苯丙酸诺龙对烧伤后α1(Ⅰ)型前胶原蛋白mRNA表达影响的实验研究

目的探讨苯丙酸诺龙对烧伤后成纤维细胞α1(Ⅰ)型前胶原蛋白mRNA表达的影响及其作用机制. 方法 Wistar 大鼠32只,制成20%TBSA深Ⅱ度烧伤模型,随机分为苯丙酸诺龙治疗(NP)组和对照组,于4、7、14和21天分别取创面肉芽组织,测定其成纤维细胞中雄激素受体及α1(Ⅰ)型前胶原蛋白mRNA含量,分析比较两组间成纤维细胞雄激素受体和α1(Ⅰ)型前胶原蛋白mRNA的表达及其相关关系. 结果 NP组在7、14和21天α1(Ⅰ)型前胶原蛋白mRNA的表达均高于同期对照组,两组间比较有统计学意义(P＜0.05).NP在4、7、14和21天成纤维细胞雄激素受体的表达均明显高于同期对照组,有统计学意义(P＜0.05).雄激素受体的表达与胶原蛋白基因的表达之间有相关关系,且有统计学意义. 结论 NP能促进Ⅰ型前胶原蛋白mRNA和成纤维细胞雄激素受体的表达,二者间存在正相关关系,NP在转录水平促进胶原蛋白的合成,这种作用与改变成纤维细胞雄激素受体的含量有关.     

隆乳术后乳房硬化12例

隆乳术后乳房硬化１２例刘晓雪，岑瑛，周继林丰满的乳房视为女性美的标志。要求隆乳的妇女日趋增多，但隆乳术后假体周围组织纤维包囊挛缩，乳房硬化这一并发症却大大地影响了隆乳术后效果。现将我院１９９４年２月～１９９５年１月接收的外院隆乳术后乳房硬化１２例，报...     

99TcmO-4甲状腺双时相检查鉴别诊断甲状腺疾病

甲状腺机能亢进症 (简称甲亢 )、桥本甲亢、亚急性甲状腺炎 (简称亚甲炎 )的甲亢期均表现甲状腺高功能状态 ,临床表现相似 ,不易区别。本研究测定了甲状腺血流相 5ｍｉｎ显像 ,利用感兴趣区 (ＲＯＩ)技术 ,获得时间 放射性曲线 ,结合 2 0ｍｉｎ静态甲状腺像进行定量分析 ,可提供更多的鉴别诊断信息。一、资料与方法1 临床资料。正常对照组 2 0例 (男2例 ,女 18例 ) ,甲状腺各项指标正常 ,除外心、脑及肝肾疾病 ,年龄 17～ 6 0岁 ,平均 38岁。甲亢患者 38例 (男 11例 ,女2 7例 ) ,平均年龄 33岁 ;桥本甲亢 31例(男 7例 ,女 2 4例 ) ,平均年龄…     

进口HOLTER记录仪改用国产电池

目前国内引进各种型号 Holter 仪器,其记录仪的电池常为人们担心而不能广泛应用,影响了临床及科研工作。若依赖进口电池,价格昂贵且不能随时可得。为解决其能源问题,我们对西德赫力格(HELLGE)产Memoport—C型 HoLter 的记录仪(Melchers—FERROSTAAL 美最时富乐斯多制)的电池,改用国产普通5号电池代替。     

吸入性损伤患者早期气管切开拔管时机及后期并发症分析

Objective To investigate the appropriate extubation time and treatment of late complications after early tracheotomy in patients with moderate or severe inhalation injury. Methods One hundred and fifty patients ( 105 males and 45 females) with inhalation injury were admitted to our hospital from January 2000 to January 2009. Among them, 109 out of 129 cases with moderate inhalation injury received early tracheotomy, and all 21 cases with severe inhalation injury received early tracheotomy. Data were collected for analysis as follows: ( 1 ) incidence of re-intubation due to suffocation and pneumonia incidence after extubation within 2 weeks or after 2 weeks post inhalation injury (PⅡ), and mortality rate within the first week after injury were recorded. (2) Conservative treatments including expectorant, oral antibiotics, and absolute bedrest were recommended for patients who had severe cough, hoarseness or poor pulmonary function after late extubation and closure of tracheostomy wound. Fiberoptic bronchoscopy findings ( tracheostenosis degree, granuloma formation rate, vocal cord paralysis rate) and pulmonary function index ( FEV1 ) data were collected and analyzed in 30 cases with moderate inhalation injury and 10 cases with severe inhalation injury within 3 months after injury for follow-up. Data were processed with t test or chi-square test. Results There was no obvious difference in the rate of re-intubation after extubation in patients with moderate inhalation injury between those done within 2 weeks PⅡ ( 15/70, 21.4% ) and those done after 2 weeks PⅡ (2/25, 8.0% ) ( x 2 = 1.52, P ＞ 0.05 ). Pneumonia incidence in patients of moderate inhalation injury with extubation within 2 weeks PⅡ (21/70, 30.0% ) was lower than those with extubation after 2 weeks PⅡ (15/25, 60.0% ) (x 2= 7.04, P ＜ 0.05). Levels of above-mentioned indexes in patients with severe inhalation injury extubated in diffferent stages were similar to those of patients with moderate inhalation injury.Within the first week after injury, mortality rate of patients with severe inhalation injury was higher than that of patients with moderate inhalation injury ( x 2 = 11.90, P ＜ 0.05 ). During follow-up, tracheostenosis rate in patients with moderate or severe inhalation injury was 100.0%; granuloma formation rate and vocal cord paralysis rate in patients with severe inhalation injury were higher than those of patients with moderate inhalation injury ( with x 2 value respectively 4.59, 13.47, P values all below 0.05 ). The FEV1 value of patients with moderate inhalation injury in the 1st, 2nd, 3rd month after injury was respectively higher than that of patients with severe inhalation injury ( with t value respectively 5.48, 12. 10, 6.25, P values all below 0.05). The values recovered to normal level in the 3rd month after injury. Conclusions Extubation time of tracheotomy for patients with moderate or severe inhalation injury within 2 weeks or after 2 weeks PⅡ has its own advantage and disadvantage, and it should be performed according to specific conditions of each patient. Conservative treatment is optional for late complications of respiratory system.     

