急性胰腺炎并胃损害相关因素分析

目的:探讨分析急性胰腺炎并胃损害发病原因及临床相关因素。方法:收集资料完整急性胰腺炎118例,对其并发胃损害病例77例的发病原因、内镜表现、病情程度、临床症状、血清胃泌素变化、幽门螺杆菌(HP)感染情况等相关因素进行统计学分析。结果:胆源性胰腺炎78例中,胃损害占69.2%;酒精源性胰腺炎26例中,胃损害占65.4%。118例急性胰腺炎胃泌素平均值(87.64±15.45)μg/ml,同时血淀粉酶(230.24±33.36)U/ml,两者的变化没有明显相关性;68例胃损害患者胰腺炎发病时血清胃泌素(83.65±16.23)μg/ml,恢复正常时(77.46±18.25)μg/ml,两者比较无显著性差异。急性胰腺炎轻度57例中,胃损害占56.1%;中度46例中,胃损害占67.4%;重度l5例中,胃损害占93.3%。胆源性胰腺炎HP感染27例(50.0%),酒精源性感染7例(41.2%)。结论:急性胰腺炎合并胃粘膜损伤并不是酒精的直接作用,也不是通过胃泌素刺激胃酸分泌增加这一途径引起,HP感染在胰源性胃损害的发展中可能不起主要作用。胃粘膜损伤可能与病情严重程度有关,与胰腺本身病变所致的胃粘膜损害因素加重和抗损害能力的削弱有关。治疗应积极应用抑制胰酶分泌的药物,及早使用抑酸剂及胃粘膜保护剂。     

胃液、胃粘膜组织总胆汁酸测定对胆汁返流性胃炎的诊断价值

目的 :探讨空腹胃液、胃粘膜组织总胆汁酸 (TAB)的含量对胆汁返流性胃炎的诊断价值。方法 :对 47例胆汁返流性胃炎 (RG)组 ,15例消化性溃疡 (PU)组 ,2 0例慢性浅表性胃炎 (CSG)组及 12例正常对照组在胃镜检查的同时 ,抽取胃液 ,钳取胃粘膜组织作 TBA含量测定。胃粘膜组织同时作 HP及病理组织学检查。结果 :胆汁返流性胃炎组胃液及胃粘膜组织 TBA含量分别为 (315 .85 5 0± 35 .946 8)μm ol/ L ;(0 .2 10 7± 0 .0 810 )μmol/ g。明显高于 PU、 CSG及正常对照组 (P <0 .0 0 1)。胃粘膜组织 TBA含量与胃液 TBA含量呈明显正相关 ,rs=0 .82 8,P <0 .0 0 1。胃粘膜的炎症程度也随 TBA含量的增加而加重。χ2 =15 .6 37,P <0 .0 0 5。随着 TBA含量的增加 ,HP的检出率下降 ,χ2 =9.42 ,P <0 .0 1。结论 :胃液、胃粘膜组织 TBA含量对胆汁返流性胃炎有诊断价值。而胃粘膜组织 TBA含量更有价值。     

胃黏膜内细胞因子与幽门螺旋杆菌感染的关系

目的研究幽门螺旋杆菌(HP)感染对胃黏膜内细胞因子产生的影响,并分析细胞因子与胃黏膜炎症间的关系。方法据HP改良Giemsa染色结果将内镜下诊断为慢性胃炎(20例)、胃溃疡(20例)、十二指肠溃疡(20例)的患者共60例分为HP阳性研究组(28例),HP阴性对照组(32例),钳取胃黏膜,制成组织匀浆,测定上清液TNF-α、IL-8的浓度及病理组织学检查。结果HP阳性研究组TNF-α、IL-8含量为(22.64±10.60)pg/ml.mg、(1448.70±522.30)pg/ml.mg,HP阴性对照组为(8.98±10.60)pg/ml.mg、(690.90±441.60)pg/ml.mg。TNF-α、IL-8含量越高,炎症越重,每高倍镜视野内单核细胞,中性粒细胞越多,浸润程度越深。结论HP可通过以炎症细胞因子TNF-α、IL-8为介导的致病环节参与胃十二指肠疾病的发生。     

糖调节蛋白Grp78在幽门螺杆菌感染者胃黏膜中的表达及意义

目的:了解葡萄糖调节蛋白Grp78在幽门螺杆菌(HP)感染人胃黏膜组织中的表达情况.方法:应用半定量RT-PCR及Western blotting方法检测人胃黏膜组织中Grp78 mRNA及蛋白的表达.结果:HP未感染组28例,Grp78 mRNA表达为0.8038±0.0500,感染组32例,Grp78 mRNA表达为1.1586±0.0839;未感染组Grp78蛋白表达为0.4345±0.0545,感染组Grp78蛋白表达为0.6204±0.0412.两组相比差异显著(P<0.01).结论:正常胃黏膜组织有Grp78 mRNA的表达及蛋白的合成.HP感染胃黏膜增加Grp78 mRNA的表达及蛋白的合成,这可能有利于胃黏膜的自身保护.     

