甲亢131I治疗后早发甲低相关因素分析

目的：探讨甲状腺功能亢进症（简称甲亢）^131I治疗后早发甲状腺功能减退症（简称甲低）的相关因素。方法：240例甲亢患者行^131I治疗，观察各影响因素并记录完整，1年内随访，对可能与早发甲低有关的多个因素用向前逐步筛选变量法行Logistic回归判别分析，对各研究指标行单因素X^2检验。结果：①多因素分析结果示患者年龄、甲状腺质量、发病情况、吸碘率曲线形态、给予患者每克甲状腺组织的^131I剂等5个因素与早发甲低发生相关；单因素分析结果示甲状腺质量、最高吸碘率、甲亢患者所服^131I剂量等3个因素与早发甲低相关。②经检验，Logistic回归方程有统计学意义。③对研究对象行Logistic回归判别即回代检验，早发甲低发生与不发生的准确性分别为64.08％、78.83％，总准确性为72.50％。结论：分类估算和调整给药剂量是治愈甲亢、降低早发甲低发生率的关键；加强随访和必要时补充甲状腺激素是减少早发甲低发展成永久性甲低的重要措施。     

99mTc-MIBI心肌灌注断层显像监测蒽环类药物的心脏毒性

目的 :探讨99mTc-MIBI心肌灌注断层显像在蒽环类药物心脏毒性监测中的价值。方法 :2 3例接受蒽环类药物治疗的患者 ,在治疗前进行心电图、心肌酶学检查、核素心室造影测左室射血分数 (LVEF)和99mTc MIBI心肌灌注断层显像并计算相对定量值。并于每一周期治疗后重复上述检查。结果 :蒽环类药物治疗一周期后 ,2 3例患者心肌相对定量值明显下降 (P <0 .0 1)。其中 11例吡喃阿霉素、6例表阿霉素和 6例米托蒽醌治疗的患者 ,心肌相对定量值明显下降 (P <0 .0 5 ) ,心电图和心肌酶学无明显变化 (P >0 .0 5 )。蒽环类药物治疗多周期后的 10例患者心肌相对定量值较治疗前下降 (P <0 .0 5 )。 9例患者的心肌相对定量值 (最大累积剂量为 2 0 0mg/m2 )与一周期后无明显差别 (P >0 .0 5 )。10例患者治疗前及多周期治疗后LVEF均 >6 0 %,且化疗前后无明显差别 (P >0 .0 5 )。结论 :99mTC MIBI心肌灌注断层显像能监测蒽环类药物所致的心肌损害 ,且较左室射血分数敏感 ,比心电图和心肌酶学检查优越 ,有利于指导蒽环类药物的临床应用。     

~(18)F-FDG PET/CT扫描早期诊断重症急性胰腺炎继发感染的探讨

目的探讨氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(~(18 )F-FDG PET/CT)在早期诊断重症急性胰腺炎(SAP)继发感染的评估价值。方法分别构建两种细菌(ATCC 25922和ATCC 25923)的SAP SD大鼠感染组模型,并以生理盐水构建对照组模型。分别在建模后0、1、3h检测动物全血细胞计数和血清淀粉酶,建模后3h行~(18)F-FDG PET/CT显像,并进行生物学分布、HE染色和Gram染色等验证PET显像结果。结果~(18 )F-FDG PET/CT显像提示,两种细菌感染组大鼠模型均显示胰腺部位的放射性浓聚灶;大肠埃希菌组、金黄色葡萄球菌组和生理盐水组靶(胰腺)/非靶(肌肉)比值(SUV)分别为4.22±0.61、4.32±1.21、2.26±0.35,两种细菌感染组模型动物SUV值无统计学差异(P0.05),大肠埃希菌感染组模型与对照组模型比较有统计学差异(P0.01)。生物学分布结果与PET显像结果一致。结论~(18)F-FDG PET/CT可以作为早期诊断SAP继发感染的检测方法。     

