碘化钾、碘酸钾对缺碘大鼠甲状腺形态与作用的实验研究

目的：研究碘化钾、碘酸钾对大鼠甲状腺形态学结构的影响。方法：将Wistar大鼠随机分为4组,低碘组（LI）、正常组（NI）、碘化钾组（KI）、碘酸钾组（KIO3）,3个月后观察形态学变化,并做体视学分析,获得定量参数后进行统计学处理。结果：LI组滤泡及滤泡腔的平均体积VQ、平均表面积SQ、体积密度VV、表面积密度SV均明显小于NI组,而数密度NV及比表面积S/V均明显高于NI组;经治疗3个月后,KI组和KIO3组的上述指标均有明显恢复,但尚未完全恢复正常。KI组和KIO3组之间无显著性差异。结论：低碘可致大鼠甲状腺形态典型的小滤泡增生性改变,而KI和KIO3在治疗缺碘性甲状腺肿方面均有很好的疗效,且在本实验期间两者的疗效无显著性差异。     

临沂市尘肺合并肺结核调查分析

目的 探讨尘肺合并肺结核的发病特点。方法 对历年来职业病档案中的现患及死亡病例逐个核实统计。结果 ①单纯尘肺560例,尘肺合并肺结核156例,合并率为21．79%。②退伍工程兵合并结核病死亡率高于厂矿企业工人。③尘肺合并肺结核死亡高于其他疾病。结论 ①尘肺合并肺结核率随期别的增加而显著增高;②尘肺合并肺结核发病率随年代的增加而降低;③尘肺合并肺结核死亡率高于单纯尘肺死亡率,随尘肺期别的增加而增高;④尘肺合并肺结核死亡所占比例随年代的增加而显著降低。     

Exogenous insulin-like growth factor II enhances post-infarction regional myocardial function in swine

OBJECTIVES: Insulin-like growth factor II (IGF-II) promotes cardiac myocytegrowth and contractility in vitro. This study was designed toinvestigate the effect of exogenous IGF-II on regional myocardialfun ction at the area of infarct in the pig. METHODS: Myocardial infarction was induced in 12 female anoesthetizedpigs by affigel blue beads, embolizing microvessels of the leftanterior descending coronary artery distribution. In the experimentalgroup (n=6), IGF-II (0.12 µg. kg^–1 in two animalsand 0.6 µg. kg^–1 in four) was incorporated intothe beads and delivered by them to the infarct area. Myocardialfunction was followed echocardiographically, and the excisedheart was analysed immunohistochemically and histopathologically. RESULTS: Myocardial function in injured zones, inversely related to anechocardiographic segmental wall motion score (mean ±SEM), was similar between the two groups at baseline, but at4 weeks post-infarction was significantly (P=0.008) reducedin the control group (0.58± 0.38 vs 3.42 ± 0.84),in contrast to nearly baseline values in the experimental group(0.58 ± 0.33 vs 1.17 ± 0.42, P=0.41). Cardiacperformance in injured segments was sign better after myocardialinjury in the experimental group (P=0.04). Tissue samples fromboth groups (4 weeks post-infarction), stained with haematoxylinand eosin demonstrated pen-infarct myocyte hypertrophy, correspondingto regions selectively stained by an antibody for CD56, whichhighlights growing cardiac myocytes. By image analysis semi-quantification,staining for CD56 was significantly (P=0.04) higher in the peri-infarctregion of the experimental group, as compared with controls(106.5 ± 2.8 vs 92 ± 4.4 gray level units). Microvesselsstained for von-Willebrand factor were similar in nwnber inboth groups (P=0.8), as were mesenchymal cells stained for vimentin(P=0.7). CONCLUSIONS: Exogenous IGF-II, delivered to the infarct area amelioratesregional cardiac function in the pig, perhaps by inducing peri-infarctmyocyte growth.     

