安徽省青少年留守状况的流行病学调查

目的:描述安徽省青少年的留守状况,探索不同类型青少年留守率的差异.方法:采用分层整群抽样的方法抽取皖南、皖北城乡普通中学7所,获得样本3 421人,其中留守青少年682人.自行设计流行病学凋查表对研究对象的一般人口学特征和留守状况进行问卷调查.结果:安徽省10 ～ 18岁青少年的留守率为19.94％.不同类型青少年留守...     

A study of the referral patterns of obstetric clinics and the performance of receiving neonatal intensive care units in Taiwan

To study the referral patterns of obstetric clinics, and the performance of receiving intensive care units measured by the survival of transported neonates, transport records were collected prospectively between July, 1991 and June, 1992. Two hundred and fifty-four transported neonates born in 51 obstetric clinics (level I units) in Tainan City and County, in southern Taiwan, were enrolled in this study. Nineteen percent of the transported neonates were very low birthweight infants (<1500 g). Nearly equal numbers of them were transported to eight district hospitals (level II units) and to a tertiary center (level III unit), but these infants were 1.5 times more likely to die in a level II unit than a level III unit. In addition, equal numbers of infants assisted by mechanical ventilators were transported to level II and III units, but these infants were three times more likely to die in a level II unit than a level III unit (P = 0.006). Seventy-seven percent of the normal birthweight infants (≥2500 g) were transported to level II units, and the mortality in this group was 12.3% compared with 0% in those transported to the level III unit. Approximately 56% of these normal birthweight infants in level II units died of severe birth asphyxia. The referral patterns of level I units had an unfavorable effect on the survival of neonates requiring mechanical ventilation. Enhancing the skills of the staff in level I units to recognize and stabilize such infants, elevating the capability of level II units in treating some of these cases, and increasing the hospital beds for level III care are necessary to increase their chance of survival.     

Does a computerized price comparison module reduce prescribing costs in general practice?

OBJECTIVE: We aimed to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module into the computer record system of a defined group of GPs. The GPs' expectations for and experiences with the module were examined. METHOD: We performed a controlled follow-up study on antecedent data before and after intervention. A questionnaire was administered to the intervention group at the introduction and 1 year later. Data on prescribing were collected in the database of the Health Insurance Aarhus County, as a normal routine for accounting. The GPs were not aware of the ongoing cost supervision study. Additional cost information software was introduced on 1 January 1993 to 20 practices with 28 GPs. The software assisted the GPs in a semiautomatic way to identify and prescribe the cheapest drugs. The subjects comprised 158 practices including 231 GPs in Aarhus County, Denmark. Questionnaires were sent to the 20 intervention practices. The main outcome measures were prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD quarterly during 1992 and 1993. RESULTS: Compared with the controls there were no changes in prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD in the intervention group after the introduction of the module. CONCLUSION: Simply giving a random group of GPs computer assistance to choose less expensive drugs did not reduce expenditure per DDD. Cost containment procedures should be more intensive than just giving the doctors a computer-assisted decision aid.      

Temperature response to severe head injury and the effect on body energy expenditure and cerebral oxygen consumption

This study examines the relationship between core temperature and whole body energy expenditure, cerebral oxygen consumption (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP) in severely head injured children. A total of 107 serial measurements of temperature, energy expenditure, CMRO2, CBF, and ICP were made in 18 head injured children receiving neurointensive care. Energy expenditure was measured using indirect calorimetry, and CMRO2 and CBF using the Kety-Schmidt technique. The mean rectal temperature was 37.8 degrees C (34-39.1 degrees C) despite modification with paracetamol. Within each child there was a positive relationship between rectal temperature and energy expenditure, energy expenditure increasing by a mean of 7.4% per degree C. There was no evidence of significant relationships between rectal temperature and CMRO2, CBF, or ICP. Mild induced hypothermia in two children did not result in decreased CMRO2 or CBF measurements. The efficacy of interventions aiming to modify cerebral energy metabolism by changing core temperature cannot be readily assessed by the response of the whole body.     

Mode of action of the IgG inhibitor of erythropoiesis in transient erythroblastopenia of children

Twelve cases of transient erythroblastopenia of childhood (TEC) have been studied to evaluate their marrow cell erythropoiesis in vitro and the effect on it of their serum or IgG. The number of colony-forming units-erythroid (CFU-E) and burst-forming units-erythroid (BFU-E) in the bone marrow of nine cases was extremely variable and did not allow any conclusion regarding the pathogenesis of this anemia. An IgG inhibitor of growth of erythroid colonies or bursts was detected in 8/12 cases. This IgG inhibitor had no effect on the growth of granulocyte-macrophage colonies. Further studies on its mode of action indicated that the IgG did not have antierythropoietin antibody properties and did not affect the mature erythroblasts, as shown by a lack of inhibition of their responses to erythropoietin and by the lack of a cytotoxic effect on 59Fe-labeled erythroblasts. In four cases, preincubation studies demonstrated a direct effect of the IgG on the CFU-E, which was complement-mediated in three cases and complement- independent in one case. In two other cases, the IgG suppressed the growth of normal BFU-E only without affecting the growth of CFU-E. The IgG inhibitor was no longer present after the erythroblastopenia had remitted. These studies demonstrate that in the majority of cases of TEC, an IgG suppressor of erythropoiesis in vitro is present. Its mode of action is heterogeneous regarding its requirement for complement. Its target cells are the earlier or later erythroid progenitors, BFU-E or CFU-E, but not the differentiated erythroblasts.     

