The human antibody response to simultaneous injection of six specific polysaccharides of pneumococcus

A new experimental procedure for the production of arteriosclerosis in the bird is described. The subcutaneous implantation of diethylstilbestrol by means of which a sustained increase in the concentration of cholesterol, phospholipid, and neutral fat can be readily established, is shown to induce atherosclerosis of the aorta. The atherosclerosis has been compared with that artificially induced in the bird by the prolonged feeding of cholesterol and also with that occurring spontaneously. The stilbestrol-induced lesion more closely resembled the spontaneously occurring one in the bird than did that produced by cholesterol feeding. But all 3 lesions were fundamentally similar, differing only in the amounts and proportions of the various lipid constituents present. The concentrations of cholesterol in plasma of the stilbestrol-treated and cholesterol-fed birds were of the same order. Yet cholesterol constituted a greater proportion of the lipids deposited in the arterial wall of the cholesterol-fed than in that of the stilbestrol-treated birds. This finding suggests that the cholesterol content of the vascular lesion depends not only on the absolute concentration of cholesterol in plasma, but also on the proportion of cholesterol to other lipid constituents in plasma.     

Emergent treatment of patients with traumatic aorta ruptures

Objective ： To discuss our experience on the diagnosis and treatment of thoracic aorta rupture （TAR） that is one of the main common causes of death in the victims under blunt chest trauma. Methods： Between July 2001 and March 2006, 9 patients （6 men and 3 women, aged from 20 to 54 years ） suffering from acute traumatic aorta rupture after motor vehicle accidents received emergent surgical treatments in our hospital. Based on our experience in the rescue of the first TAR patient we introduced a practical procedure on the diagnosis and treatment of TAR in our department. All the other patients generally followed this procedure. Eight patients received contrast material enhanced helical computerized tomography scan before the operation. The leakage of coustrast medium from the aorta isthmus was found, and diagnosis of TAR was confirmed. Seven patients underwent immediate operation within 14 hours after accidents. One patient was treated on the 5th day of the accident because of delayed diagnosis of aortic rupture. All patients received general anesthesia with double lumen endotracheal tube and normothermic femoro-femoral partial cardiopulmonary bypass, with beating heart and aortic clamping. One patient received simple repair, and others received partial replacement of thoracic aorta with artificial vascular graft. Results： Seven TAR patients were successfully salvaged. Three patients combined brain injury as well as extremitiy hemiplegia before operation. After treatments one was fully and two partially recovered without paraplegia. Conclusions： Proper practical protocol is emphasized for the surgical repair of TAR because it will reduce the mortality of severe blunt chest injury.     

准分子激光原位角膜磨镶术患者并发症的预防与护理

目的 探讨行准分子激光原位角膜磨镶术(LAsIK)患者预防角膜瓣并发症的护理措施.方法 收集1370例(2578只眼)行准分子激光原位角膜磨镶术的患者,所有患者均使用法国产Moria M2旋转式角膜板层刀,刀头分别为110号和90号来完成角膜瓣的制作.对所有手术患者进行角膜瓣并发症的预防护理.结果 本组角膜瓣并发症的发生率为2.3%.结论 LASIK手术中发生角膜瓣的并发症是不可避免的,正确的预防护理措施可有效地减少其发生.     

Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review

Summary.  Background: The reported diagnostic accuracy of the D-dimer test for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE) varies. It is unknown to what extent this is due to differences in study design or patient groups, or to genuine differences between D-dimer assays. Methods: Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of venous thromboembolism were systematically searched for in the MEDLINE and EMBASE databases up to March 2005. Reference lists of all included studies and of reviews related to the topic of the present meta-analysis were manually searched for other additional potentially eligible studies. Two reviewers independently extracted study characteristics using standardized forms. Results: In total, 217 D-dimer test evaluations for DVT and 111 for PE were analyzed. Several study design characteristics were associated with systematic differences in diagnostic accuracy. After adjustment for these features, the sensitivities of the D-dimer enzyme-linked immunofluorescence assay (ELFA) (DVT 96%; PE 97%), microplate enzyme-linked immunosorbent assay (ELISA) (DVT 94%; PE 95%), and latex quantitative assay (DVT 93%; PE 95%) were superior to those of the whole-blood D-dimer assay (DVT 83%; PE 87%), latex semiquantitative assay (DVT 85%; PE 88%) and latex qualitative assay (DVT 69%; PE 75%). The latex qualitative and whole-blood D-dimer assays had the highest specificities (DVT 99%, 71%; PE 99%, 69%). Conclusions: Compared to other D-dimer assays, the ELFA, microplate ELISA and latex quantitative assays have higher sensitivity but lower specificity, resulting in a more confident exclusion of the disease at the expense of more additional imaging testing. These conclusions are based on the most up-to-date and extensive systematic review of the topic area, including 184 articles, with 328 D-dimer test evaluations.     

男性不同发育阶段靶组织中雄激素水平生理性变化

目的:研究中国汉族男性不同发育阶段靶组织中雄激素[睾酮(T)、双氢睾酮(DHT)]生理变化趋势,探讨其在主导男性性发育和成熟中的作用.方法:78例不同年龄的男性,因包茎或包皮过长行包皮环切术.年龄从出生后9个月至34岁.新鲜的包皮组织制备匀浆,其上清用放射免疫方法测定睾酮、DHT水平,浓度单位转化为每毫升蛋白pmol/mg,进行多项式曲线配合分析其变化趋势.选择8例4-6岁儿童、8例14-16岁发育期男子、6例24～26岁成年男子,进行组间比较分析.结果:通过雄激素生理性变化趋势的曲线和不同年龄组的组间比较发现.新生儿时期有短暂的高水平的睾酮和DHT,尤其是DHT.儿童时期靶组织中的睾酮和DHT保持低水平[(0.368±0.229)nmol/(mg·L)和(0.589±0.375)nmol/(mg·L)],T/DHT比值为0.752+0.405.随着青春期发育开始,靶组织中睾酮和DHT水平升高,并在14～16岁之间达到峰值[(1.120±0.278)nmol/(mg·L)和(2.394±0.813)nmol/(mg·L)],T/DHT比值0.376±0.161.成年后,靶组织中睾酮和DHT水平分别维持在较高水平[(1.184±0.295)nmol/(mg·mL)和(2.250±0.666)nmol/(mg·L)],T/DHT比值为0.511±0.164.结论:研究结果描绘男性不同发育阶段靶组织中雄激素水平的生理性变化趋势,也印证了靶组织中雄激素在介导性发育和维持性成熟中的重要作用.     

切开复位内固定治疗跟骨关节内骨折

[目的]探讨波及距下关节的跟骨关节内骨折的手术治疗问题。[方法]从2002年3月-2005年11月，对收治的26例31足跟骨关节内骨折患者，采用跟骨外侧“L”形切口，切开复位，解剖型跟骨钛板内固定的方法进行治疗。[结果]全部患者随访13-19个月（平均13．4个月），23例27足切口I期愈合，有3例4足手术后切口皮肤部分感染坏死，经换药或扩创后愈合；3例出现足外侧皮肤麻木。按照孙宏慧等的疗效评定标准，优良率占84％。[结论]对于Sanders分型中Ⅱ、Ⅲ、Ⅳ型的跟骨关节内骨折，采用手术切开复位内固定的方法进行治疗，效果满意，能最大程度地恢复足部功能。     

