精液中一氧化氮含量与精子凋亡关系的初探

目的研究精液中一氧化氮（NO）含量对精子凋亡的影响及其与男性不育之间的相关性,寻找治疗男性不育的有效途径。方法依据世界卫生组织（WHO）标准进行精液常规检测。应用硝酸还原酶法测定不育组和对照组精液中NO的含量。应用末端脱氧核苷酸转移酶（TdT）介导的原位末端标记（TUNEL）法检测精子凋亡情况,观察不育组精子凋亡的形态结构改变,统计2组间精子凋亡率。结果不育组精液中NO含量[（58．37±14．14）μmol/L]高于对照组[（35．20±8．23）μmol／L]（P〈0．01）;对照组精子凋亡率为9．67％±2．54％,低于不育组精子凋亡率33．98％±10．54％（P〈0．01）。将不育组分为弱精组、少精组和畸形精子组,以畸形精子组NO含量最高,凋亡率也为最高,弱精组及少精组次之。结论不育组高浓度NO和精子凋亡率呈正相关,随着NO浓度增高,精子凋亡率增加。精液中高浓度NO可能是男性生育力下降的原因之一。     

老年帕金森病患者血清同型半胱氨酸及血尿酸水平与认知功能障碍的相关性

目的探讨血清同型半胱氨酸（Hcy）和血尿酸（UA）的水平与帕金森病（PD）患者认知功能障碍的相关性。方法检测58例帕金森病患者和50例健康老人的血清同型半胱氨酸及血尿酸水平,采用简易精神状态检查（MMSE）量表对老年 PD 患者进行认知功能评分。结果老年帕金森病组的 Hcy 浓度[（25．89±3．01）μmol／L]显著高于健康老年组[（13．29±2．13）μmol／L]（P ＜0．01）;血尿酸水平显著低于健康老年组[（267．34±68．43）μmol／L 比（341．26±52．75）μmol／L,P ＜0．01],并且 PD 伴认知障碍组的 Hcy 浓度显著高于 PD 无认知障碍组[（29．54±4．35）μmol／L 比（20．78±3．17）μmol／L ,P ＜0．05],PD 伴认知障碍组的血尿酸水平显著低于 PD 无认知障碍组[（245．10±55．61）μmol／L 比（302．21±52．31）μmol／L ,P ＜0．05]。结论老年帕金森病患者会出现血清同型半胱氨酸水平升高及血尿酸水平的降低,其变化与程度认知功能障碍的发生有一定关联度。     

精浆转铁蛋白、抑制素B在男性生育中的临床诊断意义

目的 为探讨精浆中转铁蛋白（Tf）含量、抑制素B含量测定在男性生育力方面的影响及意义。结果 不孕少精子组、极度少精子组精浆中Tf的含量明显低于正常生育组，经统计学分析差异有显著性（P〈0．01），抑制素B含量结果测定少精子组、极度少精子组、无精子组与正常生育组比较，统计学分析差异有显著性（P〈0．01）。结论 精浆中Tf水平的测定、抑制素B含量测定是观察睾丸支持细胞功能，评价曲细精管生精功能的一个特异性的指标，对男性不孕的诊断治疗具有指导意义。     

血清总胆红素与系统性红斑狼疮活动性的关系

目的探讨系统性红斑狼疮（SLE）患者血清中总胆红素（TBIL）水平与疾病活动程度的关系与意义。方法用重氮盐改良J-G法检测和比较分析54例SLE患者和50名健康人血清TBIL的水平。结果SLE患者组血清TBIL水平[（9．80±4．98）μmol／L]比健康对照组[（13．54±5．20）μmol／L]明显降低（P〈0．001）；经糖皮质激素治疗后血清TBIL浓度[（12．83±5．18）μmol／L]与治疗前[（5．79±3．73）μmol／L]相比，差异有显著意义（P〈0．001）；活动期SLE血清TBIL水平[（5．93±3．78）μmol／L]低于非活动期[（8．93±4．18）μmol／L（P〈0．05）；蛋白尿组[（6．64±3．56）μmol／L]低于非蛋白尿组[（9．30±4．36）μmol／L]（P〈0．05）；血管炎组[（6．32±4．31）μmol／L]和非血管炎组[（9．96±5．03）μmol／L]之间相比有明显显著意义（P〈0．001）。结论TBIL可能参与SLE的发病机制，TBIL的血清水平可作为反映SLE活动程度、肾脏损害以疾病进展或改善的指标。     

男性不育患者精液LDH-X的检查结果分析

目的：测定男性不育患者精液乳酸脱氢酶同工酶X（LDH-X）的含量．探讨其对男性不育诊断的意义。方法：选择生育组、精液常规正常不育组、精液常规不正常不育组、少精症不育组作为研究对象。精液LDH-X测定采用深圳华康生物医学工程有限公司提供的试剂盒．使用速率法检测。结果：不育患者精子LDH-X较生育组均有明显下降，与生育组差异有非常显著性（P〈0．01），且与精子的a＋b级具有相关性（r=0．601．P〈0．05）．各不育组精浆/精子LDH-X比值与生育组差异有显著性或非常显著性。结论：不育患者精子LDH-X含量下降，是男性不育临床诊断的较好指标。精浆／精子LDH-X比值对于男性不育的临床诊断也有一定参考价值。     