新辅助化疗治疗Ⅲ期非小细胞肺癌的临床评价

目的　评价新辅助化疗 (术前诱导化疗 )在治疗ⅢA 期非小细胞肺癌 (NSCLC)中的应用价值。方法　将 10 2例Ⅲ A 期NSCLC患者随机分为 2个组 :新辅助化疗组 5 1例 ,诱导化疗后行手术治疗 ,其中 3 0例术前接受支气管动脉灌注 (BAI)化疗 ,2 1例术前接受全身化疗。单一手术组 5 1例 ,确诊后直接行手术治疗。结果　新辅助化疗组总有效率 (CR PR )为 49.0 % (2 5 / 5 1) ,化疗不良反应患者可耐受。新辅助化疗组手术切除率和完全性切除率为 92 .2 %和 5 4.9% ,明显高于单一手术组 (72 .5 %和 3 5 .3 % ,P<0 .0 5 )。新辅助化疗组患者 (3 4例 )平均中位生存期为 2 5个月 ,2年生存率为 5 5 .9% (19/ 3 4)。单一手术组患者 (3 2例 )平均中位生存期为 13个月 ,2年生存率为 2 8.1% (9/ 3 2 )。 2组比较有显著性差异 (P <0 .0 5 )。结论　对ⅢA 期NSCLC患者进行新辅助化疗可提高手术切除率 ,延长患者中位生存期 ,提高患者 2年生存率。     

Cisplatin plus gemcitabine versus a cisplatin-based triplet versus nonplatinum sequential doublets in advanced non-small-cell lung cancer: a Spanish Lung Cancer Group phase III randomized trial.

PURPOSE: To compare the survival benefit obtained with cisplatin plus gemcitabine, a cisplatin-based triplet, and nonplatinum sequential doublets in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Stage IIIB to IV NSCLC patients were randomly assigned to receive cisplatin 100 mg/m2 day 1 plus gemcitabine 1,250 mg/m2 days 1 and 8, every 3 weeks for six cycles (CG); cisplatin 100 mg/m2 day 1 plus gemcitabine 1,000 mg/m2 and vinorelbine 25 mg/m2 days 1 and 8, every 3 weeks for six cycles (CGV); or gemcitabine 1,000 mg/m2 plus vinorelbine 30 mg/m2 days 1 and 8, every 3 weeks for three cycles, followed by vinorelbine 30 mg/m2 days 1 and 8 plus ifosfamide 3 g/m2 day 1, every 3 weeks for three cycles (GV-VI). RESULTS: Five hundred fifty-seven patients were assigned to treatment (182 CG, 188 CGV, 187 GV-VI). Response rates were significantly inferior for the nonplatinum sequential doublet (CG, 42%; CGV, 41%; GV-VI, 27%; CG v GV-VI, P =.003). No differences in median survival or time to progression were observed. Toxicity was higher for the triplet: grade 3 to 4 neutropenia (GC, 32%; CGV, 57%; GV-VI, 27%; P <.05); neutropenic fever (CG, 4%; CGV, 19%; GV-VI, 5%; P <.0001); grade 3 to 4 thrombocytopenia (CG, 19%; CGV, 23%; GV-VI, 3%; P =.0001); and grade 3 to 4 emesis (GC, 22%; GCV, 32%; GV-VI, 6%; P <.0001). CONCLUSION: On the basis of these results, CG remains a standard regimen for first-line treatment of advanced NSCLC.     

Infants born to narcotic dependent mothers: Physical growth patterns in the first 12 months of life

Objectives: To describe the physical growth patterns of infants born to narcotic dependent mothers (INDM) over a 12 months period and, if possible, to relate the growth to drug taking patterns during pregnancy.
Methodology: The growth of a cohort of 43 INDM was measured during the first 12 months of life. Weight and length measurements were compared with percentile charts and converted to Z scores. Questionnaire data about drug taking practices, demographic variables and the neonatal period (including withdrawal scores) were obtained.
Results: Twenty-four (55.8%) of INDM had evidence of neonatal drug withdrawal requiring treatment with phenobarbitone. At birth, Z scores for weight and length indicated relative intrauterine growth retardation. By 12 months, there had been some catch up growth, but Z scores for weight and length were still below zero. Persistent weight retardation at 12 months was correlated with methadone dosage during pregnancy, but not the need for phenobarbitone therapy.
Conclusions: The growth patterns of INDM in the first 12 months of life indicated that at birth there was evidence of intrauterine growth retardation, but by 12 months the growth was little different from the rest of the community. There appears to be some influence of narcotic agents taken while pregnant on subsequent growth of INDM.     

