同轴微导管支气管动脉四重栓塞治疗大咯血

目的:探讨支气管动脉同轴微导管四重栓塞术治疗大咯血的临床价值,观察大咯血栓塞治疗的临床效果及与并发症的关系。方法:大咯血患者42例,首先行明胶海绵微粒栓塞,再行丝线栓塞,第三步注入血管硬化剂,最后行大颗粒明胶海绵栓塞,所有病例随访6个月～2年。结果:本组病例短期、中期及远期疗效有效率均为100%。结论:支气管动脉同轴微导管四重栓塞术是治疗大咯血的一种简便、创伤小、长期疗效稳定且高效的疗法。     

肝性脑病并发电解质和酸碱失衡的探讨

目的　探讨肝性脑病时电解质和酸碱平衡紊乱的发生规律。方法　对 80例肝性脑病患者的动脉血气、电解质和血浆渗透压等检测结果进行回顾性分析。结果　肝性脑病患者中单纯酸碱失衡占 35 0 % ,二重酸碱失衡占 37 5 % ,三重酸碱失衡占 2 5 0 %。电解质紊乱一般多表现为低钠血症 (4 3 75 % )、低钾血症 (30 0 0 % )、低氯血症 (2 6 2 5 % ) ,血浆渗透压降低亦很常见。结论　肝性脑病患者经常出现电解质和酸碱平衡紊乱 ,并且使其病情更趋复杂化 ,应该及时给予纠正     

Elevated urinary β2 microglobulin in the first identified Japanese family afflicted by X-linked myopathy with excessive autophagy

Here we report what is to our knowledge the first identified Japanese family afflicted by X-linked myopathy with excessive autophagy. The index case is a 52-year-old man with almost 40 years of progressive proximal muscle weakness. High urinary β2 microglobulin, normal serum β2 microglobulin, autophagic vacuoles with sarcolemmal features, and a hemizygous c.164–7T>G mutation in the VMA21 gene were found. His two maternal uncles had similar clinicopathological findings. High urinary β2 microglobulin without obvious renal dysfunction might result from decreased urine acidification in the distal convoluted tubules caused by the VMA21 gene mutation. These findings might prove to be useful as a preliminary marker suggestive of X-linked myopathy with excessive autophagy.     

家庭治疗对精神分裂症患者社会功能和生活质量影响的经济学评价

目的:评估家庭治疗改善精神分裂症患者社会功能和生活质量的经济学价值。方法:①选择2003-06/2005-09在广西壮族自治区人民医院心理康复中心住院的精神分裂症患者96例,均符合世界卫生组织国际疾病分类第10版关于精神分裂症的诊断标准,且自愿接受量表评估。②入院时用随机数表法将患者分为2组:家庭治疗组(n=50)与对照组(n=46)。对照组进行药物常规治疗;家庭治疗组在此基础上进行9次家庭治疗,观察6个月。内容包括:以疾病健康教育为主要内容的集体家庭治疗4次;以单个家庭为单位的个别家庭治疗4次;几个家庭参与的集体家庭治疗1次。③两组分别于入组时和治疗6个月后采用简明精神病量表(总分18～126分,分数越高,精神症状越严重)、日常生活能力量表(总分14～56分,分数越高,日常生活能力越差)、健康状况调查问卷(0～100分,分数越高,生活质量越高)评估患者精神状态、日常生活能力和健康状况,将各量表评分的变化作为效果。④分别计算两组患者6个月内的医疗费用总成本,简明精神病量表/日常生活能力量表减分量(E1,E2)(入组时简明精神病量表/日常生活能力量表分数-治疗6个月末简明精神病量表/日常生活能力量表分数),健康状况调查问卷增分量(E3)(治疗6个月末健康状况调查问卷分数-入组时健康状况调查问卷分数),平均成本-效果比(C/E),增量成本效果比(△C/△E)犤(家庭治疗组的成本-对照组的成本)/(家庭治疗组的效果-对照组的效果)犦。⑤计量资料和计数资料差异比较分别采用t检验和χ2检验。结果:精神分裂症患者96例均进入结果分析。①效果的确定:家庭治疗组E1,E2,E3均明显高于对照组犤家庭治疗组:(29.00±9.67),(17.06±5.00),(16.50±6.20)分;对照组:(20.67±9.48),(11.13±6.01),(10.00±9.36)分,t=2.420,2.994,2.294,P<0.05犦。②成本的确定:家庭治疗组和对照组的人均成本分别为(5797.06±949.52)和(5360.67±1511.96)元。③成本-效果分析结果:家庭治疗组和对照组平均成本-效果比C/E1分别为199.90和259.34,C/E2分别为339.80和481.64,C/E3分别为351.34和536.07;说明取得同等的治疗效果,家庭治疗的成本比对照组的成本少。与对照组比较,家庭治疗组的增量成本效果比△C/△E1为52.39,△C/△E2为73.59,△C/△E3为67.14;说明家庭治疗治疗组多付出的成本是经济的,可以通过少量的成本换取较高的效果。结论:抗精神病药物联合家庭心理治疗,能显著改善精神分裂症患者的临床症状、社会功能和生活质量,比单纯的药物治疗更能节省医疗费用成本,是一种高效低耗的治疗方法。     

Analysis of focal spared areas in fatty liver using color Doppler imaging and contrast-enhanced microvessel display sonography.

