微卫星多态性和多位点序列分析技术在光滑念珠菌基因分型中的应用评估

目的评估微卫星多态性分析技术在临床光滑念珠菌基因分型中的作用。方法收集2011年1月至2012年12月仁济医院和东方医院临床分离的光滑念珠菌59株,采用多位点序列分析(MLST)和微卫星多态性分析技术进行基因分型,比较2种基因分型方法的结果和分辨力。结果 59株光滑念珠菌经MLST分型得到6个序列型,其中ST-7型43株、ST-10型7株、ST-15型和ST-55型各3株、ST-3型2株、ST-43型1株,鉴别力指数(DP)为0.456;经微卫星多态性分析方法分为10型,其中A型25株、B型10株、C型8株、D型6株、E型3株、F型和G型各2株、H~J型各1株,DP为0.770。结论微卫星多态性分析方法简便、快速,分辨力高于MLST技术,可作为实验室基因分型的首选方法。     

全骨盆切除者使用不同代步工具的能量消耗

目的比较全骨盆切除者使用不同代步工具的能量消耗。方法对1 例中年男性全骨盆切除者使用4 种代步工具(接受腔、代步车、轮椅、假肢)时,进行运动心肺功能测试。结果患者使用假肢的移动速度最慢,轮椅最快;使用假肢的心率最高,代步车最低;使用接受腔进行手支撑行走的绝对耗氧量、相对耗氧量和代谢当量均最大,代步车最小。结论使用接受腔进行手支撑行走的能量消耗最大,其次分别为假肢、轮椅、代步车。     

机械通气时人机对抗的原因分析及防治策略

目的探讨机械通气患者发生人机对抗的原因和防治对策。方法对在机械通气过程中出现人机对抗78例患者的临床资料进行回顾性分析。结果78例发生人机对抗的机械通气患者中,其发生原因包括：气道阻塞27例,不能耐受插管16例,分钟通气量不足9例,支气管痉挛7例,持续高热4例,急性肺水肿4例,单肺通气3例,抽搐、肌肉痉挛3例,管道漏气2例,呼吸机故障2例,气胸1例。结论人机对抗的发生均有其诱发因素。气道阻塞、不能耐受插管、潮气量不足、支气管痉挛等是主要原因。加强气道管理、设置合适的通气模式和（或）参数、解除气道痉挛、祛除诱因等综合有效防治措施,可避免和减少人机对抗的发生。     

孤独症、肢体残疾、智力残疾儿童家庭经济负担调查

目的评估孤独症、肢体残疾和智力残疾儿童的家庭经济负担。方法对此三类残疾儿童和普通儿童家长(共227名)以访谈的形式进行关于家庭经济负担的调查。结果残疾儿童的医疗支出、看护支出明显多于普通儿童,而教育支出、衣着支出、游乐支出明显少于普通儿童。儿童家庭人均收入仅受父母文化程度影响。除孤独症儿童外,肢体残疾、智力残疾儿童的家庭经济援助明显多于普通儿童。家庭儿童个数越多,经济援助越少。与普通儿童相比,三类残疾儿童的抚养负担依次为：孤独症儿童(19582.4元/年)、肢体残疾儿童(16410.1元/年)、智力残疾儿童(6391.0元/年)。结论相比普通儿童,肢体残疾、智力残疾和孤独症儿童的家庭有着较大的经济负担。     

美托洛尔与卡托普利联合治疗慢性心力衰竭

目的了解或评价美托洛尔与卡托普利联合治疗慢性充血性心力衰竭的疗效和安全性。方法以90例心脏病伴轻中度心力衰竭的患者为研究对象。按随机化原则分为3组:美托洛尔联合卡托普利组、美托洛尔组、卡托普利组,在心力衰竭标准用药基础上,美托洛尔、卡托普利均从小剂量开始,逐渐递增至目标剂量,在8个月内检查超声心动图3次,以评价左室舒张末期容积。结果治疗后3组的左室射血分数(LVEF)均有增加,左室收缩末期容积(LVESV)和左室舒张末期容积(LVEDV)均有减少,但美托洛尔联合卡托普利组与美托洛尔组、卡托普利组比较,差异有显著性(P0.05)。美托洛尔联合卡托普利组有24例(80%)耐受目标剂量,其多见的不良反应为头晕,但不良反应发生率与单独美托洛尔组、单独卡托普利组比较,差异无显著性。3组均未发现肝、肾功能损害或血象、电解质和糖代谢变化。结论美托洛尔与卡托普利用在心衰标准用药基础上治疗轻、中度CHF患者安全有效,可显著改善左室重塑。     

