WONCA Online电子病例介绍——甲状腺舌管囊肿

·病例简介:患者,男,58岁。因颈前方无痛、巨大肿物就诊。自诉肿物出现之前有咽痛、发热等症状,肿物在3d内逐渐增大。无吞咽困难、声音嘶哑等症状,否认颈部、咽、食管创伤,无咳嗽、体重减轻等。既往有高血压、2型糖尿病、高脂血症史,无吸烟、嗜酒史。·体格检查:一般情况可,发育正常,营养中等。发音正常,咽部无创伤及肿物。颈前方有一2cm×3cm肿物,表面光滑、质软,呈卵圆形,由舌骨达环状软骨水平。吞咽或伸舌时肿物上升。·实验室检查:喉镜检查:鼻咽部正常,气道通畅,无肿块或外压性改变,声带正常。CT检查发现甲状腺部位分叶状囊肿,从前后伸…     

Cellular and sub-cellular localisation of GABA(B1) and GABA(B2) receptor proteins in the rat cerebellum

Following the recent discovery that GABA(B) receptors expressed in cell lines are only functional when both GABA(B1) and GABA(B2) are expressed, the present study reports on the development of polyclonal antisera specific for carboxyl-terminal portions of the two related GABA(B) receptor components respectively. Western blotting indicated the specificity of affinity-purified antibodies for native or recombinant expressed GABA(BR1) and GABA(BR2), with no cross-reactivity, both antisera detecting the heterodimer in rat cerebellar membranes. Immunohistochemistry revealed a distinct distribution of both receptor proteins in rat cerebellum. GABA(B1) immunoreactivity was primarily located in the granule cell layer and Purkinje cells, with discrete immuno-positive cell bodies being present in the molecular layer. GABA(B2) staining revealed intense immunoreactivity in the molecular layer, with weaker staining in the granule cell layer. Purkinje cell bodies were less intensely immuno-positive for GABA(B2). Co-localisation of both receptor proteins was observed using double immunofluorescence techniques, consistent with the notion that both proteins are required for the formation of functional GABA(B) receptors in vivo. Immunofluorescence also indicated that GABA(B) receptors did not co-localise with glial fibrillary acid protein, confirming a neuronal localisation for GABA(B) receptors. Electron microscopic analysis of the molecular layer revealed that the distribution of immunolabelling for both GABA(B1) and GABA(B2) was mainly located on the membrane of Purkinje cell dendrites and spines and in parallel fibre terminals.     

解放军医学图书馆典阅环境改善的回顾与展望

对解放军医学图书馆建馆10余年典阅环境改善状况进行了回顾，并对建设多功能、高品位、人文化的图书馆内部环境的实践进行了总结和展望。     

Successful treatment of corrosive esophageal strictures after failed esophageal reconstructions with colon and jejunum

Dense and extensive esophageal strictures after caustic agent ingestion require surgical treatment. Colon, stomach and jejunum can be used to reconstruct esophagus. Here, we report an unusual patient with corrosive esophageal stricture who had received unsuccessful esophageal replacements twice at other hospitals. Colon interposition had been first performed 6 months after corrosive esophageal burn, but the colon graft necrosis occurred. Esophageal reconstruction had been carried out 10 years later in another hospital. However, the graft necrosis developed again 5 months later. A salvage operation was performed to remove the necrotic transplant in our hospital. Then as much food as possible had been given to expand the stomach through the gastrostomy since the procedure. The patient underwent esophagecto-my and concomitant gastroesophagostomy in the neck 1. 5 years later. Esophageal dilations had been performed to prevent recurrent anastomotic stricture for 1 year. He has eaten a normal diet since being discharged.     

尿毒症患者甲状旁腺素水平与营养关系的探讨

目的探讨尿毒症患者甲状旁腺素与营养状况的关系,为延缓慢性肾功能不全进展而改善患者营养状况提供临床依据。方法测定患者血清甲状旁腺素(PTH)、ALB、Hb;使用改良定量主观评估表 MQSGA 评估患者营养状况。结果 PTH 与 MQSGA、ALB,存在相关关系(P<0.05),与 Hb 存在显著相关关系( P<0.001);PTH 与 MQSGA、Hb 之间 Logistic 回归分析(P<0.05)。结论 PTH 是影响尿毒症患者营养状况的重要尿毒素。清除血清 PTH 能改善患者营养状况。     

输血传播病毒样微小病毒基因检测

目的：测定慢性肝炎患者体内输血传播病毒(TTV)样微小病毒（TLMV）的全基因序列，并研究人群中TLMV感染状况。方法：采用日本学者Shunji Mishiro提供的序列选择TLMV-CBD279和CBD-231最保守区设计引物，用慢性乙型肝炎且TTV阳性患者血清制备DNA模板，进行PCR扩增；将阳性PCR产物连接至pGEMR-T质粒，碱裂解法提取质粒DNA并纯化。以T7 引物为起 始全自动荧光测序仪测序。结果：获得162bp基因序列，该序列与日本株CBD231、CBD279同源性为72%，丙型肝炎患者及健康献血员感染率最高。结论：在＊慢性乙型肝炎患者体内存在TLMV感染。     

