急、慢性肾功能衰竭血清铁蛋白的研究

目的：评估急、慢性肾功能衰竭的血清铁蛋白浓度，建立一种新的鉴别诊断标准。方法：随机选择35名急性肾功能衰竭（简称急性肾衰）患者，和35名慢性肾功能衰竭（简称慢性肾衰）患者分成两组，急性肾衰A组和慢性肾衰B组，并选30名正常人为C组和20名急性上呼吸道感染者为D组作为对照，测定血尿素氮（BUN）、血清肌酐（Scr）、红细胞压积（Hct）、血红蛋白（Hb）、血清铁蛋白（SF）和血清铁（SI）水平。结果：A组SF水平明显高于B、C组（P<0.01），B组与C组SF无明显差异（P>0.05）。结论：急性肾功能衰竭患者血清铁蛋白增高，慢性肾功能衰竭患者血清铁蛋白无明显变化。     

癫癎对雄性Wistar大鼠生殖系统的影响

目的：研究癫癎发作对雄性Wistar大鼠生殖系统相关指标的影响,企为临床癫癎男性患者提高生育质量提供依据.方法：运用氯化锂-匹罗卡品建立Wistar雄性大鼠癫癎模型,取血样、睾丸、附睾、精子分别测定其血清性激素、脏器系数、精子计数,观察精子活力及形态,分析癫癎对雄性大鼠生殖的影响.结果：癫癎造模成功组（A组）及癫癎造模未成功组（B组）的总睾酮（TT）及孕酮（P）水平均显著低于健康对照组（C组）,而A组TT水平又显著低于B组,A组大鼠孕酮（P）水平与B组比较差异无显著意义.而A组黄体生成素（LH）及卵泡刺激素（FSH）均显著高于B组及C组,A组大鼠泌乳素（PRL）水平显著高于B组及C组,雌二醇（E2）在三组间比较差异无显著意义.A组与C组及B组相比睾丸脏器系数（睾丸重/体重）显著降低.A组大鼠精子计数低于C组及B组.在精子活动率,A组及B组低于C组.在大鼠精子畸形形态的观察中,A组及B组中可观察到较多的精子头部畸形.结论：氯化锂-匹罗卡品建立的Wistar雄性大鼠癫癎模型对生殖系统的相关检测指标均有较明显的影响.     

早期肠内营养对肥胖急性重症胰腺炎患者预后的影响

 目的:评估早期肠内营养对肥胖重症急性胰腺炎患者病情发展经过和预后的影响。方法:选择2007年1月至2013年1月间在我院收治的重症急性胰腺炎患者156例,根据患者接受营养方式及体重指数（BMI）分布情况分为A组（BMI<25 kg/m2,常规治疗加延迟的肠内营养,n=107）、B组（BMI≥25 kg/m2 ,常规治疗加延迟的肠内营养,n=22）和C组（BMI≥25 kg/m2 ,常规治疗加早期肠内营养,n=27）,比较3组患者预后评分（Ranson评分和APACHE-II评分）、局部并发症、系统并发症及病死率等的差异,并检测3组患者入院24 h 内血清白细胞介素 6（IL-6）、C 反应蛋白（CRP）和肿瘤坏死因子α（TNF-α）水平。结果:B组患者Ranson评分显著高于A组患者(P<0.05),B组与C组患者Ranson评分及入院时APACHE-II评分无显著差异(P>0.05)。B组患者胰腺坏死、胰腺感染或脓肿和呼吸功能衰竭的的发生率显著高于A组(P<0.05) 。通过早期肠内营养干预,C组患者胰腺感染或脓肿和呼吸功能衰竭发生率显著低于B组患者（P<0.05）。B组患者病死率高达36.4%, 显著高于A组的65%（P<0.05）;而C组患者病死率减至11.1%, 显著低于B组患者（P<0.05）。B组患者CRP 和TNF-α水平均显著高于A组（P<0.05）, C组患者CRP 和TNF-α水平又显著低于B组患者（P<0.05）。结论:早期肠内营养能降低肥胖重症急性胰腺炎患者胰腺感染或脓肿和呼吸功能衰竭的发生率及病死率,显著改善预后,并可减轻炎症因子的表达。     

