城市社区卫生服务集团化模式探讨

社区卫生服务是实现公共卫生目标的有效形式,已被许多国家的公共卫生服务的实践所证明,但由于各国的实际情况不同而采取的社区服务的模式亦不完全相同。近年来,我国社区卫生服务经历了启动、开展、发展的过程,并随着医疗卫生体制改革的不断深入,日渐呈现出迅猛发展的势头。但就     

X线、MSCT和MRI对主动脉夹层的临床运用对比研究

目的对比分析X线、MSCT及MRI在主动脉夹层（AD）中影像学特征,并评价其临床运用价值。方法 30例经手术或行DSA造影证实的AD患者,对其X线、MSCT及MRI检查影像资料进行分析,总结归纳其影像特点。结果 X线仅见AD的间接征象,而MSCT和MRI均能不同程度地显示真假两腔、内膜破口、内膜片及附壁血栓。结论 X线对AD只能提示诊断,而MSCT和MRI可作特异性诊断,并且MRI在显示AD的破口位置、无钙化的内膜片及附壁血栓时均优于MSCT,但对内膜及主动脉壁钙化和急危重者的检查MSCT优于MRI。     

The causal relationships between obstructive sleep apnea and elevated CRP and TNF-α protein levels

BackgroundObstructive sleep apnea (OSA) and inflammation are closely related. This study aimed to evaluate the associations and causal effect between C-reactive protein (CRP) and tumour necrosis factor-alpha (TNF-α) levels and OSA.MethodsPooled analysis was conducted to compare the expression differences of CRP and TNF-α between OSA patients with different severity and controls, and between continuous positive airway pressure (CPAP) and non-CPAP interventions for OSA patients. Using published GWAS summary statistics, we conducted a bidirectional two-sample Mendelian Randomization (MR) to estimate the causal relationships between CRP and TNF-α levels and OSA risk. Effect estimates were evaluated using inverse-variance weighted (IVW) as primary method, and several other MR methods as sensitivity analysis.ResultsBoth TNF-α (WMD [95%CI] = 5.86 [4.80–6.93] pg/ml, p < .00001) and CRP (WMD [95%CI] = 2.66 [2.15–3.17] mg/L, p < .00001), showed a significant increase in OSA patients compared with controls and this increasing trend was associated with OSA severity. Besides, compared to blank control (non-CPAP), CPAP treatment can reduce high TNF-α (WMD [95%CI]= −4.44 [−4.81, −4.07]pg/ml, p < .00001) and CRP (WMD [95%CI]= −0.91 [−1.65, −0.17] mg/l, p = .02) in OSA. Moreover, the primary MR analysis by IVW showed that OSA was the genetically predicted cause of elevated CRP (estimate: 0.095; 95% CI, [0.010–0.179]; p = .029) using six SNPs as the instrument variable, which were repeated by weighted median (estimate: 0.053; 95% CI, [0.007, 0.100]; p =.024) and MR RAPS (estimate: 0.109; 95% CI, [0.079, 0.140]; p = 1.98x10⁻¹²). Besides, the causal effect from elevated CRP on increased OSA risk was almost significant by IVW (OR:1.053; 95% CI, [1.000, 1.111]; p = .053). However, there were no causal associations between TNF-α and OSA from both directions.ConclusionsIncreased CRP and TNF-α were associated with OSA severity and sensible to CPAP treatment. Also, OSA had a suggestive causal effect on elevated CRP.     

肾上腺腺瘤的CT表现

目的:探讨肾上腺腺瘤的CT平扫及动态增强后的特征表现。方法:对35例肾上腺占位的患者资料进行回顾性分析,计算其平扫CT值、相对廓清率及绝对廓清率。然后行统计学分析。结果:有完整资料的19例肾上腺肿瘤中,腺瘤8例,非腺瘤11例。腺瘤的平扫CT值≤10HU的有7例,相对廓清率≥60%和绝对廓清≥40%分别为5例和4例;非腺瘤平扫CT值>10HU的有11例,相对廓清率≥60%和绝对廓清≥40%分别为1例。结论:可采用平扫CT值≤10HU,相对廓清率≥60%或绝对廓清率≥40%作为肾上腺腺瘤与非腺瘤的鉴别阈值。     

