补肾益气逐浊法治疗ABO溶血致习惯性流产的临床研究

目的观察补肾益气逐浊法治疗ABO溶血所致习惯性流产的临床疗效。方法将152例患者随机分为两组，治疗组98例，用补肾益气逐浊法，选用黄芪、菟丝子及蚕砂颗粒剂口服；对照组54例，口服胸腺肽肠溶胶囊等。结果在降低血清抗体效价方面，治疗组总有效率为95．9％，对照组为51．9％；在妊娠疗效方面，治疗组总有效率为95．9％，对照组为42．1％。治疗组疗效明显优于对照组（P〈0．01）。结论补肾益气浊法治疗ABO溶血所致的习惯性流产疗效显著。     

Hepatitis B immunity in adolescents and necessity for boost vaccination: 23 years after nationwide hepatitis B virus vaccination program in Taiwan

The first universal hepatitis B vaccination program for newborns in the world was launched in Taiwan in July 1984. Most studies on the effectiveness of hepatitis B vaccination focused on the seroprevalence of HBs Ag among children under 14 years old. Only few studies focused on the seropositivity of anti-HBs among adolescents aged 15–18 years old. The present study aimed to evaluate the impact of the nationwide hepatitis B vaccination program on the immunity to HBV infection and the necessity of boost among adolescents. In this study including eight annual seroprevalence surveys from 2000 to 2007, 2342 college entrants (1589 15-year-olds in group I and 753 18-year-olds in group II) and 1851 university freshmen (18-year-olds in group III) participated. Subjects identified anti-HBs, HBs Ag and anti-HBc negative were given boost three doses of HBV vaccine. The HBs Ag seroprevalence was 11.6%, 3.5% and 1.0% for participants who were born before 1984, 1984–1986 and after 1986. The anti-HBs-seropositive rates were significantly higher in group II (83.1%) than in group I (53.0%) and group III (53.5%). All 572 participants who were seronegative for anti-HBs, HBs Ag and anti-HBc became anti-HBs-seropositive after catch-up vaccination. It is concluded that the anti-HBs-seropositive rate decreased to 50% in 15 years after vaccination, and boost vaccination was 100% effective. The necessity and age for boost among anti-HBs negative adolescents and the timing of the first immunization should be further evaluated.     

现代医学200词——138．黏附分子

所谓黏附分子是指存在于细胞表面，参与细胞间或细胞与细胞外基质的粘附的分子群的总称。广义来说，纤维连结蛋白、层粘连蛋白、透明质酸等细胞外基质的构成成分也是由细胞分泌并存在于细胞表面，也可归入黏附分子的范畴。但狭义所指的黏附分子是指贯通细胞膜的糖蛋白或构成细胞膜的糖脂质。膜贯通型糖蛋白黏附分子按其构造特征可分为若干家族。在免疫系统中的黏附分子主要分为整合素家族、免疫球蛋白超家族、选择素家族、钙粘素家族、连接蛋白家族以及唾液粘蛋白家族等。     

Fat and water separation in balanced steady-state free precession using the Dixon method.

In this work the feasibility of separating fat and water signals using the balanced steady-state free precession (SSFP) technique is demonstrated. The technique is based on the observation (Scheffler and Hennig, Magnetic Resonance in Medicine 2003;49:395-397) that at the nominal values of TE = TR/2 in SSFP imaging, phase coherence can be achieved at essentially only two orientations (0 degrees and 180 degrees ) relative to the RF pulses in the rotating frame, under the assumption of TR < T2, and independently of the SSFP angle. This property allows in-phase and out-of-phase SSFP images to be obtained by proper choices of the center frequency offset, and thus allows the Dixon subtraction method to be utilized for effective fat-water separation. The TR and frequency offset for optimal fat-water separation are derived from theories. Experimental results from healthy subjects, using a 3.0 Tesla system, show that nearly complete fat suppression can be accomplished.     

Working‐correlation‐structure identification in generalized estimating equations

Selecting an appropriate working correlation structure is pertinent to clustered data analysis using generalized estimating equations (GEE) because an inappropriate choice will lead to inefficient parameter estimation. We investigate the well‐known criterion of QIC for selecting a working correlation structure, and have found that performance of the QIC is deteriorated by a term that is theoretically independent of the correlation structures but has to be estimated with an error. This leads us to propose a correlation information criterion (CIC) that substantially improves the QIC performance. Extensive simulation studies indicate that the CIC has remarkable improvement in selecting the correct correlation structures. We also illustrate our findings using a data set from the Madras Longitudinal Schizophrenia Study. Copyright © 2008 John Wiley & Sons, Ltd.     

Trans fat intake lowers total cholesterol and high-density lipoprotein cholesterol levels without changing insulin sensitivity index in Wistar rats

Epidemiologic studies have demonstrated that trans fat intake increases the risk of some chronic diseases. We hypothesize that trans fat intake would increase the risk of cardiovascular disease and type 2 diabetes mellitus by changing the lipid profile in plasma, the secretion of adipokines in adipose tissue, and the insulin sensitivity. Accordingly, the major objective of present study was to investigate the effect of dietary intake of trans fat on lipid profile, insulin sensitivity, and adipokine levels in plasma. Two groups of Wistar rats were fed a diet containing 4.5% trans fat or a control diet containing no trans fat for 16 weeks. Fasting glucose level was monitored every 2 weeks. At the end of feeding experiment, blood, heart, kidney, liver, omental adipose tissue, and semitendinosus muscle were collected. The trans fat content in organs, lipid profile, adipokine, insulin, and glucose levels in plasma were analyzed. The trans fat content in adipose tissue, heart, kidney, liver, and muscle of rats fed trans fat were 169.9, 0.6, 1.2, 1.7, and 2.5 mg/g samples, respectively. The trans fat content in these organs contributed to 15.9%, 1.2%, 2.3%, 4.3%, and 6.1% of the total fat, respectively. The plasma glucose level, insulin level, and insulin sensitivity index were not significantly different between the trans fat and control groups. The results indicated that trans fat intake might not be related to insulin resistance. However, lipid profile and plasma adipokine levels were significantly changed after trans fat feeding. The trans fat fed group showed significantly lower total cholesterol and high-density lipoprotein cholesterol levels than the control group. The decreased high-density lipoprotein cholesterol level may indicate the detrimental effect of trans fat intake on lipid profile. Adiponectin and resistin levels were significantly higher in the trans fat group than the control group. Leptin levels were significantly lower in the trans fat group than the control group. The results indicated that dietary intake of trans fat can significantly change the adipokine levels, but the possible links between adipokine level change caused by trans fat intake and metabolic effects of this change need further investigations.     

王成荣治疗子宫内膜异位症“火热致瘀”理论探讨

王成荣研究员长于以中医药诊治子宫内膜异位症（EMT），根据其临床经验认为“火热致瘀”是EMT的基本病因、病机，且火热与瘀血互为因果、恶性循环，致使EMT病程缠绵不愈、反复复发。王老据此提出“清热解毒、化瘀散结”的治疗法则，为治疗EMT开辟了另一思路和理论。     

输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL），后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例，RLU组20例。PCNL组9例。结果：URSL组碎石成功18例；7例不成功，其中3例改为开放手术，1例改为后腹腔镜取石。2例行ESWL术，1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例，2例滑入肾内，经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功，术后15例有伤口漏尿。PCNL组成功9例，无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小，取石成功率高，在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。