Incidence of Chromosomal Abnormalities from a Morphologically Normal Cohort of Embryos in Poor-Prognosis Patients

Purpose: Preimplantation genetic diagnosis of aneuploidy was performed on the embryos yielded by 70 poor-prognosis patients, with the aim of transferring those with a normal chromosomal complement, thus possibly increasing the chances of pregnancy. Methods: Multicolor fluorescence in situ hybridization (FISH) was applied for the simultaneous detection of chromosomes X, Y, 13, 16, 18, and 21. Inclusion criteria were (1) a maternal age of 36 years or older (n = 33), (2) three or more previous in vitro fertilization cycles (n = 20), and (3) an altered karyotype (n = 17). Results: A total of 412 embryos underwent FISH, resulting in 234 (57%) that were chromosomally abnormal. Euploid embryos were available for transfer in 59 patients, generating 19 pregnancies (32%), with an implantation rate of 19.9%. Conclusions: High rates of chromosomally abnormal embryos in poor-prognosis patients can determine repeated in vitro fertilization failures when embryo selection is performed on the basis of morphological criteria alone. Hence, the FISH analysis could represent the prevailing approach for the identification of embryos possessing full potential for developing to term.     

吉西他滨治疗高龄晚期非小细胞肺癌

目的:观察吉西他滨治疗高龄晚期非小细胞肺癌的疗效,并与同期单纯支持治疗的患者比较,以探讨高龄晚期非小细胞肺癌的治疗方案。方法:吉西他滨组21例,采用吉西他滨单药化疗,剂量为1250mg/m2,静脉滴注,第1、8天用药,每21天为1周期,共4周期。对照组23例不用任何化疗,单纯支持对症治疗。结果:吉西他滨组总有效率为28.6%,其中PR6例,SD12例,PD3例。对照组无CR和PR者。吉西他滨组中位缓解期6.3个月。吉西他滨组和对照组中位肿瘤进展时间分别为5.8和2.6个月,中位生存时间分别为12.8和4.6个月(P<0.01);1年生存率分别为46.6%和9.2%(P<0.01)。吉西他滨组KPS、体重增加和临床症状改善情况均显著高于对照组(P<0.01)。毒副反应方面吉西他滨组12例(57.1%)出现Ⅰ、Ⅱ级血小板减少,7例(33.3%)出现Ⅰ、Ⅱ级白细胞下降,未见Ⅲ、Ⅳ级毒性反应。少数患者血红蛋白下降Ⅰ度,恶心呕吐Ⅰ/Ⅱ度。结论:吉西他滨单药治疗高龄晚期非小细胞肺癌是安全有效的。     

青年人宫颈癌临床病理特征和预后的研究

目的：深入探讨青年宫颈癌患的临床病理特点及预后情况。方法：回顾性分析128例宫颈癌患青中年组的临床病理情况，用Kaplan—Meier进行生存分析。结果：与中年组相比，青年组患具有以下特点：①婚前性生活史比例高。②症状以接触性出血为主，宫颈多为糜烂，其次是赘生物，但其直径多在1cm左右。③患患腺癌比例高(P≤0．05)，细胞分级低比例明显较高(P≤0．05)，易发生淋巴结转移及宫旁转移。④中位生存期及5年生存率明显低于中年组(P≤0．05)。结论：青年宫颈癌患具有特定的临床病理特点，且其生存率低于中年组，病理类型、病理分级、有无脉管浸润淋巴转移及肌层浸润深度是影响预后的独立因素。     

老年住院患者抗菌药使用情况调查分析

目的：为临床合理选用抗菌药提供科学依据。方法：对我院部分临床科室老年患者在不同情况下使用抗菌药的有关数据进行统计分析。结果：233份病历平均年龄82岁，使用抗菌药141人次，抗菌药使用率为61％。应用最多者为头孢菌素类（15种，97例次），占36．4％。静脉给药84例，占31．6％，口服给药13例，占4．9％；抗菌药联合用药68例次，占30．7％；使用前10位的抗菌药多数为国产药物。结论：我院老年患者抗菌药使用情况总体比较合理。     

氯沙坦和非洛地平治疗中老年高血压合并高尿酸血症的疗效观察

[目的 ]　比较氯沙坦和非洛地平对中老年高血压合并高尿酸血症的疗效。　 [方法 ]　 60例中老年高血压合并高尿酸血症患者随机分成两组 ,分别服用氯沙坦 (氯沙坦组 ,n =3 0例 )和非洛地平 (非洛地平组 ,n =3 0例 ) ,分别测定两组患者治疗前后的血压、2 4h动态血压、血尿酸、空服血糖、血脂和肝肾功能。　 [结果 ]　氯沙坦和非洛地平均有明显的降压效果 (P <0 .0 1) ,两组的降压效果相似 (P <0 .0 5 ) ,但氯沙坦降低血尿酸的效果优于非洛地平 (P <0 .0 0 1) ,对血糖、肝肾功能、血脂均无明显作用 ,未发生明显不良反应。　 [结论 ]　氯沙坦治疗中老年高血压安全、有效 ,与非洛地平相似 ,并且有降低高血尿酸作用     

