二氧化氯消毒剂的亚急性毒性试验

目的研究二氧化氯消毒剂亚急性毒性,作出生物安全性评价。方法采用动物试验法进行了实验室试验观察。结果该二氧化氯消毒剂给药量在117 mg/kg(体重)条件下,对大鼠的体重、血常规及血液生物化学等指标无异常变化,与阴性对照组比较均无显著差异(P>0.05)。病理检查发现,高剂量组个别动物肺脏切片可观察到少数组织轻度充血改变,但无组间特异性分布,同样的变化在对照组动物中也能观察到,其它脏器均无异常变化。结论二氧化氯消毒剂亚急性毒性试验组动物观察指标基本正常,少部分组织有异常变化,主要考虑为动物质量问题。因此,该消毒剂在本次实验条件下,未显示有亚急性毒性作用。     

大脑中动脉分叉处动脉瘤的显微外科手术

目的:总结显微外科手术夹闭大脑中动脉分叉处动脉瘤的临床经验和体会。方法:回顾性分析28例经显微外科手术治疗的大脑中动脉分叉处动脉瘤患者的临床资料、手术过程,总结经验。结果:28例患者共30个动脉瘤,其中5例伴有脑内血肿;根据计算机断层血管造影(computed tomography angiography,CTA)或数字减影血管造影(digital subtraction angiography,DSA)评估动脉瘤的大小、形态、朝向和与分叉血管的关系,精心设计显微手术;术后随访6~12月,格拉斯哥预后分级(Glasgow outcome scale,GOS)评分优良22例,中残4例,重残1例,植物生存状态1例。结论:对于大脑中动脉分叉处动脉瘤,应及早手术,术前影像学上的准确分析与评估、合适的手术入路、娴熟的手术技巧是有效夹闭大脑中动脉分叉处动脉瘤,提高术后疗效的关键。     

今又生联合化疗治疗晚期恶性肿瘤的近期疗效观察

目的观察今又生(重组人p53腺病毒注射液)联合化学治疗(简称化疗)晚期恶性肿瘤的有效性和安全性。方法选择2009年1月至2010年3月经过病理组织学和/或细胞学证实为晚期恶性肿瘤患者21例,其中男性13例,女性8例;年龄22~73岁,中位年龄53岁。鼻咽癌6例,非小细胞肺癌6例,肝癌3例,胃癌2例,结肠癌2例,直肠癌1例,乳腺癌1例。接受今又生联合化疗的治疗方案。按照实体瘤的疗效评价标准(RECIST)评估患者的近期疗效。用卡氏评分(KPS)评估患者的生活质量,按照WHO抗癌药物毒副作用分级标准评价毒性反应。结果 21例患者中,完全缓解(CR)1例,部分缓解(PR)11例,稳定(SD)6例,疾病进展(PD)3例;客观有效率(RR)为57.1%(12/21),疾病控制率(DCR)为85.7%(18/21)。生活质量改善者有13例(61.9%),生活质量稳定者6例(28.6%),生活质量下降者2例(9.5%)。G3/4毒性主要与化疗有关,包括白细胞减少、恶心、呕吐等。今又生引起的不良反应主要是发热,其中有23.8%(5/21)患者出现Ⅰ度发热反应,38.1%(8/21)患者出现Ⅱ度发热反应。结论今又生联合化疗能够使晚期恶性肿瘤患者获得较好的近期临床疗效,改善患者的生活质量,且毒性低,安性好,但远期疗效仍需观察。     

