湖南省永州市大学生近视眼抽样调查分析

目的:了解永州地区大学生近视眼成因,为大学生眼保健提供一条可行性思路。方法:采取群体抽样方法,通过问卷与客观检查相结合的方式对永州地区具有代表性的部分高校在校大学生最常见的屈光不正(近视)进行流行病学调查,并对调查结果进行统计学分析处理。结果:此次抽样人数17384例,应答17030例,应答率97.96%,符合抽样调查要求,其中近视眼患病率高达63.08%,不同系部学生近视眼患病率存在显著统计学意义(P<0.01),大学生近视屈光状态与其父母屈光状态有显著统计学意义(P<0.01)。大学生学习环境、个人生活习惯均影响近视眼的发生和发展。结论:永州地区高校大学生近视眼患病率高,眼保健意识淡薄,希望社会和相关政府部门加强重视,改善大学生学习环境,提高大学生眼保健意识,从而降低永州地区大学生近视眼发病率,促进永州地区防盲治盲工作进展。     

精氨酸治疗肾小球疾病时肾小管功能损害的临床观察

目的 :观察精氨酸治疗肾小球疾病时肾小管功能损害的临床效果。方法 :用精氨酸 10 g静滴 ,每天一次 ,治疗有肾小管功能损害的患者 75例 ,其中慢性肾功能不全氮质血症期患者 2 1例。治疗前查血pH值 ,如 pH <7.35 ,予 5 %NaHCO312 5～ 2 5 0ml静滴或口服碳酸氢钠片直至 pH≥ 7.35方用。比较治疗前后尿α1 MG、β2 MG、简化毛氏试验和肾功能。结果 :尿α1 MG治疗前为 43.3± 10 .5mg/L ,治疗后为 16 .3± 6 .6mg/L(P <0 .0 1) ,差异显著 ,尿 β2 MG治疗前 2 2 .7± 9.1mg/L ,治疗后 4.3± 1.4mg/L(P <0 .0 1) ,差异显著。简化莫氏试验结果明显改善 ,慢性肾功能不全患者血Bun治疗前 13 .3± 5 .7mmol/L ,治疗后 8.6± 3 .2mg/L ,血Cr治疗前 2 76± 31μmol/L ,治疗后 177± 2 5 μmol/L ,并异显著 (P <0 .0 1)。结论 :精氨酸可显著改善小管重吸收功能和肾小球滤过功能 ,对于慢性肾功能不全患者而言 ,亦是有效的治疗方法。     

Between caring and curing

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable.     

内外合治治疗老年性阴道炎50例临床观察

运用短柏地黄丸加味配合中药外洗治疗老年性阴道炎５０例（治疗组）,同时用西药治疗３９例（对照组）。结果,治疗组总有效率（９２％）明显高于对照组（７４．４％）。两组比较有显著性差异（Ｐ〈０．０１）。提示知柏地黄丸加味配合中药外洗能提高卵巢功能,增强雌激素水平,增强局部抵抗能力,对治疗老年必阴道炎有明显疗效。     

生存分析模型在肺结核患者治愈率分析中的应用

目的：将生存分析方法应用于肺结核病治愈率的动态描述及其影响因素分析。方法：以江苏省盐城市6个县登记治疗并实施全程督导管理的172例肺结核初治菌阳病人的3年随访资料为例,采用生存分析估计治愈率,用非参数的Cox比例风险回归模型对肺结核治愈率进行单因素和多因素分析,并对有统计学意义的影响因素尝试用Weibull分布的参数方法拟合治愈率曲线。结果：生存曲线给出不同时间点的治愈率,随着治疗时间的持续,肺结核病人的治愈率由低到高,最终接近100％;Cox回归模型显示肺结核病治愈率受多种因素影响,如吸烟、不同治疗方案及不同区县等。结论：生存分析方法适用于肺结核病等慢性传染病疗效指标的动态描述及其影响因素的分析。     

Advances in new antivirals for chronic hepatitis B

Chronic hepatitis B virus (HBV) infection remains a global health burden. Timely and effective antiviral therapy is beneficial for patients with HBV infection. With existing antiviral drugs, including nucleos(t)ide analogs and interferon-alfa, patients can achieve viral suppression with improved prognosis. However, the rate of hepatitis B surface antigen loss is low. To achieve a functional cure and even complete cure in chronic hepatitis B patients, new antivirals need to be developed. In this ...     

