早期胰岛素强化治疗对严重创伤患者凝血状态变化的研究

目的 探讨早期胰岛素强化治疗对严重创伤患者凝血状态变化的影响.方法 选择138例严重创伤患者(ISS >20分),随机分为胰岛素强化治疗组和对照组,分别给予胰岛素强化治疗和常规治疗,记录每天胰岛素用量和血糖值,分别检测血小板数(PLT)、D二聚体(DD)、蛋白C(PC)、蛋白S (PS)、抗凝血酶-Ⅲ(AT-Ⅲ)、血栓调节蛋白(TM)、组织纤溶酶原激活物(TPA)、纤溶酶原激活物抑制物-1(PAI-1)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FBG)等12项涉及到与凝血功能有关的实验室指标.结果 强化治疗组每日平均胰岛素用量显著高于常规治疗组(P<0.01),平均血糖值显著低于常规治疗组(P<0.05).强化治疗严格控制血糖后,强化治疗组 APTT、PT、TT较常规治疗组缩短, FBG升高(P<0.05),血小板高;TM低于常规治疗组(P<0.05),PC和PS则高于常规治疗组(P<0.05), AT-Ⅲ降低;PAI-1和DD低于常规治疗组,TPA则高于常规治疗组(P<0.05).结论 胰岛素强化治疗能有效降低ICU中危重患者凝血系统功能紊乱.     

云南省农村地区男男性接触者与HIV相关的风险行为

目的探讨中国农村地区男男性接触者(MSM)与艾滋病病毒(HIV)相关的风险行为的具体特点和问题。方法采用半结构化深度访谈的方式进行定性研究。通过一个当地的MSM联系网络,以滚雪球和相互转告的方式招集了24名访谈对象。主要测量指标是与HIV有关的风险行为的上升情况。结果在中国农村地区,风险行为、社会歧视、独生子女政策以及传统中医的观念,在HIV的传播中都起着重要的作用。在中国,许多MSM过着双重生活;调查显示,安全套的使用情况也是因人而异,使风险行为"合理化"的意图是决定是否使用安全套的主要因素;就泌尿生殖系统的问题主动寻求医疗帮助的现象很不普遍,而现有卫生系统以及医务人员对此问题表现出来的不敏感,也进一步加剧了这种现象。结论在资源匮乏的农村地区,MSM人群存在着HIV流行的趋势,并有向普通人群传播的危险。     