下咽癌淋巴引流的活体显像研究

目的：探讨下咽癌颈淋巴结转移时肿瘤区域引流淋巴结的活体显像方法，从肿瘤活体淋巴引流的角度观察下咽癌前哨淋巴结和颈淋巴结转移的方式，为颈淋巴结清扫术提供指导信息。方法：在表面麻醉和喉内镜引导下，用特制的注射针将^99mTc标记的人球蛋白注入20例下咽癌的肿瘤部位，在注射后不同时间采用SPECT扫描观察放射性核素通过淋巴扩散的过程及其在引流淋巴结内的浓集，以明确前哨淋巴结的位置和肿瘤颈淋巴结引流过程。同时对颈淋巴清扫标本进行病理检查。结果：20例肿瘤引流淋巴结均获得满意活体显像，显像的淋巴结最大3．5cm，最小1．0cm；12例梨状窝癌的颈部引流淋巴结位于肿瘤侧，其余8例中线结构的肿瘤颈部引流淋巴结均具有明显的优势偏向，即单侧颈部引流现象，没有出现双侧对称引流的病例。20例肿瘤引流淋巴结主要分布在Ⅱ、Ⅲ、Ⅳ区，未发现Ⅰ区和Ⅴ区显像的淋巴结。术后病理证实20例中有16例发现病理阳性淋巴结，且均位于引流优势侧，未出现对侧和双侧颈淋巴结转移的病例。结论：无论是中线结构或偏中线结构的下咽部癌肿，其向颈部的淋巴引流具有明显的优势偏向特点，术前进行引流淋巴结的活体显像对预测肿瘤转移部位和有目的地进行择区性颈淋巴结清扫术具有重要意义。     

Reciprocating tachycardia during central venous cannulation in a patient with Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome is important for the anesthesiologist because the sudden development of tachyarrhythmias may result in deleterious hemodynamic changes. We describe an episode of reciprocating tachycardia triggered by the insertion of the guide wire during central venous cannulation in a patient with this syndrome.     

硬膜外阻滞麻醉分娩镇痛配合Doula式分娩及连续胎心监护的临床分析

目的:观察硬膜外腔阻滞麻醉分娩镇痛配合Doula式分娩及连续胎心监护的临床效果及对产科质量的影响。方法:将低浓度罗哌卡因和小剂量含芬太尼的混合液注入硬膜外腔。配合Doula式分娩及连续胎心监护,用于76例没有产科并发症及麻醉禁忌症进入活跃期的初产妇作为观察组,将单纯采用Doula式分娩的89例相同条件的初产妇作为对照组,比较两组的镇痛效果及其对产科质量的影响。结果:两组镇痛效果有极显著性差异(P<0.01),催产素使用有显著性差异(P<0.05),产程时间、分娩方式、产后出血量、胎儿窘迫、胎心监护异常发生率及新生儿窒息发生率无显著性差异(P>0.05)。结论:硬膜外腔阻滞麻醉用于分娩镇痛,效果可靠,对母婴无不良影响,配合Doula式分娩及连续胎心监护,安全有效。     

呼吸道感染患儿快速A组β溶血性链球菌检测临床分析

目的:研究儿童A组β溶血性链球菌(GABHS)感染的情况,对快速GABHS抗原检测方法进行评价。方法:随机选择呼吸道感染患儿1485例,对其进行快速GABHS抗原检测,对部分阳性者进行青霉素类药物治疗1周后复查,并与抗链O及咽培养比较。结果:1485例呼吸道感染患儿中GABHS阳性率为23.2%(345例),主要为上呼吸道感染,下呼吸道感染则较少见。咽炎合并急性肾炎患者GABHS阳性率高达80%,与普通咽炎(21.6%)比较,P<0.01,有统计学意义,治疗1周后,复查抗链O阳性率改变较前无显著差异,GABHS抗原检测阳性率与咽培养无显著差异(P>0.05),抗原检测转阴率与临床症状转阴率无显著差异。结论:GABHS感染是小儿呼吸道感染疾病常见病因,常引起肾炎及风湿热等,快速GABHS抗原检测可作为其感染的诊断方法及疾病恢复的快速检测指标之一,对判断疾病转归很有帮助。