重症颅脑损伤并发肺部感染原因分析及中医辨证施治配合早期物理干预效果

目的:研究颅脑损伤并发肺部感染的原因及中医辨证施治配合早期物理干预的效果。方法:选择在本院就诊的重症颅脑损伤患者作为本次前瞻性研究的对象,观察受试对象的一般资料,并将合并肺部感染的患者随机分为给予中医辨证施治配合早期物理干预的观察组和早期物理干预的对照组,观察呼吸功能和神经功能恢复情况。结果:并发肺部感染患者的年龄、伤后发生误吸例数、送至医院就诊时间、合并胸部损伤例数、既往存在肺部疾病例数均明显多于未并发肺部感染的患者,且与肺部感染的发生呈正相关;观察组的血氧饱和度、动脉血氧分压均明显高于对照组;呼吸恢复平稳、X线征象消失、肺部啰音消失均明显低于对照组。结论:年龄、伤后误吸、合并胸部损伤、既往存在肺部疾病以及送医时间与并发肺部感染密切相关,中医辨证施治配合早期物理干预能够有效改善呼吸功能和神经功能,具有积极的临床价值。     

Phase II trial of continuous low -dose temozolomide for patients with recurrent malignant glioma

BACKGROUND:In this phase II trial,we investigated the efficacy of a metronomic temozolomide schedule in the treatment of recurrent malignant gliomas(MGs).METHODS:Eligible patients received daily temozolomide(50 mg/m2)continuously until progression.The primary endpoint was progression-free survival rate at 6 months in the glioblastoma cohort(N=37).In an exploratory analysis,10 additional recurrent grade III MG patients were enrolled.Correlative studies included evaluation of 76 frequent mutations in glioblastoma(iPLEX assay,Sequenom)aiming at establishing the frequency of potentially"drugable"mutations in patients entering     

浙江省舟山市普陀山中青年僧尼人群心血管疾病危险因素特点

目的了解浙江省舟山市普陀山中青年僧尼人群心血管疾病危险因素流行现状及特点。方法对浙江省舟山市普陀山僧尼人群进行常规体格检查和心血管疾病相关实验室检查,对检查结果进行分析。结果本次实际调查僧尼679人,应答率为84.98%(679/799),排除60岁以上(62名)僧尼以及个别缺失的资料,最终纳入581名中青年僧尼为本研究实际研究对象,男性448名,平均年龄为(37.5±9.5)岁,女性133名,平均年龄为(34.3±9.0)岁。男性血压水平、体质指数(BMI)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和空腹血糖水平明显高于女性(P<0.05或<0.01),而高密度脂蛋白胆固醇(HDL-C)水平明显低于女性(P<0.01)。男性高血压、高TC血症、高TG血症、糖尿病、肥胖患病率分别为24.33%、12.28%、25.22%、3.79%、20.09%,女性分别为11.32%、3.76%、9.77%、0.75%、9.77%。随着年龄的升高,高血压、高TC血症、高TG血症、糖尿病(男性)、超重(女性)、肥胖(女性)及超重+肥胖患病率均呈显著增加趋势。不论男性女性人群,低TC发生情况有随年龄增长而降低的趋势。结论普陀山中青年僧尼人群中,主要心血管病危险因素水平男性高于女性,且随年龄增加,危险因素水平呈上升趋势。应对这类人群开展更为有针对性的危险因素干预和管理。     

不同产地绞股蓝Se、总蛋白及总皂苷含量及三者相关性分析

对5省绞股蓝Se、总蛋白及总皂苷含量进行测定,分析三者相关性。采用氢化物发生-原子荧光光谱法(HG-AFS)测定绞股蓝Se含量,凯氏定氮法测定绞股蓝总蛋白含量,超声波法提取绞股蓝皂苷和香草醛-高氯酸比色法测定绞股蓝皂苷的含量。5省中湖北咸丰绞股蓝Se含量最高,四川青城绞股蓝总蛋白及总皂苷含量最高。贵州锦屏绞股蓝Se、总蛋白及总皂苷含量均为最低。5省绞股蓝Se含量与总蛋白含量、总皂苷和总蛋白含量均呈显著正相关,r分别为0.910、0.919;实验中随着Se含量的上升,总皂苷的含量也呈上升趋势,但两者之间无显著相关性。绞股蓝Se、总蛋白、总皂苷含量之间有密切的关系,值得更深入的研究。     

个性化需求干预在提升乳腺癌患者满意度的应用

目的 探讨个性化需求干预在提升乳腺癌患者满意度的应用。方法 采用便利抽样法,抽取复旦大学附属华山医院乳腺外科行乳腺癌手术治疗的患者234例为研究对象,分为干预组108例,对照组126例,干预组接受常规护理与个性化需求干预相结合,对照组接受常规护理。于患者出院前进行乳腺癌患者健康需求知晓和住院期间满意度测评。结果对照组患者健康需求知晓评分各维度得分低于干预组,比较有统计学意义(P＜0.01),满意度测评除在入院环境及费用查询介绍、呼叫铃应答、处理化疗反应等常规非干预护理项目上比较无统计学意义(P＞0.05),其他干预项目结果均具有统计学意义(P＜0.01)。结论 个性化需求干预能够提升乳腺癌患者满意度。     

Month of birth is not a risk factor for narcolepsy with cataplexy in the Netherlands

