糖尿病肾病59例临床分析

本文报告糖尿病367例中并发糖尿病肾病59例占16.1％,近十年来,糖尿病人有增多趋势,糖尿病肾病发生率也显著增加,1966～1976年糖尿病住院治疗的才100例,糖尿病肾病发生率为5％,而1977～1986年有267例,糖尿病肾病发生率为20.2％。经用胰岛素等治疗后好转22例,死亡12例,病死亡率为20.3％,糖尿病肾病除严格控制血糖水平外、无特效疗法。出现持续性旦白尿,病情已到中期或晚期,如何早期诊断是我们今后研究的重要课题。     

Alterations of G-protein Coupling Function in Phosphoinositide Signalling Pathways of Rat Hippocampus by Ischaemic Brain Injury

The activation of membrane-associated phospholipase C is rapidly and transiently induced in the central nervous system by a variety of stimuli. Ischaemic brain injury is one of the situations that leads to a dramatic increase in polyphosphoinositide (PPI) turnover. In this study, stimulation of PPI hydrolysis by glutamate (500 μM) was measured in hippocampal slices from rats up to 21 days after an ischaemic insult of 30 min. Ischaemia was induced using the four-vessel occlusion method. PPI hydrolysis elicited by glutamate was significantly increased in the slices prepared from ischaemic rats 24 h after reperfusion, the accumulation of inositol phosphates (InsP_s) and inositol 1,4,5-trisphosphate (InsP₃) was 614±74% ( n = 8) and 182±11% ( n = 9) of the basal level respectively. This potentiation was also observed 21 days after ischaemia. Hyper-responsiveness to glutamate was also accompanied by an increase in AIF⁻₄-stimulated formation of [³H]inositol phosphates. In addition, global ischaemia did not change either high-affinity [³H]glutamate binding in hippocampal membranes or the stimulation of PPI hydrolysis by carbachol or noradrenaline in hippocampal slices. The present results suggest that the increased responsiveness to glutamate is the result, at least in part, of functional changes at the G-protein level, and may contribute to the pathophysiology of ischaemic brain injury or to the regenerative phenomena that accompany ischaemic damage.     

Analysis of Implantation in Assisted Reproduction Through the Use of Serial Human Chorionic Gonadotropin Measurements

Purpose: Our purpose was to examine implantation of singleton pregnancies achieved following various assisted reproductive technologies (ARTs) through the appearance and rising titers of serum human chorionic gonadotropin (hCG) levels. Methods: A total of 114 singleton pregnancies resulting from in vitro fertilization and intrauterine insemination was analyzed. Patients were divided into five groups according to the type of ovarian stimulation protocol [gonadotropin stimulation with/without the use of gonadotropin-releasing hormone agonist (GnRHa), long protocol, or flare-up technique] and to the day of embryo transfer (day 2 or day 3 after oocyte retrieval). Serial serum hCG levels were measured between 10 and 25 days after fertilization and log-transformed. Linear regression analyses were performed and extrapolated to hCG = 10 mIU/ml (hCG ₁₀ ), which was used as an estimate of detectable implantation. The slopes of the regression lines were used to estimate the rising speed of hCG. Results: There were no significant differences in the days of hCG in maternal serum to reach 10 mIU/ml (implantation) or in the slopes of the regression lines for all five studied groups. Conclusions: The appearance of hCG in maternal serum was used to assess the time of clinically detectable implantation. Furthermore, because hCG production is a marker of trophoblastic activity, its serum doubling time was used as an indicator of embryo quality. Results showed that in various ART protocols with and without GnRHa, there were no significant differences in implantation time or embryo quality. Embryo development in early pregnancy follows a preprogrammed-timing schedule and depends mainly on the embryonic age of the health, successfully implanted conceptus.     

阿魏酸在血瘀证兔体内的药代动力学

为验证及研究症治药动学假说（ｓｙｎｄｒｏｍｅａｎｄＴｒｅａｔｍｅｎｔＰｈａｒｍａｃｏｋｉｎｅｔｉｃｓ，Ｓ＆ＴＰＫ）的客观性和基本规律，本文以ＲＰ－ＨＰＬＣ法同时测定了活血祛瘀药物阿魏酸在正常及高分子右旋糖酐所制血瘀症（微循环障碍）兔体内经时浓度，以ＭＣＰＫＰ药动学程序在ＣＯＭＰＡＱ８０３８６机上自动拟合了药动学参数。统计结果表明，与正常组相比，阿魏酸在血瘀症兔体内的分布容积（Ｖ＿１和Ｖ＿Ｂ）及消除速率（ＣＬＢ）显著减小（Ｐ＜０．０５），半衰期（ｔ＿（１／２β）及相同时间段曲线下面积（ＡＵＱ）非常显著增加（Ｐ＜０．０１）。结论：实验结果基本符合Ｓ＆ＴＰＫ的观点：即同一药物在不同证兔体内的药代动力学参数经统计学处理有显著差异。     