大鼠正常血糖脑缺血及高血糖脑缺血时p38MAPK的表达

目的探讨p38MAPK与脑缺血及高血糖脑缺血损害的关系。方法实验大鼠随机分为3组:(1)高血糖脑缺血组(简称高血糖组,20只),于脑缺血术前30min尾静脉注射25%葡萄糖(4g/kg);(2)正常血糖脑缺血组(简称正常血糖组,20只),于脑缺血术前30min尾静脉注射等量18%D-甘露醇;(3)手术非缺血性对照组(10只)。采用双侧颈动脉结扎和放血法在高血糖组和正常血糖组制造全脑缺血模型,通过免疫组织化学技术与Western blot免疫印迹技术对比检测缺血30min,再灌注1、3、6h各时间点脑组织p38MAPK表达。结果对照组海马CAI区、CAIII区,未见p38MAPK阳性神经元;免疫组化在CAI区和CAIII区,在缺血30min,再灌注13、、6 h不同时间点高血糖组阳性细胞数与正常血糖组比较差异无统计学意义(P>0.05);Western blot检测可见正常血糖组和高血糖组脑缺血30min,再灌注1、36、h时激活的p38MAPK蛋白明显增加,高血糖组灰度比值(分别为7.25±1.91、8.64±2.41、9.58±2.98、12.00±3.01)与正常血糖组(分别为6.68±1.51、7.92±1.75、8.34±2.00、9.02±2.27)比较,p38MAPK差异无统计学意义(P>0.05)。结论脑缺血再灌注时p38MAPK被激活,参与缺血性损伤的发生,但高血糖并不能明显增加p38MAPK的总量,故在高血糖加重脑缺血性损伤中p38MAPK可能不发挥主要作用。     

膀胱炎性肌纤维母细胞瘤2例CT影像报告并文献复习

目的 探讨膀胱炎性肌纤维母细胞瘤(IMTB)的临床特点及CT影像学特征,加强认识以提高诊断水平.方法 回顾性分析2例IMTB患者的临床与影像资料,并结合文献进行探讨.结果 IMTB患者年龄偏小,以无痛性肉眼血尿和排尿困难为最常见症状,好发于顶壁、前壁及侧壁,增强呈"快进慢出"强化征象,无盆腔其它脏器或淋巴结转移.结论 ...     

Research Progress on Emerging Viral Pathogens of Small Ruminants in China during the Last Decade

China is the country with the largest number of domestic small ruminants in the world. Recently, the intensive and large-scale sheep/goat raising industry has developed rapidly, especially in nonpastoral regions. Frequent trading, allocation, and transportation result in the introduction and prevalence of new pathogens. Several new viral pathogens (peste des petits ruminants virus, caprine parainfluenza virus type 3, border disease virus, enzootic nasal tumor virus, caprine herpesvirus 1, enterovirus) have been circulating and identified in China, which has attracted extensive attention from both farmers and researchers. During the last decade, studies examining the etiology, epidemiology, pathogenesis, diagnostic methods, and vaccines for these emerging viruses have been conducted. In this review, we focus on the latest findings and research progress related to these newly identified viral pathogens in China, discuss the current situation and problems, and propose research directions and prevention strategies for different diseases in the future. Our aim is to provide comprehensive and valuable information for the prevention and control of these emerging viruses and highlight the importance of surveillance of emerging or re-emerging viruses.     

双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

血清抑制素A在预测孕早期先兆流产孕妇妊娠结局中的应用

目的探讨抑制素A在预测孕早期先兆流产孕妇妊娠结局中的价值。方法选择孕6～13周稽留流产孕妇18例及B超检查示活胎的先兆流产孕妇27例（妊娠继续组17例和难免流产组10例）,同孕龄正常孕妇40例。采用ELISA法测定各组孕妇血清抑制素A水平。结果正常孕妇血清抑制素A在孕早期随孕龄增加而增加,孕10～11周达高峰,孕12～13周逐渐降低。难免流产组血清抑制素A水平明显低于妊娠继续组（P〈0.01）;当抑制素A〈0.3 MoM时可筛查出90%的难免流产,敏感性为90%,特异性为94.1%。结论孕早期血清抑制素A的检测有助于预测先兆流产孕妇不良妊娠结局,当血清抑制素A〈0.3 MoM时对预测难免流产有较高的敏感性和特异性。