104例中重度慢性阻塞性肺疾病稳定期患者肺康复治疗的回顾性队列研究

目的：观察中重度慢性阻塞性肺疾病（COPD）稳定期患者肺康复治疗的疗效及对患者日常生活能力的影响。方法采用回顾性队列研究方法,选取中重度COPD稳定期住院患者104例,分为暴露组（53例,常规药物治疗＋呼吸肌锻炼＋有氧运动疗法）和非暴露组（51例,常规药物治疗）,分别对2组患者治疗前后的呼吸困难评分、日常生活能力（ADL ）评分、6 min步行距离（6‐MWD）及肺功能进行检查及评估。结果所有患者均随访2年以上,暴露组患者治疗后,6‐MWD、呼吸困难评分和ADL评分与治疗前比较,差异有统计学意义（P＜0．05）,与非暴露组比较差异也有统计学意义（P＜0．05）,但两组患者治疗前后肺功能检测差异均无统计学意义（P＞0．05）。结论全面的肺康复治疗措施,能减轻中重度COPD 患者的呼吸困难,并提高其日常生活能力。     

ＣＴ／ＣＴ图像融合用于非小细胞肺癌放射治疗对Ｖ２０及放射性肺炎影响的临床研究

目的　探讨ＣＴ／ＣＴ图像融合技术应用于非小细胞肺癌（ＮＳＣＬＣ）放射治疗计划对Ｖ２０和放射性肺炎（ＲＰ）的影响。方法　４０例入组患者均经病理组织学或细胞学证实为ⅢＡ、ⅢＢ期ＮＳＣＬＣ,三维适形放疗（３Ｄ-ＣＲＴ）剂量达到４０００ｃＧｙ肿块缩小达２５％后随机分为常规缩野放疗组２０例（Ａ组）和ＣＴ／ＣＴ图像融合缩野放疗组２０例（Ｂ组）,两组均追加剂量至６６００ｃＧｙ。记录临床资料、Ｖ２０、放疗结束３个月内ＲＰ发生情况等。ＲＰ用ＲＴＯＧ急性放射性损伤分级标准判断。采用ＳＰＳＳ１１.５软件包进行统计学分析。结果　４０例患者中ＲＰ发生率为２２.５％（９／４０）,其中Ａ组６例（３０.０％）,Ｂ组３例（１５.０％）,两组间差异无统计学意义（Ｐ＝０.２5６）。Ａ、Ｂ组的患侧肺Ｖ２０（ＩＶ２０）和全组的健侧肺Ｖ２０（ＣＶ２０）、患侧肺Ｖ２０均与ＲＰ发生有关,差异有统计学意义（Ｐ＜０.０５）,Ｗｉｌｃｏｘｏｎ检验两组间患侧肺Ｖ２０、健侧肺Ｖ２０差异均有统计学意义（Ｐ＜０.０５）。结论　ＣＴ／ＣＴ图像融合执行的缩野追加剂量放疗未增加ＲＰ的发生率,且有可能降低患侧肺Ｖ２０,为进一步提高局部放疗剂量,获得更好的局控率提供了理论参考依据。     

类风湿性关节炎合并弥漫大B细胞淋巴瘤5例并文献复习

目的 探讨类风湿性关节炎(RA)合并弥漫大B细胞淋巴瘤(DLBCL)的临床特点,提高对此类疾病的认识.方法 回顾性分析首都医科大学附属北京世纪坛医院2011年1月-2018年1月住院治疗的RA合并DLBCL患者的临床资料.结果 RA合并DLBCL患者5例,占同期RA住院病例的0.32％(5/1561),其中男1例,女4...     

手术室几种洗手方法分析

手术前医务人员洗手方法要求操作简便，而且洗手液对皮肤无刺激，价格适宜，最终达到术前手的消毒。为选择其理想的洗手方法，我们将美逸柔和碘伏洗手液分别进行刷洗、擦抹、揉搓，与过去传统的肥皂刷洗后酒精、新洁尔灭浸泡的方法进行分析、比较，最终首选美逸柔揉搓，次选碘伏擦抹，作为手术前手的消毒。     

