Emerging technologies in therapeutic ultrasound: Thermal ablation to gene delivery

Ultrasound is used today in medicine as a modality for diagnostic imaging. Recently, there have been numerous reports on the application of thermal and nonthermal ultrasound energy for treating various diseases. In addition to thermal ablation of tumors, non-thermal ultrasound combined with drugs and genes have led to much excitement especially for cancer treatment, vascular diseases, and regenerative medicine. Ultrasound energy can enhance the effects of thrombolytic agents such as urokinase for treatment of stroke and acute myocardial infarction. New ultrasound technologies have resulted in advanced devices such as a) ultrasound catheters, b) Non-invasive methods as high intensity focused ultrasound (HIFU) in conjunction with MRI and CT is already being applied in the clinical field, c) Chemical activation of drugs by ultrasound energy for treatment of tumors is another new field recently termed "Sonodynamic Therapy", and d) Combination of genes and microbubble have induced great hopes for ideal gene therapy (sonoporation). Various examples of ultrasound combined modalities are under investigation which could lead to revolutionary therapy.     

不同干扰模式对受害马尾松人工纯林林分结构的影响

在浙江安吉选择松材线虫病危害的马尾松人工纯林,分别进行暂不采伐直至10年后统一伐除受害木的集中干扰、采伐受害松木的适度干扰、采伐受害松木与周边松木及生长势弱松木的强度干扰,探讨不同干扰模式使受害马尾松林恢复健康的可能性.16年后的试验结果表明: 3种模式下受害林分马尾松的重要值为集中干扰>适度干扰>强度干扰,阔叶树的重要值则正好相反;与集中干扰相比,适度和强度干扰后的马尾松、阔叶树的平均胸径分别提高1.2、1.7倍和1.3、1.9倍,平均树高分别提高了1.5、2.0倍和1.2、1.8倍,林分每公顷蓄积量分别是集中干扰样地的5.2和3.8倍;适度和强度干扰的各径阶株数均远高于集中干扰样地,胸径结构近似于反J型曲线,也形成了复层林,物种丰富度和多样性指数均显著高于集中干扰样地,林木个体差异及林分复杂性指数均表现为适度干扰>强度干扰>集中干扰.适度和强度干扰下单层马尾松同龄纯林均演替为复层马尾松-阔叶树混交异龄林.3种模式均是正向阔叶化演替,演替速度为强度干扰>适度干扰>集中干扰.表明适度干扰更有利于病害马尾松林分恢复,间伐马尾松纯林能加快阔叶混交化进程以抵御松材线虫病的入侵.     

Early intervention in psychosis: concepts,evidence and future directions

The rise of the early intervention paradigm in psychotic disorders represents a maturing of the therapeutic approach in psychiatry, as it embraces practical preventive strategies which are firmly established in mainstream health care. Early intervention means better access and systematic early delivery of existing and incremental improvements in knowledge rather than necessarily requiring dramatic and elusive breakthroughs. A clinical staging model has proven useful and may have wider utility in psychiatry. The earliest clinical stages of psychotic disorder are non-specific and multidimensional and overlap phenotypically with the initial stages of other disorders. This implies that treatment should proceed in a stepwise fashion depending upon safety, response and progression. Withholding treatment until severe and less reversible symptomatic and functional impairment have become entrenched represents a failure of care. While early intervention in psychosis has developed strongly in recent years, many countries have made no progress at all, and others have achieved only sparse coverage. The reform process has been substantially evidence-based, arguably more so than other system reforms in mental health. However, while evidence is necessary, it is insufficient. It is also a by-product as well as a catalyst of reform. In early psychosis, we have also seen the evidence-based paradigm misused to frustrate overdue reform. Mental disorders are the chronic diseases of the young, with their onset and maximum impact in late adolescence and early adult life. A broader focus for early intervention would solve many of the second order issues raised by the early psychosis reform process, such as diagnostic uncertainty despite a clear-cut need for care, stigma and engagement, and should be more effective in mobilizing community support. Early intervention represents a vital and challenging project for early adopters in global psychiatry to consider.     

超声介入治疗常见妇科囊性炎症包块的疗效评价*

摘要目的：比较超声引导介入治疗盆腔脓肿、输卵管积脓、输卵管积液、包裹性积液及宫颈囊肿的临床效果,了解超声引导介入治疗常见的妇科囊性炎症包块的临床价值。方法：选取我院妇科门诊2007 年1 月～2011 年3月收治的常见妇科囊性炎症包块共108例,其中盆腔脓肿11 例、输卵管积脓19 例、输卵管积液43 例、盆腔包裹性积液31 例、宫颈囊肿4 例,给予超声实时引导抽囊液、甲硝唑冲洗治疗,治疗后3 个月内复查超声评价和比较疗效。结果：盆腔脓肿、输卵管积脓、盆腔包裹性积液包块均明显缩小(12/43)或消失(29/43),治疗有效率100%;输卵管积液包块治疗有效率95％(41/43),宫颈囊肿均痊愈。各组间比较无统计学差异（P>0.05）。结论：超声引导介入治疗对输卵管积脓、盆腔脓肿、盆腔包裹性积液均有显著的疗效,且治疗效果无差异,值得推广应用,代替传统的非必要的手术治疗。     

