成人50例手握力测量及临床意义

目的 探讨成人手握力的正常值及影响因素.方法 对50例18～60岁健康成人使用Jamar液压计测量手握力,并测量其生理手形指标包括全手长、中指长、手宽和腕厚度.分析年龄、性别、优势手、生理手形指标对握力的影响.结果 男性握力平均值右手为47kg,左手为45 kg;女性右手为32 kg,左手为29 kg;女性手的握力约为男性的2/3.右手握力高于左手(P<0.01);50例中右手势利者占92%,左手势利者占8%,优势手的握力明显高于非优势手(P<0.01).右手势利组中,优势手比非优势手握力高9%;而左手势利组中,优势手比非优势手握力高3%.手形指标中,手宽度跟握力的相关性最强,对握力的作用最大(P<0.05).结论 手的握力大小跟性别、侧别、优势手别、手宽度有关,参考健侧握力时需要考虑左、右优势手别对握力的影响.     

The Living Donor Collective: A Scientific Registry for Living Donors

In the setting of an overall decline in living organ donation and new questions about long‐term safety, a better understanding of outcomes after living donation has become imperative. Adequate information on outcomes important to donors may take many years to ascertain and may be evident only by comparing large numbers of donors with suitable controls. Previous studies have been unable to fully answer critical questions, primarily due to lack of appropriate controls, inadequate sample size, and/or follow‐up duration that is too short to allow detection of important risks attributable to donation. The Organ Procurement and Transplantation Network does not follow donors long term and has no prospective control group with which to compare postdonation outcomes. There is a need to establish a national living donor registry and to prospectively follow donors over their lifetimes. In addition, there is a need to better understand the reasons many potential donors who volunteer to donate do not donate and whether the reasons are justified. Therefore, the US Health Resources and Services Administration asked the Scientific Registry of Transplant Recipients to establish a national registry to address these important questions. Here, we discuss the efforts, challenges, and opportunities inherent in establishing the Living Donor Collective.     

The effect of anti‐emetic doses of dexamethasone on postoperative blood glucose levels in non‐diabetic and diabetic patients: a prospective randomised controlled study

There are few data regarding postoperative hyperglycaemia in non‐diabetic compared with diabetic patients following postoperative nausea and vomiting prophylaxis with dexamethasone. Eighty‐five non‐diabetic patients and patients with type‐2 diabetes were randomly allocated to receive intravenous dexamethasone (8 mg) or ondansetron (4 mg). Blood glucose levels were measured at baseline and then 2, 4 and 24 h following induction of anaesthesia. In non‐diabetic patients, the mean (SD) maximum blood glucose was higher in those who received dexamethasone compared with ondansetron (9.1 (2.2) mmol.l^?1 vs. 7.8 (1.4) mmol.l^?1, p = 0.04). In diabetic patients, the mean (SD) maximum blood glucose was also higher in those who received dexamethasone compared with ondansetron (14.0 (2.5) mmol.l^?1 vs. 10.7 (2.4) mmol.l^?1, p < 0.01). Multivariate analysis demonstrated that dexamethasone administration was a significant predictor of maximum postoperative blood glucose increase (p < 0.01) after adjusting for potential confounders. There was no interaction between baseline blood glucose level, or presence or absence of diabetes, and dexamethasone administration. We conclude that dexamethasone increases postoperative blood glucose levels in both non‐diabetics and diabetics.     

Quantitative ultrasound calcaneus measurements: normative data for the Greek population

Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity, and is widely used worldwide for the assessment of skeletal status. This, however, generally occurs in the absence of adequate clinical guidelines. As accurate interpretation of the results and correct classification in individual fracture risk assessment are of great value, the present study was carried out to establish a reference database for calcaneal QUS measurements across age group and gender in Greece. A total of 1205 subjects (821 females and 384 males) from three age groups (409 children, 341 adults and 455 elderly) were recruited. QUS measurements were performed at the heel with the Sahara device, which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS), and then combines these variables into a single parameter, the quantitative ultrasound index (QUI). Overall, gender-related differences were more pronounced among the elderly, while age-related differences were more pronounced among females. Elderly men had higher QUS parameters than women of peer age, but no major gender differences were observed in children and adults. In males, only BUA showed a variation with age, being higher in adult and elderly men compared to boys. On the other hand, all QUS parameters varied significantly with age in females, the general trends being mildly positive from childhood to adulthood, when peak levels were observed, and negative thereafter. The results for the Greek population were in the range reported previously for other populations, but some discrepancies were evident, probably resulting from ethno-specific characteristics and different QUS instrumentation. Importantly, using the manufacturers or the local database as the reference population for computing T-scores led to significantly different classification of subjects into conventional categories of risk. These data could be useful as a guide for comparing the results of individual studies, as well as for the assessment of Greek men and women at risk of fracture.     

