胸液胆固醇对胸膜腔积液渗漏性的鉴别诊断价值

目的探讨胸液胆固醇浓度（Pch）及胸液与血清中胆固醇浓度（Sch）的比值（P／Sch）对胸膜腔积液渗漏性的鉴别诊断价值。方法检测154例胸腔积液患者Pch、Sch、胸液乳酸脱氢酶（PLDH）、血清乳酸脱氢酶（SLDH）、胸液蛋白质（Pprot）、血清蛋白质（Sprot）；并计算出P／Sch、胸液与血清蛋白比值（P／Sprot）、胸液与血清乳酸脱氢酶比值（P／SLDH）。分别研究Pch和P／Sch对胸膜腔积液渗漏性诊断的敏感性和特异性，并与Light标准等进行比较。结果Pch和P／Sch对胸膜腔积液渗漏性诊断的敏感性分别为91.5％和96.1％，特异性分别为87.5％和95.8％。P／Sch对胸膜腔积液渗漏性诊断的敏感性高于PLDH和P／Sprot(P＜0.05)，特性性高于Light标准和P／Sprot（P＜0.05）。结论Pch及P／Sch对胸膜腔积液的渗漏性具有很高的鉴别诊断价值。     

C反应蛋白在胸腔积液诊断中的价值

目的：研究C反应蛋白（C－rective protein,CRP)在区分渗出性和漏出性胸腔积液中的价值，以及在渗出性胸腔积液鉴别诊断中的作用。方法：测定89例胸积液患者胸不及血清CRP水平，比较渗出液（74例）与漏出液（15例）之间，以及不同原因所致渗出液之间CRP水平的差别，结果：渗出液组胸水CRP，胸水CRP／血清CRP明显高于漏出液组（P均＜0．01），肺炎旁性胸腔积液组胸水CRP，血清CRP，胸水CRP／血清CRP明显高于结核性胸膜炎组及癌性胸水组（P均＜0．01），若以胸水CRP＞30mg.L，作为渗出液的计算标准，其敏感性为93．2％，特异性为86．7％，正确指数为92．1％，结论：胸水CRP水平有助于区分渗出性和漏出性胸腔积液，并有助于区分肺炎旁性胸腔积液与其他原因引起的渗出液。     

46例充血性心力衰竭导致胸腔积液分析

目的：探讨充血性心力衰竭致胸腔积液误诊原因。方法：对46例充血性心力衰竭合并胸腔积液患者进行分析。结果：院前误诊结核性胸膜炎22例、支气管肺炎8例、8例院前诊断充血性心力衰竭入院后胸水为渗出液误诊为结核性胸膜炎，8例为胸水原因待查。结论：老年人出现胸腔积液，尤其是双侧胸腔积液，要考虑为心源性胸腔积液可能性大，心源性胸腔积液多为漏出液，但有时可表现为渗出液。     

CT值对良恶性胸水的诊断价值

目的探讨CT值对胸水渗出液、漏出液以及其良恶性的诊断价值.方法对82例已确定胸水性质的患者做胸部CT检查,测定其CT值,按胸水性质分组,进行统计分析.结果癌性胸水组CT值大于结核性胸水组(P＞0.01);癌性胸水组、结核性胸水组CT值大于漏出液组(P＞0.01).结论胸部CT值对胸水性质有鉴别意义.     

高龄胸腔积液31例临床分析

本科1994年1月至1997年12月收治高龄胸腔积液五例，现分析如下。临床资料一般资料：31例患者均为70岁以上的老人，年龄最大的86岁。女性20例，男性11例。发病至就诊时间平均2．3个月。临床表现：31例均表现为胸闷、气息、食欲下降、乏力。痰血5例，发热1例，关节疼痛2例，夜间阵发性呼吸困难2例。胸水性质：血性14例，其中结核性2例，结缔组织疾病1例，恶性11例；黄色17例。尽例介于渗出液和漏出液之间，27例为渗出液。胸水乳酸脱氢酶（LDH）检查＞20OU者27例，其中良性胸水5例。胸水癌胚抗原（CEA）检查＞10U者5例，均为恶性。X线胸片…     

