IL-6 IL-10及TNF-α在急性有机磷农药中毒引发 MODS中的作用及临床意义

目的观察急性有机磷农药中毒（AOPP）伴多器官功能障碍综合征（MODS）患者血清细胞因子IL-6、IL-10及TNF—α的动态变化，探讨AOPP引发MODS的机制。方法采用酶联免疫吸附试验双抗体夹心法检测42例AOPP伴MODS患者血清中细胞因子的水平，并与正常对照组进行比较。结果AOPP患者血清IL-6、IL—10及TNF—α水平均升高，与对照组比较差异有统计学意义（P〈0．01）。结论AOPP可导致细胞因子失调，细胞因子参与了全身炎症反应综合征（SIRS）向MODS的发生发展。     

急性脑梗死患者血清细胞因子的变化及醒脑静的治疗干预

目的探讨醒脑静注射液对急性脑梗死患者血清细胞因子含量的影响。方法测定25例急性脑梗死患者醒脑静治疗前后血清TNF—α、IL-1β、IL-6含量的变化，并与同期门诊健康体检者比较。结果急性脑梗死患者血清TNF—α、IL-1β、IL-6水平较正常对照组明显增高，且与梗死灶面积相关；应用醒脑静注射液治疗2周后，血清TNF-α、IL-1β、IL-6水平较用药前下降，仍高于正常对照组，但无明显统计学意义（P〉0．05）。结论TNF—α、IL-1β和IL-6参与脑缺血后的炎性及再灌注损伤，醒脑静可能通过减轻细胞因子介导的炎性反应对脑损伤具有保护作用。     

危重病患者SIRS早期细胞因子水平动态变化的研究

目的：探讨炎性细胞因子[肿瘤坏死因子－α（TNF-α）,白细胞介素－1β（IL-1β）和白细胞介素－6（IL－6）在危重病患者SIRS早期的动态变化及对MODS早期诊断的意义。方法：应用酶联免疫法测定30例危重病患者SIRS早期TNF－α、IL－1β及IL－6的动态变化,比较SIRS组及正常对照组的TNF－α、IL－1β及IL－6的变化,结果：30例患者血 TNF－α、IL－1β及IL－6水平均明显升高,较正常对照组差异显著（P均＜0．01）。结论：炎性细胞因子参与子MODS的发生发展;SIRS期血中TNF－α、IL－1β及IL－6水平对MODS的早期诊断有十分重要的意义。     

急性冠脉综合征患者血清TNF-α、IL-6、IL-8变化的临床意义

目的讨论肿瘤坏死因子（TNF—α）及白细胞介素（IL-6,IL-8）在急性冠脉综合征（ACS）患者血清中浓度变化及其意义。方法选取76例ACS患者,其中不稳定型心绞痛（UAP）患者37例,急性心肌梗死（AMI）39例;90例非ACS患者中稳定型心绞痛（SAP）患者49例,陈旧性心肌梗死（OMI）41例,冠脉造影正常者20例,采用放射免疫法测定上述病例的血清TNF—α．IL-6、IL-8浓度。结果（1）冠心痛组（SAP组、UAP组、AMI组、OMI组）血清TNF—α浓度均显著高于正常对照组;ACS组（UAP组、AMI组）血清TNF—α、IL-6、IL-8水平显著高于非ACS组（5AP、OIM组）;AMI组血清TNF—α水平显著高于UAP组;SAP组与OMI组血清TNF—α水平差异无显著性;而IL-6、IL-8差异显著。（2）SAP组与UAP组冠脉狭窄程度比较差异无显著性。结论TNF—α、IL-6、IL-8参与冠心病的形成;并且在ACS的发病中起重要作用。检测血清TNF—α浓度将有助于诊断和预测ACS的发生、发展和预后。     

成人肝移植围手术期多器官功能障碍综合征患者血清细胞因子的变化

目的探讨应用免疫抑制剂对肝移植围手术期多器官功能障碍综合征（MODS）患者血清细胞因子变化的影响。方法采用放射免疫分析法测定53例成人原位肝移植术（OLT）后MODS患者血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）、IL-8和IL-10水平；并按照是否接受了床旁持续血液净化（CBP）治疗分为治疗组和对照组，比较两组患者血清细胞因子变化及重症加强治疗病房（ICU）住院时间、病死率和ICU治疗费用。结果53例患者发生MODS后血清TNF-α、IL-6、IL-8和IL-10水平均较正常参考值显著升高（P均＜0．05）；其中接受CBP治疗后血清TNF—α、IL-6和IL-8水平均较治疗前显著降低（P均＜0．05），而血清IL-10水平则与治疗前持平。治疗组患者的ICU住院时间较对照组明显延长,ICU治疗费用也明显增加，差异均有显著性（P＜0．05或P＜0．01），但两组间病死率无明显差异。结论术后应用免疫抑制剂可导致成人肝移植围手术期MODS患者机体促炎／抗炎反应失衡，以抗炎因子过度释放为主。CBP治疗可降低血清促炎因子水平，是有效的支持治疗手段。     