系统性红斑狼疮合并自发性肾上腺出血1例

A 58-year-old female was referred to our department with intermittent suffocation for 1.5 years, aggravated for a month. 1.5 years before she developed oral ulcer, raynaud phenomenon, proteinuria, bilateral pleural effusion, ANA and anti-dsDNA positive. This patient was diagnosed with systemic lupus erythematosus (SLE). After given hormones, hydroxychloroquine sulfate (HCQ), her symptom relieved soon. The patient stopped her pills 1 year ago. One month ago, she had chest tightness, increased urine foam, and suffered from oliguria. Her admission medical examination: blood pressure (BP) 130/80 mmHg, conjunctiva pale, and lower lung breath sounds reduced. There was no tenderness, rebound pain and abdominal muscle tension in the abdomen. Liver and spleen rib inferior, mobile dullness negative, and lower extremity edema. Blood routine tests were performed with hemoglobin (HGB) 57 g/L. Urine routine: BLD (3+). 24-hour urinary protein 3.2 g. serum albumin 20.5 g/L, C-reactive protein (CRP) 12.85 mg/L, erythrocyte sedimentation rate (ESR) 140 mm/h. Antinuclear antibody (ANA) (H)1 ∶10 000;, anti-dsDNA antibody 1 ∶3 200;, anti-Smith antibody, anti-U1-snRNP / Sm antibody were positive, blood complement 3(C₃) 0.43 g/L, complement 4(C₄) 0.07 g /L. Anticardiolipin antibody (ACL), anti-β2-GP1;, lupus anticoagulant (LA) were negative, HRCT suggested bilateral medial pleural cavity product liquid. Admission diagnosis: SLE lupus nephritis, anemia, pleural effusion, and hypoproteinemia. We treated her with methylprednisolone 1 000 mg×3 d;, late to 48 mg/d and cyclophosphamide 1.0 g, HCQ 0.2 g bid, gamma globulin 10 g×5 d. Day 2 of treatment;, this patient developed acute right upper quadrant pain, not accompanied by nausea, vomiting, blood stool and diarrhea. Antipyretic antispasmodic treatment was invalid, after the morning to ease their own abdominal pain. Day 4 of treatment, daytime blood HGB 77 g/L. Bilateral renal vascular ultrasound: bilateral renal artery blood flow velocity was reduced. The abdominal pain of the above symptoms recurred at night, BP was 120/80 mmHg, and no positive signs were found on abdominal examination. No abnormality was found in the vertical abdominal plain film. Blood routine examination: HGB 53 g/L, Plasma D dimer 2 515 μg/L;, amylase in hematuria was normal, the stool occult blood was negative. Abdominal computed tomography (CT): normal structure of right adrenal gland disappeared, irregular mass shadow could be seen in adrenal region, CT value was about 50 HU. Morphological density of left adrenal gland was not abnormal. The retroperitoneum descended along the inferior vena cava to the right iliac blood vessel and showed a bolus shadow. The density of some segments increased. The lesion involved the right renal periphery and reached the left side of abdominal aorta. Most lesions surrounded the inferior vena cava, the right renal vein and part of the small intestine. The boundary between the upper lesion and the vena cava was unclear. Iodine-containing contrast agent was taken orally. No sign of contrast agent overflowing was found in the abdominal cavity. Hematoma and exudative changes were considered in retroperitoneum. Conclusion of contrast-enhanced ultrasound of blood vessels: The retroperitoneal inferior vena cava (volume 3.5 cm×3.5 cm×1.5 cm) was hypoechoic and had no blood flow lesion. The adrenal gland had a high possibility of origin. Left renal vein thrombosis extended to inferior vena cava. According to the above data;, it was analyzed that the cause of retroperitoneal hematoma of the patient was left adrenal vein thrombosis caused by hypercoagulable state, which led to vascular rupture and hemorrhage caused by increased vascular pressure in adrenal gland. Therefore, on the basis of continuing to actively treat the primary disease, and on the basis of dynamic observation of no active hemorrhage for 3 days, the anticoagulant therapy was continued with 10 mg/d of apixaban. Clinical symptoms were gradually eased, HGB did not decrease. Two weeks later, the ultrasonic examination showed that the irregular cluster hypoechoic range behind the inferior vena cava was significantly smaller than that before (1.8 cm×1.2 cm×0.7 cm). Abdominal CT examination after 1 month showed that there was no abnormal morphological density of bilateral adrenal glands and basic absorption of retroperitoneal exudation. Adrenal hemorrhage is uncommon. SLE with adrenal hemorrhage is rarer. In SLE patients;, especially those complicated with APS, if abdominal pain accompanied by HGB decrease occurs, except after gastrointestinal hemorrhage, the possibility of adrenal hemorrhage should be warned.     

