小剂量肝素治疗脓毒症的临床分析

Objective To investigate the therapeutic effects of low-dose heparin on sepsis. Methods Seventy-nine sepsis patients were randomly divided into tow groups: beparin treatment group (n=37) and routine treatment group(n =42). The 7-day and 28-day mortality, the days in ICU and the length of stay, the changes of oxygenation index, the days of mechanical ventilation and the rates of disseminated intravascular coagulation (DIC), acute renal failure (ARF), acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome(MODS) were observed. The levels of APTT, PT and platelet (PLT) count were determined before and after treatment in two groups. Results The rates of DIC, ARF and MODS in beparin group decreased significantly after therapy: rate of BIC, 15.4% vs 38. 7% (P=0.03) ; rate of ARF, 25.0% vs51.9% (P=0.04); rate of MODS, 26.3% vs50.0% (P=0.04). In heparin group, the 28-day mortality was statistically reduced (15.4% vs 32.4%, P = 0. 03). The differences between beparin group and routine group were not statistically significant in the 7-day mortality (7. 7% vs 12. 9% ,P =0. 08) ,the days in ICU(Z =0. 281 ,P =0. 779,rank sum test) ,the length of stay (Z = 0. 562, P = 0. 574, rank sum test), the oxygenation index (P = 0. 82), the days of mechanical ventilation [(126.07±166.21)h vs (179.27±221.7)h,P=0.28] and the rate of ARDS (44.0% vs 46.2% ,P= 0. 88). The differences in APTT, PT and PLT were not significant between the two groups. Conclusion Low-dose beparin can decrease the mortality rate of sepsis and improve the prognosis of patients. It is a safe promising therapy in sepsis patients without severe side effects.     

高血压与颈动脉内膜中层厚度的关系

目的　研究高血压病程与颈动脉粥样硬化的关系。方法　用高频超声检测3 0 5例高血压病患者和1 1 2例健康人的颈动脉内膜中层厚度(IMT)。结果　(1 )高血压病组IMT明显高于正常对照组(P <0 . 0 5 ) ;高血压病不同病程各组之间比较有显著性差异(P <0 . 0 5 ) ;高血压病有无合并冠心病组间比较有显著性差异(P <0 . 0 5 )。(2 )颈动脉IMT增厚与冠心病密切相关。结论　超声检测高血压病患者的颈动脉情况,可以判断动脉粥样硬化程度,监测高血压病的进展、预后,在高血压动脉粥样硬化防治监测上有重要意义。     

肾上腺皮质激素对柯萨奇B3病毒感染小鼠心肌的保护作用

目的 探讨肾上腺皮质激素对柯萨奇岛病毒感染小鼠心肌损害的治疗作用。方法将200只4周龄Balb／c小鼠随机分为正常对照组、病毒对照组和病毒感染后早期激素治疗组、中期激素治疗组及晚期激素治疗组，每组加只。在病毒感染后不同时期计算心肌病理积分，空斑形成单位法测定心肌细胞病毒滴度，化学发光法检测血清肌钙蛋白I水平。结果病毒感染后7-10天，柯萨奇B3病毒感染各组小鼠心肌病理积分均显著高于正常对照组，而各感染组之间无显著性差异。病毒感染后14天，中期激素治疗组小鼠心肌病理积分显著低于其他病毒感染组，30天后中期激素治疗组小鼠心肌已完全正常，而其他各组小鼠心肌仍有病变。病毒感染后早期激素治疗组心肌病毒滴度显著高于其他各组，且消失慢。病毒性心肌炎小鼠血清肌钙蛋白I水平显著升高，并与病理变化呈直线正相关。结论肾上腺皮质激素可以明显减轻病毒性心肌炎时心肌的病理损害，对心肌细胞有保护作用，尤以病毒感染中期使用激素治疗疗效最好。     

聚合酶链反应检测耐甲西林金黄色葡萄球菌的研究

为对聚合酶链反应扩增Ｍｅｃ＾Ａ基因诊断耐甲氧西林金黄色葡萄球菌的可行性评价。应用ＰＣＲ方法检测了１２０株保留的金黄色葡萄球菌菌株，扩增结果与药敏检测结果进行比较，发现４０株对甲氧西林，苯唑西林耐药的金黄色葡萄球菌ＰＣＲ扩增结果均为阳性，而有４株菌株对甲氧西林苯唑西林敏感的金黄色葡萄球菌ＰＣＲ扩增结果阳性。     

疑难病例报告并文献析评

目的探讨不明原因发热伴淋巴结肿大患者的诊断思路与方法及治疗方案。方法对不明原因发热的患者进行相关检查,明确诊断,制定治疗方案,并查阅国内外有关文献进行分析。结果该患者经淋巴结活检确诊为组织细胞性坏死性淋巴结炎,用激素治疗后好转。结论临床上对不明原因发热伴淋巴结肿大患者应及时行淋巴结活检并排除其他疾病,以明确诊断。     

狼疮性肾炎患者肾组织Epstein-Barr病毒感染状况及其致病作用初探

并感染之间以及不同病理类型之间差异均无统计学意义(P＞0.05).肾组织EBER和EBV LMP1表达阳性的LN患者的血清中anti-Sm-Ab阳性率显著高于两标记物表达阴性的LN患者(EBER:34.3%vs 8.7%,EBV LMP1:35.3%vs 9.1%,P均＜0.05).结论 肾组织EBV感染可能参与了LN的发病,其机制可能部分与诱导机体产生自身抗体anti-Sm-Ab有关.     