严重创伤患者血清IL-6、IL-8和TNF—α的动态变化

目的对血清白细胞介素-6（IL-6）、白细胞介素-8（IL-8）及肿瘤坏死因子-α（TNF-α）等细胞因子严重创伤后的动态变化进行研究。方法45例严重创伤患者入选（创伤组），分别在入院的第1、3、5、10、15天动态检测TNF—α、IL-6和IL-8的水平。并选取20名健康体检者为对照（健康对照组）。将结果进行统计学分析。结果创伤组患者损伤后当天血清IL-6、IL-8和TNF-α浓度较健康对照组均显著升高。IL-6在损伤后当日即升高，在第3～5天达到高峰后开始逐渐下降。IL-8在损伤后第1天仅呈轻度升高，第3～5天达到高峰后开始逐渐下降。TNF-α在损伤后第1天即升高，第3～5天后即逐渐恢复到基础水平。结论动态观察严重创伤患者细胞因子活性的变化有助于病情的评估。     

乌司他丁对重度急性有机磷农药中毒患者细胞因子影响的研究

目的探讨乌司他丁干预对重度急性有机磷农药中毒（AOPP）引发多器官功能障碍综合征（MODS）患者血清TNFα、IL-6及IL-10水平动态变化的影响。方法重度AOPP引发MODS患者46例，临床随机分为常规治疗组（n=24）、乌司他丁干预组（n=22），同步检测两组患者血清中上述细胞因子的动态变化，并与健康对照组（n=20）进行对比分析。结果常规治疗组与乌司他丁干预组患者血清中TNF-α、IL-6及IL-10水平均高于健康对照组（P〈0．01）；两组治疗前后比较，血清TNF—α、IL-6及IL-10水平均有明显降低（P〈0．01），但乌司他丁干预组血清TNF-α、IL-6的降低水平较常规治疗组更明显（P〈0．01），而治疗后血清IL-10水平两组比较无显著性差异（P〉0．05）。乌司他丁干预组的病死率明显低于常规治疗组（P〈0．05），痊愈患者的住院时间也明显缩短（P〈0．01）。结论TNF-α、IL-6及IL-10等细胞因子参与重度AOPP引发MODS患者的病理过程；乌司他丁干预能明显降低重度AOPP患者血清TNF-α、IL-6水平，从而降低并发MODS的重度AOPP患者的病死率。     

AOPP引发MODS患者血清MMP-9和炎症递质的变化及其临床意义

目的观察急性有机磷农药中毒（AOPP）致多器官功能障碍综合征（MODS）患者血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）、白细胞介素-10（IL—10）及基质金属蛋白酶-9（MMP-9）的动态变化及其关系，探讨AOPP引发MODS的机制。方法采用酶联免疫吸附试验双抗体夹心法检测42例AOPP伴MODS患者血清中TNF-α、IL-6、IL-10及MMP-9的水平，与正常对照组进行比较，并采用Pearson相关分析方法分析MMP-9与TNF—α、IL-6、IL-10的相关关系。结果AOPP患者血清TNF-α、IL-6、IL-10含量均升高，与正常对照组相比差异非常显著。血清MMP-9水平与TNF-α、IL-6、IL-10的水平呈明显的正相关关系。结论AOPP可导致炎症递质失调。MMP-9通过调控炎症递质参与了全身炎症反应综合征（SIRS）向MODS的发生发展过程。     

多发性创伤后血清TNF-α、IL-1β、IL-6及IL-10变化的连续观察

目的 探讨创伤患者TNF－α、IL－1β、IL－6及IL－10血清浓度的变化及临床意义。方法 25例多发性创伤患者分别在受伤后第2、3、5、10及15天测定外周血清TNF－α、IL－1β、IL－6及IL－10的变化，并与正常对照组进行对比分析。血清TNF－α浓度采用放免法测定，IL－1β、IL－6、IL－10浓度采用酶联免疫吸附法测定。结果 TNF－α、IL－1β、IL－6及IL－10血清浓度在多发性创伤后均较正常对照显著增高，IL－1β及TNF－α于2周后恢复正常，而IL-6、IL-10增高持续至2周后。结论 TNF－α、IL－1β、IL－6及IL－10参与了多发性创伤病理生理过程，动态观察可能和病情程度有关。     

急性心肌梗死患者炎症因子的动态变化及临床意义

目的动态观察急性心肌梗死（AMI）患者血液中自介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF—α）的动态变化,并与同期正常人群血液中细胞因子比较,探讨其在AMI患者发生发展中的作用。方法选择AMI患者40例,与健康对照组45名作对比研究。应用放射免疫分析法测定血浆中3种细胞因子（TNF-α、IL-1β、IL-6）的含量。结果两组比较,AMI组血液中IL-1β、TNF-α、IL-1总体水平明显高于健康对照组。3者均在第7天达到高峰期,明显高于入院当时及随后的第1、3、5天的水平。但IL-6水平在入院当时及随后的第1、3、5天无明显升高。结论炎性细胞因子在AMI心肌损伤过程当中起一定的作用,部分炎症因子随心肌梗死病程动态变化。     