内窥镜下银夹法泪囊鼻腔吻合术临床观察

目的报告在内窥镜下经鼻腔用银夹法进行泪囊鼻腔吻合术治疗慢性泪囊炎的手术方法和治疗效果的观察。方法自2003年10月开始至今,在内窥镜下,以枪状镊定位,经鼻腔切开泪囊内侧壁,用银夹将泪囊与鼻粘膜吻合的方法,治疗慢性泪囊炎26例27眼。术后3个月观察患者有无溢泪,泪道冲洗是否通畅,以此来评定这种方法的治疗效果。结果接受这种方法治疗的26例27眼慢性泪囊炎患者,治愈24眼,有效1眼,无效2眼,总有效率92．60％（25／27）,无其他术后并发症。结论运用这种方法治疗慢性泪囊炎,具有面部无瘢痕,操作简便,损伤小,恢复快,治疗效果满意等诸多优点。     

Specificity of commercially available antibodies used for gastrin measurement

We examined the specificity of commercially available antibodies used in measurement of serum gastrin. Antibodies were obtained from five commercial laboratories, and antibody immunoreactivity with gastrin and cross-reactivity with cholecystokinin (CCK) were determined. All antibodies were equally immunoreactive with gastrin, and cross-reactivity of three antibodies with CCK was minimal (less than 5%). In contrast, substantial cross-reactivity with CCK was found with two antibodies. To determine the clinical significance of cross-reactivity with CCK, secretin injection tests were performed in 24 individuals: seven in normal health, four with Zollinger-Ellison syndrome, three with antral gastrin cell hyperfunction, six with ordinary duodenal ulcer disease, and four with atrophic gastritis. Serum gastrin levels were measured with all five gastrin antibodies. The response to secretin was negative in all normal subjects and in those with duodenal ulcer and antral gastrin cell hyperfunction. The response to secretin was positive in all four patients with gastrinoma with use of the five antisera. All four patients with atrophic gastritis had normal responses to secretin when antibodies with minimal CCK cross-reactivity were used; however, two of four had false positive secretin test results when serum gastrin levels were measured with the two antibodies with a high degree of cross-reactivity with CCK. These studies indicate that significant cross-reactivity of gastrin antibodies with CCK can result in false positive secretin injection test results and can lead potentially to the erroneous diagnosis of Zollinger-Ellison syndrome.     

Synergy with cefsulodin or piperacillin and three aminoglycosides or aztreonam against aminoglycoside resistant strains of Pseudomonas aeruginosa

Fifty-one strains of Pseudomonas aeruginosa, with resistance to one or more amino-glycosides, were tested for synergy with cefsulodin or piperacillin plus amikacin, tobramycin, gentamicin or aztreonam by the agar dilution technique. Cefsulodin plus any one of the three aminoglycosides regardless of the degree of resistance to the aminoglycoside was synergistic against P. aeruginosa for two thirds of the isolates. In contrast, synergy rates with piperacillin were much less uniform. The highest rate of synergy with piperacillin (90.0%) was observed with gentamicin for the gentamicin resistant strains. The lowest rate of synergy was observed with piperacillin plus amikacin (32.2%) for isolates with moderate resistance to amikacin. Synergy for strains with moderate resistance to amikacin was observed more commonly with cefsulodin than with piperacillin. Synergy for strains with a known mechanism of resistance to amikacin was more common with cefsulodin regardless of the mechanism of resistance. Cefsulodin or piperacillin in combination with aztreonam was rarely synergistic (less than 12%).     

肥厚型与扩张型心肌病的心电图改变

目的观察肥厚型与扩张型心肌病病例的心电图改变。方法对9例肥厚型心肌病与19例扩张型心肌病患者心电图资料进行分析。结果肥厚型心肌病组77．8％心电图出现异常,以ST—T改变发生率最高（6例,67％）,左心室肥大次之（5例,56％）,传导障碍（3例,33％）,有1例V3-V5导联出现巨大倒置T波（11％）。扩张型心肌病组全部患者均有不同程度心电图改变,ST—T改变发生率（12例,63％）与肥厚型大致相等,P波改变（12例,63％）、传导障碍（9例,47％）、心房颤动（4例,21％）、室性心动过速（3例,16％）发生率均较肥厚型高,左心室肥大较肥厚型低（37％）。结论肥厚型与扩张型心肌病均可引起多种类型心电图改变,重视临床及心电图变化,采取进一步的检查措施可以最大限度地减少该病的误诊。     

