Ankylosing spondylitis and heterogeneity of HLA-B27 in Chinese.

OBJECTIVE To examine the relationship between ankylosing spondylitis and heterogeneity of HLA-B27 in Chinese.

METHODS We subtyped HLA-B27 in 76 patients with ankylosing spondylitis and 1 200 healthy Chinese of Han nationality. Polymerase chain reaction was designed to amplify specific regions of class I (exon 2 and 3). Amplified sequences were tested with eight sequence-specific oligonucleotides to distinguish all HLA-B27 subtypes.

RESULTS The HLA-B27 was closely related to ankylosing spondylitis and at least four subtypes presented in Chinese patients. B2704 was the most common subtype, occurring in 54.8% and 50.85% respectively in HLA-B27 positive ankylosing spondylitis patients and healthy controls. The main HLA-B27 subtypes in the HLA-B27 positive patients distributed in similar proportion to those of HLA-B27 positive healthy controls (P < 0.1).

CONCLUSIONS The prevalences of various subtypes of HLA-B27 vary in different races. HLA-B2704 is the main subtype in Chinese Han nationality. The HLA-B27 specific residues that are shared by the subtypes might be involved in the pathogenesis of ankylosing spondylitis.

     

Preliminary study on relationship between tcm syndrome-type and insulin resistance in coronary heart disease

To observe the relationship between TCM Syndrome-type and insulin resistance (ISR) in coronary heart disease (CHD). Methods: Fifty patients were divided into 3 groups according to the Syndrome Differentiation-typing in TCM, the Heart blood stasis (HBS) Syndrome group, the Phlegm-Turbid stagnation (PTS) Syndrome group and both Qi-Yin Deficiency (QYD) Syndrome group. The fasting blood glucose (FBG), fasting blood insulin (Ins), insulin antibody (IAA), islet cell antibody (ICA), glutamic acid decarboxylase antibody (GAD-Ab) and related blood lipid parameters in patients were determined and insulin sensitive index (ISI) was calculated simultaneously. Then the above-mentioned data were compared with those determined in 20 healthy control subjects. Results: The levels of FBG and Ins in CHD group were higher than those in the healthy control group significantly (P＜0.05), but ISI level was obviously lower (P＜0.01). Moreover, the positive percentage of IAA (40%) was higher in CHD group than that in the control group (5%) significantly (P＜0.01). Comparison between the 3 TCM Syndrome-type groups and the control group showed that ISI level in HBS and PTS group was obviously lower than that in the control and the QYD (P＜0.05) respectively, and the IAA positive percentage in the former 2 groups (50%, 47.37%) was higher than that in the latter two (5%,P＜0.01 and 15.38%, P＜0.05) markedly. While Ins level increased only in the HBS group (P＜0.05). Besides, patients of HBS and PTS Syndrome were accompanied by lipid metabolic disturbance. Conclusion: ISR presents in part of CHD patients particularly in those with HBS and PTS Syndrome, which was partly due to the existence of serum IAA in patients.     

A Study of Immunological Indices for Diagnosis of Chronic Berylliosis

The results of the Be-induced leukocyte migration inhibition test(Be-MIT),the lymphocytetransformation test(LI),the E-rosette formation test(E-RFC),the old tuberculin test(OT),andsero-immunoglobulin(IgG,IgA,IgM)measurements on 13 cases of berylliosis,44 members ofthe observation group,and 51 members of the contact group are rèported.In the Be-MIT,2 ofthe berylliosis patients were new cases that had been diagnosed and treated for a long time,andboth tested positive(18%).Fourteen patients from the observation group tested positive(32%),and 15 from the contact group tested positive(30%).The 8 cases in the control group testednegative;7 patients from the observation group and 3 of the berylliosis cases tested negative afterbeing treated.The lymphocyte transformation rates of the observation group and the berylliosisgroup were significantly lower than that of the control group(P<0.01).Both Et-RFC and Ea-RFC contents in the group with berylliosis were much lower than those in the control group(P<0.01).OT tests were performed on 8 berylliosis patients and 10 healthy men.Seven patientsshowed negative reactions and one showed a positive reaction.All the healthy men showedpositive reactions.The IgG and IgA levels of the observation group were significantly higherthan those of the control group(P<0.01).The Be-MIT could detect active beryllium disease atan early stage as well as Be-sensitive individuals.This test could be used as a supplementarydiagnostic index for the differential diagnosis of berylliosis and for the evaluation of a curativeeffect.1989 Academic Press,Inc.     

