粤西农村地区居民主观幸福感调查

目的 了解农民主观幸福感和生活满总度状况.方法 采用主观幸福感单一项目测量、幸福感阶梯量表和生活满意度自编问卷,对粤西农村地区228例居民进行抽样调查.结果 ①大部分农村居民具有较高的主观幸福感,但农民幸福感的均值略低于中值水平;②农民的主观幸福感不存在性别差异,但在年龄上则表现出统计学上的显著差异,中年农民群体的主观幸福感显著低于年轻群体和老年群体;③农村居民的未来幸福感显著高于目前幸福感和过去幸福感;④农村居民的住房、经济与其主观幸福感的关系最大,有超过半数(51.3%)的农民对经济收入感到不满念.结论 应重点关注中年农民群体的幸福感和生活满意度,增加农民经济收入是提高他们主观幸福感的根本途径.     

关节腔内灌注氨甲环酸降低全膝关节置换手术出血的前瞻性随机对照研究

目的探讨关节腔内注射氨甲环酸在减少全膝关节置换术后出血的疗效和安全性。方法选取符合纳入标准的患者60例,采用RandA1.0软件随机平均分为两组。氨甲环酸组于术后关节腔内注射50 ml溶有3.0 g氨甲环酸的生理盐水,夹闭引流管1 h后负压吸引;对照组则术后通过引流管直接向关节腔注入生理盐水50 ml,夹闭引流管1 h后负压吸引。术后三日每天复查患者血常规、凝血指标,并记录每日引流量,术后3~5 d行下肢静脉造影,观察血栓发生率。结果氨甲环酸组术后3 d总的引流量以及总失血量明显少于对照组。氨甲环酸组输血人数明显小于对照组。两组患者在术后凝血功能、血栓发生率及术后不良事件方面差异无统计学意义。结论全膝关节术后关节腔内注射氨甲环酸可有效减少出血量,并不增加血栓发生概率。     

腰椎崩裂性滑脱椎弓钉复位固定椎体间植骨融合术

目的　比较腰椎崩裂性滑脱椎弓钉复位固定椎体间植骨融合术与椎体后外侧植骨融合术两种方法的优劣。方法　统计1 1 7例腰椎崩裂性滑脱病人行椎弓钉复位固定 +植骨融合术后疗效 ,其中滑脱椎体复位固定 +椎体后外侧植骨融合术 90例 ,滑脱椎体复位固定 +椎体间植骨融合术 2 7例 ,内固定于术后一年取出。结果　术后 2年脊柱滑脱程度 ,后外侧组为 1 5 9% ,椎体间组 3 9% ,后外侧组植骨融合率为 92 2 % ,椎体间组为 1 0 0 % ,腰腿痛症状改善的评价采用JOA标准 (满分为 2 9分 ) ,后外侧组术后平均为 2 2 3分 ,椎体间组为 2 6 3分 ,后外侧组术后 73 3%的人能参加一般的体力劳动和家务活 ,椎体间组为88 9% ,后外侧组术中平均输血 1 0 0 0ml,椎体间组术中平均输血 1 0 0ml,并发症发生率两个组无明显差异 ,绝大多数并发症临床上无重要意义。结论　椎弓钉腰椎复位固定 +椎体间植骨融合术更符合生物力学原理 ,能更有效矫正腰椎滑脱 ,增加植骨融合率 ,防止术后再滑脱 ,改善患者症状更明显 ,而且手术相对简单 ,出血少     

The role of neurotensin as a novel biomarker in the endoscopic screening of high-risk population for developing colorectal neoplasia

Colorectal cancer screening programs aim at early detection of cancer to reduce incidence rates and mortality. The objective of this study is to identify the role of neurotensin in the endoscopic screening of high-risk population for developing colorectal neoplasia. Blood samples from patients referred for urgent colonoscopy to investigate symptoms suspicious of colorectal cancer were collected. Blood neurotensin levels were measured using enzyme-linked immunosorbent assay. Colonoscopy findings were used as reference for determining the diagnostic accuracy of blood neurotensin. The study comprised 26 patients in total: 12 healthy and 14 with colon pathology (13 high-grade dysplasia adenomatous polyps, 1 adenocarcinoma). There were no statistically significant differences in the clinical and biochemical parameters between colon pathology and healthy group except neurotensin levels. Pathology in colon was associated with 3.7-fold increase in NT levels. In multivariate analysis, patients with pathology in colon have increased serum neurotensin levels compared to controls adjusted for age, gender, BMI and co-morbidities. The value of 12.93 pg/ml is associated with 87.5% sensitivity and 91.7% specificity for discriminating the colon pathology from normal colonic epithelium (p = 0.001). Neurotensin plasma values differentiate healthy people from patients suffering from colonic pathologies such as adenomatous polyps and cancer. The use of neurotensin as a potential endoscopic screening tool for identifying high-risk population for developing colorectal cancer is promising, but much has to be done before it is validated in larger scale prospective studies.     

