细菌性角膜溃疡误诊原因及预后分析

目的研究细菌性角膜溃疡的特点,分析引起误诊的原因,探讨影响患者预后的相关因素。方法回顾性分析。以2011年1月至2013年12月间山东省眼科医院收治的83例(83只眼)确诊为细菌性角膜溃疡的患者作为研究对象。通过统计患者误诊疾病、发病诱因、眼部临床表现、就诊医院、所行辅助检查等,分析误诊原因。通过统计不同确诊时间的患者药物、手术治疗的情况,分析误诊患者确诊前病程与其预后的关系。结果 83例患者的发病诱因中49例有各种角膜外伤史,包括植物性外伤22例(占26.5%)。42例患者眼部临床表现为病史迁延、病灶边界不清,伴类似伪足或类似卫星灶、类似内皮斑等。33例患者于首诊医院误诊,误诊疾病分别为真菌性角膜炎28例(占33.7%)、病毒性角膜炎5例(占6.0%)。首诊医院为省市级医院的误诊率为29.3%,县级及以下医院的误诊率为50.0%。省市级医院行角膜刮片及培养者占70.7%,刮片阳性率27.6%。县级及以下医院行实验室检查者仅占30.1%,刮片阳性率15.4%。预后:误诊患者中确诊前病程≤2周者药物治愈6例(占30.0%),行角膜病灶切除治愈4例(占20.0%),行角膜移植治愈10例(50.0%),总治愈率100%。病程大于2周者,药物治愈2例(占15.4%),行角膜病灶切除治愈3例(占23.1%),行角膜移植治愈6例(46.1%),行眼内容剜除2例(占15.4%),总治愈率84.6%。结论目前细菌性角膜溃疡的误诊率仍较高,普及严格、规范的实验室检测结合其他辅助检查能有效降低误诊率。早确诊、早治疗有助于改善误诊患者预后。     

The development and validation of methods for evaluating the immune system in preweaning piglets

The preweaning piglet has been found to be a valuable research model for testing ingredients used in infant formula. As part of the safety assessment, the neonates' immune system is an important component that has to be evaluated. In this study three concurrent strategies were developed to assess immune system status. The methods included (1) immunophenotying to assess circulating innate immune cell populations, (2) monitoring of circulating cytokines, particularly in response to a positive control agent, and (3) monitoring of localized gastrointestinal tissue cytokines using immunohistochemistry (IHC), particularly in response to a positive control agent. All assays were validated using white papers and regulatory guidance within a GLP environment. To validate the assays precision, accuracy and sample stability were evaluated as needed using a fit for purpose approach. In addition animals were treated with proinflammtory substances to detect a positive versus negative signal. In conclusion, these three methods were confirmed to be robust assays to evaluate the immune system and GIT-specific immune responses of preweaning piglets.     

虚拟实验室在《临床检验基础学》实验课中的应用

探讨高等教育医学检验技术专业《临床检验基础学》实验课教学改革问题。文章分析了实验教学中存在的困难及其对教学质量和培养目标的影响。通过构建一种基于网络和虚拟仿真技术的《临床检验基础学》虚拟实验室提供模拟的教学环境、各种虚拟化仪器设备、虚拟化实验过程和虚拟化的数据处理等,利用这种开放式网络化的实验教学平台作为现实实验教学的补充,学生随时可反复进行实验操作,提高教学质量。虚拟仿真实验室建设将是今后四年制医学检验技术专业实践教学改革提高教学质量的一个重要方向。     

医学类高校微生物实验室的安全管理

医学高校微生物实验室的安全管理十分重要,加强微生物实验室的安全管理,应从实验室的建章立制、安全管理教育、培训、日常管理方面着手,使学生树立起安全防范意识,遵守安全制度,养成良好的学习习惯。     

Electrical and contractile consequences of Na+ or Ca2+ gradient reduction in cultured heart cells

