急性脑卒中后发热与预后的关系

急性脑血管病，尤其是急性脑卒中发病后常出现发热，探讨发热的病因及对病程的影响对我们临床治疗工作有非常重要的意义，且对病人的预后估计有一定的指导。我们将1997年至2003年所收集的急性脑卒中后发热患者80例结合文献进行分析如下。     

卡瓦内酯和二氢醉椒素对大鼠胃-脑干标本GABA能活性的调节作用

有研究表明,卡瓦胡椒Piper methys-ticum Forster f.的镇静、抗惊厥、解痉和中枢肌松弛作用与卡瓦内酯类(kavalactones)有关,但机理并不清楚。因此,作者采用新生大鼠胃-脑干标本研究了卡瓦内酯及其中一个活性化合物二氢醉椒素对脑干孤束核(NTS)神经元GABA能活性的影响。     

颜乾麟治疗颤证经验举隅

颜乾麟教授出身中医世家,自幼随父学医,承习家传,悉心揣度,勤奋耕读,深研奥旨,临证善用经方,颇有心得。笔者有幸跟师学习,见其多从阴虚血瘀来论治颤证,屡用屡效,现将其治疗经验总结介绍如下。1病因病机颤证是指由内伤积损或其他慢性病证致筋脉失控,以头身肢体不自主摇动、颤抖为主要临床表现的一种病证。属祖国医学的“颤振”、“振战栗”、“颤证”、“手颤”、“足颤”等范畴。中医对颤证病因病机的基本认识来源于《内经》,《内经》指出:“诸暴强直,皆属于风”,《证治准绳·杂病》曰:“颤,摇也;振,动也。筋脉约束不住耳莫能任持,风之象也…     

食管鳞状细胞癌及癌前病变组织中p16基因甲基化的研究

目的：探讨食管鳞状细胞癌及癌前病变纽织p16基因CpG岛的甲基化情况．及其在食管癌发生和早期诊断中的价值。方法：采用MSP方法，对食管癌前病变不同阶段、鳞状细胞原位癌和浸润癌的病变组织进行了甲基化检测．并与其相应的正常组织和慢性食菅炎组织的甲基化情况进行对比分析。结果：轻、中、重度不典型增生、鳞状细胞原位癌和浸润癌的甲基化频率分别为22．73％(5/27)、46．15％(6/13)、77．78％(7/9)、78．57％(11/14)和64．86％(24/37)。67例正常对照组织中3例(4．48％)p16基因甲基化，与病变组织相比，差异有统计学意义，P=0．000。10例慢性食管炎组织中1例(10％)p16基因甲基化。结论：p16基因甲基化可能是食管癌发生的最早期事件之一。     

2型糖尿病辩证分型和客观指标关系的研究进展

回顾近10年2型糖尿病辩证分型与客观指标之间关系的研究概况，提出目前研究中存在的问题，并初步探讨解决问题的思路和方法。     

弹性排班联合量化计分绩效考核制度在基层医院手术室护理人力资源管理中的应用

目的:调动护士工作积极性,提高护理质量.方法:选取2011年1月～2011年12月和2012年1月～2012年12月在手术室工作的28位护理人员,对年手术例数,年加班时数、年欠班时数等与传统人力资源管理进行统计和比较.同时,进行量化计分绩效考核满意度的问卷调查.结果:弹性排班联合量化计分绩效考核打破了传统的排班模式加平均分配奖金的管理模式,使管理者能更有效地利用人力资源,充分调动了护士工作的主动性和积极性,由被动变为主动,从而使病人、手术医生及护士均获得满意[1].结论:护理人员对弹性排班联合量化计分绩效考核制度持赞同意见.     

食管鳞状细胞癌中FBXO32基因表达及其临床意义

目的观察食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)中FBXO32基因的表达,探讨该基因在ESCC发生、发展中的作用。方法分别应用RT-PCR及免疫组织/细胞化学法检测食管癌细胞和ESCC组织中FBXO32 mRNA及蛋白表达,观察DNA去甲基化剂5-氮杂-2’-脱氧胞苷(5-aza-2’-deoxycitydine,5-aza-dC)对食管癌细胞系(TE1、TE13、T.TN、Yes-2)FBXO32基因表达的影响。结果 TE13、T.TN、Yes-2细胞株中均未检测到FBXO32 mRNA及蛋白表达,在去甲基化剂作用后,4株食管癌细胞株中FBXO32基因表达均上调。FBXO32 mRNA在ESCC和癌旁正常组织中的表达量分别为0.24±0.15和0.49±0.21,ESCC组织中FBXO32 mRNA表达量明显低于癌旁正常组织(P<0.05),且与患者的淋巴结转移及肿瘤组织的分化程度密切相关。51例ESCC组织中,12例FBXO32基因蛋白表达,阳性率为23.5%,明显低于正常食管黏膜组织(70.5%,P<0.01),且FBXO32与患者的淋巴结转移密切相关。结论 FBXO32基因在ESCC中的异常低表达与ESCC的发生、发展密切相关,且甲基化可能是其表达沉默的机制之一。     

呼吸机计划性脱机的研究进展

机械通气在挽救患者性命的同时,还带来了很多负面作用,因此积极的脱机显得非常重要。当患者病情改善,就应准备进入自主呼吸试验(SBT)。脱机参数尤其是浅快呼吸指数和呼吸道闭合压对脱机有很好的指导价值。目前常用的脱机方法有SBT法、有创-无创序贯通气法和电脑智能法。其中SBT法是目前使用较多的脱机方法,它又包括压力支持通气、持续呼吸道正压通气和T管试验。有创-无创序贯通气法适用于拔管后呼吸窘迫的患者,并且拔管后立即使用才能获益。电脑智能法便于操作,临床效果有待研究。     

肾移植术后感染新型冠状病毒1例

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.