再生障碍性贫血血清IFN-γ、IL-17、EPO、TPO水平的变化

目的：探讨再生障碍性贫血(AA)血清血小板生成素(TPO)、白细胞介素-17(IL-17)、γ-干扰素(IFN-γ)、促红细胞生成素(EPO)水平变化及意义。方法：回顾性分析2019年7月～2020年9月在天津市第一中心医院进行治疗的259例AA患者一般临床资料,将AA患者纳入试验组,选取同期健康体检者81例纳入对照组,比较两组一般临床资料,探讨血清IFN-γ、IL-17、EPO、TPO在AA中诊断价值。结果：试验组IFN-γ、IL-17、EPO、TPO均显著高于对照组,差异有统计学意义(P<0.05)。极重型患者血清IFN-γ、IL-17、EPO、TPO水平均显著高于非重型、重型患者,重型患者血清IFN-γ、IL-17、EPO、TPO水平高于非重型患者,差异均有统计学意义(P<0.05)。原发性、继发性两组血清IFN-γ、IL-17、EPO、TPO水平比较差异无统计学意义(P>0.05)。治疗后试验组患者血清IFN-γ、IL-17、EPO、TPO水平明显低于治疗前,差异有统计学意义(P<0.05)。血清IFN-γ、IL-17、EPO、TPO在预后评估中均具有一...     

流行性乙型脑炎患儿IL-18的检测及意义

目的：检测流行性乙型脑炎（乙脑）患儿血清及脑脊液（CSF）中白细胞介素-18（IL-18）水平,以探讨其乙脑发病机制中的作用。方法：总共收集到62份乙脑患儿极期（普通型20例、重型26例、极重型16例）、47份恢复期（普通型20例、重型21例、极重型6例）血清标本,50份极期（普通型18例、重型20例、极重型12例）、31份恢复期（普通型15例、重型12例、极重型4例）CSF标本,和20份对照组血清及CSF标本,用ELISA法检测其血清及CSF中IL-18水平。结果：3组患儿极期血清和CSF中IL-18水平均显著高于对照组（P〈0.001）,极重型最高,依次为重型、普通型,3组间两两比较差异有统计学意义（P〈0.001）;死亡组患儿（6例）极期血清中IL-18水平显著高于存活组（56例）（P〈0.01）,3组患儿极期血清和CSF中IL-18水平均显著高于恢复期（P〈0.001）,3组恢复期血清中IL-18水平与对照组比较差异均无统计学意义（P〉0.05）;3组恢复期CSF中IL-18水平均高于对照组,普通型与对照组、普通型与重型两两比较差异无统计学意义（P〉0.05）,重型显著高于对照组（P〈0.05）,极重型显著高于重型、普通型（P〈0.001）。结论：动态检测乙脑患儿血清和CSF中IL-18水平有助于判断病情和预后,恢复期CSF中IL-18水平比血清水平更能反映颅内病变。     

G-CSF治疗后中性粒细胞反应预测重型再生障碍性贫血免疫抑制治疗早期疗效

目的观察分析免疫抑制治疗(IST)重型再生障碍性贫血(SAA)前采用G-CSF治疗后中性粒细胞反应(ANC反应)对免疫抑制治疗早期疗效的预测价值。方法从我院血液科2015年2月至2016年2月期间收治的SAA患者中选出10例作为观察对象,所有患者均给予G-CSF方案化疗。结果对比慢性期和进展期的总有效率,慢性期显著高于进展期,组间数据差异具有统计学意义(P0.05);进展期SAA患者骨髓移植的发生率显著高于慢性期SAA患者,组间数据差异具有统计学意义(P0.05);影响IST后早期疗效的独立因素与治疗时间、G-CSF治疗10d内的ANC反应、治疗前的Ret水平有关。结论针对重型再生障碍性贫血患者采用G-CSF方案效果确切,且IST前G-CSF治疗后的ANC反应能够提示骨髓残存造血,是预测患者接受IST早期疗效的重要指标。     

早期高压氧联合纳络酮对重型颅脑损伤患者血CRP水平的影响

目的观察早期高压氧联合纳络酮对重型颅脑损伤患者血CRP水平的影响。方法选择重型颅脑损伤患者82例,随机分为观察组和对照组,每组41例。对照组给予常规治疗,观察组在对照组的治疗基础上应用早期高压氧联合纳络酮治疗。观察两组治疗10d后的血CRP水平变化、格拉斯哥昏迷评分（GCS）及伤后3个月格拉斯哥预后分级评分（GOS）情况。结果治疗10d后观察组的血CRP水平明显低于对照组,差异有统计学意义（P〈0.05）;治疗14d后观察组GCS评分明显高于对照组,差异有统计学意义（P〈0.05）,治疗3个月后观察组恢复良好率明显高于对照组,病死率明显低于对照组,差异有统计学意义（P〈0.05）。结论早期高压氧联合纳络酮治疗重型颅脑损伤有较好的临床疗效,可显著降低患者的血CRP水平,促进患者神经功能恢复。     