妊娠期肝内胆汁淤积症患者血清及脐血硒水平检测及其意义

目的:探讨孕妇血清硒含量与妊娠期肝内胆汁淤积症发病的相关性。方法:采用病例对照研究的方法,选择符合标准的病例组50例,另外正常妊娠孕妇50例作为对照组,抽取全血用原子吸收分光光度法测定其硒的含量。结果:妊娠期肝内胆汁瘀积症组比正常妊娠组血清硒(80.56±3.59μg/dl,111.40±3.53μg/dl)和脐血硒(90.28±3.16μg/dl,110.02±2.85μg/dl)含量显著降低(P<0.05)。结论:硒摄入不足可能是妊娠期肝内胆汁淤积症的诱发因素。     

幽门螺杆菌相关性胃疾病端粒酶活性检测和分析

目的 :探讨幽门螺杆菌 (HP)相关性胃疾病、端粒酶活性与胃癌三者之间的关系。方法 :利用TRAP ELISA方法 ,检测 94例胃粘膜活检标本 ,其中正常胃粘膜 10例 ,浅表性胃炎 2 1例 ,萎缩性胃炎 33例 ,不典型增生7例 ,胃癌 2 3例。胃粘膜病变中HP阳性 4 1例 ,HP阴性 2 0例。结果 :端粒酶活性表达在萎缩性胃炎、不典型增生及胃癌组织中与正常胃粘膜比较有显著性差异 (P <0 .0 5或P <0 .0 1) ,在胃癌组织中表达最强 ;HP阳性胃粘膜病变组与HP阴性胃粘膜病变组比较有十分显著性差异 (P <0 .0 1)。结论 :HP感染可使端粒酶活性表达增强 ,促进细胞增殖。HP相关性胃疾病增殖特性与胃癌的增殖特性相似。     

硒与扩张型心肌病

经测定DCM 136例,其血硒含量为0.039±0.012μg/ml,发硒含量为0.28±0.052ppm。与正常人血硒含量0.086±0.028μg/ml,发硒含量0.64±0.16ppm和其它心脏病血硒0.089±0.081μg/ml,发硒0.63±0.52ppm相比。发现DCM患者血硒及发硒均显著降低。低硒可能是DCM病因之一。低硒可做为DCM诊断及鉴别诊断的依据。     

慢性胃炎的定量诊断

为探讨严谨的慢性胃炎诊断标准,作者对131例胃粘膜活检标本进行定量研究。结果发现,正常胃粘膜固有层间质中炎性细胞数为22±10.54个/HP,Ⅰ°慢性浅表性胃炎(CSG)为128±84.37个/HP(P<0.001)。对正常胃粘膜、CSG、慢性萎缩性胃炎(CAG)的腺体数量、直径与病变程度的关系,采用0～6     

尿毒症患者胃粘膜病变与幽门螺旋菌的关系

检测25例尿毒症患者胃粘膜病变及幽门螺旋菌(HP),探讨两者间的关系。结果均为胃炎(100％),其中轻、中、重度分别为10,8,7例。HP检出率36％(9/25例)。检出HP的9例轻、中、重度胃炎各3,4,2例;未检出HP的16例,轻、中、重度各7,4,5例。虽然HP感染可降低胃粘膜抵抗力致粘膜损伤,但HP感染不是尿毒症胃粘膜病变的主要原因。     

幽门螺旋杆菌感染胃黏膜的内镜特点及随访分析

目的 探讨幽门螺旋杆菌(HP)感染胃黏膜的内镜特点以及胃黏膜的改变与HP感染的关系和根除HP后对其的影响.方法 应用快速尿素酶试验、病理切片苏木素-曙红(HE)染色和13C-尿素呼气试验(UBT)检测HP;用PII三联疗法根除HP.结果 2217例患者胃镜表现胃黏膜均有不同程度的改变,随访1034例.随访患者中根除HP后,431例患者均为大致正常胃黏膜,占41.7%,344例仅表现胃黏膜充血和花斑样改变,占33.3%(P＜0.05);258例患者的糜烂灶明显减少,占25.0%,主要为散在的平坦性糜烂(P＜0.05),而隆起样糜烂消失.结论 HP感染胃黏膜均有一定的内镜特点,说明内镜下胃黏膜的改变与Hp感染导致胃黏膜的损伤有关.     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.