T淋巴细胞、自然杀伤细胞和巨噬细胞在子宫内膜异位症在位内膜中的表达

目的通过观察子宫内膜异位症(endometriosis,EMs)患者在位内膜中免疫细胞CD45RO、CD3、CD4、CD8、CD56和CD68阳性细胞数量表达,探讨T淋巴细胞、自然杀伤细胞和巨噬细胞在子宫内膜异位症在位内膜中的表达变化以及意义;方法应用免疫组织化学染色方法,采用CD45RO、CD3、CD4、CD8、CD56、CD68单克隆抗体对45例EMs患者在位内膜中的阳性细胞进行标记,测定其在EM患者在位内膜中的表达数量。同期选取16例宫颈原位癌非EMs患者作为对照;结果 EMs组和对照组在位内膜中均有CD45RO、CD3、CD4、CD8、CD56和CD68阳性细胞表达,EMs组在位内膜中的CD45RO、CD8、CD68阳性细胞数量明显高于对照组,差异有统计学意义(P<0.05),CD3、CD4阳性细胞数量略高于对照组,差异无统计学意义(P>0.05),CD56阳性细胞数量较对照组无明显改变,差异无统计学意义(P>0.05)。CD4+/CD8+比值较对照组降低,差异有统计学意义(P<0.05)。两组患者分泌期内膜中CD45RO、CD3、CD4、CD8、CD56、CD68阳性细胞数量较增殖期增加,但差异无统计学意义(P>0.05);结论 EMs患者在位内膜中免疫细胞的数量变化影响机体免疫功能的改变,在EMs的发生、发展中起着重要作用。     

吸入麻醉对认知功能减退老年患者脑电双频谱指数的影响

目的:探讨吸入麻醉对认知选择功能减退老年患者意识消失、意识恢复以及麻醉加深过程中脑电双频谱指数(bispectral index,BIS)的影响。方法:选择北京大学第三医院2012年1~9月行择期手术的65岁以上老年患者,使用简易智能量表筛选出认知功能减退者60例和认知功能正常者60例。应用七氟醚实施全身麻醉,记录两组患者意识消失和意识恢复时的BIS,以及呼气末七氟醚体积分数(end-tidal concentration of sevoflurane,C ET Sev)变化于0.7%~2.8%过程中的BIS,采用独立样本t检验和重复测量数据的方差分析进行两组比较。结果:共117例患者完成了研究,认知功能减退组患者意识消失时的BIS高于认知功能正常组,差异有统计学意义(P<0.01),恢复时BIS的差异无统计学意义(P>0.05),认知功能减退组患者的BIS在C ET Sev变化于0.7%~2.8%过程中低于认知功能正常组,差异有统计学意义(P<0.05),C ET Sev分别为0.7%、1.05%、1.4%和1.75%时,认知功能减退组患者的BIS低于认知功能正常组,差异有统计学意义(P<0.05),C ET Sev分别为2.1%、2.45%和2.8%时BIS的差异无统计学意义(P>0.05)。结论:吸入麻醉期间,认知功能减退老年患者意识消失时的BIS水平高于正常患者,麻醉加深过程中的BIS水平低于正常患者,在浅麻醉时更为明显,其机制可能与认知功能减退相关的神经系统退行性变以及神经递质系统功能障碍有关。     

Right Ventricular Outflow Tract Reconstructive Model in Adult Sheep

Patients born with congenital right ventricular outflow tract lesions are faced with invasive procedures to establish hemodynamic and physiological stability. Commonly, multiple subsequent surgical procedures are required due to deterioration of a previous repair. These procedures carry additive risks of mortality and morbidity. Less aggressive procedures with accompanying lower risk is ideal. Success in percutaneously placing a transcatheter valve has previously been reported; however, continued safety and efficacy of any technique needs continual assessment. We developed a model for preclinical evaluation of a percutaneous placement of a pulmonic transcatheter valve in adult sheep, including preoperative, surgical, and postoperative techniques for long-term evaluation. Adult sheep were assessed and determined to be acceptable for study enrollment. Perioperative antibiotics and analgesics were given prior to a left thoracotomy. A Medtronic, Hancock 1 valve conduit was inserted for reconstruction of the right ventricular outflow tract. The Hancock 1 valve conduit alone represented the control group and the test animals comprised the addition of a Melody? transcatheter pulmonary valve (TPV), within the Hancock 1 valve conduit. Fifteen adult sheep survived the surgical implant procedure with no perioperative mortality. There were four early postoperative deaths, three due to infection and one due to heart failure, secondary to intraoperative heart block. The remaining 11 animals remained healthy, gained weight, and survived to termination at 5 months. An initial definite-sized valve conduit was implanted, followed by inserting a single size TPV, which allowed a more accurate physiological assessment of any chosen valve. Our developed adult sheep model for percutaneous TPV implantation for right ventricular outflow tract lesions was successful for long-term assessment by utilizing our preoperative, surgical, and postoperative techniques.     

