卫生院改革中的"软法"运行现状及功能实现

乡镇卫生院改革是一项关乎农村稳定、农民安康的工程。从既有的工作轨迹及发展趋势来看,这项改革是在以“两办(中共中央办公厅、国务院办公     

ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

目的 比较不同栓塞材料的门静脉栓塞术（PVE）与联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）对剩余肝体积（FLR）增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法 采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌（HCC）或肝内胆管癌（ICC）病人,将其分为4组：ALPPS组及分别采用氰基丙烯酸正丁酯（NBCA）、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果 各组的手术切除例数及二期手术切除率分别为：ALPPS组38例（99.4%）,NBCA组32例（76.2%）,明胶海绵组20例（60.6%）,微球组10例（83.3%）。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 mL/d和 8.5 mL/d,均高于明胶海绵组（3.7 mL/d）。结论 采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。     

急性缺血性脑卒中合并非瓣膜性心房颤动应用利伐沙班时机选择及血栓发生的因素分析

目的 探讨急性缺血性脑卒中合并非瓣膜性心房颤动(NVAF)患者选择抗凝剂利伐沙班的最佳治疗时机及血栓事件发生的因素分析。方法 募集2019年1月～2020年12月苏州市立医院神经内科的221例急性缺血性脑卒中合并NVAF患者,随访途中失访15例,最终纳入206例。根据抗凝时间不同,分为A组68例,抗凝启用时间不超过3 d; B组68例,抗凝启用时间4～14 d; C组70例,抗凝启用时间>14 d,记录并比较90 d内3组临床复合终点事件、缺血事件及出血事件发生率。用多因素logistic回归分析影响因素。结果 A组、C组在住院时间、再次住院时间、被动随访次数均显著高于B组(P<0.05);3组年费用支出比较,差异无统计学意义(P>0.05)。3组患者在栓塞、出血、临床复合终点事件发生率方面比较无统计学差异(P>0.05)。多因素logistic回归分析显示,脑梗死面积直径≥3 cm(OR=1.05,95%CI:1.02～1.18,P=0.023)、静脉溶栓(OR=1.04,95%CI:1.01～1.12,P=0.019)、CHA₂DS     

Chemoprotective effect of plant phenolics against anthracycline-induced toxicity on rat cardiomyocytes. Part III. Apigenin, baicalelin, kaempherol, luteolin and quercetin

Flavonoids are found universally in plants and act as free radical scavenging and chelating agents with antiinflammatory, antiischemic, vasodilating and chemoprotective properties. In this study, the antilipoperoxidative and cytoprotective effects of apigenin, baicalein, kaempferol, luteolin and quercetin against doxorubicin-induced oxidative stress were investigated in isolated rat heart cardiac myocytes, mitochondria and microsomes. After preincubation of cardiomyocytes with the test compounds for 1 h the cardiomyocytes were treated with the toxic agent, doxorubicin (100 micro M for 8 h). Cardiomyocyte protection was assessed by extracellular LDH and cellular ADP and ATP production. Cytoprotection was concentration dependent for baicalein > luteolin congruent with apigenin > quercetin > kaempferol. All test compounds had signi fi cantly better protective effects than dexrazoxan, an agent currently used for adjuvant therapy during anthracycline antibiotic therapy. In microsomes/mitochondria the IC(50) values of lipid peroxidation inhibition for quercetin, baicalein, kaempferol, luteolin, and apigenin were 3.1 +/- 0.2/8.2 +/- 0.6, 3.3 +/- 0.3/9.6 +/- 0.5, 3.9 +/- 0.3/10.1 +/- 0.8, 22.9 +/- 1.7/18.2 +/- 0.7, and 338.8 +/- 23.1/73.1 +/- 6.4 mM, respectively. The antilipoperoxidative activity of apigenin differed from its cytoprotective effects, but correlated with the free radical scavenging of 2,2-diphenyl-1-picrylhydrazyl radical and half peak oxidation potential (E(p/2)). Apigenin was the least effective of the flavonoids studied in all models except the cardiomyocyte model where its cardiomyocyte cytoprotective effect was comparable to other compounds.     

