住院患者入院时血糖水平与医疗费用、疾病预后的相关研究

目的探讨住院患者人院时不同血糖水平与住院时间、医疗费用及疾病预后的关系。方法选取2009年11月至2011年7月期间人院的4868例患者,按入院24h内测得的血糖水平分为非高血糖组3429例、高血糖组1439例,后者包括糖尿病和应激性高血糖患者;根据患者年龄分为非老年组（年龄〈60岁）2532例和老年组（年龄≥60岁）2336例;其中278例冠心病患者再分为高血糖组120例和非高血糖组158例。各组间进行有关数据比较。结果高血糖组患者的住院天数、医疗费用和总病死率均显著高于非高血糖组（中位数住院日：15vs10d,P〈0．01;中位数医疗费用：14064．7vs8980．9元,P〈0．01;死亡率：2．92％vs0．61％,P〈0．01）。按年龄分组后,无论是非老年组还是老年组中糖尿病和应激性高血糖患者的医疗费用均明显高于非高血糖患者,住院日明显延长;应激性高血糖患者的医疗费用明显高于糖尿病患者;非老年组中应激性高血糖患者的死亡率明显高于非高血糖患者,但与糖尿病患者相比无明显差异,老年组糖尿病和应激性高血糖患者的死亡率无明显差异,但均明显高于非高血糖患者。冠心病患者中糖尿病和应激性高血糖患者与非高血糖患者的年龄无明显差异,前两组的医疗费用明显高于非高血糖组,住院日更长（分别为14,15和12d）、死亡率更高（分别为6．41％,7．14％和0．63％）。结论入院时高血糖水平预示患者有更高的医疗花费、更长的住院时间和更高的死亡率。     

心脏型肌球蛋白结合蛋白C基因缺失突变导致肥厚型心肌病特点分析

目的观察肥厚型心肌病（HCM）患者心脏型肌球蛋白结合蛋白C基因（MYBPC3）缺失突变及其表型的特点。方法在100例HCM患者中对MYBPC3的所有外显子及其侧翼内含子序列进行基因扫描,聚合酶链反应（PCR）扩增目的片段,双脱氧末段终止法测序。对突变患者进行家系调查,分析其表型特点。结果在两例先证者中分别发现两个缺失突变14262_14264delAAG和14364delG,均位于外显子25。表型分析发现两例先证者均有劳力性胸闷、胸痛和晕厥史,超声心动图表现为不对称性肥厚（室间隔/左室后壁分别为2.5、3.2）,但SAM征阴性,发病年龄分别为38岁和29岁。结论缺失突变是MYBPC3基因突变的常见形式,14262_14264delAAG或14364delG突变导致的HCM表现为不对称性心肌肥厚,患者容易出现晕厥等症状,应该警惕心源性猝死的发生。     

高糖对小鼠胰岛和胰岛b细胞株INS-1E的长期作用

目的探讨高糖对胰岛B细胞INS-1E和小鼠胰岛的慢性作用。方法雌性NMRI小风6-10周龄,苯巴比妥腹腔注射麻醉,应用胶原酶技术消化胰腺分离胰岛。传代培养的INS-1E细胞和分离的小鼠胰岛分别于含11．1,25．0mmol/L葡萄糖的RPMll640培养液中培养72h,然后于含3．3,16．7mmol／L葡萄糖的Krebs-Ringer缓冲液中培养60min,留取上清液行胰岛素测定。INS-1E细胞在含不同浓度的葡萄糖的RPMI1640培养液中培养72h,提取其总RNA,合成相应的cDNA,再行RT-PCR检测胰十二指肠同源异形盒-1（Pdxl）,胰岛素1（Insl）,胰岛素2（Ins2）和葡萄糖转运子2（Glut2）的基因表达。结果高糖培养后INS-1E细胞和小鼠胰岛的基础INS分泌增加[INS-1E细胞：（10．47±0．78）vs（7．71±0．59）ng／10000细胞,P〈0．01;小鼠胰岛：（3．85±0．26）vs（2．18±0．21）μg／L,P〈0．001],糖刺激的INS分泌减少[INS-1E细胞：（17．11±1．98）vs（30．76±2．20）ng／10000细胞,P〈0．001;小鼠胰岛：（14．78±1．03）VS（20．46±1．49）μg／L,P〈0．01];高糖处理后INS-1E细胞的Pdxl,Insl,Ins2和Glut2的mRNA水平下降。结论高糖对胰岛β细胞具有慢性毒性作用。     

