妇科腹腔镜手术脏器及血管损伤并发症分析

目的分析腹腔镜手术脏器及血管损伤并发症发生的情况,探讨预防和减少其发生的措施。方法对2003年1月~2005年12月在本院妇产科施行的2 684例腹腔镜手术的资料进行回顾性分析,观察脏器及血管损伤并发症的发生情况。结果妇科腹腔镜手术总的并发症发生率为2.53%(68例),脏器及血管损伤并发症发生率为0.37%(10例)。其中与trocar穿刺相关损伤4例(肠系膜血管损伤与后腹膜血管损伤各2例),术中并发症3例(术中大出血1例,膀胱损伤2例),术后并发症3例(输尿管损伤2例,肠瘘1例)。结论随着手术范围的扩大和手术难度的增加,妇科腹腔镜手术并发症有所增加,并发症的发生也与操作者的经验相关。降低手术并发症发生率,应重视适应证的选择,并提高操作者的手术技术。     

Methods for Examination an Explanted Coronary Sinus Lead Stabilized with a Coronary Stent

The aim of our investigation was to test the suitability of a novel method for the analysis of the integrity of an explanted pacemaker lead stabilized by a stent. A coronary sinus lead has been explanted 27 months after implantation and has been examined by optical‐, confocal‐, x‐ray‐, and scanning electron microscopy. Several surface injuries were found on the insulation. Based on the surface characteristics, it is possible to define and differentiate the source of damages as well as to measure the extent of injuries. Impedance of the explanted lead has also been measured and electronic integrity has been verified. (PACE 2013; 36:e27–e30)     

PCV21 Cost Consequences of Acute Myocardial Infarction in Diabetic Patients-The First Year

Bolus formulations of new thrombolytic agents for the treatment of acute myocardial infarction (AMI) may offer benefits in efficiency of administration, door-to-needle time, quality improvement, and costs.
METHODS: A telephone survey of 23 experienced emergency room (ER) staff at community and urban hospitals encompassed the "hassle" involved with thrombolytic administration. Nurses were asked to compare a hypothetical single bolus with an infusion formulation of rt-PA under assumptions of equal efficacy and safety. A "hassle" analysis examined the differences in aspects such as protocol complexity, interference with other tasks, potential for error, and training requirements.
RESULTS: In all aspects, bolus injection was associated with significantly less hassle than infusion (p < .001). In particular, bolus injection was perceived as less problematic for nurses in terms of following the protocol, interference with timely performance of other tasks, distraction from other tasks, and hassle associated with the thrombolytic procedure. The results also suggested that bolus injections may reduce door-to-needle time.
CONCLUSION: A single bolus thrombolytic may offer promise for improved ease of care, quality patient management, and incremental reductions in door-to-needle time. Direct observational studies are needed to more precisely measure the potential reductions in door-to-needle time using bolus injection.     

施他宁、善得定和生长激素治疗重症急性胰腺炎的临床疗效研究

目的:评价应用施他宁、善得定和生长激素治疗重症急性胰腺炎的疗效。方法:对1993年7月～2001年11月收治的21例应用施他宁、善得定和生长激素治疗的患者(观察组)进行回顾性分析,并与1991年10月～1995年3月收治的18例重症急性胰腺炎未用施他宁、善得定和生长激素治疗的患者(对照组)进行对照,观察两组治疗期间第1天、第3天、第7天APACHE(acutephysiology,and chronic health evaluation)Ⅱ评分的变化、住院日数、并发症、治愈率、死亡率、血淀粉酶恢复正常天数及主要症状的改善天数。结果:观察组能减少并发症,降低死亡率,缩短住院日数、血淀粉酶恢复天数及主要症状的改善天数。结论:施他宁、善得定和生长激素可能是较有效的治疗重症急性胰腺炎的药物。     

Characterization of linkage disequilibrium structure, mutation history, and tagging SNPs, and their use in association analyses: ELAC2 and familial early-onset prostate cancer

