精子形态变化对体外受精率的影响

目的:通过对ICSI和IVF受精率的统计,比较精子形态中的精子正常形态率、头部畸形率、畸形精子指数(TZI)和精子畸形指数(SDI)对受精结果的影响。方法:用Krger's严格标准法分别计算每组样本的精子正常形态率、头部畸形率、TZI和SDI值,与受精率进行比较。结果:①IVF组和ICSI组的受精率,与精子正常形态率、头部畸形率、TZI、SDI均无相关性。②IVF组和ICSI组中SDI>1.6和SDI<1.6的受精率、优质胚胎率和临床妊娠率差异均无统计学意义(P>0.05)。③IVF组和ICSI组中精子正常形态率≤15%与精子正常形态率>15%的二组间受精率、优质胚胎率和临床妊娠率的差异均无统计学意义(P>0.05)。结论:精子形态在体外受精时对受精率无影响,不能用精子形态来直接评价体外受精的结果。     

大脑中动脉钙化的CT与经颅多普勒超声对照研究

目的探讨大脑中动脉（middle cerebral artery,MCA）水平段（M1）钙化的量化指标与血流动力学的关系。资料与方法搜集经头颅CT确诊M1段钙化且行经颅多普勒超声（transcranial Doppler,TCD）检查者41例,按有无钙化分为钙化组和无钙化组。分析MCA钙化组血流动力学参数与钙化量化指标是否有相关性;检验钙化组与无钙化组血流动力学参数及狭窄发生率的差异。结果MCA搏动指数（pulsatility index,PI）与钙化体积以及积分值呈线性相关;钙化组与无钙化组PI差异有统计学意义（P〈0.05）,但狭窄发生率差异无统计学意义（P〉0.05）。结论MCA钙化程度与TCD反映血管弹性的PI相关,但与反映狭窄程度的血流速度无相关性。     

老年冠心病患者踝臂指数和心脏结构与功能的相关分析

目的探讨老年冠心病患者踝臂指数(ABI)和心脏结构与功能的相关性。方法87例老年冠心病患者,按ABI分组,A组ABI≤0.9,B组ABI>0.9,同时测量2组的心脏结构指标:左心房直径(LAD)、左心室舒张期直径(LVDD)、左心室后壁厚度(LVPW)。左室收缩功能指标:左室缩短率(FS)、左室射血分数(EF)。左室舒张功能指标:EF斜率。结果A、B2组比较,年龄、血脂、血糖、肝功能、肾功能、LAD、LVDD、LVPW和EF斜率均无显著性差异。FS和EF均有显著性差异,A组较B组明显降低(P<0.05)。结论ABI与老年冠心病患者的心脏功能有较好的相关性,对其预后的判定有一定的价值。     

放射性核素阴囊血池显像技术诊断精索静脉曲张的临床研究

目的:探讨放射性核素阴囊血池显像(RSI)技术诊断精索静脉曲张(VC)的价值。方法:本组126例有男性不育1年以上病史、精液分析异常的患者分别接受临床体格检查(PE);RSI技术检查,计算两侧阴囊血池指数值(SBPI),并观察是否有精索静脉血液返流;以及彩色双功能多普勒显像(CDFI)检查,对VC进行分型、定度。将PE,RSI结果分别与CDFI结果对比。结果:PE、RSI诊断VC的灵敏度分别为:71.7%、96.5%,特异度分别为:69.1%、97.1%。RSI诊断VC的灵敏度、特异度均高于PE。结论:RSI技术是诊断临床型、亚临床型VC的简单、安全、有效的无创诊断方法,也是一种非侵袭性,更加客观、准确地诊断VC的有效方法。     

A method for assessing quality of control from glucose profiles.

AIM: As the practice of multiple assessments of glucose concentration throughout the day increases for people with diabetes, there is a need for an assessment of glycaemic control weighted for the clinical risks of both hypoglycaemia and hyperglycaemia. METHODS: We have developed a methodology to report the degree of risk which a glycaemic profile represents. Fifty diabetes professionals assigned risk values to a range of 40 blood glucose concentrations. Their responses were summarised and a generic function of glycaemic risk was derived. This function was applied to patient glucose profiles to generate an integrated risk score termed the Glycaemic Risk Assessment Diabetes Equation (GRADE). The GRADE score was then reported by use of the mean value and the relative percent contribution to the weighted risk score from the hypoglycaemic, euglycaemic, hyperglycaemic range, respectively, e.g. GRADE (hypoglycaemia%, euglycaemia%, hyperglycaemia%). RESULTS: The GRADE scores of indicative glucose profiles were as follows: continuous glucose monitoring profile non-diabetic subjects GRADE = 1.1, Type 1 diabetes continuous glucose monitoring GRADE = 8.09 (20%, 8%, 72%), Type 2 diabetes home blood glucose monitoring GRADE = 9.97 (2%, 7%, 91%). CONCLUSIONS: The GRADE score of a glucose profile summarises the degree of risk associated with a glucose profile. Values < 5 correspond to euglycaemia. The GRADE score is simple to generate from any blood glucose profile and can be used as an adjunct to HbA1c to report the degree of risk associated with glycaemic variability.     

