原发性输尿管癌31例临床分析

目的：提高原发性输尿管癌的术前诊断水平。方法：对南京医科大学第一附属医院1989-2002年间收治的31例原发性输尿管癌的临床资料进行回顾性分析。结果：31例中，肉眼血尿22例(71．0％)，腰痛11例(35，5％)。B超、静脉肾盂造影(IVU)、CT和逆行造影检查的阳性率分别为输尿管腔内占位4例(13．0％)、输尿管腔内占位3例(11．5％)、膀胱或合并膀胱占位8例(36．4％)，输尿管充盈缺损6例(40．0％)。29例患者经手术治疗，其中13例行患侧肾、输尿管、膀胱袖状切除。结论：老年患者反复发作的腰痛及血尿应考虑原发性输尿管癌的可能，造影诊断对本病有较高价值，应作CT及MRU无创检查。     

中西医结合治疗小儿支原体肺炎临床观察

小儿支原体肺炎是由支原体感染引起的呼吸道疾病。近年来支原体肺炎有逐渐增加的趋势，西医采用大环内酯类抗生素治疗，其疗程较长，且近期有一定的复发率。单纯中药治疗是难以控制的，笔者采用中西医结合治疗取得满意疗效，现总结如下。     

Phenotypic and genetic analyses of T-cell-mediated immunoregulation in patients with Type 1 diabetes.

AIMS: To investigate the contribution of regulatory T cells and co-stimulatory molecules in CD4(+) T cells to the development of Type 1 diabetes (T1D). METHODS: Twelve patients with T1D, nine patients with systemic lupus erythematosus (SLE), and 12 age-matched healthy control subjects participated. We analysed the proportions of CD25(+)CD4(+) T cells and natural killer T cells (NKT cells), and the expression levels of Foxp3, CTLA-4, CD28, ICOS, PD-1 and BTLA in peripheral blood mononuclear cells and purified CD4(+) T cells. RESULTS: There were no significant differences in the proportions of CD25(+) CD4(+) T cells or NKT cells among the three groups. PD-1 expression levels of peripheral CD4(+) T cells from T1D patients were significantly lower than those from healthy control subjects (P = 0.00066). In contrast, PD-1 expression levels were similar in SLE patients and healthy control subjects. The expression levels of Foxp3, CTLA-4, CD28, ICOS and BTLA were similar in the three groups. CONCLUSIONS: Decreased expression of the PD-1 gene in CD4(+) T cells may contribute to the development and/or maintenance of autoimmune T1D. As the population studied was small and heterogeneous, further studies are required to confirm the findings.     

Toluene vapor exposure and urinary excretion of hippuric acid among workers in China.

A factory survey was conducted in three provinces in China from 1985 to 1989. The time-weighted average toluene concentrations in breathing zone air were monitored by diffusive sampling, whereas hippuric acid (HA) concentrations in shift-end urine samples were measured by high performance liquid chromatography (HPLC). Exposed workers (456 men and women) were those for whom toluene (up to 548 ppm toluene) accounted for greater than or equal to 90% of total exposure (by vapor concentration in ppm), whereas 517 nonexposed controls were recruited from the same factories or from factories of the same region. There was a linear correlation between the intensity of toluene exposure and HA concentration in the shift-end urine. Comparison of the results with findings in the literature shows that the toluene-induced increase in urinary HA concentration among workers in China is significantly smaller than the published values, whereas HA concentrations in urine samples from nonexposed controls are comparable to the levels previously reported.     

胰岛素样生长因子-Ⅰ对软骨细胞凋亡的抑制

目的:探讨胰岛素样生长因子-Ⅰ(IGF-Ⅰ)对软骨细胞增殖及白细胞介素-1(IL-1)诱导软骨细胞凋亡的影响,揭示其抗损伤作用机制,为关节软骨损伤治疗提供理论依据。方法:分离培养人胚胎关节软骨细胞,采用四氮甲基唑蓝(MTT)法测定不同含量软骨细胞增殖活性的变化,利用光镜、电镜、DNA电泳及流式细胞仪测定作为凋亡检测指标。结果:IGF-Ⅰ呈剂量依赖式促软骨细胞增殖,当IGF-Ⅰ含量达50μg/L时,促软骨细胞增殖作用达最大值。IL-1组光镜、电镜下可见典型的细胞凋亡形态学改变,琼脂糖凝胶电泳示特征性的DNA梯状条带,IGF-Ⅰ处理组未见明显凋亡征象。流式细胞仪检测发现,IGF-Ⅰ处理后软骨细胞凋亡率显著降低。结论:IGF-Ⅰ能促进软骨细胞增殖,对IL-1诱导的软骨细胞凋亡具有保护作用。     

