老年心内科带教实习医师的体会与沟通调查

根据老年患者生理和心理变化的特点,了解医学生与老年患者沟通现状,培养沟通技能,探讨老年心内科的临床教学,指导学生对老年心内科患者进行更好的诊治。     

带蒂肌皮瓣修复深度电损伤创面

目的：探讨大面积深度电损伤创面修复的方法。方法：总结了采用带蒂肌皮瓣转移修复电损伤创面的病例，介绍了带蒂肌皮瓣切取的方法及注意事项和典型病例。结果：12例带蒂肌皮瓣移植均一期成活，功能及外形满意。结论：带蒂肌皮瓣具有血供丰富，抗感染能力强，不需吻合血管等优点，带蒂肌皮瓣移植是修复深度电损伤创面的理想方法。     

第三腰椎横突综合症与末端病关系的研究

本文从临床、解剖学、组织学等方面探讨了第三腰椎横突综合症与末端病之间的关系。结果表明:腰_3横突末端承受的拉应力最大,损伤是导致第三腰椎横突综合症的主要原因,腰_3横突末端血管受累,局部组织供养障碍是导致腰_3横突末端组织病理变化的主要环节,腰_3横突痛的病理属于末端病的改变。     

SLE患者ACTH的变化及不同剂型糖皮质激素治疗对其的影响

目的初步探讨促肾上腺皮质激素(ACTH)与系统性红斑狼疮(SLE)发病的关系,以及不同剂型的糖皮质激素治疗(GC)对SLE患者ACTH的抑制情况。方法初发SLE患者52例,随机分成两组:地塞米松组和甲泼尼龙组,另收集20例健康体检者作对照。比较治疗前后ACTH水平,并分析ACTH与SLE临床及实验室指标的相关性。结果治疗前SLE组ACTH水平显著高于对照组(P<0.05),其中轻中度活动组水平显著高于对照组(P<0.05)。ACTH与白细胞计数及免疫球蛋白G呈正相关(P<0.05),与抗SSB抗体的阳性率呈负相关(P<0.05)。地塞米松组与甲泼尼龙组治疗前后的ACTH水平差异无统计学意义。结论 SLE患者存在ACTH的应答异常,并与病情活动相关,ACTH可能参与了SLE的发病。与甲泼尼龙治疗相比,短期使用大剂量地塞米松治疗初发SLE对ACTH水平影响差异无显著性。     

Development of an ELISA for quantification of tumstatin in serum samples and tissue extracts of patients with lung carcinoma

BackgroundTumstatin, an angiogenesis inhibitor with anti-tumor activity in mice, is the bioactive NC1 domain of Col IVa3, the potential significance of tumstatin as an endogenous angiogenesis inhibitor in human is not yet completely understood. This study aimed to develop an enzyme-linked immunoassay (ELISA) for tumstatin to accurately measure its concentrations in biological samples.MethodsRecombinant tumstatin as an immunogen was expressed by E. coli. The purified tumstatin was injected into mice for antibody generation. An ELISA was developed with the monoclonal antibodies.ResultsThe detection limit of the ELISA was 1.4 ng/ml, and the intra- and inter- assay CVs were within 10%. Recovery of tumstatin added to sera was 92.7–115%. Patients with metastases had serum tumstatin levels 50% lower than patients without metastases (P = 0.039). Tumstatin levels in poorly differentiated tumor tissues were significantly lower than in nontumorous tissues and well-differentiated tumor tissues (P < 0.001).ConclusionsThe development of a highly sensitive and reliable ELISA method capable of quantifying tumstatin in human serum samples and tissue extracts is reported. This assay for tumstatin in biological samples may be helpful in evaluating the therapeutic and/or prognostic value of tumstatin in cancer patients.     

Extent and features of liver steatosis in vitro pave the way to endothelial dysfunction without physical cell-to-cell contact

Background and aimsSeveral chronic multifactorial diseases originate from energy unbalance between food intake and body energy expenditure, including non-alcoholic fatty liver disease (NAFLD), diabetes, and cardiovascular disorders. Vascular endothelium plays a central role in body homeostasis, and NAFLD is often associated with endothelial dysfunction (ED), the first step in atherosclerosis. Both sugars and fatty acids (FAs) are fuel sources for energy production, but their excess leads to liver steatosis which may trigger ED through a network of mechanisms which need to be clarified. Here, we investigated the crosstalk pathways between in vitro cultured steatotic hepatocytes (FaO) and endothelial cells (HECV) being mediated by soluble factors.Methods and resultsWe employed the conditioned medium approach to test how different extent and features of hepatic steatosis distinctively affect endothelium leading to ED. The steatogenic media collected from steatotic hepatocytes were characterized by high triglyceride content and led to lipid accumulation and fat-dependent dysfunction in HECV cells. We found a parallelism between (i) extent of hepatocyte steatosis and level of lipid accumulation in HECV cells; (ii) type of hepatocyte steatosis (with macro- or microvesicular LDs) and extent of oxidative stress, lipid peroxidation, nitric oxide release and expression of ED markers in HECV cells.ConclusionsThe present findings seem to suggest that, in addition to triglycerides, other soluble mediators should be released by steatotic hepatocytes and may influence lipid accumulation and function of HECV cells. Further studies need to depict the exact profile of soluble factors involved in steatotic hepatocyte-endothelium crosstalk.     

基于计算机视觉的无创性食管内曲张静脉测压系统设计原理

无创性食管曲张静脉测压是当前的一个研究热点,本文提出了一种基于计算机视觉的食管曲张静脉测压系统,该系统采用基于PCI总线的图像采集、USB接口的压强采集、边缘检测、动态跟踪等处理方法。