不同介入方案治疗急性下肢静脉血栓的临床效果与安全性比较

目的 探讨不同介入方案治疗急性下肢静脉血栓(DVT)的临床效果与安全性。方法 选取我院2015年1月～2019年12月介入科收治的急性DVT患者54例作为研究对象,按照治疗方式的不同分为研究组27例和对照组27例。研究组采用血管腔内综合治疗,对照组采用导管介导溶栓治疗,比较两组患者疗效评价、治疗前后膝上、下15 cm与患肢周径差、治疗前后皮肤肿胀张力、静脉通畅率、住院时间和并发症发生情况。结果 经治疗后研究组患者膝上、下15 cm与患肢周径差均短于对照组(P0.05);经治疗后研究组患者皮肤肿胀张力恢复程度显著优于对照组(P0.05);经治疗后研究组患者静脉通畅率显著高于对照组(P0.05);研究组治疗有效率显著高于对照组(P0.05);研究组患者住院时间明显少于对照组,且其并发症发生率显著低于对照组(P0.05)。结论 血管腔内综合介入治疗能够有效改善患者下肢症状,提高DVT恢复情况,降低并发症的发生,从而有效提高患者生活质量,为临床治疗DVT提供重要参考。     

Effect of Histamine on the Permeability of the Nasal Mucosa in vivo

Objective--Histamine is one of the chemical mediators released during the acute phase of allergic rhinitis and is considered to cause the increase in epithelial permeability observed. We tried to examine the effect of histamine on nasal mucosal permeability in vivo. Material and methods--Histamine at different concentrations was administered to the nostrils of healthy subjects and the nasal transepithelial potential difference (PD) was measured. We also examined nasal mucosal permeability by means of a histochemical technique using horseradish peroxidase (HRP) in guinea pigs. Results--Administration of 10^?1 M histamine significantly reduced the nasal PD in healthy subjects. After administration of 5.4×10^?1 M histamine to the noses of guinea pigs, most of the intercellular spaces showed positive reactions to HRP and this effect was significantly inhibited by pretreatment with mepyramine and the antihistamine bepotastine besilate. Conclusion--These results indicate that histamine plays an important role in the change in mucosal permeability observed in allergic rhinitis in vivo via the histamine H₁ receptor.     

Significance of the SISI Test and Its Relation to Recruitment

Auditory brainstem responses (ABR) evoked by clicks allow a threshold evaluation for the high-frequency range (2-4 kHz) but not for middle and low frequencies (0.5-1 kHz). In 19 normally hearing subjects aged between 24 and 40 years, ABRs have been recorded using clicks and 0.5- and 1-kHz tone pips, with durations of 6 and 3 ms, respectively, and rise-decay times of 3 and 1.5 ms. The input signal was filtered by a passband filter of 20-5000 Hz. Parameters of tracings elicited by the different kinds of stimuli are compared. Tone-pip ABR morphology does not show the conventional seven peaks but a single large vertex-positive wave. On the ascending branch high-frequency potentials, probably corresponding to the I, II, III and IV-V click-evoked peaks, were visible in some cases, but they rapidly disappeared as the stimulus intensity was decreased. Their 2.3-3 ms greater mean latency values are presumably related to the rise times of the stimuli employed. In terms of bioelectric generators, this large vertex-positive peak probably corresponds to the Jewett V wave. It probably represents a generalized asynchronous dendritic activity. Thus it is possible to obtain ABRs to middle- and low-frequency stimuli. Mean amplitude values of the slow wave are considerably higher than those of the Jewett V wave, but standard deviations are also larger. The positive wave has been identified in response to 1-kHz tone pips in 100% of cases at 30 dB nHL and in 52% of cases at 20 dB, while for 0.5-kHz tone pips in 73.7% of cases at 30 dB and in 57% at 20 dB. On the whole the threshold is located between 15 and 30 dB nHL.