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital,a General Tertiary Hospital in Beijing△

Objectives To investigate the positive rate of different hepatitis B virus (HBV) serological markers, and the demographic factors related to HBV infection.
Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen (HBsAg), HBV surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), HBV core antibody (HBcAb), and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and de- partment, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.
Results Among 27 409 samples included, 2681 (9.8%) were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%,5.8%,and 4.7%, respectively. The positive rate of HBsAg of males (13.3%) was higher than that of females (7.3%,P=0.000). Among the 2681 HBsAg (+) patients, 1230 (45.9%) had HBV-DNA test, of whom 564 (45.9%) were positive. Patients with HBsAg (+), HBeAg (+), and HBcAg (+) result usually had high positive rate of HBV-DNA results (71.8%,P=0.000).
Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.     

Expression of Toll-like receptor 4 in neonatal cord blood mononuclear cells in patients with preeclampsia

The expression of Toll-like receptor 4 (TLR4) in neonatal cord blood mononuclear cells (MNCs) and serum TNF-α were investigated in order to explore the roles of TLR4 in the pathogenesis of preeclampsia.The study enrolled 27 patients suffering from preeclampsia (experimental group) and 21 normal pregnancy patients (control group).After MNCs were separated, the expression of TLR4 mRNA and protein was detected by using real-time quantitative PCR and Western blotting respectively, and the expression of TNF-α by using ELISA.The results showed the TLR4 mRNA level in cord blood MNCs (2-CT:0.07±0.17), TLR4 protein expression level (absorbance ratio:0.81%±0.15%) and TNF-α level (9.5±1.73 pg/mL) were all increased in experimental group as compared with control group with the differences being statistically significant (P<0.05).There was a positive correlation between the expression of TLR4 mRNA and TNF-α in both experimental group and control group (r=0.54 and 0.53, respectively, P<0.05).It was concluded that TLR4 expression in the experimental group of cord blood MNCs was increased and there was a positive correlation between the expression of TLR4 mRNA and TNF-α in both groups.TLR4-mediated release of inflammatory cytokines may be one of the important reasons leading to preeclampsia.     

A Clinical Study on the Effect of Yinxing Damo (银杏达莫) Combined with Betahistine Hydrochloride Injection on Vertebral Basilar Artery Ischemic Vertigo

Objective: To evaluate the therapeutic efficacy of Yinxing Damo (银杏达莫, YXDM) combined with Betahistine Hydrochloride Injection (BHI) on vertebra basilar artery ischemic vertigo (VBIV).Methods: Ninety patients with VBIV were randomly divided into two groups; 45 patients (the treated group)were treated with YXDM and BHI intravenous dripping, once a day for 14 days. Another 45 patients (control clinical syndromes and the index of the transcranial Doppler (TCD) and hemorheology were observed. Results: The total effective rate was 100% in the treated group, which was better than that in the control group90.5%, (P＜0.05). The indexes of TCD and hemorheology in the treated group were obviously improved after treatment, (P＜0.01). Conclusion: YXDM combined with BHT injection had better effect in treating patients with VBIV is an ideal drug for VBIV.     

MUC5AC EXPRESSION UP-REGULATION GOBLET CELL HYPERPLASIA IN THE AIRWAY OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objective To determine the number of goblet cells, the change of MUC5AC expression in chronic obstructive pul monary disease (COPD) patients and the relationship of smoking with goblet cell, MUC5AC, and lung function. Methods Eighteen patients undergoing lung resections for a solitary peripheral carcinoma were classified by lung function as having COPD. Twenty patients with normal lung function served as the control group. Normal lobe bronchioles far away from the lesion site were taken for paraffin section. Goblet cells were identified by AB/PAS staining and the ex pressionof MUC5AC in the paraffin's section was tested by immunohistochemistry. Results Goblet cell hyperplasia was observed in the COPD group. The positive rate of goblet cell in COPD group (0.20% ± 0.10%) was significantly higher than that in the normal lung function group (0.13% ± 0.06%, P ＜ 0.05). The positive rate of MUC5AC expression in the COPD group (0.27% ± 0.09%) was higher than that in the normal lung function group (0.20% ± 0.10%, P ＜0.05).The positive rate of goblet cell in smokers (27.93% ± 9.00%) of the COPD group and normal lung function group was higher than that in non-smokers (17.70% ± 9.37%, P ＜ 0.05), while MUC5AC expression had no significant difference between smokers and non-smokers (17.88% ± 6.44% and 10.88% ± 7.10%, respectively). Conclusion For COPD patients with declined lung function, there were goblet cell hyperplasia and increased expres sion of MUC5AC. MUC5AC expression up-regulation may due to goblet cell hyperplasia. Smoking may be an important factor for goblet cell hyperplasia.     

