未破裂脑动脉瘤的治疗选择

未破裂脑动脉瘤的处理存在争议。由于其自然史尚未完全明确,因此最佳的治疗策略也不清楚。目前对未破裂脑动脉瘤处理的共识包括观察、显微手术夹闭和血管内治疗。用于随访已知未破裂脑动脉瘤的方法学也有争议,可能取决于经治医生的偏好。大多数动脉瘤由神经外科医师和介入神经放射科医师处理,但未破裂动脉瘤通常是由神经科医师在对患者进行其他神经系统疾病的筛查时首先发现的。因此,关于何时对患者进行筛查和如何对未破裂动脉瘤采取最佳处理的知识将对其日常医疗实践有直接的影响。未破裂动脉瘤经常导致包括缺血事件、癫和头痛在内的其他神经系统症状,这些症状可能促进更积极的干预治疗。由于缺乏设计完善真正基于人群的研究或随机试验,因此目前的最佳处理必须以现有文献和每例患者当时的具体情况为根据。     

Randomized placebo-controlled trial comparing montelukast and cetirizine for treating perennial allergic rhinitis in children aged 2–6 yr

Leukotriene receptor antagonists (LTRAs) were recently added to the method of treating allergic rhinitis (AR). However, in children under 6 yr old, there has been no study about its efficacy in treating AR. We aim to compare the clinical efficacy of montelukast, cetirizine and placebo in the treatment of children from 2 to 6 yr old with perennial allergic rhinitis (PAR), to see if there are any significant differences. Sixty children were selected and treated with montelukast, or cetirizine, or placebo once daily. The efficacy of the three agents was compared with the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Total Symptom Score (TSS) by diary. In addition, we also examined serum IgE, serum eosinophil cationic protein (ECP), blood eosinophil counts, nasal airway resistance (NAR) and eosinophil percentage in nasal smears. The results revealed that both montelukast and cetirizine were significantly efficacious compared with placebo in NAR, eosinophil percentage in nasal smears, PRQLQ, TSS and all symptom items except nasal itching, throat itching and tearing. For nasal itching, only cetirizine was significantly efficacious. On the other hand, for night sleep quality, montelukast was significantly superior to cetirizine.     

Nucleotide changes around the splicing acceptor of intron 24 in the factor VIII gene and its impact on splicing.

Nucleotide 6724 of the factor VIII gene harbors a polymorphism of low frequency. A report from Taiwan claimed that 97.9% of the 83 alleles examined were of the A nucleotide at this position, which is quite different to the data from Western populations. Furthermore, this nucleotide is the start of exon 25, located in juxtaposition to the splicing acceptor of intron 24. We wonder if the nucleotide change at this location might have any effect on the splicing process of pre-mRNA. Using genomic DNA with direct sequencing of the polymerase chain reaction-amplified intron 24/exon 25 junction site, we found that 59 of the 60 patient samples were of the GTG sequence at nucleotides 6724-6726. The polymorphism is similar between populations in Taiwan and Western countries. The sequence of intron 24 around the splicing acceptor was always TCCAACTCTATTGCCCTCAG (-20 to -1), except for one hemophiliac patient who had a mutation in which the absolute consensus AG doublet of the intron 24 splicing acceptor changed to the AA dinucleotide. Owing to the mutation, exon 24 was erroneously spliced to exon 26, and exon 25 was skipped. This finding further testifies to the importance of the invariant AG dinucleotide in the example of the factor VIII gene.     

医务人员年度考核相关问题探讨

如何做好医务人员年度考核,是各级领导和组织人事部门必须研究的课题。本文对医务人员年度考核中相关问题:如考核标准单一、纯定性考核或纯量化测评等,进行了分析,结合医院工作特点,对解决上述问题进行了一些探讨。提出要敢于打破平均分配优秀等次名额的做法,根据不同的考核目的、考核对象及其工作性质,设计不同的考核标准体系,并采用定性考核和量化测评相结合的考核办法的设想。其目的是通过探讨,起到抛砖引玉的作用。     

Differential analgesic effect of tenoxicam on post-cesarean uterine cramping pain between primiparous and multiparous women.

BACKGROUND AND PURPOSE: Uterine cramping pain is related to prostaglandins, which are mediated by cyclooxygenase. However, it is unknown whether the analgesic effects of the non-selective cyclooxygenase inhibitor tenoxicam are different between primiparous and multiparous women. This placebo-controlled, double-blind study compared the analgesic effect of tenoxicam on post-cesarean uterine cramping pain in primiparous and multiparous women. METHODS: Forty primiparous women and 40 multiparous women who were scheduled for elective cesarean delivery were allocated into the following 4 groups: saline-primipara (SP) group, tenoxicam-primipara (TP) group, saline-multipara (SM) group, and tenoxicam-multipara (TM) group. Saline or 20 mg tenoxicam was intravenously injected immediately after clamping of the umbilical cord. All patients received patient-controlled analgesia for postoperative pain control. Resting wound pain, uterine cramping pain, morphine consumption, and morphine-related side effects were evaluated at 4 and 24 hours after surgery. RESULTS: At 24 hours after surgery, tenoxicam-related relief of uterine cramping pain was 2.1 in primiparous women (visual analog scale: SP 5.6 (4.4-6.8) minus TP 3.5 (2.2-4.9); p < 0.01). The tenoxicam-related morphine-sparing effect was 14 mg (45%) in primiparous women (SP 31.4 mg (23.9-38.8) minus TP 17.4 mg (11.6-23.2); p < 0.01). The tenoxicam-related relief of uterine cramping pain and tenoxicam-related morphine-sparing effect were not significant in multiparous women. CONCLUSIONS: This study revealed that the analgesic effect of tenoxicam on post-cesarean uterine cramping pain is greater in primiparous women than in multiparous women. Further studies are required to determine whether a higher dosage of tenoxicam is beneficial to reduce uterine cramping pain in multiparous women.     