IL-17A在急性呼吸窘迫综合征肺泡炎症中的表达及意义

为探讨急性呼吸窘迫综合征肺泡炎症中IL-17A的表达及意义,选择急性呼吸窘迫综合征肺泡炎症患者98例,根据病情严重程度分为A组(轻度,36例)、B组(中度,32例)及C组(重度,30例),均进行IL-17A水平及中性粒细胞计数检测,比较3组患者血清IL-17A水平、中性粒细胞计数、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation scoring systemⅡ,APACHEⅡ)评分、序贯器官功能衰竭(sequential organ failure assessment,SOFA)评分及治疗前后血清IL-17A水平,分析不同预后患者血清IL-17A水平及其价值。结果显示,C组患者血清IL-17A水平、中性粒细胞计数、APACHEⅡ评分及SOFA评分均高于A组和B组,且B组高于A组(P0.05);3组患者治疗后血清IL-17A水平均低于治疗前,但C组血清IL-17A水平仍高于A组和B组,且B组高于A组(P0.05);经Pearson分析,IL-17A水平与APACHEⅡ评分、SOFA评分呈正相关(P0.05);经28 d随访,98例患者中存活60例,死亡38例,存活者血清IL-17A水平明显低于死亡者(P0.05);经受试者工作特征(receiver operating characteristic,ROC)曲线分析,AUC为0.859。研究提示,急性呼吸窘迫综合征肺泡炎症患者IL-17A的表达水平升高,动态监测IL-17A水平可判断病情进展及预后。     

急性呼吸道腺病毒感染患儿血清细胞因子的动态变化

目的探讨急性呼吸道腺病毒（AdV）感染患儿的细胞因子水平,及其在腺病毒感染发病与发展中的致病作用及意义。方法采集临床住院患儿血清和咽拭子,分别用酶联免疫法（ELISA）及实时荧光定量PCR法检测AdV-IgM及AdV核酸,两者结果均为阳性者入选AdV感染组。采用流式细胞蛋白分析技术（CBA）检测20例AdV感染者急性期、恢复期和20例正常对照儿童血清IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ及IL-17A。结果 AdV感染患儿急性期血清中的IL-2、IL-4、IL-6、TNF、IL-17A水平显著高于恢复期和正常对照组（P〈0.01）;而血清中的IL-10、IFN-γ水平急性期显著低于恢复期和正常对照组（P〈0.05）;恢复期和正常对照组相比差异无统计学意义（P〉0.05）。结论儿童急性呼吸道腺病毒感染会引起细胞因子水平的改变,它们在血清中水平失衡,对发病及病情的发展有一定影响。     

几种血液净化方式对尿毒症患者交感神经皮肤反应及甲状旁腺激素的影响

目的：用交感神经皮肤反应（SSR）检测来评价不同血液净化方式对尿毒症植物神经病（AD）的疗效,从而优选出一种或几种有效的治疗尿毒症AD的血液净化方式。方法：将长期血液透析的115例患者,包括普通血液透析治疗组51例（A组）,血液透析滤过治疗组30例（B组）,血液透析＋灌流治疗组22例（C组）,腹膜透析治疗组12例（D组）,于治疗前及治疗3个月后行SSR检测,并检测同期的血磷、血清甲状旁腺激素（PTH）水平,比较这四种血液净化方法对尿毒症AD的疗效。结果：此115例患者仅有1例PTH在正常水平,占0．9％,余114例（99．1％）皆异常且PTH水平与SSR的各检测值之间有明显的相关性（P〈0．01）。A组治疗前后血磷、PTH、SSR上、下肢起始潜伏期（OL）及峰-峰波幅值（Amp）无明显差异（P〉0．05）;B组治疗前后血磷无明显改变（P〉0．05）,PTH较治疗前明显下降（P〈0．01）,SSR上、下肢OL明显缩短（P〈0．01）,SSR上、下肢峰-峰波幅值较治疗前明显增高;C组和D组治疗后血磷、PTH水平均明显下降（P〈0．01）,SSR上下肢OL较治疗前明显缩短,上下肢峰-峰波幅值较治疗前明显增高。经两两比较得出：经治疗C组和D组血磷、PTH下降程度较A组、B组明显（P〈0．01）,其中C组、D组两组间血磷、PTH下降程度无明显差异（P〉0．05）,B组PTH下降程度较A组明显（P〈0．01）;C组、D组SSR上、下肢OL的缩短程度及峰-峰波幅值的增高程度较B组、A组明显（P〈0．91）,B组SSR上、下肢OL的缩短程度及峰-峰波幅值的增高程度较A组明显（P〈0．01）,其中C组、D组两组间上、下肢OL的缩短程度及峰-峰波幅值的增高程度无明显差异（P〉0．05）。结论：血液透析＋灌流、腹膜透析可有效清除中大分子毒素,对尿毒症AD的治疗疗效显著;血液透析滤过可部分清除中大分子?     