剖宫产瘢痕部位妊娠的治疗方法探讨

目的探讨剖宫产瘢痕部位妊娠(CSP)发生的高危因素及治疗方法。方法回顾性分析78例CSP患者的临床资料,分析各种治疗方案。结果甲氨蝶呤治疗11例;米非司酮联合甲氨蝶呤治疗4例;米非司酮治疗4例;子宫动脉栓塞术的综合治疗40例;药物预处理后予以清宫术5例;直接清宫术1例;经腹疤痕处妊娠物祛除术7例;全子宫切除术1例;其他5例。结论 CSP的治疗应根据患者具体情况个体化治疗。介入+清宫术治疗是一种较安全、有效的方法,术中出血少,术后住院时间短,值得临床推广。     

高频彩色多普勒超声在阴囊、睾丸疾病中的诊断价值

目的探讨高频彩色多普勒超声在阴囊、睾丸疾病中的诊断价值。方法对151例经手术及病理证实的阴囊、睾丸疾病声像图和彩色血流进行回顾性分析。结果151例中包括:睾丸肿瘤6例(其中精原细胞瘤3例、胚胎细胞癌1例、畸胎瘤1例、恶性淋巴瘤1例);睾丸囊肿1例;睾丸微石症4例;睾丸炎5例;睾丸结核4例;睾丸扭转5例;睾丸创伤10例;附睾肿块35例(其中附睾囊肿21例、附睾炎性结节11例、附睾结核3例);鞘膜积液39例(其中睾丸鞘膜积液27例、精索鞘膜积液4例、精索睾丸鞘膜积液6例、交通性鞘膜积液2例);隐睾6例(均为腹股沟型);精索静脉曲张36例(其中21例为左侧、7例为右侧、8例为双侧);均经手术及病理证实。结论高频彩色多普勒超声能显示各种阴囊、睾丸疾病的声像图和血供特点,为临床诊断提供了重要价值。     

衰减校正在18F-FDG符合显像中对肺癌纵隔淋巴结转移的诊断价值

目的:评价137Cs穿透衰减校正(AC)在氟?眼18F?演-2-脱氧葡萄糖(18F-FDG)符合显像中对肺癌纵隔淋巴结转移的诊断价值。方法:对54例肺癌纵隔淋巴结转移患者行18F-FDG符合显像,衰减校正采用137Cs点源,分别重建有衰减校正和无衰减校正(NAC)图像。统计肺部及纵隔淋巴结转移病灶的数目,并对两组图像进行比较分析。结果:54例患者AC图像共检出肺部病灶55个,纵隔病灶154个。NAC图像共检出肺部病灶55个,纵隔病灶127个。所有病例中AC与NAC病灶数目相同者31例(57%),AC病灶数目多于NAC者21例(39%),AC病灶数目少于NAC者2例(4%)。AC检出纵隔淋巴结转移病灶而NAC未检出者4例(7%)。结论:AC图像质量明显优于NAC图像,AC对肺部病灶的检出率无明显改善,但对纵隔淋巴结转移病灶的检出率有较大提高。     

Polyspecificity of antistreptococcal murine monoclonal antibodies and their implications in autoimmunity

mAbs produced by immunization of BALB/c mice with Streptococcus pyogenes M type 5 membranes were further characterized for their reaction with S. pyogenes pep M5 protein and with autoantigens associated with human cell lines. mAbs 36.2.2 and 54.2.8 simultaneously reacted with M protein and a membrane protein(s) of S. pyogenes. When cell lines were mixed with 54.2.8, we saw nuclear fluorescence along with staining of the cytoskeleton. Subsequent experiments revealed that 54.2.8 was an anti-DNA antibody that reacted with DNA, poly(I), poly(dT), and weakly with cardiolipin. Its reactivity with the cytoskeleton could be blocked with anti-vimentin. On the other hand, 36.2.2 reacted with the cytoskeleton, sparing the nucleus, and was inhibited by the alpha helical proteins myosin, actin, and keratin. mAb 54.2.8 was inhibited with myosin, but not with actin and keratin. None of the antibodies studied were inhibited by collagen, and none of them were rheumatoid factors. The results imply that Group A streptococci can activate B cell clones against myosin, alpha helical proteins, or DNA, thereby contributing to the enhancement of autoantibody production.     