经口咽入路齿状突骨折内固定的手术配合

目的探讨经口咽入路齿状突骨折复位内固定的护理配合。方法术前访视,做好心理护理和健康宣教;物品准备齐全,加强手术体位的护理,密切配合医生的工作,重视术中病情的变化。结果手术过程顺利,医生对手术护理配合满意,术中病人无出现严重并发症。结论术前准备充分,术中手术人员配合默契是保证手术顺利完成的关键。     

The Efficacy of Cytokine-Induced Killer Cell Infusion as an Adjuvant Therapy for Postoperative Hepatocellular Carcinoma Patients

Background

Even after surgery, hepatocellular carcinoma (HCC) has poor prognosis; adjuvant therapy is needed to improve effectively the outcome of HCC patients. We evaluated the efficacy of cytokine-induced killer (CIK) cell infusion as an adjuvant therapy for postoperative HCC patients.

Methods

A total of 410 patients were studied retrospectively (January 2002 to January 2007): 206 received surgery alone; 204 received surgery and at least four cycles of CIK cell transfusion (CIK group). Kaplan–Meier and Cox regression analyses were used to explore differences in OS between two groups.

Results

The CIK group overall survival rates were significantly higher than that of the surgery-alone group (log-rank test; p = 0.0007). Multivariate survival analysis showed that CIK cell treatment was an independent prognostic factor. In subgroup analysis, patients who received ≥8 cycles of CIK cell transfusion exhibited significantly better survival than the <8 cycle group (p = 0.0272). There was no significant difference in overall survival in patients with ≤5-cm tumors between the CIK and surgery-alone groups (p = 0.7567). However, in patients with >5-cm tumors, the CIK group displayed significantly better overall survival than the surgery-alone group (p = 0.0002).

Conclusions

Postoperative immunotherapy with CIK cell transfusion may be an effective adjuvant treatment for improving the outcomes of HCC patients; >8 cycles of CIK cell transfusion may ensure that patients derive maximal benefits. Moreover, patients with large tumors might benefit more from CIK cell adjuvant treatment than patients with small tumors.     

利用3D打印颅脑辐射等效体模进行个性化适形放疗的剂量验证

目的 建立利用3D打印颅脑辐射等效体模对患者进行个性化放疗剂量验证的方法,为三维适形放射治疗安全提供一种可靠的剂量保证手段。方法 采集两例患者（患者1和患者2）的CT图像数据,基于患者1的图像数据,重建其颅骨与脑组织,制作颅脑体模,验证颅骨与脑组织的等效材料。基于患者2的图像数据,根据3D图像重建并选用组织等效材料重建完全的头颅结构,采用3D打印技术制作全头颅体模。通过对目标区域插入电离室剂量仪并行放射治疗方案,获得头颅体模病灶部的剂量,验证和校准实际放疗计划的安全性。结果 对所获两个体模分别进行DR、CT成像,颅脑体模的等效骨骼与患者1骨骼的X射线灰度值差异为13 721,颅脑体模的等效脑组织与患者1的脑组织的CT值差异为35~40 HU,全头颅体模等效颞肌与患者2的颞肌组织的CT值差异为18~28 HU,影像数据表明体模材质的辐射等效性与人体组织近似,并且等效剂量分布符合常规治疗范围,体模的剂量验证可以有效验证放疗计划系统的准确性。结论 基于3D打印和组织等效技术所设计的个性化放疗体模,可应用于个性化放射治疗验证。体模制作方法简单快速,个性化程度高,为三维适形放射治疗安全提供一种可靠的剂量保证手段。     

骨斑点症的X线分析（附5例报告及文献复习）

目的分析骨斑点症的影像学表现。方法5例临床怀疑骨斑点症患者经头颅、胸部、肩关节、双肱骨、双尺桡骨、双手骨、脊柱、骨盆、双股骨、双胫、腓骨及足骨X线摄影检查，对全部患者的X线照片结合文献复习进行分析。结果病变以骨盆、腕骨、跗骨、指（趾）骨和长管状骨的骨骺及干骺端为好发部位，很少累及颅骨、肋骨、脊柱、胸骨、锁骨。病变呈对称性分布，以松质骨内0．2～1．5cm散在多发的大小不等的圆形或卵圆形致密阴影为特征，越靠近关节病灶越密集。结论骨斑点症是一种罕见的无临床症状的遗传性疾病，可依据其特征性X线表现进行确诊和鉴别诊断。     

隐球菌性脑膜脑炎的CT、MRI影像表现及其诊断意义

目的 :探讨隐球菌性脑膜脑炎的CT及MRI影像表现及其诊断价值。材料和方法 :回顾对比分析 2 6例经脑脊液墨汁染色证实隐球菌脑膜脑炎头颅CT及MRI的影像学改变。结果 :早期CT及MRI表现为正常、弥漫性脑水肿、轻度脑积水 ;亚急性期及慢性期表现为脑萎缩、脑积水、胶状假囊、脑内多灶低密度区及异常信号区、隐球菌瘤 ,脑膜增厚、强化 ,以基底池、环池、侧裂池及四叠池为著 ;脑内强化血管影增多。结论 :CT及MRI检查对隐球菌性脑膜脑炎病变部位、病理形态及变化、发展的阶段可提供定位的诊断依据 ,有助于临床分型、病期的判定、选择治疗方案及估计预后、治疗情况。