路志正教授"知常达变"辨治妇科病经验撷萃

路志正教授从事中医临床多年,不仅对内科杂病有丰富的临床经验,对妇科疾病的诊疗,亦很有特色。笔者于2003年有幸侍诊左右,耳濡目染,略有所得,不揣浅陋,举述验案二则。健脾祛湿行水治疗闭经、不孕患者某,女,32岁,已婚,2003年10月9日初诊。主诉:月经稀少10余年,闭经2年。患者15岁     

常温与低温体外循环心脏直视手术对细胞因子及补体的影响

目的探讨常温及低温体外循环心脏直视手术对细胞因子及补体的影响。方法选择先天性和风湿性心脏病患者40例,随机分为常温组及低温组各20例,分别于术晨、体外循环结束时及术后1、4、7、14 d抽取患者静脉血标本,测定血浆TNF、IL-2、C3、C4值。结果两组术前各项检查指标无显著差异。(1)两组术后1~4 d的IL-2水平较术前显著下降,至术后7 d恢复正常。体外循环结束至术后4 d,低温组IL-2显著低于常温组。(2)体外循环结束时以及术后1、4、7 d,常温组TNF水平显著低于低温组。两组体外循环结束时及术后1、4 d均高于术前,常温组至术后7 d、低温组术后14 d恢复正常。(3)体外循环结束时及术后1、7 d,常温组C3水平高于低温组,术后4 d两组无差别;常温组及低温组于体外循环结束时、术后1、4 d均低于术前,至术后7 d常温组恢复正常,低温组至术后14 d恢复至术前水平。(4)两组体外循环结束时及术后1、4 d C4水平均低于术前。体外循环结束时、术后1 d,常温组C4水平高于低温组。结论常温体外循环心脏直视手术对细胞因子及补体的影响显著轻于低温组,因而对术后机体的恢复优于低温方法。     

骨髓转移癌的骨髓象诊断及临床分析

目的 探讨临床表现及骨髓象改变在骨髓转移癌患者诊断中的意义。方法 对41例骨髓转移癌患者的临床资料及骨髓象进行分析，观察主要临床改变。结果 所有病例均在髓片可找到多少不等的成团、成簇的转移癌细胞，且形态学可见明显异常改变。结论 对明确诊断为恶性肿瘤的患者常规骨髓穿刺涂片可早期发现骨髓转移，多部位或多次穿刺涂片可提高阳性发现率。     

高血胆固醇症病人体内铁贮水平与心肌灌注 左心室功能的相关研究

目的评价血清铁参数与高血胆固醇症(HCL)病人心肌灌注、室壁运动异常及血管造影显示的冠状动脉疾病(CAD)程度的相互关系.方法选择38名具有高血胆固醇症(LDL-C＞3.38mmol/L)从未治疗过的男性病人(平均年龄59±6岁)作为HCL组和32名年龄匹配而胆固醇水平正常(NCL)的男性为NCL组,进行冠状动脉造影并在10d内行SPECT检查,应用99mTc-甲氧基异丙基异氰(MIBI)进行静息/负荷门控断层心肌灌注显像、室壁运动功能图像分析;同时测定血清铁参数、血脂及常规血液学参数.结果在HCL组发现血清铁蛋白(SF)与心肌灌注系数(r=0.70,P＜0.01),可逆系数(r=0.66,P＜0.01)和室壁运动系数(r=0.53,P＜0.05)之间呈显著性相关;而总铁结合力与灌注系数之间呈一弱(负)相关(r=-0.52,P＜0.05).在NCL组铁参数与灌注系数及室壁运动系数之间无显著性相关.多元回归分析证实血清铁蛋白水平是决定HCL病人中心肌灌注的独立因素(β=0.55,P＞0.05).铁参数与两组通过冠状动脉造影(CAG)进行评分所定义的CAD程度无关.结论体内铁贮水平升高与HCL病人心肌灌注和功能异常的严重性和程度有着密切的关系,但与CAD的造影显示的病变范围无关.血清铁蛋白水平增高,可增加铁介导的氧化应力和LDL过氧化作用,导致HCL相关的血管内皮功能紊乱并进一步损伤心肌灌注和室壁运动功能.