利用报告基因rNIS监测大鼠骨髓间充质干细胞移植大鼠心肌的可行性研究

Objective To investigate the feasibility of rat sodium/iodide symporter (rNIS) as a reporter gene monitoring rat bone marrow mesenchymal cells (rBMSC) transplanted to rat myocardium in vivo.Methods Recombinated adenovirus vector was constructed by rNIS/enhanced green fluorescence protein (EGFP) (Ad-rNIS/EGFP).rBMSC transfected by Ad-rNIS/EGFP were studied using fluorescence microscope.Fifteen rats were transplanted with rBMSC and randomly divided into three groups:rNIS group (with rNIS transfection), blocked group (with rNIS transfection) by oral intake of perchloric sodium before planar imaging(GE Millennium MPR SPECT), and control group (without rNIS transfection).All rats underwent 99Tcm-pertechnetate planar imaging.The biological distribution of 99Tcm-pertechnetate was studied.The expressions of rNIS gene and protein in myocardium were measured by real time polymerase chain reaction (PCR) and western blot, respectively.The expressions of CD29, CD44, CD90, CD11b, CD34 and CD45 were measured by immunohistochemistry.Results rBMSC transfected by Ad-rNIS/EGFP showed EGFP expression under fluorescence microscope.The transplanted rat myocardium could be visualized on 99Tcm-pertechnetate planar imaging in rNIS group.The relative uptake ratio( Rheart/Rhmb, RUR) was 6.7 ±0.4.RUR in control group (3.0 ±0.2) was lower than that in rNIS group (t =2.78, P=0.03).The percentage injection dose per gram of tissue (% ID/g) of the transplanted myocardium was 60.2 ± 20.8 in rNIS group,which was higher than that (2.5 ± 0.4) % ID/g of control group ( t = 7.13, P＜0.001 ).rNIS gene and protein were highly expressed in transplanted myocardium in rNIS group but less expressed in control group.The expressions of CD29, CD44 and CD90 were positive, CD45 and CD45 negative CD11b mildly positive in the myocardium transplanted with infective rBMSC.Conclusion rNIS can efficiently monitor rBMSC transplanted to rat myocardium.     

Rh2逆转耐药细胞对顺铂抗性作用的机制

目的 探讨人参单体Rh2逆转肺腺癌耐药A549DDP细胞对顺铂抗性作用的机制.方法 以Rh2单独作用为Rh2组,低效浓度的顺铂单独作用为DDP组,二者联合作用为Rh2+DDP组,不加药物干预为对照组,紫外光分光光度计检测各组细胞的线粒体PTP开放情况,流式细胞仪检测细胞内钙离子浓度及线粒体跨膜电位的变化及细胞凋亡状况,Western印迹检测细胞色素C及Caspase-3表达;Hoechst33258染色荧光显微镜下观察细胞形态的变化.结果 Rh2组和DDP组细胞内钙离子浓度与对照组的接近,Rh2+DDP组细胞内钙离子浓度升高,与对照组比较,差异有统计学意义(t=22.47,P<0.01).前3组细胞的线粒体吸光度(A540nm)值接近,而Rh2+DDP组A540nm值明显低于对照组(t=8.21,P<0.01).前3组线粒体跨膜电位接近,Rh2+DDP组细胞内线粒体跨膜电位明显低于对照组(X~2=46.01,P<0.01).前3组细胞的胞质中细胞色素C和Caspase-3表达极低,Rh2+DDP组细胞色素C和Caspase-3高表达.荧光显微镜下,前3组细胞核荧光分布均匀;Rh2+DDP组的细胞核数目减少,荧光成团块分布,很多细胞核缩小或变形.前3组凋亡细胞百分率分别为6.32%、7.24%、7.41%,3组间差异无统计学意义,Rh2+DDP组凋亡细胞百分率为21.96%,与对照组差异有统计学意义(t=10.92,P<0.05).结论 无毒浓度的Rh2逆转A549DDP细胞对顺铂的耐药性作用可通过线粒体凋亡通路实现.     

老年肱骨近端骨质疏松性骨折的临床治疗策略

目的探讨老年肱骨近端骨质疏松性骨折的治疗方法与疗效。方法本组病例收集自2003年3月—2010年3月,共51例,其中男22例,女29例,年龄55~74岁,平均(63.6±7.4)岁。按Neer分型:二部分骨折21例,单纯三部分骨折18例,三部分合并关节脱位3例,单纯四部分骨折9例。其中2例三部分骨折合并关节脱位及7例四部分骨折采用半肩关节置换术,其余均采用锁定加压钢板内固定治疗。随访时间5~34个月,平均(17.6±6.4)个月。结果患者分别按Neer肩关节功能评分标准评估,未见显著性差异。结论锁定加压钢板内固定术是治疗老年肱骨近端骨质疏松性骨折有效选择之一,半肩关节置换为复杂肩关节损伤提供了一个有效的治疗手段。     

含HN基因的重组鸡痘病毒抑制骨肉瘤细胞SAOS-2的体外实验研究

目的探讨含HN的重组鸡痘病毒（rFPVHN）对骨肉瘤细胞SAOS-2的抑制效应。方法以rFPVHN感染人骨肉瘤细胞SAOS-2,应用MTT法检测细胞活性,罗丹明123结合FACS测定线粒体跨膜电位,测定肿瘤细胞表面唾液酸含量,底物染色反映检测Caspase-3活性。结果 rFPVHN感染可有效抑制SAOS-2肿瘤细胞,杀伤率达58.9%。感染使SAOS-2肿瘤细胞线粒体膜电位下降,导致SAOS-2肿瘤细胞凋亡。细胞表面唾液酸水平明显下降;Caspase-3活性被激活。结论 rFPVHN可诱导SAOS-2肿瘤细胞凋亡。     