再生障碍性贫血患者血清环孢素浓度的影响因素与疗效分析

目的：分析影响再生障碍性贫血（ AA）患者环孢素（ CsA）血药浓度的因素以及与免疫抑制治疗（ IST）疗效的关系。方法41例住院接受IST的初诊AA患者,在患者起始治疗后定期检测血清CsA浓度,同时分析患者初诊时γ干扰素（ IFN-γ）浓度、白蛋白含量、促红细胞生成素（ EPO）水平、T细胞亚群、确诊至IST的时间、肾功能、年龄、性别等指标与CsA浓度之间的关系。结果治疗有效者第2、3周及第3个月CsA浓度明显高于治疗无效者[（180.3±38.3）ng／mL vs（118.5±37.5）ng／mL,（250.4±81.2）ng／mL vs（154.1±42.0）ng／mL,（254.9±109.0）ng／mL vs（116.1±28.4） ng／mL],差异均有统计学意义（P＜0.01）。患者治疗前IFN-γ水平、白蛋白含量均与第3个月CsA浓度呈正相关（ r＝0.588,P＝0.003;r＝0.633,P＜0.01）。而确诊至IST时间与第3个月CsA浓度呈负相关（r＝-0.607,P＜0.01）,且确诊至IST时间≤21 d者有效率高于＞21 d者（71.4％vs 16.1％）,差异有统计学意义（P＜0.01）。患者的年龄与第3个月CsA浓度呈负相关（r＝-0.471,P＝0.002）,且年龄≤40岁者有效率高于年龄＞40岁者（88.9％vs 43.5％）,差异有统计学意义（P＜0.05）。 EPO水平及血肌酐浓度与CsA浓度无相关性（P＞0.05）。有效者与无效者性别差异无统计学意义（P＝0.265）。结论 CsA浓度早期达到有效浓度并能长期维持在有效浓度,预示着患者IST疗效较好。同时,治疗前IFN-γ水平、白蛋白水平和诊断距治疗时间是影响CsA浓度的重要因素。     

社区获得性肺炎患者呼出气冷凝液和血清中C反应蛋白检测的临床意义

目的：研究社区获得性肺炎（CAP）不同病原体感染患者呼出气冷凝液（EBC）和血清中C反应蛋白（CRP）水平的差异以及治疗前后的变化规律,探讨对CAP患者病原体鉴别、病情评估及疗效评价的价值。方法：收集100例CAP患者入院第1、3、7天EBC及血清标本,记录体温、咳痰量、咳嗽频次、血沉、CURB-65评分。纳入病原体明确的患者52例,分为细菌组25例,支原体组15例,病毒组12例。采用酶联免疫法测定EBC和血清CRP浓度。结果：（1）入院时细菌组和支原体组EBC中CRP高于健康对照组,差异均有统计学意义（P＜0.01）;细菌组血清CRP高于健康对照组,差异有统计学意义（P＜0.01）;细菌组EBC和血清中CRP高于支原体组与病毒组,差异均有统计学意义（P＜0.01）;支原体组EBC中CRP高于病毒组,差异有统计学意义（P＜0.01）。（2）细菌组第3天和第7天EBC和血清中CRP水平低于第1天,差异均有统计学意义（P＜0.01）;支原体组第3天和第7天EBC中CRP水平低于第1天,差异均有统计学意义（P＜0.01）。（3）观察组治疗后第3天、第7天患者痰量、咳嗽频次、体温、血沉及CURB-65评分均较治疗前改善,差异均有统计学意义（P＜0.01）。结论：检测CAP患者EBC和血清中的CRP浓度有助于CAP的病原体鉴别、病情评估和疗效评价。     

