Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis complicating acute cholecystitis: a case report

Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder. In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.     

Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia

Background Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot. A high level amputation is inevitable in these patients. This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-arterial transplantation with that of intra-muscular transplantation.
Methods In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 （16 patients with 18 affected limbs） received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 （16 patients with 17 affected limbs） received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index （ABI）, claudication, transcutaneous oxygen pressure （tcPO2） and angiography （15 limbs of 14 patients） were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.
Results Two patients died from heart failure. The improvement of rest pain was seen in 76.5% （13/17） of group 1 and 93.3% （14/15） of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% （8/18） in group 1 and 41.2% （7/17） in group 2. The value of tcPO2 increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% （15/18） in group 1 and 94.1% （16/17） in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups.
Conclusions Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia,     

Sellar chordoma presenting as pseudo-macroprolactinoma with unilateral third cranial nerve palsy

We described a 61‐year‐old female with a sellar chordoma, which presented as pseudo‐macroprolactinoma with unilateral third cranial nerve palsy. Physical examination revealed that her right upper lid could not be raised by itself, right eyeball movement limited to the abduction direction, right pupil dilated to 4.5 mm with negative reaction to light, and hemianopsia in bitemporal sides. CT scanning showed a hyperdense lesion at sellar region without bone destruction. Magnetic resonance imaging (MRI) revealed the tumor was 2.3 cm×1.8 cm×2.6 cm, with iso‐intensity on T1WI, hyper‐intensity on T2WI and heterogeneous enhancement on contrast imaging. Endocrine examination showed her serum prolactin level increased to 1,031.49 mIU/ml. The tumor was sub‐totally resected via pterional craniotomy under microscope and was histologically proven to be a chordoma. Postoperatively, she recovered uneventfully but ptosis and hemianopsia remained at the 6th month.     

校园网络环境下的病理生理学自主学习模式研究

目的探讨校园网络环境下的病理生理学自主学习模式。方法随机选取学院2012级临床医学6-7班、10-11班分别为对照组(传统教学模式)和教改组。教改组实施以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式,对学生考核成绩进行对比分析和问卷调查。结果教改组学生成绩高于对照组,学生的自主学习能力明显提高(P<0.05)。结论以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式可以实现以学助教,有利于学生的终身发展。     

二十二碳六烯酸改善棕榈酸诱导的C2C12细胞胰岛素抵抗作用

目的 观察二十二碳六烯酸(DHA)对棕榈酸诱导的C2C12细胞胰岛素抵抗的影响.方法 将C2C12细胞诱导分化成熟,加棕榈酸及DHA处理,通过实时聚合酶链反应(real-Time qPCR)及免疫印迹检测C2C12细胞葡萄糖转运体4(GLUT4)、胰岛素受体-β(IR-β)、胰岛素受体底物-1(IRS-1)、单核细胞趋化蛋白-1(MCP-1)、白细胞介素-6(IL-6)、诱导型一氧化氮合酶(iNOS)表达;谷胱甘肽检测试剂盒检测超氧化物岐化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性,荧光分光光度计检测活性氧(ROS);[3H]-2-脱氧-D-葡萄糖检测C2C12细胞葡萄糖摄取量.结果 棕榈酸组与对照组比较,磷酸化胰岛素受体底物-1(P-IRS-1)的表达上调[(2.9±0.3)比(1.1±0.1),P＜0.05];磷酸化胰岛素受体-β(p-IRβ)表达下调[(0.87 ±0.09)比(1.58±0.21),P＜0.05];GLUT4表达下调[(1.1±0.3)比(3.3±0.4),P＜0.05];炎症分子MCP-1、IL-6、iNOS表达明显上升:[MCP-1:(27.2±0.6)比(1.0±0.1),P＜0.001;IL-6:(94.9 ±6.5)比(0.8±0.0),P＜0.001;iNOS:(288.0±15.6)比(1.8±0.6),P＜0.001].C2C12细胞氧化应激标志物ROS升高2.1倍(P＜0.05),SOD、GSH-Px活性分别下降63％及49％(P＜0.05);DHA组与棕榈酸组比较,p-IRS-1的表达下调[(1.3±0.2)比(2.9±0.3),P＜0.05],p-IRβ表达上调[(1.3±0.2)比(0.9±0.1),P＜0.05],GLUT4表达明显升高[(2.8±0.4)比(1.1±0.3),P ＜0.05];炎症分子MCP-1、IL-6、iNOS表达均明显下调[MCP-1:(18.5±0.3)比(27.2 ±0.6),P＜0.001;IL-6:(1.7±0.4)比(94.9±6.5),P＜0.001;iNOS:(5.0±0.9)比(288.0 ±15.6),P＜0.001],氧化应激标志物ROS下降55％(P＜0.05),SOD、GSH-Px活性升高72％及64％ (P ＜0.05).结论 DHA通过激活C2C12细胞的胰岛素信号通路,减少细胞的炎症反应及氧化应激而改善胰岛素抵抗.     

