随意型髂骨皮瓣及其临床应用

目的:探讨创伤所致的前臂骨折感染合并骨与皮肤缺损的一种新的治疗方法。方法:先行全身及局部治疗,纠正贫血及低蛋白血症,选用有效抗生素控制急性炎症后,手术清除病灶,在同侧第12肋下方设计并切取蒂在第12肋下方的随意型髂骨皮瓣交叉移植于前臂受区,修复骨与皮肤缺损。结果:手术均获成功,皮瓣全部一期成活,感染均在术后一个月内随着皮瓣与受区皮肤愈合而治愈。骨折全部愈合,愈合时间45~120d,平均96d。结论:本方法简单实用,疗效可靠,不需特殊器械设备与技术,易于掌握应用。     

乔本氏病针吸细胞学免疫表型观察研究

目的 探讨乔本氏病针吸甲状腺内浸润淋巴细胞免疫表型活性及临床意义。方法利用流式细胞仪检验技术测定甲状腺内浸润淋巴细胞CD3、CD4、CD8、CD4／CD8、CD7、CD19、NK、CD44、CD95／Fas、Bcl-2免疫活性，同时利用放免检验技术，测定T3、FT3、T4、FT4、7T3、TSH、TGA、MCA8项指标。结果表明乔本氏病甲状腺内浸润淋巴细胞大部分为T淋巴细胞，少数为B淋巴细胞，并且CD3＋、CD7＋T淋巴细胞比值最高，CD4＋T淋巴细胞次之，但均明显高于CD8＋T淋巴细胞，CD4／CD8比值与正常外周血相似，CD19＋B淋巴细胞及NK细胞比正常外周血B淋巴细胞不同程度减低，诱导细胞凋亡基因CD95／Fas表达明显增高，而抑制凋亡基因Bcl-2减低最明显，CD44正常，显示该病良性免疫反应紊乱疾病。8项放免指标T3、FT3、T4、FT4、γT3各项指标仅有20％～22％增高，69％～79％均呈正常，2％-7％减低，TSH增高有20％，TGA、MCA增高有79．5％-79．9％，20．1％～20．5％在正常范围内。结论乔本氏病甲状腺内浸润淋巴细胞免疫活性及分布和功能异常，更有助于进一步探讨了解乔本氏病发病机制，为自身免疫性甲状腺疾病诊断、预防、治疗及预后观察提供理论依据，并认为小针头甲状腺疾病诊断最权威性诊断和鉴别诊断指标。     

黄连温胆汤对痰热瘀阻型原发性微血管心绞痛患者内皮功能的影响

目的：观察痰热瘀阻型原发性微血管心绞痛（PMVA）患者在使用黄连温胆汤后血浆血管性假血友病因子（vWF）及同型半胱氨酸（Hcy）水平的变化,进而探讨痰热瘀阻型PMVA的发病机理。方法：选择经检查明确诊断为痰热瘀阻型PMVA的患者,共84例,随机分为常规治疗组和联合治疗组,常规治疗组根据病情予以常规药物治疗,联合治疗组在常规药物治疗基础上加用黄连温胆汤治疗,同时选择正常体检人群43例作为正常对照组,测定所有研究对象在入选时以及PMVA患者在治疗5 d后的vWF及Hcy水平。结果：PMVA组患者vWF水平较正常对照组显著升高,差异有统计学意义（P<0.01）;PMVA组患者Hcy水平与正常对照组相当,差异无统计学意义（P>0.05）。联合治疗组和常规治疗组治疗后vWF水平均较治疗前显著下降,差异均有统计学意义（P<0.01）;治疗后,联合治疗组vWF水平低于常规治疗组,差异有统计学意义（P<0.05）;但联合治疗组vWF水平治疗前后差值11.819μg/L,常规治疗组vWF水平治疗前后差值7.407μg/L,2组治疗前后差值比较,差异无统计学意义（P>0.05...     

