强化教育对社区精神分裂症患者遵医行为和康复的影响

目的 探索健康教育对社区精神分裂症患者遵医行为和康复的作用.方法 对100例显效出院的社区精神分裂症患者按先后出院的顺序随机分为教育组和对照组各50例.教育组出院后进行定期家庭随访、电话咨询、集体座谈等多种形式的强化健康教育,定期评价其遵医行为,及时纠正不遵医行为并给予指导;对照组出院后不予干预.两组分别于出院后1月,6月,12月对遵医行为和BPRS,SDSS量表进行评定.结果 教育组在出院后6月和12月遵医行为明显高于对照组(P＜0.01);BPRS、SDSS在出院6月、12月时评定结果明显低于对照组(P＜0.01).结论 健康教育能提高社区精神分裂症患者遵医行为,促进其心理、社会功能的康复,减少其复发率.     

经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例

目的 探讨da Vinci Si机器人甲状腺手术不同径路的安全性.方法 2014年1月济南军区总医院用da Vinci Si外科手术系统完成甲状腺腺叶切除2例.1例取腋窝径路,于患侧腋窝沿腋前线取切口约5 cm,对侧锁骨中线乳头上方取横切口约8 mm,建立皮下隧道至术区,经腋窝切口置入da Vinci Si外科手术系统摄像臂及1、2号器械臂,经8 mm trocar置入3号器械臂.另一例取胸前径路,于胸骨切迹下约12 cm处建立观察孔12 mm,双侧锁骨中线乳晕上方处建立操作孔8 mm,观察孔置入摄像臂,操作孔置入1、2号器械臂,术中止血及腺体切除均采用超声刀,标本用取物袋取出,术毕于术区留置负压引流管并关闭手术切口.结果 2例患者均成功实施机器人甲状腺腺叶切除术,无中转开放或腔镜手术,无手术并发症,术中估计出血量10 ～20 mL,平均手术时间为163 min,平均引流量90.5 mL.病理诊断分别为结节性甲状腺肿和甲状腺滤泡性腺瘤.术后测甲状旁腺素及血清钙磷均在正常范围.结论 经腋窝与胸前径路机器人甲状腺腺叶切除安全可行,手术美容效果好.     

可移植性人脑胶质瘤组织裸小鼠脑内移植及其MR显像研究

背景与目的:文献报道的胶质瘤动物原位移植模型,大多数是将细胞悬液立体定向接种于鼠脑内,操作繁杂,耗时长,难以在短时间内完成批量实验.本研究接种可移植性人脑胶质瘤组织于裸小鼠脑内,探讨建立人脑胶质瘤裸小鼠原位移植模型及其MR活体成像的可行性.方法:在套管针内,置入位于裸小鼠皮下生长的可移植性人脑胶质瘤组织2 mm3,经微型颅钻钻颅孔后经套管针推入裸小鼠右尾状核内,第30天在配有小鼠专用micro-23微线圈的1.5T MR机上进行头颅扫描和专用软件测量显像的肿瘤体积.继而取全脑作连续冰冻切片,HE染色,在光学显微镜下观察肿瘤病理特征,在体视显微镜目镜下用测微尺测量肿瘤.然后将上述两种方法测得的数据进行统计学分析,评价荷瘤鼠活体MR显像计算肿瘤体积的可行性.结果:经MR扫描的15只颅内接种肿瘤的小鼠,有14只的尾状核区域见到肿瘤显像;在脑切片上,与MR像相同部位见到了肿瘤组织.经脑切片测得的肿瘤体积[(23.19±10.18)mm3]和经MRI测得的肿瘤体积[(23.45±11.64)mm3]比较差异无统计学意义(P＞0.05).肿瘤模型制作成功率为93%(14/15),肿瘤模型MR显像成功率为100%(14/14).结论:经套管针定量植入胶质瘤组织于裸小鼠尾状核,制作可移植性裸小鼠人脑胶质瘤原位模型,具有操作便捷、省时、便于批量制作、致瘤率高等优点.配有小鼠专用微型线圈的1.5T MR机可用于荷瘤裸小鼠的头颅成像、在活体上对移植瘤进行定位和体积测量等研究.     

