血浆脂蛋白(a)与冠状动脉病变的关系

目的　探讨血浆脂蛋白 (a) [LP(a) ]水平与冠状动脉病变程度、范围及稳定性的关系。方法　测定 2 5 6例冠脉造影患者的LP(a)、血浆总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL CL)、低密度脂蛋白胆固醇 (LDL C)的血浆浓度。结果　 ( 1)患者冠状动脉病变范围越大、程度越重 ,其血浆LP(a)水平越高 (P <0 .0 1) ;( 2 )不稳定性心绞痛患者血浆LP(a)水平高于稳定性心绞痛患者 (P <0 .0 1) ;( 3)血浆LP(a)水平与其它血脂没有相关性。结论　LP(a)与冠脉粥样病变的范围、程度及稳定性相关 ,对冠心病的诊断和预后判断具有一定意义     

血尿酸和血脂代谢紊乱对冠状动脉病变的影响

目的研究高尿酸血症及血脂代谢紊乱对冠状动脉粥样硬化病变的影响。方法收集所有行冠状动脉造影检查的患者327例,按检查结果分为正常对照组113例,单支病变组70例,双支病变组72例、多支病变组72例。检测所有患者血清中的血尿酸,脂蛋白（α）[Lp（α）],总胆固醇（TG）,甘油三酯（TC）,低密度脂蛋白（LDL）,高密度脂蛋白（HDL）,载脂蛋白（B）（apoB）的水平,进行统计学分析。结果血尿酸水平在以上各组间无统计学意义上差异,而Lp（α）,TG,TC,LDL高于正常对照组,多元相关回归分析显示:冠脉病变计分和血尿酸及TC无相关关系,LDL,HDL,apoB,TG,Lp（α）与冠心病显著相关,而TC与冠心病无独立相关。结论尿酸与冠状动脉病变无明显相关,而血脂及糖代谢紊乱与冠状动脉粥样病变显著相关。     

女性血浆脂蛋白(a)与冠状动脉病变的关系

目的:探讨女性血浆脂蛋白(a)[Lp(a)]水平与冠状动脉病变程度及范围的关系。方法:72例女性根据冠状动脉造影结果,分为冠心病组和非冠心病组,测定Lp(a)、TC、TG、HDL-C、LDL-C、载脂蛋白A(apoA)、载脂蛋白B(apoB)的血浆浓度。结果:冠心病组患者中血浆Lp(a)水平明显高于非冠心病组患者(P<0.05);血浆Lp(a)水平在冠状动脉闭塞及多支病变患者中显著升高。结论:女性血浆Lp(a)水平与冠状动脉粥样病变的程度及范围有关,是病变严重程度的一个预测因素。     

脂蛋白Lp(a)、血浆脂质及其它脂蛋白水平与冠状动脉病变的关系

本文对冠状动脉造影显示出的冠状动脉病变程度进行评分,同时测定血浆脂蛋白Lp(a)(一种胆固醇含量丰富的脂蛋白)、总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL胆固醇)、及高密度脂蛋白胆固醇(HDL胆固醇).证实血浆脂蛋白Lp(a)水平可     

凝血因子Ⅰ和血脂水平对冠状动脉病变严重程度的影响

目的 :研究血浆凝血因子Ⅰ (Fg)和血脂水平对冠状动脉病变严重程度的影响。方法 :对 94例冠心病患者进行了冠状动脉造影检查 ,管腔狭窄程度≥ 5 0 %认为是有意义的病变血管 ,两支及以上血管病变认为是多支血管病变。血浆Fg浓度测定采用Follin酚法 ,采用标准酶法测定血清总胆固醇 (TC)、三酰甘油 (TG)及高密度脂蛋白胆固醇 (HDL C)水平 ,采用免疫比浊法测定载脂蛋白 (apo)A和apoB。 结果 :多支血管病变患者血浆Fg浓度增高 ,同时表现TC、TG亦升高 ,HDL C降低 ,而且发现冠状动脉病变严重程度与血浆Fg浓度间存在显著正相关 (r =0 .37,P <0 .0 1) ,与血清HDL C之间存在显著负相关 (r =- 0 .33,P <0 .0 1)。结论 :血浆Fg和血脂水平对冠状动脉病变严重程度有不同程度的影响。     