Clinical outcomes of open treatment of old condylar head fractures in adults

The aim of this study was to classify the clinical feasibility and outcomes of open reduction treatment of old condylar head fractures (CHFs).This was a retrospective case series study of patients with old CHFs that were treated with open reduction and internal fixation, with anatomic reduction and sutured fixation of the articular disc. Preoperative and postoperative examinations were recorded and analyzed, including temporomandibular joint (TMJ) symptoms, occlusion, maximum interincisal opening (MIO), and mandibular deviation. Computed tomography (CT) was used to assess condylar morphology and position.Eleven patients with old CHFs were included (nine unilateral and two bilateral). The mean period from condylar fracture to operation was 8.9 months (ranging from 6 to 14 months). The mean follow-up period after surgery was 16.1 months (ranging from 12 to 22 months). At the end of follow-up period, no malocclusion was found, and the MIO had expanded considerably to 37.4 ± 3.8 mm. Postoperative CT showed that all fragments were properly reduced and the condyles were in the normal position. All patients showed apparently improved TMJ function, occlusion, and facial appearance.Our results showed that open reduction treatment could be an effective method for the treatment of old CHFs.     

上海市闵行区中老年群体中不同骨密度人群的尿钙水平调查分析

目的探索上海市闵行区中老年人群钙营养状况及其与骨质疏松的相关性。方法对长期居住在上海闵行区的50岁以上的1460例体检人群进行问卷调查和体格检查,DXA测定腰椎、总髋、股骨颈和Ward三角区的骨密度,化学发光法测定空腹血钙、尿钙。根据WHO标准诊断骨量正常、减少和疏松,尿钙低于1.7 mmol/L为缺钙,骨质疏松尿钙高于5.3 mmol/L为高尿钙流失,其余为正常尿钙水平。结果 1460人中,骨质疏松人数为337人,占总人数的23.08%,骨量正常人数为420人,占总人数的28.77%。其中男性骨质疏松率为4.12%,女性骨质疏松率为37.88%。尿钙水平偏低人数为365人,占总人数的25.0%,高尿钙水平人数为176人,占总人数的12.1%。其中男性尿钙水平偏低率为30.32%,女性尿钙偏低率为22.78%。尿钙水平值以60岁以下骨量减少组3.67 mmol/L最高。三年尿钙水平变化值以女性骨质疏松组差异最显著(P0.05)。结论缺钙率女性略低于男性群体,但骨质疏松率女性远远高于男性。老年群体中缺钙为普遍现象,缺钙外加高钙流失是导致老年性骨质疏松的主要因素。骨质疏松干预过程中,除补钙外,采取有效防治钙流失的措施是防治骨质疏松的关键。     

β-cypermethrin-induced acute neurotoxicity in the cerebral cortex of mice

A Type II pyrethroid pesticide β-cypermethrin is widely used in agriculture and domestic applications for pest control. However, the effect of β-cypermethrin on the glutamate neurotransmitter has not been well-documented. In the current study, mice were treated with 20, 40, or 80?mg/kg β-cypermethrin by a single oral gavage, with corn oil as a vehicle control. Four hours after treatment, we investigated glutamate levels and glutamate-metabolizing enzyme (phosphate-activated glutaminase, PAG; glutamine synthetase, GS) activities in the cerebral cortex of mice, using a HPLC system with ultraviolet detectors and a colorimetric assay. Glutamate uptake levels in the synaptosomes of cerebral cortex and mRNA expression levels of PAG, GS, and glutamate transporter-1 (GLT-1) in the cerebral cortex were detected by a radioactive labeling method and qRT-PCR, respectively. Toxic symptoms were observed in mice treated with 40 or 80?mg/kg β-cypermethrin. Compared with the control, significant decreases in glutamate level and GS activity, and an obvious increase in synaptosomal glutamate uptake, were found in the cerebral cortex of mice treated with 80?mg/kg β-cypermethrin. No significant changes were found among groups in PAG activity or PAG, GS, and GLT-1 mRNA expression levels. These results suggest that β-cypermethrin treatment may reduce the glutamate level in the mouse cerebral cortex, which is associated with decreased GS activity and increased synaptosomal glutamate uptake. Our findings provide a partial explanation for the neurotoxic effects of synthetic β-cypermethrin insecticides.     

肺癌患者同步放化疗期间症状群的调查研究

目的调查分析肺癌患者同步放化疗期间症状群的发生及分布特征。方法采用M.D安德森症状评估量表中文版(MDASI-C)对141例同步放化疗的肺癌患者进行调查。Spearman相关分析用于症状间相关性的分析;主成分分析用于提取患者的症状群。结果同步放化疗的肺癌患者疲乏症状强度得分最高,为(6.1±2.0)分,疲乏症状发生频率亦最高,为95.7%;MDASI-C各症状间均存在正相关(P<0.01),相关系数为0.13～0.74;主成分分析显示存在3个症状群:消化道症状群、情感症状群和病感症状群,3个症状群的内部信度Cronbach’sα系数分别为0.84、0.80和0.82。结论肺癌患者同步放化疗期间存在不同的症状群,认识该症状群有助于医护人员准确预见并为建立干预措施提供参考,以减轻肺癌患者的症状负担,提高其生活质量。     

医保目录与医疗服务的错位

"脊柱内固定钢板"按医保目录可以报销,而固定钢板的钉子却由患者全额自付;五六年前制定的目录中仅有黑白超床旁检查项目,而未设床旁彩超项目,目前二级以上医院几乎全部淘汰黑白超,改用彩超,可彩超没有收费标准……诸如此类的问题让人难以理解。建议相关部门建立互通机制。