羊肝片吸虫病调查与诊治

羊肝片吸虫病有明显的地方性流行特点,而且多发于潮湿、低洼和沼泽等地带。新疆巴里坤县石人子乡处于天山腹地,湿地中部,数条小溪在其流淌,是肝片吸虫病的多发区。该乡每年只对羊只进行一年两次定期驱虫,但没有在牧地灭螺,发病率达30％。而近几年在肝片吸虫流行季节采取牧地消灭中间宿主的措施,使发病率降低到2％,降低了牧民的经济损失。     

CT引导臭氧消融术治疗腰椎间盘突出（附2500例报告）

目的：探讨臭氧消融术治疗腰椎间盘突出临床应用价值。方法：2500例腰椎间盘突出患者在CT引导下,根据病变分型及特殊解剖位置,采用侧后方入路或正后方入路,利用日本产19～21GPTE穿刺针,穿刺至病变椎间盘或突出物内,注入适量臭氧,再行CT扫描,观察髓核消融状况。结果：总有效率92．1％。术前VAS评分为6．7±1．6,术后1周平均为3．6±2,术后3月平均为4．1±2。髓核融解术前与术后1周和3个月VAS评分有统计学意义（P〈0．05）,术后1周与3个月差异无统计学意义（P〉0．05）。结论：臭氧消融术治疗腰椎间盘突出疗效显著、微创、安全、简单,具有较好的临床应用价值。     

Exploring Factors Related to Metastasis Free Survival in Breast Cancer Patients Using Bayesian Cure Models

Background: Breast cancer is a fatal disease and the most frequently diagnosed cancer in women with anincreasing pattern worldwide. The burden is mostly attributed to metastatic cancers that occur in one-third ofpatients and the treatments are palliative. It is of great interest to determine factors affecting time from cancerdiagnosis to secondary metastasis. Materials and Methods: Cure rate models assume a Poisson distribution for thenumber of unobservable metastatic-component cells that are completely deleted from the non-metastasis patientbody but some may remain and result in metastasis. Time to metastasis is defined as a function of the numberof these cells and the time for each cell to develop a detectable sign of metastasis. Covariates are introduced tothe model via the rate of metastatic-component cells. We used non-mixture cure rate models with Weibull andlog-logistic distributions in a Bayesian setting to assess the relationship between metastasis free survival andcovariates. Results: The median of metastasis free survival was 76.9 months. Various models showed that fromcovariates in the study, lymph node involvement ratio and being progesterone receptor positive were significant,with an adverse and a beneficial effect on metastasis free survival, respectively. The estimated fraction of patientscured from metastasis was almost 48%. The Weibull model had a slightly better performance than log-logistic.Conclusions: Cure rate models are popular in survival studies and outperform other models under certainconditions. We explored the prognostic factors of metastatic breast cancer from a different viewpoint. In thisstudy, metastasis sites were analyzed all together. Conducting similar studies in a larger sample of cancer patientsas well as evaluating the prognostic value of covariates in metastasis to each site separately are recommended.     

LONG-TERM SURVIVAL OF PATIENTS WITH HIV-RELATED SYSTEMIC NON-HODGKIN'S LYMPHOMAS

Background: the overall outcome of patients with HIV-related non-Hodgkin's lymphomas (HIV–NHL) is poor because of the adverse clinico-pathological features of HIV–NHL and of the underlying HIV infection. However, the experience of physicians in the management of HIV–NHL has increased, in particular in the use of intensive chemotherapy regimens, leading to an improvement in the prognosis of some of these neoplasms. Because some patients with AIDS may survive up to 5 years, it is possible to evaluate the long-term efficacy of the treatment of patients with HIV–NHL. In the general population, aggressive NHL, that are those occurring in HIV patients, may be considered cured after 2 years of lasting complete remission (CR) after chemotherapy. Patients and methods: we reviewed our monoinstitutional case-series of 73 HIV-infected patients with systemic NHL, observed between April 1985 and February 1993. Two groups of patients were arbitrarily identified, the first one (group A) including patients with a CR lasting for at least 2 years (N=13) and the other including all remaining patients (group B) (N=60). Results: the 13 patients of group A differed significantly from the other patients in terms of higher CD4+ cell count and performance status (PS) at the time of diagnosis of NHL. There was no significant difference in the histological subtypes of the HIV–NHLs. The overall survival of the 73 patients was 8 months. In a separate analysis on all patients, age less than 30 years, PS less or equal to 1, a CD4+ cell count equal to or higher than 100/mm³ and the absence of B symptoms were significantly associated with a longer survival. The median survival in patients of group A was 42 months, however none of these patients relapsed during a median observation time of 42 months (range, 24–90). Conclusions: long-term survival and possibly cure can be obtained in some patients with HIV–NHL, in particular in those with a better PS and a less advanced immune dysfunction. In fact some of these patients are alive without evidence of disease 4 to 7 years after therapy, and others died of causes related to underlying HIV infection, in particular opportunistic infections, rather than relapse of NHL.