肛裂内括约肌切断术的研究进展

［摘要］　肛裂是肛肠外科常见、多发疾病,严重影响患者的生活质量。内括约肌切断术是临床上常用的手术方法,但是此手术方式多样,各有利弊,该文简述近年来内括约肌切断术治疗肛裂的研究进展。     

二维斑点追踪纵向应变评价不同部位右心室起搏患者心脏收缩同步性

目的利用二维斑点追踪超声纵向应变比较不同部位右心室起搏对左心室收缩不同步性的影响。方法有双腔起搏器植入指征的无器质性心脏病变患者共60例,按1:1随机数表法随机分为两组,根据分组结果分别将右心室电极植入右心室流出道间隔部(right ventricular outflow tract septum,RVOTs)及右心室心尖(right ventricular apex,RVA)。术后起搏器程控并保证心室完全起搏后,进行二维斑点超声成像分析,记录左心室收缩时纵向应变达峰时间的最大差(LS-TD)。结果 RVA组左心室收缩时纵向应变最大差大于RVOT组,差异有统计学意义[(161.6±43.9)ms vs.(74.3±13.7)ms,P<0.001]。结论二维斑点追踪超声纵向应变结果显示RVOT起搏时的左心室收缩同步性优于RVA起搏。     

软坚护肝片的急性毒性及一般药理学研究

目的 观察软坚护肝片对实验动物的急性毒性及中枢神经系统、心血管系统和呼吸系统的影响.方法 小鼠20只,按最大给药量法给予软坚护肝片(19.84 g/kg),2次/d,14 d后观察急性毒性反应;不同剂量软坚护肝片(0.31、0.62、1.24 g/kg)分别给予各组小鼠灌胃给药,观察小鼠自主活动和运动协调能力;不同给药剂量软坚护肝片(0.31、0.62、1.24 g/kg)分别给予各组麻醉大鼠十二指肠给药,观察大鼠的收缩压、舒张压、平均动脉压、心率、呼吸频率、呼吸幅度.结果 软坚护肝片19.84 g/kg灌胃给药14 d后,小鼠无毒性反应.软坚护肝片各剂量组对小鼠自主活动和运动协调能力无明显影响(P＞0.05);对麻醉大鼠血压、平均动脉压、心率、呼吸频率、呼吸幅度均无明显影响(P＞0.05).结论 软坚护肝片对实验动物心血管系统、呼吸系统、自主神经系统均无明显影响.     

Insulin Clearance and the Incidence of Type 2 Diabetes in Hispanics and African Americans: The IRAS Family Study

OBJECTIVE

We aimed to identify factors that are independently associated with the metabolic clearance rate of insulin (MCRI) and to examine the association of MCRI with incident type 2 diabetes in nondiabetic Hispanics and African Americans.

RESEARCH DESIGN AND METHODS

We investigated 1,116 participants in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study with baseline examinations from 2000 to 2002 and follow-up examinations from 2005 to 2006. Insulin sensitivity (S_I), acute insulin response (AIR), and MCRI were determined at baseline from frequently sampled intravenous glucose tolerance tests. MCRI was calculated as the ratio of the insulin dose over the incremental area under the curve of insulin. Incident diabetes was defined as fasting glucose ≥126 mg/dL or antidiabetic medication use by self-report.

RESULTS

We observed that S_I and HDL cholesterol were independent positive correlates of MCRI, whereas fasting insulin, fasting glucose, subcutaneous adipose tissue, visceral adipose tissue, and AIR were independent negative correlates (all P < 0.05) at baseline. After 5 years of follow-up, 71 (6.4%) participants developed type 2 diabetes. Lower MCRI was associated with a higher risk of incident diabetes after adjusting for demographics, lifestyle factors, HDL cholesterol, indexes of obesity and adiposity, and insulin secretion (odds ratio 2.01 [95% CI 1.30–3.10], P = 0.0064, per one-SD decrease in log_e-transformed MCRI).

