麝香注射液对急性脑梗死患者CD62P与TNF-α的影响

目的 :观察麝香注射液治疗急性脑梗死 ( ACI)的作用机制。方法 :6 3例 ACI患者随机分为两组 ,治疗组 32例用麝香注射液加盐酸川芎嗪注射液治疗 ,对照组 31例用盐酸川芎嗪注射液治疗。采用流式细胞仪、电化学发光法测定两组 ACI患者治疗前后血小板 CD6 2 P的阳性表达率与肿瘤坏死因子 α( TNFα)、白介素 6( IL 6 )水平 ,并与 30例健康人组作对照及相关分析。结果 :ACI患者治疗前后 CD6 2 P、TNFα和 IL 6均显著高于健康人组 ( P<0 .0 5或 P<0 .0 1) ,ACI患者 CD6 2 P表达与 TNFα、IL 6水平升高呈正相关 ;麝香注射液组治疗后 CD6 2 P、TNFα和 IL 6水平的降低较对照组显著 ( P<0 .0 5或 P<0 .0 1) ,临床治愈、显效率亦明显高于对照组 ( P均 <0 .0 5 )。结论 :麝香注射液治疗 ACI的作用机制与其抑制血小板活化增强、减轻细胞因子介导的中枢神经系统免疫应答及炎症损伤等有关。     

糖尿病缺血性中风中医证型与血清炎症细胞因子关系的研究

目的 :探讨 型糖尿病缺血性中风不同证型与血清炎症细胞因子的关系。方法 :应用放射免疫分析法测定患者入院时血浆白介素 6 (IL 6 )、肿瘤坏死因子α(TNFα)的水平及血液高凝状态指标 ,并与非风痰瘀阻证及正常人对照组作比较。结果 :风痰瘀阻证组糖尿病合并脑梗死者 TNFα、IL 6和血小板聚集率(PAg T)、血浆纤维蛋白原 (FG)、体外血栓长度 (ETL)显著高于非风痰瘀阻证组及正常人对照组 (P<0 .0 5或P <0 .0 1)。风痰瘀阻型患者 TNFα、IL 6与 PAg T、FG、ETL均呈明显正相关 (P均 <0 .0 1)。结论 :高TNFα和 IL 6可能是 型糖尿病缺血性中风风痰瘀阻证重要的病理生理基础 ,并在疾病发生发展过程中起重要作用。     

SIRS MODS患者活化血小板与细胞因子关系的研究

目的　研究全身炎症反应综合征 (SIRS)、多器官功能障碍综合征 (MODS)患者活化血小板、细胞因子变化及其两者之间关系。方法　采用流式细胞仪测定SIRS、MODS患者的CD6 2P、CD6 3阳性血小板的百分率 ,采用酶放大化学发光免疫法测定TNF -α、IL - 6、IL - 8、sIL - 2R值 ,同时对两者之间进行相关性分析。结果　SIRS、MODS患者的CD6 2P、CD6 3、TNF -α、IL - 6、IL - 8、sIL - 2R值较正常对照组均明显升高 (P均 <0 0 1) ;MODS组CD6 2P、CD6 3、TNF -α、IL - 6、IL - 8、sIL - 2R值均高于SIRS组 (P <0 0 1或P <0 0 5 ) ;死亡组CD6 2P、CD6 3、TNF -α、IL - 6、IL - 8、sIL - 2R值均高于存活组 (P <0 0 1或P <0 0 5 ) ;相关性分析显示 ,CD6 2P、CD6 3与TNF -α、IL - 6、IL - 8呈正相关 (P <0 0 5 )。结论　SIRS、MODS患者血小板活化明显 ,促炎细胞因子高表达 ,血小板活化与促炎细胞因子高表达正相关 ,两者均与病情、预后有关。     

