成人腹股沟疝成因的现代认识

虽然人们对成人腹股沟疝诊治已有近500年历史,然而,有关其发生的确切原因仍未完全明了。近年来随着人们对该问题的关注,特别是利用现代技术手段进行临床和基础研究所获得结果,在一定程度上使人们对成人腹股沟疝成因有了新的了解。以下就近年来有关进展情况作一介绍,以供同道们参考。1鞘状突未闭和嵌闭机制削弱鞘状突未闭(PPV)是导致婴幼儿腹股沟疝的主要原因已为大多数人所认同,因为采用单纯疝囊高位结扎即可取得满意效果。然而PPV在成人腹股沟疝发生中的作用一直没能确定。早年有人认为PPV是成人腹股沟疝发生的主要因素,并因此判断腹股…     

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。     

四参三根二花汤治疗鼻咽癌放疗不良反应80例临床观察

放射治疗（放疗）是鼻咽癌患者首选的治疗方法。在放疗过程中，许多患者经常出现口咽部反应，如咽部充血、疼痛、白膜、口腔粘膜溃疡等不良反应，轻者影响进食，重者迫使放疗停止，直接或间接地影响患者的治疗效果和生存期。笔者在临床中自拟四参三根二花汤在鼻咽癌患者放疗中使用，进行临床观察，收到良好效果，现总结如下：     

Inhibition of inward rectifier K+ currents by angiotensin II in rat atrial myocytes: lack of effects in cells from spontaneously hypertensive rats.

We examined the effects of angiotensin II (Ang II) on inward rectifier K+ currents (IK1) in rat atrial myocytes. [125I]Ang II-binding assays revealed the presence of both Ang II type 1 (AT1) and type 2 (AT2) receptors in atrial membrane preparations. Ang II inhibited IK1 in isolated atrial myocytes with an IC50 of 46 nmol/l. This inhibition was abolished by the AT, antagonist RNH6270 but not at all by the AT2 antagonist PD123319. Treatment of cells with pertussis toxin or a synthetic decapeptide corresponding to the carboxyl-terminus of Gialpha-3 abolished the inhibition by Ang II, indicating the role of a Gi-dependent signaling pathway. Accordingly, Ang II failed to inhibit IK1 in the presence of forskolin, dibutyryl-cAMP or protein kinase A catalytic subunits. In spite of the increased binding capacities for [125I]Ang II, Ang II failed to affect IKI in cells from spontaneously hypertensive rats (SHR). AT, immunoprecipitation from atrial extracts revealed decreased amounts of Gialpha-2 and Gialpha-3 proteins associated with this receptor in SHR as compared with controls. The reduced coupling of AT, with Gialpha. proteins may underlie the unresponsiveness of atrial IK1 to Ang II in SHR cells.     

1例成人Still病的临床观察与护理

成人Still病(AOSD)又称变应性亚败血症,病因及发病机制不明,临床表现复杂多样,主要以弛张热、一过性多形性皮疹、关节痛为主要临床表现,并伴有周围血粒细胞增生,严重者可出现多脏器功能损害[1],激素治疗有效。该病临床较少见,早期临床表现缺乏特异性,所以极易误诊。我科2006年2月9日收治1例AOSD病人,现报告如下。1临床资料病人,男,18岁。于2006年1月3日无明显诱因出现咽痛、发热,体温最高达39.3℃,鼻塞,伴周身酸痛、关节疼痛,2006年1月7日晨起排血尿1次,门诊血常规检查:白细胞14.2×109/L,中性粒细胞0.918,淋巴细胞0.053,单核细胞0.029,…     

新生儿听力筛查研究及其评价

我国每年有两千万新生儿出生，约有2万～6万新生儿患有听力障碍，远高于目前已开展的两病筛查（先天性甲状腺功能低下1：7000，苯丙酮尿症1：16500）。开展新生儿听力筛查，是一项社会意义重大的优生工程。本院已将新生儿听力筛查作为重点工作，由专职听力筛查的儿科医生和主管护师共同承担此项工作，并对患儿进行追踪随访，为早诊断、早干预提供帮助，同时调查家长对筛查结果的评价。现介绍如下。     