La核糖核蛋白6对人血管内皮细胞增殖与凋亡的作用

Objective To investigate regulatory effect of Acheron (Achn) on proliferation and apoptosis of human vascular endothelial cell. Methods ( 1 ) Eahy926 cells were cultured in serum-free DMEM medium (96-well plates) and were divided into Achn inhibition group (transfected with plasmid psi-Achn), psi4.1 group (transfected with psi4. 1 empty vector), Achn induction group (transfected with pcDNA-Achn), pcDNA3.1 group (transfected with pcDNA3.1 empty vector), cotransfection group [cotransfected with pcDNA-Achn + psi-calcium/calmodulin-dependent serine protein kinase (CASK)] , blank control group (treated with PBS) according to the random number table (the same method below). The cell proliferation was determined by MTT assay at post transfection hour (PTH) 1, 24, 48, 72, with expression of absorbance value. (2) Total protein of Eahy926 cells were extracted and quantitated by BCA assay, and then they were divided into Achn antibody precipitation group (100 μg protein) , CASK antibody precipitation group ( 100 μg protein), IgG antibody group ( 100 μg protein), Western blot group (20 μg protein).Achn and CASK protein levels were determined by immunoprecipitation and Western blot. (3) Synchronously cultured Eahy926 cells were divided into LPS induction group (treated with 5 mol/L LPS), Achn transfection group (transfected with pcDNA-Achn), cotransfection group (cotransfected with psi-CASK and pcDNA-Achn) , KCl group (treated with 5 mol/L KCl), and blank control group (treated with 5 mol/LPBS). Cells in transfection groups were stimulated by LPS for 12 hours after PTH 24. Caspase-3 protein level was detected by immunohistochemistry. (4) Synchronously cultured Eahy926 cells were divided into Achn inhibition group (transfected with psi-Achn vector), Achn induction group ( transfected with pcDNA-Achn vector), and blank control group ( treated with PBS). Apoptosis rate was determined by FITC/PI with flow cytometry. Data were processed with one-way analysis of variance and t test. Results ( 1 ) The cell proliferation in Achn inhibition group was lower than that in psi4.1 group from PTH 24, and the differences were statistically significant at PTH 48, 72 (with t value respectively 10. 777, 6.112, P values all below 0. 05 ).The cell proliferation in Achn induction group during PTH 24-72 were higher that in pcDNA3. 1 group (with t value respectively 5. 367, 6. 053, 9. 831, P values all below 0.05 ). The cell proliferation in cotransfection group at PTH 48, 72 were significantly lower than that in Achn induction group ( with t value respectively 5.481, 9. 517, P values all below 0. 05). (2) Achn protein was detected in CASK antibody precipitation group while CASK protein was also detected in Achn antibody precipitation group. (3) Caspase-3 level in Achn transfection group was lower [( 15.6 ± 0. 5 ) %] as compared with that in LPS induction group [(32. 8 ±2.6)%, t = 10. 083, P ＜ 0. 05], and that in cotransfection group showed further inhibition [(7.0 ±2.0)%,t =9.827, P ＜0.01]. (4) Apoptosis rate in Achn inhibition group[(45.6 ± 10.9)%] was higher than that in blank control group [(13.2±4.3) %, t =7.043, P ＜0.05]; while that in Achn inductiongroup [(5.3 ±2.9)%] was lower than that in blank control group ( t =6.499, P ＜0.05).Conclusions Achn can promote human vascular endothelial cell proliferation, and inhibit its apoptosis induced by LPS or burn serum, and the effect is related to CASK.     

吉非替尼对非小细胞肺癌的疗效与T细胞亚群变化分析

目的 观察吉非替尼治疗晚期非小细胞肺癌（NSCLC）临床疗效与外周T淋巴细胞亚群变化的关系。方法对组织或细胞病理证实的35例晚期NSCLC患者口服吉非替尼250 mg/d。采集全部患者治疗前及治疗后外周血标本,三色染色后流式细胞仪分析CD3+、CD4+、CD8+ T淋巴细胞亚群变化。结果 35例患者中部分缓解13例,稳定13例,进展9例,疾病控制率为74.2%。治疗前后T淋巴细胞亚群无显著差异。结论 吉非替尼治疗晚期非小细胞肺癌疗效较好,毒副反应轻微。治疗后T淋巴细胞可以恢复到治疗前水平。     

结核分枝杆菌特异性CD4+α/β T细胞受体四聚体筛选细胞系的构建及检测

目的 构建及应用结核分枝杆菌(Mycobacterium tuberculosis,Mtb)特异性CD4+α/βT细胞受体(TCR)四聚体筛选细胞系.方法 从Mtb多肽阳件反应结核患者中,PCR扩增HLA-DR β链,构建HLA-DR β链和加载有结核抗原肽的HLA-DR α链全长基因的表达载体pMT-HLA-DRB及pMT-HLA-DRA-P,磷酸钙转染法转入果蝇S2(Schneider2)细胞中进行表达配对,细胞免疫组化法初步鉴定表达情况,并应用所建立细胞系以流式细胞术筛选Mtb特异性CD4+α/βTCR四聚体.结果 细胞免疫组化法及流式细胞术鉴定显示获得细胞膜上表达结核抗原肽/HLA-DR复合物的稳定S2细胞株,并筛选出2种Mtb特异性CD4+α/β TCR四聚体.结论 成功构建Mtb特异性CD4+α/β TCR四聚体筛选细胞系,为分析鉴定Mtb特异反应性TCR四聚体,探索开发结核诊断新方法 及新型结核疫苗的研制提供了工具.     