不同病因胸腔积液经细管引流前后性质变化特点

摘要：目的 分析不同病因的患者胸腔积液（胸液）引流前后性质及细胞学变化特点。方法 收集天津市胸科 医院呼吸与危重症医学科一病区2016年4月—2017年12月179例中、大量胸液患者资料,根据胸液病理及理化等特 点将其分为结胸组37例、恶性组87例、炎症组39例和心衰组16例。经胸腔置细管引流500~1 000 mL胸液,于引流 前及引流24 h后分别留取标本4 mL,对白蛋白、乳酸脱氢酶（LDH）、白细胞、单核细胞、多核细胞及间皮细胞变化特 点进行统计学分析。结果 结胸组、炎症组、恶性组胸液引流前后基本仍为渗出液。心衰组引流后5例（83.33%）渗 出液变为漏出液。引流前,恶性组、炎症组、心衰组患者胸液白细胞计数均低于结胸组;引流后,该3组仍低于结胸 组,且炎症组、心衰组低于恶性组（P＜0.05）;恶性组引流后白细胞升高（P＜0.05）。引流前,恶性组、炎症组、心衰组 胸液单核细胞计数低于结胸组;引流后,炎症组、心衰组仍低于结胸组;恶性组引流后升高（P＜0.05）。4组患者引流 前、引流后组间,且各组引流前后多核细胞计数差异均无统计学意义（P＞0.05）。引流前,恶性组胸液间皮细胞计数 高于其他3组;引流后,恶性组间皮细胞计数下降,但仍最高（P＜0.05）。结论 慢性充血性心力衰竭伴胸液者引流 前后性质变化较大。肺癌所致恶性胸液者引流前后细胞成分变化较大。对于胸液性质及病理结果的可靠性需结合 标本送检时间谨慎判读。     

流式细胞仪分析联合CEA检测对结核性和癌性胸腔积液鉴别诊断价值探讨

目的探讨流式细胞仪分析联合CEA检测对结核性和癌性胸腔积液鉴别诊断价值。方法采用流式细胞仪联合CEA检测对26例恶性胸水和36例结核性胸水脱落细胞做DNA含量测定、细胞周期分析。结果 CEA：恶性组为（70.15±65.23）ng/ml;结核组为（7.92±3.51）ng/ml,两组比较差异有显著性（P〈0.01）。恶性组胸水G2/M、S期细胞比例明显高于结核组（P〈0.01）,而G0/G1期明显低于结核组（P〈0.01）。胸水CEA检测对恶性胸水诊断敏感率为76.9%,特异性为90.9%;胸水DNA含量分析对恶性胸水诊断敏感率为73.1%,特异性为100.0%,若两者同时阳性其敏感率57.7%,特异性为100.0%,若两者之一阳性敏感率92.3%,特异性为88.5%。结论联合应用胸水CEA和流式细胞分析,可使恶性胸水诊断率提高,有助于提高良恶性胸水的鉴别诊断。     

64例老年性双侧胸腔积液临床分析

目的：探讨老年性双侧胸腔积液临床表现、病因、诊断、及鉴别诊断。方法：对所有患者均进行胸腔B超、X线、CT检查和胸水常规生化检查。结果：临床表现无特异性，恶性胸腔积液26例(40．6％)，心功能衰竭21例(32．7％)，结核5例(7．8％)，非特异性细菌感染4例(6．25％)，其它疾病8例(12．48％)。胸水为渗出液35例，其中恶性胸腔积液22例，心衰2例；胸水为漏出液20例，其中心衰15例，恶性胸腔积液1例；胸液界于二者之间9例，其中恶性胸腔积液3例，心衰4例，心包炎1例，结核1例。结论：老年性胸腔积液临床无特异性表现，以恶性胸腔积液最多，心衰次之，结核和非特异性细菌感染占第三、四位，单纯用渗出液和漏出液鉴别病因可导致误诊。     

ADA、CRP、LDH及CEA在良恶性胸腔积液中的诊断价值

目的探讨腺苷脱胺酶(ADA)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)及癌胚抗原(CEA)在良恶性胸腔积液中的诊断价值。方法对50例漏出液、50例渗出液、100例恶性胸腔积液患者分别行ADA、CRP、LDH及CEA检查,比较不同疾病中上述指标的浓度及诊断的准确性。结果 ADA在渗出液中的浓度显著高于漏出液及恶性胸腔积液(P<0.05)。CRP在渗出液中具有最高浓度(P<0.05)。LDH在漏出液、渗出液、恶性胸腔积液中的浓度依次升高(P<0.05)。CEA在恶性胸腔积液中的浓度要显著高于其余两类胸腔积液(P<0.05)。结论 LDH在漏出液的诊断中具有较高的价值,CRP及ADA具有较好的诊断胸腔渗出液的价值,CEA对恶性胸腔积液具有较好的诊断价值。     