孤立性左肝胆管结石并肝管狭窄的外科治疗

目的总结近２０年来孤立性左肝胆管结石并发左肝胆管狭窄的临床治疗体会．方法原发性肝胆管结石１０１８例，年龄２７～７２岁，其中孤立性左肝胆管结石１３３例，手术治疗１１２例，对其临床资料进行回顾性分析，包括各肝管狭窄并发率，术前各项检查确诊率，手术治疗方式，再狭窄率．结果左肝管狭窄的发生率为５９８％，左外肝管和左内肝管分别为８４０％和８４８％，均以重度狭窄为主．狭窄切开整形后高位胆肠吻合术是处理左肝管狭窄的常用手术方式（５２２％），远期再狭窄率为１７１％；左半肝切除术施实率为１９４％，再狭窄率为００％；狭窄整形术和狭窄扩张术的施实率分别为９０％和１９４％，再狭窄率分别为５００％和９２３％．左外肝管狭窄通常采用肝段或肝叶切除术（７８７％），而左内肝管狭窄的处理则通常采用非左半肝切除术（８４８％）．左内肝管狭窄的术前／后影像学确诊率明显低于左肝管和左外肝管，平均确诊率依次２５９％，９３３％和８７９％．结论二级肝管狭窄是孤立性左肝管结石的常见并发症，肝叶或肝段切除术是其首选治疗原则．过多依赖非肝叶／段切除术和不适当的肝段切除术是遗留狭窄和远期疗效差的重要原因     

生长激素在肝硬变门脉高压低蛋白血症手术前的应用研究

目的：研究生长激素（rhGH)对肝硬变门脉高压低蛋白血症患者手术前的治疗价值。方法：肝硬变门脉高压抑行脾切除、门奇静脉断流手术患者60例，Child分级B级，随机分为rhGH治疗组30例，对照组30例。rhGH组术前5d每天皮下注射rhGH 4IU，对照组给予安慰剂生理盐水。两组术前均行相同肠外营养支持。测定治疗前、治疗后3d、4d、5d血浆白蛋白、球蛋白、前白蛋白及空腹血糖。结果：rhGH组治疗后3d前白蛋白较治疗前及对照组明显升高（P＜0．05），治疗后4d、5d仍维持较高水平；治疗后5d白蛋白较治疗前及对照组明显升高（P＜0．05）。rhGH组患者一般情况改善，生活质量提高。对照组白蛋白、前白蛋白无明显变化。两组空腹血糖、球蛋白无明显改变。结论：rhGH联合肠外营养支持对纪正肝硬变门脉高压低蛋白血症患者术前低蛋白状态，改善生活质量有良好疗效，由于rhGH起效慢，应早期、足量、足疗程应用。     

广东省SARS家庭聚集性病例流行病学分析

目的　了解广东省传染性非典型肺炎 (SARS)家庭聚集性病例的流行病学特征 ,探讨家庭因素在本病传播方面的作用。方法　采用统一个案调查表 ,用描述性流行病学方法对广东省SARS家庭聚集性病例进行分析。结果　截至 5月 1 5日止 ,在广东省 1 5 1 2例SARS病例中 ,6 0户家庭出现聚集性病例 ,共 1 91例 ,占全省病例总数的1 2 6 %。家庭聚集性病例的病死率为 9 9% ,高于全省平均病死率 (3 7% ) (P <0 0 1 )。家庭聚集性病例主要发生在2 0 0 3年 1月至 3月 ,占家庭聚集性病例总数的 90 6 % (1 73/ 1 91 )。病例以 30～ 4 9岁青壮年为主 ,占 5 2 9% (1 0 1 / 1 91 ) ;职业以干部职员为主 ,占 1 3 6 % (2 6 / 1 91 ) ,其次为饮食、服务人员 ,占 1 2 6 % (2 4 / 1 91 )。 4 1 7%家庭的首发病例在发病前两周有明确或可疑接触史。在 1 2 9例家庭聚集二代感染病例中可能因陪护或探病感染发病的有 4 2户 ,共 92例 ,占71 3%。首发病例与二代病例发病时间间隔中位数为 7d。结论　家庭聚集性病例的病死率较高 ,家庭聚集性病例有较大比例可能在医院内感染 ,但家庭密切接触也是造成疫情传播的原因之一 ,控制医院内感染和及早对病例进行家庭隔离可以减少聚集性病例的出现     

原发性膀胱腺癌临床病理分析

对６例原发性膀胱腺癌进行临床病理分析，患者年龄４０～７６岁，男４例，女２例。术前病程多为２个月，以血尿症状为主。６例均经病理检查证实，其中４例加做ＰＡＳ染色，证实有ＰＡＳ阳性物质，免疫组化标记ＣＥＡ４例，有３例呈阳性结果。本组随访结果５例死亡，存活时间９～４３月，１例尚存活１３月。结合文献着重讨论了影响膀胱腺癌预后诸因素。     

袍甲螨属在我国首次发现及一新种记述（蜱螨亚纲：袍甲螨科）

本文记述了新种三歧袍甲螨Ｅｒｅｍａｅｏｚｅｔｅｓｔｒｉｆｕｒｃｕｓｓｐ．ｎｏｖ，模式标本采自广东省珠海海滨土壤中，保存于白求恩医科大学生物学教研室。     

美宝湿润烧伤膏在治疗慢性泪囊炎的应用

目的：观察美宝湿润烧伤膏(MEBO)在治疗慢性泪囊炎的应用价值。方法：对87例102只慢性泪囊炎采用泪道探通手术与MEBO置留治疗。常规泪点表面麻醉，扩张泪点，用生理盐水或氯霉素眼水冲洗鼻泪管、泪囊、泪小管，再用无菌注射器装入5ml MEBO，用5号自制泪道冲洗针沿泪道方向插入，直达泪囊推药，使鼻泪管、泪囊、泪小管内充满MEBO，一周后继续上述方法治疗，一般连续治疗2—5次。结果：治疗总有效率为100％，随访6个月，无一例复发。结论：在泪道探通手术后随即留置MEBO治疗慢性泪囊炎，临床效果良好，操作简单方便，经济有效，值得临床推广应用。