多轴向螺钉-棒椎弓根固定系统植入治疗寰枢椎损伤的特征

目的:总结应用多轴向钛螺钉-棒系统椎弓根钉植入技术治疗寰枢椎损伤的特点。方法:选择山东省东营市人民医院、加拿大脊柱外科中心、山东省立医院脊柱外科1999-01/2004-01治疗的寰枢椎损伤患者。应用后路多轴向钛螺钉-棒系统固定融合手术治疗38例,固定位置为寰椎(C1)的双侧块和枢椎(C2)的椎弓根,并与46例采用关节突螺钉复合后方椎板下钢丝固定植骨融合进行对比分析。结果:84例患者全部进入结果分析。①治疗组脊髓损伤的治愈率和总有效率(治愈 有效)高于对照组,但差异无显著性(92%,85%,χ2=0.29,P>0.05)。②治疗组对椎动脉孔的入侵率明显低于对照组(5%,30%,χ2=6.99,P<0.05)。③治疗组对椎管的入侵率明显低于对照组(5%,28%,χ2=6.02,P<0.05)。④术后治疗组α角(寰枢椎角)为(26.8±5.42)°,对照组α角为(25.6±5.82)°,两组对比差异无显著性(t=1.27,P>0.05)。⑤治疗组1例轻度错位(≤7mm),1例神经轻度放射痛,术后5个月取出内固定后消失,余无固定松动、椎动脉损伤、神经压迫征发生,3个月融合28例,6个月全部融合。对照组4例出现骨折所致不稳,3例半脱位,5例不融合,6例神经痛。结论:对急性寰、枢椎损伤患者进行C1双侧块和C2椎弓根后路多轴向钉-棒系统固定融合手术治疗方法简单、易于避开椎动脉,定位准确,直视下进行操作,安全性高,固定可靠。     

Personal genome testing: Test characteristics to clarify the discourse on ethical, legal and societal issues

Background

As genetics technology proceeds, practices of genetic testing have become more heterogeneous: many different types of tests are finding their way to the public in different settings and for a variety of purposes. This diversification is relevant to the discourse on ethical, legal and societal issues (ELSI) surrounding genetic testing, which must evolve to encompass these differences. One important development is the rise of personal genome testing on the basis of genetic profiling: the testing of multiple genetic variants simultaneously for the prediction of common multifactorial diseases. Currently, an increasing number of companies are offering personal genome tests directly to consumers and are spurring ELSI-discussions, which stand in need of clarification. This paper presents a systematic approach to the ELSI-evaluation of personal genome testing for multifactorial diseases along the lines of its test characteristics.

Discussion

This paper addresses four test characteristics of personal genome testing: its being a non-targeted type of testing, its high analytical validity, low clinical validity and problematic clinical utility. These characteristics raise their own specific ELSI, for example: non-targeted genetic profiling poses serious problems for information provision and informed consent. Questions about the quantity and quality of the necessary information, as well as about moral responsibilities with regard to the provision of information are therefore becoming central themes within ELSI-discussions of personal genome testing. Further, the current low level of clinical validity of genetic profiles raises questions concerning societal risks and regulatory requirements, whereas simultaneously it causes traditional ELSI-issues of clinical genetics, such as psychological and health risks, discrimination, and stigmatization, to lose part of their relevance. Also, classic notions of clinical utility are challenged by the newer notion of 'personal utility.'

Summary

Consideration of test characteristics is essential to any valuable discourse on the ELSI of personal genome testing for multifactorial diseases. Four key characteristics of the test - targeted/non-targeted testing, analytical validity, clinical validity and clinical utility - together determine the applicability and the relevance of ELSI to specific tests. The paper identifies and discusses four areas of interest for the ELSI-debate on personal genome testing: informational problems, risks, regulatory issues, and the notion of personal utility.     

Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006

Background

In order to improve treatments for cannabis use disorder, a better understanding of factors associated with successful quitting is required.

Method

This study examined differences between successful (n = 87) and unsuccessful (n = 78) cannabis quitters. Participants completed a questionnaire addressing demographic, mental health, and cannabis-related variables, as well as quitting strategies during their most recent quit attempt.

Results

Eighteen strategies derived from cognitive behavioral therapy were entered into a principal components analysis. The analysis yielded four components, representing (1) Stimulus Removal, (2) Motivation Enhancement, (3) (lack of) Distraction, and (4) (lack of) Coping. Between groups comparisons showed that unsuccessful quitters scored significantly higher on Motivation Enhancement and (lack of) Coping. This may indicate that unsuccessful quitters focus on the desire to quit, but do not sufficiently plan strategies for coping. Unsuccessful quitters also had significantly more symptoms of depression and stress; less education; lower exposure to formal treatment; higher day-to-day exposure to other cannabis users; and higher cannabis dependence scores.

Conclusions

The findings suggest that coping, environmental modification, and co-morbid mental health problems may be important factors to emphasize in treatments for cannabis use disorder.     

防治术后高龄肺癌患者心律失常47例

1 临床资料唐都医院胸腔外科自2000-01/2002-01年间共施行高龄肺癌手术216(男167,女49)例,年龄70～82岁,平均年龄75岁.术前心电图异常42例,低氧血症23例,阻塞性和限制性肺通气功能障碍32例.其中行全肺切除15例,肺叶切除163例,肺楔形切除38例.     

噻吗洛尔的透皮特性及影响其透皮吸收的因素

采用V-C水平扩散池对噻吗洛尔穿透完整无毛小鼠和人皮肤以及去角质层无毛小鼠和人皮肤的透过特性进行了摸索。对影响噻吗洛尔透皮吸收的因素如水合、介质pH以及各种透皮促进剂对其穿透率的影响进行了系统的研究。本文应用YWC-C₁₈健合固定相,以水-乙腈-三乙胺(87:13:1)为流动相系统,对噻吗洛尔进行了体外反相高效液相色谱法检测。实验结果表明噻吗洛尔透皮吸收的可行性,其透皮穿透率随着水合时间的适当延长、介质pH值的增大以及各类透皮促进剂的使用有显著性的增加。其中10%和1%azone合用体现了较好的协同作用。本结果为噻吗洛尔TTS的进一步研制提供了实验基础。