蒙古族T2DM及其并发症患者Lp（a）水平的临床分析

目的研究蒙古族2型糖尿病（T2DM）及糖尿病性视网膜病变（DR）、糖尿病性神经病变及糖尿病性肾病（DN）患者脂蛋白（a）[Lp（a）]的关系,及Lp（a）水平与其他脂类的关系。方法采用免疫透射比浊法测定血浆Lp（a）浓度,酶学终点分析法测定血浆TG、TC浓度,磷钨酸～镁沉淀测定HDL—C,聚乙烯硫酸盐沉淀法测定血浆LDL—C。结果与蒙古族正常对照组比较,T2DM患者的血浆Lp（a）、TG浓度均升高,而HDL—C浓度降低,LDL—C、TC浓度无统计学意义。糖尿病并发症与T2DM比较,DR患者除了TG浓度降低外,其他浓度均升高;糖尿病性神经病变的患者中血浆Lp（a）、TG浓度降低,而HDL—C浓度升高;DN患者TC、LDL—C、HDL—C、Lp（a）浓度高于T2DM患者。短暂治疗后,各组其他脂类水平明显降低,但Lp（a）水平却无显著性变化。结论动态监测T2DM患者血浆Lp（a）水平的变化可以帮助医生对糖尿病性发展及其并发症的发生做出良好的预测与诊断。     

载脂蛋白比值、BMI与冠状动脉狭窄程度关系分析

目的探讨血浆载脂蛋白比值(apoAl/apoB)、BMI与冠状动狭窄程度的关系。方法将拟接受冠脉造影术检查的1079例患者作为研究对象,冠脉造影结果按Gensini积分评价,根据冠脉造影术结果将所有研究对象分成冠心病组(940例,积分0分)和对照组(139例,积分为0分);再根据Gensini积分将冠心病组分成三个亚组:轻度病变组(342例,1分≤积分30分),中度病变组(345例,30分≤积分60分),重度病变组(253例,积分≥60分)。测量患者身高、体重,检测血脂水平,计算体重指数(BMI)、apoAl/apoB值。结果冠心病组患者年龄高于对照组(P0.05),高血压病、糖尿病、吸烟、冠心病家族史比例均高于对照组(P0.05);BMI、TC、TG、LDL、apoB、Lp(a)、HCY水平均高于对照组(P0.05),HDL、apoAl、apoAl/apoB均低于对照组(P0.05)。冠心病患者Gensini积分与年龄、高血压病史、糖尿病史、吸烟史、冠心病家族史、BMI、TC、TG、LDL、apoB、LP(a)、HCY呈正相关(P0.05),与HDL、apoAl、apoAl/apoB呈负相关(P0.05)。高血压病史、糖尿病史、冠心病家族史、高BMI、高LDL、高apoB、高Lp(a)是冠心病的独立危险因素,apoAl、apoAl/apoB是冠心病的保护因素。结论低apoAl/apoB值或高BMI是冠心病的危险因素,能在一定程度上反映冠状动脉狭窄的严重程度,预测冠心病的风险。     

冠心病家族史儿童血浆脂类水平的研究

目的：探讨有冠心病（CHD）家族史儿童的血脂,脂蛋白,载脂蛋白（Ano)水平,方法：对83例有CHD家族史的儿童检测血浆总胆固醇（TC）,甘油三酯（TG）,低密度脂蛋白－胆固醇（LDL－C）,高密度脂蛋白－胆固醇（HDL－C）,ApoA I,ApoB100,ApoE及脂蛋白（a)[Lp (a)]浓度,以无CHD家族史的健康儿童作为对照。结果：与对照组比较,有CHD家族史的儿童血TG,TC,LDL－C,Apo B100,Lp(a)的浓度明显增高,HDL－C,Apo AI,ApoE水平降低（P均＜0．01）;但男,女血脂水平差异不显（P＞0．05）,有早发CHD家族史的儿童与无早发CHD家族史儿童及对照组比较,血TG,TC,LDL－C,Apo B100,Lp(a）浓度增高;HDL－C,ApoE,ApoA I 水平下降（P均＜0．01）,以本研究指标检测结果判别其父母是否有CHD,具有较高的阳性率,有早发CHD家族史阳性率更高。结论：结果提示有CHD家族史儿童血脂水平可预测成年后发生CHD的危险性。     

