高频彩色多普勒超声对睾丸肿瘤的诊断价值

目的：探讨高频彩色多普勒超声对睾丸肿瘤的诊断价值。方法：回顾性分析36例经手术病理证实的睾丸肿瘤的临床病理资料及声像图特征。结果：超声确诊34例,诊断符合率94.44%。结论：高频彩色多普勒超声对睾丸肿瘤的诊断有着极为重要的价值。     

治疗射血分数降低的心力衰竭的药物研究进展

心血管疾病是导致死亡的主要原因,并在世界范围内增加卫生保健的费用支出。心力衰竭可简单地描述为心脏无法满足机体的需求,它是很多其他心血管疾病的终点。过去的30年间我们见证了为改善心衰患者存活率及生活质量所做出的巨大努力,其中多数尝试是成功的。考虑到大多数成功的案例都是针对左心室射血分数降低的心力衰竭(reduced left ventricular ejection fraction,HFr EF)患者,本文将针对HFr EF的药物治疗研究进展进行综述,重点介绍临床应用中的新型药物和正处于临床试验中的新型药物。     

急诊教学中心肺复苏模拟情景式教学的构建

目的探讨并构建一种适合于急诊医学心肺复苏课程的模拟情景式教学方法。方法以新疆医科大学临床技能中心为依托,利用高级仿真心肺复苏模拟人（SIMMAN）,对不同心跳骤停类型的抢救流程进行系统编程,让40名学生分2组进行演练,演练结束后利用自制问卷进行调查,应用SPSS15．0软件对问卷调查数据进行描述性分析。结果分层式程序训练与情景式教学结合最能直接掌握心肺复苏操作的要点（75．56％）;在教师的引导下基于临床实际病例或问题进行资料查阅、小组讨论及汇报是心肺复苏教学的最好方式（97．78％）;在教师带领下以病例学习方式收获大（73．33％）;心肺复苏教学以情景式教学和分层式教学相结合较好（75．56％）。结论心肺复苏模拟情景式教学的构建,充分体现了急诊医学教学连贯性和可持续性的特点,能有效改进教学方法、提高急诊医学教学质量和增强学生临床问题应对能力。     

子宫全切手术治疗子宫肌瘤126例临床分析

目的：比较经腹与经阴道子宫全切术治疗子宫肌瘤的临床疗效。方法将该院于2011年5月—2014年5月收治的126例子宫肌瘤患者随机分为两组,观察组选用经子宫全切治疗,对照组选用经腹子宫全切术治疗,观察并比较两组患者各手术指标以及术后并发症情况。结果观察组各手术指标以及术后恢复指标均明显低于对照组,比较差异均有统计学意义(P<0.05)。结论经阴道子宫全切术治疗子宫肌瘤的临床疗效好,具备微创手术特点,能有效减少术中出血量等指标,患者术后恢复速度较快,值得在临床上予以推广。     

Assessing the delivery of neutrophils to tissues in neutropenia

Studies of neutrophil kinetics in neutropenic individuals, as well as clinical observations of variability in the occurrence of infection among patients with neutropenia, have suggested that blood neutrophil counts may not uniformly reflect the effective delivery of neutrophils to extravascular tissues where the cells perform their principal host defense functions. To evaluate this possibility we developed a sensitive, reproducible method of measuring the extravascular delivery of neutrophils to a normal mucosal site of neutrophil turnover. This method is based upon the quantification of neutrophils recoverable from saline mouth wash specimens. Twenty-five mL specimens, obtained in a controlled manner from neutropenic patients and normal subjects, were centrifuged and the sediments resuspended in 1.0 mL Hank's buffer with 2 micrograms acridine orange, incubated at 37 degrees C for 15 minutes, and then examined in a hemocytometer chamber by fluorescence microscopy. Neutrophils could be clearly distinguished by their characteristic fluorescence and were counted. With this method as few as 1,500 neutrophils were detected reliably in mouth wash specimens. Mucosal neutrophil counts varied less than 10% with repeated sampling of individual subjects over 5-day periods and were consistently greater than 1.3 X 10(5)/specimen in non-neutropenic individuals. Although profound neutropenia was generally reflected by lower than normal oral mucosal neutrophil counts, these counts were significantly higher in individuals with chronic severe neutropenia (blood neutrophils less than 300/mm3) than in patients with acute neutropenia of comparable severity that had developed following chemotherapy. Also, in individuals recovering from profound neutropenia, neutrophils usually reappeared earlier in mouth wash specimens than in blood, and oral mucosal neutrophil counts attained recovery levels more rapidly than did blood counts. This phenomenon was particularly evident in an individual with cyclic neutropenia. Moreover, mucosal neutrophils could occasionally be detected in profoundly neutropenic patients when neutrophils were not present in blood samples. These findings indicate that mucosal neutrophil counts in individuals with neutropenia provide information about the delivery of neutrophils to tissues that may not be apparent from blood neutrophil counts alone.     

