肿瘤坏死因子α与性激素结合球蛋白在孕早期糖尿病中的表达及其临床意义

目的探讨妊娠期糖尿病(GDM)患者孕早期肿瘤坏死因子α(TNF-α)、性激素结合球蛋白(SHBG)与胰岛素抵抗的关系及对妊娠结局进行研究。方法选择395例孕15周前妇女留取空腹静脉血和血浆,随访至24²8周进行75 g口服葡萄糖耐量试验。测定孕妇孕早期TNF-α、SHBG及HOMA-IR水平。结果 (1)395例孕妇中有65例(16.5%)诊断为GDM。(2)孕早期,GDM孕妇的TNF-α、HOMA-IR均显著高于正常孕妇(P<0.01);而GDM孕妇的SHBG显著低于正常孕妇(P<0.01)。Pearson分析显示,GDM组TNF-α、SHBG均与HOMA-IR呈正相关;正常孕妇的TNF-α、SHBG均与HOMA-IR不相关。(3)GDM妊娠的不良妊娠结局显著高于正常妊娠。(4)单项检测TNF-α的灵敏度为69.2%,特异度为75.5%;单项检测SHBG的灵敏度为70.8%,特异度为40.3%。TNF-α与SHBG联合检测,灵敏度和特异度分别为92.3%、93.0%。结论 TNF-α、SHBG对于早期预测GDM有非常重要的作用。联合TNF-α和SHBG检测可提高诊断GDM的灵敏度和特异度。     

个体化护理对肾结石经皮肾镜超声碎石术后肾造瘘管的影响

目的探讨个体化护理对肾结石经皮肾镜超声碎石术（PNUL）后患者肾造瘘管的影响。方法选择2010年3月—2013年3月收治的肾结石患者184例,按照随机数字表法分为研究组与对照组,每组各92例。两组患者均采取PNUL治疗,对照组患者术后采取常规护理,研究组患者在此基础上采取个体化护理干预,比较两组患者住院时间、拔出造瘘管时间及术后并发症发生情况。结果研究组患者住院时间、拔出造瘘管时间分别为（7．98±1．68）,（5．12±1．66）d,均少于对照组的（10．23±2．54）,（7．54±1．12）d,差异有统计学意义（t值分别为2．824,2．537;P〈0．05）。研究组无瘘管堵塞和感染患者;瘘管脱落发生率研究组为1．09％,对照组为11．96％,两组比较差异有统计学意义（x2=8．915,P〈0．01）;研究组护理的总满意度为98．91％,对照组为78．26％,两组比较差异有统计学意义（x2=114．649,P〈0．01）。结论针对肾结石PNUL术后患者。肾造瘘管采取个体化护理,能够有效降低术后并发症,保障治疗效果及手术的成功率。     

临床护士积极心理品质与专业自我概念的相关性研究

目的：了解临床护士积极心理品质与专业自我概念状况及两者相关性,为护理管理提供依据。方法采用自制一般情况调查表、积极心理品质量表和护理专业自我概念量表（ PSCNI ）对1139名临床护士进行问卷调查。结果临床护士积极心理品质量表总分为（174．95±16．68）分,节制维度条目平均得分最高,为（3．76±0．59）分,超越维度平均得分最低,为（2．13±0．41）分;护理专业自我概念量表总分为（91．32±12．76）分,技能维度条目平均得分最高,为（3．65±0．28）分,满意度条目平均得分最低,为（2．46±0．36）分。专业自我概念得分值与积极心理品质得分值呈正相关（ r值分别为0．218～0．526,P＜0．05）;多元回归分析显示,认知维度、情感维度、人际维度、公正维度及超越维度是专业自我概念的主要影响因素。结论临床护士专业自我概念状况不佳,提高护士积极心理品质,有助于增强专业自我概念水平。     

养血清脑颗粒对偏头痛病人头痛发作的影响研究

目的 :观察养血清脑颗粒对偏头痛病人的治疗效果。方法 :将 70例确诊为偏头痛的病人随机分为养血清脑颗粒组(治疗组 ) 3 5例和对照组 3 5例 ,治疗组服用养血清脑颗粒 ,对照组给予西比灵胶囊治疗 ,连续观察 3 0d。结果 :两组均可减少偏头痛发作持续时间和发作次数 ,但养血清脑颗粒组优于西比灵组 (P <0 .0 5 ) ;两组总有效率比较无统计学意义 ,但在缓解率上 ,治疗组优于对照组 (P <0 .0 1) ,在伴随症状的改善上 ,治疗组亦优于对照组。结论 :养血清脑颗粒对偏头痛病人头痛发作有良好的治疗作用。     

E-cadherin gene C-160A promoter polymorphism and risk of non-cardia gastric cancer in a Chinese population

AIM: To test the hypothesis that E-cadherin gene (CDH1) C-160A promoter variant genotype is associated with an increased risk for developing gastric cancer. METHODS: In this population-based case-control study of gastric cancer in Jiangsu Province, China, we performed polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to genotype the C-160A polymorphism of CDH1 promoter in 206 non-cardia gastric cancer patients and 261 age- and sex-matched but unrelated cancer-free controls. RESULTS: The frequencies of genotypes CC, CA and AA were 57.8%, 36.4% and 5.8% in gasfric cancer cases, respectively, and 58.2%, 34.9% and 6.9% in controls respectively. The distributions of CDH1 genotypes were not significantly different between gastric cancer cases and controls (P=0.87 for genotype frequency and P=0.92 for allele frequency). Compared with the CC genotype, the CA and AA genotypes were not associated with an increased risk for non-cardia gastric cancer (adjusted odds ratios (OR)=1.15, and 95% confidence interval (95% CI)=0.78-1.72 for CA genotype, and OR = 0.90 and 95% CI = 0.42-2.01 for AA genotype). CONCLUSION: E-cadherin gene C-160A promoter polymorphism may not play a major role in the etiology of non-cardia gastric cancer in Chinese population.     

