重叠甲型肝炎病毒感染对慢性乙型肝炎影响的对比研究

应用ELISA法对126例CHB患者检测血清抗－HAV－IgM，同时应用肝穿刺活检、荧光定量PCR及免疫组化技术对重叠与未重叠HAV感染者进行了临床与病理学对比。具有可比性的重叠与未重叠感染者8例、16例1年后做第2次肝穿活检；HBeAg阴性重叠感染者9例做HAV感染急性期、 恢复期血清HBeAg定性、HBV－DNA含量对比。结果发现重叠HAV感染者22例。重叠感染者较未重叠感染者ALT、TBIL增高、PTA降低，但A／G、γ－EP无显著差别；血清HBeAg、肝组织HBcAg阳性率及血清、肝组织HBV－DNA含量低；肝组织炎症活动度重，但纤维化程度无明显差别。重叠与未重叠感染者1年前肝脏病变无显著差别，1年后仍无显著差别。HAV感染恢复期血清HBeAg阳性率、HBV－DNA含量高于急性期。提示重叠HAV感染加重CHB肝脏炎症活动度， 但并不加重纤维化程度及加速进展；抑制HBV复制，但并不持久。     

Attitudes Towards Bariatric Surgery in the General Public

Background

Prevalence rates of obesity are still rising. Weight loss surgery (WLS) is the most invasive but also most effective treatment option when behavioral modification has failed. Research indicates that health care professionals hold ambivalent views on bariatric surgery, while views of the general public have not yet been investigated.

Methods

In a German representative sample of n?=?3,003 respondents in a computer-assisted telephone interview, n?=?1,008 persons were interviewed on their views of the effectiveness of bariatric surgery and other interventions for obesity. Also, willingness to recommend a treatment was assessed.

Results

Lifestyle-based interventions were viewed as most effective in terms of weight loss. About 50 % of the population stated that WLS is “very effective” while still a quarter of respondents did not ascribe effectiveness to WLS. Higher age was associated with lower expectations of effectiveness while higher stigmatizing attitudes and genetic attributes for obesity were associated with higher expectations of effectiveness. Seventy-two percent would not recommend WLS or undergo it, if applicable, themselves. Higher educated respondents and those that viewed WLS as effective were more likely to recommend WLS.

Conclusions

The German general public seems to be rather cautious regarding bariatric surgery. It may be assumed that false beliefs on the effectiveness and risk patterns of bariatric surgery are still very common, despite rising surgery numbers. Our results further emphasize the need for providing evidence-based information on bariatric surgery to the general public.     

牙源性角化囊肿的临床与X线诊断（附26例分析）

本文报告了经手术、病理证实的２６例牙源性角化囊肿，着重分析了其临床特点与Ｘ线表现，提出了本病的Ｘ线诊断依据：①单房不含牙的牙源性囊肿，囊内不含死髓牙的根尖者。②多房不含牙的牙源性囊肿，房的大小、形态相似，并有沿颌骨长轴发展趋向者。③单或多房含牙的牙源性囊肿，所含牙齿不具备真正含齿囊肿特点者。④多发性颌骨囊肿，房的大小、形态及部位有对称分布倾向者。     

Discovery of a new waveform for intraoperative monitoring of hemifacial spasms

Background

Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated.

Methods

Thirty-two patients with typical hemifacial spasm and 12 with trigeminal neuralgia as a control were included. The facial muscle response was recorded during microvascular decompression surgery while the offending artery wall was stimulated (2?mA?×?0.2?ms). The latency, amplitude, and effective refractory period were analyzed.

Results

A waveform was recorded from the facial muscles of patients with hemifacial spasm when the offending artery wall was stimulated and was named the “Z-L response.” The latency was 7.3?±?0.8?ms, the amplitude was 0.08?±?0.02?mV, and the effective refractory period was 3.5–4?ms. The Z-L response disappeared immediately after microvascular decompression. No waveform was recorded from the facial muscles of patients with trigeminal neuralgia while the anterior inferior cerebellar artery, which adheres to the facial nerve, was stimulated (2?mA?×?0.2?ms).

Conclusion

We found a new waveform for intraoperative monitoring of hemifacial spasm. The Z-L response was useful when the abnormal muscle response was absent before decompression or persisted after all vascular compressions were properly treated. Particularly, the Z-L response may help neurosurgeons determine the real culprit when multiple offending vessels exist.     

Construction and application of traditional Chinese medicine-oriented care model for stroke

目的 通过理论与临床相结合的研究方式构建中风病辨证施护模式,以提高护理效果和患者满意度.方法 将200例中风病患者按病区分为观察组104例和对照组96例.对照组采用中医常规护理方案;观察组构建中风病辨证施护模式,采用该模式对患者辩证分型施护.连续14d后评价效果.结果 观察组疗效、Barthel指数评价及患者满意度显著高于对照组,并发症发生率显著低于对照组(P<0.05,P<0.01).结论 中风病辩证施护模式应用于临床效果可靠,患者满意,可作为中医临床护理和研究的借鉴.     