未成熟卵母细胞评分系统对人类未成熟卵体外成熟及发育潜能的评价

目的:建立未成熟卵母细胞评分系统,并评价其对人类未成熟卵体外成熟及发育潜能的预测作用。方法:将未成熟卵母细胞取出体外,根据卵母细胞形态及其周围颗粒细胞形态、分布进行评分,然后分别进行成熟培养和体外受精,再将卵母细胞评分与其成熟率、受精率、优质胚胎率,以及相应卵母细胞的颗粒细胞凋亡情况进行比较。结果:随着卵母细胞评分的降低,卵子的成熟率、受精率、卵裂率及优质胚胎率均下降,而颗粒细胞的凋亡率升高。结论:本研究所设计的未成熟卵母细胞评分系统能够较准确地反映卵母细胞的发育潜能,具有一定的应用价值。     

婴幼儿哮喘的危险因素

目的寻找婴幼儿喘息、儿童哮喘的危险及保护因素。方法1个月~3岁肺炎患儿82例、毛细支气管炎65例、婴幼儿哮喘76例,107例正常儿童作为对照。采用向家长书面问卷调查方法询问各组婴儿既往病史、家族及个人过敏史、怀孕出生及婴幼儿喂养情况、生活条件等。结果父母任何一方有喘息史、父母任何一方有其他过敏史、父母任何一方吸烟、湿疹等个人过敏史任何一种、父(母)亲有哮喘史及过敏史、兄弟姐妹有哮喘史及过敏史、个人有过敏性鼻炎、个人有药物过敏、母妊娠期间早孕反应重、母亲是素食者、母亲文化程度低是婴幼儿哮喘的危险因素;而自然分娩、婴幼儿期补充VitD和钙剂、生后冬季户外活动时间长、每天平均睡眠时间长、住所有上下水设备是婴幼儿哮喘的保护因素。结论个人过敏史和家族过敏史为婴幼儿哮喘的主要危险因素。     

Validity of a computer-assisted neurobehavioral test battery in toxicant encephalopathy

The computer-assisted Neurobehavioral Evaluation System 2 (NES2) test battery provides an efficient method of measuring neurobehavioral effects in epidemiological studies, and a newer computer-assisted battery, NES3, has been developed to assist in neuropsychological assessment. This study assesses the validity of some NES2 and NES3 tests in patients diagnosed with toxicant encephalopathy (TE) following exposure to lead or to mixed solvents. This information can be used to improve the interpretation of NES test results in research studies and clinical evaluations examining central nervous system function. Performance on a battery of computer-assisted tests, consisting of several NES2 and NES3 tasks, by persons diagnosed with TE was compared to that of control subjects to determine if performance differences reflected a priori hypothesized brain-behavior relationships. Performance on the NES2 and NES3 tests was also correlated with performance on analogous standard neuropsychological tests. Significant performance differences between the patient cases and controls were observed in most of the predicted domains on the NES tests. Overall, moderate correlations were obtained between standard neuropsychological tests and NES2 and NES3 tests from the same functional domains. The results suggest that a test battery composed of NES2 and NES3 tests can identify clinically significant performance deficits in solvent-exposed patients who have been diagnosed with TE using traditional clinical neuropsychological test methods. The results with lead-exposed TE patients are less robust. Possible explanations for these differences are discussed.     

肾综合征出血热血清TNF-α、E-选择素、L-选择素、ICAM-1、TGF-β1的变化及其意义

目的:阐明TNF-α、可溶性E-选择素、L-选择素、ICAM-1、TGF-β1在肾综合征出血热(HFRS)发病机制中的作用。方法:34例HFRS患者(轻症组19例,重症组15例)按病期采血,分别用放射免疫法和ELISA检测TNFα、E-选择素、L-选择素、I-CAM-1和TGF-β1,并同期作肾功能和血常规检查。结果:从发热期至多尿期,血清TNF-α、E-选择素、L-选择素和ICAM-1水平均显著增高,而TGF-β1显著降低,TNF-α与BUN呈一致性变化趋势,而与血小板的变化趋势相反。结论:TNF-α、E-选择素、L-选择素、ICAM-1等细胞因子在肾综合征出血热发病机制中起重要作用,而TGF-β1水平下降可能是造成失控性全身炎症反应和多器官功能障碍综合征的重要因素之一;合理的对症治疗和适量使用免疫调节剂可望改善本病的预后。