论我国医患冲突成因及和谐关系构建

目前我国医患之间的矛盾与冲突，实质上是新时期我国社会矛盾在卫生工作中的具体表现，反映了社会群体在经济状况、价值取向、角色意识、道德水平、法律法规等多方面的矛盾与冲突。和谐医患关系应是构建我国和谐社会的内容之一。和谐医患关系的构建需要完善的社会医疗保障体系建立、国家卫生行政管理加大、财政补偿合理投入、医疗服务质量提高、医学知识教育普及与提高、媒体理性传播、社会大众道德控制水平提升，法律法规完善等全方位的努力，有赖于医事主体双方及全社会的关注与通力改善。     

LONG‐TERM FOLLOW UP OF PATIENTS WITH SMALL GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH USING ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY

Background: Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors of the gastrointestinal tract. GIST are defined by positive immunohistochemical staining for KIT or CD34 and thus are generally diagnosed after surgery. Because small GIST are rarely diagnosed before surgery, the clinical course of these small tumors is not clear. The aim of the present study was to follow changes in size and configuration of small GIST that were pathologically confirmed using endoscopic ultrasonography‐guided fine‐needle aspiration biopsy (EUS‐FNAB). Methods: Between July 1997 and December 2003, 16 tumors in 16 patients (10 men and 6 women) with an immunohistochemical diagnosis of GIST were regularly followed in our hospital. The median patient age when EUS‐FNAB was performed was 62 years (range 26–82 years) and the median follow‐up period was 4.9 years (range 0.5–9.6 years). Results: Fourteen tumors showed no remarkable changes in size and shape during follow up compared with the initial diagnosis. Two tumors enlarged: one tumor approximately doubled its diameter in 8 years and the other tumor increased from 1.8 cm at diagnosis to up to 10 cm after only 2 years. Doubling time of the latter tumor was calculated as 3.1 months. Conclusions: We conclude that EUS‐FNAB might be a good modality for final diagnosis of GIST without surgery, and that GIST without rapid growth on follow up can be endoscopically followed.     

发作性睡病伴发的幻觉症——随访22年一例

患者十六岁开始有逐渐加重的睡眠发作,伴有轻度不典型猝倒。14岁后出现入睡前幻觉,主要为鲜明生动的听幻觉,偶有幻视、幻嗅。幻觉严重时继发关系妄想和被害妄想,失去自知力。22年随访结果:患者精神状态良好,仍有轻度睡眠发作及入睡前幻觉,不影响日常工作和生活。对诊疗作了评价。     

干性型老年黄斑变性60例随访观察

探刊干性型老年黄斑变性（age-related macular deganeration，AMD)的病变发展特征并 寻找监测AMD病情进展的较敏感指标。 方法：用眼底彩色照相和眼底荧光血管造影(FFA)、明视视网膜电囤(ERG)、FM100-hue 色彩试验及视力检查，对60例(111眼)50~80岁、视力≤1.0的干性型AMD患者进行3～74个月(平均30.2个月)的随访观察。 结果：本组68眼经FFA检查、平均25.6个月随访，其中25%的患眼病灶损害有快慢不一的发展．全部111眼视力在平均30.2个月随访中有18%患眼的视力下降2行以下，且与病灶进展相符，FM100-hue 色彩试验的被随访者中，随访2年以后，其总错误分明显的增加(P<0.01)．63眼的明视ERG在随访过程中无明显变化。 结论：大部分干性AMD患眼的病灶损害和视力可以在较长时间内维持稳定。FM100—hue的总错误分可能为监测AMD病情进展的较敏感指标． （中华眼底病杂志，1997，13：150-152）     

抗—HCV阳性单采浆供血员HGV感染随访研究

为了解单采浆供血员庚型肝炎病毒（ＨＧＶ）感染及其转归，对１０２名抗－ＨＣＶ阳性单采浆供血员冻存血清进行抗－ＨＧＶ和ＨＧＶＲＮＡ检测，对抗－ＨＧＶ和（或）ＨＧＶＲＮＡ阳性者作３年随访研究。采用ＥＩＡ法检测抗－ＨＧＶ，包被抗原来自ＨＧＶ不同功能区的合成肽。应用ＲＴ－ＰＣＲ法检测ＨＧＶＲＮＡ，引物选自ＨＧＶＮＳ３区。结果表明，抗－ＨＣＶ阳性单采浆供血员ＨＧＶＲＮＡ阳性率为１９．６１％（２０／１０２），抗－ＨＧＶ阳性率为１７．６５％（１８／１０２），ＨＧＶ感染率（抗ＨＧＶ和／或ＨＧＶＲＮＡ阳性）为２４．５１％（２５／１０２），而对照组仅为０．９４％（１／１０６）。提示单采血浆是ＨＧＶ感染的重要危险因素。ＨＧＶＲＮＡ和抗－ＨＧＶ的３年阴转率分别为３５．００％（７／２０）和１１．１１％（２／１８），说明ＨＧＶ感染有慢性携带趋势     