Update on Clinical Features and Brain Abnormalities in Neurogenetics Syndromes

Neuroimaging methods represent a critical tool in efforts to join the study of the neurobiology of genes with the neurobiology of behaviour, and to understand the neurodevelopmental pathways that give rise to cognitive and behavioural impairments. This article reviews the clinical features and highlights studies with a focus on the relevant gene–brain–behaviour connections observed in neurogenetic syndromes, such as Williams, Rett, Fragile X, Prader‐Willi, Angelman, Down and velocardiofacial (22q11.2 deletion) syndromes. The relationship of altered brain regions and activation patterns are discussed for each syndrome, as well as the clinical, cognitive and behavioural correlates of these neuroimaging findings.     

Shear Syndrome: The Worst Case Scenario of Crush Syndrome

Shear syndrome is described as a complication of crush syndrome. In addition to compression of and injury to the electrode, complete transection occurs. In this case, the free end migrated to the pulmonary artery with the potential for further complications.     

Superior mesenteric artery syndrome: Diagnosis and management

Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).     

原发性肾病综合征合并布加综合征16例

目的：探讨原发性肾病综合征合并布加综合征的病因、发病情况、临床特点及治疗方案。方法：对2001—2004年16例原发性肾病综合征合并布加综合征的临床资料进行回顾性分析。结果：原发性肾病综合征合并布加综合征为血栓形成所致，起病急，表现为肝脾肿大、进行性顽固性腹水、上腹痛、消化道出血、水肿等。积极治疗原发病，溶栓抗凝治疗能促进腹水消退，防治肝肾功能衰竭，防治血管狭窄，缩短病程。介入治疗尤其局部溶栓术在短期内更能明显改善患者临床症状和实验室指标。结论：临床上应提高对本综合征的认识，对疑似病例应尽早做相关影像学检查以明确诊断，并根据病情制定恰当的治疗方案。     

Intermittent Preexcitation: Marked Enhancement of Anterograde Conduction in the Atrioventricular Accessory Pathway with Isoproterenol

A 29-year-old man presented with intermittent preexcitation and exertional syncope. Electrophysiological evaluation in the control state demonstrated a single, left posterior free-wall atrioventricular accessory pathway. The anterograde and retrograde effective refractory periods and block cycle lengths were long in the control state. No tachycardias were induced during programmed electrical stimulation. After intravenous administration of isoproterenol, anterograde conduction of the accessory pathway was markedly enhanced (block cycle length shortened 45% to less than 240 ms) and rapid antidromic reciprocating tachycardia (CL = 250 ms) associated with syncope was observed. Following successful surgical dissection of the accessory pathway the patient has been without tachycardia or exertional symptoms. We conclude that, under the influence of exercise or emotion, patients with intermittent preexcitation may be at risk for serious arrhythmias.     

高嗜酸性粒细胞综合征的临床及实验室特征研究

目的 探讨高嗜酸性粒细胞综合征(HES)各亚型的临床及实验室特点,尤其是骨髓及外周血涂片中嗜酸性粒细胞的形态学特征.方法 回顾性分析该院2017-2020年63例HES患者的临床和实验室资料,复检外周血和骨髓涂片中嗜酸性粒细胞的形态学特征.结果 63例H ES患者中有反应性HES患者54例,特发性HES患者9例.反应性...     

A Case of Delayed Presentation of Thigh Compartment Syndrome

Background

Thigh compartment syndrome is a rare and devastating process. It generally occurs within hours to days of a traumatic event, although cases have been reported nearly 2 weeks after the initial event.

Objectives

To evaluate the literature describing the timing between inciting event and presentation of thigh compartment syndromes, with a focus on delayed presentations of this rare condition. To describe the unique properties of thigh compartments, and finally, to review the anatomy and techniques needed to measure the compartment pressures of the thigh.

Case Report

A case of a 54-year-old man is presented. He sustained trauma to his thigh 17 days prior to presenting to our ED with severe, sudden-onset pain in his right thigh. Compartment pressures were measured and confirmed the diagnosis of compartment syndrome caused by two large intramuscular hematomas. No other contributing events were identified.

Conclusions

Compartment syndrome in the thigh should be considered in patients with a concerning examination and a history of recent trauma. This particular case represents the longest reported time between injury and development of a thigh compartment syndrome.     

单纯阻断肾静脉左肾静脉下移治疗胡桃夹综合征的临床护理

目的探讨单纯阻断肾静脉左肾静脉下移治疗胡桃夹综合征围手术期的护理。方法回顾性分析总结6例单纯阻断肾静脉左肾静脉下移术后患者围手术期护理过程及经验。结果对6例单纯阻断肾静脉左肾静脉下移术的护理要点包括心理护理、尿道准备、术后特殊体位的护理;血尿的观察及腹膜后出血、血肿等并发症的严密观察。结论良好的具有针对性的全程性护理对单纯阻断肾静脉左肾静脉下移术治疗胡桃夹综合征的成功至关重要。