OBJECTIVE: The purpose of this study was to investigate whether focal fatty sparing (FFS) formation in the liver relates to aberrant blood flow. METHODS: Sixty-three FFSs of the liver in 52 patients were examined by color Doppler flow imaging and contrast-enhanced microvessel display sonography. The 63 FFSs included 16 FFSs in the porta hepatis, 14 FFSs around the gallbladder fossa, and 33 other FFSs. The control group included patients with a diagnosis of fatty liver but no FFSs or focal lesions near the porta hepatis. RESULTS: Fourteen of 16 FFSs in the porta hepatis showed venous blood toward those areas that were differentiated from the portal and hepatic veins. Focal fatty sparings in the hilus hepatis correlated with aberrant veins, having a statistical significance compared with the control group (P < .0001). Seven of 14 FFSs around the gallbladder fossa contained blood vessels, 5 of them veins and the remaining 2 arteries. Two FFSs were located around hemangiomas. Three FFSs were located around maldeveloped vessels. CONCLUSIONS: The blood supply to an FFS in the porta hepatis may be correlated with aberrant veins. Focal fatty sparings around the gallbladder fossa may be associated with aberrant blood flow.     

The effect of sonication on simulated osteoarthritis. Part I: effects of 1 MHz ultrasound on uptake of hyaluronan into the rabbit synovium

High molecular weight (MW) hyaluronan (HA) preparation is considered to be more biologically active than HAs of lower MWs. However, many of the HA preparations currently used to treat osteoarthritis (OA) have lower MWs by the enhanced penetration of HA molecules into the synovial lining cells. In this study, we determined the effectiveness of sonophoresis on the delivery of high MW HA into synovial membrane using an animal model of OA. A total of 1000 kDa (HA1000) and 3000 kDa (HA3000) HA were labeled with fluorescein and injected into the knees of rabbits. Low-intensity continuous ultrasound at 1 MHz, 400 mW/cm2 was applied to the knees for 10 min treatment bid. Synovial fluid analysis revealed increased absorption and fluorescence microscopy showed deeper penetration of both HA1000 and HA3000, more so with the latter. Histologic examination indicated that ultrasound treatment resulted in no apparent damage to the synovial membrane. These results suggest that simultaneous sonication with HA injection might compensate for the short half-life of HA. Consequently, this dual treatment would render HA a far more effective tool in the management of OA.     

Fluorescence spectroscopic determination of dipyridamole binding on pancreas-1 tumor cell membrane

BACKGROUND: The traditional method to determine the binding sites of inhibitors bound to nucleoside transporters on cell membrane is the radioactive assay. This method suffers from radiolabel instability and the need to dispose of reactive materials. Fluorescence spectroscopy has been increasingly applied to biochemical analysis due to its high sensitivity and selectivity. We describe fluorescence spectroscopy for the determination of the binding sites of dipyridamole bound to nucleoside transporters on pancreas-1 tumor cell membrane. METHODS: Pancreas-1 tumor cell was cultured in Dulbecco's modified Eagle medium under appropriate conditions. The cell plasma membrane was separated from the ultrasonically dissolved cell mixture by gradient centrifugation. After dipyridamole was bound to the cell membrane, the test sample was obtained by ultrasonically dissolving the labeled membrane in 10 mmol/l tris-HCl membrane lysis solution. Under selected experimental conditions, the fluorescence intensity of dipyridamole was determined. RESULTS: At lambda em of 295 nm and lambda em of 485 nm, dipyridamole was proportional to its concentration ranging from 1.0 x 10(-12) to 5.0 x 10(-11) mol/l with a detection limit of 2.8 x 10(-13) mol/l (0.14 pg/ml) at 3sigma. The value of affinity constant of the cell membrane to dipyridamole was 4.7(+/-0.5) x 10(10) l/mol and the average total number of binding sites of a pancreas-1 tumor cell was 1.9(+/-0.2) x 10(6). CONCLUSIONS: The proposed method can be used in the study of binding characters of dipyridamole on the cell membrane.     

综合医院急诊科应对群体性伤害紧急医疗救援

综合医院急诊科开展群体性伤害的紧急医疗救援，建立一支训练有素的队伍应从建立突发事件应急救援指导小组、培养急诊医护人员基本技能、制定应对群发伤预隶、掌握4个阶段重点等方面进行，循序渐进规范急诊质量体系。     

结直肠癌中VEGF-C与TAM表达及临床意义

目的探讨结直肠癌组织中血管内皮生长因子-C(VEGF-C)的表达与肿瘤相关巨噬细胞(TAM)定量的关系及在淋巴结转移过程中的作用和可能机制.方法采用免疫组织化学SP法检测50例结直肠癌组织及正常黏膜组织中VEGF-C蛋白的表达,并在光镜下进行巨噬细胞计数.结果在结直肠癌组织中,VEGF-C阳性表达率为62%(31/50),显著高于正常肠黏膜的表达(P<0.01);TAM计数平均为(29.42±6.11)个/HP,显著高于正常肠黏膜(P<0.01).结直肠癌VEGF-C的表达和TAM计数均与淋巴结转移密切相关(P<0.01),与Dukes分期显著相关(P<0.01),而与病理分级无关(P>0.05).VEGF-C的表达和TAM计数呈正相关(rs=0.83,P<0.05).结论在结直肠癌组织中VEGF-C的表达和TAM浸润有关,两者在淋巴结转移中有协同作用,联合检测VEGF-C及TAM为评估结直肠癌预后提供了重要的参考指标.