L'étude des potentiels auditifs du tronc cérébral évoqués par des clics permet une évaluation objective du seuil auditif dans le domaine des hautes fréquences (2-4 kHz), mais pas dans celui des fréquences moyennes et basses (0, 5-1 kHz).

Nous avons étudié, chez 19 sujets normo-entendants aˇgés de 24 à 40 ans, les potentiels auditifs du tronc cérébral évoqués par des clics et des pips tonaux de 0,5 et 1 kHz, la durée des pips tonaux étant respectivement de 6 et 3 ms, avec un temps de montee de 3 et 1,5 ms.

Le signal était filtré avec une bande passante de 20-5000 Hz. Nous avons ainsi comparé les paramètres des tracés obtenus avec ces différents types de stimulus et trouvé que les pips tonaux n'évoquaient pas l'apparition des sept pics conventionnels, mais seulement une onde assez ample, positive au vertex; parfois, il est possible de reconnaiˇtre sur sa branche ascendante la présence de potentiels à haute fréquence qui correspondent selon toute probabilité aux pics I, II, III et IV-V évoqués par des clics. Leur amplitude décroiˇt et ils disparaissent lorsqu'on diminue l'intensité de la stimulation. Les latences de cette onde ample, positive au vertex, supérieures de 2,3-3 ms à celles de l'onde V de Jewett, sont probablement liées au temps de montée du stimulus employé. En termes d'origine bioélectrique, cette onde correspond vraisemblablement à celle du pic V de Jewett. Elle semble représenter une activité dendritique, asynchrone. On peut done obtenir des potentiels auditifs du tronc cérébral avec des stimuli de basse et de moyenne fréquence. Les amplitudes moyennes de cette onde sont beaucoup plus importantes que celles du pic V de Jewett, mais les déviations standard sont aussi plus grandes. Cette onde est présente dans 100% des cas pour les pips tonaux de 1 kHz à 30 dB nHL et dans 52% à 20 dB, tandis qu'elle est présente dans 73,7% des cas à 30 dB et dans 57% à 20 dB lorsque on emploie des pips tonaux de 0,5 kHz. Les seuil objectif se situe ainsi entre 15 et 30 dB nHL.     

关于医疗卫生体制改革的认知差异性

卫生改革的顺利实施依赖于卫生系统内不同群体的合作,但是现有的文献表明,不同群体对于医疗卫生体制改革的认知存在较为明显的差异,影响卫生政策的实践效果.通过对文献的分析,对差异的程度进行定性分析;对认知差异的定量研究是未来研究需关注的领域.     

医疗服务价格水平差异评价及政策启示——以四川省为例

本文构建了医院医疗服务价格水平差异指数HPDI作为量化评价工具,对四川省18家公立医院价格水平及影响因素进行评价分析。结果表明,区域内公立医院价格水平管制合理、有效,内部因素中医技和临床类项目影响显著,外部因素中等级与规模因素影响显著。建议价格主管部门更加科学化、精细化研究价格水平问题,合理把握价格调整尺度、做好价格改革方案。     

Proteomic Analyses of the Effects of Drugs of Abuse on Monocyte-Derived Mature Dendritic Cells

Drug abuse has become a global health concern. Understanding how drug abuse modulates the immune system and how the immune system responds to pathogens associated with drug abuse, such hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1), can be assessed by an integrated approach comparing proteomic analyses and quantitation of gene expression. Two-dimensional (2D) difference gel electrophoresis was used to determine the molecular mechanisms underlying the proteomic changes that alter normal biological processes when monocyte-derived mature dendritic cells were treated with cocaine or methamphetamine. Both drugs differentially regulated the expression of several functional classes of proteins including those that modulate apoptosis, protein folding, protein kinase activity, and metabolism and proteins that function as intracellular signal transduction molecules. Proteomic data were validated using a combination of quantitative, real-time PCR and Western blot analyses. These studies will help to identify the molecular mechanisms, including the expression of several functionally important classes of proteins that have emerged as potential mediators of pathogenesis. These proteins may predispose immunocompetent cells, including dendritic cells, to infection with viruses such as HCV and HIV-1, which are associated with drug abuse.     

