乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用

Objective To study the immediate conservative breast surgical reconstruction by trans-ferring the same lateral latissimus dorsal myocutaneous flap (LDM) for the treatment of stage Ⅱ and stage Ⅲ breast cancer, combined with neoadjuvant chemotherapy. Methods Breast cancer patients in stage Ⅱ and Ⅲ with pathological diagnosis by core needle biopsy, had undergone immediate conservative breast reconstruction surgery with transferring the latissimus dorsal myocutaneous (LDM). We scored the reconstructed breast twice at one month after operation and completion of radiation. The final score was decided using the mean value of the twice evaluating score. Kaplan-Meier survival was used to analyze the survival of 18 cases with traditional mastectomy. Results The tumor size ranged from 30 mm to 55 mm before neoadjuvant chemotherapy, and ranged from 25mm to 45 mm after neoadjuvant chemotherapy. The median weight of the tumor specimens in breast conservative operation was 140 g (90 g to 220 g). A-mong the 18 patients, 16 cases had more than 3 scores with satisfied cosmetics (93.33 % ). Dorsal subcu-taneous seroma in donation area was observed in 5 of 18 patients (27.78 %) and dorsal incision dehiscence was observed in 2 of 18 patients (11.11%). None of the patients developed recurrence except that 1 pa-tient (5.55 %) had distance metastasis (bone metastasis} in a mean 22-months follow-up. The Kaplan-Meier survival curve in breast conservation reconstruction patients had no different from that of traditional mastectomy patients at the same time. Conclusions Immediate conservative breast surgical reconstruction by using the same lateral latissimus dorsal myocutaneous flap is an effective method for stage Ⅱ and stage Ⅲ breast cancer patients combined with neoadjuvant chemotherapy, which can increase satisfactory breast so that cosmetic outcome can be reached.     

Thyroid diseases associated with interferon α treatment for viral hepatitis

There are many complications during the interferon alpha (IFNα) treatment for viral hep-atitis,and thyroid disease is the most common side-effect in endocrine aspects. Thus, clinicians are drawing much attention to the interferon induced thyroiditis (IIT). Though the etiology is not clear,some factors may contribute to the susceptibility to IIT, such as genetic predisposition, gender,and hepatitis C virus (HCV) in-fection. The pathogenesis may be secondary to immune modulation by IFNα and/or by its direct effects on the thyroid. Autoimmune IIT may manifest as Graves' disease, Hashimoto's thyroiditis and the development of thyroid antibodies without clinical symptoms. Non-autoimmune IIT can manifest as destructive thyroiditis or hypothyroidism with negative thyroid antibodies. Screening for autoantibodies and serum thyroid-stimulating hormone(TSH)is recommended before, during and after IFNα treatment. Early detection and therapy of these conditions is important.     

应用秩和比法研究门诊人数增长与门诊医疗质量因子的关系

目的研究医院门诊人数增长与门诊医疗质量因子的关系,找出影响门诊人数增长的主要门诊医疗质量因子。方法利用秩和比法对实例进行分析。结果影响门诊人数增长的门诊质量因子,首先是高中级职称比(χ2=32.43,P<0.05),其次是副高以上职称的坐诊工时比(χ2=31.91,P<0.05),再次是新技术项目或重大改革(χ2=28.54,P>0.05)。结论研究医院门诊人数增长与门诊医疗质量因子的关系时,秩和比法有应用推广的价值。     