Association of the Platelet Membrane Glycoprotein Ⅰ a C807T Gene Polymorphism with Aspirin Resistance

To explore the correlation between the C807T polymorphism of platelet membrane gly- coprotein Ⅰa (GPⅠa) gene and aspirin resistance in Chinese people, 200 patients with high-risk of atherosclerosis took aspirin (100 mg/d) for 7 days. Platelet aggregation function was detected using adenosine diphosphate (ADP) and arachidonic acid (AA) before and after the administration of aspi- rin. Then the subjects were divided into three groups according to the results of platelet aggregation function: an aspirin resistant (AR) group, an aspirin semi-responder (ASR) group and an aspi- rin-sensitive (AS) group. Platelet GPⅠa gene 807CT polymorphism was examined by means of po- lymerase chain reaction-sequence specific primers (PCR-SSP). The results showed that T allelic fre- quency in AR group and ASR group were higher that of AS group (P<0.005), and the prevalence of genotypes (TT TC) of these two groups was significantly higher than that in AS group (P<0.05). Platelet GPⅠa T allele was significantly associated with aspirin resistance as revealed by multiple logistic regression (OR=3.76, 95% CI: 2.87–9.58). The results suggest that inherited platelet GPⅠa variations may have an important impact on aspirin resistance and the presence of GPⅠa T allele may be a marker of genetic susceptibility to aspirin resistance.     

EB病毒和巨细胞病毒感染与自身免疫性肝炎Ⅰ型的关系探讨

目的 探讨EB病毒(EBV)和巨细胞病毒(CMV)感染与Ⅰ型自身免疫性肝炎1型(AIH-I型)之间的关系.方法 采用酶联免疫吸附技术(ELISA)检测AIH-I型患者和对照组血清中EBV和CMV抗体IgG和IgM, CMV-IgM阳性者行聚合酶链反应(PCR)检测血清的CMV-DNA;EBV-IgM阳性者行肝组织活检免疫组织化学检测EBV抗原,再阳性者行原位杂交检测EBV特异基因,比较各对应组之间的差异.结果 在AIH-I型组和对照组之间,CMV-IgM、CMV-IgG、EBV-IgM和EBV-IgG比较差异均有统计学意义(P<0.05).AIH-I型组与对照组中CMV-IgM阳性者15例,其血清CMV-DNA均为阴性.AIH-I型组和对照组血清EBV-IgM阳性者21例,检测其肝组织中EBV抗原,阳性6例;对此6例原位杂交检测肝组织EBV基因(EBER),结果均为阴性.结论 自身免疫性肝炎患者CMV-IgG和EBV-IgG阳性率均比对照组高,推测AIH-I型患者既往感染该病毒;但IgM阳性率高于对照组并不能证明现症感染,提示IgM与自身免疫性肝炎患者某些自身抗原存在交叉免疫反应,并通过分子模拟机制诱发自身免疫性肝炎. Abstract： Objective The purpose of this study was to initially explore the relationship between the epstein-barr virus and cytomegalo virus infection and type I autoimmune hepatitis(type I AIH). Methods The IgG/IgM antibodies in EBV and CMV in serum between type I AIH group and the control group were detected by enzyme-labeled immunosorbent assay(ELISA). CMV-DNA was detected by polymerase chain reaction(PCR) in serum of CMV-IgM positive reaction. Immunohistochemistry was used to detect the EBV antigens in liver tissue which was obstained by liver biopsy.Situ hybridization was used to detect EBV -specific genes in liver tissue which also getted by liver biopsy.Then compared the differences in each other. Results Between the type I AIH group and the control group, there were significant difference in CMV-IgM, CMV-IgG, EBV-IgM and EBV-IgG (P<0.05). In the type Ⅰ AIH group and the control group, the serum CMV-DNA were negative in 15 cases CMV-IgM positive and 6 cases of 21 cases of serum EBV-IgM positive reaction in serum were positive by immunohistochemistry,but then negative by in situ hybridization.Conclusions CMV-IgG and EBV-IgG positive rate in type Ⅰ AIH group was higher than the control group, and it suggested that type Ⅰ AIH type patients had been infected with the virus.CMV-IgM and EBV-IgM positive rate in type Ⅰ AIH group was higher than the control group too, which could not prove present infection.These indicated that cross-immune response was existed between IgM antibodies of EBV and CMV in serum and certain self-antigen in patients with autoimmune hepatitis and suggested that autoimmune hepatitis may be induced by molecular simulation mechanism.     

