巴基斯坦国际医疗救援队配置与工作模式—汶川地震陇南灾区医疗救援纪实

目的分析汶川地震中赴陇南巴基斯坦国际医疗救援队的配置与工作模式，为我国地震灾后医疗队建设和配置提供一手数据和参考。方法通过随队工作，见证和分析救援队的功能定位、人员构成、装备配置、物资贮备、工作模式和绩效，总结其优、缺点：结果巴基斯坦国际医疗救援队功能定位为搜救与医疗救治。人员共28名，包括正副领队各1名（领队为流行病专家，副领队为行政人员）、医师6名、护理人员2名、医技师3名，战地搜救与转运人员10名、后勤工作人员5名。医疗队装备包括：战地救护车1辆、医院1所（由7顶帐篷组成）、海事卫星电话2部医疗救援装备和药品耗材包括：X线检查床1台，B型超声扫描仪1台，心电检查仪1台，手术室配套设备1套，ICU设备2套，200例手术的麻醉药品及耗材，500人份的输液及有关药品，500人份的检查试剂和耗材，3000人份的口服药品、药棉、绷带。后勤物资包括：炊事用具1套、供应全队2周食用的米、面等食物和水、厕所设施2套医疗队的帐篷医院存1天内建成，10天内接诊1256例地震伤员，完成14台手术和236例x线和B超检查和314例生化检查。结论巴基斯坦国际医疗救援队配置与功能定位一致、学科齐全、结构合理，兼顾转运救治和公共卫生。设备配置与物资装备在满足一线抢救300-500例伤员的同时，还考虑了自身生存与环境保护，值得借鉴。医疗队若能在灾后第一周赶到重灾区，作用和绩效会更大。     

人工耳蜗植入后听力康复效果相关因素的研究

目的初步分析语前聋儿童耳蜗植入后听力康复效果的相关因素。方法对多通道人工耳蜗植入的42名语前聋的聋儿，进行重建听阈、听觉能力、智力评估，并调查他们的一般情况、家庭情况、术前助听器配戴和训练情况等。结果和结论影响聋儿听觉能力康复水平的因素有：父亲、母亲的职业，家庭人均月收入，发现聋到植入时间的长短，耳蜗植入后时间和开机时间长短。logistic回归分析结果显示：家庭人均月收入高、开机时间长、连续助听时间长、母亲文化程度高均有助于听觉能力的培建。     

左旋精氨酸对兔肺缺血/再灌注损伤时Fas/FasL表达的影响

目的 探讨左旋精氨酸对肺缺彬再灌注损伤（PIRI）时Fas／FasL表达的影响。方法 采用在体兔单肺原位缺血／再灌注模型。实验兔30只，随机分为假手术对照组（C组）、肺缺彬再灌注组（I／R组）和肺缺彬再灌注加左旋精氨酸组（L-Arg组），每组10只。分别于再灌注3h取左肺组织，观察Fas／Fas配体（Fas／FasL）mRNA定位表达、凋亡指数（AI）、肺组织湿干质量比（W／D）、肺损伤组织学定量评价指标（IQA）及光镜、电镜下的组织形态学改变。结果 L-Arg组Fas／FasLmRNA在肺小动脉内（外）膜、肺小静脉内膜、肺泡上皮及肺支气管上皮呈弱阳性表达，明显低于I／R组（P〈0．05）；AI、W／D和IQA值显著低于I／R组（P〈0．01和P〈0．05）；肺组织形态学异常改变不同程度减轻。结论 左旋精氨酸可下调肺组织Fas／FasL mRNA的表达而减轻细胞凋亡，对PIRI发挥积极的防治作用。     

云南省鼠疫耶尔森菌多位点可变数目串联重复序列分析

目的 通过多位点可变数目串联重复序列分析(multiple-locus variable-number tandem-repeat analysis,MLVA)方法,对云南省鼠疫菌株进行基因分型。 方法 采用聚合酶链反应(PCR)和毛细管电泳,通过BioNumerics软件进行处理,分析云南省158株鼠疫耶尔森菌基因型。 结果 选取鼠疫菌的14个VNTR位点,5个VNTR位点对云南省鼠疫菌具有多态性分析意义,利用这5个位点对云南菌株进行分析,云南158株鼠疫菌可分为2个群,3个簇,5个基因型,野鼠鼠疫菌属于A簇,丽江玉龙鼠疫菌属于B簇,家鼠鼠疫菌属于C簇,与传统的生态分型结果吻合。 结论 本次试验筛选的5个位点可以用于云南省鼠疫菌的分型,云南家鼠鼠疫菌、野鼠鼠疫菌及玉龙鼠疫菌分属不同的基因簇,玉龙鼠疫菌与野鼠鼠疫菌同属一个群,聚类结果与实际的地理相关性很好。     

