Birth outcomes of patients with isolated anorectal malformations: A population‐based case‐control study

In most patients affected by isolated anorectal malformation (IARM) the etiology is largely unknown. Thus, the aim of our project was to analyze possible risk factors for IARM. In the first step, birth outcomes of cases with IARM were analyzed on the basis of maternal socio‐demographic variables, and these data are presented in this paper. Gestational age at delivery, birthweight, preterm birth, low birthweight and small for gestational age of cases with IARM were evaluated in the function of maternal age, birth/pregnancy order, marital and employment status of mothers in the population‐based large dataset of the Hungarian Case‐Control Surveillance of Congenital Abnormalities, 1980–1996. The study samples included 231 live‐born cases with IARM, 361 matched and 38 151 population controls without any defect. IARMs are more frequent in males, twins and newborn infants with low birthweight and small‐for‐gestational‐age, the latter being the consequence of intrauterine growth restriction. In addition, mothers of cases were younger but with higher birth order, and had lower socio‐economic status. These maternal variables are characteristic for the gypsy population in Hungary. The higher proportion of gypsy women among the mothers of cases with IARM was confirmed during the home visits of the study. Male sex and intrauterine growth restriction of cases, in addition to low socioeconomic status and gypsy origin of mothers may have a role in the risk of IARMs.     

不同麻醉方法在阑尾切除术中的疗效比较

目的对不同麻醉方法对阑尾切除术的治疗疗效进行分析研究。方法随机选取我院69名阑尾炎患者,分成A、B两组,A组25名为对照组,在手术时行蛛网膜下腔麻醉方法;B组34名为治疗组,行局部麻醉方法。将A、B组患者麻醉效果及手术后效果进行对比研究。结果 B组手术后排气时间和住院时间低于A组,并发症比例相比于A组较低,患者恢复较好,有效率高于A组。结论局部麻醉方法能够有效减少患者在阑尾切除术中的疼痛感,改善患者病情,减少并发症,具有较高临床使用和推广价值。     

基于多指标成分定量结合化学计量学评价不同产地和不同采收期桔梗质量

目的 采用多指标成分定量结合化学计量学方法对不同产地和不同采收期的桔梗Platycodon grandiflorum进行质量评价。方法 采用热浸法测定其醇溶性浸出物含量,应用超高效液相-电喷雾检测器（UPLC-CAD）法同时测定桔梗皂苷D、桔梗皂苷D₃、去芹糖桔梗皂苷D、桔梗皂苷E、去芹糖桔梗皂苷E 5个活性成分含量,揭示不同采收期桔梗化学成分含量动态积累规律。运用主成分分析法分别对不同生长年限、不同产地桔梗进行综合评价,单因素方差分析比较不同产地桔梗各指标成分含量。结果 以春季4月、秋季9～10月、三年生为桔梗的最佳采收期。主成分分析、方差分析表明不同产地桔梗中指标含量存在显著性差异,同一产地不同批次间也有区别;根据主成分分析对不同产地桔梗进行综合评分,排名靠前的产地为甘肃陇南及河南省地区,陕西商洛、安徽亳州、内蒙古赤峰产地次之,山东淄博和山西太原产地排名较后。结论 以多指标成分定量结合化学计量学建立的评价方法明确了桔梗最佳采收期,评价了不同产地桔梗的质量,为桔梗药材质量控制研究提供依据。     

40例原发性胃肠道弥漫大B细胞淋巴瘤临床特征、细胞来源与预后分析

背景与目的:原发性胃肠道弥漫大B细胞淋巴瘤(primary gastrointestinal diffuse large B-cell lymphoma,PGI-DLBCL)的发病部位及其临床表现与胃肠道其它肿瘤性疾病难以鉴别,误诊率较高,且其标准治疗的方法仍未确定。本研究旨在分析PGI-DLBCL的临床特征、肿瘤细胞来源及预后,并探讨有效的联合治疗方法。方法:分析我院1998～2007年诊治的40例PGI-DLBCL,应用Kaplan-Meier法、log-rank检验和Cox回归模型对其临床资料和实验室检测结果进行生存分析及单因素和多因素预后分析。通过免疫组化染色分析34例患者的肿瘤细胞来源。治疗方法包括联合化疗、手术 联合化疗及放疗、单纯手术等,联合化疗方案为CHOP及CHOP样方案。结果:40例PGI-DLBCL患者中,年龄10～89岁中位年龄56.5岁,男女比例1.86∶1,胃与肠道的发病比率为1.05∶1。预后分析可追访病例38例中,死亡12例(31.6%),3年和5年生存率均为64.7%。9例多部位发病的患者中,8例(88.9%)在3年内死亡。9例(26.5%)肿瘤细胞来源于生发中心(germinal center,GC),25例(73.5%)来源于非生发中心(non-germinal center,non-GC)。单因素预后分析发现肿瘤细胞来源、国际预后指数(international prognosis index,IPI)、B症状对生存率的影响有显著性(P<0.05)。Cox多因素预后分析显示血清乳酸脱氢酶(LDH)升高组患者的死亡风险是LDH正常组的2.87倍。结论:PGI-DLBCL发病以中年男性为主,多部位发病是该类患者死亡的重要原因。肿瘤细胞来源、IPI、B症状对预测患者生存和指导治疗有重要作用,其中初诊时血清LDH水平升高是本组患者的独立预后因素。     