Effect of kidney-reinforcing,blood-activating and stasis-removing recipes on adhesion molecule expression of bone marrow mesenchymal stem cells from chronic aplastic anemia patients

OBJECTIVE:To explore the effect of kidney-reinforcing,blood-activating and stasis-removing recipes on adhesion molecule expression of bone marrow mesenchymal stem cells(MSCs) from patients with chronic aplastic anemia(CAA).METHODS:We used threeTraditional Chinese Medicine recipes,namely a kidney-reinforcing recipe(KRR),blood-activating and stasis-removing recipe(BASRR),and kidney-reinforcing,blood-activating and stasis-removing recipe(KRBASRR),and a normal saline control to prepare herbal medicine serum in Sprague Dawley rats.Thirty CAA patients were enrolled in the experimental group,including 17 kidney-Yang deficient patients and 13 kidney-Yin deficient patients.Ten healthy individuals were included in the control group.MSCs were isolated from bone marrow samples,and the cell density was observed to measure their proliferation ability by microscopy on days 2,7,and 14 after isolation.In addition,the expression of adhesion molecules of bone marrow MSCs(CD106,CD49d,CD31 and CD44) were detected by flow cytometry after 48 h of treatment with the four different herbal medicine serums.RESULTS:The proliferation of MSCs from kidney-Yang deficient and kidney-Yin deficient patients was weaker than that of MSCs from the control group.The expression of all adhesion molecules of bone marrow MSCs from CAA patients was obviously lower than that in the control group(P< 0.01).The expression of CD49d and CD31 in MSCs from patients with a kidney-Yin deficiency was lower than in those with a kidney-yang deficiency(P< 0.05 and P<0.01,respectively).For kidney-Yang deficient patients,CD31 expression in the KRBASRR group was significantly higher than that in the BASRR group(P<0.01),while CD44 in the KRBASRR group was significantly higher than that in both KRR and BASRR groups(P<0.01).For kidney-Yin deficient patients,CD106 and CD49d expression in the KRBASRR group was obviously higher than that in the KRR group(P<0.05),while CD31 and CD44 expression in the KRBASRR group was significantly higher than that in both KRR and BASRR groups(P< 0.05 and P<0.01,respectively).CONCLUSION:The bone marrow microenvironment in CAA patients is abnormal.The effect of KRBASRR may be better than that of KRR and BASRR for kidney-Yang deficient and kidney-Yin deficient patients by improving the expression levels of MSC adhesion molecules.     

Survivin和P27kip1在肝细胞癌中的表达及临床意义

目的 研究原发性肝癌中Survivin和P27kip1表达的关系,并探讨其在HCC中发生发展的作用.方法 收集HCC组织及相应癌旁组织标本各40例,应用免疫组织化学(SP)法,检测Survivin蛋白和P27kip1蛋白的表达.结果 85%(34/40)的肝癌组织表达Survivin蛋白,而癌旁及正常肝组织内无一例呈阳性表达.Survivin蛋白表达的阳性率在肝内转移者为96.7%,显著高于无肝内转移者 (50.0%,P<0.05);在门静脉癌栓浸润者为61.5%,显著高于无门静脉癌栓浸润者 (90.3%,P<0.05).20%(8/40)的肝癌组织内可见到P27kip1阳性表达,80%(32/40)癌旁组织可见不同程度P27kip1阳性表达,两者比较差异有统计学意义(P<0.05).34例Survivin表达阳性组织中有4例见P27kip1表达阳性 (11.7%),而6例 Survivin表达阴性组织中有4例见P27kip1阳性表达 (66.7%),两者比较差异统计学意义(P<0.05).结论 Survivin在肝癌组织中选择性表达,与肿瘤转移、血管浸润等恶性生物学行为有关,其作用机制可能涉及P27kip1蛋白阳性表达的降低,导致了细胞周期的失控并促进细胞异常增殖,从而参与了HCC的发生和发展. Abstract： Objective To investigate the role of Survivin and P27kip1 expression in the pathogenesis of hepatocellular carcinoma(HCC).Methods Forty histologically verified HCC specimens and their neighboring noncancerous tissues were obtained.Immunohistochemistry was used to detect protein expressions of Survivin and P27kip1.Results Survivin protein expression was positive in 34 of 40 (85%)cases.By comparison,no positive expression of Survivin was detected in corresponding tissues.The positive rate of Survivin protein expression in the cases of intrahepatic metastasis was higher than those without intrahepatic metastasis(P<0.05),and the rate of Survivin expression in the cases of portal vein invasion was higher than those without portal vein invasion(P<0.05).The expression of P27kip1 was positive in 8 of 40 (20%) cases and 80% in noncancerous tissues.The expression of P27kip1 was 11.7% in the cases of Survivin expression,which was lower than the cases without Survivin expression(66.7%).Conclusions The optional expression of Survivin have a close correlation with the tumor macastasis and vascular infiltration. Survivin expression may play an important part in HCC,which offer a wide prospective for clinical application in the primitive prognosis of hepatic-carcinoma.     