125例胸腹水蛋白质分析

目的：探讨胸腹水中蛋白质的变化，与疾病诊断、治疗及预后的相关性。方法：总蛋白与白蛋白测定分别采用双缩脲法与溴甲酚绿法经全自动生化分析仪检测；纤维蛋白原测定根据凝固法原理经全自动血凝仪进行检测；C-反应蛋白测定利用全自动生化仪检测。结果：漏出液中总蛋白、白蛋白、纤维蛋白原和C-反应蛋白的平均含量分别为16．6g/L、11．7g/L、0．57g/L和3．60mg／L，而渗出液中分别为34．5g/L、19．5g/L、1．42g/L和17．60mg／L。结论：胸腹水中各蛋白质成分的含量变化范围较大，可能与胸腹水形成的病因及其部位与疾病的病理过程相关。此外，渗出液C-反应蛋白水平较漏出液明显增高，提示检测胸腹腔积液C-反应蛋白水平可能有助于渗出液与漏出液的鉴别．也将有助于了解机体内的病理生理反应过程。     

Blockade of hoarding in rats by diazepam: an analysis of the anxiety and object value hypotheses of hoarding

The security hypothesis suggests food hoarding by rats serves to preempt attack and therefore might be motivated by anxiety. The object value hypothesis suggests rats hoard objects that they perceive as valuable as related to some state or need. These hypotheses were evaluated with the anxiolytic drug diazepam, which is purported to both decrease anxiety and increase motivation to eat, and which accordingly either may decrease or increase hoarding. Using a new hoarding paradigm, diazepam (Valium: 0.25–5 mg/kg), was found to produce a dose-related reduction in hoarding that was dependent upon food pellet size and that was reversed by flumazenil (Ro 15-1788), a benzodiazepine receptor antagonist. Diazepam also slowed eating speed, blocked dodging, a movement used to initiate hoarding, and impaired spatial navigation in a learning-set swimming pool task. The results fail to support the object value hypothesis of hoarding. Since perception of food size, motivation, motor ability and spatial abilities all probably contribute to successful food hoarding, the results provide several explanations other than, or in addition to, anxiety reduction for the drug's effects on hoarding. Nevertheless, the study provides a number of new sensitive measures of the effects of anxiolytic drugs and new insights into their behavioral effects.     

Does Resilience Moderate the Relationship Between Stress and Smoking Status?

Background: There is a growing evidence that resilience to stress can promote nonsmoking. However, few studies have undertaken quantitative research to investigate whether resilience, generated by internal and external factors, moderates the impact of stress on the likelihood of smoking. Objective: This study aims to help fill this knowledge gap in relation to smokers and ex-smokers, and those people who have never smoked. Methods: A large online cross-sectional survey was administered in Australia (2015–2016) to collect data on demographic variables, levels of internal and external resilience, and stress from current and past smokers (n?=?400) and those who have never-smoked (n?=?921). Logistic regressions were employed to test our hypotheses. Results: Most participants were female (82%) and ranged between 18 and 77?years. Higher levels of reported perceived stress and stress-related variables did significantly predict smoking. The combined impact of internal and external resilience factors predicted never-smoking and lessened the relationship between perceived stress and stress-related variables, and the likelihood of smoking. Conclusion: These results are important because they suggest that the social environment should be developed to augment social support and internal properties such as developing “a strong sense of purpose in life” to encourage people not to commence smoking, rather than focus on smoking cessation.     

Addiction medicine and domestic violence

Domestic violence is a major medical and legal problem, resulting in a great many deaths and injuries each year. Alcohol and other drug dependencies are frequently found in both the perpetrators and victims of violence. This fact gives addiction medicine practitioners a unique opportunity to intervene in both life-threatening disorders. This article gives diagnostic and intervention guidelines for dealing with the issue of domestic violence in the addiction medicine patient population.     

Sensitivity of morphine-tolerant rats to muscarinic and dopaminergic agonists: Relation to tolerance or withdrawal

Male hooded Wistar rats were treated chronically once daily with morphine sulfate (20 mg/kg SC) after completing a session in an operant chamber. Periodical challenges with morphine (8 mg/kg) prior to the operant session established that tolerance development was virtually complete within 10 days. The morphine-treated rats were more sensitive to the behavioral suppressing effects of apomorphine, a dopamine agonist, and pilocarpine, an acetylcholine agonist, when administered in the tolerant state (morphine given 30 min prior to operant session), regardless of whether they were administered peripherally or directly into the striatum. Conversely, the morphine-treated rats were less sensitive to both agonists when administered in the withdrawal state (morphine given 24 h prior to the operant session). In animals undergoing a similar regimen of chronic morphine treatment, receptor binding studies revealed a lowered affinity (Higher K _D apparent) for the dopamine receptor in the striatum of morphine-withdrawn rats, using ³H-spiroperidol as the ligand. The morphine-withdrawn rats also appeared to have fewer muscarinic cholinergic receptors (lower B _max), using ³H-QNB as the ligand. The also had a lower concentration of membrane-bound phosphodiesterase modulator protein. In general, no significant differences were observed for the above parameters in the morphine-tolerant rats. These behavioral and neurochemical studies are consistent with the view that morphine-tolerant rats are supersensitive to dopamine and acetylcholine agonists and morphine-withdrawn rats are subsensitive.     

