However, genetic research in this respect is still in its infancy. MATERIALS AND METHODS: To identify the underlying genomic regions influencing FNCS variables, we performed a remarkably large-scale whole genome linkage scan involving 3998 individuals from 434 pedigrees for four FNCS geometry parameters, namely buckling ratio (BR), cross-sectional area (CSA), cortical thickness (CT), and section modulus (Z). The major statistical approach adopted is the variance component method implemented in SOLAR. RESULTS: Significant linkage evidence (threshold LOD = 3.72 after correction for tests of multiple phenotypes) was found in the regions of 20q12 and Xq25 for CT (LOD = 4.28 and 3.90, respectively). We also identified eight suggestive linkage signals (threshold LOD = 2.31 after correction for multiple tests) for the respective geometry traits. The above findings were supported by principal component linkage analysis. Of them, 20q12 was of particular interest because it was linked to multiple FNCS geometry traits and significantly interacted with five other genomic loci to influence CSA variation. The effects of 20q12 on FNCS geometry were present in both male and female subgroups. Subgroup analysis also revealed the presence of sex-specific quantitative trait loci (QTLs) for FNCS traits in the regions such as 2p14, 3q26, 7q21 and 15q21. CONCLUSIONS: Our findings laid a foundation for further replication and fine-mapping studies as well as for positional and functional candidate gene studies, aiming at eventually finding the causal genetic variants and hidden mechanisms concerning FNCS geometry variation and the associated hip fractures.     

三嵌段高分子骨组织工程支架材料的体内生物学性能评价

目的：对三嵌段高分子骨组织工程支架材料-聚（丙交酯-乙交酯）[天冬氨酸-聚乙二醇1的生物相容性进行评价，探讨用于骨组织工程的可行性。 方法：实验于2003-08／12在华中科技大学同济医学院附属协和医院骨科实验室完成。①过敏试验：20只豚鼠随机分为试验组、对照组，每只豚鼠脊柱两侧皮内注射等体积聚（丙交酯-乙交酯）[天冬氨酸-聚乙二醇]浸提液、生理盐水及体积分数为0．05的甲醛溶液，记录激发部位红斑水肿。②急性全身毒性试验：12只小白鼠随机分为试验组和对照组，该两组腹腔分别注射浸提液及生理盐水，4，24，48及72h观察动物的一般状态。③植入试验：聚（丙交酯-乙交酯）[天冬氨酸-聚乙二醇]植入6只新西兰大白兔肌肉内，1，4及8周切取材料周围0．5cm处肌肉组织，苏木精-伊红染色，光镜下观察。 结果：①过敏试验结果：皮内注射浸提液及生理盐水动物皮肤无红斑水肿，注射体积分数为0．05的甲醛溶液出现中度以上红斑水肿。②急性全身毒性试验结果：阴性对照组未见毒性症状，试验组4h后仅1只有轻微的运动减少，24h后恢复正常。③植入试验结果：所有试验动物伤口均一期愈合。 结论：聚（丙交酯-乙交酯）[天冬氨酸-聚乙二醇]具有良好生物相容性，是一种新的骨组织工程支架材料。     

Study on Bone Mineral Density and its Influencing Factors among 1 214 Older Adults in Xuhui District, Shanghai

Osteoporosis is a common disease in older adults. The basic evidence for the diagnosisof osteoporosis is the decrease of bone mineral density (BMD) [1]. Studies showed that the risk of fractures would rise as the bone mineral density decreased, and the me…     

羊踯躅根治疗慢性肾小球肾炎的实验及临床研究

本文用反复静脉注射小剂量牛血清白蛋白复制家兔慢性肾炎,用羊踯躅根治疗。同时,用该药对慢性肾炎病人进行疗效观察。阳性组兔肾小球呈现中至重度颗粒形免疫荧光,肾组织呈明显慢性硬化性肾小球肾炎改变。尿蛋白±～++。治疗组兔及病人治疗后病变及症状均明显减轻或消失。结果提示循环免疫复合物反复沉着可引起兔类似人类的慢性硬化性肾小球肾炎,羊踯躅根对病变有一定的控制和治疗作用,这可能与其抑制免疫发病机制有关。     

Solid and papillary epithelial neoplasms of the pancreas: CT findings

Five female patients and one male patient with solid and papillary epithelial neoplasms of the pancreas were examined with computed tomography (CT). The mean age of the patients was 27 years (range, 13-46 years). All cases showed well-encapsulated, round or lobulated masses consisting of both cystic and solid areas. Cystic portions showed CT numbers that suggested hemorrhagic necrosis. There were no internal septations within the masses. In three tumors located in the head of the pancreas, dilatation of the biliary tree was absent or minimal, although the masses were large. Two tumors contained calcifications. One tumor demonstrated metastatic deposits in liver and lymph nodes. Metastatic masses appeared similar to the primary pancreatic mass. Solid and papillary neoplasm of the pancreas should be the primary diagnostic consideration when characteristic CT findings are detected in a young female patient.     

陇南川北中华白蛉种型与垂直分布的初步研究

陇南川北中华白蛉(Phlebotomus chinensis)体形存在大小两型,其分布界线大型在海拔2000米以上,小型在海拔1600米以下,雄蛉触角列式大体与两型白蛉分布的情况相对应。在海拔1600米以下,雄蛉触角列式为2/3～15的占98.3％,呈2/3～8,1/9～15的仅占1.7％,后者被认为是前者的个体变异。在海拔2000米以上,雄蛉触角列式呈2/3～8,1/9～15的占98.97％,恰与海拔1600米以下的相反。两型主要的形态特征并无区别。在相似条件下,不包括滞育蛉在内,大型完成发育史的时间平均为52.3天;小型为53.6天,两型无差别。但两型在滞育期的出现时间略有不同,小型的滞育期较大型早出现一旬。本文对陇南川北中华白蛉种型分化作了分析和讨论。根据所得的初步结果,认为目前还不能从分类学上给予准确的评价,有关问题尚待深入研究。由于两者分布高度不同,体形大小有别,建议将分布在海拔2000米以上的中华白蛉,暂称大型中华白蛉。海拔1600米以下的中华白蛉,暂称小型中华白蛉,这仅仅为了表达和阐述的方便,并不是分类学上的正名。