以消化系统症状为首发表现的系统性红斑狼疮与克罗恩病的临床特征比较

目的 比较以消化系统症状为首发表现的系统性红斑狼疮(SLE)与克罗恩病(CD)的临床特征.方法 选取以不明原因腹痛、腹泻等消化系统症状为主诉并最后确诊为SLE者为研究对象,并按1∶2比例随机选取同期收入住院的CD患者为对照组,对两组进行比较分析.结果 收集到以消化系统症状为首发表现的SLE患者(SLE组)31例,对照组CD患者(CD组)62例.CD组腹痛(P=0.014)、腹泻(P=0.016)、发热(P=0.018)及血便(P=0.000)症状较SLE组多见;而SLE组腹胀(P=0.001)及恶心、呕吐(P=0.000)症状较CD组多见.CD组白细胞(P=0.032)、血小板(P=0.000)、血清白蛋白(P=0.032)水平及大便隐血阳性率(P=0.007)较SLE组高.SLE组天门冬氨酸氨基转移酶(P=0.000)、丙氨酸氨基转移酶(P=0.000)水平高于CD组,且补体C3水平(P=0.000)降低更为明显.结论 临床上应注意鉴别以消化系统症状为首发表现的SLE与CD的临床特征,以减少误诊、漏诊. Abstract： Objective To compare the clinical features of Crohn's disease (CD) and systemic lupus erythematosus (SLE) presenting symptoms of digestive system as initial manifestations. Methods Patients with SLE presenting to our department with symptoms of digestive system such as abdominal pain and diarrhea as initial manifestations were analyzed retrospectively. During the same period, control group. Results A total of 31 SLE patients presenting symptoms of digestive system as initial manifestations were collected. Sixty-two patients with CD were selected. The symptoms of abdominal pain (P=0.014), diarrhea (P=0.016), fever (P=0.018) and hematochezia (P=0.000) were more frequent in patients with CD than those in patients with SLE. But the symptoms of bloating (P=0.001), nausea and vomiting (P=0.000) were more frequent in patients with SLE as compared to patients with CD. The levels of white blood cell (P=0.032), platelets (P=0.000) and serum albumin (P=0.032) were higher in patients with CD than those in patients with SLE. The proportion of positive stool occult blood test (P=0.007) was also higher in patients with CD than that in patients with SLE. However, the levels of AST (P=0.000) and ALT (P=0.000) were higher and the level of C3 (P=0.000) was lower in patients with SLE as compared to patients with CD.Conclusions The clinical features of SLE presenting symptoms of digestive system as initial manifestation should be differentiated from CD by physicians to facilitate correct diagnosis.     

半月板桶柄状撕裂的MRI诊断与关节镜下分类的相关研究

目的 探讨MRI对半月板桶柄状撕裂的诊断与关节镜下分类的比较研究.方法 分析63例患者65个经关节镜检查证实为半月板桶柄状撕裂的术前MRI的特征性表现,并将5种MRI征象(双后交叉韧带征、半月板翻转征、空领结征、碎块内移征和外周残半月板征)与关节镜下Dandy分型进行比较.结果 MRI桶柄状撕裂诊断符合率89.2%.碎块内移征和空领结征阳性率最高,分别为84.6%和81.5%;双后交叉韧带征(双PCL征)、半月板翻转征(双前角征)、外周残半月板征不如上二者普遍(阳性率分别为43%、21.5%、29.3%).未发现外侧半月板双PCL征;内侧半月板交锁Ⅰ型和Ⅱ型及外侧半月板半长全宽型、全长半宽型与MRI碎块内移征和空领结征有相关性;2例为半月板撕裂Ⅲ级信号,5例为假阴性.结论 5种MRI征象中最少2种(碎块内移征和空领结征阳性率最高)以上出现应高度怀疑为桶柄状撕裂. Abstract： Objective To evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Methods Sixty-three patients who had a diagnosis of bucket handle tear in arthroscopy were included in our study.Meniscal tears were evaluated in arthroscopy according to Dandy's classification.The MRIs were retrospectively analyzed regarding the following findings:absence of bow tie sign,presence of double posterior cruciate ligament(PCL), fragment within the intercondylar region,flipped meniscus sign, abnormal circumferential meniscus sign. Sensitivity were evaluated for the presence of each individual sign. Results Locked types Ⅰand Ⅱfragment of medial meniscus and half-length,whole-width and whole length-half-width fragement of lateral meniscus in arthroscopy were correlated with fragement within the intercondylar notch and absent bow tie signs in MRI.We didn't find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear.The most common signs in MR imagings of meniscal bucket handle tears were the fragement in the notch sign and the absent bow tie sign.They were observed with frequency of 84.6% and 81.5% respectively.The presence of double posterior cruciate ligament, flipped meniscus sign, abnormal circumferential meniscus sign were less common(43%,21.5% and 29.2%,respectively). Conclusions The presence of at least two of the five MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.     

