Endoscopic pH monitoring for patients with suspected or refractory gastroesophageal reflux disease.

BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms. METHODS: Patients undergoing prolonged ambulatory pH studies for the evaluation of GERD-related symptoms were assessed. Patients with a known diagnosis of GERD were tested on medical therapy, while patients with suspected GERD were tested off therapy. The wireless pH capsules were placed during upper endoscopy 6 cm above the squamocolumnar junction. RESULTS: One hundred ninety-one patients underwent a total of 198 pH studies. Fifty ambulatory pH studies (25%) were excluded from the analysis: 27 patients (14%) had insufficient data capture (less than 18 h on at least one day of monitoring), 15 patients had premature capsule release (7%), seven were repeat studies (3.5%) and one had intolerable pain requiring capsule removal (0.5%). There were 115 patients undergoing pH studies who were off medication, and 33 patients were on therapy. For the two groups of patients, results were as follows: 32 (28%) and 22 (67%) patients with normal studies on both days; 58 (50%) and five (15%) patients with abnormal studies on both days; 18 (16%) and three (9%) patients with abnormal studies on day 1 only; and seven (6%) and three (9%) patients with abnormal studies on day 2 only, respectively. CONCLUSIONS: Prolonged 48 h pH monitoring can detect more abnormal esophageal acid exposure but is associated with a significant rate of incomplete studies.     

靶重建放大扫描对肺孤立性结节病变的诊断意义

目的：探讨靶重建放大扫描技术对肺孤立性结节病变的诊断价值。方法：对63例患者先行常规CT平扫，选定结节处为兴趣区，行薄层靶重建放大扫描，层厚、层距为2mm，FOV为160。结果：42例恶性病变中有37例表现为深分叶，占88．1％；21例良性病变中有15例表现为浅分叶，占71．4％。恶性结节中15例内部出现条状低密度支气管征；7例出现血管集中征；8例出现空泡征；病变内部出现液化坏死13例，其中恶性病变ll例。22例出现钙化，包括12例良性病变和10例恶性病变。2例错构瘤内均见小面积脂肪性低密度影。结论：靶重建放大扫描比普通CT扫描可提供更多的信息，对良恶性病变的鉴别诊断有一定价值。恶性病变大多数为深分叶，良性病变大多数为浅分叶或无分叶。     

环戊硫酮治疗干眼的临床疗效评价

Objective To investigate anethol trithione therapic efficiency on dry eye. Methods It was a prospective random double-blind controlled study. Eighty cases diagnosed dry eye in Ocular Surface Out-patient Clinic of Xiamen University Affiliated Xiamen Eye Center from 2006 to 2008 were divided into two groups: anethol trithione group and control group, 40 cases in each group. Every group was then divided into two subgroups: weak dry eye subgroup, middle and severe dry eye subgroup. All groups had been added with 0.05% refresh drops. All patients had been detected and evaluated by subjective symptoms of dry eye, visual acuity,corneal fluorescent staining(F1), break-up time(BUT) and Schirmer Ⅰ test (SⅠT) at pre-therapy and 3,7,28 d of post-therapy. All groups had been compared and analyzed by F test and sample mean difference (SMD) or median difference (MD) comparison between pre-therapy and post-therapy. Results Except of tear and red eye, the other subjective symptoms of dry eye, F1, BUT and SⅠT of weak dry eye subgroup of both groups had been improved at 7 d after therapy. Only those of middle and severe dry eye subgroup of anethol trithione group had been improved at 7 d after therapy compared with those of pre-therapy: SMD=0.96 (visual tiredness), 1.26 (dry and unsmooth sensation), 0.82 (foreign body sensation), 1.28 (burning sensation), 1.05 (photophobia), 1.48 ( pain ) ; MD=0.30 (visual acuity), 4.00 (F1) ,5.00 (BUT), 5.00 (SⅠT) [F=15.30 (visual tiredness), 15.68 (dry and unsmooth sensation ), 13.56 (foreign body sensation), 20. 91 ( burning sensation ), 18.90 (photophobia), 27.22 ( pain ), 10.54 (visual acuity), 188.21 (F1) ,261.76 (BUT) ,269.05 (SⅠT) ;P<0. 05]. Those of middle and severe dry eye subgroup of control group hadn't significantly been improved at 28 d after therapy: SMD=0.10 (visual tiredness) ,0.16 (dry and unsmooth sensation) ,0.09 (foreign body sensation) ,0.38 ( burning sensation ), 0.24(photophobia) ,0.36 (pain) ,0.23 (red eye) ; MD=0.10 (visual acuity) ,0.50(F1) ,0.50(BUT), 0.50(SⅠT) [F=1.76 (visual tiredness), 1.61 (dry and unsmooth sensation), 1.02 (foreign body sensation),2.39 (burning sensation), 2.42 (photophobia), 2.73 ( pain ), 2.55 ( red eye ), 1.46 ( visual acuity) ,2.35 (F1) ,2.90 (BUT) ,2.76 (SⅠT) ; P>0.05]. SⅠT of anethol trithione group had been improved more significantly after therapy (F=13.77, P<0.05). Conclusion Anethol trithione could significantly improve middle and severe dry eye patients' symptoms and signs whose lacrimal gland function survival and it has clinical application value.     