超声检查在肛周感染性疾病中的诊断价值

目的:通过对一定样本的肛周感染患者的超声影像分析,探讨超声检查在肛周感染性疾病中诊断的价值,旨在早期为临床提供早期干预证据.方法:利用飞利浦IU22超声对我院2010年10月到2012年10月收治的60例肛周感染患者进行扫查,根据病变部位,特征及超声声像图进行分型分析并与实际手术结果对照,评价超声在肛周感染性疾病上的诊断及治疗方法选择的价值.结果:超声诊断单纯型肛周脓肿28例,肛瘘20例,复合型肛周脓肿12例;与手术所见符合率分别为单纯脓肿93.33％,肛瘘100.0％,复合型肛周脓肿90.91％.术前超声诊断和手术确诊病例数之间没有统计学差异(P＞0.05).结论:超声在肛周感染性疾病的诊断中具有快速、准确、经济等独特的优势,并可根据声像图对其作出较准确的分型,为临床治疗方法的选择提供可靠的依据.     

血浆脑钠肽对不同年龄急性冠脉综合征患者介入治疗术后临床预后的意义

目的：探讨并比较血浆脑钠肽（BNP）对不同年龄组急性冠脉综合征（ACS）患者经皮冠脉介入（PCI）术后临床主要不良心脏事件（MACE）的预测价值。方法：回顾分析2007年12月至2010年3月因ACS在我院行PCI的患者,分为260岁和〈60岁两组,入院常规检验BNP,随访住院期间及出院后6个月内MACE（包括死亡、心源性休克、再发心绞痛、非致命性再次心肌梗死、非致命性心力衰竭、心律失常、靶血管血运重建、再次入院复合终点）的发生情况。结果：随访269例260岁患者,失访7例（2．6％）,118例〈60岁患者,失访3例（2．5％）,262例≥60岁患者的年龄与BNP水平显著正相关（r=0．368,P〈0．01）,而115例〈60岁患者无显著相关性（r=-0．014,P〉0．05）。年龄≥60岁患者BNP水平与〈60岁患者比较,差异显著（P〈0．01）,年龄260岁患者MACE与〈60岁患者比较,差异显著（P〈0．01）,两组患者BNP水平与LVEF呈显著负相关（P均〈0．01）。多因素logistic回归分析显示：BNP可独立预测两组患者住院期间及出院后6个月内MACE（≥60岁OR=4．369P〈0．01;〈60岁OR=7．773P〈0．01）发生率。两组患者BNP水平对MACE预测的ROC曲线结果比较,差异无统计学意义（P〉0．05）。结论：不同年龄患者BNP水平及MACE发生率存在差异,但年龄并不影响BNP对ACS患者临床预后的预测价值。     

护理干预对骨科患者术后两种镇痛效果及满意度的影响

目的:探讨护理干预对骨科患者术后使用硬膜外持续微量注射镇痛及静脉自控微量注射镇痛效果的影响.方法:根据研究要求将患者按硬膜外持续微量注射镇痛及静脉自控微量注射镇痛方式分为实验组A、B组和对照组A、B组,实验组给予护理干预,对照组给予常规护理,然后对比两种术后镇痛方式护理干预组与常规护理组之间的镇痛满意度.结果:通过分析、比较,硬膜外持续微量注射镇痛患者及静脉自控微量注射镇痛患者镇痛满意度护理干预实验组均明显高于常规护理对照组.结论:常规的硬膜外持续微量注射镇痛及静脉自控微量注射镇痛使患者术后取得镇痛效果的过程中,系统的护理干预是提高镇痛满意度的重要因素.     

心理干预对高血压合并脑梗塞患者负性情绪及生活质量的影响

目的:探讨心理干预措施对高血压合并脑梗塞患者负性情绪及生活质量的影响。方法:本次选择的研究对象共92例,均为住院的高血压合并脑梗塞患者,采用简单随机分组方法,分为干预组和对照组,每组46例。对照组给予常规治疗及护理,干预组在对照组的基础上给予心理干预。在入组时、入组后1个月采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL一90)作为测评工具,测评两组患者干预前后负性情绪和生活质量情况。结果:入组时两组患者的SDS评分、SAS评分及SCL-90各项分值比较差异无统计学意义(P0.05);干预治疗1个月后干预组较对照组患者的SDS评分、SAS评分及SCL-90各项分值均降低,差异有统计学意义(P0.05)。结论:心理干预不仅能缓解患者抑郁焦虑等负性情绪,而且有利于患者生活质量的提高。     

丹顶鹤胆囊的显微观察

应用光镜及透射电镜观察一例成体雄性丹顶鹤胆囊。结果表明,丹顶鹤胆囊粘粘膜、肌层和外膜三部分组成。粘膜上皮高柱状、游离端有密集排列的微绒毛,胞质面端有许多粘液颗粒,说明上皮细胞具有吸收功能并可分泌粘液。