不同药物配方在分娩镇痛中的临床观察

目的 探讨产妇在分娩时镇痛时麻醉药物的选择.方法 选择我院2007年5月至2009年4月期间单胎初产妇150例随机分为三组,分别使用0.75%罗哌卡因20 ml+芬太尼0.2 mg+生理盐水至100 ml;0.75%罗哌卡因20 ml+曲马多200 mg+生理盐水至100 ml;0.75%罗哌卡因20 ml+曲马多200 mg+氟哌利多50 mg+生理盐水至100 ml,观察各组的疼痛评分、镇静评分及副作用.结果 使用芬太尼的患者镇痛、镇静效果明显优于其他的药物配伍,并且不良反应轻.结论 芬太尼在分娩镇痛中具有镇痛、镇静效果好,不良反应少,用药少的优势. Abstract： Objective To explore the choice of narcotic drugs required for analgesia in childbirth in maternal. Methods Random selection in our hospital from May 2007 to April 2009 during the period 150 cases of singleton pregnancies were divided into three groups of primipara.The use of 0.75% ropivacaine 20 ml+fentanyl 0.2 mg+saline to the 100 ml; 0.75% ropivacaine 20 ml+tramadol 200 mg+saline to the 100 ml; 0.75% ropivacaine 20 ml+tramadol 200 mg+droperidol 50 mg+physical salt to 100 ml. Observed in each group the pain score, sedation score and side effects. Results Patients using the fentanyl analgesic, sedative effect is superior to other drug compatibility, and side effects of light. Conclusions Fentanyl labor analgesia with analgesic, sedative effect is good, fewer adverse reactions, medication less advantage.     

410例膝关节外伤MRI诊断分析

目的 探讨MRI对膝关节外伤的诊断价值.方法 回顾性分析410例膝关节外伤的MRI表现,其中72例行CT检查,380例同时拍摄X线平片,比较3种方法对膝关节外伤的诊断价值.结果 MRI、CT及X线对膝关节外伤的阳性检出率分别为99.02%(406/410)、70.83%(51/72)、30.00%(114/380).MRI表现分别为骨挫伤伴或不伴骨折、关节腔积液、半月板损伤、韧带损伤、关节周围软组织损伤.MRI阳性检出率明显高于CT组及X线组,组间比较差异有统计学意义(P<0.05).结论 MRI对膝关节外伤具有独特而重要的诊断价值,而且无创伤、无辐射,能够最大限度弥补X线及CT检查的不足,可作为膝关节外伤的常规检查手段. Abstract： Objective To investigate the diagnostic value of MRI imaging on detecting knee joint injury. Methods MRI manifestations of knee joint injury in 410 cases were analyzed retrospectively. Of all patients, 72 cases underwent CT scan,380 cases underwent X-ray examinations and to compare the diagnostic value of the three methods in detecting knee joint injury. Results The positive rates of MRI, CT, X-ray in detecting knee joint injury were 99.02%(406/410), 71.83%(51/71), 30.00%(114/380) respectively. Knee joint injury manifested as bone contusion or bone contusion accompanied with bone fracture, joint effusion, meniscus injury, ligament injury, para-articular soft tissue injuries with MRI. The positive rate was significantly higher than that of CT and X-ray, the difference was statistical significance. Conclusions MRI not only play a peculiar and important role in the diagnosis of the knee joint injury with non-invasion or radiation, but also can largely make up for the disadvantage of CT and X-ray,and could be used routinely.     