血小板膜糖蛋白与高血压脑梗死的关系研究

目的通过测定高血压脑梗死患者血小板膜糖蛋白指标,为临床治疗高血压脑梗死提供有用的参考数据。方法采用流式细胞术对80例高血压脑梗死患者、30例正常血压脑梗死患者及35例原发性高血压患者血小板膜糖蛋白进行检测。结果高血压脑梗死组、正常血压脑梗死组与原发性高血压组血小板膜糖蛋白CD62P、CD63均显著高于健康对照组,且高血压脑梗死组、正常血压脑梗死组血小板膜糖蛋白CD62P、CD63均明显高于高血压组。高血压脑梗死组与正常血压脑梗死组血小板膜糖蛋白差异无统计学意义。血小板膜糖蛋白不同梗死灶各组之间均有明显差异。结论脑梗死和高血压患者均存在血小板活化,脑梗死患者血小板活化与病情及梗死灶大小有关。血小板膜糖蛋白检测对高血压患者的病情分析和脑梗死的预防及早期诊断和治疗具有重要意义。     

综合康复治疗对脑卒中偏瘫患者预后的影响

目的观察综合康复治疗对脑卒中偏瘫患者预后的影响。方法将100例脑卒中偏瘫患者分为康复组和对照组，各50例，康复组采用神经肌肉促进技术，同时辅以功能性电刺激、经络导平针灸等方法进行6个月综合康复治疗；对照组仅给予临床常规药物治疗。于治疗前后，采用Fugl-Meyer评分评定患者的运动功能；用Barthel指数评定日常生活活动能力。结果康复组患者的Fugl-Meyer评分及Barthel指数明显提高，与对照组差异有非常显著性意义（P〈0．01）。结论综合康复治疗对脑卒中偏瘫患的预后明显好于单纯药物治疗。     

Differential diagnosis of fetal hyperechogenic cystic kidneys unrelated to renal tract anomalies: A multicenter study.

OBJECTIVES: To identify important factors in the differential diagnosis of renal cysts associated with hyperechogenic kidneys. METHODS: This was a retrospective multicenter study. We identified 93 fetuses presenting between 1990 and 2002 with hyperechogenic kidneys and which had a diagnosis of nephropathy confirmed later. We analyzed retrospectively the prenatal ultrasound findings of those fetuses which were found sonographically to have renal cysts. RESULTS: Of the 93 fetuses presenting with hyperechogenic kidneys and with a later diagnosis of nephropathy, there were 28 with autosomal dominant polycystic kidney disease (ADPKD), 31 with autosomal recessive polycystic kidney disease (ARPKD), 11 with Bardet-Biedl syndrome, nine with Meckel-Gruber syndrome, six with Ivemark II syndrome, one with Jarcho-Levin syndrome, one with Beemer syndrome and one with Meckel-like syndrome. One third of the fetuses (30/93) had renal cysts. Cystic characteristics (size, location, number) were not very useful for diagnosis; more useful was diagnosis of an associated malformation. Three (11%) of the fetuses with ADPKD had cysts, as did nine (29%) of those with ARPKD, three (27%) of those with Bardet-Biedl syndrome, all (100%) of those with Meckel-Gruber syndrome, three (50%) of those with Ivemark II syndrome, and each of the three cases with other syndromes (Jarcho-Levin, Beemer and Meckel-like syndromes). None of the cases with trisomy 13 had cysts. There were no associated malformations in the 12 cases with renal cysts and polycystic kidney disease; the other 18 cases with renal cysts were associated with malformations that were often specific, such as polydactyly in Bardet-Biedl and Beemer syndromes, occipital defect and Dandy-Walker malformation in Meckel-Gruber or Meckel-Gruber-like syndromes, and thoracic and/or vertebral abnormalities in Jarcho-Levin and Beemer syndromes. CONCLUSION: Renal cysts associated with hyperechogenic kidneys are not rare. The clue to diagnosis is the demonstration of an associated malformation. If no malformation is found, the main diagnosis remains polycystic kidney disease, i.e. ARPKD or ADPKD.     

