脊髓损伤住院病人的医疗和非医疗费用调查分析

目的调查脊髓损伤住院病人的医疗和非医疗费用的支付情况及其主要影响因素.对损伤后疾病负担做出基本估计,为残疾预防,促进与维护健康提供有价值的参考依据.方法以1998-2001年脊髓损伤康复科出院患者的原始资料为依据,自行设计费用调查问卷.资料应用SPSS完成.结果111例脊髓损伤住院病人医疗费用占总费用占58.03%,非医疗费用占41.97%.康复训练费用仅占医疗费用的12.86%.脊髓不完全性损伤费用多,康复治疗效果明显,患者的期望值高,因此住院时间较长.费用来源于公费、肇事责任方的患者平均住院日及费用无明显差异,自费患者住院天数、医疗费用明显减少.在脊髓损伤后非医疗费用中,陪护费占34.26%.结论遏止交通事故,工业伤害,减轻社会的总体负担;要逐步降低康复医院的药品费用的比重,提高康复训练中技术服务价值:应将脊髓损伤纳入重大疾病预防控制工作.     

Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma

BACKGROUND: Pooling of contrast material on computed tomographic (CT) scan represents free extravasation of blood as a result of active bleeding. For patients with blunt hepatic injury, aggressive management such as angiography or celiotomy is usually indicated if this sign is detected. The purposes of this study were to further categorize this CT scan finding and to correlate its characteristics with clinical outcomes. This CT scan classification might be helpful for the selection of appropriate management. METHODS: During a 42-month period, 276 patients with blunt hepatic injury were treated. Two hundred twelve of them were hemodynamically stable after initial resuscitation and underwent abdominal CT scan examination. Pooling of contrast material was detected on the CT scans of 15 patients. The CT scans and medical records were reviewed. Special attention was paid to the presence, location, and character of the extravasated contrast material. RESULTS: The finding of pooling of contrast material on CT scan was categorized into three types according to its location and character. Type I showed extravasation and pooling of contrast material in the peritoneal cavity (six patients). All patients with type I CT scan findings became hemodynamically unstable soon after CT scan examination and required emergent laparotomy. Type II findings showed simultaneous presence of hemoperitoneum and intraparenchymal contrast material pooling (six patients). Four patients with type II CT scan findings required laparotomy for hemostasis. Type III findings showed intraparenchymal contrast material pooling without hemoperitoneum (three patients). All patients with type III CT scan signs remained hemodynamically stable. CONCLUSION: With the use of a high-speed spiral CT scanner, it is possible to predict the necessity of operative management or angiography for patients with blunt hepatic injury before deterioration of hemodynamic status. The presence of pooling of contrast material within the peritoneal cavity indicates active and massive bleeding. Patients with this CT scan finding show rapid deterioration of hemodynamic status. Most of these patients might require emergent surgery. Pooling of contrast material in a ruptured hepatic parenchyma indicates active bleeding. Close monitoring and emergent angiography should be performed. Deterioration of hemodynamic status in these patients usually requires prompt surgical intervention. Intraparenchymal pooling of contrast material with unruptured liver capsule often indicates a self-limited hemorrhage. Patients with this CT scan finding have a high possibility of successful nonoperative treatment.     

癫痫共病的诊断和治疗

【摘要】 癫痫共患病在癫痫患者中十分常见,包括了精神类疾病和非精神类疾病。虽然目前对癫痫共病已经有了一定认识,但是仍然存在被低估,造成治疗不足的情况。加强对癫痫共病的认识,不但可以及早加强风险防范,兼顾癫痫治疗的远期获益,更重要的是可以改善癫痫患者生活质量,促进全面健康。本文从癫痫共病的分类,临床表现,诊断和治疗等多方面进行了阐述,希望可以深入对癫痫共患病的认识,做到早发现,早治疗,进而为制定更合理的治疗策略提供依据。     

