聚乙二醇干扰素α-2a间隔10日与间隔7日治疗慢性丙型肝炎临床观察

目的：比较聚乙二醇干扰素α-2a（PEG INFα-2a）间隔10日与间隔7日联合利巴韦林治疗慢性丙型肝炎的临床疗效及不良反应的差异性。方法：65例符合条件的患者,给予聚乙二醇干扰素α-2a间隔7日联合利巴韦林抗病毒治疗12周。随后随机分为两组,A组33人,采用聚乙二醇干扰素α-2a间隔10日联合利巴韦林治疗;B组32人,采用聚乙二醇干扰素α-2a间隔7日联合利巴韦林治疗。两组均予以48针聚乙二醇干扰素α-2a皮下注射,观察两组治疗效果及不良反应的差异。结果：两组前12针治疗方案相同,治疗12针时的HCV RNA应答率,A、B两组分别为59%、61.5%,差异无显著性意义（P〉0.05）。治疗24针时HCV RNA的阴转率A、B两组分别为87.2%、88.5%,差异无显著性意义（P〉0.05）。治疗结束时HCV RNA阴转率,A、B两组分别为89.7%、92.3%,治疗结束6个月时HCV RNA阴转率,A、B两组分别为82.1%、80.8%,差异无显著性意义（P〉0.05）。A组的重度不良反应发生率低于B组,差异有显著性意义（P〈0.01）。结论：聚乙二醇干扰素α-2a间隔10日与间隔7日联合利巴韦林治疗慢性丙型肝炎疗效无显著性差异。在治疗12周后,延长聚乙二醇干扰素α-2a的给药间隔期,改为10天1次皮下注射,可有效减轻各种不良反应的发生。     

P13K/AKT通路在刺五加保护大鼠缺血再灌注心肌细胞损伤中的作用

目的 研究刺五加注射液对缺血再灌注损伤心肌细胞的保护作用机制中PI3K/AKT信号通路的作用.方法 取Wistar大鼠幼鼠心室肌细胞进行体外培养,缺氧及复氧各3h建立缺血再灌注损伤细胞模型.培养的心肌细胞分成:正常对照组(Co),缺血再灌注组(I/R),I/R+复方刺五加注射液组(Pi)和I/R+复方刺五加注射液+LY294002(Pi+Ly).采用免疫细胞化学染色法和Western-bloting检测细胞内P-AKT蛋白含量.结果 免疫细胞化学染色法及Western-bloting果均显示,IR组P-AKT蛋白表达水平明显高于正常对照组;实验组(Pi)与其他各组(IR、Pi+Ly)比较,实验组(Pi)P-AKT蛋白表达水平明显升高(P<0.05).结论 刺五加注射液减轻心肌缺血再灌注损伤可能与其激活PI3K/AKT信号通路有关.     

稽留流产病人survivin、bax及caspase-3的表达

目的 探讨survivin、bax及caspase-3的表达与稽留流产的关系.方法 以35例稽留流产病人为病例组,30例正常妊娠者为对照组.采用免疫组织化学sP法检测绒毛细胞滋养细胞和合体滋养细胞及蜕膜组织蜕膜细胞中survivin、bax和caspase-3的表达.结果 病例组妊娠组织中survivin的表达明显低于...     

EXPERIENCE WITH LYOPHILIZED HUMAN DURA MATER FOR URETHRAL STRICTURES

Purpose

We report our results using lyophilized human dura mater for urethral strictures.

Materials and Methods

The results of 131 urethroplasties using lyophilized human dura mater grafts were reviewed. The etiology of the stricture was unknown in most cases and 44.3% had not been previously treated. Mean stricture length was 10 cm. A dura mater patch was used in 124 cases and tubular graft in 7.

Results

Average followup was 56.6 months. The overall complication rate during the first month was 16.3%. At 6 months the graft failed in 2 cases and 25.2% had stricture recurrence. Good results were obtained in the longer term in 41.1% of cases, with a high recurrence rate and malignancy in 4 cases (3.2%) which required penectomy.

