性别对骨关节炎患者全膝关节置换术后康复效果的影响

目的 探讨性别因素对接受人工全膝关节表面置换术的膝骨关节炎患者术后功能的影响. 方法 前瞻性研究了 2003年 3月～ 2005年 8月期间行单侧人工全膝关节表面置换术(均使用不保留后交叉韧带后稳定型固定平台假体)的 40例 (40髋 )膝关节骨关节炎患者,男女各 20例( 20膝),对其相关的临床因素用 t检验和χ 2检验进行分析. 结果平均年龄:男 72.6岁、女 70.8岁;病程:男 10.4年、女 9.7年;体重指数:男 26、女 26;术后平均住院时间:男 17 d、女 18 d;止血带使用时间:男 104 min、女 94 min;引流量:男 806 mL、女 742 mL;术前、术后 1周、 2周和 1年的膝关节伸屈度数男分别为 7.0°～ 114.0°、 3.0°～ 91.0°、 0.4°～ 103.0°和 0～ 125.0°,女分别为 8.0°～ 111.0°、 2.0°～ 86.0°、 1.0°～ 98.0°和 0～ 122.0°;术前、术后 1周、 2周和 1年的膝关节活动度:男分别为 108°、 89°、 109°和 123°,女分别为 104°、 87°、 101°和 126°;术前和术后 1年的 HSS评分:男分别为 57、 89分,女分别为 53、 87分.两性别组各时间点的伸屈度数、活动范围及术前和术后 1年的 HSS评分差异无统计学意义 (P >0.05);而同一患者术前和术后 1年的伸屈度数及 HSS评分则差异有统计学意义 (P >0.05). 结论 性别对行全膝关节置换的骨关节炎患者术后功能无明显影响,全膝关节置换能有效缓解骨关节炎相关的疼痛并改善膝关节的功能.     

Performance and comparison of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease formulae in estimating glomerular filtration rate in a Chinese Type 2 diabetic population.

AIMS: Our aim was to assess performances of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease (MDRD) formulae in estimating glomerular filtration rate (GFR) in Chinese diabetic populations and their association with vascular risks. METHODS: A total of 1009 patients with Type 2 diabetes were categorized into low estimated GFR groups (GFR < 60 ml/min/1.73 m(2)) and control groups by the two equations. The performances of these formulae were assessed at different stages of kidney function. Carotid artery intima-media thickness (IMT) and the prevalence of diabetic retinopathy or albuminuria were compared among the groups. The ability of these formulae to identify established vascular risk markers using sensitivity, specificity, positive and negative predictive values were also compared. RESULTS: The prevalence of low estimated GFR was 32.7% with the Cockcroft-Gault formula and 5.2% with the MDRD formula, respectively. In low estimated GFR subjects by the MDRD formula, IMT was significantly thicker than those by the Cockcroft-Gault formula (1.2 mm vs. 1.0 mm; P < 0.05), with a higher prevalence of albuminuria (78.4 vs. 52.8%, P < 0.05) and diabetic retinopathy (46.5 vs. 30.5%; P < 0.05). The Cockcroft-Gault formula gave a specificity of 71.7% and a sensitivity of 37.0%, and the MDRD formula gave a specificity of 96.6% and a sensitivity of 7.9% in estimating low GFR relevant for established vascular risks. CONCLUSIONS: These formulae performed differently in Chinese diabetic populations. The simplified MDRD formula is minimally superior to the Cockcroft-Gault formula for its high specificity and positive predictive values in estimating low GFR relevant for vascular risks.     

从六经辨治腰椎间盘突出症

腰椎间盘突出症是临床常见病、多发病。随着现代影像诊断技术的发展,该病的诊断越来越明确,治疗方法多有牵引、针灸、理疗、穴注等,具体到针灸治疗本病症,则多从足太阳、足少阳、足少阴论治,笔者从六经辨治本症,取得较好疗效,现分经论述如下。1太阳证(1)表现:恶寒,全身酸胀不适;或恶风汗出,腰背有僵硬感;或腰臀部及下肢后外侧牵强不适;更甚者脊柱和腰部像折断一样疼痛,下肢不能运动自如。查舌淡、苔薄白或薄黄,脉浮紧或浮缓或弦。(2)处方:合谷、列缺、外关、后溪、风门、膀胱俞、委中、昆仑、京骨、大钟、金门等。以泻法为主。(3)方义:太阳…     

中医医院管理循证理念的应用

随着"三医改革"的不断深入,医疗市场的竞争日趋激烈,人们对医院管理在生存和发展中的重要作用也日益关注.由于中医院面临着管理理念、资源优化、人才构筑和公平竞争的诸多问题,以往的经验管理已不能适应时代性、国际化的要求.面对瞬息万变的生存环境,需要各级中医医院能够主动参与竞争,充分发挥中医药特色,强化自身优势,对市场的变化迅速作出反应,这对中医医院管理工作提出了更高的要求.     

