血管紧张素Ⅱ和氯沙坦对小鼠腹膜淋巴孔的调控作用

目的 研究血管紧张素Ⅱ (AngⅡ )和AngⅡ受体抑制剂氯沙坦对腹膜淋巴孔的调控作用并探讨其机制。方法 分别在健康小鼠腹膜腔注射0.9%氯化钠溶液、AngⅡ、氯沙坦和AngⅡ +氯沙坦 ,2h后处死实验小鼠 ,取小鼠膈腹膜 ,作扫描电镜观察、计算机图像处理和定量分析。结果 注射AngⅡ后 ,腹膜腔腹膜淋巴孔的直径和分布密度分别为 (4.42±0.57) μm和 (53.60±10.07)/0.1mm2,较正常对照组[分别 (2.89±0.86) μm和(27.74±7.49)/0.1mm2]增大和增多(P<0.05)。注射氯沙坦后 ,淋巴孔的孔径和开放数目分别为 (2.02±0.48) μm和 (12.87±3.12)/0.1mm2 ,较正常对照组减小和减少(P<0.05)。联合应用AngⅡ和氯沙坦时 ,淋巴孔的孔径较正常对照组减小、分布密度减少。结论 AngⅡ可使腹膜淋巴孔孔径增大 ,开放数目增多 ;氯沙坦可使淋巴孔孔径减小 ,开放数目减少 ;联合应用AngⅡ和氯沙坦 ,AngⅡ对腹膜淋巴孔的调控作用被逆转     

子宫动脉栓塞治疗子宫肌瘤89例报告

目的 评价子宫动脉栓塞术治疗子宫肌瘤的近期疗效。方法 89例子宫肌瘤患者，采用Seldinger技术分别作左右子宫动脉主干插管检查和栓塞治疗，栓塞剂采用聚乙稀醇颗粒(PVA)或白芨混合颗粒。结果 72例(80．9％)完成随访，随访时间1～28个月。有94．1％(64／68)的患者月经复常；治疗后瘤体缩小25．2％～76．8％(M=41．3％)。除了术中术后疼痛(65例)和发热(16例)外，有2例因肌瘤坏死行子宫切除术，1例出现卵巢早衰。结论 子宫动脉栓塞术治疗子宫肌瘤的近期疗效满意，远期疗效尚待进一步观察。     

影响脐血IgE值因素的研究

目的　本研究对影响脐血IgE值的可疑因素进行分析 ,探讨影响儿童食物过敏的可疑因素。方法　选取孕期妇女 10 5名及其所生婴儿 ,采用标准问卷调查获取资料 ,对影响脐血IgE的因素进行分析。 结果　母亲的过敏性疾病史、父亲过敏性疾病史中的皮炎表现型、孕期妇女过敏性疾病发作史、有过敏史妇女孕后期摄入过量的牛奶和鸡蛋均与脐血IgE值的上升有关 ,且上述 5个因素对脐血IgE水平的影响依次降低。 结论　母亲的过敏性疾病史和父亲过敏性疾病史中的皮炎表现型是导致新生儿脐血IgE值升高的主要危险因素 ;同时 ,妊娠期加强对有过敏史妇女的保护 ,防止过敏性疾病的复发 ,在孕后期控制有过敏史妇女牛奶、鸡蛋等大分子食物致敏原的摄入 ,有助于降低脐血IgE值。     

CT检查对新生儿缺氧缺血性脑病预后判断的价值

目的　探讨CT检查对判断新生儿缺氧缺血性脑病 (HIE)预后的价值。方法　对 85例HIE患儿分别在生后 1周内、2周～ 2个月、3～ 6个月、1～ 1 5岁进行CT检查 ;同时在生后12～ 14d进行新生儿行为神经测定 ;在 1～ 1 5岁测定发育商判断预后。结果　生后 1周内CT结果分度为重度者预后不良率为 4 0 9% (9/ 2 2 ) ,为中度者预后不良率为 5 7% (3/ 5 2 ) ;2个月时CT随访结果异常者预后不良率为 6 0 0 % (6 / 10 ) ;CT结果中度且 12～ 14d的NBNA评分≥ 35分与 <35分者的预后差异无显著性 ,CT结果重度且 12～ 14d的NBNA评分 <35分者有 72 7% (8/ 11)预后不良。结论　生后 1周内CT分度及生后 1个月左右随访结果 ,同时结合临床、生后 12～ 14dNBNA评分对判断HIE患儿的预后、制定治疗方案及疗程有重要意义。     