雌激素对缺氧/复氧神经元高迁移率族蛋白B1及核因子-κB表达的影响

目的 探讨雌激素对缺氧/复氧诱导新生大鼠皮质神经元损伤的保护作用及其机制.方法 将培养7 d的大鼠皮质神经元随机分为三组,A组为正常对照组,B组采用缺氧/复氧(H/R),C组采用雌激素(17βE2)预处理加H/R处理,各组在H/R后0、1、3、6、12、24 h各时间点,以TUNEL法比较各组凋亡细胞,免疫组化方法比较各组高迁移率族蛋白B1(HMGB1)、核因子-κB(NF-κB)表达.结果 ①B组凋亡神经元明显多于正常对照组(H/R后3～24 h),C组凋亡细胞数目显著少于B组,三组比较差异有统计学意义.②B组HMGB1、NF-κB的表达较正常对照组明显增加,C组HMGB1、NF-κB表达较B组明显减少.结论 雌激素可使H/R后神经元HMGB1、NF-κB表达降低,抑制神经元凋亡,提高其存活率,这可能是其脑保护作用的机制之一. Abstract： Objective To explore the protective effects of estrogen on injured neurons induced by H/R and the mechanisms of that. Methods The cortical neurons cultured for 7 days were randomly divided into group A (normal control group), group B (H/R alone), group C (pretreatment with Estrogen -17βE2 and H/R). Then the apoptotic neurons were count by TUNEL, and the expression of HMGB1,NF- κB was observed by immunocytochemical technique, on each time point after reoxygenation 0,1,3,6,12,24 h of each group. Results ①The number of apoptotic neurons in group B was more than that in control group after H/R 3-24 h, and was less in group C than in group B. ②Compared with group A, the expression of HMGB1 and NF-κB was higher in group B,and was lower in group C than in group B. Conclusions Estrogen could decrease the expression of HMGB1 and NF-κB to inhibit neuronal apoptosis after H/R, which may be one of the mechanisms in which estrogen exerts its neuro-protective effect.     

叶酸联合塞来昔布对食管癌的化学预防作用

目的 探讨选择性环氧合酶-2(COX-2)抑制剂塞来昔布联合叶酸预防食管癌的有效性.方法 将84例食管上皮轻、中重度不典型增生患者随机分为叶酸组(28例)、塞来昔布联合叶酸组(28例)以及安慰剂组(28例),连续服用12个月后,再行胃镜及病理复查.终点指标定义为食管上皮不典型增生的组织学分级有严重程度的改变,记录其逆转、稳定、进展变化,比较各治疗组疗效.结果 塞来昔布联合叶酸组的不典型增生的好转率为60.7%(17/28),显著高于对照组(P＜0.05).叶酸组对食管上皮各级不典型增生并未有显著影响.结论 塞来昔布和叶酸联合应用可能降低食管癌发病的危险,尚需进一步扩大样本量的研究. Abstract： Objective To determine the validity of celecoxib combined with folate for the prevention of esophageal carcinoma.Methods Eighty four subjects completed the trial. Subjects had histologically confirmed mild or moderate esophageal dysplasia at baseline. And they were randomly divided into three groups: folate group,celecoxib plus folate group and control group.Esophagogastroduodenoscopy was performed before and after a 12-month intervention. Per-subject change (regression, stable or progression) in the worst dysplasia grade was defined as the primary end point. Results were compared by agent group.Results The relative reverse rate of celecoxib plus folate group was 60.7%(17/28), significantly higher than that in placebo group (P＜0.05). Folate alone did not influence changes in dysplasia grade by baseline histology subgroup(P＞0.05).Conclusions Celecoxib and folate have better effects than celecoxib alone in the chemoprevention of esophageal carcinoma for high risk subjects. Further trials with larger numbers are needed to confirm these results.     

四种抗体联合检测在SLE患者中的诊断价值

目的 探讨抗双链DNA(dsDNA)抗体、抗Smith(Sm)抗体、抗核小体抗体(AnuA)、抗组蛋白抗体联合检测在系统性红斑狼疮(SLE)患者中的诊断价值.方法 抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体均采用欧蒙斑点法测定98例SLE患者(分为活动期和稳定期)、90例其他结缔组织病患者及40例健康人血清中的四种自身抗体.结果 98例SLE患者中抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体阳性率分别为45.9%、 29.6%、 57.1%、33.6%,特异性分别为100%、99.2%、98.5%、89.2%;抗dsDNA抗体和AnuA在活动期SLE中的敏感性与稳定期相比差异有统计学意义(P<0.05);抗dsDNA抗体和AnuA以及四种抗体联合检测时阳性率分别为70.4%和79.6%,明显高于其中任何单项检测的阳性率,且明显高于疾病对照组,差异有统计学意义(P<0.05).结论 所检测的四种抗体在SLE中都具有很高的特异性和敏感性,其中抗dsDNA抗体和AnuA对活动期SLE具有很好的诊断价值,抗体的联合检测可较大程度提高SLE检测阳性率,四种抗体有明显的互补作用,尤其抗dsDNA抗体和AnuA的联合检测具有很好的组合价值. Abstract： Objective To investigate the diagnostic significance of combined detection of anti-double stranded DNA antibody(anti-dsDNA),anti-Smith antibody(anti-Sm)and antinuclesome antibody(AnuA) and anti-histone antibody in systemic lupus erythematosus(SLE),and evaluate the significance of combined detection of these autoantibodies in the diagnosis of SLE. Methods Ninety-eight cases of SLE patients who were divided into active and stable stage group and 90 disease controls and 40 healthy people were detected with Euro immunoblot assay.Results In the assays mentioned above. The serum positive rates of anti-dsDNA,anti-Sm, AnuA and anti-histone antibody were 45.9%,29.6%,57.1% and 33.1% in SLE, and the specificities were 100%,99.2%,98.5% and 89.2% respectively in patients with SLE.The positive rates of anti-dsDNA and AnuA in active SLE group were 57.5%,65.1%,which was apparently higher than that in the stable stage group;The sensibility of combined detection of anti-dsDNA and AnuA was 70.4%, four autoantibodies combined detection in SLE was 79.6%, which was apparently higher than any single autoantibodies, the difference had statistical significance. Conclusions These four autoantibodies have very high sensibility and specificity respectively, combined detection of four autoantibodies can markedly raise the relevance ratio in SLE, while their specificity didn't have a visual reduction. Especially, the sensibility of combined detection of anti-dsDNA and AnuA can markedly increased in active SLE patients. This compose can raise effectively the diagnosis of active SLE.So the detections of the four antibodies are complementary for the diagnosis of SLE.     