Early uptake of 99mTc-C2A in the acute phase of myocardial infarction as a prognostic indicator for follow-up cardiac dysfunction

OBJECTIVE: The C2A domain of Synaptotagmin I is a molecular probe for the specific imaging of cell death. Here we test the hypothesis that the uptake of 99mTc-C2A in the acute phase of an infarction is associated with cardiac dysfunction in follow-ups. METHODS: The left coronary artery was occluded in Sprague-Dawley rats for 0, 10, 20, and 30 min. 99mTc-C2A was injected intravenously at 2 h of reperfusion. Anterior planar images were acquired with one million counts on a gamma camera 3 h after injection. 99mTc-C2A uptake was calculated as the total counts in the left ventricle region minus blood pool signal. The in-vivo signal detected was correlated with wall motion score index at 1 and 3 weeks follow-ups measured by echocardiography. RESULTS: 99mTc-C2A uptake was higher with increased ischemic time (2244+/-852, 4054+/-1223, and 6178+/-1451 for 10, 20, and 30 min ischemia, analysis of variance P<0.001). A significant correlation was found between 99mTc-C2A uptake and wall motion score index at 1 week (R=0.800, P=0.0006) and 3 weeks (R=0.810, P=0.0008). CONCLUSION: In this ischemia/reperfusion model, 99mTc-C2A uptake in the acute phase was associated with functional abnormality at 1 and 3 weeks. This demonstrates the potential diagnostic and prognostic value of 99mTc-C2A as a novel imaging agent.     

全腹膜外补片植入术中补片不固定的实验研究

目的评价全腹膜外补片植入术中补片不固定的安全性和有效性。方法将50只SD大鼠建立疝缺损(3cm2)模型,按随机数字表分为2组,使用聚丙烯补片(12 cm2)采用腹膜外补片植入术进行修复。甲组为补片固定组,乙组为补片不固定组。大鼠于术后不同时间分批处死,记录补片的挛缩度、腹壁抗张强度以及组织细胞学变化。结果所有大鼠术后腹腔均无粘连。2组大鼠在术后7 d、14 d、30 d、60 d和90 d补片的挛缩度分别为6.7%±1.3%vs 7.3%±1.5%、12.3%±1.3%vs 12.4%±1.6%、14.0%±2.0%vs 14.5%±1.3%、17.4%±2.1%vs 18.4%±1.5%和18.9%±2.2%vs19.5%±2.6%(P>0.05);2组大鼠的腹壁抗张强度分别为(288.4±8.4)mm Hg vs(286.6±10.2)mm Hg、(300.4±11.2)mm Hg vs(298.8±11.4)mm Hg、(305.0±11.7)mm Hg vs(303.3±16.1)mm Hg、(309.0±10.8)mm Hg vs(307.6±8.9)mm Hg和(311.8±9.8)mm Hg vs(310.0±8.6)mm Hg(P>0.05);2组大鼠的组织细胞学变化一致。结论当补片面积是大鼠疝缺损的4倍以上时,不固定的腹膜外补片植入术是安全有效的。     

胶质细胞活化对慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)大鼠脊髓背角P物质的影响

目的探讨胶质细胞活化对慢性前列腺炎/慢性盆腔疼痛综合征（chronic prostatitis/chronic pelvic pain syndromes,CP/CPPS）大鼠脊髓背角P物质的影响。方法完全福氏佐剂和3%角叉菜胶前列腺内注射造成CP/CPPS模型,脊髓插管给药胶质细胞活化抑制剂Propentofylline干扰CP/CPPS模型大鼠,免疫组织化学方法观察正常组、疼痛模型组、药物干扰组脊髓节段（L6和S1）背角的胶质细胞的活化和P物质的定性定位,并用放射免疫的方法观察三组脊髓背角P物质的变化。结果脊髓背角胶质细胞活化阳性细胞数疼痛组明显增加,药物干扰组明显减少;P物质主要表达于脊髓背角且疼痛模型组明显增多,药物干扰组明显减少。结论胶质细胞活化是CP/CPPS大鼠脊髓背角P物质变化的重要原因,胶质细胞活化抑制剂的应用将是治疗CP/CPPS的新亮点。     

