Delta hepatitis virus infection in China

To assess the prevalence, epidemiological features and prognostic implications of hepatitis D (Delta) in Sichuan Province, The People's Republic of China, 649 sera (515 from HBsAg positive patients and 134 from HBsAg negative subjects) were tested by radioimmunoassay (RIA) for antibody to the hepatitis D virus (anti-HD). Forty-seven sera (7.2%) showed some degree of reactivity. Serial dilutions of these sera indicated that prozoning was not responsible for the equivocal results. Thirty-four of the 47 sera were submitted under code to a second laboratory for independent analysis. According to those results anti-HD antibodies were detected in four of these sera. The overall prevalence of anti-HD in the HBsAg positive patients therefore was 0.8% (4/515). On the basis of clinical, biochemical and histological data 427 HBsAg positive sera were further divided into acute Type B hepatitis, chronic Type B hepatitis, healthy carrier state and hepatocellular carcinoma (HCC) subgroups. Two of 65 (3.1%) anti-HD positive sera belonged to the acute Type B hepatitis group; one of 104 (0.9%), the chronic Type B hepatitis group and one of 246 (0.4%), the healthy carrier group. No antibody was detected in sera from 12 HBsAg positive HCC patients. All HBsAg negative patients were negative for anti-HD antibody. The results of this study indicate that despite a high prevalence of hepatitis B virus infection, positive serology for delta virus is uncommon in Sichuan Province, The People's Republic of China.     

生物可降解性尿道内支架修复战伤性尿道狭窄的研究

目的建立战伤性尿道狭窄动物模型,探讨生物可降解性尿道内支架对其进行重建修复的可行性。方法将新西兰雄兔28只分为两组,实验组(n=20):以定位爆炸法建立尿道狭窄模型。一月后行逆行尿道造影、尿道镜检查,并切除狭窄段尿道,行病理组织学观察证实。后置入人工合成生物可降解尿道内支架,置入术后2、4、8、12周分别行逆行尿道造影、尿道镜检查以及尿流动力学检测。并在以上各时间点处死5只动物,取狭窄处尿道组织,观察组织学修复重建情况。对照组(n=8):于实验组爆炸处理后4周和支架置入12周,分别取对照组4只动物与实验组对比观察。结果实验组所有动物爆炸后4周在尿道球部狭窄形成稳定狭窄模型(狭窄段长5～10 mm,尿道腔缩窄50%以上)。尿道内支架置入后2周,组织学观察见黏膜上皮新生迹象,并有炎性细胞浸润;4周时上皮新生明显,炎性细胞消失;8周时出现尿道平滑肌细胞再生,12周时见损伤后尿道组织结构完全修复,与正常尿道组织比较差异无统计学意义(P>0.05)。。同时间点尿道镜检查证实尿道腔隙、黏膜形态结构无异于正常对照组。尿流动力学检测显示两组间差异无统计学意义(P>0.05)。。结论应用成功建立的战伤性尿道狭窄动物模型,证实生物可降解性尿道内支架能作为修复战伤性尿道狭窄的理想材料,具有损伤小,易操作,功能恢复快的特点。     

腹腔镜肝右后叶囊肿开窗引流术35例报告

目的：探讨肝右后叶肝囊肿的腹腔镜处理方法。方法：1998年1月～2005年12月对35例有症状的肝右后叶囊肿（21例主要位于Ⅵ段，14例主要位于第Ⅶ段）采用四孔法行囊肿开窗引流术。囊肿位于肝右后叶上段者采用肝上入路，胆囊牵引钳或三叶钳推压肝脏使其向前向下，暴露肝后囊肿，囊肿开窗，修剪带蒂大网膜放入囊肿。囊肿位于肝右后叶下段者采用肝下入路，超声刀切开肝结肠韧带，右三角韧带及肝肾间疏松组织，胆囊牵引钳抬起肝脏，囊肿开窗，大网膜放入囊腔引流。结果：35例肝右后叶肝囊肿均在腹腔镜下完成肝囊肿开窗引流术，无中转开腹手术。15例采用肝上入路，20例采用肝下入路。手术时间30～95min，平均46min。无手术并发症。35例病理检查结果均为先天性肝囊肿。术后症状均消失。术后住院2～5d，平均3．8d。35例随访6～36个月，平均34个月，33例无复发，2例（为肝上入路病例）囊肿未完全消失，但较术前明显缩小，无明显症状，观察半年未见增大。结论：肝下及肝上入路囊肿开窗引流是腹腔镜下处理肝右叶肝囊肿的有效方法。     

微波子宫内膜去除术与子宫切除术治疗异常子宫出血的疗效比较

目的 比较微波子宫内膜去除术(MEA)和子宫切除术(AH)治疗异常子宫出血的疗效.方法 将异常子宫出血80例分为MEA组和AH组各40例,比较两组临床疗效、手术时间、术中出血及手术前后白细胞变化. 结果 MEA和AH治疗异常子宫出血的有效率无显著差异(39/40 vs 40/40,χ2=0.000,P=1.000).MEA手术时间短[(4.8±1.2)min vs(102.5±34.6)min,t=17.848,P=0.000];术中出血少[0 ml vs(138.3±40.6)ml,t=21.544,P=0.000]. 结论 MEA是一种治疗异常子宫出血有效且微创的手术.     

Pathways from first health care seeking to diagnosis: obstacles to tuberculosis care in rural China.

OBJECTIVE: To examine health care seeking pathways for patients with tuberculosis (TB) and barriers related to these pathways in counties under the National TB Control Programme in rural China. METHODS: A cross-sectional study was conducted in two counties of east China in 2004-2005. A total of 557 TB patients were recruited and interviewed by physicians at the time of TB diagnosis. RESULTS: Of 557 participants, 13.3% had presented to a specialised county TB dispensary (CTD) directly after onset of symptoms, 31.4% had first sought care at a village health station and 51.2% had visited a township or county hospital first. The proportion of referral by a first health care provider to a CTD was highest in county level hospitals (73.5%) and lowest in village health stations (21.7%). The most prompt pathway from first health care seeking to TB diagnosis was to visit a CTD directly, with a median provider's delay of only one day. There was an increase in provider's delay when more health facilities were involved. CONCLUSION: To improve direct referral from general health care providers, especially village health care workers, to TB specialists would significantly shorten the delays in TB diagnosis in rural China.     

Late atrioventricular block after heart transplantation.

Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. Sinus node dysfunction is the most common indication, and late onset of atrioventricular (AV) block has rarely been reported. We report the case of a patient who developed advanced AV block at 41 months after transplantation. Right bundle branch block with progressive increase of QRS complex duration was noted in serial electrocardiograms. At the time of late AV block development, the patient did not have acute rejection and coronary angiogram was normal. The mechanism of late onset of AV block is unclear, but it may be caused by progressive conduction.     

青霉素配伍利多卡因后的药物动力学研究

本文报道青霉素配伍利多卡因后的药物动力学及生物利用度研究结果,证明利多卡因对青霉素的生物利用度无影响,且可促进青霉素的吸收,为良好的青霉素无痛溶媒,建议推广使用。