2型糖尿病患者血清脂蛋白(a)水平及其与冠心病的关系

目的　探讨 2型糖尿病患者血清脂蛋白 (a) [Lp(a) ]水平及其与冠心病的关系。方法　选择 90例 2型糖尿病及 6 8例健康对照者测定其血清Lp(a)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)水平 ;计算低密度脂蛋白胆固醇 (LDL C)水平及TC、TG、LDL C与HDL C比值。结果　 (1)糖尿病组血清Lp(a)水平与对照组比较差异无显著性意义 (P >0 .0 5 )。 (2 )将 2型糖尿病患者分为糖尿病伴冠心病和单纯糖尿病亚组后发现 :①糖尿病伴冠心病亚组血清Lp(a)水平明显高于单纯糖尿病亚组 [(2 3.78± 2 3.73)mg/dlvs (13.31± 10 .6 6 )mg/dl;P <0 .0 1]及对照组 [(2 3.78± 2 3.73)mg/dlvs (16 .2 8± 17.95 )mg/dl;P <0 .0 5 ];②糖尿病伴冠心病亚组血清Lp(a)水平与LDL C呈正相关关系 (r =0 .32 16 ,P <0 .0 5 )。结论　 2型糖尿病患者血清Lp(a)水平增高可能与冠心病发病有密切关系。     

不同类型高脂蛋白血症患者血浆可溶性细胞粘附分子变化的探讨

目的 :探讨高脂蛋白血症患者血浆中可溶性细胞粘附分子 1(sICAM 1)与甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、总胆固醇 (TC)、脂蛋白a(Lp a)、高密度脂蛋白胆固醇 (HDL C)的相互关系及临床意义。方法 :经体检排除心肌梗死、脑卒中、短暂性脑缺血、癌症、严重肝肾疾病的患者 16 0例 ,空腹采血。用ELISA方法测定sICAM 1,全自动生化分析仪测定血脂。结果 :①高脂蛋白血症患者血浆中sICAM I水平与TG(r =0 .15 ,P <0 .0 1)、LDL C(r =0 .16 ,P <0 .0 1)水平呈正相关 ;②高脂蛋白血症患者血浆中sICAM 1水平与HDL C(r =- 0 .15 ,P <0 .0 1)水平呈负相关。结论 :sICAM 1可能是早期动脉粥样硬化性疾病的标志 ,也可能是致病的病因基础     

Ligaments of the larynx and the adjacent pharynx and esophagus

Two ligament systems of the larynx are demonstrated by dissection. The suspensory ligament of the esophagus is attached to the posterior aspect of the cricoid cartilage and is also a part of the fascial sheath which is common to the hyoid, thyroid, and cricoid. The ligaments at the inner margins of the vocal, ventricular, and aryepiglottic folds are distinctive in site and, inferentially, in function. The aryepiglottic ligaments join at the incisura between the arytenoid cartilages and are continued as the corniculopharyngeal ligament which splays into the flexible tissues in the anterior wall of the hypopharynx, posterior to the suspensory ligament of the esophagus. These ligament systems are involved in two different actions in swallow. The gross superior and anterior motions of the larynx are transmitted to the esophagus by the suspensory ligament, so that the esophagus is elevated in relation to the bolus and is also opened. These esophageal displacements resemble, in effect, the swallow displacements of the pharyngoesophageal segment and of the constrictor wall of the hypopharynx. The marginal ligaments of the laryngeal folds help to implement the constriction and closure of the larynx during swallow. By anatomical inference, the corniculopharyngeal ligament effects vertical traction within the flexible tissues of the anterior wall of the hypopharynx.     

