内窥镜采集大隐静脉在高龄患者冠状动脉旁路移植术中的应用效果

目的 评价内窥镜采集大隐静脉在高龄冠心病患者冠状动脉旁路移植术(CABG)中的应用效果.方法 选取拟行CABG的冠心病患者336例,按年龄分为高龄组(年龄≥75岁)98例,低龄组(年龄＜75岁)238例,两组患者术中均采用内窥镜取大隐静脉,比较两组取材及手术时间、取材质量、下肢手术并发症等情况.结果 两组的静脉血管桥长度、大隐静脉修补次数、切口长度及切口缝合时间比较,差异无统计学意义(P＞0.05),而高龄组获取大隐静脉时间及手术总时间短于低龄组(P＜0.05),术后下肢麻木、皮下血肿、水肿、切口中度以上疼痛发生率也低于低龄组(P＜0.05).结论 内窥镜采集大隐静脉作为一种微创取血管的方法,取材质量良好、切口小、并发症少,用于CABG安全有效,尤其适用于75岁以上高龄冠心病患者.     

医患纠纷调解模式比较研究

当前，我国化解医患纠纷的调解模式主要有三种，分别为：卫生行政调解、司法调解和第三方调解。这三种调解模式各有其特点与优点，但同时也存在一定的缺点与不足。实践表明，单纯地依托三种模式中的任何一种用于调解医患纠纷是不够的，而必须在加强分工与协作的基础上，构建“三调解联动”的多元调解体系，形成全方位、多层次的大调解格局，实现三种调解模式的互补与衔接。     

沙利度胺联合三维适形放射治疗中晚期肝癌

目的:探讨沙利度胺(TLD)联合三维适形放射(3-DCRT)治疗中晚期原发性肝癌的临床疗效及不良反应。方法:60例患者分观察组和对照组各30例,观察组在3-DCRT基础上加口服TLD,对照组不用TLD。结果:近期疗效显示观察组肿瘤完全缓解(CR)4例,部分缓解(PR)22例,无变化(NC)3例,进展(PD)1例,总有效率为86.7%(P0.05)。两组未见严重不良反应发生。随访3年,观察组1、2、3年生存率分别为73.3%、56.7%、36.7%;对照组为46.7%、30.0%、13.3%(P0.05)。结论:应用TLD与3-DCRT联合治疗中晚期原发性肝癌疗效明显,不良反应轻,具有一定的临床应用价值。     

2型糖尿病合并颈动脉血管病患者的危险因素分析

目的:探讨C肽与2型糖尿病颈动脉血管并发症的关系及2型糖尿病患者颈动脉血管病变的危险因素。方法:对2型糖尿病患者100例颈动脉进行检测,将血管病变组50例与非颈血管病变组50例进行对照,记录患者年龄、病程、吸烟状况、血压、空腹、餐后血耱、糖化血红蛋白、血脂及空腹餐后c肽。结果:糖尿病颈血管病变组患者年龄大、吸烟多、病程长、低密度脂蛋白胆固醇(LDL-C)明显升高、空腹及餐后C肽明显降低。结论:年龄、吸烟、病程、高血糖、高血脂、高血压及低C肽水平是糖尿病颈动脉血管病变的危险因素。     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

安神方对失眠大鼠中枢氨基酸类神经递质的影响

目的 研究安神方颗粒对失眠造模大鼠中枢神经递质的影响.方法 60只Wistar大鼠随机方法分为中药高、中、低剂量组和生理盐水组4组;采用限制运动方法制备大鼠焦虑抑郁失眠模型,同时给予药物干预.15 d后,处死并冰台上分离大鼠海马及下丘脑,冷冻离心后分离上清液,高效液相色谱法测定谷氨酸(GLU),γ-氨基丁酸(GABA)含量.结果 海马及下丘脑GLU含量下降(P<0.05,P<0.01),GABA含量升高(P<0.05,P<0.01);且海马部神经递质含量变化与药物浓度成正相关性.结论 中药安神方颗粒可以通过调节中枢神经递质,如谷氨酸(GLU)和γ-氨基丁酸(GABA),从而达到治疗失眠症目的 .     

基于fsQCA组态视角的基本医疗保险欺诈骗保的影响因素研究

目的:探索基本医疗保险欺诈骗保现象发生的关键因素和骗保模式,为保障基本医保制度的长期稳定运行提供政策建议。方法:立足于国家医疗保障局曝光的医保欺诈典型案例,运用模糊集定性比较分析方法探究欺诈骗保的关键因素及其典型模式。结果:导致医保欺诈行为的组态有4种解,其总体一致性为0.936282,总体覆盖率为0.648143;得出骗保行为发生的4条路径,并概括出参保人群妨碍、政治压力缺位、政策过程艰难、社会意识缺乏4种典型骗保模式。结论:规范参保人的参保行为是医保欺诈治理的重点;完善医保监管体系建设是医保欺诈治理的关键;健全欠发达地区民营及基层医疗机构管理制度是医保欺诈治理的当务之急。     

肠道旺炽性血管增生3例临床病理分析及文献复习

目的 探讨旺炽性血管增生(FVP)的临床病理特点、诊断及鉴别诊断。方法 分析3例FVP临床资料,观察其组织学形态及免疫组化特征,并复习相关文献。结果 3例患者均为男性,中位年龄58岁(31～65岁),均为无明显诱因下出现腹部疼痛不适,影像学检查提示肠占位合并肠套叠和肠梗阻。3例均行手术切除,病变黏膜表面缺血、溃疡合并黏膜脱垂及纤维化。镜下见增生的血管呈小叶状分布,自黏膜层延伸至浆膜层,增生血管穿插于黏膜肌及固有肌层之间,血管大小不等,分化良好,无相互吻合现象,部分管壁增厚,内皮细胞形态温和或轻度异型,核分裂象罕见。免疫组化染色显示Vimentin、CD34、CD31、F-Ⅷ血管内皮阳性,SMA血管周围平滑肌阳性,Ki-67增殖指数较低。结论 FVP是一种罕见的良性假瘤样血管增生性病变,在完全的手术切除后不会复发。但因其类似其他良性或恶性的血管病变或肿瘤,容易造成误诊,所以正确认识并诊断该疾病非常重要。     

室管膜瘤临床病理特征及H3K27me3表达的意义

目的 探讨室管膜瘤(ependymomas,EPN)中H3 K27 me3的表达及其与预后的相关性.方法 回顾性分析48例EPN的临床病理学特征,采用免疫组化法检测H3 K27 me3的表达,分析其在不同部位及不同组织学分级的表达差异及与肿瘤预后的关系.结果 48例EPN中男性19例,女性29例;30例位于脊髓、5例位...