Sleep apnea--an overview

Though distressing and potentially dangerous, sleep apnea may be an under-recognized disease in many countries. The obstructive type, which usually presents with loud snoring and excessive daytime sleepiness, is by far the commonest form. It causes a great deal of medical, social and psychological morbidity as well as an increased mortality. Doctors of different specialties have an important role in detecting and referring suspected patients for early assessment and treatment. Multidisciplinary management in a general hospital and accurate assessment with polysomnography are essential as modern and sometimes effective methods of treatment are becoming available.     

冷敷在重睑成形术中的应用效果观察

重睑成形术是眼睑美容手术之一。随着人民生活水平的提高,要求美容的人也越来越多[1]。由于该手术大部分需要切开剥离,去除眼轮匝肌或去脂去皮,容易引起皮下组织水肿、淤血,影响恢复和术后效果。2005年11月—2006年11月,笔者对124例重睑受术者进行术中冰生理盐水冷敷,在减轻水肿、淤血程度、缩短恢复期方面疗效显著。现报道如下。1资料与方法1.1临床资料本组共124例,其中女118例,男6例,年龄20岁～58岁。将受术者按手术时间先后顺序随机分为实验组和对照组各62例。1.2方法两组均使用电凝止血,5-0丝线缝合后用无菌纱布包扎伤口,口服5d抗生素。…     

卫生资源配置不平衡之殇

在我国卫生资源总体不足和配置不合理。一方面,中国有13亿人口,占世界总人口的22%,而卫生总费用仅占世界卫生总费用的2%。更严重的是另一方面,据卫生部提供的数据,目前全国80%的医疗资源集中在大城市,其中的30%又集中在大医院。每年到大医院就诊的人群,有80%左右是在基层医院即可解决的常见病、多发病。     

The use of 19F spectroscopy and diffusion-weighted MRI to evaluate differences in gene-dependent enzyme prodrug therapies.

To evaluate noninvasive measures of gene expression and tumor response in a gene-dependent enzyme prodrug therapy (GDEPT), a bifunctional fusion gene between Saccharomyces cerevisiae cytosine deaminase (CD) and Haemophilus influenzae uracil phosphoribosyltransferase (UPRT) was constructed. CD deaminates 5-fluorocytosine (5FC) to 5-fluorouracil (5FU), and UPRT subsequently converts 5FU to fluorouridine monophosphate, and both of these reactions can be monitored noninvasively in vitro and in vivo using 19F magnetic resonance spectroscopy (MRS). Following transient transfection the CD-UPRT fusion protein exhibited both UPRT and CD enzymatic activities as documented by 19F MRS. In addition, an increase in CD activity and thermal stability was witnessed for the fusion protein compared to native CD. Stable expression of CD-UPRT in 9L glioma cells increased both 5FC and 5FU sensitivity in vitro compared to CD-expressing and wild-type 9L cells. Noninvasive 19F MRS of both CD and UPRT gene function in vivo demonstrated that in animals bearing CD-expressing tumors there was limited conversion of 5FC to 5FU with no measurable accumulation of cytotoxic fluorinated nucleotides (F-nucs). In contrast, CD-UPRT-expressing tumors had increased CD gene activity with a threefold higher intratumoral accumulation of 5FU and significant generation of F-nucs. Finally, CD-UPRT yielded increased efficacy in an orthotopic animal model of high-grade glioma. More importantly, early changes in cellular water mobility, which are felt to reflect cellular death, as measured by diffusion-weighted MRI, were predictive of both durable response and increased animal survival. These results demonstrate the increased efficacy of the CD-UPRT GDEPT compared to CD alone both biochemically and in a preclinical model and validate both 19F MRS and diffusion-weighted MRI as tools to assess gene function and therapeutic efficacy.     

Onset, progression, and plateau of skeletal lesions in fibrous dysplasia and the relationship to functional outcome.

Most lesions in FD and their attendant functional disability occur within the first decade; 90% of lesions are present by 15 years, and the median age when assistive devices are needed is 7 years. These findings have implications for prognosis and determining the timing and type of therapy. INTRODUCTION: Fibrous dysplasia of bone (FD) is an uncommon skeletal disorder in which normal bone is replaced by abnormal fibro-osseous tissue. Variable amounts of skeletal involvement and disability occur. The age at which lesions are established, the pace at which the disease progresses, if (or when) the disease plateaus, and how these parameters relate to the onset of disability are unknown. To answer these questions, we performed a retrospective analysis of a group of subjects with FD. MATERIALS AND METHODS: One hundred nine subjects with a spectrum of FD were studied for up to 32 years. Disease progression was assessed in serial (99)Tc-MDP bone scans by determining the location and extent of FD lesions using a validated bone scan scoring tool. Physical function and the need for ambulatory aids were assessed. RESULTS: Ninety percent of the total body disease skeletal burden was established by age 15. Disease was established in a region-specific pattern; in the craniofacial region, 90% of the lesions were present by 3.4 yr, in the extremities, 90% were present by 13.7 yr, and in the axial skeleton, 90% were present by 15.5 yr. Twenty-five of 103 subjects eventually needed ambulatory aids. The median age at which assistance was needed was 7 yr (range, 1-43 yr). The median bone scan score for subjects needing assistance was 64.3 (range, 18.6-75) compared with 23.1 (range, 0.5-63.5) in the unassisted subjects (p < 0.0001). Among subjects needing assistance with ambulation, 92% showed this need by 17 yr. CONCLUSIONS: The majority of skeletal lesions and the associated functional disability occur within the first decade of life. The implication is that the window of time for preventative therapies is narrow. Likewise, therapeutic interventions must be tailored to where the patient is in the natural history of the disease (i.e., progressive disease [young] versus established disease [older subjects]). These findings have implications for prognosis, the timing and type of therapy, and the development of trials of new therapies and their interpretation.