经皮肾镜气压弹道碎石术与开放手术治疗鹿角形肾结石的比较

目的比较经皮肾镜碎石术(PCNL)与开放手术治疗鹿角形肾结石的有效性和安全性。方法回顾性分析我院自2003年6月至2008年12月收治120例鹿角形肾结石患者的临床资料,其中PCNL组79例,开放手术组41例,比较两种治疗手段的手术时间、术中出血量、术后住院天数、结石排净率、并发症发生率等指标。结果 PCNL组与开放手术组的手术时间、术中出血量、术后住院天数差异均有统计学意义(P0.05),结石排净率、术后并发症发生率差异无统计学意义(P0.05)。结论 PCNL是治疗肾鹿角型结石的一种安全有效的治疗方法。     

Organ Donation: Cross-Sectional Survey of Knowledge and Personal Views of Brazilian Medical Students and Physicians

Objective

To assess the knowledge, attitudes, and behavior associated with cadaver organ donation and transplantation among medical students and physicians.

Patients and Methods

We randomly selected 350 medical students, 150 physicians, and 150 intensive care unit physicians. Each completed a questionnaire consisting of 9 self-administered items, from which we gathered data about their knowledge about brain death and criteria for the diagnosis of brain death; their hypothetical behaviors, assuming willingness to donate their own or their family's organs; their trust in physicians; and their confidence in a diagnosis of brain death made by physicians.

Results

We observed that knowledge about brain death increased with medical education level; the best results were noted in intensive care unit physicians. Agreement to transplant organs from brain-dead donors (odds ratio [OR], 4.58), confidence in brain-death diagnosis by physicians (OR, 2.17), and knowledge about criteria for the diagnosis of brain death (OR, 2.26) were predictors of willingness to donate one's own organs.

Conclusion

Enhanced medical knowledge of and involvement in donation are needed to achieve cadaver organ donation.     

Küpffer cells promote acute rejection via induction of Th17 differentiation in rat liver allografts

Background

Th17, a newly identified CD4+ T-cell subset, has been implicated in transplant rejection. Differentiation of Th17 cells is associated with transforming growth factor-β (TGF-β) and interleukin-6 (IL-6), which are the main products of Küpffer cells.

Objective

To determine whether Küpffer cells promote acute liver allograft rejection by inducing Th17 cell differentiation.

Methods

A rat model of allogeneic liver transplantation using Dark Agouti (DA) to Brown Norway (BN) rats was established with or without gadolinium chloride (GdCl₃) pretreatment. Isogeneic liver transplantation (BN to BN) was performed as a control. Concentrations of cytokines secreted by Küpffer cells or Th17-related cytokines detected in the liver and peripheral blood were analyzed using immunohistochemistry assays, flow cytometry, and enzyme-linked immunosorbent assays. Survival differences were compared between treatment groups. In vitro, Küpffer cells from liver grafts were isolated and co-cultured with naïve CD4 T cells.

Results

Both Küpffer cells and Th17 cells infiltrated liver allografts, accompanied by an increase in concentrations of IL-6 and TGF-β. Pretreatment with GdCl₃ attenuated intragraft infiltration of Küpffer cells and Th17 cells, and decreased IL-6 and TGF-β concentrations. Liver function improved after pretreatment, and mean (SD) survival time was prolonged, compared with the control group (16.33 [0.96] days vs 11.50 [0.99] days, respectively; P < .01). In vitro, Küpffer cells from livers with allografts secreted significantly higher concentrations of IL-6 and TGF-β and induced Th17 differentiation more effectively compared with livers with isografts (30.8% vs 8.1%, respectively).

Conclusion

Küpffer cells have the potential to induce Th17 cells by secreting IL-6 and TGF-β, and as a result, promote acute liver allograft rejection.     

A survey of bone mineral density of healthy Han adults in China

Summary  

A recent survey of bone mineral density (BMD) in China recruited 7,042 healthy Han Chinese aged 20 years and older. The mean BMDs were different in gender, age, and region; the proportions of men and women older than 50 years with a high risk of osteoporosis were estimated as 10.4% and 31.2%, respectively     

糖尿病足患者的临床特征分析及护理对策

目的结合糖尿病足的临床特征进行分析,探讨糖尿病足的护理对策。方法分析32例糖尿病足的临床特征及采取的治疗与护理措施。结果 30例足部共分离出42株病原菌,其中革兰阳性菌占45.0%,革兰阴性菌占55.0%,并有混合性细菌感染;临床主要特征表现为血糖值异常(87.5%),足部感觉、触觉减退(59.4%),足部皮肤温度下降(56.2%),踝动脉-肱动脉血压比值(ABI)为0.5～0.7(53.1%),足部麻木感(50.0%)。结论糖尿病足的发生与多种因素有关,应采取局部护理、健康教育、环境控制、个人卫生、心理疏导等护理对策,减少或避免致残的发生。     

