肝部分切除治疗肝内胆管结石疗效分析

目的　探讨肝段切除与胆管切开取石术治疗肝内结石的效果。方法　对 98例肝内胆管结石进行回顾性分析 ,按治疗方式分A组采用肝段切除为主的联合手术 4 8例 ,B组采用胆管切开为主的联合手术 5 0例 ,观察两组治疗效果及并发症发生率。结果　A组较B组术后残石率 ,结石复发率 ,再手术率均低 (P <0 .0 5 ) ,有显著性差异。结论　肝段切除为主的联合手术能有效降低肝内胆管结石术后残石发生、结石复发和再手术率 ,是当前治疗肝内胆管结石的首选术式     

剖宫产术中大出血35例分析

目的：讨论剖宫产术中大出血的原因及防治措施。方法：于1995年1月至2005年1月期间,共1986例剖宫产术中,大出血≥1000ml者35例(1.76％),对其临床资料进行回顾性分析。结果：在输血输液的基础上,缝合子宫下段伤口断裂1例,止血有效；双手挤压子宫体和催产素20u子宫体注射34例,6例患者止血有效；Ⅰ号可吸收性肠线“8”字缝合子宫壁28例,23例患者止血有效；子宫动脉上行支结扎术5例,3例患者止血有效；子宫次全切除术2例止血均有效。结论：子宫收缩乏力是导致剖宫产术中大出血的首要原因。治疗应在促进子宫收缩、清理胎盘及胎膜、必要时结扎子宫动脉上行支、甚至行子宫切除术。     

Typus melancholicus and the Temperament and Character Inventory personality dimensions in patients with major depression

Although many clinical studies have been conducted to determine the etiological role and clinical implications of typus melancholicus for unipolar depression, maladaptive personality features in depressive patients have not been well described. This study explores typus melancholicus, as measured by the rigidity subscale of the Munich Personality Test, and maladaptive personality features, as measured by the Temperament and Character Inventory (TCI), in 131 remitted patients with DSM-IV major depression and 154 normal controls. The patients reported significantly higher scores on rigidity and harm avoidance and significantly lower scores on self-directedness and cooperativeness. Only 23.6% of the variance of the rigidity scale was explained by the variance of the seven TCI scales, in which only persistence was significantly correlated positively to rigidity. Cluster analysis identified four subgroups, two of which were characterized by a high rigidity score. One of these two subgroups showed no maladaptive personality features, as measured by the TCI, while the other showed high harm avoidance and low self-directedness. These results indicate that the personality of depressive patients is characterized not only by typus melancholicus but also by maladaptive personality features, that typus melancholicus is not well represented by any TCI scale, and that typus melancholicus and maladaptive personality features can coexist in some depressive patients.     

术后后装放疗、吉西他滨化疗治疗原发性肝癌(英文)

目的探讨术后后装放疗加吉西他滨全身化疗对原发性肝癌的治疗效果。方法 1999年10月～2001年12月,将44例行肝癌切除术的原发性肝癌患者随机分为综合治疗组和对照组,每组22例。综合治疗组术中放置施源管3～6根,确定驻留点3～8个,术后3～10天行后装放疗,单次剂量10Gy,照射2～4次,总剂量20～40Gy。放疗结束3周后,开始吉西他滨化疗,静滴1.4g每周1次,4周为1周期,每周期3次,共6个周期。对照组手术后不放、化疗。手术前后定期查血常规、肝功能、AFP、胸片、B 超或 CT。结果综合治疗组后装放疗后 AFP 转阴率100%(17/17),对照组62.5%(10/16)(P<0.05);6月复发率0,低于对照组27.3%(6/22)(P<0.01);综合治疗组1年复发率18.2%(4/22)、转移率0和1年生存率100%(22/22),与对照组的45.5%(10/22)、13.6%(3/22)和77.3%(17/22)均有显著差异(p<0.05)。结论术后后装放疗加吉西他滨全身化疗是提高原发性肝癌近期治疗效果,降低复发率和转移率的有效手段。     