李振华教授调理脾胃用药规律探讨

李振华教授，生于1924年，河南省洛宁县人。著名中医脾胃学专家，全国片批名老中医。国务院特殊津贴专家，原中华中医药学会常务理事、第七届全国人大代表，曾任河南中医学院院长，从事中医临床与教学六十余载，长于内科杂病，晚年潜心于脾胃学说研究，著有《中国传统脾胃病学》等，并负责研究河南省重点科研项目“脾胃气虚本质的研究”及“七五”国家重点科技攻关项目“慢性萎缩性胃炎脾虚证临床及实验研究”，且均荣获河南省科技进步成果奖。经过多年临床实践，李老整理总结出调理脾胃的用药规律。提出通过药物件味归经，以及药效应用与脾胃的生理、病理特点相结合的川药大法。     

临床护士针刺伤调查及职业安全管理探讨

目的 了解护士的职业安全意识，以探讨职业安全管理模式。方法 采用随机抽样方法对100名临床护士进行针刺伤经历及相关问题的回顾性问卷调查。结果97．0％被调查护士在工作期间发生过针刺伤，77.30／被针刺伤〉1次／年，71．6％在操作和处置中被污染针头所伤，54．6％的针刺伤不能确定感染源；与针刺伤有关的主要操作有清洗、处置注射器、回套针帽、处置临床医疗废物等；在针刺伤发生后40．0％护士不知道报告的程序和处理措施；所有护士都希望获得针刺伤相关的知识及帮助与支持。结论 临床护士针刺伤发生率高．防护意识不强，职业安全制度不健全。建议卫生行政管理部门及医疗单位管理部门建立、健全职业安全制度，加强医护人员职业防护培训，以促进医疗职业安全．     

激光荧光检测仪对乳牙合面患龋敏感位点的流行病学研究

目的：定量分析乳牙合面的龋病敏感点位，为指导临床预防和治疗龋病提供依据。方法：采用激光荧光检测仪（DIAGNOdent）检测156名5～6岁儿童共561颗患龋的乳磨牙合面，记录合面龋坏最严重的位点。结果：在上颌第2乳磨牙中，龋坏最严重的位点有60．1％发生在远中窝。在下颌第2乳磨牙中，龋坏最严重的位点有51．2％发生在舌沟；而在下颌第1乳磨牙中，龋坏最严重的位点则易发生在远中窝，占该牙记录位点的34．9％。结论：不同的牙合面患龋严重部位具有统计学规律，提示这些位点是龋坏容易发生和发展的地方，是临床上预防和治疗不可忽略的重要部位。     

What is the prognostic value of myocardial perfusion imaging using rubidium-82 positron emission tomography?

OBJECTIVES: The objective was to determine the prognostic value of rubidium-82 (82Rb) positron emission tomography (PET) myocardial perfusion imaging (MPI). BACKGROUND: 82Rb PET MPI accurately diagnoses coronary artery disease (CAD). However, there are limited data evaluating its prognostic value. METHODS: Follow-up (3.1 +/- 0.9 years) was obtained in 367 patients who underwent dipyridamole 82Rb PET MPI. Patients were divided into groups based on their summed stress score (SSS): group I, normal (<4); group II, mild (4 to 7); and group III, moderate (8 to 11) to severe (> or =12). RESULTS: There were significant differences among patients in the 3 SSS groups for hard events (cardiac death and myocardial infarction [MI]) (p < 0.001) and total cardiac events (hard events, revascularization and hospitalization) (p < 0.001). The annual hard events rates were 0.4%, 2.3%, and 7.0% in the normal, mild, and moderate-severe groups, respectively. In adjusted survival models, 82Rb PET SSS was the strongest predictor of total cardiac events and a significant predictor of hard events. Among patients referred for PET after 99mTc single-photon emission computed tomography, the annual total event rate was higher with abnormal versus normal SSS on PET (15.2% vs. 1.3%, p < 0.001). In patients with obesity, the annual total event rate was 11.1% with an abnormal scan and 1.5% with a normal scan (p < 0.001). CONCLUSIONS: This study shows that 82Rb PET MPI has significant prognostic value for predicting cardiac events, including death and MI. It also seems to have prognostic value in patients whose diagnosis remains uncertain after single-photon emission computed tomography MPI and in obese patients. The prognostic value of PET MPI may improve the management of cardiac patients.