Cronkhite—Canada综合征一例及临床分析

患者男,54岁,主因间断腹胀2年加重伴腹泻、腹痛1个月余前来就诊。既往家族史无特殊。患者于20年前出现明显脱发;近14年来易“感冒”,约7～8次／年。2年前出现腹胀,多于下午加重。1个月前因发现咽部乳头状瘤行镜下切除术,术后4d无明显诱因出现腹泻及黄色糊样或水样便,无黏液、脓血,最多20次／d,每次量约20～50g,时有便不尽感,伴下腹部阵发性绞痛,便前出现疼痛,便后缓解。     

胰头占位性病变致胰管出血一例

患者男,63岁,因＂上腹胀20余天,黑便3 d＂入院.患者于20余天前无明显诱因下出现上腹胀,呈间断性,常于进食后2～3 h出现,伴腰背部酸胀感,无腹痛,无恶心、呕吐,无发热,二便正常,未予重视.3 d前患者无明显诱因下排黑色成形便1次,量约200 g,伴间断性上腹胀,无恶心、呕吐,无头晕、心悸,于外院行胰腺CT示胰头占位,MRCP示胰管扩张、胆总管略扩张（图1）.     

原发性支气管肺淀粉样变性1例报告

患者女，63岁，农民，因间断性咳嗽半年，伴胸痛、咳血3d，于2009年5月至我院就诊。半年前患者出现间断性干咳，曾在当地按气管炎口服消炎药，病情反复。3d前患者咳嗽加重，并出现咳血，鲜红色，每天5～6次。无吸烟史，否认结核、肿瘤及慢性气管炎等病史。查体：体温、脉搏、     

经共聚焦激光显微内镜诊断乳糜泻一例

患者女,60岁,农民,因间断性腹部不适伴腹泻3年余,加重1个月就诊.患者3年前无明显诱因出现腹部不适,排便后可缓解,为稀糊黏液便,无脓血便,2～3次/d,伴乏力.近1个月上述症状频繁出现.曾服用奥美拉唑、铝碳酸镁、匹维溴铵等药物,效果不佳.自发病以来,患者睡眠精神不佳,体质量无减轻.自述贫血20余年,否认糖尿病及甲状腺功能亢进病史.主食为面食,无烟酒嗜好.月经规律,育有1子1女,家人体健,家族史无特殊.曾诊断为肠易激综合征,予对症处理,效果欠佳.     

间位结肠引起右上腹痛1例

病例：患者男,38岁,以“间断性右上腹痛5月余”为主诉入院。患者入院前5个月无明显诱因出现间断性右上腹痛,进食后、排便前、活动后加重,疼痛剧烈难忍,伴呃逆,晨起腹痛减轻,便次增多,每日约2～3次,为不成形便。当地医院结肠镜检查未见异常,胃镜检查示非萎缩性胃炎伴糜烂,予抑酸治疗,症状无缓解。入院前20余天腹痛加重,以右上腹为著。患者既往体健,发病以来精神可,饮食、睡眠尚好,小便正常,体质量无明显变化。     

急性空肠扭转致肠梗阻1例

病例：患者男,25岁,因＂呕吐、腹痛、腹泻伴发热4d＂于2011年5月27日至复旦大学附属华东医院急诊科就诊.患者4d前着凉后自觉乏力、头晕,呕吐2次,量较多,呕吐物为胃内容物,伴喛气,随后出现阵发性腹痛,以左上腹为主,呈痉挛样,腹泻5-6次/d,水样便,色黄,伴发热,体温最高40 ℃,无畏寒、寒战,无反酸,无咳嗽、咳痰,无胸闷、胸痛,无呕血、黑便,无呼吸困难.     

