五所医院特需医疗服务状况调查

通过对上海医科大学附属华山医院、协和医院、北京同仁医院、中山医科大学附属第一医院、浙江医科大学附属第二医院开展的特需医疗服务情况的调查，论述了五所医院的具体做法，在对调查结果进行分析的基础上，就特需医疗服务的管理提出了建议。     

Carotid-cavernous sinus fistula associated with a primitive trigeminal artery

Carotid-cavernous sinus fistulas are not rare, but they have never been reported in association with persistent primitive trigeminal artery. We recently encountered such a case. The Jaeger-Hamby procedure was employed, with mandatory occlusion of the primitive trigeminal artery.     

影响脐血IgE值因素的研究

目的　本研究对影响脐血IgE值的可疑因素进行分析 ,探讨影响儿童食物过敏的可疑因素。方法　选取孕期妇女 10 5名及其所生婴儿 ,采用标准问卷调查获取资料 ,对影响脐血IgE的因素进行分析。 结果　母亲的过敏性疾病史、父亲过敏性疾病史中的皮炎表现型、孕期妇女过敏性疾病发作史、有过敏史妇女孕后期摄入过量的牛奶和鸡蛋均与脐血IgE值的上升有关 ,且上述 5个因素对脐血IgE水平的影响依次降低。 结论　母亲的过敏性疾病史和父亲过敏性疾病史中的皮炎表现型是导致新生儿脐血IgE值升高的主要危险因素 ;同时 ,妊娠期加强对有过敏史妇女的保护 ,防止过敏性疾病的复发 ,在孕后期控制有过敏史妇女牛奶、鸡蛋等大分子食物致敏原的摄入 ,有助于降低脐血IgE值。     

Calcification and ossification of chronic encapsulated intracerebral haematoma: case report.

We report a case of calcified chronic encapsulated intracerebral haematoma (ICH) in a 29-year-old female who presented with progressive left sided weakness and intermittent seizures since childhood. The preoperative magnetic resonance (MR) imaging of the head initially suggested that a partially thrombosed aneurysm or vascular malformation was present. However, no vascular stain was found on the digital subtraction angiography (DSA) of both the carotid and vertebral arteries. The excised mass was histologically diagnosed as a chronic ICH. We traced the patient's medical history and found that at the age of one she sustained a head injury after a fall. So far, to our knowledge, no case of epilepsy secondary to a calcified chronic encapsulated ICH occurring 28 years after head injury has been reported. Calcified chronic encapsulated ICH concomitant with new bone formation within is even rarer. The possible pathogenesis of this case is discussed.     

Skeletal unloading induces resistance to insulin-like growth factor-I (IGF-I) by inhibiting activation of the IGF-I signaling pathways.

We showed that unloading markedly diminished the effects of IGF-I to activate its signaling pathways, and the disintegrin echistatin showed a similar block in osteoprogenitor cells. Furthermore, unloading decreased alphaVbeta3 integrin expression. These results show that skeletal unloading induces resistance to IGF-I by inhibiting activation of the IGF-I signaling pathways at least in part through downregulation of integrin signaling. INTRODUCTION: We have previously reported that skeletal unloading induces resistance to insulin-like growth factor-I (IGF-I) with respect to bone formation. However, the underlying mechanism remains unclear. The aim of this study was to clarify how skeletal unloading induces resistance to the effects of IGF-I administration in vivo and in vitro with respect to bone formation. MATERIALS AND METHODS: We first determined the response of bone to IGF-I administration in vivo during skeletal unloading. We then evaluated the response of osteoprogenitor cells isolated from unloaded bones to IGF-I treatment in vitro with respect to activation of the IGF-I signaling pathways. Finally we examined the potential role of integrins in mediating the responsiveness of osteoprogenitor cells to IGF-I. RESULTS: IGF-I administration in vivo significantly increased proliferation of osteoblasts. Unloading markedly decreased proliferation and blocked the ability of IGF-I to increase proliferation. On a cellular level, IGF-I treatment in vitro stimulated the activation of its receptor, Ras, ERK1/2 (p44/42 MAPK), and Akt in cultured osteoprogenitor cells from normally loaded bones, but these effects were markedly diminished in cells from unloaded bones. These results were not caused by altered phosphatase activity or changes in receptor binding to IGF-I. Inhibition of the Ras/MAPK pathway was more impacted by unloading than that of Akt. The disintegrin echistatin (an antagonist of the alphaVbeta3 integrin) blocked the ability of IGF-I to stimulate its receptor phosphorylation and osteoblast proliferation, similar to that seen in cells from unloaded bone. Furthermore, unloading significantly decreased the mRNA levels both of alphaV and beta3 integrin subunits in osteoprogenitor cells. CONCLUSION: These results indicate that skeletal unloading induces resistance to IGF-I by inhibiting the activation of IGF-I signaling pathways, at least in part, through downregulation of integrin signaling, resulting in decreased proliferation of osteoblasts and their precursors.     