神农架原始森林高毒力苏云金芽孢杆菌菌株分离鉴定研究

目的：调查湖北神农架原始森林苏云金芽孢杆菌（简称B.t)天然资源,以期发现新的B.t亚种或毒力特异性菌株。方法：B.t的分离采用热处理筛选法,高毒力菌株的筛选采用常规生物测定程序。B.t亚种鉴定采用血清学反应和常规生理生化反应方法。结果;从神农架原始森林160份不同生态类型的土壤样品,共分离出B.t18株,从中筛选出8株高毒力菌株,较国内对棉铃幼虫高毒力生产菌株HD－1而言,菌株A3、B4、C5、C6、D2和E6对夜蛾科3种害虫（棉铃幼虫、斜纹夜蛾、甜菜夜蛾）均具有相对较高毒力,其中A3、B4对棉铃幼虫具显著高毒力水平,毒力指数分别为2.98和4.26,C5和C6对斜纹夜蛾和甜菜夜蛾有较高毒力,菌株F3和F8对致倦库蚊较国内生产高毒株HD－567有相对较高的毒力水平,毒力指数分别为13.7和16.4,经生理生化反应和血清学反应鉴定,A3属于H3abc型,F3和F8型属H14型,A3、B4、C5、C6、D2、E6属H7型。结论：神农架原始森林高毒力B.t菌株分离,进一步丰富了我国B.t的天然资源,具有较高的科学研究价值和广阔的应用开发前景。     

苗药黑骨藤多糖部位HGT-5A的细胞免疫抑制作用及其可能的活性成分

目的观察苗药黑骨藤多糖部位HGT-5A的细胞免疫抑制作用及探讨其可能的活性成分。方法采用二硝基氯苯建立小鼠迟发型超敏反应模型,初次致敏当天开始ig给予HGT-5A,每天1次,连续10 d,第11天处死小鼠测定耳肿胀度,观察HGT-5A体内对细胞免疫反应的影响;用[3 H]TdR掺入法检测HGT-5A及其多糖组分对小鼠脾细胞增殖反应的影响;用MTT法检测HGT-5A对脾淋巴细胞存活的影响。结果HGT-5A 50和100 mg.kg-1可以明显抑制迟发型超敏反应模型小鼠耳肿胀,耳肿胀度由模型组的(8.9±2.2)mg分别降低至6.4±1.7和(7.1±1.5)mg;HGT-5A 50～500 mg.L-1体外应用可促进小鼠脾细胞自发增殖反应,但在HGT-5A 100 mg.L-1以上时可明显抑制刀豆蛋白A诱导的小鼠脾细胞增殖反应(P<0.05),对脂多糖诱导的小鼠脾细胞增殖反应无明显影响;HGT-5A与脾细胞共培养24,48和72 h对脾细胞存活无明显影响。从HGT-5A分离获得的中性糖部位HP1,酸性糖部位HP2,从HP1中分离得到的多糖成分HP1-3,以及从HP2中分离得到的多糖成分HP2-3和HP2-4 0.5～50 mg.L-1可促进脾细胞自发增殖反应;HP2,HP1-3,HP1-4,HP2-2和HP2-4明显抑制刀豆蛋白A诱导的T细胞增殖反应。结论 HGT-5A可抑制T细胞活化增殖,对细胞免疫反应具有抑制作用,多糖成分HP1-3,HP1-4,HP2-2和HP2-4可能是黑骨藤发挥免疫抑制作用的活性成分。