高效液相色谱法测定大车前子中车前子苷的含量

建立了一种测定中药大车前子中车前子苷含量的高效液相色谱法。方法 采用C18色谱柱,流动相为流莲为1.0 mL·min[-1]的甲醇-水-冰醋酸(40:60:0.5)。采用紫外检测苷在288 nm波长处进行检测。对采集的7个地区的车前子药材进行了含量测定。结论 各地大车前子中车前子苷含量变化较大。     

无创神经脑刺激在儿童心理障碍治疗中的应用

无创神经脑刺激治疗儿童心理障碍是当下较为先进的物理治疗手段.本文着重介绍了无创神经脑刺激的两种代表技术-经颅磁刺激与经颅直流电刺激的工作原理,两者分别在儿童抑郁症、注意缺陷多动障碍与孤独症谱系障碍中的治疗应用,以及对无创神经脑刺激在儿童心理障碍治疗中存在的问题与未来的发展,其中人工智能的引用是其发展很具潜力的方向.     

ALPPS治疗巨大原发性肝癌患者近远期疗效研究

目的 探讨联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)治疗巨大原发性肝癌(PLC)患者的近远期疗效.方法 2016年1月～2018年2月我院诊治的98例巨大PLC患者,其中20例接受ALPPS治疗(A组),38例在经肝动脉化疗栓塞术(TACE)治疗后手术切除肿瘤(B组),和40例接受直接手术切除肿瘤(C组).术...     

Socioeconomic status,individual behaviors and risk for mental disorders: A Mendelian randomization study

BackgroundThere is increasing attention on the association of socioeconomic status and individual behaviors (SES/IB) with mental health. However, the impacts of SES/IB on mental disorders are still unclear. To provide evidence for establishing feasible strategies on disease screening and prevention, we implemented Mendelian randomization (MR) design to appraise causality between SES/IB and mental disorders.MethodsWe conducted a two-sample MR study to assess the causal effects of SES and IB (dietary habits, habitual physical activity, smoking behaviors, drinking behaviors, sleeping behaviors, leisure sedentary behaviors, risky behaviors, and reproductive behaviors) on three mental disorders, including bipolar disorder, major depressive disorder and schizophrenia. A series of filtering steps were taken to select eligible genetic instruments robustly associated with each of the traits. Inverse variance weighted was used for primary analysis, with alternative MR methods including MR-Egger, weighted median, and weighted mode estimate. Complementary methods were further used to detect pleiotropic bias.ResultsAfter Bonferroni correction and rigorous quality control, we identified that SES (educational attainment), smoking behaviors (smoking initiation, number of cigarettes per day), risky behaviors (adventurousness, number of sexual partners, automobile speeding propensity) and reproductive behavior (age at first birth) were causally associated with at least one of the mental disorders.ConclusionsMR study provides robust evidence that SES/IB play broad impacts on mental disorders.     

湖北省输入性皮肤利什曼病一例并文献复习

患者,男,37岁。左下肢皮疹4周,伴轻压痛。无发热等全身症状。患者曾在伊拉克援外工作。皮肤科专科检查：左小腿屈侧见3个暗红色斑块,中央见浅溃疡面,上覆淡黄色分泌物。皮损组织病理学检查：皮肤溃疡形成及散在小灶状微脓肿形成,伴淋巴细胞、组织细胞浸润,组织细胞内可见直径2～4μm嗜碱性圆形小体。Giemsa染色(+)。皮损组织PCR检测提示硕大利什曼原虫。特比萘芬片口服6周治疗无效后,改为氟康唑胶囊口服,8周后皮损基本痊愈。治疗期间未出现严重不良反应。     

卫生事业管理专业毕业生规范化培训探析

借鉴临床医生规范化培训模式,探索卫生管理人才的规范化培养模式。分析卫生管理专业毕业生实施规范化培训的必要性,指出规范化培训的重要意义,从建立培训机制、确定培训内容、严格培训考核和规范培训师资方面提出逐步探索建立完整的规范化培训模式。