2型糖尿病周围神经病变与血清超氧化物歧化酶活性的关系

目的探讨血清超氧化物歧化酶(SOD)活性在2型糖尿病(T2DM)周围神经病变检测中的临床应用价值。方法选取125例T2DM周围神经病变患者及125例健康者,用邻苯三酚比色法测定其血清SOD活性。比较T2DM周围神经病变患者与健康者血清SOD活性,分析T2DM周围神经病变患者血清SOD活性与患者性别、年龄及血糖水平的关系。结果 T2DM周围神经病变组血清SOD活性与对照组比较差异有统计学意义(t=7.798,P=0.000)。T2DM周围神经病变患者血清SOD活性与患者性别、年龄无关;血糖水平6.1~<7.0mmol/L、≥7.0mmol/L组患者间SOD活性的比较,差异有统计学意义(P=0.034)。结论 T2DM周围神经病变患者血清SOD活性水平增高且与血糖水平有关,可能随血糖水平升高而增高。     

经阴道三维超声诊断子宫畸形的临床价值

目的探讨应用经阴道三维超声成像诊断子宫畸形的临床价值。方法收集我院经宫腔镜或/和腹腔镜确诊的子宫畸形患者56例,回顾性分析其术前经阴道二维超声及三维超声特点,比较经阴道二维超声和三维超声对子宫畸形的诊断价值。结果术前经阴道二维超声诊断子宫畸形43例,诊断准确率76.8%(43/56);经阴道三维超声成像诊断子宫畸形51例,诊断准确率91.1%(51/56),二者比较差异有统计学意义(P=0.040)。结论经阴道三维超声的容积后处理模式可多角度观察子宫轮廓及内部结构,特别是子宫底部及内膜情况,可在术前辅助诊断子宫畸形,为临床手术提供更多参考信息。     

单唾液酸四己糖神经节苷脂对弥漫性轴索损伤的疗效观察

目的 探讨单唾液酸四己糖神经节苷脂(GM1)在弥漫性轴索损伤(DAI)中的应用效果及其机制.方法 80例弥漫性轴索损伤患者随机分为GM1治疗组(n=40)和胞二磷胆碱治疗对照组(n=40),疗程20日,观察治疗期间患者的意识变化和远期疗效.结果 (1)与对照组比较,治疗2周后,治疗组患者的意识明显改善,两组比较差异有统计学意义(P＜0.01);(2)治疗组治愈率60.0%,总有效率90.0%,对照组为37.5%和72.5%,两组比较差异有统计学意义(P＜0.05).结论 单唾液酸四己糖神经节苷脂治疗弥漫性轴索损伤患者具有较好的催醒作用,缩短昏迷时间,降低伤残率.     

应用钉-棒系统治疗退行性脊柱侧弯的疗效分析

目的 回顾分析钉-棒系统内固定+植骨融合治疗退行性脊柱侧凸矫治中的疗效.方法 2004-01～2007-12间运用TSRH、CD脊柱内固定系统+植骨融合治疗的42例退行性脊柱侧凸患者.采用后路矫形手术方法 .术后随访6～25个月(平均15个月).通过对术前术后影像学资料进行分析,比较冠状面和矢状面的矫形效果并通过C7椎体中点距骶骨中心垂线(CVSL)的距离来分析躯干平衡的重建,并随访术后疼痛是否缓解以及功能的恢复.结果 所有患者术后外观矫形效果明显.侧凸术后主弯矫正率平均68.7%.末次随访主弯冠状面Cobb角平均丢失4.6°.C7中点距CVSL由术前平均2.7 cm矫正为术后0.26 cm.23例腰背疼痛的患者中17例术后得以缓解,31例患者术后参加正常的生活工作.结论 钉棒系统+植骨融合治疗退行性脊柱侧弯可得到冠状面上较高的矫正率、重建躯干平衡,有效矫正脊柱侧弯,术后功能恢复满意.     

背带式缝合预防剖宫产产后出血的临床应用

目的:观察背带式缝合术用于预防巨大儿、双胎妊娠剖宫产术后出血的疗效及安全性。方法:将巨大儿、双胎妊娠剖宫产行预防性子宫背带式缝合术的产妇22例作为研究组,另选择同期住院巨大儿、双胎妊娠行剖宫产的产妇25例,未行背带式缝合术而使用传统方法治疗,作为对照组。比较两组术后2h阴道出血量、产后出血发生率的情况。结果:研究组术后出血量明显少于对照组,产后出血发生率低于对照组,差异有统计学意义(P<0.05)。结论:背带式缝合术用于预防巨大儿、双胎妊娠剖宫产产后出血有效,操作简单,值得临床推广。     