急性脑出血患者血清甲状腺激素水平的变化及其临床意义

目的探讨急性脑出血患者血清甲状腺激素水平及其临床意义。方法根据脑出血量多少、神经功能缺损程度及治疗2周后的疗效,将98例急性脑出血患者分为：脑出血量≤30ml为A组、〉30ml为B组;神经功能缺损程度轻型的为C组、中型的为D组、重型的为E组;疗效为显效的为F组、有效的为G组、无效的为H组。选择40例健康者作对照。采用电化学发光法检测急性脑出血患者和健康对照者血清中T3、T4、FT3、FT4、TSH水平。结果急性脑出血患者A、B、C、D、E、G和H组与健康对照组,B组与A组,D、E组与C组,G、H组与F组之间,甲状腺激素水平差异均有统计学意义（P〈0.05）,T4、FT4、TSH水平升高,而T3、FT3水平下降。而疗效为显效的F组与健康对照组比较,甲状腺激素水平差异无统计学意义（P〉0.05）。结论急性脑出血患者T4、FT4、TSH水平升高和T3、FT3水平下降与病情的严重程度及预后密切相关。     

厄贝沙坦治疗2型糖尿病早期肾病的临床观察

目的：探讨厄贝沙坦对2型糖尿病早期肾病尿白蛋白、转铁蛋白的影响。方法：将36例入选患者随机分为三组,A组血压正常,仅用降糖药治疗;B组血压正常,降糖基础上给厄贝沙坦（75mg／d）;C组伴高血压,降糖基础上加厄贝沙坦,随访血压、24h尿白蛋白排泄量（24hUAlb）,24h尿转铁蛋白（24hUTRF）等。结果：3个月后,A组24hUAlb、24hUTRF及平均脉压（MAP）均无明显变化（P〉0．05）;B组24hUAlb、24hUTRF显著降低（P〈0．05）,MAP无显著变化（P〉0．05）;C组24hUAlb、24hUTRF及MAP均显著降低（P〈0．05）,且24hUAlb减少与MAP下降无相关性。结论：厄贝沙坦对2型糖尿病早期肾病有独立于降压作用之外的肾脏保护作用,且无明显副作用。     

血清胱抑素检测对糖尿病早期肾功能损害的诊断意义

目的探讨血清半胱氨酸蛋白酶抑制剂C（Cys C）检测对糖尿病早期肾功能损害的诊断意义。方法将76例1型或2型糖尿病患者按尿白蛋白排泄率（UAER）分为3组（B、C、D组）,20例无糖尿病的正常人为A组。其中,B组为正常蛋白尿患者31例（UAER〈20μg/min）,C组为微量蛋白尿患者28例（UAER 20～200μg/min）,D组为大量蛋白尿患者17例（UAER〉200μg/min）。同时测定各组血肌酐（Scr）及Cys C,并计算肌酐清除率（CCr）。结果 2型糖尿病各组血清Cys C水平与对照组相比明显升高,而且其水平随蛋白排泄率的升高而升高（P〈0.05）,而Scr在B组、C组间的差异无统计学意义（P〉0.05）。结论 Cys C与糖尿病肾病的病情呈正相关,Cys C可作为2型糖尿病肾病患者早期监测的新指标。     

