某医院中老年医务工作者代谢综合症现状调查

目的:了解河北医科大学第二医院院中老年医务工作者代谢综合症(MS)的患病情况,为本院职工采取合理的预防措施提供依据.方法:选择2009年度参加体检的40岁以上职工1163例作为研究对象,选择腰围、血压、空腹血糖、甘油三酯、高密度脂蛋白胆固醇等数据,进行统计分析.结果:我院中老年医务工作者代谢综合症患病率为28.20%,其中男性31.55%,女性26.36%,差异无统计学意义;在40-49岁年龄组男性高于女性,差异有统计学意义.结论:在我院中老年医务工作者的代谢综合症患病率较为严重,且随年龄增高而升高.庄重视MS的早期干预和控制,预防心脑血管疾病的发生.     

关节镜下行(足母)外翻外侧松解背侧入路的研究

目的探讨关节镜下行躅外翻外侧松解背侧入路的可行性及方法。方法解剖研究采用10具新鲜保留踝关节的足部标本。在关节镜监视下,以钩刀松解外侧关节囊和躅内收肌斜头。观察各入路与周围神经血管、肌腱之间的关系,并统计松解范围。临床研究对5例躅外翻患者行关节镜下外侧松解加内侧软组织紧缩手术,患者均为女性,平均年龄30岁。术前躅外翻角为24^o-38^o,平均30^o,跖间角为9^o-11^o,平均10^o。结果解剖研究近侧切口与躅短伸肌腱非常接近,为0—3mm,平均1．5mm;与躅长伸肌腱相距为1—4mm,平均2．4mm。远侧切口与第一趾背动脉和趾背神经非常接近,为1～3mm,平均1、4mm,极易损伤。6例正常足中,1例松解跖籽骨韧带,1例作部分松解（70％）。在4例足母外翻足中,2例松解跖籽骨韧带,1例作了部分松解（50％）。临床研究5例患者平均随访时间9个月。最后一次随访时X线片示足母外翻角4^o-9^o,平均7^o,跖间角8^o～10^o,平均9^o。患者均恢复良好,对外形满意,未见肌腱损伤、麻木、感染、跖趾关节僵硬等并发症发生。结论背侧入路关节镜下外侧松解是可行的,其手术切口较小,镜下视野清晰,可以根据需要松解外侧结构的各个部分,由于不损伤血管,减少了跖骨头坏死的发生。     

老年股骨转子间骨折:内固定与人工关节置换

股骨转子间骨折是老年人常见病损之一.随着人类平均寿命的增长、社会人口的老龄化,股骨转子间骨折的发病率逐年增高,与股骨颈骨折相比,其发病的平均年龄更高、患者全身状况更差,因此预后也较差[1].老年人股骨转子间骨折的治疗经历了从非手术治疗到内固定手术治疗,再到现在颇有争议的人工关节置换,治疗方法的选择长久以来一直存在争议.当然,随着医疗技术水平的提高,手术治疗取代保守治疗已成为广大医生的共识.     

近侧趾间关节移植重建近侧指间关节内固定方法的生物力学研究

目的比较近侧趾间关节移植重建近侧指间关节4种内固定的生物力学性能,为临床选择内固定提供依据。方法取48对指、趾尸体标本,随机分成4组,分别用交叉克氏针、十字钢丝加单枚斜形克氏针、微型钢板背侧和微型钢板侧方固定,制成近侧趾间关节移植重建近侧指间关节标本,测量模拟活动后内固定的生物力学性能。结果微型钢板背侧固定和十字钢丝加单枚克氏针斜形固定2种固定方法具有较好的稳定性,微型钢板固定和交叉克氏针固定2种固定方法稳定较差。结论十字钢丝加单枚克氏针斜形固定操作简单、软组织剥离少、有较强的稳定性,是较好的固定方法,适合早期功能锻炼。     

Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines

Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general medical condition.     