骶骨骨巨细胞瘤的外科治疗

目的 探讨骶骨骨巨细胞瘤外科切除边界与局部复发率及骶神经保留节段与神经功能的关系.方法 对1996年8月至2008年8月行肿瘤切除的48例骶骨骨巨细胞瘤患者进行回顾性分析,男20例,女28例;年龄19～74岁,平均34.7岁.肿瘤累及S1～S5 4例,S1～S4 7例,S1～S3 15例,S1,2 12例,S2～S5 8例,S3～S5 2例.采用单纯后路29例,前后联合入路19例.整块切除2例,边缘切除12例,边缘切除加刮除25例,刮除9例.术后定期随访,观察局部复发情况与骶神经功能.结果 41例随访18～115个月,平均43.5个月.术中出血量550～12000 ml,平均3560 ml.1例发生良性肺转移,2例发生肉瘤变后死亡.15例肿瘤原位复发,其中整块切除复发率0(0/2)、边缘切除18.2%(2/11)、边缘切除加刮除40.9%(9/22)、单纯刮除66.7%(4/6).边缘切除局部复发率低于单纯刮除,差异有统计学意义.保留双侧S3神经根者大小便功能障碍发生率7.4%(2/27),保留单侧S3神经根者33.3%(4/12),差异有统计学意义.结论 外科切除边界与骶骨骨巨细胞瘤局部复发率相关,在注意保留骶神经根的前提下应以边缘切除为目标;保留双侧S3神经根可使绝大部分患者的括约肌功能得以恢复.

Abstract：

Objective To discuss the relations between optimal surgical margin and local recurrence and the impact of preserving segment of sacral nerve root on neural functions based on the clinical and pathological features of giant cell tumor(GCT).Methods From August 1996 to August 2008,48 patients with sacral GCT undergoing tumor resection were respectively analyzed,including 20 males and 28 females with an average of 34.7 years(range,19-74).The tumors were located in S1-S5 in 4 patients,S1-S4 in 7,S1-S3 in 15,S1,2 in 12,S2-S5 in 8,and S3-S5 in 2.Surgical methods included single posterior approach in 29 cases,combined anterior-posterior approach in 19.The surgical margins adopted were en-bloc in 2 patients,marginal in 15,marginal and curettage in 25,and curettage in 9.Results Forty-one of 48 cases were successfully followed up,the average time was 43.5 months(range,18-115).The average blood loss during surgery was 3560 ml(range,550-12 000).Benign lung metastasis occurred in one case 6 years after operation,2 patients died of malignant transformation.Local recurrence occurred in 15 cases.The recurrence rates in patients with en-bloc resection,marginal resection,marginal resection combined with curettage,and curettage were 0,18.2%,40.9%,66.7%,respectively.The recurrence rate of marginal group was significantly lower than that of the curettage group.Of 27 cases with bilateral S3 nerve root preservation,2 sufiered from urine or fetal dysfunction.with an incidence rate of 7.4%.While 4 of 12 patients with unilateral S3 nerve root preservation suffered from sphincter disturbance,with an incidence rate of 33.3%.The significant difference between groups in nerve root preservation was confirmed.Conclusion Optimal surgical margin for sacral GCT is of great importance to local control of tumor recurrence,the surgical procedure of sacral GCT should aim at the marginal resection on the basis of rational sacral nerve roots preservation;preservation of bilateral S3 nerve roots contributes to the recovery of sphincteral function in most patients.     

县医院健康教育版面宣传效果分析

健康教育版面宣传是一种有效手段和方法 ,县医院健康教育版面宣传教育是传播健康知识 ,预防疾病 ,使病人早日康复的主要形式之一 ,各级医院均广为采用 ,但版面宣传的效果如何是一个值得探讨的问题 ,阜宁县人民医院院预防保健科对此进行了专题调查分析。为了解健康知识版面宣传效果及广大病员和家属等人员所要求的健康知识情况 ,阜宁县人民医院于 1 999年第三季度对健康教育宣传栏刊出的 30多块健康知识版面随机抽取 2 1 8名观众进行现场效果询问调查。方　　法1 由观众先观阅健康知识版面 ,时间在 1个小时内 ,随后再到指定地点当场接受专业…     

新生儿重度缺氧缺血性脑病的护理

通过对我院新生儿科1998—02～2000—06收治的18例重度新生儿缺氧缺血性脑病治疗方案的3项对症处理(控制惊厥，降低颅内压，消除脑干症状)及3项支持疗法(保持呼吸道通畅，纠正休克，维持血糖高值)，在执行治疗及护理过程中密切观察患儿的脑干症状、惊厥情况及前囱张力的变化，加强监测各项生命体征，准确抽取血标本检查血气、血糖及电解质的变化等，维持良好的通气、换气功能是配合抢救成功的关键。使重度缺氧缺血性脑病治愈率、好转率达66．7％，疗效满意。