采用放射性内照射建立甲状腺功能减低及相关性眼病Wistar大鼠模型

目的：采用人类促甲状腺激素（hTSH）刺激及放射性碘-131（131I）注射Wistar大鼠的方法,建立甲状腺功能减低（甲减）及其甲状腺相关眼病（TAO）的动物模型。方法：将20只Wistar大鼠随机分为实验组和正常组,实验组大鼠腹腔内注射hTSH。第8周腹腔内注射131I,根据不同剂量将实验组分为低剂量组（A组）、中剂量组（B组）及高剂量组（C组）。第16周后处死所有大鼠,机械分离甲状腺,取眼眶组织做病理学观察,采用常规HE染色方法,观察和分析大鼠眼眶内的病理学变化。用电化学发光法测定血清FT3和FT4,酶联免疫吸附法测大鼠血清促甲状腺素（rTSH）和TRAb水平。结果：131I注射后8周,大鼠血清FT4水平A组（16.98±2.92）pmol/L、B组（1.84±0.44）pmol/L和C组（1.35±0.37）pmol/L均降低,三组与正常组（D组）比较差异均有显著性（P〈0.05）;且C组和B组明显低于A组,差异有显著性（P〈0.05）;血清rTSH水平C组（2.53±0.10）mIU/L、B组（2.37±0.32）mIU/L略高于D组（2.17±0.38）mIU/L,A组（1.78±0.36）mIU/L略低于D组,但差异均无显著性（P〉0.05）;A组血清TRAb（4.69±1.52）IU/ml和B组（4.49±2.60）IU/ml水平明显低于D组12.79±0.75）IU/ml,而C组血清TRAb（10.36±4.48）IU/ml与D组比较无明显差异（P〉0.05）。眼眶组织学观察,实验组出现眼眶组织黏液变性、水肿,眼肌水肿以及肥大细胞为主的浸润,细胞间隙明显增宽。随着131I剂量的增加,B和C组出现脂肪组织和纤维组织增生,肌纤维变性断裂,肌细胞核肥大变性,眼眶血管扩张,C组肌纤维甚至有空泡形成。结论：采用hTSH刺激和131I注射制作的动物模型具有甲减及TAO的普遍特征,并证实甲减伴有TAO的存在,方法简便易行,不仅可用于131I治疗后甲减基础研究的需要,也可作为对其他原因所致甲减或TAO机制探索的模型。     

长期吸烟对血液粘度的改变及原因分析

目的 :初步探讨长期吸烟对血液粘度改变和原因以及对人体正常微循环的影响。方法 :取 10 0例健康吸烟组和 10 0例健康不吸烟对照组样本分别作血液粘度和血常规中RBC、Hgb的检测。结果 :吸烟组血液粘度明显高于不吸烟对照组 ,二者所测得值经统计学处理 (t检验 )有显著性差异。结论 :为维持人体正常微循环 ,必须不吸或少吸烟     

Enhanced response to music in pregnancy

Given a possible effect of estrogen on the pleasure‐mediating dopaminergic system, musical appreciation in participants whose estrogen levels are naturally elevated during the oral contraceptive cycle and pregnancy has been investigated (n = 32, 15 pregnant, 17 nonpregnant; mean age 27.2). Results show more pronounced blood pressure responses to music in pregnant women. However, estrogen level differences during different phases of oral contraceptive intake did not have any effect, indicating that the observed changes were not related to estrogen. Effects of music on blood pressure were independent of valence, and dissonance elicited the greatest drop in blood pressure. Thus, the enhanced physiological response in pregnant women probably does not reflect a protective mechanism to avoid unpleasantness. Instead, this enhanced response is discussed in terms of a facilitation of prenatal conditioning to acoustical (musical) stimuli.     