Analysis of vaginal recurrences in stage I endometrial adenocarcinoma

OBJECTIVE: To determine the risk of vaginal recurrence in Stage 1 endometrial cancer and treatment morbidity associated with different therapeutic approaches MATERIAL AND METHODS: Between 1995 and 2005, 341 patients with clinical Stage I endometrial cancer were treated at Istanbul Medical Faculty. One hundred and forty-four women were included in this study as the follow-ups and records were complete. The patients with no myometrial invasion received no further therapy following hysterectomy. When there was superficial myometrial invasion postoperative vaginal vault radiation was used, and if deep myometrial invasion was present, external pelvic radiation was given. RESULTS: Overall 5-year survival rate for all patients with Stage I disease was 80%. Nine patients (6.25%) developed recurrent disease, three of whom had vaginal recurrences. All three vaginal recurrences were small and diagnosed at routine follow-up exam within 51 months of primary therapy. CONCLUSION: This selective treatment protocol for patients with Stage I endometrial cancer avoided radiation entirely in 38% of the patients while achieving a very low rate of vaginal recurrence and good overall survival.     

富血小板血浆联合骨髓间充质干细胞促进兔前交叉韧带重建后腱骨愈合

目的 探讨富血小板血浆(platelet-rich plasma, PRP)联合骨髓间充质干细胞(bone marrow mesenchymal stem cells, BMSCs)通过Wnt/β-catenin途径对兔前交叉韧带(anterior cruciate ligament, ACL)重建后腱骨愈合的影响。方法 40只进行ACL重建术的新西兰白兔随机分为4组：control组、PRP组、BMSCs组和PRP+BMSCs组,术后采用顶端注射的方法将相应的凝胶注入骨道内;HE染色观察各组兔腱骨病理变化;ELISA检测各组兔血清中VEGF、TGF-β1含量的变化;Micro-CT检测各组兔腱骨结合处骨密度的变化;生物力学测定各组兔腱骨最大加载负荷的变化;Western blot检测各组兔腱骨界面组织中Wnt1、Wnt3a、β-catenin蛋白的表达。结果 HE染色结果显示,PRP+BMSCs组中肌腱和骨连接处的软骨纤维和软骨细胞较PRP和BMSCs组增加。与PRP组和BMSCs组比较,PRP+BMSCs组兔血清中VEGF、TGF-β1含量和兔腱骨结合处骨密度、最大加载负荷均增加,...     

稳定(牙合)垫治疗对颞下颌关节腔内压力的影响

目的:通过测量戴稳定(牙合)垫前、后颞下颌关节腔内压力的变化,检验稳定(牙合)垫治疗对颞下颌关节腔内压力的影响.方法:用自行开发的多导颞下颌关节腔内压力测试仪,对22例患者进行戴稳定(牙合)垫前、后的颞下颌关节腔内压力穿刺测量,直接获取关节腔内的压力数值,并对戴稳定(牙合)垫前、后正中咬合和大张口状态下的压力数值用配对t检验进行统计比较分析.结果:戴稳定(牙合)垫前正中咬合和大张口状态的颞下颌关节腔内压力分别是(61.3±48.5)mm Hg(1 mm Hg=0.133 kPa)和负压(33.2±34.2)mm Hg;戴稳定(牙合)垫后正中咬合和大张口状态的颞下颌关节腔内压力为(39.5±24.5)mm Hg柱和负压(36.3±25.3)mm Hg.正中咬合状态下的戴稳定(牙合)垫后关节腔内压力值小于戴稳定(牙合)垫前压力值,两者比较差异有统计学意义(P＜0.05);大张口状态下的压力数值在戴稳定(牙合)垫前、后差异没有统计学意义(P＞0.05).结论:戴稳定(牙合)垫能降低正中咬合状态下颞下颌关节腔内压力.     

子宫内膜癌与代谢综合征的关系

子宫内膜癌是女性生殖系统常见的一种恶性肿瘤,近年发病率逐年增高,确切病因不明,现调查显示与肥胖、高血压、糖尿病、血脂代谢障碍等代谢紊乱关系密切。子宫内膜癌的主要治疗手段为手术、放疗、化疗及内分泌治疗,对其发病高危因素的却少有防治重视。