人巨细胞病毒UL143基因在临床低传代分离株中的多态性研究

目的 探讨人巨细胞病毒(human eytomegalovirus,HCMV)UL143序列在临床患儿低传代分离株中的多态性及其与临床疾病的关系.方法 对19株HCMV临床低传代分离株进行HCMV-UL143 PCR扩增分析及伞序列测定分析.结果 19株HCMV感染患儿临床分离株均因碱基插入造成移码突变,开放阅读框架(ORF)比Toledo株短.根据序列变异情况可将19个序列分为2组,第1组16个序列新增一个MYRISTYL位点;缺失2个PKC磷酸化位点.未发现黄疸、小头畸形、先天性巨结肠等不同疾病类型的序列之间的差异.结论 HCMV-UL143较多存在于临床低传代分离株中,序列呈现一定多态性.     

基于功能性电刺激无支撑站立姿态控制环的设计和研究

研究的目的在于实现功能性电刺激中瘫痪患者功能性站立的仿真。通过对人体站立姿态进行动力学分析,利用最优控制理论,以脚部受地面作用力点到踝关节的距离及控制力矩取极小值为最优控制准则,建立并优化被控制模型,设计最优控制器;以一参考输入为随机曲线的比例微分控制器模拟截瘫患者完好上身的活动,利用最优控制器和卡尔曼状态观测器,构建整个控制系统;以一名身高162 cm、体重55 kg的中国青年男性为样本,利用线性二元回归法计算仿真所需数据,对整个控制系统进行仿真研究。仿真结果表明,截瘫患者腿部肌肉只需要提供较小的力矩便可以维持身体平衡,因而在理论上截瘫患者在不需要双臂辅助的条件下,能够站立较长时间。     

法洛四联症伴肺动脉瓣缺如3例报道并文献复习

目的总结法洛四联症伴肺动脉瓣缺如患儿的临床特点和诊治经验。方法收集复旦大学附属儿科医院2007年11月至2009年2月收治的法洛四联症伴肺动脉瓣缺如3例患儿的临床资料,总结其临床表现、影像学特征、治疗和预后。结果男1例,女2例,年龄39 d至4个月。临床均表现为气急、咳喘及轻度发绀;体检可闻及胸骨左缘来回杂音。超声心动图和心导管检查除法洛四联症表现外,可见肺动脉瓣环发育不良或缺如,伴肺动脉重度反流、肺动脉瘤样扩张,均未见动脉导管未闭,其中1例左肺动脉不连接伴发育不良。2例临床症状严重的患儿施行手术根治,其中1例手术效果满意,另1例左肺动脉不连接伴发育不良患儿术中死亡;1例患儿临床症状尚不明显,仍在密切随访中。结论法洛四联症伴肺动脉瓣缺如尽管少见,但由于在婴儿期甚至新生儿期即可引起严重气道受压从而危及生命,临床中遇到难以控制的呼吸窘迫新生儿和小婴儿应考虑本病的可能。尽早手术根治解除气道受压呼吸困难症状是唯一的治疗方法,无呼吸道受压症状可考虑6个月左右择期手术。手术病死率高于单纯法洛四联症,尤其是伴一侧肺动脉不连接或发育不良的患儿。     

CD44+/CD24-细胞在乳腺癌组织及细胞系中的数量与分布

Objective To study the distribution and quantity of CD44VCD24- cells in breast cancer tissue and the cell lines,and as well as its correlation with the expression of various breast cancer markers and molecular subtyping of breast carcinoma.Methods The expression of CD44 / CD24,estrogen receptor,progesterone receptor,HER2,human estrogen-induced protein PS2,bcl-2 and nm23 in 60 cases of invasive ductal carcinoma of breast were studied by either single or double immunohistochemical staining.The co-expression of CD44 and CD24 in 3 breast cancer cell lines (MCF-7,MDA-MB-468,and MDA-MB- 231) was also examined.Results The quantity and distribution of CD44 + /CD24- cells varied greatly and no specific patterns were identified.The percentage of CD44 + /CD24- in breast cancer was 65%.The amount of CD44+/CD24- cells did not correlate with the age of patients,lymph node metastasis,tumor　 size,molecular subtypes and expression of various breast cancer markers in breast carcinoma.The proportion of CD44+/CD24- cells in MCF-7,MDA-MB-468,and MDA-MB-231 cell lines was < 1%,5% and > 80% ,respectively.Conclusions CD44+ /CD24- cells are demonstrated in certain breast cancer tissues and cell lines.However,there is no relationship obtained between the quantity or the distribution of these cells and the molecular subtyping or the clinicopathologic parameters in breast cancer.