山东省结核病控制项目病人发现情况分析

目的：对世界银行贷款山东省结核病控制项目的病人发现工作一个全面的评析，对今后工作提出建设性意见。方法：对各市地上报到省结防中心的季度报表资料进行统计分析。结果：在项目开展的第四年项目覆盖全部人口，共发现结核病人196588例，其中143571例为涂阳肺结核病人。可疑者就诊率为1．6‰，涂阳新登记率平均为17．2／1万，涂阴涂阳比例为0．4：1。结论：病人发现成果显著，共有19万多各类病人被登记。涂阳新登记率不高，主要因可疑者就诊率及痰检率偏低而致，涂阴病人的登记也较小。     

糖尿病合并菌阳肺结核32例临床分析

目的 分析研究糖尿病合并菌阳肺结核的发病趋势,病变特点,疗效及转归。方法 对519例肺结核病人合并糖尿病51例中(9.8％)的菌阳肺结核32例进行临床分析。结果 显示糖尿病合并肺结核的例数,呈明显上升趋势,糖尿病合并菌阳肺结核比例明显高于菌阴肺结核,且糖尿病合并菌阳肺结核发病年龄,并发空洞的机会,复治比例,多耐药及持续菌阳比例均明显高于单纯菌阳肺结核。本组痰菌阴转时间平均为2.93月,较单纯菌阳肺结核痰菌阴转时间平均1.8月,明显延迟(p<0.01)。结论对于糖尿病合并菌阳肺结核病例,必须从一开始即采用强杀菌力的正规化疗方案,并确保足够疗程,根据耐药情况及时调整化疗方案,同时积极治疗控制糖尿病,才能获得满意疗效。     

Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway

BACKGROUND: Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs. OBJECTIVES: We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern. METHODS: A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing. RESULTS AND CONCLUSIONS: It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed.      

含利福喷丁方案对结素强阳性患者预防性治疗效果观察

目的：探讨含利福喷丁方案对结核菌素强阳性患者预防性治疗的依从性及治疗效果。方法：追踪观察结核菌素强阳性患者的利福喷丁预防性治疗过程，了解方案的依从情况及结核病发病情况。结果：5468例结核病高危患者，预防性治疗接受率83．87％，药物不良反应发生率7．20％。活动性结核病5年发病率404．968／10万，低于一般人群。结论：含利福喷丁的预防性治疗方案，对结核病的发生具有较好的预防作用，且依从性良好。     

Accessory cell damage and loss of overall white cell viability inhibit lymphocyte responses after ultraviolet-B irradiation but without evidence of in vitro suppression

The effect of different doses of ultraviolet B irradiation (UVR) on the proliferative responses of Balb/c spleen cells has been tested. In 72-hour cultures, there was dose-dependent suppression of proliferation in response to phytohemagglutinin (PHA). Cell viability after UVR was found to be reduced in a dose- and time-dependent manner. Proliferation increased by greater than 100 percent after low-dose (20 J/m2) UVR when either normal or gamma-irradiated peritoneal cells were added to the cultures, but not at higher doses. Delaying UVR until 24 hours after stimulation of cultures with PHA did not substantially increase [3H]-thymidine uptake. Stimulation of mixtures of UV-irradiated and control cells or incorporation of medium conditioned with UV-irradiated cells provided no evidence of suppression of proliferation. The accessory cell population is an important target for UVR, but cells are physically damaged to the extent that, at higher doses, the response to PHA stimulation cannot be restored.     

去卵巢骨质疏松性骨折大鼠胰岛素样生长因子1表达与葛根素的干预效应

目的:观察葛根素对去卵巢骨质疏松性骨折大鼠胰岛素样生长因子1表达的影响。方法:实验于2005-02/2006-01在解放军第四五四医院骨科和南京医学院完成。实验材料:葛根素购自中国生物药品鉴定所。SD雌性大鼠40只,8月龄,体质量(280±19)g,由南京医学院实验动物中心提供。实验方法:将大鼠用4%戊巴比妥钠40mg/kg腹腔内麻醉,在无菌条件下行双侧卵巢摘除术,术后继续饲养2个月,借助骨折器建立股骨闭合性骨折模型。按随机排列表法分为对照组和治疗组,每组20只。治疗组术后给予灌胃20mg/(kg·d)剂量的葛根素,对照组给予2mL生理盐水处理。于骨折后第2周利用Western-blot和RT-PCR方法检测胰岛素样生长因子1蛋白与胰岛素生长因子1mRNA表达,观察葛根素对胰岛素生长因子1表达的影响。结果:40只大鼠全部进入结果分析。①Western-blot检测胰岛素生长因子1蛋白:与对照组相比,治疗组胰岛素生长因子1蛋白表达明显升高(1.40±0.09,3.2±0.31,P<0.05)。②RT-PCR分析胰岛素生长因子1mRNA表达:与对照组相比,治疗组胰岛素生长因子1mRNA表达明显升高(12.3±2.09,23.1±1.32,P<0.05)。结论:葛根素可以通过调节胰岛素生长因子1的表达,从而可能加快去卵巢大鼠骨质疏松性骨折的愈合。     

人骨髓间充质干细胞的贴壁分离与体外培养

目的:验证贴壁方式分离人骨髓间充质干细胞,并进行体外扩增培养的可行性。方法:实验于2006-02/12在解放军济南军区总医院脊髓修复科完成。①实验材料:骨髓来源于解放军济南军区总医院脊髓修复科收治的脊髓完全性损伤患者,对本实验知情同意。基础培养液由含体积分数为0.15胎牛血清和低糖α-MEM配置。②实验方法:无菌条件下髂后上棘穿刺抽取骨髓组织6mL,进行细胞培养,观察细胞生长情况,待细胞融合成片、长满培养瓶底部后,用质量浓度为2.5g/L的胰蛋白酶流过所有细胞表面。倒置显微镜下观察细胞变圆、部分脱壁后,立即加入有血清培养液终止消化。③实验评估:取第3代生长状态良好的细胞,胰蛋白酶消化制成细胞悬液,接种,以细胞数为纵坐标,时间为横坐标,绘制细胞生长曲线。同时每隔2h进行细胞贴壁率检测。结果:①骨髓间充质干细胞的形态学观察:倒置显微镜下,骨髓间充质干细胞接种1d即贴壁,去除悬浮细胞后继续培养3d贴壁细胞开始增殖,伸展为椭圆型、短梭型、多角型及不规则型等。至14d细胞密集在集落中心,基本铺满瓶底,第3～5代细胞呈均匀一致的长梭型,排列成旋涡状或放射状。②骨髓间充质干细胞的生长曲线:细胞传代后3d内处于潜伏期,3d后进入生长期,7d后进入平台期。③骨髓间充质干细胞的贴壁率:随着培养时间的延长,骨髓间充质干细胞贴壁率逐渐升高。传代后2,4,6,8,10,12,14,16,18,20h细胞贴壁率分别为(20.20±0.25)%,(33.00±0.29)%,(46.50±0.32)%,(69.20±0.30)%,(76.60±0.34)%,(86.50±0.27)%,(90.30±0.20)%,(96.10±0.28)%,(98.50±0.12)%,(99.00±0.07)%。结论:贴壁法分离骨髓间充质干细胞操作简便,经体外扩增培养后细胞增殖活性强,传代周期为7d,是比较理想的骨髓间充质干细胞培养方法。