《中医内科临床诊疗指南——头痛》制定中患者偏好与价值观的调查研究

目的:研究原发性头痛患者偏好与价值观,为形成推荐意见强度分级共识时提供参考。方法:采用横断面网络调查,通过半开放式电子问卷形式,使用视觉模拟评分(VAS)测量影响患者选择治疗措施的考虑因素重要性、总体治疗措施方向、头痛辨证汤剂治疗、原发性头痛的中成药及非药物治疗措施等方面的偏好与价值观。结果:调查共纳入研究对象217人。影响患者选择治疗措施的考虑因素重要性评分、总体治疗措施方向的偏好评分、偏头痛及紧张型头痛治疗措施的偏好评分差异具有统计学意义(P<0.01)。患者在选择治疗措施时最关注疗效,总体偏好于选择非药物疗法。在偏头痛治疗中,患者对针刺治疗偏好程度最高;在治疗紧张型头痛时,患者对推拿治疗的偏好程度最高;在治疗丛集性头痛时,患者对不同干预措施没有表现出明显偏好。结论:总体上,不良反应少的非药物疗法,如针灸、推拿等在原发性头痛治疗中更受患者欢迎,临床实践指南的制定应该考虑头痛患者的这一偏好与价值观结果。     

呼出气一氧化氮在支气管哮喘- 慢性阻塞性 肺疾病重叠诊治中的应用价值

目的 探讨呼出气一氧化氮（FeNO）在哮喘- 慢性阻塞性肺疾病重叠（ACO）诊疗的应用价 值。方法 选取2018 年1 月—2018 年12 月天津医科大学第二医院呼吸内科收治的ACO、哮喘及慢性阻塞 性肺疾病（COPD）患者共171 例作为研究对象。其中,ACO 患者41 例（ACO 组）,哮喘患者44 例（哮喘 组）,COPD 患者86 例（COPD 组）。选取同期该院健康体检者45 例作为对照组。分析4 组临床特征、外周 血指标、FeNO 及肺功能指标[ 第1 秒最大呼气量（FEV1）、用力肺活量（FVC）、第1 秒最大呼气量/ 预计 值（FEV1%pred）及第1 秒最大呼气量/ 用力肺活量（FEV1/FVC）] 的差异,以及FeNO 与肺功能及外周血指 标的关系。结果 哮喘组年龄低于COPD 组及ACO 组（P <0.05）。ACO 组外周血EOS％、FeNO 水平低于 哮喘组,而高于COPD 组（P <0.05）。ACO 组和哮喘组FeNO 与外周血EOS％水平呈正相关（r s =0.383 和 0.316,P =0.044 和0.037）。COPD 组和ACO 组的FEV1、FVC、FEV1%pred 及FEV1/FVC 低于哮喘组（P <0.05）。 结论 FeNO 和外周血EOS% 对ACO 诊断具有重要的参考价值,与肺功能联合应用有助于ACO 的诊断。     

东菱精纯克栓酶对荷瘤裸鼠全血Casson值的影响

为观察并了解东菱精纯克栓酶对荷瘤裸鼠全血Casson值的影响,采用锥板式粘度计对移植了胃癌和鼻咽癌的荷瘤裸鼠使用东菱精纯克栓酶前后的全血粘度进行检测,并采用线性回归的方法求出各组Casson粘度(CV)及Casson屈服值(CY)。结果显示,使用东菱精纯克栓酶后两组荷瘤裸鼠全血(CV)值皆明显下降(P＜0.01);(CY)值在胃癌组明显下降(P＜0.01),鼻咽癌组无明显变化(P＞0.05)。结果表明,使用东菱精纯克栓酶对荷瘤裸鼠的血液流变学参数有明显改善,提示有可能将其应用于临床预防肿瘤转移及扩散。     

Effects of pioglitazone on proliferation and differentiation of human preadipocytes

Objective: To explore the effects of thiazolidinediones (TZDs) pioglitazone on proliferation and differentiation of human preadipocytes. Methods :Omental adipose tissue biopsies were obtained from 15 patients who were undergoing elective open-abdominal surgery. The primary culture and differentiated induction of human preadipocytes were performed, and the human preadipo-cytes were treated with pioglitazone at different concentrations at proper moments. Dynamic morphological changes of the human preadipocytes were observed, and their proliferation and differentiation were assessed with Colorimetric MTT Assay and Oil Red O Staining. Results:After 24 hours and 72 hours with pioglitazone, 0.1 μmol/L (μmol/ml) pioglitazone increased the MTT values of the human preadipocytes by 25.3% and 34.8% ,respectively(P ＜ 0.05), while 1 μ mol/L pioglitazone by 27.4% and 26.6%(P＜ 0.05), compared with the control group without pioglitazone. The human preadipocytes with pioglitazone cumulated more adipose in the endochylema than those without pioglitazone obviously. 0.1 μmol/L pioglitazone increased the differentiation degree of the human preadipocytes differentiated for 8-10 days by 44.81% and 1 μmol/L pioglitazone by 53.76%(P ＜ 0.05). Conclusion:Thiazolidinediones pioglitazone may significantly promote the proliferation and differentiation of the human omental preadipocytes.     

医务人事档案管理存在问题与思考

目的探讨当前医务人员档案管理中存在的问题。方法结合近年来在规范医务人员档案管理方面的实践,比较以往的档案管理方法与模式。结果根据医务人员档案管理的特殊性提出完善其新思路、新方法。