过敏性鼻炎、荨麻疹患者血清IL－4、TNFα的检测

目的　了解过敏性鼻炎、荨麻疹患者血清白细胞介素 4 (IL 4 )、肿瘤坏死因子α(TNFα)水平及意义。方法　对 2 3例过敏性鼻炎、34例荨麻疹患者以及 2 5名健康者采用放射免疫分析法测定IL 4和TNFα。结果　过敏性鼻炎患者血中IL 4水平高于正常对照组 (P <0 .0 1) ,TNFα水平高于正常对照组 (P <0 .0 5 )。荨麻疹患者血清IL 4水平明显高于正常对照组 (P <0 .0 5 ) ,TNFα水平与对照组差异无显著性。结论　过敏性鼻炎患者血清IL 4、TNFα和荨麻疹患者血清IL 4水平明显升高与机体免疫功能紊乱有关。     

危重病早期连续性血液净化的疗效分析

目的　探讨危重病早期连续性血液净化 (CBP)在救治中的作用和效果。方法　将 12例早期行CBP治疗的危重病患者设为治疗组 ,14例未行CBP治疗的危重病患者设为对照组 ,动态检测和分析两组患者血浆皮质醇、肿瘤坏死因子 α(TNF α)、白介素 1β(IL 1β)、白介素 2 (IL 2 )、白介素 6 (IL 6 )水平 ,观察患者的临床变化和预后。结果　 12h内两组血浆皮质醇、TNF α、IL 1β、IL 2、IL 6水平均升高 ,但对照组皮质醇、TNF α、IL 1β、IL 2、IL 6呈进行性升高 ,皮质醇于 4 8h前后达到高峰 ,72h仍明显高于正常。与对照组相比 ,治疗组皮质醇达高峰时间提前 ,峰值降低 ,于第 2 4、4 8、72小时血浆水平均显著降低 (P均 <0 .0 0 1) ,72h恢复正常 ;TNF α、IL 1β升高幅度亦偏低 (P均 >0 .0 5 ) ;而IL 2、IL 6于 12h后随即大幅降低(P均 <0 .0 5 ) ,并维持一个较低水平 ;治疗组症状迅速改善 ,并发功能障碍的器官数和病死率降低(P均 <0 .0 5 )。结论　危重病早期CBP治疗可降低应激反应和全身炎症反应 ,防治并发多脏器功能障碍综合症 (MODS) ,降低病死率。     

多种细胞因子监测对严重感染患者的意义

目的 :观察严重感染患者早期血液细胞因子水平与预后的关系。方法 :采用自身对照研究 ,对入院 2 4小时内的严重感染患者进行急性生理学和慢性健康状况评分 (APACHE )评分 ,收集入院后 2日的血液 ,检测肿瘤坏死因子α(TNFα)、可溶性肿瘤坏死因子受体 (S TNF R)、白介素 6 (IL 6 )和 IL 8,以及外周血白细胞计数、血小板计数等指标。所得结果按治疗结果存活与否进行统计处理。结果 :5 9例患者死亡 15例。 15例死亡者的 APACHE 评分为 (2 1.3± 6 .2 )分 ,存活组为 (9.3± 5 .4 )分 ,P<0 .0 5。外周血白细胞计数、中性粒细胞分类、血小板计数在 2组间均无显著性差异。入院当日存活组血液 TNFα水平明显较死亡组为高 ,血液 S TNF R浓度在 2组间无显著性差异 ;死亡组血清 IL 6和 IL 8平均值也明显高于存活组。入院第 2日 ,死亡组 TNFα水平较前一日明显升高 ,存活组变化不大 ;2组 S TNF R则较前一日变化不大 ;死亡组 IL 6水平较前一日明显降低 ,存活组变化不大 ;2组 IL 8水平则均较前一日大为降低。 15例死亡组中入院当日血清 IL 8高于 10 0μg/ L者有 11例 ,而存活组中仅 3例高于 10 0μg/ L。结论 :血清 IL 6、IL 8水平与感染程度相关 ,其中 ,IL 8血清水平可作为早期衡量患者预后的指标     