医学生的医学同理心特点

目的探讨医学生同理心的特点,为有针对性地培养医学生的医患沟通能力提供依据。方法采用杰斐逊医学生同理心量表（JSE—HP）对天津医科大学和天津中医药大学临床专业564名医学生进行问卷调查。通过社会科学统计软件包SPSS17．0建立数据库进行统计分析。采用内部一致性分析各量表信度,描述性统计分析医学生在各变量的分布、t检验比较不同特征医学生的同理心特点,F检验比较不同年级医学生同理心的特点。结果①本研究问卷的Cronbach仅系数在0．608～0．857之间,量表具有较好的信度;②医学生同理心量表（杰斐逊量表）得分在32—138分之间（量表总分范围为20～140）,均值为（103．73±17．87）分,这说明被试医学生的医学同理心高于中等水平;③性别、年级、对所学专业满意程度等人口统计学资料不同的医学生同理心的差异有统计学意义（P〈0．05或〈0．01）。结论①医学生的总体同理心水平略高于中等水平;②性别不同和是否独生子女对医学同理心没有影响,对所学专业满意程度高和学过心理学课程的医学生同理心水平高;③不同年级的医学生同理心变化较大,随着年级的增长,整体呈下降趋势。     

Gender Differences in the Electrophysiological Characteristics of Atrioventricular Conduction System and their Clinical Implications

Objective - The underlying mechanisms of the differences in sex distribution of patients with atrioventricular (AV) nodal re-entrant tachycardia and Wolff-Parkinson-White syndrome are poorly understood. The objective of this study was to determine potential gender differences in the electrophysiological properties of the normal AV conduction system that may be attributable to differences in sex distribution. Design - The AV conduction properties were studied in 96 patients (52 men and 44 women) who underwent electrophysiological testing, 32 patients with atrial tachycardia, 39 with idiopathic ventricular tachycardia and 25 with unexplained palpitations or syncope. Results - The AH (83 &#45 15 ms) and His-ventricular intervals in men (42 &#45 6 ms) were significantly longer than in women (78 &#45 14, 38 &#45 6 ms, p < 0.05, respectively), as was the PR interval (160 &#45 17 vs 152 &#45 13 ms, p = 0.02). The effective refractory period of AV node in men (349 &#45 75 ms) was longer than in women (297 &#45 45 ms, p = 0.03). However, no significant difference was observed between men and women with respect to the incidence of AV nodal dual pathway and the maximum AH interval achieved during premature stimulation or incremental pacing. The AV block cycle length was significantly longer in men (371 &#45 76 ms) than in women (330 &#45 52 ms, p = 0.02). A longer ventriculoatrial block cycle length was also found in men than in women although not at a significant level (436 &#45 107 vs 384 &#45 90 ms, p = 0.08). In addition, men (23%) were twice as likely to have ventriculoatrial dissociation during ventricular pacing as women were (11%, p = 0.2). Conclusion - The data show that gender-related differences in AV conduction properties may be responsible for the differences in sex distribution observed in patients with AV nodal re-entrant tachycardia and those with ventricular pre-excitation.     

时间差攻击疗法治疗下呼吸道多重耐药铜绿假单胞菌感染疗效观察

目的：探讨时间差疗法治疗下呼吸道多重耐药铜绿假单胞菌感染的疗效。方法：将有多重耐药铜绿假单胞菌感染的病例随机分为实验、对照两组,实验组采用磷霉素与头孢哌酮-舒巴坦时间差攻击疗法,对照组采用磷霉素与头孢哌酮-舒巴坦同时联合疗法。结果：治疗14 d 后,实验组的有效率为85.71%,对照组为65.12%。经χ2检验,有显著性差异（P ＜0.05）。结论：时间差攻击疗法疗效好,为多重耐药铜绿假单胞菌感染提供了一种新的治疗方法。