急诊体外循环手术治疗危重心血管病的临床应用

目的总结31例急诊体外循环手术（ECPB）经验,探讨ECPB在救治危重心血管病中的作用及应用指征。方法2000年3月～2005年3月,我们为31例危重心血管病患者施行了ECPB手术。其中急性胸主动脉夹层瘤行人造血管置换术8例（Bentall手术4例）,急性心肌梗死伴左心衰行CABG术6例,心房黏液瘤嵌顿致急性肺水肿行黏液瘤摘除术3例,心内膜炎伴赘生物形成行瓣膜替换术6例,机械瓣失功行2次挟瓣术2例,动脉导管破裂大出血行导管切断缝合术1例,法洛四联症急性缺氧发作行矫治术3例,房间隔缺损介入封堵失败行修补术2侧。结果术后存活25例,手术成功率80．6％。术后早期发生并发症者21例,占67．7％。结论严重的血流动力学障碍常导致心血管病危象和对药物治疗无反应,此时,ECPB是抢救患者生命的惟一有效方击。必须快速建立体外循环,在心、脑、肾等重要脏器发生不可逆损害前恢复有效的血流灌注,是手术成功和减少术后并发症的关键。     

定点诱变HBcAg质粒在人永生化B淋巴母细胞系中的稳定表达

目的:构建携带V60, G87, L97突变位点的HBV全基因组真核细胞表达载体,转染慢性HBV感染者永生化B淋巴母细胞系(LCL),建立相同HLA背景下的慢性HBV感染CTL应答的刺激细胞和靶细胞.方法:用定点突变技术在HBVp3.8Ⅱ质粒C基因区3个氨基酸V60, G87, L97位置进行突变(p3.8Ⅱ- V60, G87, L97),转化E. coli XL1-Blue感受态细胞扩增筛选,用限制性内切酶SacⅠ和KpnⅠ分别将野生型和突变型p3.8Ⅱ质粒进行双酶切, 插入EBO-plpp真核细胞表达载体,转染LCL,潮霉素稳定筛选后,鉴定目的基因在转染细胞是能够稳定表达.结果:DNA序列分析表明,野型HBV DNA核心区第60, 87, 97位氨基酸发生了预期的突变,Western Blot和微粒子免疫荧光法证明,转染的LCL能稳定表达HBV 抗原.结论:定点诱变HBcAg质粒在人永生化B淋巴母细胞系中可稳定表达.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

新生儿高间接胆红素血症蓝光照射后皮测胆红素值与血清胆红素值的比较分析

目的:探讨高间接胆红素血症患儿经12h蓝光照射后,暴露部位与遮盖部位经皮测胆红素值与血清胆红素值的关系。方法:将32例患儿蓝光照射12h后,分别作血清胆红素值测量和经皮作暴露部位、遮盖部位胆红素值测量。将所得数据进行统计学处理,然后进行比较。结果:暴露部位与遮盖部位经皮测胆红素值与血清胆红素值有高度相关性(P<0.01)。结论:蓝光照射结束12h,经皮胆红素测定仪无论检测遮盖部位还是暴露部位胆红素值,都能较准确地反映患儿的血清胆红素水平。     

双语教学在内科教学中的实践与探讨

目的:通过对临床医学本科生中开展的《内科学》双语教学效果的调查,探讨临床理论教学中开展双语教学的方法。方法:以2000级65名临床医学本科生为研究对象,以翻译英文病例方式对双语教学活动效果进行总体评价,并自编调查问卷进行反馈调查。结果:81.5%的学生对内科护理学开展双语教学持赞成态度,双语教学开展后学生的专业英语应用能力比开展前明显提高。结论:医学教育的后期,在英语基础较好的临床医学本科生中可开展双语教学,但要注意教学内容的选取。     

尖锐湿疣患者外周血CD14^＋单核细胞Toll样受体的表达

目的探讨CD14+单核细胞Toll样受体(TLRs)的表达在尖锐湿疣发病机制中的作用. 方法采用双色免疫荧光染色流式细胞术检测了34例尖锐湿疣患者外周血CD14+单核细胞表面TLR1、TLR2及TLR4的表达. 结果尖锐湿疣患者外周血CD14+单核细胞TLR4表达水平为(4.8±1.7)%,明显高于对照组的(2.6±1.0)%(P＜0.001);CD14+单核细胞TLR1的表达水平为(11.8±3.8)%,明显低于对照组的(16.4±5.1)%(P＜0.001);TLR2为(90.8±6.6)%,与对照组的(90.4±6.7)%相比,差异无统计学意义(P＞0.05).结论单核细胞表面的TLR4在对病毒识别、增强特异性的信号传导、启动抗病毒的固有免疫反应中起着重要作用.     

帕罗西汀在临床中的应用

肠易激综合征：肠易激综合征（IBS）的病因和发病机制复杂，迄今尚未完全弄清，也没有统一的治疗方法，仍限于经验性的对症治疗。IBS病人常伴有明显的精神心理障碍，与抑郁焦虑有密切关系。帕罗西汀对治疗伴有明显抑郁心理障碍的IBS病人疗效显著，且较安全。     

甘草甜素治疗流行性乙型脑炎38例

本文报道常规治疗加用甘草甜素(强力宁)2mL/(kg·d)于5％葡萄糖250mL静滴治疗流行性乙型脑炎38例,男23例,女15例,年龄8mo-7yr,平均3.4±SD1.8yr。治愈好转率95％,而对照组为83％。未发现明显副作用,提示甘草甜素可增加乙脑的治愈好转率。     

夏白汤治疗妊娠剧吐

妊娠呕吐是妊娠期最常见的症状，多发生在怀孕后的４０天至９０天期间。笔者采用自拟方夏白汤治疗１５８例妊娠剧吐全部治愈。一般资料：本组１５８例中，年龄２３～２９岁；初孕妇１４４例，多孕妇１４例。治疗方法与结果：１５８例中，有３０例中度以上脱水，首先补液纠...     

一起因水源污染引起的教工、学生感染性腹泻的现状调查

目的分析蓬莱某全日制封闭管理学校,在校学生、教工出现腹痛、腹泻、恶心、呕吐等症状的发病原因。方法采用描述流行病学和分析流行病学方法对蓬莱某中学的疫情资料进行统计分析。结果蓬莱市某中学在校教工和学生共计1856人。有468名教职工和学生出现腹痛、腹泻、恶心、呕吐等症状,其表现酷似食物中毒和诺瓦克感染性腹泻,经监测和流调发现在疾病的三间分布上除在时间分布上有一定的聚集性,在发病人群和班级分布均无显著性。实验室检测在水源水中查出粪大肠和侵袭性大肠O135型,属于典型的点源性暴发疾病。结论蓬莱市某中学发生的本次事件是由该校自备水源受到温血动物粪便污染而导致的一起由侵袭性大肠O135型感染而引起的点源性暴发疾病。