早期腭裂修复术后瘘的发生率研究

目的 探讨婴儿期腭裂手术后瘘发生的规律。方法 对1995年7月～2001年9月期间施行的2～12个月龄的531例腭裂修复术后瘘发生率进行回顾性分析。结果 全组腭裂术后瘘发生率为4.9%，双侧完全性腭裂术后瘘发生率（7.8%），明显高于不完全性腭裂（4.4%），单侧完全性腭裂（4.3%,P＜0.01），后两组之间无显著性差别（P＞0.05）；术后瘘发生率与年龄，及本组所采用的不同术式无关（P＞0.05）；其中硬腭部瘘占完全性腭裂术后瘘率70%，较其它部位差异有非常显著性意义（P＜0.01）。结论 婴儿期腭裂手术并不会增加瘘发生率，对于双侧完全性腭裂，推荐做术前正畸治疗。     

20例小儿喉乳头状瘤治疗体会

目的　探讨小儿喉乳头状瘤的疗效。方法　 2 0例患儿均于支撑喉镜下以手术方法彻底切除肿瘤 ,其中单纯手术 (Ⅰ组 ) 11例 ,手术 +微波治疗 (Ⅱ组 ) 6例 ,术后以干扰素治疗 (Ⅲ组 ) 3例。结果　总治愈率 60 % ,Ⅰ组、Ⅱ组、Ⅲ组治愈率分别为 :45 .4%、83 .3 %、66.7%。Ⅱ组治愈率高于Ⅰ组 (P <0 .0 5 )。结论　术后以微波处理创面可提高手术治疗率。     

磷脂酶A2激活在急性缺血性脑损伤中的作用机制及尼莫地平的保护作用

目的 探讨磷脂酶A2(PLA2)激活在急性缺血性脑损伤中的作用机制及尼莫地平的保护作用。方法 将局灶性脑缺血模型大鼠分为假手术组、缺血组及尼莫地平干预组，测定PIA活力、脑细胞游离ca^2 浓度、脑含水量及脑组织PLA2表达量的改变。结果 尼莫地平可使缺血后脑细胞游离ca^2 浓度、PIA2活性及脑组织含水量明显降低，但对脑缺血后脑组织PIA2mRNA表达降低不明显。结论 PIA2激活参与了急性脑损伤的病理过程，尼莫地平能抑制PLA2活性、降低细胞游离ca^2 浓度，减轻脑水肿的病理改变，对缺血性脑细胞损害有一定的保护作用。     

Integrating children's services in England: national evaluation of children's trusts

Background Poor co‐ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders. Methods This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed‐methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi‐structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents. Results In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi‐purpose children's centres, and increasingly pooled finances. Provision of multi‐agency and multi‐professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations. Conclusion Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind.     

CLINICAL SIGNIFICANCE OF THE DETECTION OF MINIMAL RESIDUAL DISEASE IN CHILDHOOD B-ALL BY FLOW CYTOMETRY

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高危新生儿脑干听觉诱发电位的近期观察

目的 为了解高危新生儿脑干及听觉功能障碍情况.方法 于1995年8月～1996年1月对128例高危新生儿进行脑干听觉诱发电位(Anditory Brainstem Responses—ABR)测定.结果 急性期高危新生儿ABR异常率为51.4%,其中高胆红素血症,低体重儿,窒息和丁胺卡那霉素应用组ABR异常率分别为61.1%、66.7%、53.8%和 2.8%.血清胆红素(Sb)值>290.7μmol/L和重度窒息儿ABR异常率明显高于Sb<290.7μmol/L和轻度窒息儿.早产儿和足月小样儿ABR异常率无明显差异.丁卡组对听阀的近期影响不大.结论 高危新生儿是脑干和听觉功能障碍的高危人群,应当密切随防和早期干预.