正常与缺血性心肌梗死及心肌肥厚大鼠超声心动图参数变化趋势比较

目的 通过对正常和心血管疾病状态下的大鼠进行连续超声心动图检测,获得客观准确的大鼠心脏超声参数的变化趋势。方法 建立缺血性心肌梗死和压力负荷增高诱导心肌肥厚的大鼠模型,分别在术前、术后1、2和4周进行超声心动图检测,在相同时间点对正常大鼠进行超声心动图检测,并记录超声参数数据。结果 正常大鼠各心脏参数随时间的变化均有所升高,属正常生长状态。心肌梗死大鼠心脏变化以心室重构和功能障碍为主,心室内径和心室容积随时间变化显著增加,射血分数和短轴缩短率显著降低,差异均有统计学意义（P＜0.05）。心肌肥厚大鼠心脏变化以形态改变为主,左室前、后壁厚度随着时间的延长显著增加,收缩末期容积显著下降,射血分数和短轴缩短率代偿性升高,差异均有统计学意义（P＜0.05）。结论 应用超声心动图可获得正常和疾病状态下较为客观准确的大鼠心脏超声数据,为后续应用大鼠实验模型研究各种心血管疾病提供了数据参考。     

大型三甲医院分院神经内科住院患者疾病构成特点

【摘要】 目的 分析大型三甲医院分院神经内科住院患者的疾病构成及相关特点,为临床诊治工作提供科学客观依据。方法 收集四川大学华西医院上锦分院?成都上锦南府医院神经内科2012年4月1日~2018年3月31日住院患者的病历资料,共收治17104例患者,其中男性8667例（5067%）,女性8437例（4933%）,年龄4～100岁,平均（5237±1775）岁,以首页的主要诊断即第一诊断按照WHO 国际统一疾病分类法（ICD 10）并结合神经内科“Midnights”定性原则作为疾病分类标准,采用 SPSS 220软件进行数据统计、分析。结果 脑血管疾病、中枢神经系统感染性疾病、头晕和眩晕、神经系统疾病相关的精神障碍、周围神经疾病所占比例依次为2045%、1176%、846%、743%、740%。2012年～2018年神经内科罕见病所占比例依次为505%、833%、966%、1028%、1079%、1126%、1144%。结论 大型三甲医院分院神经内科位列前五的病种为脑血管疾病、中枢神经系统感染性疾病、头晕和眩晕、神经系统疾病相关的精神障碍、周围神经疾病,罕见病所占比例呈逐年升高趋势,各级医院神经内科应加强卒中中心的发展及对罕见病的认识,推进双向转诊及分级诊疗,以使患者能最大获益。     

Abrupt visual loss during anti-vascular endothelial growth factor treatment for type 3 neovascularization

AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization. METHODS: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss. RESULTS: The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001). CONCLUSION: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.     

CCLG-ALL2008方案治疗不同分子生物学特征儿童急性淋巴细胞白血病的长期疗效分析

目的 探讨CCLG-ALL2008方案治疗具有不同分子生物学特征的初诊儿童急性淋巴细胞白血病（ALL）的长期疗效。方法 选取按照CCLG-ALL2008方案治疗的940例初诊ALL患儿为研究对象,针对不同分子生物学特征ALL的长期疗效进行回顾性分析。结果 940例ALL患儿中,男570例,女370例,中位年龄5（1~15）岁,中位随访时间65（3~123）个月。完全缓解（CR）率为96.7%,预期10年总体生存（OS）率为（76.5±1.5）%,无事件生存（EFS）率为（62.6±3.0）%。患儿经治疗达CR后,总复发率为21.9%,其中ETV6-RUNX1阳性患儿复发率最低,且易于晚期复发;MLL重排阳性患儿复发率最高,且易于早期复发。ETV6-RUNX1阳性患儿的预期10年OS率明显高于伴有TCF3-PBX1阳性、BCR-ABL阳性、MLL重排及无分子生物学特征患儿（P < 0.05）。ETV6-RUNX1阳性患儿的预期10年EFS率明显高于伴有BCR-ABL阳性和MLL重排患儿（P < 0.05）。结论 分子生物学特征是影响ALL患儿长期预后的指标,MLL重排、BCR-ABL融合基因阳性是预后的不良指标,ETV6-RUNX1融合基因阳性患儿长期生存率较高。     