Peritoneal cystic mesothelioma presenting as a cystic mass in the pelvis: a challenging differential diagnosis

Peritoneal cystic mesothelioma is a relatively rare neoplasm, characterized by cystic lesions of various sizes on both visceral and parietal peritoneal surfaces. When located in the pelvis, a wide spectrum of cystic or multicystic lesions should be included in the differential diagnosis. From an imaging point of view, no definite differential diagnostic suggestions can be made, because reports of peritoneal cystic mesothelioma are few and consist mostly of case reports. The rarity of this disease, as well as its malignant potential, include it among the challenging differential diagnoses of pelvic/peritoneal cystic masses, especially in the case of a paraovarian cyst with identification of ovaries with non-suspect morphology. In this case, repetition of transvaginal ultrasound examination after a few weeks seems to be appropriate. When the findings persist, cystic peritoneal mesothelioma must be included in the differential diagnosis. Nevertheless, it seems that the definitive diagnosis of peritoneal cystic mesothelioma can be made only after surgery. Imaging with ultrasonography and magnetic resonance could play an important role in disease follow-up.     

Transmyocardial laser revascularization in combination with coronary artery bypass: Clinical, wall motion and perfusion effects

Background. Transmyocardial laser revascularisation (TMR) is increasingly used in the management of intractable angina in the absence of graftable vessels, however it’s role in combination with coronary artery bypass remains undefined. The aim of this pilot study was to investigate the impact of the combination therapy. Methods. Patients (20) undergoing elective coronary artery bypass surgery with one or more non-graftable coronary arteries were prospectively randomized to either have bypass graft surgery alone (CABG) or bypass graft surgery and transmyocardial revascularization with a holmium — YAG laser to non-graftable areas (CABG+TMR). All patients had exercise tolerance test preoperatively and at 6 and 18 months follow-up. Stress echocardiography was performed on 17 patients 18 months following surgery. Wall motion analysis (1=normal, 2=hypokinesis, 3=akinesis, 4=dyskinesis) using the 16 segment model of the left ventricle and rest and stress perfusion analysis were performed. Results. Both groups of patients were similar in preoperative demographics and operative data. There was no perioperative mortality. There was no difference between the two groups in angina scoring at 6 and 18 months follow-up. Exercise tolerance improved by a mean of 46.8±20.0 seconds per patient in the CABG group and by 199.2±66.5 seconds per patient in the CABG+TMR group (p<0.05) and this was maintained at 18 months (157±46.3 vs 61±39.2 seconds; p<0.05). Regional wall motion score index (WMSI) (total score/number of segments) was calculated in non-revascularizable myocardium treated with TMR and compared to areas that were not lased. Although the WMSI in TMR regions is lower at each stage of dobutamine stress, this does not reach statistical significance. Conclusion. The combination of coronary artery bypass and transmyocardial laser revascularization is safe and improves exercise tolerance in patients in whom complete revascularization cannot be achieved by bypass graft surgery alone. Competition paper presented at the 48th Annual Conference of IACTS at Chennai Feb. 2002     

蛇床子中一新的角型呋喃香豆素

从辽宁新民产蛇床Cnidium monnieri 果实中分离鉴定8个化合物,分别为欧山芹素(oroselone,Ⅰ),β谷舀醇(Ⅱ),哥伦比亚内酯(columbianadin,Ⅲ),佛手柑内醋(bergapten,Ⅳ),O-乙酰哥伦比亚甙贰元(O-acetycolumbianetin,v),O-乙酰异蛇床素(cniforinA,Ⅵ),爱得尔庭(edultin,Ⅶ)和'-乙酰白芷素(2'-acetylangelicin,Ⅷ)。其中化合物Ⅷ为一新化合物,化合物Ⅰ系首次从该植物中分得。     

烧伤内毒素血症

1985年7月～1987年11月,对收治于美国约翰·霍普金斯大学巴尔的摩烧伤中心的68例烧伤病人,采用基质显色法鲎试验进行了407次血浆内毒素的定量检测,经多次验证,该试剂稳定可靠,但也发现两个问题:(1)目前广泛用加热+稀释的方法企图移除血浆中干扰内毒素检出的因素(我们用70℃,10min)尚无法全部移除该干扰因素。通过对204个血浆标本(包括部分正常对照的人血浆)加入已知量标准内毒素的检测,平均检出率只达54.2％。在未能全部解决这一难题前,应对各个样品另加已知量的内毒素求其检出率,再行换算,才能获得血浆内真正的内毒素值。(2)肝素可明显抑制内毒素的检出,采全血5ml,抗凝用的肝素应不超过20U,否则,内毒素检出值将相应下降。对一组39例不同烧伤面积的病人,在伤后5天内连续进行血浆内毒素的检测,血循环中总内毒素的平均量与烧伤面积相关,伤后3～4天有一峰值。另对29例烧伤面积20～75％病人,进行伤后两周内定期抽血检查、内毒素阳性者17例(占58.6％)。提示烧伤后内毒素血症比较常见。本组内毒素血症与革兰氏阴性杆菌菌血症或创面脓毒症的相关率为71％。其他来源,尚待探索。