精子形态分析标准化研究进展

精子形态是评价男性生育力的一项重要参数,但精子形态分析本身存在许多不足,由于质量保证措施常被忽略,实验室室间检验能力验证计划还未推广,导致实验室内部和不同实验室间的分析结果具有广泛差异性。精子形态分析需要建立完善的检测技术体系和相应的质量控制体系,本文对近年来国内外有关精子形态分析标准化的研究进展进行综述。     

糖尿病合并痰菌阳性肺结核病80例临床分析

目的评价糖尿病合并肺结核痰菌阳性患者的治疗效果。方法观察80例糖尿病合并肺结核痰菌阳性患者,用口服降糖药或胰岛素控制血糖,按2E3H3R3Z3/H3R3标化抗结核治疗,随诊1年并监测血糖、糖化血红蛋白及痰菌转变。结果 6个月疗程痰菌阴转率为98.7%,随诊1年痰菌阴性率为97.4%;X线胸片渗出病变大部分吸收,空洞大部分闭合;而血糖平均控制水平一般。结论糖尿病合并肺结核痰菌阳性中结核菌有一定的耐药率,易出现空洞,血糖的控制并不完全影响肺结核的控制。     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象，随机分为观察组和对照组，各45例。对照组采用传统腰麻联合丙泊酚麻醉，观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉，比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分），以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组麻醉后上述指标波动较对照组小（P<0.05）；麻醉前，两组患者皮质醇、肾上腺素水平无显著差异（P>0.05），麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）；两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）；观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）；观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果，可有效缓解患者疼痛，减少术后不良反应发生。     

Survival among Breast Cancer Patients: Comparison of the U.S. Military Health System with the Surveillance,Epidemiology and End Results Program

IntroductionAccessibility to health care is important to cancer survival. The U.S. military health system (MHS) provides universal health care access. However, whether the universal care has been translated into improved cancer survival is unknown. We compared survival of patients with breast cancer in the MHS with that in the U.S. general population and assessed the differences in cancer stage at diagnosis and treatment receipt between the two populations.MethodsThe MHS patients (n = 31,548) were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (n = 63,096) were identified from the Surveillance, Epidemiology, and End Results (SEER) program. The two populations were matched on age, race, and diagnosis year. Multivariable Cox regression hazard modeling was used to estimate hazard ratios (HRs) comparing ACTUR with SEER. Multivariable logistic regression was used to estimate odds ratios (ORs) comparing stage and treatment receipt.ResultsACTUR patients exhibited a 24% lower overall mortality than the SEER patients (HR = 0.76, 95% CI, 0.71-0.80). They were less likely to present with later stage compared to the SEER patients (OR = 0.61, 95% CI, 0.55-0.67 for stage IV tumors). The ACTUR patients with stages I-III tumors were more likely to receive surgery (OR = 1.35, 95% CI, 1.20-1.52) but less likely to receive radiation (OR = 0.91, 95% CI, 0.88-0.94). The survival advantage of ACTUR patients remained regardless of surgery or radiation receipt.ConclusionsBreast cancer patients with universal health care access had improved survival compared to patients in the general population.     

Association Between Serum C-Reactive Protein Concentration and Nutritional Status of Malignant Tumor Patients

Background: The level of the systemic inflammatory marker C-reactive protein (CRP) is elevated in many patients with malignant disease and may be related to nutritional status.

Objective: To analyze the association between serum CRP levels in patients with malignant tumors and their nutritional status.

Method: A total of 3,692 cases were analyzed and the serum CRP levels were determined using an immunometric assay. Nutritional status was assessed by using patient-generated subjective global assessment (PG-SGA). The biochemical evaluation of prealbumin (PA), albumin (ALB), cholesterol (CHOL), and triglycerides (TG) were assayed within 48?h admission to the hospital. The association between serum CRP concentration and the nutritional status, the stage of the tumor and other factors was analyzed by univariate and multivariate logistic regression analysis.

Result: Elevated serum CRP was observed in 47.6% (1,548/3,269) of patients compared with the reference value, and the median CRP concentration was 18.29?mg/l. Patient serum CRP concentrations in the malnourished group (PG-SGA B?+?C) were higher than in the well-nourished (PG-SGA A) patients (P?<?0.05). The serum CRP level was related to the patients' age, gender, tumor stage, and was affected by hepatitis, liver cirrhosis, diabetes, but it has no effect on hypertension. The CRP high patients had lower PA and ALB levels, lower Karnofsky performance status scores, and higher PG-SGA scores (P?<?0.05), and there was no relationship with CHOL and TG levels. Weight loss in the previous 1?mo was seen with CRP positive patients (P?<?0.05).

Conclusion: Almost 50% of malignant tumor patients had elevated serum CRP levels indicating a systemic inflammatory state. The nutritional status was worse in cancer patients with higher concentrations of serum CRP. The level of CRP was associated with the tumor stage, and, as stage is a prognostic factor, so can CRP be used as a prognostic maker in malignant tumors patients.