血管内栓塞破裂性前交通动脉瘤和术前影像学评估

目的总结46例破裂性前交通动脉瘤血管内治疗的经验和体会,探讨术前影像学分析对手术安全性的影响。方法经血管内途径,采用可脱性弹簧圈对46例破裂性前交通动脉瘤患者行栓塞治疗,术中8例患者采用双微导管技术动脉瘤栓塞,2例采用支架辅助栓塞。结果本组46例患者中,32例栓塞程度〉95%,11例栓塞程度95%,2例栓塞程度90%,1例栓塞程度约80%。42例患者术后恢复良好,无任何神经功能缺失。1例患者术后一侧大脑前动脉栓塞,1例术后呈植物生存状态。术后死亡2例。结论通过术前的影像学评估分析来指导前交通动脉瘤的栓塞,避免了盲目性,减少了并发症的发生,使本组弹簧圈栓塞前交通动脉瘤效果满意。     

The Effectiveness and Cost-Effectiveness of a Rural Employer-Based Wellness Program

Context: The cost-effectiveness of employer-based wellness programs has been previously investigated with favorable financial and nonfinancial outcomes being detected. However, these investigations have mainly focused on large employers in urban settings. Very few studies examined wellness programs offered in rural settings. Purpose: This paper aims to explore the effectiveness and cost-effectiveness of a rural employer-based wellness program. Methods: Six rural employers were categorized into 3 groups: a control group and 2 intervention groups with varying degrees of wellness activities. Participants were asked to complete an annual health risk assessment (HRA) that addressed 16 wellness areas. At the conclusion of 4 years, HRA and effectiveness data were utilized to examine program effectiveness and combined with program costs to estimate cost-effectiveness. Findings: The “Coaching and Referral” group—the highest in intensity of participant engagement—exhibited superior improvement in several wellness areas and in percentage of employees with good health indicators compared to the control and the Trail Marker, lower-intensity intervention groups. However, the Trail Markers had more favorable cost-effectiveness ratios. Conclusions: Rural worksite wellness programs have shown great potential in their effectiveness and cost-effectiveness. Such programs need not be too aggressive, tedious, and costly to generate a favorable return for employers and funders. However, employers should be encouraged to experiment with different levels of wellness program intensities until a more favorable outcome can be realized.     

Polymorphisms of folate metabolic genes and susceptibility to bladder cancer: a case-control study

Epidemiological studies have shown an association between low folate intake and an increased cancer risk. Major genes involved in folate metabolism include methylene-tetrahydrofolate reductase (MTHFR) and methionine synthase (MS). We investigated joint effects of polymorphisms of the MTHFR (677 C-->T, 1298A-->C) and MS genes (2756 A-->G), dietary folate intake and cigarette smoking on the risk of bladder cancer in a case-control study. The study population consisted of 457 bladder cancer patients and 457 healthy controls, matched to the cases in terms of age, gender and ethnicity. Genotype data were analyzed in a subset of 410 Caucasian cases and 410 controls. Compared with individuals carrying the MTHFR 677 wild-type (CC) and reporting a high folate intake, those carrying the variant genotype (CT or TT) and reporting a low folate intake were at a significantly 3.51-fold increased risk of bladder cancer (95% CI: 1.59-6.52). In contrast, individuals carrying a variant genotype and reporting a high folate intake were at only a 1.39-fold increased risk (95% CI: 0.71-2.70), and those carrying the wild-type and reporting a low folate intake were at only 1.56-fold increased risk (95% CI: 0.82-2.97). The interaction between genetic polymorphisms and folate intake was significant on the multiplicative scale (P = 0.01). When analyzed in the context of smoking status, compared with never smokers with the MTHFR 677 wild-type, the risk increased to 6.56-fold (95% CI: 3.28-13.12) in current smokers carrying the variant genotype. Analyses of the MTHFR 1298, MS 2756 genes revealed similar results. In addition, age at cancer onset in former smokers increased as the proportion of the heteromorphic haplotype in the individual increased (P = 0.005). Our results strongly suggest that polymorphisms of the MTHFR and MS genes act together with low folate intake and smoking to increase bladder cancer risk. These results have important implications for cancer prevention in susceptible populations.     

