老年髋部骨折的牵引治疗

目的了解因全身其他因素,不能接受手术治疗的老年髋部骨折患者,进行牵引治疗的结果。方法2000年11月至2005年1月共有102例老年髋部骨折患者,因伴有心脏病、糖尿病、高血压等内科疾病而行牵引治疗。其中股骨颈骨折37例,股骨粗隆间骨折65例,年龄48～98岁,平均75．8岁。所有病例均在家中接受牵引治疗。结果1年内死亡9例,死亡率8．8％（9／102）。其他并发症依次为褥疮30例,发生率29．4％（30／102）,肺部感染6例,发生率5．9％（6／102）,下肢深静脉血栓2例,肺栓塞1例,泌尿系感染1例。股骨颈骨折愈合15例,愈合率51．7％（15／29）。股骨粗隆间骨折愈合40例,愈合率97．6％（40／41）。调查时与伤前Harris评分比较,股骨颈骨折组平均下降23．1分,股骨粗隆间骨折组下降15．6分。结论对于无移位或稳定的股骨颈骨折,以及部分粗隆间骨折,牵引治疗可以获得良好的结果,且其花费低,在现阶段仍具有一定的适用范围。     

Persistent efficacy of live attenuated hepatitis A vaccine (H2-strain) after a mass vaccination program

Background Live attenuated hepatitis A vaccine （ H2 strain） is widely applied in prevention of hepatitis A epidemic in China and other countries now. It is essential to observe and confirm the vaccine immune efficacy, population antibody level and its persistent efficacy after mass immunization. Methods A total of 220 children with negative anti-HAV antibody （ aged 1-3 years） were taken for follow-up assay to observe seroconversion and geometric mean titre（GMT） level 2 months, 12 months, 6 years, and 10 years after inoculation. Another survey sampled from subjects of different age groups （3, 6, 9, 15, 18, 25 and 35 years） to compare anti-HA antibody positive rate before and after inoculation performed 10 years previously. Epidemiological observations were taken for 10 years to evaluate the relationship between vaccine coverage and hepatitis A morbidity. Serum antibody to HAV was detected by enzyme linked immunoassay （ELISA, calibrated by WHO international reference） and ABBOTY Axsym HAVAB microparticle enzyme immunoassay. Results Seroconversion in follow-up assay 2 months and 10 years after inoculation was 98.6% and 80. 2% respectively. For children, the vaccination anti-HA antibody positive rates were significantly different before and after 10 years, 7.69% cf 70.45% （aged 3 years） and 52. 58% cf 71.78% （aged 18 years）. When vaccine coverage rose from 57% to 74%, there were no any HA epidemics. When vaccine coverage reached 85%, there were no any HA cases. With vaccine coverage between 85% and 91%, there were no any HA cases in cohorts from the age of 1 year to 15 years during the 10 years. Conclusions Live attenuated hepatitis A vaccine has an obvious long-term effectiveness in prevention and control of HA epidemics through mass vaccination.     

功能磁共振成像定位皮质运动区与术中电刺激运动诱发电位的前瞻对照研究

目的以术中电刺激运动诱发电位（MEP）监测为对照,评价中央区脑肿瘤术前运用血液氧饱和水平检测（BOLD）技术的功能磁共振成像（fMRI）定位皮质运动区的准确性。方法此项前瞻性研究选取了16例中央区脑肿瘤。开颅手术前分别执行手运动激发程式,运用BOLD技术的fMRI定位皮质运动区。将fMRI影像与磁共振导航序列影像融合。以术中MEP监测作为皮质运动区定位的标准技术。在神经导航下定位fMRI的各个激活区,单独或联合运用短串经颅电刺激（TCES）和直接皮质电刺激（DCES）,在前臂及手部记录复合肌肉动作电位。比较两种技术的吻合度,以评价fMRI定位的皮质运动区的准确性。结果fMRI与MEP的吻合率为92．3％,其中与TCES的吻合率为100．0％,与DCES的吻合率为66．7％。结论运用BOLD技术的fMRI敏感度高,可实现中央区脑肿瘤术前皮质运动区的准确定位。     

Seasonal Variation and Spatial Distribution of Polycyclic Aromatic Hydrocarbons in Atmospheric PM10 of Beijing, People’s Republic of China

No abstract available.     

Spinal glucocorticoid receptors contribute to the development of morphine tolerance in rats