In association analyses, it is critical that informative single-nucleotide polymorphisms (SNPs) be selected for study and utilized appropriately. We sequenced 38 kb, including exons of ELAC2, promoter region and conserved upstream intergenic sequences. A comprehensive characterization of linkage disequilibrium (LD) structure and mutation history was performed using our principal components analysis (PCA) method and a phylogenetic analysis. We identified a complex pattern of LD structure consistent with the occurrence of both recombination and mutation events within ELAC2. Four overlapping and noncontiguous LD groups were defined. Eight tagging SNPs (tSNPs) were identified, accounting for over 90% of the genetic variation of the 19 total variants. We tested associations between familial early-onset prostate cancer (PRCA) and each variant independently and in haplotypes. We performed these tests using all 19 variants and the 8 tSNPs; the results using tSNP haplotypes accurately represent the association evidence for the full haplotypes. We observed increased evidence for association when SNPs were analyzed in haplotypes. The phylogenetic analysis indicated three haplotypes, clustered farthest from the root-node, all of which were found more often in cases than controls. These three haplotypes together showed the best evidence of association with familial, early-onset PRCA (P=0.0024; odds ratio=2.23; 95% CI, 1.33-3.74), indicating possible allelic heterogeneity. Our results suggest that 8 tSNPs are required to comprehensively assess associations in ELAC2, and that haplotypes should be considered for analysis, and that a knowledge of mutation history may be helpful in parsing allelic heterogeneity and suggesting combinations of haplotypes to be tested.     

2009年内蒙古自治区盟(市)、旗县(区)两级健康教育机构与人力资源现状调查

目的了解2009年内蒙古盟市、旗县(区)两级健康教育机构与人力资源现状。方法采用《2009年健康教育所(中心)业务工作调查表及基本情况调查表》(卫统46表)对内蒙古盟市、旗县(区)两级健康教育机构设置、人力资源、经费和活动形式进行问卷调查。结果全区12个盟市中有7个盟市级健康教育所为独立建制;104个旗县(区)均有健康教育机构,其中有20个为独立建制。盟市、旗县(区)两级分别有专职健康教育人员73人和190人,两级机构人员学历以本科(40.7%)和大专(39.5%)为主,职称构成均以中级(36.5%)和初级(39.16%)为主,医学背景(公共卫生或临床医学)人员比例仅为人员总数的32.3%。两级健康教育机构的经费主要来源于财政拨款,健康教育机构的工作形式主要有印刷小册子、折页、宣传画、举办健康知识讲座等。结论内蒙古自治区健康教育存在管理体制不顺,专业人员数量偏少、整体素质偏低,财政投入不足,活动形式过于老化与单一等突出问题,需要在医药卫生体制改革中得到解决。     

磺胺嘧啶银胶原蛋白烧伤膜的制备及其释放度研究

目的 :研制磺胺嘧啶银 (SD -Ag)胶原蛋白烧伤膜 ,建立了分光光度法测定SD -Ag的累积释放量的大小 ,为进一步开发胶原蛋白膜剂提供经验。方法 :应用交联剂法制备胶原蛋白烧伤膜 ,采用均匀设计方案 ,考察累积释放量的大小。结果 :制备后得到乳白色半透明、光滑 ,具有弹性的凝胶膜状物。胶原蛋白膜的累积释放量为 (22 38±0 036) %。结论 :用交联剂法制备胶原蛋白膜简便 ,便于铸型 ,成膜性好。本方法准确、快速、简便 ,可用于SD -Ag 胶原蛋白烧伤膜的累积释放量的测定     

Suppression by phenobarbital of ethionine-induced hepatocellular carcinoma formation and hepatic S-adenosylethionine levels