暴发型克罗恩病死亡2例报告

例1：男，46岁。因腹泻、发热7个月，便血3d，于2006年10月19日入山东省立医院。患者腹泻为稀水样便，2～3次／d，伴间断性发热，体温最高39．2℃，不伴腹痛，在当地医院诊为克罗恩病，并予以柳氮磺胺吡啶（SASP）和激素治疗，效果差。3d前突发便血，鲜红色血便伴多量血块，给予生长抑素、去甲肾上腺素等保留灌肠．大便转为成形黑绿色便。     

内镜下不典型肠结核1例报告

患者女,20岁。因中下腹痛伴腹泻3个月,加重2周,于2011年3月31日就诊于我院。3个月前患者无明显诱因出现中下腹痛,每天大便4～6次,每次50～100 g,为棕黄色稀水样大便,伴体质量减轻,偶感乏力,食欲减退;无明显发热、盗汗、咳嗽、咳痰。近2周乏力明显,腹痛加重。体检：体温37.6℃,脉搏75次/min,呼吸19次/min,血压115/75 mmHg。     

遗传性出血性毛细血管扩张症致上消化道出血一例

患者男，49岁，以“间断黑便4个多月，加重20d”为主诉入院。患者入院前4个多月（2005年6月），无明显诱因出现黑色成形软便，呈间断性，伴头晕，心悸，乏力。入院前20天始，每日排黑便1～2次，量不定，稀软不成形，自觉头晕，心悸，乏力加重，不能从事日常活动，遂来我院就诊。无鼻衄及齿龈出血，无皮肤出血，无呕血，无晕厥。既往史：自7岁左右起有鼻衄史，于1999年行鼻黏膜剥离术，后因为再次鼻衄，于2004年12月再次行鼻黏膜剥离术，至今未有鼻衄。个人史：吸烟20年，3～4支／d；饮酒10年，白酒50g／d。家族史：有家族性鼻衄史。其曾祖父、祖父、父亲、伯伯均有鼻衄史，伯伯有4子1女，均有出血史，有的鼻衄，有的胃出血。     

以反复消化道出血为突出表现的小肠间质瘤1例

病例：患者女,61岁,因“间断黑粪伴暗红色血便3年,加重5d”于2013年1月21日收治入院。患者3年来无明显诱因间断出现黑粪,伴暗红色血便,每次约50～200mL。发作时间间隔为1个月至半年不等,每次发作均排3—5次黑粪,并伴暗红色血便,有时成形,有时不成形。便前偶有上腹部隐痛和呕吐,呕吐物为胃内容物,无咖啡渣样物或血凝块,便后腹部隐痛可缓解。     

Cement and Concrete Nanoscience and Nanotechnology

Concrete science is a multidisciplinary area of research where nanotechnology potentially offers the opportunity to enhance the understanding of concrete behavior, to engineer its properties and to lower production and ecological cost of construction materials. Recent work at the National Research Council Canada in the area of concrete materials research has shown the potential of improving concrete properties by modifying the structure of cement hydrates, addition of nanoparticles and nanotubes and controlling the delivery of admixtures. This article will focus on a review of these innovative achievements.     

Medical and Psychology Students' Knowledge and Attitudes Regarding Aging and Sexuality

The current study surveys medical and doctoral psychology students (N = 100) from an urban northeastern university regarding knowledge and attitudes toward elderly sexuality and aging using the Facts on Aging Quiz, the Aging Sexuality Knowledge and Attitudes Scale, and measures of interest in gerontology, academic/clinical exposure to aging and sexuality, and contact with elders. The current study found that psychology students demonstrated greater aging knowledge than medical students; however, both groups showed gaps in knowledge about sexuality. Married students had greater academic/clinical exposure and greater knowledge about aging but less permissive attitudes toward elderly sexuality. Generally, knowledge about aging was the strongest correlate of knowledge about sexuality. Level of knowledge about sexuality was not associated with attitudes. Attitudes toward sexuality and aging may be more strongly tied to demographic variables reflective of religious beliefs or adherence to sociocultural norms.     