BACKGROUND: Opioid analgesic tolerance is a pharmacologic phenomenon involving the mechanisms of cellular adaptation. Central glucocorticoid receptors (GRs) have been implicated in the cellular mechanism of neuronal plasticity that has many cellular steps in common with the mechanism of opioid tolerance. In a rat model of morphine tolerance, the authors examined the hypothesis that spinal GRs would play a significant role in the development of tolerance to the antinociceptive effect of morphine. METHODS: In experiment 1, each group of rats received the GR antagonist RU38486 (0.5 or 1 microg), the mineralocorticoid receptor antagonist spironolactone (3 microg), or a vehicle, given intrathecally with morphine (10 microg) twice daily for 6 days. In experiment 2, four groups of rats were used, and each group received intrathecally 10 microg morphine plus 5 micromol GR antisense oligodeoxynucleotide, sense oligodeoxynucleotide, mixed-base oligodeoxynucleotide, or vehicle. Western blotting was used to examine the expression of GRs within the spinal cord dorsal horn. In experiment 3, the GR agonist dexamethasone (4 microg) was given intrathecally twice daily in combination with 10 microg morphine. For all experiments, the development of morphine antinociceptive tolerance was assessed using the tail-flick test. RESULTS: The development of tolerance to the antinociceptive effect of morphine was substantially attenuated when the GR antagonist RU38486 (1 > 0.5 microg > vehicle) but not spironolactone was coadministered with morphine for 6 days. A single treatment with RU38486 did not affect morphine antinociception, nor did it reverse morphine tolerance on day 7. A similar reduction of morphine tolerance was observed in those rats treated with a GR antisense oligodeoxynucleotide but not a sense or mixed-base oligodeoxynucleotide. The administration of the GR antisense oligodeoxynucleotide also prevented GR up-regulation within the spinal cord dorsal horn. Moreover, the GR agonist dexamethasone facilitated the development of morphine tolerance. CONCLUSIONS: The results indicate an important role of spinal GRs in the cellular mechanisms of morphine tolerance in rats and may have significant implications in clinical opioid therapy.     

Papillary endothelial hyperplasia (Masson tumor) of the petrous and jugulare region: case report and literature review

OBJECTIVE: Intracranial papillary endothelial hyperplasia (PEH) is rare, and only 13 cases have been reported intracranially in the literature. In this article, we present a case of PEH involving petrous and jugular foramen region due to the uncommon incidence. CASE DESCRIPTION: A 49-year-old female patient with a 4-year history of left-sided hearing loss and facial palsy. Magnetic resonance (MR) imaging disclosed the presence of a 6 x 6 x 5 cm lobular mass occupying the left petrous and jugulare region. This mass was hyperintense on both T1 and T2 weighted MR images and was enhanced strongly with gadolinium. No edema was found around the lesion. Preoperative digital subtraction angiogram examination showed that the lesion had a rich blood supply. Therefore, polyvinyl alcohol embolization was carried out to reduce bleeding during operation. A left-sided suboccipital extreme lateral approach was applied for craniotomy. The lesion was extradural and highly vascular with extension into the petrous bone. It was subtotally removed. Postoperative course of the patient was stable. Her neurologic evaluation was the same as preoperatively. CONCLUSION: Surgical excision of the lesion is the main therapy. Radiotherapy should be given to patients whose lesion cannot be totally removed.     

Role of adrenalectomy in ectopic ACTH syndrome

Evaluation of adrenalectomy in patients diagnosed with ectopic ACTH syndrome was studied. Twenty-three clinical cases diagnosed with ectopic ACTH syndrome were analyzed at Chinese Academy of Medical Sciences and Peking Union Medical College Hospital (PUMCH). Cases consisted of 14 males and 9 females, with mean age of 38 years. All 23 cases had positive clinical, biochemical and radiology evidence for diagnosis of Cushing's syndrome. Sixteen of the 23 cases were treated with total adrenalectomy and the remaining 7 were treated without surgical intervention. Sixteen cases, having no identifiable source of ectopic hormone production, experienced resolution of presenting signs and symptoms after undergoing bilateral or unilateral total adrenalectomy; 1-year survival was 67%, 2-year survival 41% and 5-year survival 15%. In patients treated conservatively without surgical intervention, 1-year survival was 0%. In patients with no identifiable source of ectopic hormone production, bilateral adrenalectomy followed by hormone replacement treatment is effective.     

Willingness to participate in HIV vaccine trials among HIV-negative gay men in Sydney, Australia

This study aimed to determine and describe HIV-negative gay men's willingness to participate in HIV vaccine trials. Data were from participants who completed face-to-face interviews during the first 18 months (to the end of 2002) of recruitment into the Health in Men cohort of HIV-negative gay men in Sydney. A key outcome measure was a scale of Willingness to Participate in HIV Vaccine Trials, with scores ranging from 1 (unwilling) to 4 (willing). The 903 participants ranged in age from 18 to 75 years (median = 36). Mean of Willingness to Participate in HIV Vaccine Trials was 2.53 (standard deviation = 0.54), with approximately 51% of the men having a score greater than the midpoint of 2.50. A reduced linear regression model yielded four significant independent associations with Willingness to Participate in HIV Vaccine Trials: lack of tertiary education (P < 0.001),having engaged 'in the previous six months' in any unprotected anal intercourse with casual or non-concordant regular partners (P < 0.001), higher self-rated likelihood of HIV infection (P < 0.01), and higher mean scores on a scale of Comfort with Participation in HIV Vaccine Trials (P < 0.001). The willingness of HIV-negative gay men at potentially higher risk for HIV to participate in HIV vaccine trials augurs well for enrolment in HIV vaccine efficacy trials. Recruitment into trials is likely to be enhanced by addressing salient concerns such as confidentiality and vaccine-induced antibody positivity. Also, it will be important to ensure that gay men are educated and fully informed about HIV vaccines and trial processes.