Uncovering category specificity of genital sexual arousal in women: The critical role of analytic technique

Based on analytic techniques that collapse data into a single average value, it has been reported that women lack category specificity and show genital sexual arousal to a large range of sexual stimuli including those that both match and do not match their self‐reported sexual interests. These findings may be a methodological artifact of the way in which data are analyzed. This study examined whether using an analytic technique that models data over time would yield different results. Across two studies, heterosexual (N = 19) and lesbian (N = 14) women viewed erotic films featuring heterosexual, lesbian, and gay male couples, respectively, as their physiological sexual arousal was assessed with vaginal photoplethysmography. Data analysis with traditional methods comparing average genital arousal between films failed to detect specificity of genital arousal for either group. When data were analyzed with smoothing regression splines and a within‐subjects approach, both heterosexual and lesbian women demonstrated different patterns of genital sexual arousal to the different types of erotic films, suggesting that sophisticated statistical techniques may be necessary to more fully understand women's genital sexual arousal response. Heterosexual women showed category‐specific genital sexual arousal. Lesbian women showed higher arousal to the heterosexual film than the other films. However, within subjects, lesbian women showed significantly different arousal responses suggesting that lesbian women's genital arousal discriminates between different categories of stimuli at the individual level. Implications for the future use of vaginal photoplethysmography as a diagnostic tool of sexual preferences in clinical and forensic settings are discussed.     

纳络酮对缺血再灌注心肌微循环血流量及其超微结构变化的影响

本文观察了纳络酮对犬缺血和再灌注心肌微循环血流量及其超微结构变化的影响。结果表明：心肌缺血再灌注时微循环血流量明显降低（P＜0．01），但再灌注早期（5min），心肌微循环血流量接近正常，缺血40min，再灌注30min，毛细血管周围组织严重水肿，内皮高度肿胀，管腔狭窄，甚至闭塞；纳络酮治疗缺血和再灌注早期，心肌微循环血流量明显增加（P＜0．01）；毛细血管周围组织水肿及管腔狭窄程度明显轻于缺血再灌注组。提示：纳络酮可减轻缺血再灌注心肌的水肿程度，增加微循环血量，推迟“无再流现象”的发生。     

高效液相色谱-串联质谱法测定人血浆盐酸伪麻黄碱浓度

目的 建立一种高效液相色谱-质谱联用技术（LC-MS/MS）测定人血浆盐酸伪麻黄碱浓度的方法。方法 血浆样品经液液萃取后,以甲醇∶水∶甲酸（60∶40∶1,V/V/V）为流动相,流速0.35 ml/min,采用Cap cell pack C18色谱柱分离,150 mm×2.1 mm, 5 μm（USA）;柱温20℃,选择离子喷雾离子化源串联质谱,通过正离子方式检测;选择反应监测（MRM）方式转化m/z=166.3/148.2（盐酸伪麻黄碱）和m/z= 152.2/134.15（内标苯丙醇胺）进行定量分析,用内标法测定含量。结果 伪麻黄碱浓度分别在5.0~400.0 ng/ml的范围内线性良好,R=0.9962,最低检测限为1.0 g/ml。结论 本方法操作简便、快速,结果准确,可用于该药物的含量测定,同时也可为临床药动学研究提供一定的参考。     

紫外线照射全血对红细胞免疫功能及脂质过氧化的影响

为了研究Ｂ波段紫外线（ＵＶＢ）照射全血对红细胞免疫功能及全血抗氧化能力的影响，利用１．５Ｊ／ｃｍ２的ＵＶＢ对全血进行照射，结果发现照射后红细胞Ｃ３ｂ受体花环促进率（ＲＦＥＲ）明显升高（Ｐ＜０．０５），而红细胞Ｃ３ｂ受体（ＲＣＲ）花环率升高更为明显（Ｐ＜０．０１），红细胞免疫复合物（ＲＢＣ－ＩＣ）花环率及与红细胞Ｃ３ｂ受体花环抑制率（ＲＦＩＲ）在照射前后无明显改变（Ｐ＞０．０５），红细胞超氧化物歧化酶（ＳＯＤ）活性在照射后明显升高（Ｐ＜０．０１），而血浆中丙二醛（ＭＤＡ）含量无明显改变（Ｐ＞０．０５）。说明紫外线照射能改善红细胞免疫功能及全血的抗氧化能力。     