Satisfaction with Family Physicians and Specialists and the use of Complementary and Alternative Medicine in Israel

Higher utilization of complementary and alternative medicine (CAM) is commonly explained by dissatisfaction or disappointment with conventional medical treatment. To explore, at two points in time in Israel, the associations between six domains of satisfaction (attitude, length of visits, availability, information sharing, perceived quality of care and overall) with conventional family physicians' and specialists' services and the likelihood of consulting CAM providers. This is a secondary analysis of interviews, which were conducted with 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45-75 in those years. Bivariate and multivariate analyses were used in the investigation. In 1993, users of CAM were less satisfied than non-users with both family physicians' and specialists' care. Lower satisfaction with the attitude of, the amount of information sharing by and in general with family physicians, and with the length of visits and perceived quality of care of specialists were significantly associated with CAM use. In 2000, lower satisfaction with specialists' attitude, length of visits, availability and in general was significantly related to the use of CAM. Lower satisfaction with family physicians and specialists is significantly associated with consulting CAM providers. However, with CAM becoming a mainstream medical care specialty in its own, lower satisfaction with conventional medicine specialists becomes the most important factor.     

卵巢囊性肿瘤的影像学分析

目的：分析卵巢囊性肿瘤的影像学特点,为临床提供可靠的诊断及治疗依据。方法回顾性分析45例经手术及病理证实的卵巢囊性肿瘤的C T或M RI影像资料。纳入标准为病灶囊性成分所占比例大于70％,肿瘤最大径超过5 cm。所有病例均行平扫及增强C T或M RI检查。结果45例中包括卵巢囊腺瘤16例、囊腺癌6例、腺癌5例、腺纤维瘤1例、畸胎瘤2例、囊肿4例、子宫内膜异位囊肿2例、输卵管系膜囊肿2例及输卵管卵巢囊肿7例。结论影像学检查对卵巢囊性肿瘤的定位、定性诊断和鉴别诊断具有一定的临床意义,明确诊断仍需要结合术后病理结果。     

高危新生儿遗传代谢病临床病因学分析

目的 初步研究新生儿重症监护室(NICU)先天性遗传代谢病(IEM)高危新生儿的临床病因学.方法 应用气相色谱-质谱联用分析法(GC/MS)对100 例临床IEM 高危新生儿进行新鲜晨尿有机酸分析,并查血常规、肝肾功能、乳酸、丙酮酸、β-羟丁酸、血氨和同型半胱氨酸,其中24 例患儿尿有机酸分析结果阳性,临床拟诊为IEM,对临床拟诊为IEM 的24 例患儿进行1 ～2 个疗程的治疗,之后复查GC/MS 尿有机酸分析.结果 24 例临床拟诊为IEM 的患儿12 例确诊为IEM,其中丙酮酸血症、酪氨酸血症和同型半胱氨酸血症各2 例,甲基丙二酸尿症、戊二酸血症Ⅱ型、乳糖不耐症、高甲硫氨酸血症、β-酮硫解酶缺乏症和鸟氨酸氨甲酰转移酶缺乏症各1 例,均呈常染色体隐性遗传.12 例IEM 患儿的临床表现各不相同,其中血管病变3 例(微血栓形成1 例和脑实质内出血2 例),新生儿惊厥和复发性代谢性酸中毒各2 例,新生儿猝死、难治性低血糖、顽固性腹泻、遗传相关性高胆红素血症和重症肺炎各1 例.12 例IEM 患儿的疾病极期,100%出现高氨血症,83%出现丙酮酸血症,67%出现肾损害和代谢性酸中毒,50%出现肝损害,42%出现血液系统损害.结论 高危新生儿IEM 临床病因复杂,随着新技术的发展,新生儿IEM 疾病谱不断扩大,进一步揭示了高危新生儿病因,为临床诊治提供依据.     

Outcome of collagen vascular diseases by treatment with plasmapheresis.

The outcome of collagen vascular diseases after treatment with plasmapheresis was studied in 9 patients with polyarteritis nodosa (PN), in 2 patients with Wegener's granulomatosis (WG), in 1 patient with allergic granulomatous angitis (AGA), and in 20 patients with systemic lupus erythematosus (SLE) associated with antiphospholipid syndrome (APS). Improvement after treatment with plasmapheresis was observed in 41.7% of the patients with PN, WG, and AGA. On the other hand, with the exception of 1 patient with thrombocytopenia and 1 patient with renal failure, all of the clinical manifestations, including thrombocytopenia, central nervous system (CNS) lupus, thrombophlebitis, lung infarction, and recurrent abortions in the SLE patients with APS, improved after plasmapheresis. Plasmapheresis is thought to be an influential strategy of treatment for patients with collagen vascular diseases.