The month of birth has been proposed as a risk factor for narcolepsy, suggesting a harmful influence during early development. Several authors have described an excess of births in March in those developing narcolepsy later. Analysis methods in published studies varied, but no study corrected completely for possible changes in seasonal birth pattern over time in the appropriate population. The present study describes changes in seasonal birth pattern of the entire Dutch population over a 79-year span and compared the monthly birth pattern of Dutch narcoleptics with the population data. Month and year of birth were noted for 307 patients with non-familial narcolepsy with cataplexy, born in the Netherlands between 1923 and 2001. The numbers of live births per month and per year from the entire Dutch population for the same period were used to calculate a virtual data set of expected births per month with exactly the number of cataplexy cases, but with the birth pattern of the Dutch population. Observed and expected numbers per month were compared using the chi-square test. In the 1970s the peak of births shifted from spring to autumn, confirming the need to correct for changing seasonal patterns. There was no significant difference between observed and expected birth numbers per month. An effect of birth month on the occurrence of narcolepsy with cataplexy was not found in a study of 307 cases after adjusting for changing birth patterns in the general population.     

Baseline imaging after therapy for unprovoked venous thromboembolism: a randomized controlled comparison of baseline imaging for diagnosis of suspected recurrence

Summary. Background: After a first unprovoked venous thromboembolism (VTE), many patients have residual pulmonary and/or lower limb vascular obstruction following completion of short‐term anticoagulation. Residual vascular obstruction may complicate the diagnosis of recurrent VTE. Whether baseline imaging, conducted after completion of anticoagulation, helps in interpreting diagnostic testing in patients who subsequently have suspected recurrent VTE is unknown. Study design: The REVERSE study is a cohort study whose primary aim was to derive a clinical decision rule to guide the duration of anticoagulation after a first unprovoked VTE. All patients underwent baseline imaging after completing 5–7 months of anticoagulant therapy. We performed a post hoc randomized controlled comparison among 121 patients investigated for a suspected recurrent VTE during follow‐up: the decision on recurrent VTE with or without baseline imaging was made available to two independent adjudicators. Results: The proportion of patients not classifiable for recurrent VTE was statistically significantly higher in the group with no baseline imaging than in the group with baseline imaging: one in five as compared with one in 25. The interobserver agreement between the two adjudicators was better in the group with baseline imaging than in the group with no baseline imaging: κ‐values were 0.78 and 0.54, respectively. Conclusions: In patients with a first unprovoked VTE, baseline imaging at completion of anticoagulant therapy helps in interpreting diagnostic tests performed in cases of suspected recurrent VTE.     

液质联用方法对海狗油大鼠药物动力学的初步研究

目的:应用LC/APCI-MS法检测大鼠血浆中海狗油的二十碳五烯酸(EPA)、二十二碳六烯酸(DHA)、二十二碳五烯酸(DPA)3个主要成分,为其药动学研究提供灵敏、准确和实用的方法。方法:取血浆样品0.1 mL经甲醇-正己烷(1∶1)沉淀蛋白并萃取后,氮气吹干后进行柱前转酯化衍生,采用Waters C18色谱柱(150 mm×4.6 mm,5μm)分离,以乙腈-水(9∶1)为流动相,流速0.3 mL·min-1,检测波长210 nm,柱温40℃。通过大气压化学电离四极杆质谱,以选择离子监测(SIM)方式进行检测。用于定量分析的EPA甲酯(EPAM)、DHA甲酯(DHAM)、DPA甲酯(DPAM)、十九碳二烯酸甲酯(内标物)的m/z分别为317.30[M+H]+、343.30[M+H]+、345.30[M+H]+、309.20[M+H]+。结果:EPAM、DHAM和DPAM的线性范围均为50～10000 ng.mL-1,定量限为50 ng.mL-1,日内、日间RSD均小于6.6%。对海狗油的大鼠药物动力学初步研究结果表明,EPA、DHA和DPA在连续给药第10 d达到稳态浓度,且时间与给药剂量之间没有关联性;大鼠血浆中EPA、DHA和DPA稳态浓度的高低与给药剂量正相关。结论:该法快速灵敏,准确度高,适用于大鼠体内EPA、DHA、DPA的药动学研究。     

鼻腔鼻窦恶性黑色素瘤17例临床分析

目的探讨鼻腔鼻窦恶性黑色素瘤的诊断和治疗,提高本病的诊疗水平。方法回顾性分析1980年3月-2011年6月收治的17例鼻腔鼻窦恶性黑色素瘤的临床资料,分析其临床病理特点、诊断、治疗及预后。结果患者的主要症状为单侧鼻塞,涕中带血,头痛;病灶位于鼻腔外侧壁和鼻中隔。17例患者中1例放弃治疗,2例行单纯放疗,14例行手术治疗,3、5年生存率分别为36．4％和22．2％。患者死亡原因为局部复发和远处转移。结论鼻腔鼻窦恶性黑色素瘤恶性程度高,易复发和转移,预后差,临床上尽早确诊。广泛彻底手术切除肿瘤,并辅以放疗、化疗、免疫治疗等综合治疗,是提高本病生存率的关键。     

声脉冲辐射力成像在下肢深静脉血栓中的应用研究

目的:应用声脉冲辐射力成像技术(acoustic radiation force impulse,ARFI)评价下肢深静脉血栓(deep venousthrombosis,DVT)的弹性成像。方法:分别用二维、彩色多普勒超声及ARFI对31例DVT患者进行检查。结果:DVT 24h内与24h后剪切波速度2组差异有统计学意义。不同回声的血栓声触诊组织成像差别不明显。结论:声触诊组织定量技术通过评价DVT血栓弹性,间接评价血栓稳定性,具有一定的临床应用价值。