亚低温治疗在急性重型颅脑损伤中的应用

目的探讨亚低温治疗在急性重型颅脑损伤中的应用效果。方法将2013年1月至2015年1月黄冈市中心医院收治的76例急性重型颅脑损伤患者分为观察组和对照组,每组38例。观察组患者于伤后24 h内行亚低温治疗,直肠温度控制在32.0~35.0℃;对照组患者采用降温毯将直肠温度控制在36.5~37.0℃;分别于治疗前及治疗后3个月检测患者颅内压(ICP)、空腹血糖(FBG)、血清乳酸水平、脑组织氧分压(Pbt O2)及脑微循环血流,于治疗后3个月进行疗效判定。结果观察组和对照组患者恢复良好率分别为34.21%(13/38)、13.16%(5/38),观察组患者恢复良好率显著高于对照组(P<0.05)。治疗前2组患者ICP、Pbt O2、脑微循环血流、FBG和血清乳酸水平比较差异均无统计学意义(P>0.05)。治疗后3个月2组患者ICP、FBG和血清乳酸水平显著低于治疗前(P<0.05),Pbt O2、脑微循环血流显著高于治疗前(P<0.05)。治疗后观察组患者ICP、FBG和血清乳酸水平显著低于对照组(P<0.05),Pbt O2和脑微循环血流显著高于对照组(P<0.05)。对照组和观察组患者的并发症发生率分别为55.26%(21/38)、39.47%(15/38),2组患者的并发症发生率比较差异无统计学意义(P>0.05)。结论亚低温治疗急性重型颅脑损伤可显著改善患者ICP、Pbt O2和脑微循环血流,促进患者恢复。     

小剂量环孢素A治疗非重型再生障碍性贫血效果观察

目的:研究小剂量环孢素A治疗非重型再生障碍性贫血(AA)的效果。方法:选取88例非重型AA患者的临床资料,按照患者接受环孢素A治疗的不同剂量进行分组,观察组42例每天服用剂量为3 mg/kg,对照组46例每天服用剂量为5 mg/kg,比较两组治疗效果。结果:观察组治疗总有效率为83.33%,与对照组总有效率的80.43%比较,差异无统计学意义(P>0.05);治疗后两组Hb、BPC、WBC指标水平均高于治疗前,差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05);观察组不良反应发生率为14.29%,明显低于对照组的28.26%,差异有统计学意义(P<0.05);治疗后观察组患者平均血药浓度显著低于对照组,差异有统计学意义(P<0.05)。结论:非重型AA行小剂量环孢素A治疗能够获得良好效果。     

分步控制性减压术在重型脑外伤患者中的治疗效果探究

目的 探究分步控制性减压术在重型脑外伤患者中的治疗效果.方法 选取2018年1月至2020年1月于本院接受治疗重型脑外伤的80例患者作为研究对象,根据不同手术治疗方法进行分组,将采用常规手术治疗的患者纳入参照组,将采用分步控制性减压术的患者纳入研究组,每组40例.比较两组患者术后即刻、术后3个月的神经行为认知状态评分及日常生活活动能力评分.结果 术后即刻,两组患者神经行为认知状态评分、日常生活活动能力评分比较差异无统计学意义;术后3个月,两组神经行为认知状态评分与日常生活活动能力评分高于术后即刻,且研究组高于参照组,差异具有统计学意义(P<0.05).结论 在重型脑外伤患者治疗中应用分步控制性减压术可有效改善患者的神仅功能,提高认知水平,恢复日常生活活动能力,对提高患者的临床疗效具有积极作用.     

亚低温联合高压氧对重型颅脑损伤术后患者应激反应的改善作用及对血清半胱氨酸蛋白酶 3、髓鞘碱性蛋白水平的影响

目的：观察亚低温联合高压氧对重型颅脑损伤患者术后应激反应的改善作用及对于血清中半胱氨酸蛋白酶3(Caspase-3)、髓鞘碱性蛋白(MBP)的影响，为重型颅脑损伤患者术后恢复提供临床治疗方案。方法：选取2018年6月—2019年6月民权县人民医院收治的94例重型颅脑损伤术后患者作为研究对象，随机数表法分为A、B组，每组各47例，A组给予亚低温治疗，B组给予亚低温联合高压氧治疗。比较治疗前后A、B两组患者的颅内压值(ICP)及日常生活能力；比较A、B两组患者的治疗效果；比较A、B两组患者治疗前后血清皮质醇(CORT)、肾上腺素(E)、Caspase-3和MBP水平。结果：治疗后，两组患者ICP水平降低，Barthel指数升高，差异有统计学意义(t=2.380、2.815,P<0.01);B组总有效率高于A组，差异有统计学意义(χ²=4.398,P<0.05)。治疗后两组患者CORT、E、Caspase-3、MBP水平均降低，B组低于A组，差异有统计学意义(t=2.349、4.239、7.855、6.353,P<0.05)。结论：重型颅脑损伤患者术后...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.