限时进食对恶性肿瘤的潜在防治作用

间歇性禁食是一种新的饮食干预策略,其可能改善恶性肿瘤治疗的疗效并减少并发症。限时进食是间歇性禁食的一种特殊形式,通常仅限制每天的进食时间窗而不限制热量,除了和其他间歇性禁食手段一样能够控制体重并改善代谢紊乱以外,限时进食还能调节昼夜节律并影响自噬水平,具有潜在的抗衰作用,相关研究已经表明了它预防肿瘤发生以及减缓肿瘤发展的潜力。同时,由于实施方案便利、不良反应轻微,限时进食有着不错的依从性及安全性,有可能成为一种适合肿瘤患者长期实施的辅助治疗方案乃至健康生活方式。本文从改善肥胖和代谢紊乱、调节昼夜节律和自噬水平以及目前与肿瘤相关的研究进展这三个方面阐述了限时进食对恶性肿瘤的潜在作用,旨在为将来的相关研究提供理论依据和探索方向,探讨限时进食作为一种营养干预手段对恶性肿瘤发生的潜在预防作用以及对恶性肿瘤的治疗或辅助治疗作用,以期可以完善对肿瘤患者的营养干预策略,改善患者的生活质量及预后。     

Ac-SDKP对实验性矽肺纤维化模型中肺泡Ⅱ型上皮细胞衰老信号激活的调节作用

目的 观察N-乙酰基-丝氨酰-天冬氨酰-赖氨酰-脯氨酸(Ac-SDKP)对实验性矽肺纤维化进程中肺泡II型上皮细胞细胞衰老的作用及其机制.方法 SPF级Wistar大鼠分组为对照组、矽肺模型组和Ac-SDKP治疗组.肺泡II型上皮MLE-12细胞分组为空白对照组、SiO2组、Ac-SDKP组和SiO2+Ac-SDKP组...     

2种聚乙二醇不饱和酸单酯共聚合包被Fe3O4制备磁性微球及其表征

目的：用两种聚乙二醇（Polyethylene glycol,PEG）不饱和酸单酯经自由基共聚包被纳米Fe3O4磁芯制备磁性微球,考察其功能化后特异性和非特异性结合作用。方法：水解沉淀法制备纳米Fe3O4磁芯;用PEG-350单甲醚丙烯酸酯和PEG-1540单顺丁烯酸单酯为单体,在正庚烷-水组成的油包水体系自由基共聚制备磁性微球;将微球表面来自PEG-1540的羟基经甲磺酸酯活化、连接乙二胺后再用活化生物素修饰。透射电镜观察其外貌;测定与碱性磷酸酶标记链亲和素（Streptavidin labeled by alkaline phosphate,AP-SAV）的特异性结合、与4-硝基-1-萘酚苯甲酸酯等的非特异性结合。结果：所得Fe3O4粒径60 nm左右,生物素修饰后粒径接近200 nm。此磁性微球可从混合蛋白中选择性分离碱性磷酸酶酶标记的链亲和素,结合容量约51 ng蛋白/g磁性微球;4-硝基-1-萘酚苯甲酸酯在浓度很低时同此磁性微球的结合低于检测限,在浓度高达64 ?滋mol/L时仍无显著结合。结论：用两种PEG不饱和酸酯共聚包被Fe3O4可制备表面亲水磁性微球,功能化后有特异相互作用且非特异性作用很弱,但还需提高此磁性微球功能化后的特异性结合容量。