小雨伞笼式钛网支撑结合植骨治疗距骨骨折后缺血坏死

目的 探讨小雨伞笼式钛网支撑结合植骨治疗距骨骨折后缺血性坏死的可行性及临床疗效.方法 针对26例距骨骨折后缺血性坏死采用经内踝截骨入路,小雨伞笼式钛网支撑结合植骨内固定治疗.结果 26例随访7个月～3年,疗效评估参照Hawkins标准:优13例,良9例,可4例,优良率达84.6%.结论 小雨伞笼式钛网支撑结合植骨符合生...     

重庆市私营医疗诊所参与艾滋病防治现状调查

目的 了解私营医疗机构艾滋病(AIDS)防治知识现状、参与艾滋病防治的能力、意愿及需求.为建立对私营医疗机构参与艾滋病防治的科学化管理体系提供基线资料.方法 采用随机抽样的方法,选择私营诊所从业人员为调查对象,对私营诊所的从业人员进行问卷调查,共116人.结果 UNGASS指标的5个题目全部回答正确的比例为27.6%,知道艾滋病自愿咨询检测的为62.9%,而完全答对4个自愿咨询点的仅有4.1%,完全答对艾滋病的4类高危人群为50%,有17.2%的被调查者不愿意参与艾滋病防治工作.问其原因,回答最多的就是觉得自己知识不够,不能参与艾滋病防治工作.结论 有针对性地对私营诊所的从业人员进行培训很有必要.提高其知识水平和将可疑患者推荐到CDC进行艾滋病初筛检测的意识,从而建立对私营医疗机构参与艾滋病防治的科学化管理体系.     

中国西南两省肺结核扶贫干预定性调查与分析

目的通过调查目前国内两省开展实施的肺结核扶贫干预,发现贫困人群肺结核患者在获得医疗卫生服务中的障碍以及卫生服务提供者在干预实施中遇到的困难及发现的问题,总结经验教训以提出政策建议。方法现场调查采用定性研究中的关键人物访谈与个人深入访谈。运用主题框架法对资料进行分析,采用MAXQDA2007软件对访谈资料进行编码管理,最后进行比较分析,进一步归纳总结得出结论。结果认知不足是造成患者不能有效利用结核减免服务的原因,贫困仍是肺结核患者就医的最大障碍。肺结核患者居住偏远和社会歧视与耻辱感的存在,是肺结核患者不能及时就诊和规则治疗的重要障碍,同时也给追踪督导带来困难。部分综合医疗机构转诊工作不到位给结防工作带来困难。结论结核防治健康教育以及归口管理仍需加强。国家结核诊疗减免力度有待加强。     

射频热凝靶点消融结合臭氧注射治疗颈腰椎间盘突出症

目的探讨射频热凝靶点消融结合臭氧注射治疗颈腰椎间盘突出症的适应证、方法和疗效。方法153例颈腰椎间盘突出症患者的临床资料进行回顾性分析,本组患者均先行射频热凝治疗,后行椎间盘内、外臭氧注射。结果本组患者术后均获随访,参照Maenab评定标准,优94例,良46例,可8例,差5例,优良率为91．5％,有效率为96．7％。结论严格掌握适应证的情况下,射频热凝靶点消融结合臭氧注射治疗颈腰椎间盘突出症安全有效,疗效可靠。     

数字化服务提高预防接种管理水平的思考与建议

随着信息技术发展和人民群众预防接种服务需求的提高, 通过数字化提高预防接种服务质量已是必然趋势。本文从明确预防接种数字化服务概念入手, 介绍当前国内外发展现况, 分析先行地区现有模式的优势及存在的不足, 借鉴总结并提出针对性解决建议, 指出应建立数据互通共享的部门协调机制、制定数据标准及功能性规范、完善免疫规划信息系统功能、加强数据收集与分析利用、强化预约管理和科普教育, 为后期全国各地预防接种数字化服务的建设提供专家指引。