不同消融方式对房颤患者的治疗现状

近年来随着介入技术的不断发展，心房颤动（房颤）的治疗已逐步由药物治疗转向介入治疗，尤其对于药物治疗效果差和症状持续性房颤患者，介入治疗可作为首选。目前存在的治疗房颤的导管消融方式有射频消融术、冷冻消融术、脉冲场消融等。本文旨在对不同消融方式在房颤患者中的治疗现状作一概述。     

JZTX-IV, a unique acidic sodium channel toxin isolated from the spider Chilobrachys jingzhao

Neurotoxins are important tools to explore the structure and function relationship of different ion channels. From the venom of Chinese spider Chilobrachys jingzhao, a novel toxin, Jingzhaotoxin-IV (JZTX-IV), is isolated and characterized. It consists of 34 amino acid residues including six acidic residues clustered with negative charge (pI=4.29). The full-length cDNA of JZTX-IV encodes an 86-amino acid precursor containing a signal peptide of 21 residues, a mature peptide of 34 residues and an intervening sequence of 29 residues with terminal Lys-Gly as the signal of amidation. Under whole-cell patch clamp conditions, JZTX-IV inhibits current and slows the inactivation of sodium channels by shifting the voltage dependence of activation to more depolarized potentials on DRG neurons, therefore, differs from the classic site 4 toxins that shift voltage dependence of activation in the opposite direction. In addition, JZTX-IV shows a slowing inactivation of sodium channel with a hyperpolarizing shift of the steady-state inactivation on acutely isolated rat cardiac cell and DRG neurons, differs from the classic site 3 toxins that do not affect the steady-state of inactivation. At high concentration, JZTX-IV has no significant effect on tetrodotoxin-resistant (TTX-R) sodium channels on rat DRG neurons and tetrodotoxin-sensitive (TTX-S) sodium channels on hippocampal neurons. Our data establish that, contrary to known toxins, JZTX-IV neither binds to the previously characterized classic site 4, nor site 3 by modifying channel gating, thus making it a novel probe of channel gating in sodium channels with potential to shed new light on this process.     

观察早期卵裂和原核消失在体外受精-胚胎移植周期中的应用价值

目的:观察早期卵裂和原核消失在体外受精-胚胎移植(IVF-ET)治疗中的应用价值。方法:①对行IVF-ET治疗的210例239个周期,于受精后18～19h观察受精情况,25～26h观察早期卵裂与原核消失情况,66～68h再进行1次胚胎观察,了解其临床妊娠率和胚胎种植率。②根据移植胚胎中有无早期卵裂或原核消失将患者分为:早期卵裂或原核消失组(139例152个周期)与无早期卵裂或原核消失组(71例87个周期),比较两组优质胚胎率、临床妊娠率和胚胎种植率。结果:①临床妊娠率为42.7%,胚胎种植率为28.9%。②发生早期卵裂的胚胎在受精后第3日的优质胚胎率高于未发生早期卵裂的胚胎(P<0.01);发生2原核消失(2PNBD)胚胎在受精后第3日的优质胚胎率又高于2原核(2PN)持续存在的胚胎(P<0.01)。③有早期卵裂或原核消失组的优质胚胎率(75.5%)、临床妊娠率(44.7%)和胚胎种植率(29.5%)分别高于无早期卵裂或原核消失组(P<0.01)。在早期卵裂或原核消失组,随移植胚胎中发生早期卵裂或原核消失的胚胎数目增加,妊娠率及多胎妊娠率有增加趋势。④受精25～26h,有0.95%的2PN合子变成≥3PN合子;1.37%的2PN合子变成1PN合子;0.83%的1PN合子变成2PN合子。结论:早期卵裂和原核消失可以作为选择移植胚胎的一个指标,可作为辅助生殖技术实验室常规观察项目,提高IVF-ET成功率。     