前列腺结核误诊为前列腺癌1例

病例男,54岁.2年前无明显诱因出现排尿困难,伴尿频、尿痛,无肉眼血尿,无发热,未行任何治疗.2年来上述症状持续存在,近1周加重,伴血尿.否认既往结核病史.人院查体:生命体征正常,营养中等,心肺未见异常.专科情况:外生殖器发育正常,睾丸、附睾末触及结节.肛诊:前列腺Ⅰ度,表面不光滑,质硬,触痛明显.实验室检查:血常规正常;血液总前列腺特异性抗原(T-PSA):2.03Ng/ml;肝肾功能正常.胸部X片:未见异常.尿路IVP+KUB双肾及肾盂未见异常.     

老年原发性高血压及2型糖尿病患者β2-AR基因46A/G多态性研究

目的　探讨 β2 肾上腺素能受体 (β2 - AR)基因 A46G多态性与老年高血压和 2型糖尿病的关系。方法　应用聚合酶链反应 -限制性片段长度多态性的方法 ,检测健康老年人 ,高血压病患者及 2型糖尿病病人各 1 30例的β2 - AR基因型。用生化技术测定研究对象的空腹血糖 ,总胆固醇 ,甘油三酯 ,高密度脂蛋白 -胆固醇。结果　高血压组 G等位基因频率 46.2 %,显著高于正常对照组 36.2 %(χ2 =5.37,P<0 .0 5) ,2型糖尿病组 G等位基因频率 42 .7%,与对照组差别无显著性意义 (χ2 =2 .33,P>0 .0 5)。结论　 β2 - AR基因可能是中国老年高血压的重要遗传因素 ,但该基因多态性与老年 2型糖尿病无显著性相关。     

General disease costing principles

The term “disease costing” applies to those economic appraisal methodologies that ascertain the cost borne by a community because of a disease. This approach has been used to calculate the social and economic costs, in terms of loss of productivity, caused by a disease that only in the most serious cases results in the death of an individual. The production losses, also defined as indirect costs, are not the only social costs caused by diseases. In addition we point also to the negative variations that are reflected onto two fundamental quantities: consumption of resources and state of health. In addition to production losses and consumption of resources, the third group is unquestionably the most important in the healthcare sector, since it deals directly with variations in the state of health. This group is denoted by the term “human costs”. In the headache field, we are far behind other pathologies, where there is a greater knowledge of the economic aspects of both the pathology-related costs and the likely benefits resulting from different therapeutical approaches. Notwithstanding the disease costing problems that are also reflected in the cost-benefit techniques, it is important for the economic analysis to gain ground since there is a growing need to keep account of the available resources and the results attainable in the healthcare policies, from the central to the peripheral levels, where the valuation tools prove even more expedient.     

Pharmacokinetics and pharmacodynamics of recombinant human growth hormone by subcutaneous jet- or needle-injection in patients with growth hormone deficiency

Eighteen growth hormone (GH) deficient children and adolescents (11 6/12–20 9/12 y) participated in a randomized open, two-period (4 weeks) cross-over study to evaluate the pharmacokinetics and pharmacodynamics of recombinant human growth hormone (rhGH) administered daily, either by subcutaneous jet-injection or conventional needle-injection. Plasma growth hormone (GH), insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), glucose, insulin, HbAlc and serum-free fatty acids (FFA) levels were analysed repeatedly. GH absorption characteristics, expressed as AUC_0-x, Cmax and Tmax ratio (%) jet-injected over needle-injected were similar in both groups. IGF-I and IGFBP-3 plasma levels were identical in both groups. Serum FFA concentrations were comparable after GH administration with either injection device. Surprisingly nocturnal blood glucose decreased to asymptomatic hypoglycaemic levels in all patients. The results of this study showed equal responses concerning absorption and bioavailability of growth hormone administered daily for 4 weeks by either a jet or a needle-injection device in GH-deficient children and adolescents.