不同部位脑梗死患者抉择加工研究

目的 探讨不同部位脑梗死患者抉择加工的变化.方法 将脑梗死患者分为额叶梗死组(21例)、颞叶梗死组(11例)、内侧颞叶梗死组(19例)、基底节梗死组(25例);大脑前梗死组(25例)、大脑后梗死组(51例)、抑郁组(62例)、焦虑组(64例);正常对照组(125例),所有被试均完成6种抉择情境问题的测试,应用简易智能精神状态量表(MMSE)评价认知功能,汉密尔顿抑郁和焦虑量表评价情绪.结果 所有脑梗死患者(脑梗死组)与正常对照组比较,在低风险与无风险损失情境(抉择情境2)、高风险与无风险收益及损失情境(抉择情境3,4)、高风险与低风险收益及损失情境(抉择情境5,6),其保守性收益及损失方案选择概率均显著增高,均差异有统计学意义(均P＜0.05).在抉择情境3,基底节梗死组与额叶梗死组、内侧颞叶梗死组比较,其保守性收益方案选择概率均显著增高,均差异有统计学意义(P＜0.01,P＜0.05);在抉择情境5,大脑后梗死组较大脑前梗死组选择保守性收益方案的概率显著增高,差异具有统计学意义(P＜0.05).在抑郁组和焦虑组中的基底节梗死组与额叶梗死组和内侧颞叶梗死组比较,其在抉择情境3的保守性收益方案选择概率均显著增高,均差异有统计学意义(P＜0.01,P＜0.05);而大脑后梗死组较大脑前梗死组在抉择情境5选择保守性收益方案的概率亦显著增高,均差异具有统计学意义(均P＜0.05).结论 脑梗死患者存在抉择加工异常,表现为收益保守与损失风险规避.基底节梗死以及大脑后梗死患者,无论是否伴有抑郁、焦虑情绪,更加倾向于收益保守.     

不明原因腹水的CT与腹腔镜联合诊断

目的探讨CT与腹腔镜联合诊断不明原因腹水的方法与应用价值。方法回顾分析6例不明原因腹水患者行CT与腹腔镜联合诊断的临床资料。结果6例患者均明确诊断,其中4例为结核,1例为腹膜肿瘤,1例为假性肠梗阻。结论腹水的诊断是比较复杂的。术前对临床信息尤其是CT图像进行仔细分析,结合腹腔镜检查,可对不明原因腹水患者作出明确诊断。     

麻醉诱导期罗库溴胺与阿曲库胺不同注射速度对血流动力学的影响

目的观察腹腔镜胆囊切除手术麻醉诱导期不同注射速度的罗库溴胺与阿曲库胺对血流动力学的影响。方法57例择期进行腹腔镜胆囊切除手术的患者随机分为R1、R2、A1、A2四组。监测并记录诱导前,肌松药注射后1、3min及手术结束时的平均动脉压（MBP）、心率（HR）,同时评估插管条件。结果A,组中,肌松药注射后1、3min的MBP比诱导前有明显下降,HR明显增快。其他各组MBP、HR未观察到明显变化。各组手术结束时的MBP、HR与诱导前比较,差异无统计学意义。结论麻醉诱导时快速注射罗库溴胺与阿曲库胺,阿曲库胺明显影响血流动力学。     

略论电子病历原始性问题

我国某些医院已在应用电子病历,电子病历原始性问题随之产生。为充分认识和切实解决这一问题,在阐述电子病历优缺点的同时,指明了电子病历原始性认定的难点及标准,进而提出了六种确保电子病历原始性的技术措施。     

Adult-onset Still's disease—pathogenesis,clinical manifestations,and new treatment options

Abstract

Adult-onset Still's disease (AOSD), a systemic inflammatory disorder, is often considered a part of the spectrum of the better-known systemic-onset juvenile idiopathic arthritis, with later age onset. The diagnosis is primarily clinical and necessitates the exclusion of a wide range of mimicking disorders. AOSD is a heterogeneous entity, usually presenting with high fever, arthralgia, skin rash, lymphadenopathy, and hepatosplenomegaly accompanied by systemic manifestations. The diagnosis is clinical and empirical, where patients are required to meet inclusion and exclusion criteria with negative immunoserological results. There are no clear-cut diagnostic radiological or laboratory signs. Complications of AOSD include transient pulmonary hypertension, macrophage activation syndrome, diffuse alveolar hemorrhage, thrombotic thrombocytopenic purpura and amyloidosis. Common laboratory abnormalities include neutrophilic leukocytosis, abnormal liver function tests, and elevated acute-phase reactants (ESR, CRP, ferritin). Treatment consists of anti-inflammatory medications. Non-steroidal anti-inflammatory drugs have limited efficacy, and corticosteroid therapy and disease-modifying anti-rheumatic drugs are usually required.

Recent advances have revealed a pivotal role of proinflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, IL-8, and IL-18 in disease pathogenesis, giving rise to the development of novel targeted therapies aiming at optimal disease control.

The review aims to summarize recent advances in pathophysiology and potential therapeutic strategies in AOSD.