社区护士职业压力与心理健康的相关性研究

目的探讨深圳市龙岗区社区护士职业压力与心理健康的相关性。方法采用SCL-90自评量表,护士工作压力源量表,康奈系医学指数(CMI)对全区随机抽取的198名社区护士进行问卷调查。结果社区护士工作压力源5个维度得分1.95～2.93分;SCL-90总分、总均分、阳性症状均分以及强迫、人际关系敏感、抑郁、焦虑、精神病性分值显著高于常模(P0.05,P0.01);护士工作压力源5个维度除工作环境及仪器设备方面外,与M～R(不适应、抑郁、焦虑、敏感、愤怒、紧张)分呈显著正相关(P0.05,P0.01)。结论社区护士工作压力呈中等偏上水平,心理存在较多问题,工作压力影响社区护士的心理健康。卫生管理部门应尽快完善社区医护机制,实现基层医疗卫生服务网络的全面覆盖,重视社区护士心理健康,从而提高社区护理质量。     

经皮穿刺联合内镜下胃造瘘术的临床应用

目的探讨经皮穿刺内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)的临床应用价值。方法 2003年5月～2010年5月,因各种原因造成的经口进食困难引起营养不良需长期营养支持的患者66例,在本院内镜中心行PEG,术后给予肠内营养。结果所有患者成功完成内镜下胃造瘘术,平均耗时20min。术后跟踪随访,所有患者造瘘管置入后营养迅速恢复,停止静脉补液。造瘘管最长留置时间2年。5例患者发生造瘘管周围皮肤感染,6例出现反流性食管炎,2例发生造瘘管旁渗血,对症处理后治愈。无消化道出血、腹膜炎等严重并发症。结论 PEG是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法 ,其技术操作简单易行、安全、有效并发症少,创伤小,值得临床推广应用。     

微波辐射对雷达操作人员精子头部及尾部超微结构的影响

目的 研究微波辐射对精子超微结构的影响.方法 利用透射电镜对10例从事微波辐射工作2年以上男性新鲜精液样本中的精子头部及尾部超微结构进行观察.结果 在电镜下微波辐射后男性精子存在多种形态超微结构异常,有以下几种类型:(1)头部异常精子,包括尖头精子、头部含空泡精子.(2)顶体异常精子,包括顶体发育不良、缺失,顶体内形成包涵体精子.(3)尾部异常精子包括尾部形态异常精子(无尾精子、短尾精子)和尾部结构异常精子(线粒体缺失精子、尾部线粒体多种形态和结构异常).结论 微波辐射可导致男性精子项体、头部、尾部线粒体结构异常.     

PBL结合情景教学法在口腔龋病教学中的应用

目的:研究情景教学法结合以问题为中心的教学方法(PBL)在口腔龋病教学中的效果.方法:将学生分成两组:时照组采用传统的教学法.观察组采用PBL结合情景教学法,比较两组的成绩.结果:观察组的成绩优于对照组(P<0.05).蛄论:情景教学法结合PBL能够加深知识的理解和记忆,促进实践能力和提高处理问题的能力.     

Genome-wide copy number variation association study suggested VPS13B gene for osteoporosis in Caucasians

Summary

Osteoporotic fracture (OF) is a serious outcome of osteoporosis. Important risk factors for OF include reduced bone mineral density and unstable bone structure. This genome-wide copy number variation association study suggested VPS13B gene for osteoporosis in Caucasians.

Introduction

Bone mineral density (BMD) and femoral neck cross-sectional geometric parameters (FNCSGPs) are under strong genetic control. DNA copy number variation (CNV) is an important source of genetic diversity for human diseases. This study aims to identify CNVs associated with BMD and FNCSGPs.

Methods

Genome-wide CNV association analyses were conducted in 1,000 unrelated Caucasian subjects for BMD at the spine, hip, femoral neck, and for three FNCSGPs —cortical thickness (CT), cross-section area (CSA), and buckling ratio (BR). BMD was measured by dual energy X-ray absorptiometry (DEXA). CT, CSA, and BR were estimated using DEXA measurements. Affymetrix 500K arrays and copy number analysis tool was used to identify CNVs.

Results

A CNV in VPS13B gene was significantly associated with spine, hip and FN BMDs, and CT, CSA, and BR (p?<?0.05). Compared to subjects with two copies of the CNV, carriers of one copy had an average of 14.6%, 12.4%, and 13.6% higher spine, hip, and FN BMD, 20.0% thicker CT, 10.6% larger CSA, and 12.4% lower BR. Thus, a decrease of the CNV consistently produced stronger bone, thereby reducing osteoporotic fracture risk.

Conclusions

VPS13B gene, via affecting BMD and FNCSGPs, is a novel osteoporosis risk gene.