丙型肝炎六例报告及随访观察

本文首次报告新疆6例丙型肝炎。对20例病毒性肝炎病人血清进行抗HCV检测,结果6例阳性。结合临床及化验检查,可诊断为丙型肝炎。对此6例进行分析,结果表明:本病多发生在输血后,临床表现不重,肝功能检查主要是ALT反复波动不降,易致慢性。     

Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

三种基牙材料对铸造玻璃瓷冠碎裂影响的研究

目的:研究不同种类和强度基牙材料与瓷冠破折碎裂的内在关系.方法:选用计算机建立上颌中切牙的三维有限元模型,模拟陶瓷层、牙本质、核桩等结构.分析在天然齿基牙、钴铬合金基牙及复合树脂基牙情况下,铸造玻璃陶瓷全冠的瓷层内及残余牙本质的应力分布情况.结果:高弹性模量的钴铬合金能够降低瓷层及残余牙本质内的最大主应力和最小主应力峰值,防止瓷层破折碎裂;而弹性模量与牙本质相近的复合树脂桩降低应力峰值的作用不明显.结论:对于有牙髓活力的牙本质基牙,尽量保存牙髓活力后行全冠修复.对于行根管治疗术后的无髓牙,进行核桩冠修复时,采用高弹性模量的高熔合金,尽量避免使用弹性模量较小的复合树脂核.     

Special issue: Group treatment after child and adolescent sexual abuse: Introduction

This introduction traces the increasing awareness of the prevalence of child sexual abuse over the last 20 years, examines the nature and consequences of such abuse and summarizes current information on the use of group treatment and its evaluation with sexually abused children and adolescents and their parents. Four examples of group treatment with different populations of abused children are described in this issue.     

Immunoglobulin mimicry by Hepatitis C Virus envelope protein E2

Hepatitis C virus (HCV) establishes persistent infection in the majority of infected individuals. The currently accepted hypothesis of immune evasion by antigenic variation in hypervariable region 1 (HVR1) of glycoprotein E2 does not however, explain the lack of subsequent immune recognition. Here, we show that the N-terminal region of E2 is antigenically and structurally similar to human immunoglobulin (Ig) variable domains. E2 is recognized by anti-human IgG antibodies and also possesses common amino acid (aa) sequence features of the conserved v-gene framework regions of human Ig light chains in particular but also heavy chains and T cell receptors. Using a position specific scoring system, the degree of similarity of HVR1 to Ig types correlated with immune escape and persistence in humans and experimentally infected chimpanzees. We propose a unique role for threshold levels of Ig molecular mimicry in HCV biology that not only advances our concept of viral immune escape and persistent infection but also provides insight into host-dependent disease patterns.     

Linear parameters of normal and abnormal cava septi pellucidi: a post-mortem study

Anatomical variations in the dimensions of different brain structures have been correlated with clinical syndromes. This study on the parameters of normal and abnormal cavum septi pellucidi (CSP) can be of clinical significance. We obtained 479 brains from autopsied persons (310 males and 169 females, 377 normal or asymptomatic and 102 abnormal or symptomatic persons, aged 22-89 years) and observed that 110 brains (75 males and 35 females) had CSP. These cava were classified into two groups depending on the past medical histories of the autopsied person: 40 asymptomatic and 70 symptomatic cava. We have defined symptomatic cava as those in autopsied persons who had known past medical history of psychiatric or neurological disease. Asymptomatic cava were in autopsied persons who had no known past medical history of psychiatric or neurological disease. The CSP parameters (length, width, depth) of the symptomatic and asymptomatic groups were measured and were statistically analyzed. Analysis showed that the cava in the symptomatic group were significantly longer and wider. Discriminant function analysis was used to derive a mathematical formula to classify CSP into an asymptomatic or symptomatic group based on length and width measurements of the cavum.     

Postoperative spindle cell nodule of the breast: Pseudosarcomatous myofibroblastic proliferation following endo‐surgery

Despite the frequent use of fine‐needle aspiration, core biopsy and surgery, postoperative spindle cell nodule (PSCN) is a rare pathological complication that may be diagnostically treacherous. Presented herein is the case of a 52‐year‐old woman who developed a 7 mm mammary nodular lesion 66 days after removal of an area of columnar cell hyperplasia involving cellular and architectural atypia, performed with the Mammotome Breast Biopsy System. The lesion was highly cellular and composed of intersecting fascicles of plump spindle cells with blunt‐ended elongated nuclei and nucleoli easily visible. Interspersed mononuclear cells and hemosiderin‐laden macrophages were evident. PSCN is a reactive, benign myofibroblastic proliferation. Differential diagnosis includes benign and malignant spindle cell lesions of the breast. Recognition of this reactive lesion will avoid overdiagnosis of spindle cell malignant tumor. Attention to clinicopathological and histological features should result in accurate recognition of this lesion.     

脑缺血及再灌注对血液粘度与红细胞变形性的影响

利用大鼠脑缺血及再灌注模型 ,探讨血液粘度、红细胞变形性指标 (DI)在脑缺血及再灌注情况下的变化。实验表明 :在缺血过程中 ,主要由于RBC的代偿作用 ,全血粘度减低 ,RBC变形性增强 ;在再灌注过程中 ,全血与血浆的粘度都升高 ,到再灌注 1 2h发现有恢复正常的趋势 ;说明在缺血、缺氧情况下 ,三磷腺苷减少及一些化学因子的释放促使了这种改变 ,长时间的再灌注会起到修复作用。随着切变率的增加 ,同组实验组中DI的测量值均呈指数函数递增 ,对此建立该模型下的数学方程 :φ =a +b×e[-c(x-x0 ) ] ;同时对同一切变率不同实验组的RBC变形性也做了研究 ,发现DI变化不仅与缺氧及代谢性酸中毒有关 ,而且与RBC自身的特性有关。     

咪唑安定镇静在神外术后躁动病人的应用

观察咪唑安定对神经外科术后躁动病人的镇静作用。发现给予咪唑安定负荷剂量静注后 ,躁动病人 93 %的时间镇静效果满意 ,平均剂量 0 .0 86mg/kg,达到Ramsay 3级镇静水平。持续静脉输注咪唑安定 [药量平均 0 .0 8mg/ (kg·h) ],停药后苏醒时间短 ,长时间应用未见蓄积作用 ,镇静程度易控制 ,不良反应少。