甲状腺全切除术后甲状旁腺激素水平变化的相关因素分析

目的:探讨甲状腺全切术后甲状旁腺激素（parathyroid hormon,PTH）水平发生变化的相关影响因素及变化趋势,从而指导临床治疗。方法:回顾性分析2015年7月至2017年7月于我院甲状腺外科行甲状腺全切除术的180例病人资料,术后均给予预防性补钙,术后24小时均复查PTH、血钙,术后1、6个月随访血PTH及血钙水平。对所有病人的临床资料进行数据分析。结果:术后24小时、术后1个月的甲状旁腺功能减退发生率分别为32.20%、19.40%,6个月后甲状旁腺功能减退的发生率0.60%。年龄、是否Ⅵ区淋巴结清扫、是否甲状旁腺自体移植等是术后24小时发生甲状旁腺激素变化的危险因素。单因素分析结果显示,是否甲状旁腺移植、术后24 h PTH值是影响术后1个月甲状旁腺激素水平的危险因素。结论:Ⅵ区淋巴结清扫、术中甲状旁腺的显露、移植甲状旁腺及数量影响术后不同时期的甲状旁腺激素水平的变化,术中甲状旁腺的血运及功能的保护至关重要。     

运用多准则决策分析法的中药临床综合评价文献特征分析及设计要点

目的 分析运用多准则决策分析法(MCDA)进行中药临床综合评价研究的文献特征和方法学现状,为今后研究者设计和实施中药MCDA研究提供建议.方法 计算机检索PubMed、The Cochrane Library、EMbase、SinoMed及中国知网(CNKI)、维普数据库(CQVIP)、万方数据库,获取自各数据库建库至...     

125I放射性粒子植入治疗恶性纤维组织细胞瘤术后肺转移瘤的短期效果观察

目的 探讨CT引导下经皮穿刺放射性125I粒子肿瘤内植入治疗恶性纤维组织细胞瘤(MFH)术后肺转移瘤的短期临床效果.方法 选择MFH术后肺转移瘤患者8例,转移病灶28个,行CT引导下经皮穿刺肿瘤内放射性125I粒子植入,处方剂量80 Gy,粒子活度0.7 mCi(2.59×107 Bq).粒子植入术后6个月复查胸部CT,与粒子植入前比较肿瘤变化,按照国际标准判定疗效.结果 接受粒子植入的瘤体平均照射剂量(172.9±39.9)Gy,D100( 77.7±10.2)Gy,D90 (97.2 ±6.8)Gy.有效率为82.1％(23/28),患者术后生存10.0 ～26.0个月,平均(14.6±3.5)个月,中位生存期13.0个月.结论 放射性粒子对MFH肺部转移病灶短期局部效果明显.     

大剂量地塞米松对免疫性血小板减少性紫癜患者浆细胞样树突状细胞功能及Toll样受体9 mRNA表达的影响

本研究探讨大剂量地塞米松对免疫性血小板减少性紫癜(ITP)患者外周血浆细胞样树突状细胞(pDC)功能及Toll样受体9(TLR9)表达的影响。15例初诊的ITP患者给予地塞米松40 mg/d,连用4 d,采用免疫磁珠分离法体外分离15例正常对照及13例治疗有效患者治疗前后外周血中pDC;用CpG-ODN 2216刺激外周血pDC并与之共培养24 h,采用ELISA方法检测上清中IFN-α、IL-6、TNF-α的含量;用实时定量聚合酶链反应(RT-PCR)检测pDC的TLR9 mRNA表达量。结果表明,①治疗前pDC产生IFN-α、IL-6、TNF-α水平〔(960.83±164.65)pg/ml,(156.15±39.89)pg/ml,(137.31±35.44)pg/ml)〕明显高于正常对照组〔(616.67±105.98)pg/ml,(89.13±21.48)pg/ml,(88.53±25.81)pg/ml,P<0.05〕;治疗后pDC产生IFN-α、IL-6、TNF-α水平分别降至(678.46±128.88)pg/ml,(97.77±26.31)pg/ml,(103.08±26.42)pg/ml,与治疗前比较差异有统计学意(P<0.05),与正常对照组相比差异无统计学意义(P>0.05);②治疗前pDC的TLR9 mRNA的表达水平高于正常对照组(P<0.05);治疗后pDC的TLR9 mRNA的表达水平低于治疗前(P<0.05),与正常对照组比较差异无统计学显著性(P>0.05)。结论:pDC分泌的细胞因子及其表达的TLR9在ITP发病中起重要作用;地塞米松可能通过下调TLR9的表达,抑制pDC分泌细胞因子的功能,而对ITP起到治疗作用。     