2006～2010年湖北省流行性脑脊髓膜炎病原学和血清学监测分析

目的分析湖北省2006～2010年流行性脑脊髓膜炎(流脑)病原学和血清学监测结果,掌握湖北省流脑的变迁规律。方法对2006～2010年分离的脑膜炎奈瑟菌(Nm)菌株进行生化鉴定、血清学分型和药物敏感性检测,并采用多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)方法进行分子分型;对所有的脑脊液和血液标本进行Nm种属特异性荧光PCR检测;对健康人群血清,运用血清杀菌试验(SBA)进行C群杀菌力抗体水平测定。结果 2007年湖北省Nm以B群为主,2008～2010年以来C群为优势菌群;对青霉素等6种抗生素均敏感,但对环丙沙星、米诺环素、萘啶酸、复方新诺明4种抗生素出现多重耐药;分子分型结果显示,湖北省B群Nm菌株具有高度的遗传多样性,未发现明显优势的克隆群,C群优势病原株为ST-4821型。RT-PCR检测(988份脑脊液)确诊29例流脑病例,其中C群22例,A群2例、B群5例。C群杀菌力总保护率(抗体滴度≥1︰8)为38.10%。结论湖北省流脑菌株发生了从B群散发到C群流行的变迁,人群对C群Nm的免疫力不足。     

Potentiometric and UV-Vis spectrophotometric titrations for evaluation of the antioxidant capacity of chicoric acid

The antioxidant capacity (AOC) of chicoric acid (ChA, the main antioxidant component of Echinacea) or an ethanol/water-extract of Echinacea flowers was determined by potentiometric and UV-Vis absorption spectrophotometric titrations with ABTS˙⁺ radical cations as the oxidizing probe. The potentiometric and spectrophotometric titration results agreed well with each other. The trolox-equivalent antioxidant capacity (TEAC) of ChA was found to be 5.00 ± 0.07 (potentiometry) and 4.81 ± 0.06 (spectrophotometry) at pH 7.4, and the TEAC value has been proven to be actually equal to the ratio of the stoichiometric ratio of the ABTS˙⁺–ChA redox reaction to that of the ABTS˙⁺–trolox redox reaction. The TEAC of the ethanol/water-extract of Echinacea flowers, expressed in mM (trolox) per gram per liter (Echinacea extract), was found to be 0.241 ± 0.006 mmol g⁻¹ (potentiometry) and 0.240 ± 0.007 mmol g⁻¹ (spectrophotometry) at pH 7.4. The stoichiometric ratio of the ABTS˙⁺–ChA redox reaction varied from 10.8 to 3.2, depending on the solution pH and the final ABTS˙⁺–ChA concentration ratio. However, the stoichiometric ratio of the ABTS˙⁺–trolox redox reaction remained ca. 2.0 at various solution-pH values and final ABTS˙⁺–trolox concentration ratios. The unusual stoichiometric ratio of the ABTS˙⁺–ChA redox reaction is examined by potentiometric/spectrophotometric titrations and cyclic voltammetry, clearly revealing the new mechanism of a rapid redox process followed by a slow redox process at pH 7.4 and 9.0 when the ABTS˙⁺–ChA molar concentration ratio is greater than 4. The electrochemistry methods coupled with spectrophotometry can conveniently and reliably provide important quantitative and qualitative information on redox chemistry, and are expected to find wider applications in accurately evaluating the redox activities of many other natural/synthesized antioxidants and oxidants.

Potentiometric/spectrophotometric titrations have revealed the antioxidation behavior and mechanisms of chicoric acid (ChA, versus trolox) against ABTS˙⁺ radical cations.     

耻骨上辅助经脐单孔腹腔镜上尿路全切除术（附8例报告）

目的：探讨耻骨上辅助经脐单孔腹腔镜（SA—LESS）上尿路全切除术的可行性、有效性和技术要点。方法：对2例肾盂癌,2例输尿管癌,1例肾盂癌合并输尿管癌,2例肾结核,1例巨输尿管症并积脓、肾萎缩患者施行SA—LESS上尿路全切除术。患者全麻,取健侧70°卧位,于脐缘内侧置人两个Trocar,自患侧耻骨联合上方置人一个Trocar,分别置入远端可弯曲腹腔镜及操作器械。先游离患侧输尿管下段,予Hem—0—lok夹闭;向上游离肾脏并离断。肾动静脉,切除肾脏;向下行袖套状切除输尿管末端周围膀胱壁,缝合膀胱切口;标本装袋,延长耻骨上切口取出。结果：8例手术均顺利完成。中位手术时间165（115～220）min,术中中位失血量140（50～200）ml。均未输血,术中未出现肠管、实质性器官和大血管损伤等并发症。均于术后第1天下床活动,第2～3天拔除腹腔和盆腔引流管,第6～7天拔除导尿管（肿瘤患者行膀胱灌注后）,第8天出院。结论：SA-LESS上尿路全切除术安全可行,术后恢复快,住院时间短,美容优势明显,值得临床应用。     

