断指再植术后坏死的相关因素分析

目的:探讨断指再植术后坏死的主要相关因素以采取有效的预防和控制措施。方法:对2013年1月至2013年12月收治的236例断指再植患者进行回顾性分析,共311指,其中男183例,女53例;年龄2～62岁,平均34.5岁,其中6岁以下6例,6岁以上230例。拇指51指,示指87指,中指78指,环指63指,小指32指。将再植术后坏死的40例40指作为观察组,其他再植存活病例作为对照组。比较两组年龄、性别、指别、吸烟史、受伤类型、断指缺血时间、离断平面、动静脉修复质量等方面的差异,分析引起再植术后坏死的相关因素。结果:手指完全离断再植236例共311指,术后坏死40指。完全离断指体再植术后坏死的主要相关影响因素包括:吸烟史、受伤类型、离断平面、动静脉修复情况(P<0.05).而与年龄、性别、指别、断指缺血时间无明显相关性(P>0.05).结论:吸烟史、受伤类型、离断平面及动静脉修复情况是完全离断指体再植术后坏死的独立预测因素,提示断指再植时应综合考虑患者基本情况、伤情,严格把握手术适应证,积极做好手术处理。     

脂蛋白相关磷脂酶A2基因R92H多态性与汉族人群冠心病易感性的关系

目的探讨脂蛋白相关磷脂酶A2基因R92H多态性与冠心病遗传易感性及冠状动脉病变程度的关系。方法采用单荧光标记探针技术检测261例冠心病患者及263例正常人脂蛋白相关磷脂酶A2基因R92H多态性。结果冠心病组RH基因型和H等位基因频率显著高于对照组(P<0.05和<0.01)。RH基因型、H等位基因人群冠心病风险增高(P均<0.01)。Logistic回归分析显示,R92H多态性是冠心病的独立危险因素(P<0.05)。冠心病组中RH和HH基因型者总胆固醇和低密度脂蛋白胆固醇水平高于RR基因型者(P<0.05和<0.01),高密度脂蛋白胆固醇水平显著低于RR基因型者(P<0.05)。冠心病组中,RH和HH基因型者多支血管病变率比RR基因型者明显升高(P<0.05)。结论脂蛋白相关磷脂酶A2基因R92H多态性与中国汉族人群冠心病相关,携带RH、HH基因型人群发生冠心病风险较高,且与更严重的冠状动脉病变有关。     

人体对逆行胃电刺激的内脏敏感性及与胃容受性、胃排空的关系

目的观察逆行胃电刺激(RGES)对内脏感觉、胃容受性和胃排空的影响,并探讨其相互关系。方法健康志愿者12例,胃镜下将双极电极同定在远端胃黏膜,观察不同参数 RGES 引起的症状程度,较小能量刺激对水负荷和固体胃排空功能的影响。结果引起初始感觉的胃电刺激能量为(265.6±134.9)smA~2,最大耐受的刺激能量为(2020.0±865.1)smA~2,对 RGES 的内脏感觉个体差异很大。小于50%引起初始感觉的刺激能量即可显著减少水负荷和延缓同体胃排空,不引起明显症状。引起初始感觉的刺激能量与刺激引起的饮水量减少(r=-0.80,P<0.05)和胃排空时间延长(r=-0.78,P<0.05)呈显著负相关。结论 RGES 可降低胃容受性和延缓胃排空,在对胃电刺激内脏敏感性高的个体这些抑制作用更强。     

基于前列腺影像报告和数据系统评估T2WI联合分段读出弥散加权成像诊断早期前列腺癌的价值

目的比较分段读出平面回波成像(readout-segmented echo-planar imaging,RS-EPI)与单次激发平面回波成像(single-shot echo-planar imaging,SSEPI)在早期前列腺癌诊断中的价值。材料与方法回顾性纳入20例行3.0T MRI SS-EPI和RS-EPI检查的早期前列腺癌患者。两位影像科医生在不提供任何临床资料的情况下参照PI-RADS标准分析T2WI、RS-EPI和SS-EPI图像,按六分区法对前列腺各个分区出现癌的可能性进行评分。共组成5种方案:方案1:T2WI;方案2:SS-EPI;方案3:RS-EPI;方案4:T2WI+SS-EPI;方案5:T2WI+RSEPI。采用受试者工作特征(receiver operating characteristic,ROC)曲线比较5种方案的诊断效能。结果方案1~5的曲线下面积分别为0.789、0.790、0.874、0.838、0.881,由高到低的顺序为T2WI+RS-EPIRS-EPIT2WI+SS-EPISSEPIT2WI。方案1与方案3、方案4、方案5,方案2与方案3、方案4,方案4与方案5之间ROC曲线下面积差异有统计学意义(P0.05)。方案1与方案2,方案3与方案4、方案5之间ROC曲线下面积差异无统计学意义(P0.05)。结论 T2WI联合应用DWI可提高早期前列腺癌的诊断效能,T2WI联合RS-EPI的诊断效能高于T2WI联合SS-EPI,更利于临床早期前列腺癌的诊断。     

Search for intrafamilial transmission of hepatitis C virus in hemophilia patients