肺癌患者外周血有核细胞IL-2R、TNF-α及IFN-γ表达的检测及其临床意义

目的　探讨肺癌患者外周血有核细胞IL 2R(CD2 5 )、TNF α和IFN γ的表达规律及其临床意义。方法　用流式细胞术对 118例肺癌患者外周血表达IL 2R、TNF α和IFN γ有核细胞的检出率进行检测和分析。结果　肺癌患者IL 2R、TNF α和IFN γ的表达率显著高于正常对照组 (P <0 .0 1) ,但其中未化疗者与正常对照组无显著性差异 (P >0 .0 5 ) ;化疗者表达率均显著高于未化疗者 (P <0 .0 1) ;在未化疗的患者中 ,伴转移者外周血有核细胞的IL 2R、TNF α和IFN γ的检出率均显著低于未转移者 (P <0 .0 1或P <0 .0 5 )。结论　肺癌患者外周血有核细胞的IL 2R、TNF α和IFN γ表达的检测有助于化疗机制的解释和病人预后的判定     

仙方活命饮治疗急性肛周脓肿的机制探讨

目的 :探讨仙方活命饮汤剂治疗急重症肛周脓肿的部分机制。方法 :随机将 6 0例急重症肛周脓肿患者分为 2组 :治疗组予口服仙方活命饮汤剂加切开排脓术 ;对照组予静脉用抗生素加切开排脓术治疗。 2组分别于切排术前、术后第 2日及第 7日测定周围血白细胞总数 (WBC)、中性粒细胞 (N )比例、血清肿瘤坏死因子α(TNFα)、白介素 6 (IL 6 )的变化 ,并对主症变化进行治疗前后的积分值比较。结果 :治疗组疼痛、脓腔情况及全身情况的积分值降低程度较对照组为低 ;降低 TNFα及 IL 6值更快、更显著 (P均 <0 .0 5 )。结论 :仙方活命饮治疗急重症肛周脓肿的机制可能与其能快速有效地降低 TNFα及 IL 6这两个细胞因子有关。     

慢性阻塞性肺疾病患者血浆TNFα、IL－10、NO的测定及临床意义

目的　探讨慢性阻塞性肺疾病 (COPD)患者急性发作期及缓解期血浆肿瘤坏死因子α(TNFα)、白细胞介素 10 (IL 10 )、一氧化氮 (NO)的变化及意义。方法　TNFα、IL 10用双抗体夹心ELISA检测 ,NO用硝酸还原酶法检测。结果　急性发作期患者的血浆TNFα、IL 10明显升高、NO明显降低 ,经临床治疗缓解后 ,患者TNF α、IL 10均显著降低 (P <0 .0 1) ,但仍明显高于对照组 (P <0 .0 5 ) ;经治疗缓解后 ,NO明显升高 (P <0 .0 1) ,但仍明显低于对照组 (P <0 .0 5 )。结论　COPD患者经临床治疗从急性发作期至缓解期 ,血浆TNF α、IL 10及NO均发生了显著变化。因此 ,测定上述指标对指导临床治疗、病情监测及疗效观察具有一定价值     

针刺对糖尿病并发急性脑梗死血浆白介素6及肿瘤坏死因子α水平的影响

目的：观察针刺治疗对Ⅱ型糖尿病并发急性脑梗死（ACI）时免疫细胞因子的影响,以探讨其作用机制。方法：将60例患者随机分为常规药物组（对照组30例）与常规药物加针刺治疗组（治疗组30例）进行对比观察,用放射免疫分析法（RIA）分别对2组患者治疗前后白介素－6（IL－6）及肿瘤坏死因子－α（TNF－α）水平进行检测,并与健康人组作比较,结果：患者入院时IL－6及TNF－α水平显著升高,与健康人组比较有非常显著性差异（P＜0．001）;治疗后,2组免疫细胞因子含量明显降低（P＜0．01和P＜0．001）,且针药联合治疗组下降产单纯常规药物对照组更大（P＜0．05）。结论：针刺可改善Ⅱ型糖尿病并发ACI患者的免疫病理反应,这种变化可能是其调整中风或神经内分泌免疫网络功能紊乱的作用机制之一。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.