Association of daytime napping and Parkinsonian signs in Alzheimer's disease

BACKGROUND AND PURPOSE: Excessive daytime sleepiness (EDS) is reported in Alzheimer's disease (AD), with unstable sleep-wake rhythms that worsen with advancing disease stage. EDS is also very common in Parkinson's disease (PD), regardless of disease severity. The purpose of this study was to determine whether more Parkinsonian motor signs exist in AD patients with more reported daytime napping compared to AD patients without daytime napping. PATIENTS AND METHODS: AD patients ((National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association) NINCDS/ADRDA criteria) were prospectively evaluated in a dementia clinic. Parkinsonian motor signs were assessed using a modified motor Unified Parkinson's Disease Rating Scale (mmUPDRS). AD patients were grouped according to daytime napping frequency: (1) minimal napping (AD-Naps), or (2) napping at least once a day (AD+Naps). Wilcoxon rank-sum tests and chi2-tests computed differences between groups for mmUPDRS, nighttime sleep disturbances, and the Mini Mental State Examination (MMSE). Statistical significance was set at P<0.05. RESULTS: AD patients were classified as AD-Naps (n=155) or AD+Naps (n=180). Compared with AD-Naps patients, AD+Naps patients had higher total mmUPDRS scores (P<0.001), higher rigidity scores (P<0.005), and more gait impairment (P<0.001). CONCLUSION: AD patients with more reported daytime napping had more Parkinsonian motor signs, suggesting that this subgroup may have an increased propensity for sleepiness resembling PD. Longitudinal studies with objective measures are needed to determine whether causal relationships exist between sleepiness and Parkinsonism in AD.     

Anatomic relations of the arachnoidea around the pituitary stalk: relevance for surgical removal of craniopharyngiomas

Purpose  

The growth pattern of craniopharyngiomas (CP) is yet to be understood due to challenges arising from the diversity of morphological features that exist. This in turn has had implications on the development of safe surgical strategies for management of these lesions. The aim of this study is to propose a morphological classification of CP based on their tumor–membrane relationship. It is hoped that this will contribute to better understanding of CP morphology and prediction of the intraoperative classification.     

MTA1基因调控人前列腺癌PC-3细胞失巢凋亡的研究

目的:探讨MTA1基因小干扰RNA(siRNA)对前列腺癌细胞PC-3增殖和失巢凋亡的影响。方法:应用MTA1 siRNA转染处理人前列腺癌细胞系PC-3后,采用实时定量PCR和W estern印迹检测MTA1基因mRNA和蛋白水平,采用软琼脂集落培养试验检测锚着不依赖性增殖,采用琼脂糖凝胶电泳和流式细胞术检测癌细胞失巢凋亡。结果:与对照组比较,MTA1基因siRNA转染组MTA1 mRNA和蛋白水平明显下降,且呈浓度依赖性(r=0.935,P=0.0001)。MTA1 siRNA转染组软琼脂集落形成数明显减少,且与浓度相关(r=0.901,P=0.0005)。琼脂糖凝胶电泳和流式细胞术结果显示,MTA1 siRNA转染可诱导前列腺癌细胞失巢凋亡,且与浓度相关(r=0.916,P=0.0003)。结论:MTA1 siRNA可抑制人前列腺癌细胞增殖,诱导失巢凋亡是其机制之一。     

强脉冲光联合三乙醇胺乳膏治疗激素依赖性皮炎的临床观察

目的：观察强脉冲光联合三乙醇胺乳膏治疗激素依赖性皮炎的临床疗效。方法7：5例激素依赖性皮炎患者,随机分为两组。治疗组3：8例,用强脉冲光治疗,1次/月,期间三乙醇胺乳膏外涂面部2,次/天;对照组3：7例,单纯外用三乙醇胺乳膏,2次/天。两组均应用抗组胺药口服3个月,3个月后判定疗效。结果：治疗3个月后,治疗组和对照组有效率分别为78.95%和54.05%,疗效有显著差异（χ2=5.24,P〈0.05）。结论：强脉冲光联合三乙醇胺乳膏治疗激素依赖性皮炎疗效满意,联合作用明显,无明显不良反应。