Leptin and cellular and innate immunity in abstinent alcoholics and controls

BACKGROUND: Basic studies indicate that in vitro and in vivo doses of leptin modulate cellular immune responses. Given evidence that concentrations of leptin are altered in alcoholics who also show immune abnormalities, this study examined the relationships between circulating levels of leptin and markers of cellular and innate immunity. METHODS: Circulating levels of leptin, natural killer cell (NK) activity, interleukin-2 (IL-2)-stimulated NK activity, and concanavalin A-stimulated production of IL-2, IL-6, IL-10, and IL-12 were compared between abstinent DSM-IV alcohol-dependent men (n = 27) and age- and gender-matched controls (n = 34). RESULTS: As compared with controls, alcoholics showed lower NK activity (p < 0.01) and a trend for lower levels of leptin (p = 0.055). In the total sample, leptin predicted NK activity (beta = 0.33; p < 0.05) after controlling for the confounding influence of body mass index, alcohol intake, and smoking. Leptin was not correlated with any of the cytokine measures. To examine whether the effects of leptin were mediated by its direct action on NK, additional studies examined in vitro effects of leptin on NK activity in healthy volunteers (n = 10); leptin doses (0.1, 1, and 10 nM) yielded levels of NK activity comparable to those with media alone. CONCLUSIONS: These data show that circulating levels of leptin are associated with NK activity in humans and suggest that abnormal in vivo concentrations of leptin may contribute to the declines of NK activity in alcoholics who are at risk for infectious diseases.     

慢性饮酒、吸烟与骨质疏松的相关性研究

目的 探讨长期大量慢性饮酒、吸烟等不良生活方式与骨质疏松的关系.方法 以乏力、腰背痛、双下肢酸困为主诉,且有长期大量慢性饮酒史、吸烟史,无其他慢性疾病史的年轻男性患者45例为观察对象,测定其血钙(Ca)、血磷(P)和血肌酐(Cr)、尿素氮(BUN)、血糖(Glu)、天门冬酸氨基转移酶(AST)、丙氨酸基转移酶(ALT)、血清碱性磷酸酶(ALP)、甲状腺功能、全段甲状旁腺激素(iPTH)、1,25-二羟维生素D3[1,25-(OH) 2D3]、双能X线骨密度仪测定腰椎L1-4及左侧股骨近段(包括颈、股骨颈上部、大粗隆)骨密度(BMD),分析饮酒、吸烟对骨量的影响.以感冒发热就诊、年龄相当、无饮酒、吸烟史及慢性疾病史的45例男性为对照组.结果 观察组1,25(OH)2D3水平均降低,血钙水平偏低,血磷正常,碱性磷酸酶呈不同程度地升高,骨密度T值提示观察组27例骨质疏松,12例骨量减少,6例正常骨量;而对照组仅有6例为骨量减少,1例骨质疏松,38例为正常骨量,两组比较差异有统计学意义(P＜0.05).结论 长期慢性大量饮酒吸烟影响骨量,甚至易导致骨质疏松.     

自身免疫与动脉粥样硬化的发生发展

在动脉粥样硬化的发生发展过程中,自身免疫具有重要作用,本文就近年有关动脉粥样硬化的免疫机制的研究进展作一简要综述.     

中青年超重和肥胖与高血压及高同型半胱氨酸血症的相关性研究

目的探讨中青年超重和肥胖与高血压及高同型半胱氨酸血症的相关性。方法选取2012年1月—2013年10月在我院进行常规健康体检者750例,测量受试者血压、身高、体质量及血清同型半胱氨酸(Hcy)水平。结果男性超重、肥胖检出率分别为36.87%(198/537)和13.97%(75/537),均高于女性的16.43%(35/213)和7.50%(16/213)(P0.05)。超重者和肥胖者高血压和高同型半胱氨酸血症检出率分别为21.03%(49/233)和11.16%(26/233)、46.12%(42/91)和41.76%(38/91),均高于正常者的9.16%(37/404)和2.23%(9/404),肥胖者高于超重者(P0.01)。收缩压(SBP)、舒张压(DBP)及血清Hcy与BMI呈正相关(r值分别为0.639、0.515、0.497,P0.01)。结论中青年尤其是男性超半数存在超重或肥胖,高血压及高同型半胱氨酸血症与BMI呈正相关,超重和肥胖者高血压及高同型半胱氨酸血症的发生率高,应积极防治。