急重症自发性颅内出血的脑血管造影和栓塞处理

目的总结急重症自发性颅脑出血患者的血管内诊治中遇到的问题，找出解决对策。结果2例出现脑缺血表现，其中1例出现永久并发症；80％患者出现术中不配合，需要有效的镇静措施。     

Shaving effects on percutaneous penetration: clinical implications

Context: Human/animal shaving biology.

Objective: To assess the effect of shaving on percutaneous penetration and skin function.

Methods: We screened 500+publications in Pub Med, Scopus, Cochrane Library and pertinent journals out of which only 17 were deemed relevant. Terms for searches included shaving and skin, percutaneous penetration and shaving, skin absorption and shaving, absorption of dyes and shaving, skin penetration, effects of shaving and absorption, shave and dyes, axillary shaving and stratum corneum, shaving and breast cancer, shaving and infections, etc.

Result: Shaving appears to have an exaggerated effect on percutaneous absorption; however, some studies do not support this evidence.

Conclusion: Shaving enhances percutaneous penetration of some chemicals; however this effect is species and chemical specific. Further investigations of chemicals of varying physio-chemical properties are mandated before a generalized theory can be promulgated.     

十二指肠损伤的临床特点及诊治

目的探讨十二指肠损伤的临床特点及手术方法,以提高十二指肠损伤的诊治水平。方法回顾性分析1993-10～2003-11我科收治的30例十二指肠损伤患者的临床特点、诊治方法、手术方式及治疗效果。结果腹部X线透视、诊断性腹腔穿刺阳性率分别为24%(6/25)、30%(6/20)。单纯十二指肠损伤占20%(6/30),合并其他腹腔内脏器损伤占80%(24/30)。损伤部位以降部多见占46.67%(14/30),水平部次之占30%(9/30)。术后并发症发生率60%(18/30),病死率20%(6/30)。结论十二指肠损伤具有术前确诊率低、术中漏诊率高、合并损伤多的特点,故并发症发生率及病死率较高。因而掌握其特点,注重早期诊断、早期手术,根据术中具体情况选择简单而合理的手术方式是提高治愈率、降低病死率的关键。     

Decreased potency of CNS depressants after prolonged social isolation in mice

Summary The duration of hypnosis induced by hexobarbital, pentobarbital, chloral hydrate or barbital was markedly reduced after prolonged social isolation of male mice. Hexobarbital and pentobarbital were affected more than chloral hydrate and barbital. The onset of barbital hypnosis was not affected. The in vitro metabolism of hexobarbital by hepatic microsomal enzymes was enhanced in isolated mice with an overall increase in liver weight. Mice deprived of social interaction gained righting reflex at a higher body level of hexobarbital as compared to the undeprived animals. These data show that chronic deprivation of social stimuli in mice increased the drug-metabolizing activity of hepatic microsomes and raised arousal levels such that CNS susceptibility to drugs was altered.This investigation was supported by PHS Training Grant No. 1T01ES 00104 from the Division of Environmental Health Sciences.     

Understanding the molecular pharmacology of the serotonergic system: using fluoxetine as a model

Objectives Serotonin is a monoamine neurotransmitter that is widely distributed in the body and plays an important role in a variety of psychological and other body functions such as mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation and social behaviour. This review will assess the use of fluoxetine, one of the most commonly used selective serotonin reuptake inhibitors, as a model for understanding the molecular pharmacology of the serotoninergic system. Key findings Seven serotonin receptor families have been discovered to date. All serotonin receptors, except 5‐HT₃, are G‐protein coupled, seven transmembrane receptors that activate an intracellular second messenger cascade. The 5‐HT₃ receptor is a ligand‐gated ion channel. Furthermore, 5‐HT_1A receptors are known as autoreceptors since their stimulation inhibits the release serotonin in nerve terminals. A transporter protein found in the plasma membrane of serotonergic neurones is responsible for the reuptake of this neurotransmitter. Selective serotonin reuptake inhibitors, such as fluoxetine, act primarily at the serotonin transporter protein and have limited, if any, reaction with other neurotransmitter systems. Selective serotonin reuptake inhibitors appear to bind with the serotonin transporter with different rates of occupancy, duration and potency. Summary The following review focuses on the interaction of serotonin with this membrane transporter in the body and assesses the use of fluoxetine as a reference drug in the understanding of this interaction.