This study was performed to determine the risk of family members of anti-hepatitis C virus (HCV)-positive hemophilia patients (index patients) for infection with HCV compared with the risk of acquiring hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis A virus (HAV) infection. All index patients (n = 141) were found to be positive by first and second generation anti-HCV enzyme immunoassays (EIAs). Among their household contacts (n = 228), 224 were negative and 1 positive by both assays. Three contacts gave positive results in first generation anti-HCV EIA and negative results in second generation assay. This latter result was confirmed by further tests (neutralization test, synthetic peptides, and supplemental assay). Percent positivity for anti-HBc was about the same in non-sexual household contacts and sexual partners (13 of 109 [12%] and 7 of 54 [13%], respectively). Percent prevalence of anti-HBc was higher in contacts of index patients with chronic hepatitis B than in those of index patients who had recovered from that disease (6 of 20 [30%] and 14 of 133 [10%], respectively; P < .05). The HBV infection rate of contacts participating in controlled self-treatment was not higher than that of controls (3 of 57 [5%] and 10 of 98 [10%], respectively). Of 44 sexual partners, 5 (11%) were found to be positive for anti-HIV. Prevalence of anti-HAV matched with the age-related distribution in the German population. These findings suggest that intrafamilial transmission of HCV to family members of hemophilia patients is uncommon. In contacts of hemophilia patients, the risk of acquiring HBV infection seems to be as high in household contacts as in sexual contacts. Participation in controlled self-treatment does not appear to be an additional risk for HCV and HBV infection. There is no doubt that sexual transmission of HCV is less common than that of HBV and HIV.     

Investigating the Association Between Obstructive Sleep Apnea and Periodontitis

Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by disruptions of normal sleep architecture. Chronic periodontitis is a chronic disease of the periodontium that elicits a general inflammatory response to local dental plaque. It has been suggested that periodontal disease may increase in severity with increasingly severe OSA because both disease entities share common inflammatory pathways, acting synergistically to alter the host response. The aim of this study is to analyze the association between severity of OSA and the prevalence/severity of periodontitis. Methods: One hundred patients from a large veterans administration sleep study center (n = 26 normal, n = 21 mild, n = 19 moderate, n = 34 severe) diagnosed with an overnight polysomnogram underwent a comprehensive periodontal examination. Periodontal parameters measured included the following: 1) mean periodontal probing depth (PD); 2) clinical attachment level (CAL); 3) gingival recession; and 4) percentage of sites with bleeding on probing, plaque, PD ≥5 mm, and CAL ≥3 mm. Results: Seventy‐three percent of the sampled population had moderate/severe periodontal disease. χ² analyses revealed no significant differences in the prevalence of periodontal disease between the apnea–hypopnea index (AHI) groups, with a negligible Spearman correlation coefficient of 0.246 between AHI severity and periodontal disease severity categories. Analysis of covariance indicated a significant association between AHI severity categories and percentage of sites with plaque, after adjusting for age. Multivariable logistic regression analysis predicting moderate/severe periodontitis with AHI score, age, and smoking status indicated a significant association with age (P = 0.028) but no significant association with the other two predictors. Conclusion: OSA was not significantly associated with the prevalence of moderate/severe periodontitis and the periodontal parameters examined, except percentage plaque.     

医院内外感染葡萄球菌的耐药性分析

目的分析医院内与院外感染葡萄球菌的耐药性,为临床用药提供依据。方法收集2011年1月至2013年12月黄石市中心医院门诊(院外)、住院(院内)患者各种标本中分离的454株葡萄球菌,用VITEK-32专用卡GPI及血浆凝固酶试验进行鉴定,药敏试验按K-B琼脂扩散法进行,根据美国临床和实验室标准化协会2006对头孢西丁的耐药情况进行分类分析,数据分析用WHONET 5.5药敏分析软件。结果在379株金黄色葡萄球菌(SA)中,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为41.2%,医院内、外标本MRSA检出率分别为44.1%和19.6%,差异有统计学意义(P0.05);共检出凝固酶阴性葡萄球菌75株,医院内、外标本耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为61.1%和38.1%,差异有统计学意义(P0.05)。未检出万古霉素、替考拉宁耐药菌株。结论耐甲氧西林葡萄球菌具有多重耐药性;院外SA感染者首选药物为庆大霉素、苯唑西林;若为院内SA和对于MRCNS引起的不论是院内或院外感染,均推荐首选万古霉素或替考拉宁。     

老年2型糖尿病患者颈动脉粥样硬化与骨密度的相关性研究

目的 探讨老年2型糖尿病患者颈动脉粥样硬化与骨质疏松症的关系.方法 昆明医科大学第二附属医院住院2型糖尿病患者200例行颈部血管彩超,IMT＜1.0 mm为对照组,IMT≥1.0 mm为实验组.均用双能X线骨密度测量技术检测骨密度,分为骨量正常组与骨量变化组,分析各组生化指标及颈动脉粥样硬化斑块与骨密度的相关性.结果 实验组发生骨量变化的机率高于对照组,差异有统计学意义(P＜0.01);年龄、HOMA、TC、TG、LDL-C、UA、MAU、硬化斑块是骨量减低的独立危险因素,BMI是保护因素(P＜0.01).结论 老年2型糖尿病患者颈部血管病变与骨密度密切相关.     

刘尚义教授运用紫菀、款冬花、百部治疗肺系疾病经验举隅

中医所言肺系疾病,属于现代医学呼吸系统疾病范畴.临床常见呼吸系统疾病包括上呼吸道感染、支气管扩张、慢性阻塞性肺疾病、肺炎等,属中医“感冒”、“肺胀”、“咳嗽”范畴.本文对我省名老中医刘尚义教授配伍运用紫菀、款冬花、百部治疗肺系疾病的经验进行了介绍.     

浅谈治未病理论中“瘥后防复”对肿瘤复发转移的指导作用

"瘥后防复"是中医预防医学"治未病"理论的重要组成之一,与现代医学三级预防中的康复性预防相似,对肿瘤复发转移的预防有一定的指导作用。本文从治未病理论中"瘥后防复"思想、中医对肿瘤复发转移的认识、"瘥后防复"思想对肿瘤复发转移的指导作用等三个方面进行了阐释。