CONCLUSIONS

Our data showed that lower MCRI predicts the incidence of type 2 diabetes.Insulin clearance is an integral component of insulin metabolism, as it regulates the cellular response to the hormone by decreasing insulin availability and mediates certain aspects of insulin action (1). The liver is the primary site of insulin clearance. Approximately 80% of endogenous insulin is removed by the liver, and the remainder is cleared by the kidneys and muscles (2). Clearance rates for insulin decrease in glucose intolerance (3), obesity (4), in particular abdominal obesity (5), hypertension (6), hepatic cirrhosis (7), and nonalcoholic fatty liver disease (8).Although the plasma concentration of insulin is largely determined by its rate of secretion and clearance, existing evidence suggests that increased insulin resistance is associated with reduced insulin clearance (9–12). Reduced insulin clearance has important physiological functions; for example, animal models have shown that decreased insulin clearance serves as a compensatory mechanism to preserve β-cell function and to maintain peripheral insulin levels in the states of insulin resistance (13,14). In addition, insulin clearance has been found to be a highly heritable trait in Mexican Americans, and specific haplotypes in the AMPD1 gene were associated with variation in insulin clearance (15).Despite its potential role in the etiology of diabetes, little is known about the factors that are independently associated with decreased insulin clearance. In addition, no previous study has investigated whether decreased insulin clearance predicts the risk of type 2 diabetes. In this study, we aimed to identify demographic and metabolic factors that are independently associated with the metabolic clearance rate of insulin (MCRI), and to examine its association with the 5-year risk of incident type 2 diabetes, using the data from a large, well-characterized cohort of Hispanics and African Americans with direct measurements of insulin metabolism (secretion, sensitivity, and clearance) and adipose tissue (visceral and subcutaneous) in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study.     

2008-2015年广西手足口病流行病学特征及时空聚集性分析

目的 分析广西2008-2015年手足口病的流行病学特征,并重点探究该病的时空聚集性,为手足口病的精准防控提供理论依据。方法 从疾病监测信息报告系统获取以县区为单位的手足口病数据,采用Excel 2010对数据进行处理,描述疾病的三间分布;利用SaTScan 9.4.2软件探测广西手足口病时空聚集性,并比较不同风险人口数为最大空间扫描半径的探测效果,从中选择最优模式。结果 广西2008-2015年各市均有手足口病病例报告,8年累计报告病例1 360 857例,年平均发病率为359.61/10万,以4~7月为发病高峰,9~11月为次高峰;男性发病率高于女性,所有病例中0~5岁儿童占92.28%。不同风险人口数最大空间扫描半径得到的探测效果不同,选择最优模式进行分析（以10%人口数为最大空间扫描半径）,南宁市和柳州市的各县区分别为主要的一类聚集区和二类聚集区,且聚集时间基本集中在每年的3~7月。结论 广西手足口病持续处于高流行态势,且存在时空聚集性,应在高发时间重点加强南宁市和柳州市各县区的手足口病防控。     

体力活动与女性乳腺癌发病关系的病例对照研究

目的 探讨体力活动与乳腺癌发病的关系。方法 采用以医院为基础的病例对照研究,调查某大学2所附属医院2012年4月~2014年12月间确诊的25～70岁549例乳腺癌患者和同期同医院就诊的549例非肿瘤患者的体力活动情况和相关危险因素。采用非条件Logistic回归模型分析体力活动与乳腺癌发病的关系。结果 校正各种混杂因素后,非职业性体力活动与乳腺癌发病风险降低有关（OR=0.69,95% CI：0.48～1.00）;与不参加体育活动者相比,参加体育活动对乳腺癌发病有保护作用（OR=0.61,95% CI：0.43～0.87）;与久坐不动的职业相比,轻度职业活动对乳腺癌发病有保护作用（OR=0.67,95% CI：0.47～0.97）,而家务活动与乳腺癌发病风险无关。不同雌激素受体（estrogen receptor,ER）和孕激素受体（progesterone receptor,PR）状态的亚组分析中,非职业性体力活动与ER+/PR+乳腺癌的发病风险降低有关。结论 非职业性体力活动、体育活动和轻度职业活动对女性乳腺癌有保护作用。     