猪门静脉回流阻断模型内毒素的移位

【目的】拟在猪的肠血管阻断模型中探讨门静脉回流阻断肠淤血可能造成的内毒素移位和肿瘤坏死因子释放。【方法】采用种群相近体质量22～25kg雌性小猪8只，无感染症状。分离门静脉和肝后下腔静脉分别阻断、然后开放各60min．观察血压、心率，阻断前和开放60min各取回肠末端小肠全层行光镜、电镜检查，测定门、颈静脉血内毒素及肿瘤坏死因子（TNF—α）含量。【结果】门静脉和肝后下腔静脉阻断后，肠淤血、水肿，并随时间延长而加重，光镜检查表明实验后肠粘膜和腺体明显损伤，电镜检查表明细胞超微结构轻微异常。阻断前后的血内毒素、TNF—α含量无显著性差异。【结论】①肠静脉回流阻断60min引起的肠道淤血可导致肠粘膜屏障损伤。②在60min内肠淤血性的损伤不会引起肠腔内内毒素的大量移位及TNF—α的释放。     

粒细胞集落刺激因子治疗大鼠局灶性脑缺血再灌注损伤

OBJECTIVE: To study the therapeutic effects of granulocyte colony-stimulating factor (G-CSF) on focal cerebral ischemia-reperfusion injury in rats. METHODS: Adult male SD rats were subjected to transient (2 h) middle cerebral artery occlusion (MCAO) and scored 48 h later for such neurological functions as spontaneous movement, paresis, forelimb motor function, climbing ability, pain sensation, and position sense. Twenty rats with the total score less than 12 were divided equally into two groups to receive daily subcutaneous injection of 20 microg/kg of G-CSF for 19 days or the same dose of saline injection (control group). The rats in the two groups were also given intraperitoneal injection of Brdu10 mg/kg for 19 days. The neurological functions of the rats in both groups were examined on a weekly basis after MCAO and on day 21, the rats were killed to prepare frozen sections of the brain tissues for double immunohistochemical staining with Brdu and glial fibrillary acidic protein antibody to identify the neural cells newly evolved from the stem cells. RESULTS: The rats in G-CSF group showed better neurological function recovery than the control rats 3 weeks after MCAO (P<0.05). Obvious regeneration of the neural cells was observed around the infarction area in the rats receiving G-CSF treatment. CONCLUSION: G-CSF promotes neurological function recovery and neural cell regeneration after cerebral infarction in rats and can be effective for intervention of focal cerebral ischemia-reperfusion injury.     

胸部X线与CT诊断支气管结核的临床价值

目的分析胸部X线及CT影像征象在支气管结核临床诊断中的价值和意义。方法收集本院经病理及电子支气管镜证实为支气管结核105例，对照其胸部X线与CT表现进行回顾性分析。结果105例患者中，胸部X线显示伴有肺内结核灶77例，气管狭窄、肺叶不张分别为51例和49例，未见异常表现17例。胸部CT扫描对气管狭窄及肺叶不张检出率明显提高，分别为72例和61例，且能观察到气管内壁情况及狭窄或阻塞后肺野情况，伴肺内结核灶79例，无异常改变只有8例。结论提高对支气管结核的影像学认识，能有效地提高临床诊断准确率。     

中西药联合胆肾推经仪治疗肝内胆管结石38例临床观察

目的 观察胆维他、25％硫酸镁、中药消炎利胆Ⅰ号联合胆肾推经仪治疗肝内胆管结石的临床疗效。方法 38例肝内胆管结石患者口服消炎利胆Ⅰ号溶石化石，胆维他利胆消炎保肝，25％硫酸镁解痉止痛扩张肝胆管。配合胆肾推经平板式电极刺激和手柄式电极推按，确定排石体位、结石部位，调节仪器频率和强度，疗程为10天和30天。结果 治疗后，经B超、胆囊造影、CT检查对比，排石总有效率91．61％。其中排净27例（占71．05％），显效8例（占20．56％），无效3例（占7．9％），与治疗前相比，差异有显著性（P〈0．1〉。结论 中西药联合胆肾推经仪治疗肝内胆管结石可明显提高排石率，改善胆道炎症，消除黄疸，是一种安全有效，经济方便的治疗方法。