脂质体阿霉素为主方案治疗高龄非霍奇金淋巴瘤的临床研究

目的 观察脂质体阿霉素联合治疗高龄非霍奇金淋巴瘤患者的有效性和安全性.方法 应用脂质体阿霉素联合COP为主的方案化疗或联合利妥昔单抗等其他治疗方案治疗34例患者,观察患者应用脂质体阿霉素过程中及其后的毒副反应及疗效.结果 全组34例患者共接受176个疗程化疗,平均每个患者累计应用脂质体阿霉素127.0 mg治疗,总有效率(CR+PR)为88.2%(30/34),其中CR 24例(70.6%),PR 6例(17.7%),SD 1例(2.9%),PD 3例(8.8%).毒副反应主要为骨髓抑制,未出现严重感染.心脏毒性发生率14.7%(5/34),无化疗相关死亡.结论 脂质体阿霉素联合治疗高龄非霍奇金淋巴瘤具有较高的安全性和有效性.     

Feasibility of treating hyperfibrinogenemia with intermittently administered batroxobin in patients with ischemic stroke/transient ischemic attack for secondary prevention.

This study evaluated the safety and efficacy of batroxobin in treating hyperfibrinogenemia for secondary stroke prevention. Patients with ischemic stroke or transient ischemic attack (TIA) were measured for plasma fibrinogen levels. Selected participants had concomitant hyperfibrinogenemia (plasma fibrinogen > or = 3.0 g/l). Patients enrolled between 1 July 2003 and 31 December 2004 were treated with batroxobin; patients enrolled between 1 January 2002 and 30 June 2003 were treated without batroxobin. Batroxobin was administered intermittently via intravenous injection at 3-monthly intervals. Patients in both groups were followed for 1 year. Any cerebrovascular events and suspected adverse events were recorded. In total, 112 ischemic stroke/TIA patients with concomitant hyperfibrinogenemia were enrolled, 52 being treated with batroxobin and 60 without batroxobin. Six patients (11.5%) with batroxobin and 16 patients (26.7%) without batroxobin had recurrent cerebral ischemic events during follow-up. Stroke/TIA recurrence in patients without batroxobin was higher than that in patients with batroxobin (P < 0.05). Two patients with batroxobin and two patients without batroxobin developed hemorrhagic stroke during follow-up. There were five deaths (9.6%) in the batroxobin group, and seven deaths (11.7%) in the nonbatroxobin group during follow-up (P > 0.05). Intermittent intravenous injection of batroxobin can efficiently reduce the risk for stroke/TIA recurrence in patients with concomitant hyperfibrinogenemia.     

川芎嗪对肾缺血再灌注时c-fos bcl-2 ICAM-1蛋白表达的影响

目的　探讨大鼠肾缺血再灌注损伤不同时间c -fos、细胞淋巴瘤 /白血病 - 2、细胞间粘附分子- 1蛋白的表达及川芎嗪对其影响。方法　用免疫组化法检测大鼠急性肾缺血再灌注不同时间内及川芎嗪干预后c -fos、细胞淋巴瘤 /白血病 - 2、细胞间粘附分子 - 1蛋白表达的分布及强度变化。结果　c -fos蛋白分布于近曲小管、远曲小管、集合管上皮细胞的细胞核、细胞浆内 ,再灌注后 1h表达明显增强 ,3h达高峰 ,6h锐减。细胞淋巴瘤 /白血病 - 2蛋白主要分布于近曲小管上皮细胞的细胞浆 ,再灌注后 1h表达明显增强 ,6h达高峰 ,2 4h仍有较强表达。细胞间粘附分子 - 1蛋白分布在肾血管、肾小管等部位 ,其中以肾血管为著 ,其表达增强于再灌注后 1h ,直到 2 4h仍有增高趋势。川芎嗪干预后c -fos、细胞间粘附分子 - 1蛋白表达明显下降 (P <0 0 1 )。细胞淋巴瘤 /白血病 - 2表达明显增高 (P <0 .0 1 )。结论　川芎嗪对肾缺血再灌注损伤有较好的保护作用