黄芪注射液对慢性阻塞性肺病病人血清负急性期蛋白的影响

应用黄芪注射液治疗 36例慢性阻塞性肺病 (COPD)病人 ,观察其对血清负急性期蛋白的影响。在常规治疗的基础上 ,静脉滴注黄芪注射液 2周 ,测定治疗前后血清白蛋白 (AIb)、前白蛋白 (PA)、转铁蛋白 (Tf) ,观察临床疗效 ,并与常规治疗对照组比较分析。结果显示黄芪治疗组临床改善优于对照组 (P<0 .0 5 ) ,治疗后 AIb、PA、Tf显著升高 ,而对照组变化不明显 (P>0 .0 5 )。表明黄芪注射液可增加 COPD病人血清负急性期蛋白的浓度 ,提高治疗效果。     

阿糖胞苷、阿柔比星联合粒细胞集落刺激因子治疗骨髓增生异常综合征的临床研究

目的 探讨阿糖胞苷(Ara-C)、阿柔比星(Acla)联合粒细胞集落刺激因子(G-CSF)治疗骨髓增生异常综合征(MDS)的临床疗效及安全性.方法 选择2011年1月至2013年1月,深圳市第四人民医院收治的初治MDS患者56例为研究对象.按照随机数字表法将其分为研究组(n=28)与对照组(n=28).研究组予以Ara-C、Acla联合G-CSF治疗,对照组按照标准化方案治疗.对两组的临床疗效、外周血常规结果及骨髓细胞原始比例、不良反应发生情况、巩固及维持治疗及生存情况进行统计学分析.本研究征得受试对象的知情同意,并与之签署临床研究知情同意书.两组患者的年龄、性别构成比、病程、疾病类型构成比及危险分型构成比与治疗前白细胞计数、血小板计数、血红蛋白(Hb)水平、中性粒细胞(Neut)计数及骨髓原始细胞比例等一般临床资料比较,差异均无统计学意义(P＞0.05).结果 ①研究组完全缓解(CR)率、治疗总有效率分别为50.0％(14/28)与82.1％(23/28),均显著高于对照组的32.1％(9/28)与53.6％(15/28),差异均有统计学意义(P＜0.05).②治疗后,研究组患者白细胞计数、血小板计数、Hb水平及Neut计数均显著高于对照组,骨髓原始细胞比例显著低于对照组,差异均有统计学意义(P＜0.05).治疗后,研究组组内白细胞计数、血小板计数、Hb水平及Neut计数较治疗前,均显著提高,骨髓原始细胞比例则显著下降,差异均有统计学意义(P＜0.05).治疗后,对照组组内白细胞计数与治疗前比较,差异无统计学意义(P＞0.05),而血小板计数、Hb水平及Neut计数则均较治疗前显著提高,骨髓原始细胞比例显著下降,差异均有统计学意义(P＜0.05).③研究组Ⅲ～Ⅳ级骨髓抑制、肺部感染、口腔溃疡及胃肠道等不良反应发生率均显著低于对照组,差异均有统计学意义(x2=12.847,17.044,7.212,14.684;P＜0.05).④研究组急性髓细胞白血病(AML)转化率(14.3％,4/28)显著低于对照组(25.0％,7/28),且差异有统计学意义(P＜0.05);研究组患者中位总体生存时间(22.0个月)较对照组(18.2个月)显著延长,差异有统计学意义(P＜0.05).结论 应用Ara-C、Acla联合G-CSF治疗MDS,治疗疗效显著,不良反应较少.因本研究纳入样本量较小,该方案是否为安全、可靠的治疗方案而值得临床推广应用,尚需多中心、大样本的前瞻性随机对照试验进一步研究证实.     

Clinical features and prognosis in adult-onset still's disease: a study of 104 cases

The objective of this study is to evaluate the clinical features and prognosis of adult-onset Still's disease (AOSD). One hundred and four AOSD patients who were analyzed retrospectively were enrolled in this study. Medical charts were systematically reviewed for: demographic data, clinical features, laboratory findings, treatments, and outcomes. The major clinical features were: spiking fever 100%, evanescent maculopapular rash 95%, polyarthralgia 90%, sore throat 78%, lymphadenopathy 66%, hepatosplenomegaly 57%, hydrohymenitis 30%, neutrophilia 98%, liver disfunction 62%, increased erythrocyte sedimentation rate (ESR) 96%, and hyperferritinaemia 99%. Reactive hyperplasia was shown in all patients who underwent lymph node biopsy. Ninety-five percent and 63% of the patients were treated with glucocorticoid and immune suppressant, respectively. Those with prednisone or its equivalent dosage of ≥0.8 mg/kg/d achieved quicker remission and less relapse. Persistent fever, evanescent rash, arthritis, and sore throat were the most prevalent symptoms in patients with AOSD, with laboratory findings of leukocytosis, elevated liver enzymes, elevated ESR and serum ferritin. Glucocorticoid and immune suppressive drugs are effective for AOSD; however, the relapsing rate is relatively high. High levels of white blood cells, serum ferritin and ESR, as well as glucocorticoid dosage were related to relapse.     