心脏瓣膜置换术后中远期疗效分析

目的　分析探讨心脏瓣膜置换术的中远期疗效。方法　 1978年至 2 0 0 1年 12月 ,行瓣膜置换手术 2 14 1例 ,同期随访 16 81例 ,计 80 2 1 1人·年 ,平均 4 77人·年。通过回顾病因、手术方式、瓣膜类型等因素 ,观察术后病人心功能改善情况 ,病死率及并发症等 ,采用t检验 ,多因素回归等统计学方法分析。结果　 92例死亡。总体生存率 5年为 (92 3± 2 2 ) % ,10年生存率为 (90 1± 2 7) %。并发症有血栓栓塞、机械瓣膜功能障碍、瓣周漏、溶血、机械瓣膜感染性心内膜炎。术后心功能 (NYHA)与术前比较有明显的提高。结论　 1.机械瓣置换术后中远期疗效满意 ,病死率及并发症均较低 ;与术前心功能和手术种类直接相关 ;2 .使用保留瓣下结构及三尖瓣成形术对术后心功能恢复有明显效果 ;3.术中良好心肌保护是提高手术成功率的关键。     

脑卒中后抑郁及其对神经功能康复的影响

目的:观察脑卒中后抑郁(Post-Stroke Depression,PSD)的发生率和相关因素;探讨选择性5-HT抑制剂对脑卒中后抑郁神经功能康复的影响.方法:选取急性脑脑卒中患者132例(脑梗死78例,脑出血54例),分别在病程2周、1,3,6,12月时给每一位入组患者行PSD诊断、神经功能缺损评分、日常生活能力评分(Activity of Daily Living Scale,ADL)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分;同时完成Zung's抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS).结果:①脑卒中患者中约44.70%出现抑郁症状;②脑卒中类型和性别与PSD发生率无相关性(P＞0.05);③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④PSD与病变部位、病灶大小、病灶单侧性均无明显相关(P＞0.05);⑤氟西汀抗抑郁治疗能明显改善病程3、6个月时的神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著.结论:脑卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者功能康复的速度和程度.抗抑郁剂治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.     

Plasma B Vitamers: Population Epidemiology and Parent-Child Concordance in Children and Adults

Scope: B vitamers are co-enzymes involved in key physiological processes including energy production, one-carbon, and macronutrient metabolism. Studies profiling B vitamers simultaneously in parent–child dyads are scarce. Profiling B vitamers in parent–child dyads enables an insightful determination of gene–environment contributions to their circulating concentrations. We aimed to characterise: (a) parent–child dyad concordance, (b) generation (children versus adults), (c) age (within the adult subgroup (age range 28–71 years)) and (d) sex differences in plasma B vitamer concentrations in the CheckPoint study of Australian children. Methods and Results: 1166 children (11 ± 0.5 years, 51% female) and 1324 parents (44 ± 5.1 years, 87% female) took part in a biomedical assessment of a population-derived longitudinal cohort study: The Growing Up in Australia’s Child Health CheckPoint. B vitamer levels were quantified by UHPLC/MS-MS. B vitamer levels were weakly concordant between parent–child pairs (10–31% of variability explained). All B vitamer concentrations exhibited generation-specificity, except for flavin mononucleotide (FMN). The levels of thiamine, pantothenic acid, and 4-pyridoxic acid were higher in male children, and those of pantothenic acid were higher in male adults compared to their female counterparts. Conclusion: Family, age, and sex contribute to variations in the concentrations of plasma B vitamers in Australian children and adults.     

直立倾斜试验加硝酸甘油含化诊断血管迷走性晕厥的临床研究

目的评价硝酸甘油(NTG)含化加异丙肾上腺素倾斜试验(ITTT)诊断血管迷走性晕厥(VS)的价值.方法将72例VS患者和36例正常对照组随机均分成ITTT和ITTT+NTG组.结果ITTT+NTG组敏感性高于ITTT(93.1%和76%,P＜0.05)有显著性差异.结论ITTT+NTG含化是一种安全、耐受性好、敏感性高,特异性强的诊断VS的方法.