高血压病患者颈动脉粥样硬化与血尿酸及载脂蛋白水平的相关性

目的 通过对高血压病患者颈动脉超声多普勒检查和血尿酸及载脂蛋白水平的测定,探讨血尿酸及载脂蛋白与颈动脉硬化程度的关系.方法 测定100例高血压病患者血尿酸及载脂蛋白水平,用超声多普勒检测颈动脉粥样硬化程度.结果 颈动脉粥样硬化程度与血尿酸及载脂蛋白水平有关.结论 血尿酸及载脂蛋白水平与颈动脉粥样硬化的程度具有相关性,血尿酸及载脂蛋白B水平升高、载脂蛋白A水平降低是动脉粥样硬化的危险因素. Abstract： Objective To evaluate the correlation among the level of serum uric acid, apolipoproteins and the degree of carotid artery atherosclerosis in patients with hypertension. Methods The serum uric acid, apolipoproteins in 100 patients with hypertension were detected, and the degree of carotid artery atherosclerosis was determined by ultrasonic Doppler examination. Results The serum uric acid,apolipoproteins had the positive correlation to the degree of carotid artery atherosclemsis. Conclusions The concentrations of serum uric acid, apolipoproteins have positive relationship to the degree of carotid artery atherosclerosis. Increase of level of serum uric acid and ApoB, reduce of level of ApoA are risk factors for carotid artery atherosclerosis.     

低浓度5-氟尿嘧啶与糖皮质激素联合激光治疗瘢痕疙瘩的疗效

目的 观察低浓度5-氟尿嘧啶(5-Fu)与糖皮质激素局部注射联合激光治疗瘢痕疙瘩的疗效及安全性.方法 瘢痕疙瘩70例,102处病灶,平均病史8.6年,平均治疗时间为10.29个月.70例瘢痕疙瘩患者108处病灶进行单纯瘢痕内注射,0.6 ml 5-Fu与5 ml曲安奈德、1 ml 2%利多卡因混合后局部注射于瘢痕全层注射,每2～4周1次,瘢痕完全萎缩后逐渐降低药物浓度并延长注射间歇期.另一组70例瘢痕疙瘩患者102处病灶将三联药物局部注射半个月后Nd:YAG激光照射,每2～4周1次.结果 在治疗6个月以上的患者中,5-氟尿嘧啶与糖皮质激素联合激光治疗瘢痕疙瘩的总有效率为97.06%,其中完全缓解者占45.10%,极大缓解者占49.02%,部分缓解者占2.94%,未缓解者为2.94%.结论 低浓度5-氟尿嘧啶与糖皮质激素局部注射联合激光治疗瘢痕疙瘩的疗效显著. Abstract： Objective To monitor the therapeutic action and security of 5-Fu and steroid injected associate with laser to keloid. Methods One hundred and two keloid focuses of 70 patients have the average 8.6 years history and the average therapy period of 10.29 months. Among them,70 patients with total 108 keloid were treated merely with intralesional injection of a mixture of 0.6 ml 5-Fu,5 ml corticosteroid and 1 ml 2% lidocaine once per 2-4 weeks. The other 70 patients with total 102 keloid around sternal area were treated with the mixture once per 2-4 weeks. And they were irradiated with apulsed Nd:YAG laser(wavelength 1064 nm)at 35-140 energy density levels after 15 days. After keloid became flattened,drug concentration was decreased with prolonged intermission of drug injection. Results The total therapy efficacy of 5-Fu associate with steroid to keloid was 97.06%. Of them, the complete remission percentage was 45.10%,the large remission percentage was 49.02%,part remission percentage was 2.94%,and the inefficacy percentage was 2.94%. Conclusions It is more effective that the combination therapy to keloid of low concentration 5-Fu,steroid and Nd:YAG laser.