氯胺酮和依托咪酯的BIS50及其对脑电双频指数的影响

目的 分别测定氯胺酮和依托咪酯诱导时半数患者入睡时的脑电双频指数(BIS)即BIS50和半数有效量(ED50)，比较他们对BIS的影响。方法 选择40例无服用精神药物和镇静催眠药、无术前用药的择期手术患者(ASAⅠ～Ⅱ级)，随机分为氯胺酮组(K组，n=20)和依托咪酯组(E组，n=20)，以半数效量序贯法分别进行氯胺酮和依托咪酯诱导的睡眠观察，以对语言指令不应和睫毛反射消失为入睡指标，同时记录BIS的变化。对取得的数据以直线回归的方法和加权均数法分别求得氯胺酮、依托咪酯的BIS50和ED50。结果 氯胺酮和依托咪酯诱导后，BIS明显下降(P=0.000983)，但两者各自BIS下降幅度在入睡与未睡患者之间没有明显差异(P=0.920501和0.956263)。氯胺酮的BIS50和ED50分别是78．81(95％可信区间67．27～97．10)和0.757mg／kg(95％可信区间0.535～1．071mg／kg)，依托咪酯的BIS50和ED50分别是60．00(95％可信区间49．74～76．95)和0.089mg，／kg(95％可信区间0.073～0.107mg／kg)。结论 氯胺酮和依托咪酯皆显著降低BIS，但仅凭BIS难以准确预计是否进入睡眠状态。     

Thymidine labeling index in breast tumors

The relationship between primary tumor proliferative activity and clinical and pathologic characteristics was analyzed in relation to menopausal status in 32 patients with malignant or benign breast disease. The thymidine labeling index (TLI) showed significantly higher median values in the cancer patients (3.48 per cent) than in the patients with benign diseases (1.02 per cent). TLI was not significantly affected by delayed incubation at room temperature for about 1 hour. In the breast cancer patients, TLI did not significantly correlate to tumor size, the presence of axillary lymph node metastasis or pathologic nuclear grading. The only significant difference was limited to the breast cancer patients without axillary lymph node metastasis in relation to menopausal status; the TLI in the premenopausal patients (5.10 per cent) was significantly higher (p<0.05) than that in the postmenopausal patients (2.28 per cent). These data thus suggest that among premenopausal patients without axillary lymph node metastasis, those with a high TLI could be potential candidates for adjuvant chemotherapy.     

浙江医科大学附二院门诊处方中精神药物使用调查

本文对浙江医科大学附属二院１９９３年７月间３１３７８张合格处方进行统计分析，并用限定日剂量（ＤＤＤ）和药物使用指数（ＤＵＩ）为指标，分析镇静催眠药物使用情况。结果表明苯二氮　类药方２０６７张，占总处方量的６．５９％，巴比妥类药方４９张，占０．１６％，麻醉药方１１１张；占０．３５％。苯二氮　类药方中．女性处方量１２０２张，男性处方量８６５张，男、女组间比较有显著性差异。苯二氮　类药方多分布在神经内科，常用的药有舒乐安定和阿普唑仑。九种常用的苯二氮　类药和麻醉性镇痛药的ＤＵＩ均小于１。提示药物滥用现象少见，该院对这类药物的管理比较严格。麻醉性镇痛药中二氢埃托啡处方占６７．５７％。     

Clinical index to predict bacteraemia caused by staphylococci

Abstract. Objectives. To define risk factors associated with bacteraemia caused by Staphylococcus aureus or coagulase-negative staphylococci; and to use them to define patients in need of empiric anti-staphylococcal antibiotic treatment. Design, Derivation set: observational, prospective study; validation set: retrospective analysis of a prospectively collected database. Setting. Derivation set: Beilinson Medical Centre, Petah Tiqva, Israel—a 900-bed university hospital. Validation set: St Thomas's Hospital, London, UK—an 800-bed teaching hospital. Subjects. All episodes of bacteraemia detected at Beilinson Medical Centre between March 1988 and September 1990 (derivation set, n = 1410), and at St Thomas's Hospital during 1987–1990 (validation set, n = 1040). Interventions. None. Main outcome measures. Percentage of staphylococcal bacteraemia in groups of patients defined by the models. Results. The following factors were associated with Staphylococcus aureus bacteraemia: focus of infection (whether high or low risk), haemodialysis, intravenous drug abuse and infection acquired in the orthopaedic ward. A logistic model was used to divide the derivation set into three groups with percentages of Staphylococcus aureus bacteraemia of 1.8%, 13.2% and 33.7% (P < 0.0001); and the validation group 2.5%, 18.2% and 53.2% (P < 0.0001). Factors associated with coagulase-negative staphylococcal bacteraemia were: central or peripheral intravenous catheter as the focus of infection, a preterm neonate, the presence of a central intravenous catheter, low temperature, and a low white blood cell count. A second model including those factors was used to divide the derivation set into three groups with percentages of coagulase-negative staphylococcal bacteraemia of 1.9%, 22.8%, and 43% (P < 0.0001). In the validation set, the percentages were 2.9%, 22.4% and 31.0% (P < 0.001). Conclusions. The present study defines groups at high risk for staphylococcal bloodstream infection, in which empiric treatment should include an anti-staphylococcal drug.