男性不育患者AsAb及精液中No水平与Na~+-K~+-ATP酶检测的临床评价

目的探讨抗精子抗体(AsAb)及精液中一氧化氮(NO)水平Na+-K+-ATP酶活性与男性不育的关系。方法分别采用ELISA法、硝酸还原酶法、钼蓝分光光度法测定132名男性不育患者及56名正常生育男性血清AsAb(IgGI、gM、IgA),精液中NO水平及Na+-K+-ATP酶活性。结果男性不育组AsAb阳性率37.12%,显著高于正常生育组3.57%(P<0.0 1);男性不育组精液中N0水平151.6±29.7μmol/L,显著高于正常生育组78.9±23.5μmol/L(P<0.01);男性不育组精液中Na+-K+-ATP酶活性为24.42±8.47μmol Pi/mg(Prot).h-1,显著低于正常生育组46.63±9.41μmolPi/mg(Prot).h-1(P<0.05)。结论血清AsAb是男性不育的确诊指标之一,精液中高水平NO与低Na+-K+-ATP酶活性可能是导致男性不育的原因之一。     

探讨血清1，5-脱水葡萄糖醇和糖化血清蛋白对妊娠期糖代谢异常的诊断价值

目的探讨糖化血清蛋白（GSP）及1，5-脱水葡萄糖醇（1，5-AG）在妊娠期糖代谢异常诊断中的价值。方法对正常妊娠组、糖筛查异常组及糖耐量异常组进行空腹葡萄糖、口服葡萄糖50g筛选、GSP、1，5-AG测定。结果糖筛查异常组GSP水平为（154±18）μmol／L、糖耐量异常组GSP水平为（157±26）μmol／L，与正常妊娠组[（136±30）μmol／L]比较，差异有统计学意义（P〈0.01）。糖筛查异常组和糖耐量异常组1，5-AG水平分别为（57．3±30．2）μmol／L、（45．2±25．7）μmol／L，显著低于正常妊娠组水平[（84．5±35．6）μmol／L，P〈0．01]。结论GSP、1，5-AG呵作为妊娠期糖代谢异常筛查及诊断指标。     

维持性血液透析患者血浆同型半胱氨酸水平及叶酸、维生素B12的干预效果

目的评价补充叶酸（FA）和维生素B12（VitB12）对维持性血液透析（MHD）患者血浆同型半胱氨酸（Hey）水平的影响。方法将61例MHD患者随机分为治疗组（30例）和非治疗组（31例）,治疗组给予FA15mg／d口服,VitB120．15mg／d肌注,疗程为8周。同时测定61例MHD患者和40名正常对照者血浆Hcy浓度和血清FA、VitB12水平。结果MHD患者血浆Hcy水平[（52．6±21．6）μmol／L]明显高于正常对照组[（10．1±3．6）μmol／L]（P〈0．001）。FA、VitB,2治疗8周后,治疗组MHD患者的血清VitB12[（638．9±229．0）ng／L]和FA水平[（17．7±4．6）μg/L）]明显高于非治疗组[（450．3±195．9）ng／L、（7．2±2．3）μg／L]（P〈0．001）,血浆Hcy水平[（28．8±5．5）μmol／L]低于非治疗组[（50．0±18．8）μmol／Lj（P〈0．001）。血浆Hey水平与叶酸、VitB。：水平均呈负相关。结论MHD患者普遍存在高Hcy血症。FA和VitB12能降低血浆Hcy浓度,对预防MHD患者心脑血管疾病的发生具有重要意义。     

老年高血压合并2型糖尿病患者血清同型半胱氨酸和血尿酸的变化及意义

目的探讨血清同型半胱氨酸（Hey）、血尿酸（SUA）与老年原发性高血压合并2型糖尿病（T2DM）的关系。方法对55例老年（≥60岁）单纯高血压患者（单纯高血压组）、50例高血压合并T2DM患者（高血压合并T2DM组）与61名正常对照者（对照组）用荧光偏振免疫法测定血清Hey及SUA含量并进行统计学分析。结果高血压合并T2DM组与对照组比较差异有统计学意义,Hcy分别为[（18．36±7．75）μmol／L与（13．05±4．13）μmoL／L,P〈0．01）]、SUA分别为[（321．50±79．34）mmol／L与（294．07±59．55）mmol／L,P〈0．05）];单纯高血压组与对照组比较差异有统计学意义,Hcy分别为[（18．20±6．15）μmol／L与（13．05±4．13）μmol／L,P〈0．01）]、SUA分别为[（329．91±76．12）mmol／L与（294．07±59．55）mmol／L,P〈0．01）];高血压合并T2DM组与单纯高血压组比较差异无统计学意义,Hcy分别为[（18．36±7．75）μmol／L与（18．20±6．15）μmol／L,P〉0．05）]、SUA分别为[（321．50±79．34）mmol／L与（329．91±76．12）mmol／L,P〉0．05）。结论高Hcy血症、高SUA血症可能是老年高血压合并T2DM发生的危险因素。     

血清铜及铜/锌值对肝癌鉴别作用的研究

本文测定了15例肝硬化、15例原发性肝癌病人的血清铜及铜／锌比值，并与17例正常人血清铜及铜／锌比值相比较，结果发现：①肝硬化和肝癌组病人血清锌水平低于正常对照组（分别为15．94±0．06和15．44±9．92μmol／L），但两组患者之间无显著性差异（P＞0．05）；②肝硬化组和肝癌组病人的血清铜水平均高于对照组，肝癌组病人的血清铜水平又显著高于肝硬化组（分别为31．92±0．07μmol／L和20．25±0．06μmol／L，P＜0．001），而肝硬化组与正常组血清铜水平差异不显著（20．25±0．06μmol／L和17．35±2．75μmol／L，P＞0．05）；③肝硬化组和肝癌组病人的血清铜及铜／锌显著高于对照组（分别P＜0．05和P＜0．001）．两组病人之间的血清铜／锌值有显著性差异（P＜0．001）。提示血清铜及铜／锌的测定有助于肝硬化和肝癌的鉴别诊断。     

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.     

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。     

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.     

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。     

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.     

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.     

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.