骨髓干细胞参与小鼠急性肾小管坏死修复的实验研究

【摘要】 目的 观察在生理和病理情况下,骨髓来源的干细胞(BMSC)能否分化成肾小管上皮细胞。 方法 绿色荧光蛋白(GFP)标记的C57BL/6转基因小鼠提供骨髓细胞。同种无荧光标记的C57BL/6小鼠100只分为正常对照组、全身照射组、缺血再灌注组、骨髓移植组、骨髓移植+缺血再灌注组。受体鼠的骨髓重建经血液常规检查和流式细胞仪检测确认,并采用荧光组织化学、免疫组织化学等方法观察绿色荧光标记的BMSC在受体鼠肾脏的分布及数量。 结果 全身致死剂量γ射线照射未造成小鼠肾脏组织结构和生理功能的明显改变。骨髓移植后第56、84天的受体鼠肾小管中有少量GFP阳性细胞的存在[(78.75±5.99)%、(79.58±4.60)%],激光共聚焦显微镜进一步证实这些细胞位于肾小管,并表达肾小管上皮细胞特异性的功能蛋白megalin。 结论 在生理和病理情况下,骨髓干细胞均可以向肾小管上皮细胞转分化,参与肾小管上皮细胞的更新,并且在急性肾小管坏死的病理条件下,骨髓干细胞的肾向转化率与肾脏受损程度有关。     

鸡抗内毒素卵黄抗体IgY的制备

目的：研究分别应用内毒素（LPS）、类脂A(LipidA)和大肠杆菌突变株15免疫鸡后其蛋黄中抗内毒素抗体IgY的产量、纯度、效价并筛选最佳免疫抗原。方法：分别应用内毒素（LPS）、类脂A(LipidA)和大肠杆菌J5突变株作为抗原免疫25周龄Leghom鸡，水溶法（WD）提取蛋黄中抗体IgY，双紫外光测定抗体含量，SDS-PSGE电泳检测抗体纯度，细胞酶联染色和ELISA检测抗体特异性、效价及筛选最佳免疫抗原。结果：3种抗内毒素IgY含量和效价分别为14.4mg/ml和1：12 800（J5）、10.61mg/ml和1：12 800（LPS）、9.26mg/ml和1：3200（LipidA），抗体纯度均为95％左右。结论：大肠杆菌突变株J5和内毒素（LPS）为最佳免疫抗原，免疫鸡后其蛋黄中抗内毒素抗体IgY的产量和效价最高。     

Non-invasive Assessment of Coronary Flow Velocity Reserve: A New Method Using Transthoracic Doppler Echocardiography

Coronary flow reserve (CFR) has been used toassess coronary microcirculation and epicardial coro-nary stenoses[1— 3 ] . CFR is defined as the ratio ofcoronary flow under maximal coronary vasodilatationto coronary flow under resting conditions[4 ] .Whenthe cross- sectional area of epicardial coronary arteriesis constant,coronary flow velocity (CFV) ratios areequal to volume flow ratios.The most common method used clinically formeasuring CFVR is intracoronary Doppler flow(ICD) analysis re…     

928株革兰阴性杆菌耐药性监测

目的：了解青岛地区临床分离的重要革兰阴性杆菌的耐药情况以指导合理用药。方法：2001年青岛3家医院临床分离的5种革兰阴性杆菌用Kirby-Bauer法进行药敏试验。结果：5种病原菌均占3家医院革兰阴性杆菌分离率的前5位，大肠埃希菌对氟喹诺酮类药物的耐药率达60％－87％，细菌对亚胺培南均呈高度敏感，但铜绿假单胞菌耐亚胺培南株占25．8％，头孢他啶的抗菌活性是三代头孢菌素中最高的；复方酶抑制剂表现出良好的抗菌活性。结论：细菌耐药问题仍是目前临床的严重问题，地域性的耐药性监测是必要的。     

小鼠不完全性脑缺血、再灌注时脑膜血流量的变化及尼莫地平的作用

目的：观察双侧颈总动脉阻断后脑血流的变化。方法：结扎双侧颈总动脉观察小鼠不完全性脑缺血及其再灌注时脑膜血流量的变化。结果：结扎颈总动脉后小鼠脑膜血流量在几秒钟内骤然下降，血流量较结扎前降低约８５．９％±６．４５％。同时血管中红细胞运动近停滞状态，血管再通时脑血流处于低灌注状态，血流量下降３４．４７％±１１．６９％，此时脑缺血再灌后脑组织实际上处于一种慢性缺血状态。再灌注１０ｄ后，小鼠脑海马ＣＡ１区神经细胞数明显减少。尼莫地平可以解除再灌注时的脑血流低灌状态。并防止由此所引起的脑海马ＣＡ１区神经细胞的缺失。结论：缺血后及时给予尼莫地平具有积极的治疗意义。     