Sabin株脊髓灰质炎灭活疫苗与不同剂型Ⅰ型Ⅲ型脊髓灰质炎减毒活疫苗序贯接种的抗体滴度比较

目的  比较Sabin株脊髓灰质炎灭活疫苗(Sabin strain-based inactivated poliovirus vaccine,sIPV)与不同剂型Ⅰ型Ⅲ型脊髓灰质炎减毒活疫苗(bivalent types Ⅰ and Ⅲ oral poliovirus vaccine,bOPV)序贯接种的抗体滴度。 方法  选择柳州400名2月龄婴儿,按1：1：1：1随机分为sIPV+2bOPV糖丸、sIPV+2bOPV液体、2sIPV+bOPV糖丸、2sIPV+bOPV液体4组,按0 d、28 d、56 d免疫程序接种疫苗。检测免前、免后28 d脊灰中和抗体滴度。 结果  序贯程序相同时,1剂sIPV糖丸组与液体组免后Ⅰ型抗体滴度分布差异有统计学意义(Z=-2.589,P=0.010),Ⅱ型(Z=-0.331,P=0.741)和Ⅲ型(Z=-1.556,P=0.120)差异均无统计学意义(均有P>0.05);2剂sIPV糖丸组与液体组免后Ⅰ型(Z=-1.249,P=0.212)、Ⅱ型(Z=-1.658,P=0.097)和Ⅲ型(Z=-1.436,P=0.151)抗体滴度分布差异均无统计学意义(均有P>0.05)。剂型相同时,2剂sIPV组与1剂sIPV组各型抗体滴度分布差异均有统计学意义(均有P < 0.05)(1剂sIPV液体组与2剂sIPV液体组：Ⅰ型：Z=-2.766,P=0.006;Ⅱ型：Z=-9.137,P < 0.001;Ⅲ型：Z=-5.529,P < 0.001。1剂sIPV糖丸组与2剂sIPV糖丸组：Ⅰ型：Z=-3.748,P < 0.001;Ⅱ型：Z=-7.660,P < 0.001;Ⅲ型：Z=-6.030,P < 0.001)。 结论  bOPV糖丸和液体剂型免疫效果相似,各地接种部门应结合疫苗效果、接种对象特征和人口密度,选择适宜剂型接种;如sIPV供应充足,建议优先选择2剂sIPV序贯程序完成脊灰基础免疫接种。     

听力正常学龄前儿童语音发育规律研究

目的:初步探讨3～5岁听力正常儿童语音发育规律.方法:在建立汉语普通话3～5岁儿童日常生活口语词库的基础上,将词库中的单音节词分解成拼音音节及音素,计算字频、音素音节出现频率,并与成人组进行比较.结果:3～5岁儿童组口语词汇中出现全部汉语普通话所包括的音位,经独立样本t检验,与成人组言语中音位分布和频率分布差异无统计学意义.3岁组口语中出现音节323个,占成人音节总数的81.8%,4～5岁组出现369个,占93.4%.结论:3岁儿童言语中出现的音位分布规律和频率高低均与成人类似,提示此时儿童已基本完成言语发育中语音系统水平的发育.     

盐酸米诺环素缓释剂对慢性牙周炎龈沟液弹性蛋白酶水平的影响

目的：观察慢性牙周炎应用盐酸米诺环素缓释软膏治疗前后龈沟液中细胞外弹性蛋白酶（elastase in su-pernatant,EA-s）和细胞内弹性蛋白酶（elastase in the pellet,EA-p）水平的变化。方法：35例慢性牙周炎患者,每例口腔左右两个象限随机分为实验组和对照组,基础治疗后实验组使用盐酸米诺环素缓释软膏,1周1次,共4周,对照组不使用盐酸米诺环素缓释软膏,测定两组治疗前后龈沟液中EA-s和EA-p水平。结果：实验组、对照组在治疗后龈沟液中EA-s和EA-p的总量和浓度均明显降低（p〈0.01）。治疗前后实验组与对照组龈沟液中EA-s和EA-p的总量和浓度变化有显著性差异,实验组优于对照组（p〈0.01）。结论：基础治疗和盐酸米诺环素缓释软膏联合应用对慢性牙周炎的治疗在降低龈沟液中EA方面优于单纯的基础治疗。     

一种新型病证相结合肝阳上亢证颈性眩晕大鼠模型的制备方法

目的 :建立一种简单、可靠的符合肝阳上亢证的颈性眩晕大鼠模型,同时建立一种简便可行的反应动物眩晕程度的评价方法。方法:选用SPF级雄性SD大鼠24只,8周龄,体重280³20 g,随机进行分组(每组6只),使用局部注射聚桂醇注射液(硬化剂)与附子汤灌胃相结合的方法制备肝阳上亢证颈性眩晕大鼠模型(联合造模组),与单用局部注射硬化剂的大鼠(硬化剂组)、单用附子汤灌胃的大鼠(附子汤组)、空白对照组进行对照,以大鼠通过一段玻璃管的时间(跑管时间)反应大鼠的眩晕程度,分别于造模前、造模后第2周、造模后第3周进行观测。结果:附子汤组与空白对照组跑管时间比较差异无统计学意义;联合造模组与硬化剂组跑管时间比较差异无统计学意义;硬化剂组与联合造模组跑管时间延长,不仅与对照组差异有统计学意义(P<0.05),且与附子汤组的差异有统计学意义(P<0.01)。造模后的跑管时间较造模前相比,差异具有统计学意义(P<0.05);比较造模后2、3周的跑管时间,差异无统计学意义(P>0.05)。结论:该造模方法能有效制成肝阳上亢证颈性眩晕大鼠模型,且跑管时间能在一定程度上...