肾上腺淋巴管瘤1例报告并文献复习

目的：探讨肾上腺淋巴管瘤的临床特点、诊断、髂别诊断、治疗及预后。方法：回顾性分析1例。肾上腺囊性淋巴管瘤的临床资料．复习相关文献并总结诊疗经验。结果：患者行腹腔镜下行左肾上腺切除术·未发生任何术中及术后并发症,术后恢复良好。结论：肾上腺淋巴管瘤是一种极为罕见的肾上腺良性肿瘤·患者一般无明显临床表现。术前诊断主要依靠影像学检查．确诊需病理学检查．手术治疗为首选方法。     

经动脉与静脉采血行血液稀释式自体血回输的对比观察

目的比较经动脉与静脉采血行血液稀释式自体血回输的效果。方法将行血液稀释式自体血回输的择期手术患者189例按时间先后分为对照组(97例)和观察组(92例)。对照组行静脉采血,观察组经动脉采血,监测两组患者采血前后血压、心率、SpO2变化;比较两组采血时间、一次穿刺采血成功率。结果两组患者采血前、采血后15min、30min平均动脉压、心率、SpO2变化比较,差异无统计学意义(均P>0.05);观察组一次穿刺采血成功率显著高于对照组,采血时间显著短于对照组(P<0.05,P<0.01)。结论经动脉采血可在保证安全的前提下,缩短采血时间,提高一次采血成功率。     

Decreased lymphocyte and increased monocyte count in peripheral blood is associated with cardiovascular disease and one - year mortality in maintenance hemodialysis patients

ObjectiveTo investigate the association between peripheral white blood cell count including its subtypes and cardiovascular disease (CVD) incidence and one-year all-cause mortality in maintenance hemodialysis (MHD) patients. MethodsA total of 371 MHD patients at Zhongshan Hospital, Fudan University between March 2009 and February, 2011 were enrolled. Demographic, hematological, nutritional and inflammatory markers were obtained. All patients were followed for one year to investigate the risks for CVD event and mortality. Spearman correlation and linear regression were used to assess the relationship between white blood cell count and other laboratory parameters. Difference in categorical factors between two groups were determined with Chi-square test, Difference in continuous values between two groups were assessed with t test. Kaplan - Meier analysis and Cox proportional hazards model were applied to assess one-year mortality predictors. ResultsPatients with CVD event had lower lymphocyte count level (1.17±0.38 vs 1.34±0.51, P＜0.05) and higher monocyte count level (0.44 ± 0.15 vs 0.37 ± 0.15, P＜0.01) than those without CVD event. Cox proportional hazard regression showed that an increased lymphocyte count was associated with reduced mortality risk, 95%CI: 0.136-0.719, P＜0.01) and that an increased monocyte count was associated with increased mortality risk, 95% CI: 2.657 - 74.396, P＜0.01) after adjustment for hsCRP. ConclusionDecreased lymphocyte level and increased monocyte level are significantly related to CVD event and are independent predictors of increased one - year all - cause mortality risk in MHD patients.     

改良腰椎板截骨回植治疗失稳性腰椎间盘突出症

目的：评价改良腰椎板截骨回植在失稳性腰椎间盘突出症中的疗效。方法：2009年3月至2011年8月对63例失稳性腰椎间盘突出症的患者行髓核摘除＋椎间融合＋椎弓根螺钉内固定＋改良腰椎板截骨回植手术,男33例,女30例;年龄22～68岁,平均48．4岁;病程3个月～13年,平均38．8个月。患者均有不同程度的腰腿疼痛,x线片、CT及MR检查诊断为失稳性腰椎间盘突出症。观测手术前后ODI和JOA评分、并发症发生率、影像学回植椎板愈合率及腰腿痛复发率。结果：62例患者切口I期愈合,1例11期愈合,无下肢深静脉血栓及椎间隙感染等并发症出现。61倒获1年或以上随访,平均随访时间33个月。术中神经损伤发生2例,硬膜囊损伤发生1例;术后1年回植椎板愈合58例：腰痛复发4例,腿痛复发1例。术后2周、6、12个月的ODI及JOA评分显著优于术前（P〈0．05）。结论：改良椎板截骨回植术治疗失稳性腰椎间盘突出症具有较低的术中神经硬膜囊损伤率和腰腿痛复发率、较高的椎板愈合率和较好的临床评分,是一种安全、有效的新方法,为临床失稳性腰椎间盘突出症手术开辟了一种新的术式。