婴儿母乳喂养与学龄前肥胖症关系的病例对照研究

①目的　探讨婴儿期母乳喂养行为与学龄前期单纯性肥胖症发生之间的关系。②方法　对 180 0名4～ 5岁儿童的婴儿期母乳喂养情况及其体质指数 (BMI)、发育情况等进行调查 ,分析母乳喂养类型和持续时间与学龄前肥胖症发生之间的关系。③结果　单因素分析发现 ,4个月内只喂母乳、主要喂母乳、母乳与配方奶量基本相同、主要喂配方奶、只喂配方奶者 4～ 5岁时肥胖发生率分别为 12 .6 3% ,13.0 4 % ,16 .98% ,18.18% ,30 .0 0 % ;儿童母乳喂养持续时间 0 ,<1,1～ 3,4～ 6 ,7～ 9,>9个月者 4～ 5岁时肥胖发生率分别为 2 9.4 1% ,30 .0 0 % ,33.33% ,17.2 4 % ,13.92 % ,12 .2 2 % .母乳喂养类型和持续时间不同的儿童学龄前期单纯性肥胖症发生率不同 ,差异有显著性 (χ2 =10 .4 0 7,P <0 .0 5 ;χ2 =2 0 .90 3,P <0 .0 0 1)。多因素Logistic回归分析发现 ,4个月内喂配方奶量越多 ,肥胖发生率越高 (OR =1.12 0 ) ;母乳喂养持续时间越长 ,肥胖发生率越低 (OR =0 .782 )。④结论　婴儿母乳喂养对学龄前期肥胖症的发生有预防作用 ;婴儿期应提倡母乳喂养 ,并尽可能延长母乳喂养时间至 9个月以上。     

白细胞介素-18基因修饰的胎肝细胞经脾移植对小鼠免疫功能的影响

目的：观察表达mIL-18的重组腺病毒基因修饰的胎肝细胞（AdmIL-18/BNL.CL2)经脾移植对正常小鼠免疫功能的影响。方法：实验组小鼠经脾移植AdmIL-18/BNL.CL2，同时设LacZ病毒对照组（Ad-LacZ/BNL.CL2),BNL.CL2细胞对照组及空白对照组。2周后处死，留取血清，制备腹腔巨噬细胞、脾淋巴细胞、肝组织匀浆液，提取肝组织总RNA。采用ELISA法检测各组小鼠血清、腹腔Mφ和脾细胞培养上清、肝匀浆中细胞因子的含量；采用半定量RT－PCR法，检测肝组织细胞因子mRNA相对表达量；以LDH释放法测定腹腔Mφ杀伤活性和脾NK细胞活性，用MTT还原比色法测定脾淋巴细胞的增殖活性。结果：实验组小鼠血清、细胞培养上清及肝匀浆中，IL－18、IL－2、IFN－γ、TNF-α稔均高于其它对照组，而IL－4、IL－10水平则低于对照组；半定量RT－PCR结果与ELISA检测结果一致；同时，实验组腹腔Mφ的杀伤活性和脾NK细胞活性，及脾淋巴细胞增殖活性也明显高于对照组。结论：AdmIL-18能有效转染至胎肝细胞并稳定表达mIL-18;AdmIL-18基因修饰的胎肝细胞经脾移植后，可显著提高肝脏、脾脏免疫细胞活性，活化腹腔Mφ，促进Th1类细胞因子表达，抑制Th2类细胞因子的分泌。