Work disability and its economic effect on 55–64‐year‐old adults with rheumatoid arthritis

Objective

To examine the extent and financial impact of work disability among older workers with rheumatoid arthritis (RA).

Methods

Year 2002 data from 5,419 subjects with RA <65 years of age in the National Data Bank for Rheumatic Diseases were used, along with US population data. Measures of work disability were employment status, part‐time work, sick day use, and limitation in work demands; the latter was assessed by the Work Limitations Questionnaire (WLQ). Measures of financial status were median household income and poverty level income. Statistical procedures included logistic and linear regression, Wilcoxon's rank sum test, and chi‐square test.

Results

Despite being better educated, subjects with RA ages 55–64 years had lower employment rates than individuals of the same age in the US (women 40% versus 53% and men 54% versus 66%). These older subjects with RA had stopped working more often than younger subjects with RA, and more worked part time (40% versus 34%; P < 0.01). However, the older subjects used sick time less often than younger subjects (35% versus 41%; P < 0.01) and were similarly limited in job demands, e.g., physical demands (mean WLQ subscale score 27.0 versus 26.6; P = 0.65). Median household income of older employed subjects was $20,000 greater than that of retired subjects; 56% of retired subjects had incomes lower than US median income versus 32% of employed subjects, and 11% had income below the poverty level.

Conclusion

Premature work cessation in persons with RA ages 55–64 years is a serious problem that needs to be addressed.

     

中国大陆人散发性先天性巨结肠症患者内皮素受体B基因的研究

目的 探讨中国大陆人散发性先天性巨结肠症（sHD）易患基因内皮素受体B（EDNRB）的突变与多态性特征。方法 以92例sHD及其中32例患儿双亲为研究对象，并以60例正常儿为对照。提取受检者外周静脉血DNA，采用聚合酶链反应-单链构象多态性技术（PCR-SSCP）对EDNRB基因外显子-2（exon-2）进行分析，并通过DNA测序检测阳性标本的核苷酸改变方式，与文献报道的其他种族sHD同一基因特征做比较。结果 全部标本EDNRB基因exon-2均未发现突变与多态性位点的存在。结论 中国大陆人sHD患者EDNRB基因的exon-2不存在突变与多态性位点。     

肝癌的冷冻治疗

冷冻疗法已成为治疗不能手术切除肝癌的重要手段.冷冻方法可选择手术中冷冻,切除或不切除肿瘤、腹腔镜下冷冻,或在超声、cT或MRI监测下,经皮冷冻.作为一局部治疗,冷冻具有超越其他治疗方法的若干优点:仅消融肝内肿瘤组织,而少伤及正常组织;由于大血管流动血流的温热作用,冷冻可安全地治疗临近大血管的肝肿瘤:冷冻比之手术更适宜治疗肝多发性肿瘤.冷冻联合肝动脉化学栓塞(TACE)、酒精注射或125碘粒子植入,有相辅相成的作用.对于冷冻在肝癌治疗中应用,可归结如下:(1)小于5 cm,尤其小于3 cm的肝癌,数目不超过3个,可以手术中冷冻或经皮冷冻.(2)大于5 cm的肝癌,先作TACE,再给予经皮冷冻.(3)大于5 cm,边缘不整,预计冷冻不完全的肝癌,可予手术中或经皮冷冻,同时在冷冻区周边部注射酒精或植入125碘粒子.     

比索洛尔和依那普利对高血压病治疗的比较观察

对１４５例原发性高血压患者分组应用比索洛尔（Ｂｉｓｏｐｒｏｌｏｌ）与依那普利（Ｅｎａｌａｐｒｉｌ）治疗，以观察各自疗效。结果显示：①比素洛尔总有效率８７．５％，依那普利总有效率７８．７％，两者疗效有明显差异。②对心率、血脂、血糖、血清电解质、血像和肝肾功能观察期间均无不良影响。③比索洛尔每晨只服１次即可维持疗效，使用方便，副作用小，耐受性好。     

先天性胆总管扩张症38例分析

目的 研究胆总管扩张症的正确诊断与治疗方法。方法 回顾性分析1985年1月至2004年1月我科手术治疗的38例先天性胆总管扩张症患者的资料，术后平均随访50个月。结果 行胆总管十二指肠吻合术2例，胆总管空肠Roux—Y吻合术9例，行胆总管扩张部切除加肝总管空肠Roux—Y吻合术27例；术后胆瘘3例，胰瘘并腹腔出血各1例，无手术死亡。结论 胆总管扩张部切除加胆肠Roux—Y吻合是本病的主要治疗方法，疗效好，局限性肝内胆管扩张可行部分肝叶切除术。