2003～2007中医药抗癌国际合作探索

近年来,国际上传统与现代结合医学发展非常迅速,其中中国传统医学是其主要的部分。自2003年2月开始,复旦大学附属肿瘤医院和美国德克萨斯州大学安德生肿瘤中心开展了旨在共同建立国际中医癌症治疗中心的国际合作。结果发现,中医学走向国际化存在着必然性和艰巨性。结论认为,要使中医学更快、更顺利地走向世界,首先要了解和解决中医目前存在的问题和困惑。其次,要坚持四个原则:1.科学态度第一原则;2.中医理论主导原则;3.开放与创新原则;4.多学科协作原则。中医学中理论精华,例如阴阳和谐(平衡)、辨证论治、脏腑五行生克、天人相应(合一)、谨守病机、上工治未病等以人为本治疗疾病重要理念必将为世界医学作出重大的贡献。     

Ureterocele in adults. Five case reports

The authors report five cases of ureterocele during six years. Mean age of the patients was 34.2 +/- 11.1 years. There were four female and one male. Pain (N = 3) and dysuria (N = 3) were the most common symptoms at examination. Diagnosis was made by ultrasound (N = 3), IVU (N = 3) or cystoscopy (N = 1). Ureteroceles were bilateral in four cases, unilateral in one case and were always intravesical with single ureter. Two patients presented lithiasis enclosed in the ureterocele. Only four patients had been operated. Surgical treatment was ureterocelectomy with ureteral reimplantation according to Cohen procedure. With mean follow-up of 10.6 +/- 4.7 months results were stable without complications.     

Postnatal development of nicotinamide adenine dinucleotide phosphate-diaphorase-positive neurons in the retina of the golden hamster

The histochemical method was used to investigate the postnatal development of nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) -positive neurons in retinas of the golden hamster. NADPH-d-positive neurons were discernible in the retina at postnatal day (P)1. From P4 onward to adulthood, when the retina acquired its laminated characteristics, NADPH-d- positive neurons were observed in the inner nuclear layer (INL) and the ganglion cell layer (GCL). Results showed that NADPH-d-positive neurons in INL and GCL followed different time courses and patterns in their development. NADPH-d-positive neurons in INL underwent a sharp increase from P4 to P8 (3.6-fold), followed by a decrease to 46% of the maximum at P12. This value was maintained relatively constant to the adult level. The mean diameters of NADPH-d-positive neurons in INL, which were smaller than those in the GCL for all ages, increased from P8 to P12 and from P20 to adulthood. As for neurons in the GCL, the increase in cell number was not so apparent for the earlier postnatal days until P20; thereafter, an obvious increase to the adult level was observed. The mean diameters of the NADPH-d-positive cell bodies in the GCL increased with age, except for P16-P20, during which time there was a slight and insignificant decrease. The tendency of changes in cell density was basically similar to that of the total number for both the INL and the GCL. Between P12 and P20, the density distribution map of the NADPH-d-positive neurons underwent dramatic changes: The highest density shifted from the upper central retina at the earlier postnatal days to the lower central retina in the adult. The two waves of increase in NADPH-d-positive neurons coincide with the process of axonal elongation and synaptogenesis and the acquisition of visual function and experience. It is suggested that these NADPH-d-positive neurons are related to these two developmental events.     

支原体和衣原体的分型及病原型检测

随着人们对支原体、衣原体认识的不断深入,已经发现支原体、衣原体的感染与临床多种疾病密切相关。尤其是20世纪90年代以来,沙眼衣原体及解脲支原体所致的泌尿生殖系统感染的发生率在欧美国家已超出淋病的发生率,在我国也呈逐年上升的趋势,成为当前性传播疾病(STD)的主要病原体