胆道术后胃瘫2例分析

胃瘫是指以胃功能性排空障碍为主要征象的胃动力紊乱综合征,是胃癌及各种腹部手术后的早期并发症之一。因其特征是胃排空速度延迟,故也称胃排空延迟症、胃弛缓症。术后胃瘫是指腹部手术后胃肠动力紊乱所致的非机械性胃排空延迟,是腹部术后相对少见的近期并发症。近年我院共收治胆道术后胃瘫2例,观报道如下：     

舒利迭对激素抵抗型哮喘患者的临床疗效

目的观察舒利迭(50/500)对激素抵抗型哮喘患者的疗效。方法将36例激素抵抗型支气管哮喘患者随机分为舒利迭治疗组和泼尼松治疗组;另选18名激素敏感型哮喘患者为对照组。泼尼松治疗组口服泼泥松治疗,舒利迭治疗组及对照组均给予舒利迭(50/500)治疗,各组氨茶碱治疗相同。记录治疗前、后患者的肺功能,并检测血清IFN-γ和IL-4的量。结果舒利迭治疗组的总有效率高于泼尼松治疗组,疗效差异显著(P0.05),且两组疗效均低于对照组,差异显著(P0.05);舒利迭治疗组的IFN-γ高于泼尼松治疗组,但差异不显著(P0.05);舒利迭治疗组的IL-4低于泼尼松治疗组,且差异显著(P0.05)。结论应用舒利迭(50/500)治疗激素抵抗型哮喘,能一定程度改善肺功能,使用安全,值得在临床推广;且激素抵抗型哮喘的发病机制可能与IL-4升高有关。     

牡丹江地区156例皮炎湿疹类皮肤病斑贴试验变应原检测结果分析

目的探讨牡丹江地区皮炎湿疹类皮肤病的常见变应原及斑贴试验的临床应用,为疾病的预防和治疗提供依据。方法采用标准抗原系列对156例皮炎湿疹患者进行斑贴试验。结果 156例皮炎湿疹斑贴试验者中,有一项或一项以上阳性者113例,阳性率为72.4%。变应原阳性率位居前三位的分别是:硫酸镍、对苯二胺、芳香混合物。结论硫酸镍、对苯二胺、芳香混合物是牡丹江地区引起皮炎湿疹类皮肤病的主要变应原。     

颈椎生理曲度的生物力学变化与交感型颈椎病关系的研究

目的探讨颈椎生理曲度的生物力学变化所致颈椎不稳与交感型颈椎病发病的关系。方法对30例交感型颈椎病患者和30例随机抽样正常健康者颈椎的X线表现做对照研究。结果观察组颈椎生理曲度不稳者为23例（76.6%）,颈椎间盘退变7例（23.4%）;不稳定节段为1个者6例,2个者13例,3个者4例。颈椎不稳主要发生在C3-C4、C4-C5、C5-C6,偶见于C6-C7,且多为中度以上。对照组颈椎生理曲度不稳者为7例（23.4%）,且多为轻度;颈椎间盘退变占21例（70%）。结论颈椎生理曲度的生物力学变化所致的颈椎失稳是交感型颈椎病的重要发病原因。     

中西医结合治疗不稳定型心绞痛临床观察

目的:观察中西医结合治疗不稳定型心绞痛的疗效.方法:将100例患者随机分为两组,对照组常规西药治疗,治疗组在对照组治疗基础上,加中药益气养阴豁痰化瘀.结果:治疗组总有效率92%,对照组总有效率70%,两组比较有效率有显著性差异(P＜0.05).结论:在西医常规治疗基础上,合中药益气养阴豁痰化瘀,中西医结合治疗不稳定型心绞痛,能明显提高临床疗效.