平板运动试验阴性患者最大ST/HR斜率对冠心病的诊断价值

目的探讨平板运动试验阴性患者最大ST/HR斜率对冠心病的诊断价值.方法选择122例平板运动试验阴性而临床有明显冠心病指征的患者进行冠状动脉造影,测定其最大ST/HR斜率.结果平板运动试验阴性患者最大ST/HR斜率诊断冠心病的敏感性为68.2%,特异性为80.8%,准确性为76.2%;运动峰值心率＜预计最大心率之85%组最大ST/HR斜率诊断冠心病的敏感性为92.8%,特异性为86.7%,准确性为89.7%,高于运动峰值心率≥预计最大心率之85%组.结论平板运动试验阴性患者最大ST/HR斜率对冠心病的临床诊断有较高的敏感性、特异性和准确性,尤其是对低运动水平的患者,对减少运动试验诊断的漏诊率具有重要意义.     

关于我国体外诊断试剂监督管理改革的建议

本文综述了美国、欧盟、日本、中国目前对体外诊断产品（试剂）监督管理的现状以及我国存在的问题。并根据我国具体情况提出了对体外诊断试剂监督管理的改革建议。     

神经导航技术在脊柱固定手术中的应用(附16例报告)

目的探索使用神经导航技术进行脊柱内固定。方法在神经导航辅助下,对16例患者置入70根椎弓根(侧块)螺钉。通过术后X线摄片核实椎弓根螺钉置入的准确性。结果置入的70根椎弓根(侧块)螺钉长度和直径选择合适,其中68根(97·1%)固定位置及方向准确;早期曾有1根穿出至椎体前方(<1mm),未作处理;1根穿出至椎间盘,经翻修后固定情况良好。无神经和血管损伤症状。结论使用神经导航技术,可以前瞻性地判断置入椎弓根(侧块)钉的大小、位置,实时监测置入过程,提高置入的准确性和安全性。术中脊柱影像三维重建及注册配准对神经导航的准确性有较大影响。     

后程三维适形放疗治疗Ⅲ期非小细胞肺癌临床研究

OBJECTIVE: To evaluate the therapeutic efficacy and radiation complications of late course three-dimensional conformal radiotherapy (3DCRT) in patients with stage III non-small cell lung cancer (NSCLC). METHODS: Eighty-six patients with stage III NSCLC were randomly divided into group A (n=42) receiving conventional radiotherapy at the total dose of 66 to 70 Gy in 33 to 35 fractions completed in 6 to 7 weeks and group B (n=44) with late course 3DCRT at the dose of 24-30 Gy in 6 fractions (400-500 cGy per fraction every other day) after 40 Gy conventional radiotherapy, completed in 5 to 6 weeks. RESULTS: The efficacy rates in groups A and B were 55.0% and 82.9%, and the complete remission rates were 7.5% and 31.7% respectively, showing significant difference between the two groups (P<0.05). The 1- and 2-year survival rates of the patients in group A and B were 62.5% vs 78.0%, and 40.0% vs 53.7% respectively, without significant difference (P>0.05). The median survival time in groups A and B were 11.4 months and 19.8 months respectively. The major radiation complications observed in the two groups were grade I to II acute radiation esophagitis and hematopoietic toxicity. The later stage radiation complications in the two groups were grade I to II radiation lung fibrosis, occurring at a similar rate between the two groups. CONCLUSION: Late course 3DCRT produces better therapeutic effects than conventional radiotherapy in patients with stage III NSCLC.     

上颌骨Le Fort I型截骨进路切除巨大鼻咽纤维血管瘤

目的:探讨上颌骨LeFortI型截骨进路切除累及翼腭凹、颞下凹巨大鼻咽纤维血管肿瘤的可行性。方法:采用矫正上颌骨先天或后天畸形的LeFortI型截骨术式进路,切除位于鼻咽部、筛窦等深在部位的纤维血管瘤。结果:该进路术野显露充分,取得了理想的治疗效果。结论:上颌骨LeFortI型截骨进路是切除鼻咽、颅底部纤维血管瘤的理想进路。     

阿昔洛韦联合胸腺肽抗乙肝病毒疗效观察

本文报道了阿昔洛韦联合胸腺肽对慢性乙型肝炎抗病毒疗效，阿昔洛韦１０ｇ，胸腺肽１６ｍｇ静滴，每日一次，连续治疗２月，共治疗３３例，治疗结束后，治疗组ＨＢｅＡｇ阴转１６例，阴转率５５１７％，ＨＢＶ ＤＮＡ阴转１８例，阴转率５４５４％。对照组ＨＢｅＡｇ阴转率９５２％（２／２５），ＨＢＶ ＤＶＡ阴转率９０９％（１／２５），两组比较有显著性差异（ｐ＜００１），表明阿昔洛韦联合胸腺肽是一种有效、价廉、使用方便的抗乙型肝炎病毒药物。     

化工行业职业性机械伤害危险因素的病例-交叉方法研究

目的 研究化工行业机械伤害的有关诱发因素，估计其作用强度。方法 采用病例-交叉设计的方法。以操作和检修时受伤的化工工人为研究对象，每个对象在受伤后2d内完成调查，收集他们受伤前10min、上一工作日同一段时间和受伤前1周内有关诱发因素暴露的信息，用配对时间段方法和一般频数法进行分析，评估各种诱发因素的危险度。结果 一般频数法分析的结构表明，操作方法异常、设备工具缺陷、工作紧迫、注意力不集中、不使用防护用品、精神状况较差、与同事配合不协调、工作环境发生变化等瞬时危害因素的RR值及95%可信限的下限均大于1。配对时间段方法分析的结果与其相拟，但95%可信限较宽。结论 化工行业职业性机械伤害的发生存在着诸多诱发因素。病例-交叉研究中的一般频数法与配对时间段方法相比，前者所得结果较为可靠，研究的相对效率较高。建议进一步使用多个时间段方法进行研究，以减小混杂因素的影响。     

紫杉醇诱导体外培养胃腺癌细胞系SGC-7901凋亡

目的：研究紫杉醇对胃腺癌细胞系SGC—7901的凋亡诱导作用。方法：紫杉醇不同浓度、不同作用时间分别处理胃腺癌细胞系SGC—7901。采用MTT法测定胃癌细胞的生长抑制率，通过组织学观察、TUNEL等手段检测胃腺癌细胞系SGC--7901细胞凋亡情况。结果：紫杉醇对胃腺癌细胞系SGC—7901有明显的抑制作用，并在一定剂量和时间范围内诱导胃腺癌细胞系SGC—7901凋亡，随着药物浓度的增加及时间的延长，凋亡细胞明显增多，当紫杉醇作用浓度为20μmol/L以上时，细胞出现破碎、坏死。结论：紫杉醇对胃腺癌细胞系SGC—7901有明显的抑制作用，诱导凋亡是其发挥抗癌作用的机制之一。     

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.