情感性精神障碍患者认知功能障碍的对照研究

目的　探讨情感性精神障碍患者是否存在认知功能损害，比较各亚型患者认知功能损害的特征。方法　对120例（抑郁症组、双相抑郁组、躁狂组及双相躁狂组各30例）情感性精神障碍患者（以下简称患者组）使用汉密尔顿抑郁量表（17项）、YOUNG躁狂量表、临床疗效总评量表、威斯康星卡片分类测验（WCST）、韦氏智力量表、韦氏记忆量表及Halstead—Retain神经心理成套检查（HRB—RC）分别于治疗前和治疗第12周末评定及比较。对照组为30名正常人。结果　（1）各亚型患者组治疗前WCST操作的总测验次数、持续错误数、随机错误数、分类数、智商（IQ）值、记忆商（MQ）值，以及抑郁症组、双相抑郁组的正确数与对照组比较，差异均有统计学意义（P〈0．05或P〈0．01）。各亚型患者组治疗第12周末与对照组比较，WCST操作的总测验次数、持续错误数、随机错误数、分类数及MQ值的差异有统计学意义（P〈0．05或P〈0．01）。在各患者组中，WCST操作的总测验次数、随机错误数、分类数、IQ值和MQ值治疗前与治疗第12周末的差异均有统计学意义（P〈0．05或P〈0．01），而组间的差异无统计学意义（P〉0．05）。（2）治疗前与治疗第12周末比较，各患者组中的HRB—RC测验的连线乙、触摸总时间、范畴，抑郁症组中的连线甲，抑郁症组、双相抑郁组治疗前的敲击次数等，与对照组的差异均有统计学意义（P〈0．05或P〈0．01）。结论　部分情感性精神障碍患者存在认知功能损害，各亚型患者间的差异不明显。     

原发性贲门无色素恶性黑色素瘤1例报道

恶性黑色素瘤好发于皮肤及邻近皮肤的黏膜等，而发生于消化道如贲门的恶性黑色素瘤少见。无色素黑色素瘤是由于在肿瘤细胞中无黑色素颗粒而命名。近来我院收治1例贲门无色素恶性黑色素瘤患者，现报道如下。     

进入体外受精-胚胎移植周期妇女应激情绪的研究

目的:探讨进入体外受精-胚胎移植(IVF-ET)周期妇女焦虑和抑郁情绪的变化特点。方法:征集46例将进行IVF-ET/胞浆内单精子注射(ICSI)的不孕症妇女,在进入治疗周期降调当日、取卵前1h、移植后12d等待人绒毛膜促性腺激素β亚单位(β-hCG)结果前这3个时间段的晨8:00～8:30间,在医院门诊采用状态焦虑和BECK抑郁量表进行心理测查并空腹采血。结果:①3个测试点妇女均有抑郁表现,但抑郁程度无差异。②状态焦虑均值在3个测试点有逐渐增高的趋势,测试点3较测试点1焦虑程度明显增高,有统计学差异(P<0.05)。③前3个测试点皮质醇激素水平显著高于正常参考值(P<0.01),测试点2和测试点3血浆皮质醇激素水平明显高于测试点1,并有统计学差异(P<0.05)。结论:进入IVF-EF周期妇女表现出较大的应激反应,并随治疗进展应激程度出现变化。应关注IVF妇女心理状况的变化。应以提高治疗的依从性和成功率。     

昼夜规律和性别对健康人窦性心率震荡的影响

目的探讨健康人窦性心率震荡的昼夜规律及其与性别的关系。方法43例非器质性心脏病的正常人,其中男22例,年龄40～70岁,平均年龄54岁;女21例,年龄42～68岁,平均年龄52岁。男女2组分别按不同的时间段分为3组：第1组（22∶00～5∶59）,第2组（6∶00～13∶59）和第3组（14∶00～21∶59）。然后分别计算震荡初始（TO）和震荡斜率（TS）。观察不同时间、不同性别间心率震荡的差异。结果女性的TO阳性率在夜间和上午高于男性（P＆lt;0.05）;而男性的TS阳性率在下午高于女性（P＆lt;0.05）。结论TO和TS均存在近日节律。