19例SARS死亡病例临床分析

为分析严重急性呼吸综合征(SARS)死亡患者的临床特征、治疗及死亡相关因素,对2003年5月6日至6月27日收治的220例SARS患者中19例死亡患者的临床、实验室、影像学资料、临床治疗及死亡相关因素进行回顾性分析。结果19例死亡SARS患者年龄24～86岁,平均(57.63±16.76)岁。大于45岁13例(68.4%)。男性15例(78.9%),女性4例(21.1%)。有明确接触史19例(100%)。并存基础病13例(68.4%)。死亡距发病时间14～54d,平均(35.37±11.66)d。临床表现主要有发热19例(100%),咳嗽12例(63.2%),畏寒5例(26.3%),气促10例(52.6%),胸闷11例(57.9%),肌痛5例(26.3%),腹泻6例(31.6%)。实验室检查血常规中早期白细胞总数正常或降低,淋巴细胞降低。血气分析低氧血症16例(84.2%);心肌酶肌酸激酶心肌型同工酶(CKMB)、乳酸脱氢酶(LDH)、α羟丁酸脱氢酶(HBDH)随病情的严重程度而进行性升高。T细胞亚群CD3、CD4、CD8绝对值随病情的严重程度而进行性降低。胸部X线双侧、肺病变面积>1/3者19例(100%)。临床诊断继发混合感染(细菌、真菌)19例(100%)。采用综合治疗,其中激素18例(94.7%)、机械通气15例(78.9%)。死于呼吸衰竭18例(94.7%)。提示年龄、合并基础病、肺部病变程度、低氧血症、T细胞亚群CD3、CD4绝对值降低、激素剂量、混合感染等是影响S     

Detection of pre－C region mutants of hepatitis B virus from HBeAg negative patients in Xi＇an area of China

Ｄｅｔｅｃｔｉｏｎｏｆｐｒｅ－ＣｒｅｇｉｏｎｍｕｔａｎｔｓｏｆｈｅｐａｔｉｔｉｓＢｖｉｒｕｓｆｒｏｍＨＢｅＡｇｎｅｇａｔｉｖｅｐａｔｉｅｎｔｓｉｎＸｉ＇ａｎａｒｅａｏｆＣｈｉｎａＨａｎＪｉｅ（韩捷）；ＹａｎＹａｎ（阎岩）；ＤｉｎｇＺｈｅｎｒｕｏ（丁振...     

血瘀证患者的血液动力学观察

本文通过对14名心血管病血瘀证患者血液动力学观察,北与非血瘀证患者(n=29)及正常对照组(n=24)比较,表明血瘀证患者的血液动力学改变乃以后负荷加重为特征,而不表现为心脏收缩功能的减退。该改变与血瘀证的血液流变性异常具有相同的意义。与已有的关于心气虛表现为左心收缩功能减退的研究结论相联系,似可认为,由负荷加重,最终累及心脏收缩功能减退为血瘀向气虚血瘀转化的病理生理基础。     

大鼠延髓腹外侧区在可乐定心血管效应中的作用

目的：探讨大鼠延髓腹外侧区（VLM）在介导可乐定心血管效应中的作用。方法：氨基甲酸乙酯麻醉SD大鼠，应用微量注射和细胞外记录等方法观察尾端延髓腹外侧区（CVLM）和头端延髓腹外侧区（RVLM）内局部给予可乐定导致的心血管活动变化。结果：单侧CVLM微量注射可乐定（5nmol/100nl,n=10)不仅能明显升主动脉血压（AP）和增加心率（HR）（P＜0．01），而且能增加同侧RVLM压力敏感性神经元（n=80)的放电频率（P＜0．01），而单侧RVLM微量注射可乐定（5nmol/100nl,n=9)，明显降低AP和HR（P＜0．01）。结论：RVLM和CVLM在介导可乐定的心血管效应中具有不同的作用。     

Inhibitory Effects of Anti-sense PTTG on Malignant Phenotype of Human Ovarian Carcinoma Cell Line SK-OV-3

To construct eukaryotic expression vector expressing full length anti-sense pituitary tumor transforming gene (PTTG) mRNA and observe its blocking effect on the potential invasion of human ovarian carcinoma cell line SK-OV-3. PCR primers containing designed enzyme cut sites were used for cloning full-length PTTG gene fragment, and the resulting PCR product was inserted into the eukaryotic vector pcDNA3. 1 in the antisense direction. The recombinant vector was then transfected into SK-OV-3 by Lipofectamine. The positive cell clone was screened by G418, PTTG and bFGF at protein level expression were detected by Western blot. The biological behavior change of transfection positive cells was observed by colony formation in soft agar assay. Our results showed that SK-OV-3 clones stably expressing full-length recombinant pcDNA3. 1-PTTGas were obtained. The expressions of PTTG and bFGF protein in transfected cells were decreased by 61.5% and 52.3%, respectively as compared with non-transfected ones. The number of colony formation was reduced significantly in transfected cells as compared with empty vector transfected and non-transfected cells. It is concluded that the recombinant vector pcDNA3. 1-PTTGas is a novel tool and provides an alternative anti-sense gene therapy targeted at PTTG in human carcinoma.     

