Proteinuria prevalence in insulin-treated patients: prediction of need for end-stage renal failure treatment

In the Dundee Diabetic clinic area (population circa 250,000), a population-based survey of the prevalence of proteinuria in diabetic patients treated with insulin showed that 9.4% of such patients had persistent proteinuria. The percentage of males with proteinuria was 11.4%, against 7.2% of females. An additional 5.2% of patients had proteinuria observed once, but did not meet the criteria for persistent proteinuria. No result was available in 10% of patients for a variety of reasons. Not every patient with diabetes and persistent proteinuria will progress to end-stage renal failure, but consideration of the group as a whole allows predictions based on published reports, to be made of the likely future incidence of renal failure, and hence future need for renal replacement services. We estimate that over the next decade two patients per 125,000 total population will develop renal failure each year. If survival is unchanged, there could be two or three times that number on treatment at any time.     

强化式分阶段教学在护理实践教学中的实施

护理专业学生实习期间是规范学生行为,培养临床工作能力,获得全面发展的社会化过程的关键时期。现就如何在实习过程中调动教与学双方面的积极性,实现教与学的最佳效果进行探索,尝试采用强化式分段教学在临床教学中的实施,将课堂教学与临床实践相结合,调动学生主观能动性,提高教学质量和护理专业学生素质,取得较好效果。     

ICAM-1在胃癌患者腹水血浆中的表达水平及其与TMN分期的关系

目的探讨ICAM-1在胃癌细胞、胃癌患者腹腔液和血浆中的表达及水平与胃癌TNM分期之间的关系。方法35例胃癌患者采用流式细胞仪检测肿瘤细胞表面ICAM-1水平；用ELISA方法定量检测腹水及血浆中可溶性ICAM-1水平及其细胞阳性表达率。结果肿瘤细胞表面ICAM-1的表达较对照组明显升高，Ⅲ期显著高于Ⅱ期(P＜0．05)，淋巴结转移组和无转移组间有显著差异(P＜0．05)。两组Ⅰ期与Ⅱ期间slCAM-1水平无明显差异(P＞0．05)，Ⅲ期明显高于Ⅱ期(P＜0．05)，有淋巴结转移者明显高于无转移者(P＜0．05)。手术切除肿瘤后，血浆中slCAM-1的水平下降，并与TMN分期有关。结论肿瘤细胞表面ICAM-1阳性率及腹水和血浆中可溶性ICAM-1浓度随着胃癌TNM分期增高而有上升趋势，且与淋巴结转移有关，可作为判断肿瘤发展程度、转移状况以及预后的指标之一．     

鼻胆管替代T管在老年胆道外科中的应用

目的 研究鼻胆管代替T管在胆总管切开后一期缝合中的作用。方法 ERCP后置入鼻胆管引流，手术中行胆总管切开取石后一期缝合胆总管，共26例。结果（1）患者术后住院天数明显减少（P＜0．01）。胆总管切开放置T管的患者，术后至少2周以上才能拔除T管，有时为了防止胆漏的发生，T管放置时间月余。（2）由于鼻胆管放置时间较短，胆汁的丢失明显减少，可防止大量的消化液，电触质及消化酶的损失（P＜0．01）不会引起电解质紊乱，消化不良，食欲减退(3)鼻胆管术后3－7d就可拔除，免除长期带T管给患者带来的痛苦。（4）减少术后并发症，特别是拔T管后的胆汗性腹膜炎。（5）节省住院费用，结论 胆总管切开取石后鼻胆管可以代替T管的作用，减少了T管引起的并发症。     

老年高血压病患者血清可溶性白介素2受体与临床分期相关性的观察

目的探讨老年高血压病患者血清中可溶性白介素－２受体（ｓＩＬ－２Ｒ）的水平，并比较老年高血压病不同临床分期的ｓＩＬ－２Ｒ变化。方法采用双抗体夹心（ＥＬＩＳＡ）法，对４６例老年高血压病人血清ｓＩＬ－２Ｒ的水平，与３０例正常人（ＮＣ）进行检测对比，并对其老年高血压病患者不同临床分期的ｓＩＬ－２Ｒ的水平进行观察。结果老年高血压病患者ｓＩＬ－２Ｒ水平明显高于对照组（Ｐ＜０．０１）；且随临床分期的增加而增高（Ｐ＜０．０１），有明显的正相关性。结论老年高血压病患者体内存在有免疫功能系乱，导致ｓＩＬ－２Ｒ的增高。ｓＩＬ－２Ｒ可作为临床观察老年高血压病的细胞免疫功能及病情判定的有效指标。     