CD44v6和组织蛋白酶D表达与食管癌预后的关系

目的　研究CD4 4v6和组织蛋白酶D(cathepsinD ,CD)表达与食管癌生物学行为的关系。方法　应用免疫组化法 ,检测 6 5例食管鳞状细胞癌组织中CD4 4v6和CD表达水平。结果　在食管癌中CD4 4v6和CD表达阳性率分别为 5 8.5 %和 6 4 .6 %。CD4 4v6和CD表达均与肿瘤分级、浸润、淋巴结转移和预后相关。结论　CD4 4v6和CD异常表达与食管癌的病理生物学行为密切相关 ,可作为是预测食管癌转移潜能和评估食管癌预后的客观指标     

重症急性胰腺炎入院24 h内死亡因素剖析

目的探讨重症急性胰腺炎死亡因素.方法应用SPSS10.0软件对52例重症急性胰腺炎病人入院24h内临床资料进行Logistic回归分析,筛选重症急性胰腺炎死亡的危险因素,并建立Logistic回归方程式.结果在调查的27个因素中血pH值、APACHEⅡ评分、早期休克、合并多脏器功能衰竭与死亡关;单因素Logistic回归分析发现休克、胸腔积液、血pH值、APACHEⅡ评分以及并发症的发生与死亡有关,而多因素分析发现只有血pH值与重症急性胰腺炎的死亡有关.结论该回归方程在病程早期对预测重症急性胰腺炎的预后及临床治疗有一定帮助;重症急性胰腺炎早期治疗中应强调维护全身脏器功能,积极纠正水电解质和酸碱平衡的紊乱,对降低死亡率具有重要的作用.     

腓骨复合组织皮瓣治疗胫骨大段骨缺损11例

我科自 1996年以来 ,采用带血管腓骨复合组织皮瓣移植Ⅰ期修复骨及软组织缺损 ,疗效满意 ,报告如下。1　临床资料　　 11例中男 9例 ,女 2例 ;年龄 14～ 4 2岁 ,病程 2 0d～ 2年。均因创伤或慢性感染致胫骨长节段骨缺损 ,并伴有不同程度皮肤软组织缺损或瘢痕挛缩及感染、骨外露。皮肤软组织缺损面积 4cm× 7cm～8cm× 17cm。移植腓骨骨段 11～ 2 2cm。2　手术方法　　采用椎管内麻醉或全身麻醉 ,手术分两组同时进行。一组取复合组织皮瓣 :依据受区创面大小、骨缺损长度于小腿外侧设计皮瓣。自深筋膜深面腓肠肌与比目鱼肌之间 ,将皮瓣向前掀…     

Study on changes of partial pressure of brain tissue oxygen and brain temperature in acute phase of severe head injury during mild hypothermia therapy

Ahighdeathrateofseverebraininjurieshasattractedmuchattention .Mildhypothermiatherapyandmonitoringbrainoxygenmetabolismandcerebralbloodflowhavebeendoneinmanyhospitals.Wimaretal1elucidatedthevalueofmonitoringbrainoxygeninseverebraininjuries.Butthemechanismofmildhypothermiaremainsunclear .Zhang2 reportedthatmildhypothermiatherapycouldrecoverthebrainoxygentonormal.Gupta3 usedanesthesiacoolingandobservedduringmildhypothermiathebrainoxygenwasdecreased .Wehavetreated 116patientswithseverebraininjuri…     

Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty.

OBJECTIVES: Aim of this study is to correlate distribution pattern of lower limb atherosclerosis with cardiovascular risk factor profile of patients with peripheral arterial occlusive disease (PAD). PATIENTS AND METHODS: Analysis is based on a consecutive series of 2659 patients (1583 men, 1076 women, 70+/-11 years) with chronic PAD of atherosclerotic origin undergoing primary endovascular treatment of lower extremity arteries. Pattern of atherosclerosis was grouped into iliac (n=1166), femoropopliteal (n=2151) and infrageniculate (n=888) disease defined according to target lesions treated. A multivariable multinomial logistic regression analysis was performed to assess relation with age, gender and classical cardiovascular risk factors (diabetes mellitus, arterial hypertension, hypercholesterolemia, cigarette smoking) using femoropopliteal disease as reference. RESULTS: Iliac disease was associated with younger age (RRR 0.95 per year of age, 95%-CI 0.94-0.96, p<0.001), male gender (RRR 1.32, 95%-CI 1.09-1.59, p=0.004) and cigarette smoking (RRR 2.02, 95%-CI 1.68-2.42, p<0.001). Infrageniculate disease was associated with higher age (RRR 1.02, 95%-CI 1.01-1.02, p<0.001), male gender (RRR 1.23, 95%-CI 1.06-1.41, p=0.005) and diabetes mellitus (RRR 1.68, 95%-CI 1.47-1.92, p<0.001). Hypercholesterolemia was less prevalent in patients with lesions below the knee (RRR 0.82, 95%-CI 0.71-0.94, p=0.006), whereas no distinct pattern was apparent related to arterial hypertension. CONCLUSION: Clinical phenotype of peripheral atherosclerosis varies with prevalence of cardiovascular risk factors suggesting differences in mechanisms involved in iliac as compared with infrageniculate lesions. Identification of molecular mechanism might have influence on future therapeutic strategies in PAD patients.