纸质病案保存期限的思考

本文作者比较了不同时期的纸质病案的使用率,讨论了旧病案的缺点,如难于保存,占用空间及实用价值不大.作者提出了改进保存病案的办法.     

Prevalence of knee abnormalities in patients with osteoarthritis and anterior cruciate ligament injury identified with peripheral magnetic resonance imaging: a pilot study.

OBJECTIVES: 1) To assess, with a peripheral magnetic resonance imaging system (pMRI), the prevalence of bony and soft tissue abnormalities in the knee joints of normal subjects, osteoarthritis (OA) patients, and individuals who have suffered an anterior cruciate ligament (ACL) rupture; and 2) to compare the prevalence among groups. METHODS: Magnetic resonance (MR) images of 28 healthy, 32 OA, and 26 ACL damaged knees were acquired with a 1.0-T pMRI system. Two radiologists graded the presence and severity of 9 MR image features: cartilage degeneration, osteophytes, subchondral cyst, bone marrow edema, meniscal abnormality, ligament integrity, loose bodies, popliteal cysts, and joint effusion. RESULTS: Ten of 28 healthy (35.7%), 24 of 26 ACL (92.3%), and all OA knees (100%) showed prevalent cartilage defects; 5 healthy (17.9%), 20 ACL (76.9%), and all OA knees (100%) had osteophytes; and 9 normal (32.1%), 21 ACL (80.8%), and 29 OA knees (90.6%) had meniscal abnormalities. One-half of the knees in the OA group (16 of 32, 50%) had subchondral cysts, and almost one-half had bone marrow edema (15 of 32, 46.9%). These features were not common in the ACL group (7.7%, and 11.5%, respectively) and were not observed in healthy knees. The OA group had the most severe cartilage defects, osteophytes, bone marrow edema, subchondral cysts, and meniscal abnormalities; the ACL group showed more severe cartilage defects, osteophytes, and meniscal abnormalities than did normal subjects. CONCLUSION: The results suggest that knees that have sustained ACL damage have OA-like reatures; most subjects (19 of 26, 73.1%) could be identified as in the early stage of OA. The prominent abnormalities present in ACL-damaged knees are cartilage defects, osteophytes, and meniscal abnormalities.     

Health-related quality of life in Taiwanese patients with bronchial asthma.

BACKGROUND AND PURPOSE: Health-related quality of life (HRQOL) is primarily an assessment of how domains of life are affected by health. This study investigated the factors influencing HRQOL of Taiwanese patients with bronchial asthma. METHODS: A cross-sectional study was conducted to assess the factors influencing HRQOL. The sample consisted of 242 outpatients with bronchial asthma. The Chinese language version of the St. George's Respiratory Questionnaire was used to measure HRQOL. Data were analyzed using simple regression and multiple regression. RESULTS: Age, marital status, level of education, asthma severity, peak expiratory flow, and previous hospital admissions were found to be predictors of HRQOL. Gender, duration of disease, and history of emergency visits were not correlated with HRQOL. The variables entered in the HRQOL model accounted for 17.4% of the total variance (adjusted R(2)). The regression coefficients indicated that the mean scores increased 7.68 in patients with moderate to severe disease severity, and increased 7.34 in patients with a history of hospital admissions. The mean scores decreased 7.60 in married patients. CONCLUSION: This study found that marital status, asthma severity, and history of hospital admissions were major predictors of HRQOL in Taiwanese patients with bronchial asthma.