The normal electrical and contractile activity of cultured neonatal rat ventricular cells is characterized and compared to activity seen in low [Ca²⁺]₀ and low [Na⁺]₀ solutions. In 0 Ca²⁺/0.5 mm EGTA solutions electrical activity is altered: the maximum diastolic potential (m.d.p.), maximum rate of rise ($\text{+}\text{V}\text{?}{}_{\mathrm{<mtext>max</mtext>}}$), and overshoot (o.s.) are reduced, while duration is increased. Low [Ca²⁺]₀ activity is insensitive to TTX and blocked by La³⁺. In low [Na⁺]₀ solutions electrical activity is generally absent; when present $\text{+}\text{V}\text{?}{}_{\mathrm{<mtext>max</mtext>}}$ and o.s. are decreased while duration is increased. Low [Na⁺]₀ activity is blocked by La³⁺. These data suggest the presence of one La³⁺-sensitive slow inward current channel. The absence of spontaneous electrical activity in low [Na⁺]₀ solutions suggests an inhibition of automaticity. To determine if this inhibition is due to a reduction of the Na⁺ gradient, drugs which raise [Na⁺]_i were examined. Both monensin (a Na⁺ ionophore) and ouabain inhibit the occurrence of spontaneous action potentials (cells respond to stimulation) indicating a dependence of pacemaker activity on a normal Na⁺ gradient. During Na⁺ gradient reduction, asynchronous subcellular contractile activity occurs independent of membrane potential fluctuation. This asynchronous activity is inhibited by La³⁺ or when Ca²⁺₀ is absent, but continues in the presence of verapamil (normal activity is blocked by all three conditions). The Na⁺Ca²⁺ exchange system is unaffected by verapamil but blocked by La³⁺, while both these drugs block the slow inward current. These data indicate that the Na⁺Ca²⁺ exchange system can directly supply Ca²⁺ (independent of electrical activity at the membrane) to intracellular sites that support contractile activity.     

A pathophysiologic approach to diagnosis of malabsorption.

Most patients with malabsorption do not have “textbook” symptoms; they often complain of a variety of more subtle manifestations including excessively large or sticky stools, abdominal discomfort or the consequences of a specific nutritional deficiency. Suspicion of malabsorption demands confirmation by determination of fecal fat content since most diseases affecting intestinal absorption alter lipid assimilation. If steatorrhea is present, an abdominal plain film and barium meal x-ray film, xylose absorption test and a Schilling test with appropriate subsequent administration of intrinsic factor, antibiotics and pancreatic enzymes will suggest whether the defect is in intraluminal digestion of triglyceride or in a mucosal process. An etiologic diagnosis should be approached by a consideration of the possible defects in the intraluminal and mucosal events of lipid absorption and the use of selected tests.Patients with carbohydrate malabsorption usually do not have steatorrhea, but complain of watery diarrhea, cramps and excessive flatus. Although the diagnosis is usually made by the appropriate carbohydrate tolerance test, both the breath hydrogen test and assay of mucosal biopsy material for disaccharidases are more accurate.     

Changes in the microvasculature with age

The microvasculature of various organs of the rat and of the mesentery of the cat were examined for histochemical changes as a function of age, using the periodic acid-Schiff (PAS) reaction. Arterioles, minute arteries, and nonmuscular venules were histochemically unchanged to approximately 17 months of age in the rat and 8 years in the cat. Subsequently, focal areas of PAS-positive material developed in the media of arterioles and small arteries and increased in extent and severity with age. The adventitia of nonmuscular venules normally stains slightly positive due to the mucopolysaccharide coating of collagen fibers. With age this adventitial layer becomes more intensely PAS-positive. In the 26-month-old rat and 19-year-old cat, the media of arterioles and small arteries were extensively hyalinized. Lesions of arteriosclerosis were not present. These observations, in consort with prior observations of others in various mammals, indicate that there is a regular systematic alteration of various elements of the microcirculation with age. A possible relationship between these anatomical changes and tissue exchange is considered.     

Prevalence of sleep apnea syndrome among patients with essential hypertension

The purpose of this study was to investigate the prevalence of sleep apnea syndrome (SAS) among patients with essential hypertension. Sixteen of 50 patients with essential hypertension were suspected of having SAS based on their responses to a sleep questionnaire. Whole-night polysomnographic recordings revealed that 11 of the 16 patients, which is 22% of the initial sample, had SAS as defined by the occurrence of at least 10 apneas lasting 10 seconds each per hour of polygraphically defined sleep. The preponderant finding of SAS in this group indicates that the possibility of the syndrome should be taken into consideration in the clinical evaluation of these patients.