Conclusions

Despite being a biologically well tolerated material, lyophilized human dura mater is not good for urethral strictures because of the high number of relapses and possibility of malignancy.     

2型糖尿病患者血糖控制与内脏脂肪指数的关系

目的：探讨2型糖尿病(type 2 diabetes mellitus, T2DM)患者血糖控制情况与内脏脂肪指数(visceral adiposity index, VAI)的关系。方法：采用流行病学现场调查的方法,对社区40岁及以上T2DM患者人口学特征、生活习惯、疾病史、家族史、服药史等资料进行收集,并进行体格检查及空腹血糖、糖化血红蛋白(glycosylated hemoglobin, HbA1c)、血脂等指标的血生化检测。以HbA1c ≥7.0%作为血糖控制不良的标准,分析其与不同水平VAI的关系。结果：共纳入1 607例研究对象,平均年龄为(59.4±8.1)岁,平均糖尿病病程为(7.0±6.4)年,其中78.3%在接受降糖治疗。按VAI四分位数升高的次序将研究对象分为Q1、Q2、Q3和Q4组,其血糖控制不良率依次为60.6%、65.7%、70.1%和71.0% (趋势χ2=12.20, P<0.001)。Logistic回归模型调整年龄、性别、收缩压、舒张压、低密度脂蛋白胆固醇、吸烟情况、心脑血管疾病史、降糖治疗情况、糖尿病病程及家族史后显示,T2DM患者血糖控制情况与VAI水平关联显著。与Q1组研究对象相比,Q2、Q3和Q4组血糖控制不良的OR值分别为1.239 (95% CI 0.918~1.672)、1.513 (95% CI 1.117~2.050)和1.535 (95% CI 1.128~2.088, 趋势P=0.003);VAI每升高一个四分位数,血糖控制不良OR值为1.162 (95% CI 1.054~1.282)。结论：T2DM患者血糖控制情况与VAI显著相关,VAI水平高预示血糖控制不佳。     

Who Would Pay Higher Taxes for Better Mental Health? Results of a Large‐Sample National Choice Experiment

Policy Points

•  Public funding for mental health programs must compete with other funding priorities in limited state budgets.
•  Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits.
•  Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size.
•  In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer.

ContextThe direct and indirect impacts of serious mental illness (SMI) on health care systems and communities represents a significant burden. However, the value that community members place on alleviating this burden is not known, and SMI treatment must compete with a long list of other publicly funded priorities. This study defines the value of public mental health interventions as what the public would accept, either in the form of higher taxes or in reductions in nonhealth programs, in return for increases in the number of mental health program beneficiaries.MethodsWe developed and fielded a best‐practice discrete‐choice experiment survey to quantify respondents’ willingness to be taxed for increased spending among several competing programs, including a program for treating severe mental health conditions. A realistic decision frame was used to elicit respondents’ willingness to support expanded state budgets for mental health programs if that expansion required either cuts in the competing publicly financed programs or tax increases. The survey was administered to a general population national sample of 10,000 respondents.FindingsNearly half the respondents in our sample either chose “no budget increase” for all budget scenarios or had preferences that were too disordered to estimate trade‐off values. Including zero values for those respondents, we found that the mean (median) amount that all respondents were willing to be taxed annually for public mental health programs ranged between $156 ($99) per year for large‐population states and $343 ($181) per year for small‐population states. Respondents would accept reductions of between 1.6 and 3.4 beneficiaries in other programs in return for 1 additional mental health program beneficiary.ConclusionsOur results are consistent with findings that a substantial portion of the US public is unwilling to pay higher taxes. Nevertheless, even including the substantial number of respondents who opposed any tax increase, the willingness of both the mean and median respondent to be taxed for mental health program expansions implies that programs providing mental health services such as state Medicaid are underfunded.