姑息性全胃切除治疗30例晚期胃癌临床分析

目的：探讨姑息性全胃切除治疗晚期胃癌的可行性及合理的手术方式，方法：回顾性分析30例行姑息性全胃切除治疗的胃癌病例，并对该术式的合理性进行评价。结果：1年生存率为60．0％（18／30），2年生存率为13．3％（4／30），术后并发症发生率为13．3％，无手术死亡者，结论：采用姑息性全胃切除术治疗晚期胃癌，具有短路手术不可代替的优点，其手术并发症发生率和手术死亡率明显升高，正确估计患者全身状况是手术的主要前提，经腹切除是最佳途径。对有腹膜播散，脏器浸润转移患者手术应慎重。     

计算机信息处理及控制(图文工作站)--电视透视X光机升级

现有任何视频X光机（电视透视系统）通过一定的方式改装，即嵌入一台计算机，能在微机显示器上看到非常清晰的透视图像，储存有价值的病灶图片，清晰打印透视图像及医生结论，同时，通过计算机键盘控制影像增强器对准及定位，透视床的移动和翻转，这样即经济实惠，又能使现有视频X光机升机。     

Fetal hydrocephalus, intrauterine diagnosis and therapy considerations: an experimental rat model

Materials and methods Fetal hydrocephalus is induced by a single intraperitoneal injection of 8 mg/kg 6-aminonikotinamide (6-AN), a niacinamide antagonist, in Sprague–Dawley rats on day 13 of gestation. Laparotomy was carried out in some rats 3, 6, 7 and 8 days after the intraperitoneal injection. The fetuses were collected by uterotomy and fixed in a formalin solution after measuring head circumference and body length for further histological investigations. The ventricular areas and volumes of the lateral ventricles were measured using a computer morphometric technique after all fetuses were serially sectioned sagittally or coronally. Furthermore, 8 maternal rats (4 treated with 6-AN and 4 controls) were used for ultrasound investigation. The fetal ventricular system and the central canal were demonstrated and compared by transabdominal ultrasound in the 6-AN and control groups. On day 19 of gestation the cerebrospinal fluid (CSF) was drained in some fetuses for 18 h through a thin micro-catheter, which was inserted into the lateral ventricle. In some other fetuses the intracranial pressure (ICP) and the intra-amniotic pressure (IAP) were measured after Doppler sonography of the cerebral blood flow (CBF). These measurements were carried out using a transuterine approach following the laparotomy.Results Hydrocephalus was produced due to the closure of all outlets of the fourth ventricle. Macrocephalus was clear on day 17 (4 days after 6-AN injection). The entire ventricular system was dilated, including the aqueduct and foramen of Monro, and cerebellar hypoplasia was revealed.Conclusion Increased ICP in 6-AN fetuses was associated with decreasing CBF. The cerebral mantel was better developed after CSF drainage. The intra-amniotic pressure was increased in all pregnant rats and was either similar to or higher than ICP.     

早期综合方法治疗51例婴幼儿先天性斜颈观察

目的:探讨早期综合方法治疗婴幼儿期先天性斜颈的效果.方法:对51例11个月以内的先天性斜颈患儿采用红外线照射、推拿、患侧胸锁乳突肌手法牵引、头部被动活动的综合治疗方法早期干预.结果:痊愈35例,基本治愈9例,好转6例,无效1例,总有效率98.04%.结论:对小儿先天性肌性斜颈及早发现并采用综合治疗方法干预效果良好.     

Bone turnover markers in postmenopausal breast cancer treated with fulvestrant – A pilot study

BackgroundTamoxifen has a protective effect on bone metabolism in breast cancer; aromatase inhibitors deleterious and that of fulvestrant is unknown.MethodsFourteen locally advanced breast cancers with clinical benefit on fulvestrant (250 mg/month) as first-line primary endocrine therapy had sequential serum bone-specific alkaline phosphatase (BAP), N-terminal propeptide of procollagen type 1 (PINP) and C-terminal telopeptide (CTX) at 0, 1, 6, 12, and 18 months. Mean percentage changes (95% CI) were calculated.ResultsChanges from baseline at 1, 6, 12, and 18 months with BAP (3.9–46.8 ng/ml) were +1.5 (?9.8 to +12.9), +2.2 (?22.1 to +26.6), +17.6 (?12.4 to +47.6), +10.8 (?29.9 to +51.7); with PINP (20.6–82.1 ng/ml) were +3.4 (?12.0 to 19.0), +18.8 (?36.7 to +74.2), +47.5 (?21.4 to 116.3), +33.3 (?49.5 to +116.1) and with CTX (0.14–1.35 ng/ml) were +30.8 (0.1 to +61.6), +13.9 (?22.3 to +50.2), +42.9 (?12.7 to +98.5), +45.2 (?28.3 to +118.8).ConclusionsLong-term (18 months) stability of bone markers may be exploited by using fulvestrant earlier in sequence of endocrine therapies particularly in adjuvant setting in those with pre-existing decreased bone mass.