呼吸内科不同区域下呼吸道感染耐药菌分布及耐药特征比较分析

目的：探索昆明医科大学第一附属医院呼吸内科不同区域[门诊、病房,呼吸重症监护病房（RIC U ）]下呼吸道感染耐药菌株的分布构成及耐药特征,为临床抗菌药物的合理应用提供依据。方法采用K‐B纸片扩散法和仪器法（VITEK‐TWO）,按照美国临床与实验室标准化研究所（CLSI）2010年版标准判读结果,对昆明医科大学第一附属医院呼吸科门诊、病房、RICU患者送检的痰液、肺泡灌洗液标本通过细菌培养鉴定及药敏试验分离出的480株耐药菌株,用WHONET5．6软件对检测数据进行分析。结果该医院呼吸门诊、病房、RICU下呼吸道感染耐药菌分布构成前4位均以革兰阴性菌为主。肺炎克雷伯菌对多数抗菌药物的耐药率大于30％,对庆大霉素、左氧氟沙星、氨苄青霉素的耐药率大于50％,RIC U与呼吸科门诊和病房相比差异有统计学意义（ P＜0．05）。亚胺培南、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、阿米卡星抗菌活性较强,其耐药率小于20％。大肠埃希菌对11种常用抗菌药物在呼吸科门诊、病房与RICU的耐药率相似。产超广谱β‐内酰胺酶（ESBLs）菌株的多重耐药率明显高于非产ESBLs菌株（P＜0．05）,产ESBLs菌株对亚胺培南耐药率小于10％。铜绿假单胞菌对头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、头孢吡肟、喹诺酮类、氨基糖甙类在呼吸科门诊和病房仍保持较高的抗菌活性,但RIIU的耐药率大于54％（ P＜0．05）。鲍曼不动杆菌对亚胺培南的耐药率在RIC U和病房明显高于呼吸科门诊,分别为70．4％、64．6％和46．2％。RIC U检出的耐甲氧西林金黄色葡萄球菌（MRSA）对利福平耐药率明显高于呼吸科门诊和病房（P＜0．05）。结论呼吸科门诊、病房和RICU的耐药菌分布构成及耐药率均有明显差异,临床医师除了熟悉本地区耐药菌分布及耐药率监测情况外,还应掌握本单位各科室不同区域耐药菌的耐药率情况,才能正确有效合理应用抗菌药物。     

血清LP-PLA2、S100B、炎性蛋白与ICU老年骨科术后患者谵妄发生及预后的关系分析

目的探究血清脂蛋白相关磷脂酶A2（LP-PLA2）、S100B蛋白（S100B）、C反应蛋白（CRP）与重症加强护理病房（ICU）老年骨科患者术后谵妄（POD）发生及预后的关系。方法选取ICU老年骨科手术患者97例作为研究对象,根据术后48 h是否发生谵妄分为POD患者24例（观察组）,术后未发生谵妄患者73例（对照组）。比较两组血清LP-PLA2、S100B、CRP水平,采用接收者操作特征（ROC）曲线及ROC曲线下面积（AUC）分析血清LP-PLA2、S100B、CRP预测POD发生的截断值、敏感度、特异度,比较观察组治疗前后血清LP-PLA2、S100B、CRP水平及不同血清水平患者临床疗效总评量表（CGI-SI）、谵妄严重程度（DRS）评分,采用Pearson分析血清LP-PLA2、S100B、CRP与CGI-SI、DRS评分的关系。结果观察组出术后恢复室前、术后24 h血清LP-PLA2、S100B、CRP水平高于对照组（P<0.05）;预测POD发生的AUC：术后24 h CRP＞术后24 h LP-PLA2＞出术后恢复室前CRP＞术后24 h S100B＞出术后恢复室前LP-PLA2＞出术后恢复室前S100B（P<0.05）;术后24 h LP-PLA2、S100B、CRP联合预测POD的AUC大于任何单一指标（P<0.05）;观察组治疗后血清LP-PLA2、S100B、CRP水平低于治疗前（P<0.05）;血清LP-PLA2、S100B、CRP高表达者CGI-SI、DRS评分高于低表达者（P<0.05）;血清LP-PLA2、S100B、CRP与CGI-SI、DRS评分呈正相关（P<0.05）。结论ICU老年骨科术后POD患者血清LP-PLA2、S100B、CRP呈高表达,可预测POD的发生风险,并与患者病情、预后有关。     

经皮穿刺联合内镜下胃造瘘术的临床应用

目的探讨经皮穿刺内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)的临床应用价值。方法 2003年5月～2010年5月,因各种原因造成的经口进食困难引起营养不良需长期营养支持的患者66例,在本院内镜中心行PEG,术后给予肠内营养。结果所有患者成功完成内镜下胃造瘘术,平均耗时20min。术后跟踪随访,所有患者造瘘管置入后营养迅速恢复,停止静脉补液。造瘘管最长留置时间2年。5例患者发生造瘘管周围皮肤感染,6例出现反流性食管炎,2例发生造瘘管旁渗血,对症处理后治愈。无消化道出血、腹膜炎等严重并发症。结论 PEG是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法 ,其技术操作简单易行、安全、有效并发症少,创伤小,值得临床推广应用。     

微波辐射对雷达操作人员精子头部及尾部超微结构的影响

目的 研究微波辐射对精子超微结构的影响.方法 利用透射电镜对10例从事微波辐射工作2年以上男性新鲜精液样本中的精子头部及尾部超微结构进行观察.结果 在电镜下微波辐射后男性精子存在多种形态超微结构异常,有以下几种类型:(1)头部异常精子,包括尖头精子、头部含空泡精子.(2)顶体异常精子,包括顶体发育不良、缺失,顶体内形成包涵体精子.(3)尾部异常精子包括尾部形态异常精子(无尾精子、短尾精子)和尾部结构异常精子(线粒体缺失精子、尾部线粒体多种形态和结构异常).结论 微波辐射可导致男性精子项体、头部、尾部线粒体结构异常.