单纯或联合药物治疗复发性外阴阴道念珠菌病48例疗效分析

目的 :探讨两种方法治疗复发性外阴阴道念珠菌病的效果。方法 :将 4 8例复发性外阴念珠菌阴道炎的患者随机分为两组 ,分别给予两种治疗方法。Ⅰ组 (2 5例 ) :每晚米可定泡腾片 1片塞入阴道 ,连续用药 7～ 10d。首次用药后 1周复查 ,临床及白带真菌学培养阴性进入维持期治疗 ,即每周 1次米可定泡腾片 1片阴道塞 ,连续 5个月。Ⅱ组 (2 3例 ) :单次口服氟康唑15 0mg外加每晚米可定泡腾片 1片阴道塞 ,连续用药 7～ 10d。首次用药后 1周复查 ,临床及白带真菌学培养阴性进入维持期治疗 ,即每月月经第 1天口服氟康唑 15 0mg外加每周 1次米可定泡腾片 1片阴道塞、连续 5个月。结果 :首次治疗后 1周及第1个月、12个月两组的治愈率、无效率及假阳性率统计学结果无差异 (P >0 .0 5 ) ,而维持治疗第 1、3和 6个月Ⅱ组的治愈率显著高于Ⅰ组、无效率显著低于Ⅰ组 (P <0 .0 5 )。结论 :氟康唑口服与米可定泡腾片阴道联合用药半年能有效减少治疗期间复发率 ,但停药后并不能降低复发率。     

阴茎背深静脉包埋术治疗勃起功能障碍5例

目的 :评价阴茎背深静脉包埋术治疗勃起功能障碍 (ED)的疗效。　方法 :对 3例静脉性和 2例动静脉混合性ED病人施行阴茎背深静脉包埋术 ,术后随访疗效。　结果 :术后 2个月首次随访 ,3例静脉性ED病人获得满意性交 ,2例动静脉混合性ED病人基本能勃起 ,口服西地那非 5 0mg后可以完成性交。 5例术后随访 3～ 12个月(平均 7个月 )保持以上疗效。　结论 :阴茎背深静脉包埋术创伤小 ,几乎无并发症 ,是治疗静脉性ED的有效疗法     

重视患者知情同意权提高医疗服务质量

为了提高医院的医疗服务质量，保证医疗安全，避免和减少医疗纠纷，医院必须严格遵守患者知情同意原则。作者着重讨论知情同意的意义，如何规范知情同意书的范围、格式和内容，以及填写注意事项等问题。     

668颗后牙镍铬合金PFM边缘适合性的临床观察

目的：观察采用2种边缘形式的后牙烤瓷熔附金属全冠边缘适合性和对牙龈健康的影响.方法：对668颗后牙,分别采用2种边缘形式的后牙烤瓷熔附金属全冠（单冠或桥的基牙）在修复2年后进行复查,检测其边缘适合性及牙龈指数（GI）和牙周探诊深度（PD）,用统计学方法分析修复体边缘形式与牙龈病变间的关系.结果：采用羽状边缘360°金属脚边的PFM边缘适合性明显优于凹面肩台型边缘PFM,凹面肩台型边缘的PFM的牙龈病变发生率,明显高于羽状边缘360°金属脚边的PFM,而边缘适合性差者较适合性好者牙龈病变发生率显著增高.结论：后牙PFM的边缘采用羽状边缘360°金属脚边是一种好的选择.     

Renal transplantation from elderly living donors

A worldwide shortage of cadaveric donors has led to the increased utilization of elderly living donors, with controversial results. In an attempt to assess the effect of donor age on graft survival and subsequent renal function, we analyzed our clinical results in 276 consecutive recipients of living related renal transplants spanning both the cyclosporine and the azathioprine eras, of whom a total of 44 recipients received kidneys from donors over 55 years old. All recipients were otherwise similar in age, race, haplotype mismatch, number of retransplants, and number of pretransplant transfusions, apart from an increased number of diabetics among the CsA-treated recipients of elderly kidneys (38% vs. 14%). The cumulative patient and graft survival rates at 1 and 5 years were independent of donor age whether CsA or AZA was utilized. Nor was the incidence of rejection or infection significantly different in the older donor group when compared with the younger cohort. Short-term and intermediate-term renal function, as assessed by serum creatinine, was however poorer but stable in the older donor group when compared with the younger one. The mean serum creatinine levels at 1 year in the CsA- and AZA-treated recipients of kidneys from older donors were 2.4 and 2.0 mg/dl, respectively, compared with 1.6 and 1.4 mg/dl, respectively, when the donor age was less than 55 years (P less than 0.001). Since renal function at the end of the first posttransplant year is considered a determinant of long-term graft survival, this is a cause for concern, but in view of the universal shortage of organs and the negligible morbidity to donors, renal transplantation from elderly living donors remains an acceptable practice.