多节段髓内星形细胞瘤的临床研究

目的 探讨不同年龄段、恶性程度不同的多节段髓内星形细胞瘤患者的诊治特点.方法 21例多节段(3个椎体节段以上)髓内星形细胞瘤患者均行后正中入路显微镜下肿瘤切除术,以UOA分值差(术后UOA和术前UOA差值)评估手术效果.以Logistic回归和多元线性同归分析统计学数据.结果 肿瘤性质直接影响肿瘤的切除程度(X2=10.41,P=0.03),高度恶性肿瘤只能大部切除或减压.年龄(X2=12.53,P=0.01)、肿瘤性质(X2=16.44,P=0.002)和部位(X2=27.12,P=0.04)影响近期手术效果(UOA分值差);青少年患者、低度恶性肿瘤手术效果较好,单纯累及胸段的患者手术效果差.结论 低度恶性或青少年多节段髓内星形细胞瘤患者应尽早手术,术后疗效满意.     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

Kindergarten children's representation and understanding of written number symbols

Two samples of kindergarten children's representation and understanding of written number symbols were examined in two time points in one academic year. About 85% of Chinese five year olds (mean = 5 years 10 months) were able to use conventional number symbols to represent the quantity of 30 or larger. At the end of the kindergarten year, 94% of Chinese six year olds (mean = 6 years 4 months) were able to use conventional number symbols to represent the quantity of 100 or larger. Some Chinese six year olds had problems in representing written addition and subtraction tasks. Children's ability to represent written number symbols, ability to represent written addition and subtraction formula and their performance on written addition and subtraction were closely related. The performance of children in a university-affiliated childcare center was better than that of the center serving working-class families in Time 1, but the performance reversed at the end of the kindergarten year.     

Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Patient Outcomes

OBJECTIVE: To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF. STUDY DESIGN: Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources. DATA COLLECTION: Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use. PRINCIPAL FINDINGS: Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p< or =.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p< or =.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes. CONCLUSIONS: This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.     

螺旋CT三期扫描对肝纤维化诊断价值研究

目的探讨螺旋CT三期扫描对肝纤维化的诊断价值。方法对66例经肝穿刺活检病理证实的慢性乙型肝炎肝纤维化患者组和42例正常对照组进行螺旋CT三期增强扫描。根据纤维化程度分期进行影像资料和相关指标的统计分析。结果肝左叶增大,肝表面形态及肝实质密度的改变,脾脏增大,门静脉增宽和侧枝循环的建立等影像学改变,随着肝纤维化严重程度的加重而有统计学差异。本研究显示57例肝纤维化患者螺旋CT三期扫描诊断肝纤维化52例,敏感性91.2%,特异性77.8%。各期肝纤维化分期准确28例,准确率49.1%;准确判断轻度纤维化(S1、S2)或重度纤维化(S3、S4)44例,准确率77.2%,诊断早期肝硬化16例,准确率84.2%。结论螺旋CT三期扫描能判断肝纤维化的程度,而且是动态观察肝纤维化的病程演进和临床随访的有效手段。     

医学数字化影像与PACS系统

随着医学影像技术的迅速发展,出现了各种医学成像设备,许多全新的数字化影像技术已用于临床,丰富了形态医学诊断的信息和层次.它主要表现在如下几个方面:1、透视与摄影的数字X线设备相继产生,如DR、CR、DF、DSA,并成为放射诊断学科的一个重要突破.因此,传统的X线设备正逐步为数字化设备所取代.2、新的成像方法不断地发展,工作站的强大的后处理功能使得这些方法得以实现.3、目前PACS成为医学影像技术的新课题,在放射科得到了广泛的应用.PACS不仅是一个产品,而且是一个系统工程.在PC的硬件软件环境下发展起来的PACS成为它的一个发展趋势.     

HPLC法测定欣康胶囊中次乌头碱含量

目的测定欣康胶囊中次乌头碱的含量。方法采用反相高效液相法,以C18为固定相,甲醇-水-三乙胺(75∶25∶0.05)为流动相,检测波长为232nm。结果平均回收率为94.65%,RSD为3.54%。结论方法简便,准确。     

介入治疗下肢深静脉血栓的临床应用

目的 探讨介入治疗下肢深静脉血栓(deep venous thrombosis,DVT)的效果. 方法 38例DVT均行深静脉置管接触性溶栓,12例联合血管球囊扩张及血管内支架置入术.按我院疗效观察标准:治愈,造影检查示血栓完全溶解,静脉壁光滑;显效,静脉回流通畅,静脉内有附壁血栓,管腔内径≥2/3;有效,静脉内仍有血栓残留,管腔内径＜2/3;无效,造影检查示静脉回流不通畅. 结果 治愈22例,显效14例,有效2例.治疗中无严重并发症发生.34例随访3～24个月,其中3～6个月7例,7～12个月12例,13～24个月15例,血栓复发2例,经再次深静脉置管接触性溶栓治疗后部分再通. 结论 介入治疗DVT操作简便,安全有效.     

头皮电烧伤骨外露带毛发皮瓣修复

目的：探讨头皮电烧伤骨外露用头皮扩张皮瓣移植修复的临床效果。方法：采用早期扩创,保留部分坏死骨质,用邻近头皮扩张使带毛发的头皮面积扩大后移植覆盖创面,电性失活骨质在血循环良好的皮瓣覆盖下,为周边及基底健康骨质生长起到支架作用,皮瓣扩张到一定面积后移植到裸露骨质上,使其得以修复。结果：在治疗的9例中,除1例皮瓣边缘在1．5cm×1．5cm坏死外,其余皮瓣全部成活,未发生感染坏死,创面均一次性封闭。结论：头皮电烧伤骨外露扩张后皮瓣带毛发修复,可缩短创面愈合时间,外形较好,易掌握,效果较为满意。     

CT导向下经皮射频消融术治疗肾上腺恶性肿瘤

目的对29例肾上腺肿瘤患者行射频消融（RFA）治疗，研究其近期局部治疗效果、不良反应和副作用。方法肾上腺肿瘤患者共29例，病灶总数31个，其中直径≤2．0cm的病灶共5个，2．1-4．0cm者18个，4．1-6．0cm者5个，≥6．1cm者3个，经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果上述病灶经消融治疗后达到完全坏死者分别为5个、18个、3个、2个。患者无严重并发症出现。结论RFA治疗安全可靠，副作用小，是治疗肾上腺恶性肿瘤的有效方法之一。