TIPS在肝移植术后难治性腹水中的应用

两例肝移植术后患者出现难治性腹水,明确病因、改善一般状况及肝肾功能后,给予TIPS治疗.TIPS术后1周,两例患者腹水消失,至今已分别随访15月、37月,均未出现肝性脑病、肝功能异常等并发症.肝移植术后TIPS的主要适应症为难治性腹水、食道静脉曲张出血及流出道梗阻.TIPS是治疗肝移植术后难治性腹水一种安全、有效的方法,具有一定的临床治疗意义.     

药物性肝损伤的发病机制

药物性肝损伤（DILI）可分为直接肝毒性和特异质性肝损伤（IDILI）.IDILI发生率较低,个体发病存在易感因素,在动物模型中很难复制.同时,IDILI缺乏可靠的临床诊断标准,使其发病机制的研究受到限制.近年来关于IDILI的发病机制,主要在遗传易感性、代谢途径、宿主免疫、线粒体毒性和胆道损伤等方面取得进展,各种发病机制的深入研究和相互关系的阐明,或将揭示IDILI的真正致病机制.     

替罗非班以及不同给药途径对AMI患者PCI术后sICAM-1的影响

探讨替罗非班以及不同给药途径对急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）后可溶性细胞间粘附因子-1（sICAM-1）的影响.选择AMI直接PCI患者90例随机分成A、B、C三组：A组不给予替罗非班;B组PCI术后静脉给予替罗非班,C组PCI术中对梗死相关冠状动脉（IRA）内注射替罗非班,两组均静脉滴注36h;分别检测三组术前及术后24h血浆sICAM-1的浓度水平.结果显示,A组PCI术后24h血浆sICAM-1的浓度水平较术前高,而B、C两组较术前均降低,差异有统计学意义（P＆lt;0.05）,但B、C两组PCI术后差异无统计学意义（P＞0.05）.因此,对于行PCI术的AMI患者应给予替罗非班,抑制术后炎症反应以及粘附反应,降低PCI术后再狭窄的发生率,但其作用效果与给药途径无关.     

中西医结合治疗儿童过敏性紫癜和预防相关肾损害的临床研究

过敏性紫癜是儿童常见的免疫系统疾病。西医治疗过敏性紫癜已形成常规模式,并有一定疗效,但也有一定局限性。本病易反复,易损伤肾脏,严重时可导致紫癜性肾炎。本文拟研究中西医结合方法治疗过敏性紫癜及预防肾脏损伤的临床效果。研究表明,中西医结合治疗该病存在一定优势,能有效治疗过敏性紫癜,并降低肾脏损害及紫癜性肾炎的发生率。但应看到本研究结论主要是通过临床经验取得,样本量小,未进行远期随访,缺乏系统深层次实验室论证,还有待进一步研究。     

急性心肌梗死患者直接经皮冠状动脉介入治疗前后窦性心律振荡的临床观察

探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入（PCI）前后窦性心律振荡（HRT）的变化及意义.选择伴室性早搏的AMI患者（观察组）和无器质性心脏病的室性早搏患者（对照组）各42例,PCI前伴室早的观察组患者,用节律Ⅱ导联记录室早的心电图,PCI后2周时观察组及对照组均记录24h动态心电图（AECG）,计算其震荡初始（TO）和震荡斜率（TS）,并行心脏彩色多普勒超声检查,测定左室射血分数（LVEF）.结果观察组PCI后2周时和对照组LVEF分别为：（59.1＆#177;7.5）%和（61.3＆#177;8.4）%.观察组PCI前TO显著升高,TS显著降低,差异有统计学意义（P＜0.05）;观察组PCI后2周TO较前降低,TS较前升高,但和对照组相比差异仍有统计学意义（P＜0.05）;观察组PCI后2周时和对照组左室射血分数（LVEF）相比无差异.提示AMI患者HRT减弱,PCI后2周HRT改善但和观察组相比仍有统计学意义,提示AMI患者PCI后早期仍存在心脏自主神经功能下降,HRT可作为评价AMI患者预后的一个指标.     

高尿酸血症与急性脑梗死患者病情严重程度和预后的相关性研究

文章探讨高尿酸血症与急性脑梗死患者病情严重程度和预后的相关性.选择急性脑梗死患者198例,男性115例,女性83例,以前瞻性病例对照的研究方法,分析高尿酸血症与急性脑梗死患者入院时、住院10天时的病情严重程度和90天预后的相关性.高尿酸血症与急性脑梗死患者入院时病情严重程度无关（P＆gt;0.05）,与住院10天时病情严重程度呈负相关（P=0.003）,与10天时的美国国立卫生研究院卒中量表（NIHSS）转归分数呈正相关（P=0.002）,与90天预后呈正相关（P=0.001）.笔者认为高尿酸血症与急性脑梗死患者住院10天时的病情严重程度和90天预后具有独立的相关性.     

大转子延长截骨在THR术后感染一期翻修中的临床应用

评价大转子延长截骨并行单纯钢丝捆扎在人工髋关节置换（THR）术后感染一期翻修中的作用及对翻修假体的影响.选取2010年10月~2013年10月期间30例髋关节置换术后假体感染性松动并行一期翻修术的患者,随访时间（34.8＆#177;13.2）月,对患者手术时间、截骨长度和愈合时间、术前术后Harris评分及术后感染控制情况进行统计.30例患者髋关节术后评分明显高于术前,手术时间为（132.4＆#177;23.6）min,经大转子截骨长度为（11.4＆#177;2.6）cm,截骨愈合时间（3.8＆#177;1.3）个月.术后感染未见复发.因此THR术后感染的一期翻修术中应用大转子延长截骨方法能缩短手术时间,髋关节功能较术前明显改善.     

Characteristics of Traumatic Experience and Survivor Perceptions of Mental Health Services: The 2004–2005 Erie County Community Trauma Survey

Trauma is associated with severe mental illness and substance abuse problems, yet it typically is not addressed sufficiently in treatment. This article reports on an assessment of mental health service recipients and their experience of traumatic events and perceptions of service providers' sensitivity, helpfulness, and knowledge regarding their trauma and service needs using a community-based participatory research model. Demographic characteristics and status of co-occurring disorders were measured. Participants perceived that individual therapists and peer service providers were sensitive to and knowledgeable about their trauma. Group treatment and peer programs were seen as being most helpful. Psychiatric services were seen as being the least sensitive to trauma issues. Implications for practice and research are discussed.     

Trauma Survivors' Emotional Distress and Barriers to Early Psychological Intervention in an Inner-City Acute Surgical Trauma Service

Fifty-five predominantly low-income ethnic minority patients were interviewed and screened for early signs of psychological distress following traumatic injury. A free, brief intervention and transportation were offered to patients who evidenced psychiatric symptoms. Over half of participants reported psychiatric symptoms, but none accepted the free intervention. This study examined reasons participants remained reluctant to engage in services despite elimination of common barriers. Results highlight the importance of perceptual barriers over structural barriers in engaging patients in psychological interventions following a traumatic event.