表观扩散系数值与肝细胞癌分级的相关性以及相关性与肿瘤大小关系的分析

[摘要]　目的　探讨表观扩散系数（apparent diffusion coefficient, ADC）值与肝细胞癌（hepatocellular carcinoma, HCC）组织学分级的相关性以及不同直径肿瘤的ADC值与HCC的相关性。方法?回顾性分析2017年—2020年180例病理证实为HCC的病例资料,按肿瘤直径大小分为＜2 cm、≥2 cm且＜3 cm、≥3 cm且＜5 cm、≥5 cm 4组,标为I、II、III、IV组。分析ADC值与HCC组织学分级的相关性,并分析在不同直径肿瘤ADC值与HCC的相关性。结果?高、中和低分化HCC的ADC值分别为（1.159±0.302）×10-3、（0.951±0.213）×10-3和（0.811±0.239）×10-3 mm2/s,逐级降低（P＜0.05）。ADC值与总体HCC的组织学分级呈负相关（r=-0.474）,与I～III组HCC的组织学分级均呈负相关（r值分别为-0.663、-0.527、-0.364）,而与IV组HCC的组织学分级无相关性。结论?ADC值可以作为非侵入性预测HCC组织学分级的指标,预测结果受肿瘤大小影响,更适用于小肝细胞癌。     

The charity and the care: the origin and the evolution of hospitals

BackgroundThe hospital is considered as one of the founding elements of modern medicine. Such an institution, originally born to be a center for housing the sick and the poor, has provided with a place to improve the medical knowledge and to educate new generations of nurses and physicians. This paper wants to remind the meaning and the development of the hospital institution in the western world.MethodsThe first part of this work analyzed the evolution of hospital, using a classical historiographical approach. In the second part, the history of the “Ospedale Maggiore” in Milan was used as a paradigm to describe the evolution of hospital from the Renaissance to nowadays through a “microhistorical approach”.ResultsThe origins of the public hospital are evidenced in early Christian age, when the Christian message led people to assist the sick and the poor and to establish centers for such interventions, initially in the house of the bishop, then in monasteries and, finally, in autonomous buildings (the hospitals). These institutions were economically supported by the donations of wealthy philanthropists. Since the nineteenth century the hospitals have changed their organization and functions, but have continued to associate the charity and the care.ConclusionChristian charity and the lay culture originated from it may be rightly credited not only as the founding element of ancient hospitals, but also as the virtue which has made possible for the development of medicine, as we know it.     

Diabetes and the survival and recovery of the anoxic myocardium.

In studies with the isolated perfused working hearts from rats with experimentally induced diabetes, the ability of the hearts to survive during, and recovery from, 30 min of anoxia has been studied. In contrast with hearts obtained from normal rats, which gave good and sustained recoveries, the hearts from diabetic animals after an initial period of recovery (approx. 2 min), exhibited cardiac failure for periods of up to 4 min. After this period the hearts entered a second phase of recovery but did not recover to the same extent as the hearts from normal animals. Hearts of diabetic animals therefore appear to be more vulnerable to anoxic damage than do those from normal rats.Using metabolic inhibitors the biochemical basis of this transient post-anoxic failure in diabetic hearts was investigated. It was discovered that the immediate post-anoxic recovery of the hearts was supported in part by endogenous supplies of pre-formed high energy phosphates and in part from energy derived from the glycolysis of endogenous glycogen. During the initial recovery period of approx. 2 min there was little dependence upon the oxidative metabolism of either endogenous or exogenous substrates. In normal hearts the role of major energy provider was rapidly assumed by oxidative processes utilizing exogenous substrate. In the insulin deficient diabetic hearts the impaired transport of glucose into the cell and consequent energy shortage led to the transient cardiac failure and accounted for the delayed secondary recovery. This condition could be completely overcome either by the provision of exogenous insulin or by the provision of substrates such as pyruvate, acetate, citrate or hydroxybutyrate, whose efficient utilization was not impaired by an insulin deficiency.The relevance of these findings in the diabetic rat heart is discussed in relation to the known insulin deficiency occurring in the human during heart failure and the proposed importance of glucose metabolism in the support of the failing myocardium. In addition, these findings are considered in relation to the possible role of insulin both in the genesis and the treatment of heart failure with particular reference to heart failure in humans with diabetes mellitus.