儿童头癣致病真菌调查及分子流行病学研究

目的调查分析儿童头癣患者生活环境中致病真菌存在情况,探索其流行病学规律,为儿童头癣的防治提供依据。方法收集儿童头癣患者临床资料,并进行病发真菌镜检和培养,收集每例儿童头癣患者生活环境中密切接触物品及亲属头发进行真菌培养,培养结果与相应患者真菌培养结果对比分析。鉴定为相同菌株者采用真菌通用引物ITS1和ITS4对rDNA的ITS区进行扩增,并采用（GACA）4单引物进行分子鉴定,用随机引物扩增DNA多态性（RAPD）方法对相同菌株者进行株间差异性分析。结果调查91例儿童头癣患者,年龄从1岁至12岁,病程1周至3月;患者病发的真菌培养结果：犬小孢子菌44株（48．35％）,铁锈色小孢子菌41株（45．05％）,须癣毛癣菌4株（4．40％）,红色毛癣菌1株（1．10％）,石膏样小孢子菌1株（1．10％）;患者亲属头发及枕巾等接触物品真菌培养结果均未分离到致病真菌：2例儿童的伙伴病发中分离到与对应惠儿相同的致病菌;有宠物接触者28例（30．77％）中有7例（7．69％）分离到与头癣患者病发相同的致病菌种。RAPD分析发现从患者分别与其对应环境中分离的犬小孢子菌的基因组DNA随机引物扩增后产生的产物片断长度多态性一致,显示无株间差异性。结论儿童头癣患者生活环境中有致病真菌存在．致病真菌主要来源于宠物及密切接触伙伴。     

Effects of Xuesetong Soft Capsules(血塞通软胶囊) on angiogenesis and VEGF mRNA expression in ischemic myocardium in rats with myocardial infarction

OBJECTIVE:To observe the effects of Xuesetong Soft Capsules(血塞通软胶囊,Notoginseng total saponin) on angiogenesis and vascular endothelial growth factor(VEGF) mRNA expression in ischemic myocardium of rats with myocardial infarction.METHODS:The left coronary artery of rats was ligated to establish the animal model of acute myocardial infarction.Rats were randomly divided into Xuesetong Soft Capsule,Shexiangbaoxin Pill(positive control),model(negative control) and sham operation groups.After 6 weeks,microvessel count(MVC),microvessel density(MVD) and VEGF mRNA expressioninischemicmyoc ardium were evaluated.RESULTS:MVC and MVD in the myocardial infarct border area in model,Shexiangbaoxin Pill and Xuesetong Soft Capsule groups significantly increased compared with those of the sham operation group(P<0.05).MVC and MVD in the myocardial infarct border area in Xuesetong Soft Capsule and Shexiangbaoxin Pill groups significantly increased compared with those of the model group(P<0.05).No significant differences between Xuesetong Soft Capsule and Shexiangbaoxin Pill groups were observed(P>0.05).The model group showed signifi-cantly higher VEGF mRNA expression than that in the sham operation group(P<0.05).Xuesetong Soft Capsule and Shexiangbaoxin Pill groups showed significantly higher VEGF mRNA expression than that of the model group(P<0.05).No significant difference between Xuesetong Soft Capsule and the Shexiangbaoxin Pill groups was observed(P>0.05).CONCLUSION:Xuesetong Soft Capsules promote angiogenesis in ischemic myocardium after myocardial infarction and the mechanism may be associated withVEGF mRNA expression.     