An 18-month carcinogenicity study was conducted in male weanling F344 rats (28/group) to examine the effects of the simultaneous feeding of selected concentrations of ethionine and 0.05% phenobarbital in a normal chow diet. The effects of a 1-6-week feeding of phenobarbital and ethionine on the hepatic levels of the related metabolites S- adenosylmethionine, S-adenosylhomocysteine and S-adenosylethionine were also examined. Ethionine at 0.3% or 0.1% induced hepatocellular carcinoma (HCCa) at incidences of 90% (19/21) and 89% (24/27), respectively. Adding phenobarbital to the 0.1% ethionine diet reduced the incidence of HCCa to 36% (10/28) and reduced the number of liver tumor-associated deaths occurring prior to terminal sacrifice from 10/27 to 1/28. No hepatic tumors were observed in rats fed 0, 0.003, 0.01, or 0.03% ethionine. Phenobarbital alone or combined with 0.03% ethionine produced no hepatic tumors. Dietary ethionine at 0.1% reduced the intracellular hepatic level of S-adenosylmethionine to <50% of that seen in control rats. Phenobarbital alone had little effect on either S- adenosylmethionine or S-adenosylhomocysteine levels. The combination of phenobarbital and 0.1% ethionine led to increases in the hepatic levels of S-adenosylmethionine of 40-60% after 3 and 6 weeks of feeding, compared to those seen in rats receiving 0.1% ethionine alone. Ethionine feeding resulted in high levels of S-adenosylethionine in the livers. Combining phenobarbital with ethionine in the diet led to 30- 50% reductions in hepatic S-adenosylethionine content. The results indicate that phenobarbital inhibits hepatocarcinogenesis by ethionine, that ethionine may cause HCCa via methyl group insufficiency, and that at levels of < or =0.03% ethionine did not show evidence of tumorigenicity.      

荭草抗肿瘤活性提取物质量标志物的初步研究

目的基于质量标志物(Q-marker)理论,分析具有抗肿瘤活性的荭草醋酸乙酯提取物的成分,研究其质量控制方法。方法首先使用UPLC-ESI-HRMS对该提取物进行成分鉴定;再使用HPLC进行成分的定量测定,同时建立其定量测定方法,并对鉴定出的化合物进行药理作用分析,初步预测Q-marker;最后采用人非小细胞肺癌A549细胞模型,研究荭草醋酸乙酯提取物及6种候选成分混合物对A549肿瘤细胞生长及迁移的影响。结果通过UPLC-ESI-HRMS结果指认出12个化合物,其中,HPLC未检出原儿茶酸、儿茶素、山柰素和芹菜素,异牡荆素和木犀草素质量分数低于0.01mg/g,不纳入Q-marker候选物之列。结合药理作用分析,最终选择了6种成分没食子酸、异荭草苷、荭草苷、牡荆素、木犀草苷和槲皮苷作为其潜在Q-marker。各样品中均能检测出这6个成分,且6个成分总量超过10%。荭草醋酸乙酯提取物及等剂量6成分混合物均能显著抑制A549细胞的增殖与迁移,并诱导其凋亡,且两组之间效果无显著性差异。结论没食子酸、异荭草苷、荭草苷、牡荆素、木犀草苷和槲皮苷作为具有抗肿瘤活性的荭草醋酸乙酯提取物中的潜在Q-...     

Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers.

BACKGROUND: The availability of genetic testing for inherited mutations in the BRCA1 gene provides potentially valuable information to women at high risk of breast or ovarian cancer; however, carriers of BRCA1 mutations have few clinical management options to reduce their cancer risk. Decreases in ovarian hormone exposure following bilateral prophylactic oophorectomy (i.e., surgical removal of the ovaries) may alter cancer risk in BRCA1 mutation carriers. This study was undertaken to evaluate whether bilateral prophylactic oophorectomy is associated with a reduction in breast cancer risk in BRCA1 mutation carriers. METHODS: We studied a cohort of women with disease-associated germline BRCA1 mutations who were assembled from five North American centers. Surgery subjects (n = 43) included women with BRCA1 mutations who underwent bilateral prophylactic oophorectomy but had no history of breast or ovarian cancer and had not had a prophylactic mastectomy. Control subjects included women with BRCA1 mutations who had no history of oophorectomy and no history of breast or ovarian cancer (n = 79). Control subjects were matched to the surgery subjects according to center and year of birth. RESULTS: We found a statistically significant reduction in breast cancer risk after bilateral prophylactic oophorectomy, with an adjusted hazard ratio (HR) of 0.53 (95% confidence interval [CI] = 0.33-0.84). This risk reduction was even greater in women who were followed 5-10 (HR = 0. 28; 95% CI = 0.08-0.94) or at least 10 (HR = 0.33; 95% CI = 0.12-0.91) years after surgery. Use of hormone replacement therapy did not negate the reduction in breast cancer risk after surgery. CONCLUSIONS: Bilateral prophylactic oophorectomy is associated with a reduced breast cancer risk in women who carry a BRCA1 mutation. The likely mechanism is reduction of ovarian hormone exposure. These findings have implications for the management of breast cancer risk in women who carry BRCA1 mutations.