腹腔镜手术对不孕症患者的诊断及治疗价值研究

目的探讨腹腔镜手术对不孕症患者的诊断及治疗价值。方法回顾性分析新疆医科大学第一附属医院2010年9月-2014年5月收治的319例不孕症患者的临床资料,对所有患者行腹腔镜下诊断及相应的手术治疗(包括盆腔粘连分解、输卵管造口术、输卵管灼断术等)。结果 319例患者腹腔镜术中检查与术前子宫输卵管碘油造影结果的符合率为72.1%(230/319),其中有43例术中发现子宫肌瘤,56例术中发现输卵管系膜囊肿,8例患者术中发现子宫内膜异位症,有2例患者诊断为盆腔结核,1例术中发现结肠肌瘤(术前考虑卵巢囊肿),其余为不同程度的盆腔慢性炎症。轻度粘连69例,妊娠21例,宫外孕2例,妊娠率33.33%。中重度粘连250例,其中行灼断术34例,灼断术患者后行体外受精及胚胎移植(IVF-ET),妊娠13例,妊娠率38.23%(13/34)。其余216例,失访3例,妊娠31例,宫外孕3例、妊娠率15.9%。结论腹腔镜对诊断输卵管性不孕及盆腔疾病有重要价值,子宫输卵管造影仅能初级筛查,诊断价值有限。在治疗输卵管粘连梗阻中,腹腔镜的治疗价值有待进一步探讨,临床预后与盆腔炎症的程度有关,应个体化选择手术方案。     

左室舒张性心衰患者左室舒张末期压力、肺毛细血管楔嵌压与N-末端脑钠肽前体的相关性研究

[摘要]　目的　探讨舒张性心衰患者血清N-末端前脑利钠肽（NT-proBNP）与左室舒张末期压力（LVEDP）、肺毛细血管楔嵌压(PCWP)的相关性及其在不同严重程度舒张性心衰患者中的诊断价值。　方法　心功能正常患者30例为正常组;心功能异常的患者60例为异常组,并按NYHA心功能分级分为3个亚组,Ⅰ~Ⅲ级各20例。采用6F猪尾导管测定LVEDP,经Swan-Ganz导管检查测定PCWP,电化学发光仪RocheElecsys 2010测定NT-proBNP。分析NT-proBNP与LVEDP、PCWP的相关性。　结果　　随着心功能级别增加,异常组血浆NT-proBNP、LVEDP、PCWP水平与正常组比较,显著升高(P<0.01)。直线相关分析表明LogNT-proBNP与LVEDP呈显著正相关(r=0.793,P<0.01)。LogNT-proBNP与PCWP亦呈显著正相关(r= 0.657,P<0.01)。　结论　血清NT-proBNP定量检测是左心室舒张功能受损的敏感指标,NT-proBNP对舒张性心衰严重程度具有明确的诊断价值。     

1例接种麻疹减毒活疫苗偶合幼儿急疹的调查报告

麻疹减毒活疫苗(简称麻疹疫苗,以下同)接种是预防控制乃至消除麻疹的核心内容和主要手段,然而,接种麻疹疫苗后个别儿童可能发生发热出疹性疾病并因此引发纠纷,此时的病因诊断常关系到临床医生的诊疗方案和患儿的病程预后,也会决定疑似预防接种异常反应的最终诊断和补偿结果。现将一起接种麻疹疫苗偶合出疹性疾病案例调查结果分析如下。     

自体富血小板凝胶治疗痛风石合并慢性溃疡的疗效观察

目的 观察自体富血小板凝胶（autologous platelet-rich gel,APG）治疗痛风石合并皮肤慢性溃疡的有效性和安全性。方法 4例痛风石合并慢性溃疡患者,经过伤口清创,清除坏死组织,刮除痛风石后,给予自体富血小板凝胶治疗。结果 4例患者经自体富血小板治疗（3例患者经过1次APG治疗,1例患者经过2次APG治疗）后,创面在8～22 d内均愈合,平均（13.7±6.8） d,没有明显不良反应。结论 采用APG治疗痛风石合并皮肤慢性溃疡,伤口愈合迅速,是一种安全有效的治疗方法。     

我国医院感染现状与控制的进展

通过对国内有关医院感染的调查和研究进行综述,总结医院感染中常见的流行性特征和防治措施,为医院感染的控制和管理提供参考依据;医院感染病原菌分布以革兰阴性菌为主,感染部位以下呼吸道感染为主,感染科室中ICU感染率最高,婴幼儿和老年人为易感人群,手是重要传播途径,抗菌药物滥用是医院感染的重要影响因素;为控制医院感染,需建立健全的医院感染的管理制度;加强医务人员,特别是新进人员及实习生培训,提高其医院感染认知水平;重视手卫生和抗菌药物的合理使用。