2008年连云港市“手足口病”流行特征及病原学分型

目的分析连云港市2008年手足口病的流行特征及病原学分型情况。方法应用流行病学方法对2008年该市的手足口病流行资料进行分析。结果依据疫情报告,实验室诊断病例45例,其中CoxA1638例,EV71型7例,其他肠道病毒0例。2008年该市临床报告手足口病例1067例,报告发病率为23.19/10万,比2007年上升442.34%,男女发病比为3.1∶1。发病年龄最小的为0岁组,最大的为8岁;0～5岁组,共计发病976例,占总发数的91.47%。发病数的构成以散居儿童最多,占76.66%。地区分布:全市各个区县均有手足口病病例报告,但城区的总体发病率高于县。结论连云港市手足口病发病率有上升趋势;控制传染源是有效防止该病流行的关键。     

凭祥市2005年鼠疫监测分析

凭祥市地处中越边境，地理位置特殊，是个县级城市，1939年有发生1例鼠疫病人的记载。该市自上世纪70年代以来始终按照国家鼠疫监测方案的具体要求，在自治区疾控中心的技术指导下，在辖区内开展鼠疫监测工作，现将2005年监测结果报告如下。     

家兔阴茎皮肤感觉脊神经来源的电生理研究

目的:探讨家兔阴茎感觉神经来源。方法:健康成年雄性新西兰白兔12只,随机均分为两组:每组6只,A组在左侧脊神经上记录,B组在右侧脊神经上记录。对家兔阴茎施加不同大小的机械刺激,用神经单纤维记录技术,在同侧S1~S4脊神经上记录单纤维放电。结果:通过对家兔阴茎施加各种不同机械刺激,在同侧S2~S3脊神经上能记录到放电,S1、S4脊神经上未能记录到放电。左侧脊神经放电纤维数量分别为:S2:39.67±3.14,S3:21.00±2.19;右侧脊神经放电纤维数量分别为:S2:40.00±3.16,S3:19.67±2.58,左右侧差异无显著性(P>0.05)。结论:家兔阴茎皮肤感觉来源于S2~S3脊神经。     

盲肠结扎穿刺致豚鼠急性肺损伤动物模型建立

目的 研究败血性急性肺损伤的动物模型，并探讨其在急性肺损伤研究中的意义。方法 用盲肠结扎穿刺(CLP)法的豚鼠急性肺损伤模型，结合动脉血气分析、外周血白细胞计数、肺湿重／干重比值(W／D)及肺组织病理观察。结果 CLP模型中动物的症状和表现缓慢出现，逐渐恶化．最后导致败血性休克，于2d左右出现大量死亡。结论 用盲肠结扎穿刺的方法制作豚鼠急性肺损伤动物模型较大鼠内毒素性休克，表现更类似于人类的肠源性肺损伤，且症状缓慢发生，逐渐恶化，有利于观察和进行各种干预。     

脂多糖直接诱导对肺微血管内皮细胞IL-8表达的影响及通过NF-κΒ调控机理的研究

目的　探讨脂多糖 (LPS)的直接诱导作用对肺微血管内皮细胞 (PMVEC)IL 8表达的影响及通过核因子κB(NF κB)的调控机理。方法　以 10 0ng/mlLPS刺激PMVEC 0 ,0 .5 ,1,2 ,4,6,8h或 1ng/ml、10ng/ml、10 0ng/mlLPS刺激 1h或6h为检测时相点 ,ELISA、原位杂交试验分别检测的培养液上清中分泌的IL 8及PMVEC内IL 8mRNA的表达 ;凝胶电泳迁移率分析 (EMSA)检验NF κΒ的活化 ;并观察NF κΒ活化抑制对IL 8表达的影响。结果　LPS能显著促进PMVEC表达IL 8,包括促进IL 8mRNA的表达及IL 8的分泌。在时间上mRNA的表达先于IL 8分泌。且LPS的直接诱导能迅速活化NF κΒ ,1h达到高峰 ,后逐渐下降。PDTC能显著抑制NF κΒ的活化及IL 8的表达 (P <0 .0 1)。结论　表明细菌致病因子LPS的直接诱导确能通过促进NF κΒ的活化 ,从而启动IL 8的高效表达和分泌 ,为多形核中性粒细胞 (PMN)的迁移提供必需的物质条件 ,导致肺损伤。     

常压及控制性降压下脊髓急性牵拉损伤比较研究

目的 评价控制性降压是否增加脊髓对牵拉损伤的易感性。材料与方法健康成年杂种犬6只，随机分为常压和控制性降压脊髓牵拉损伤组。观察常压及控制性降压水平下相同程度牵拉损伤后脊髓血流(SCBF)、体感诱发电位(SEP)、神经源性运动诱发电位(NMEP)改变的差异。结果 外周血有创动脉压(MABP)平均下降幅度为40．5％。经SSPS统计软件独立样本t检验，不同牵拉水平下，常压组及低压组的SCBF(％)、SEP波幅(Asep)(％)及NMEP波幅(％)无显著差异。结论 尼卡地平控制性降压不增加脊髓对牵拉损伤的易感性。     

市场机制下政府调节与医疗管制制度框架的构建

医疗机构分类管理的政策确定了我国医疗服务的市场取向.我国医疗市场服务因其特殊的技术经济特点也存在一般意义上的市场失灵,使政府管制这一非市场治理机制的产生与存在成为必要,以弥补与矫正市场缺陷,保证医疗服务市场的规范运行和卫生改革的顺利推进.