Direct and efficient cellular transformation of primary rat mesenchymal precursor cells by KSHV

Infections by viruses are associated with approximately 12% of human cancer. Kaposi's sarcoma-associated herpesvirus (KSHV) is causally linked to several malignancies commonly found in AIDS patients. The mechanism of KSHV-induced oncogenesis remains elusive, due in part to the lack of an adequate experimental system for cellular transformation of primary cells. Here, we report efficient infection and cellular transformation of primary rat embryonic metanephric mesenchymal precursor cells (MM cells) by KSHV. Cellular transformation occurred at as early as day 4 after infection and in nearly all infected cells. Transformed cells expressed hallmark vascular endothelial, lymphatic endothelial, and mesenchymal markers and efficiently induced tumors in nude mice. KSHV established latent infection in MM cells, and lytic induction resulted in low levels of detectable infectious virions despite robust expression of lytic genes. Most KSHV-induced tumor cells were in a latent state, although a few showed heterogeneous expression of lytic genes. This efficient system for KSHV cellular transformation of primary cells might facilitate the study of growth deregulation mechanisms resulting from KSHV infections.     

门脉高压食管静脉曲张出血介入治疗

目的评估ＥＶＳ、ＥＶＬ、组织粘合剂注射及ＴＩＰＳＳ治疗门静脉高压食管胃静脉曲张出血的优缺点。方法对７１２例食管胃静脉曲张出血病人进行了回顾分析。结果ＥＶＳ６１５例，经１８２６次治疗，急诊止血率为９６．９％，食管静脉曲张消失率为８４．６％，并发症发生率为１４．７％，肝硬化患者３４４人随访１２～１０４月，１、３、５年生存率为９１．５２％±１．３６％．７１．４２％２１．７１、４７．１３％±１．８６％。ＥＶＬ３０例，食管静脉消失率为７６．７％，复发出血１３．３％。组织粘合剂注射１２例，急诊６例全部止血。ＴＩＰＳＳ治疗先例。成功率为９０．９％食管静脉曲张消失和好转为８２．３％并发症发生率为３６％。一年内支架闭塞、狭窄、复发出血１６例（３８．０９％），随访１２～４２月，死亡１２人（２１．８％）。结论内镜下介入治疗是食管静脉曲张出血首选方法。急诊止血以ＥＶＳ和内镜下组织粘合剂注射为优，ＥＶＬ浸润性并发症低，但反复出血率较高，ＴＩＰＳＳ治疗中远期疗效不佳。     

Association of MCP-1-2518A/G polymorphism with susceptibility to autoimmune diseases: a meta-analysis

We performed a meta-analysis to estimate whether combined evidence shows the association between the MCP-1-2518A/G polymorphism and susceptibility to autoimmune diseases. Relevant articles dated to July 2014 were acquired from the PubMed, EMBASE, ISI, and CNKI databases. The number of the genotypes and/or alleles for the MCP-1-2518A/G in cases and control subjects was extracted, and statistical analysis was conducted using STATA 11.2 software. Summary odds ratios (ORs) with their 95 % confidence intervals (95 % CIs) were used to calculate the risk of autoimmune diseases with the MCP-1-2518A/G. Significant increased risk of autoimmune diseases could be found for A allele vs. G allele (OR?=?1.616, 95 % CI 1.027–2.542, P?=?0.038) and AA?+?AG vs. GG (OR?=?1.616, 95 % CI 1.027–2.542, P?=?0.038) in Asian patients with rheumatoid arthritis (RA), and for A allele vs. G allele (OR?=?1.383, 95 % CI 1.142–1.676, P?=?0.022) and AA vs. AG?+?GG (OR?=?1.575, 95 % CI 1.361–1.823, P?<?0.001) in European patients with Crohn’s disease (CD). In addition, when comparison of European patients with lupus nephritis (LN) and without LN, significant association between patients with LN and without LN also could be found for AA vs. AG?+?GG (OR?=?0.713, 95 % CI 0.545–0.933, P?=?0.014). This meta-analysis showed that the MCP-1-2518-A allele confers susceptibility to Asian patients with RA and European patients with CD.