腹膜透析病人与营养师评估饮食状况的比较

腹膜透析病人中普遍存在营养不良，影响其预后欧美国家发生率为18％～56％，我国为30％～54．4％。饮食记录对及时发现营养不良非常重要，国际上多采用1d饮食回顾法或3～7d饮食日记法。但回顾询问法不够准确。本研究采用食物模具，在有经验的营养师指导下，采用回顾询问法对病人3d饮食日记自评与营养师评估进行比较，以了解腹透病人饮食记录的准确性。     

三级医院住院医保患者例均费用比较分析研究

1996年上海实施了城镇企业职工住院医疗保险,医院的住院费用补偿中医保支付的比重扩大.该文对上海一所三级医院的例均费用进行分类研究发现医保例均费用低于上海市非医保患者和外地病人,且三者在药品、检查和手术费用也存在明显差别.本文粗略地讨论了差别的原因,并建议医保住院补偿应按疾病的严重程度区分.     

Three Year Health Outcomes Among Older Women at Risk of Elder Abuse: Women's Health Australia

BACKGROUND: Older women are at increasing risk of various forms of familial violence, yet detection is poor and very little is known of the long-term health effects of this psychosocial problem. The effectiveness of the 'Vulnerability to Abuse' Screening Scale (VASS) in predicting three year health outcomes was investigated among women enrolled in the Australian Longitudinal Study on Women's Health, now known as Women's Health Australia. METHODS: The sample comprised a cohort of 10,421 women aged 73-78 who completed the 1996 and 1999 postal surveys (attrition rate 19.5%). The Time 2 sample had a small bias towards lower risk for elder abuse at Time 1 and better health on SF-36 and self-rated health. The VASS is a 12-item self-report measure with 4 factors: vulnerability, coercion, dependence and dejection. RESULTS: Overall, physical health (PCS) declined while mental health (MCS) increased over the three year period. Decline in physical health was predicted by only the dejection factor, but not by factors which seem to more directly measure abuse. The predictive validity of the VASS for three year mental health outcomes was given partial support. Three of the four VASS factors (dejection, vulnerability, and coercion) predicted decline in mental health at the univariate level, however, after adjusting for confounders, only one VASS factor (dejection) independently predicted decline in mental health. CONCLUSIONS: While the VASS shows some promise as a marker of health risk in older women, only the dejection factor proved consistently predictive of declining health status. Further research is needed to determine longer term predictive validity of the scale and to gain a clearer picture of how abusive experiences impact on older women's health.     

儿科常见护患冲突的管理对策

目的:减少护理纠纷的发生.方法:通过对儿科常见护患冲突原因的分析,更新护理理念,增强法律意识,注重沟通技巧,重视护理工作环节衔接.结果:有效预防、化解科内护患冲突.2003～2005年我科未发生护患纠纷.结论:通过不断总结经验,持续护理质量改进,护患冲突、纠纷明显减少.     

天津市传染性非典型肺炎康复者健康状况的随访研究

目的 了解天津市传染性非典型肺炎（SARS）康复者健康状况及其主要并发症的转归，并通过特异性抗体检测完成血清学诊断，观察抗体时间变化规律。方法对2003年天津市SARS流行期间经住院治疗康复的220人，进行了发病后14个月内分3个阶段的随访研究。对全部随访者进行了血清SARS-CoV特异性抗体IgG、IgM以及淋巴细胞亚群、血生化等指标检测，同时进行了肺部高分辨CT检测和双侧髋关节MRI检测。结果随访患者中，原SARS临床确诊、临床疑似和临床观察病例的SARS-CoV特异性抗体IgG的阳性率分别为99．34％，87．5％和45．59％，提示临床疑似和临床观察病例中有较多病人漏诊。随访早期发现87人存在肺功能或（和）肺间质性变化，经过8个月观察，影像学显示46人肺部病变自愈，其余41人肺部病变也明显好转。49人发生股骨头坏死，仅在SARS-CoV特异性抗体阳性患者中发生，且多为Ⅰ期病变，经多因素分析显示，股骨头坏死与SARS病毒感染以及住院期间激素的平均使用量的联合作用有关。结论血清学诊断在SARS患者感染确证中不可缺少，应在恢复期早期进行血清抗体检测。康复者肺间质性改变有自愈倾向，股骨头坏死的发生是病毒感染与激素联合作用的结果。