黄连素通过调节miRNA-146a促进乳腺癌细胞凋亡

目的:探讨黄连素对乳腺癌MCF-7细胞凋亡的影响及其作用机制。方法:乳腺癌细胞MCF-7采用含10%小牛血清的1640培养基培养,实验分为对照组、黄连素低剂量组、黄连素中剂量组和黄连素高剂量组。给药处理24 h后,采用MTT法检测各组中MCF-7细胞的存活率;Hoechst 33258染色及流式细胞技术观察细胞的凋亡情况;采用Western blot法检测各组MCF-7细胞中NF-κB P65磷酸化水平及促凋亡蛋白Bax和抑凋亡蛋白Bcl-2的表达水平;RT-q PCR法检测细胞中microRNA-146a(miRNA-146a)的水平。为进一步探讨黄连素影响乳腺癌MCF-7细胞凋亡的作用机制,本实验还检测了转染miRNA-146a siRNA后黄连素对促凋亡蛋白Bax和抑凋亡蛋白Bcl-2的mRNA水平的影响。结果:MTT实验结果显示,与对照组相比,黄连素中、高剂量给药组MCF-7细胞的存活率明显降低,且呈一定的剂量依赖性(P0.01);Hoechst 33258染色观察到给药组细胞核呈致密浓染,或呈碎块状致密浓染;流式细胞技术实验结果亦显示,黄连素给药组MCF-7细胞凋亡率显著增加(P0.05);Western blot实验结果显示,与对照组比较,黄连素给药组的p-P65和Bcl-2表达水平明显降低,Bax表达水平明显升高,且呈一定的剂量依赖性(P0.05);RT-q PCR实验结果显示,与对照组比较,黄连素给药组的miRNA-146a表达水平明显升高,且呈一定的剂量依赖性(P0.05)。黄连素给药联合转染miRNA-146a siRNA后,与黄连素单独给药组相比,MCF-7细胞中Bax mRNA水平显著下降(P0.05),Bcl-2 mRNA水平显著上调(P0.05)。结论:黄连素能够促进乳腺癌MCF-7细胞凋亡,其机制可能有部分是通过miRNA-146a抑制NF-κB P65磷酸化,最终影响凋亡相关蛋白Bax/Bcl-2的表达。     

The Central Massachusetts Oral Health Initiative (CMOHI): a successful public–private community health collaboration

Objectives: The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts. Methods: A broad‐based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school‐based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health. Results: A state legislative Oral Health Caucus helped secure sought‐after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school‐based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established. Conclusions: Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.     

腹部术后胃瘫分析

目的：探讨腹部术后胃瘫综合征发生的原因、诊断及治疗方法。方法：对15例腹部术后胃瘫综合征患者的临床资料进行分析。结果：15例患者经非手术治疗均于术后10～48天恢复胃动力,痊愈出院。结论：胃镜检查及上消化道造影是诊断本病有价值的方法;采用胃肠减压、加强营养支持、维持水及电解质平衡、予促进胃肠蠕动的药物及中医疗法等非手术治疗可取得满意疗效。     

Serologic evaluation of human microcystin exposure

Microcystins are among the most commonly detected toxins associated with cyanobacteria blooms worldwide. Two episodes of intravenous microcystin exposures occurred among kidney dialysis patients during 1996 and 2001. Analysis of serum samples collected during these episodes suggests that microcystins are detectable as free and bound forms in human serum. Our goal was to characterize the biochemical evidence for human exposure to microcystins, to identify uncertainties associated with interpretation of these observed results, and to identify research needs. We analyzed serum samples using enzyme-linked immunosorbent assay (ELISA) methods to detect free microcystins, and gas chromatography/mass spectrometry (GC/MS) to detect 2-methyl-3-methoxy-4-phenylbutyric acid (MMPB). MMPB is derived from both free and protein-bound microcystins by chemical oxidation, and it appears to represent total microcystins present in serum. We found evidence of free microcystins in patient serum for more than 50 days after the last documented exposure. Serum concentrations of free microcystins were consistently lower than MMPB quantification of total microcystins: free microcystins as measured by ELISA were only 8-51% of total microcystin concentrations as detected by the GC/MS method. After intravenous exposure episodes, we found evidence of microcystins in human serum in free and protein-bound forms, though the nature of the protein-bound forms is uncertain. Free microcystins appear to be a small but variable subset of total microcystins present in human serum. Research is needed to elucidate the human toxicokinetics of microcystins, in part to determine how observed serum concentrations can be used to estimate previous microcystin exposure.     

腭穹隆形态对上颌全口义齿基托位移的影响

目的：研究腭穹隆形态对上颌全口义齿基托位移的影响。方法：模拟5种咬合状态,对尖、平、凹3种腭穹隆形态的上颌全口义齿的三维有限元模型进行加载。结果：3种腭穹隆形态上颌全口义齿基托在5种加载方式下,凹型腭穹隆形态基托的上腭前部及后缘区向黏膜组织的下压位移最大,基托边缘封闭区背离黏膜组织的位移最小。基托的位移方式因加载方式不同而不同。结论：上颌全口义齿基托位移方式及大小与加载方式有关;腭穹隆形态对上颌全口义齿基托位移方式无明显影响,对位移值大小有影响。