Quantitative T2 mapping evaluation for articular cartilage lesions in a rabbit model of anterior cruciate ligament transection osteoarthritis

Background  Quantitative T2 mapping has been a widely used method for the evaluation of pathological cartilage properties, and the histological assessment system of osteoarthritis in the rabbit has been published recently. The aim of the study was to investigate the effectiveness of quantitative T2 mapping evaluation for articular cartilage lesions of a rabbit model of anterior cruciate ligament transection (ACLT) osteoarthritis.

Methods  Twenty New Zealand White (NZW) rabbits were divided into ACLT surgical group and sham operated group equally. The anterior cruciate ligaments of the rabbits in ACLT group were transected, while the joints were closed intactly in sham operated group. Magnetic resonance (MR) examinations were performed on 3.0T MR unit at week 0, week 6, and week 12. T2 values were computed on GE ADW4.3 workstation. All rabbits were killed at week 13, and left knees were stained with Haematoxylin and Eosin. Semiquantitative histological grading was obtained according to the osteoarthritis cartilage histopathology assessment system. Computerized image analysis was performed to quantitate the immunostained collagen type II.

Results  The average MR T2 value of whole left knee cartilage in ACLT surgical group ((29.05±12.01) ms) was significantly higher than that in sham operated group ((24.52±7.97) ms) (P=0.024) at week 6. The average T2 value increased to (32.18±12.79) ms in ACLT group at week 12, but remained near the baseline level ((27.66±8.08) ms) in the sham operated group (P=0.03). The cartilage lesion level of left knee in ACLT group was significantly increased at week 6 (P=0.005) and week 12 (P <0.001). T2 values had positive correlation with histological grading scores, but inverse correlation with optical densities (OD) of type II collagen.

Conclusion  This study demonstrated the reliability and practicability of quantitative T2 mapping for the cartilage injury of rabbit ACLT osteoarthritis model.

     

非战争军事行动模块化药材保障

目的 探讨构建非战争军事行动模块化药材保障体系的方法及可行性.方法 收集现有非战争军事行动的伤病分布和用药资料,按照模块化原理,应用系统分析法、逻辑分析法和聚类分析法,将非战争军事行动的药材需求分为一般需求、特殊需求和补充需求,构建模块化药材保障体系.结果 依据卫勤保障任务和卫生减员分析,构建了4大类32种基本模块的模块化药材保障框架体系;在分析非战争军事行动药品耗材消耗规律的基础上,针对常见的7种非战争军事行动样式,提出了相应的卫勤保障药品耗材目录;根据非战争军事行动药材保障的实际需要,完成了模块化药材保障辅助决策系统的设计.结论 经模拟测试,非战争军事行动模块化药材保障辅助决策系统能够提高药材保障的效率,增强灵活性和适应性,是实现精确化药材保障的新途径.     

高频超声综合参数在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值

目的 探讨高频彩色多普勒超声多参数综合分析在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值.方法 对经术前超声检查及手术治疗并经病理证实的30例乳腺叶状肿瘤及120例纤维腺瘤患者的病例资料进行回顾性分析(病理结果为诊断金标准).结果 乳腺叶状肿瘤患者的年龄大于乳腺纤维腺瘤患者,两者相比差异具有统计学意义(P＜0.05);二维超声显示,肿瘤形状、包膜是否完整、内部回声是否均匀、是否存在囊性变、后方回声是否衰减在乳腺叶状肿瘤与纤维腺瘤之间的差异具有统计学意义(P＜0.05);彩色多普勒血流分级在乳腺叶状肿瘤与纤维腺瘤之间的差异具有统计学意义(P＜0.05),脉冲多普勒动脉阻力指数(RI)及收缩期峰值流速(Vmax)在乳腺叶状肿瘤与纤维腺瘤之间的差异具有统计学意义(P＜0.05).结论 乳腺叶状肿瘤和纤维腺瘤在超声声像图上具有特征性表现,对年龄较大、肿块分叶状、包膜不完整、内部回声不均匀、有囊性变、肿物后方回声衰减及肿物内血流丰富、动脉阻力指数(RI)增高及峰值流速(Vmax)增快者应考虑乳腺叶状肿瘤的可能,但高频超声多参数对于叶状肿瘤的良性与恶性的鉴别诊断仍需进一步研究.