The effect of blood flow on the material properties of bone

This project was undertaken to establish if the integral circulation had any effects upon the mechanical behavior of bone. The influence of blood flow in the rabbit tibia on the strain induced at the bone surface when under load was assessed. Recordings were taken from three adult and three immature New Zealand White rabbits which had previously had both their tibiae pinned with modified orthopedic pins. Strain readings were obtained from the exposed mid-shaft of the tibia of both hind legs before, during and after blood flow changes. The loading was static and used to maintain a strain of 250 μstrain in adult animals and 180 μstrain in immature animals prior to variation in blood flow. The blood flow was altered by means of a tourniquet inflated to 80 mm Hg and placed medial to the pinned tibia; it was inflated for a specific time (≈40 minutes) during the experimental loading. Reducing the blood flow appeared to alter the strain recorded at the bone surface while the applied load across the pins remained constant. An initial effect when there was reduced perfusion was that the strain increased following a reduction in blood flow. The strain then began to decrease in magnitude on the compressive aspect coincident with release of the cuff to a level below the value of the initial normally perfused bone. Upon return of the blood supply to normal levels following the initial hyperaemic phase, the strain value increased to a value comparable with that of normally perfused bone. During the hyperemic phase, found on the compressive aspect of the tibia, the measured strain decreased to a value below the initial loaded strain despite the load remaining constant. This demonstrates that the presence of a normal cardiovascular perfusion actually stiffens the bone while a reduction in perfusion allows the bone to deform more readily for the same external loading.     

Accumulation of immune cells and high expression of chemokines/chemokine receptors in the upstream shoulder of atherosclerotic carotid plaques

The presence of immune cells is important for plaque destabilization. Disturbed flow conditions were shown to enhance the recruitment of circulating immune cells. Thus, we analyzed in 54 atherosclerotic carotid plaques the frequency of different immune cells, HLA-DR, chemokines, and chemokine receptors, comparing the upstream with the downstream plaque shoulder. The presence of neovascularization and intraplaque hemorrhages was investigated by CD34 immunostaining and Mallory's iron stain. Immunohistochemical analyses were performed to detect smooth muscle cells (SMC: actin), macrophages (CD68), T cells (CD3), dendritic cells (DC: fascin), mature DC (CD83), and the expression of HLA-DR, chemokine receptors (CCR-2, CCR-6), and chemokines (MCP-1, MIP-3alpha). Significantly more SMC were detected downstream than upstream (p<0.001). In contrast, significantly more macrophages (p=0.01), DC (p=0.03), mature DC (p=0.007), and a higher expression of HLA-DR (p=0.004), CCR-2 (p=0.002), CCR-6 (p<0.001), MCP-1 (p=0.04), and MIP-3alpha (p=NS) were observed upstream than downstream. Immune cells were strongly associated with neovascularization. The abundance of SMC downstream provides an explanation for distal plaque growth. Enhanced recruitment of immune cells through neovessels into the upstream shoulder might be contributing to plaque destabilization.     

Towards equitable and sustainable availability of blood products in Zimbabwe: An analysis of strengths,weaknesses, opportunities and challenges

Blood transfusion can be a lifesaving intervention in a number of medical emergencies. To attain sustainable and equitable availability of blood products, it is important to understand the strengths, weaknesses, opportunities, and challenges of the national blood services programme. We, therefore, with this letter to the editor, discuss some of the strengths, weaknesses, opportunities and threats to the Zimbabwean programme since its inception. Despite several strengths and opportunities that the national blood services of Zimbabwe (NBSZ) leverages on, we argue that among other challenges, donor shortages and an upsurge of transfusion transmittable infections in the eligible donor population continue to be the biggest threats to the achievement of the programme objectives. These can be addressed through expanding the blood donor base and the catchment area. Additionally, improving the level of knowledge and attitude towards blood donation in the communities is critical for driving the sustainable and equitable distribution of safe blood products to the population.