贵州省燃煤型砷中毒病区先天畸形调查

目的探讨燃煤型砷中毒病区居民出生缺陷或先天畸形发生情况。方法采用流行病学横断面调查方法,调查贵州省燃煤型砷中毒村和非中毒村近30年出生先天畸形的发生情况;用回顾性调查方法,调查新生儿出生时缺陷情况。结果砷中毒村居民先天畸形现患率为18.26‰,非中毒村为6.91‰,二者比较差异有统计学意义(χ2=17.17,P<0.01)。砷中毒妇女先天畸形(出生缺陷)出生率为22.05‰,非砷中毒妇女为10.75‰,二者比较差异有统计学意义(χ2=7.74,P<0.01)。畸形中以胎记、腹股沟斜疝、唇裂、外耳畸形及多(并)指(趾)为多见,主要分布于0～19岁人群。结论砷中毒村出生缺陷或畸形率显著高于非中毒村,表明当地出生缺陷或先天畸形高发与砷中毒密切相关。     

SIRT1在血管相关性疾病中的研究进展

沉默信息调节因子2相关酶类1（ silent mating type information regulation 2 homolog-1,SIRT1）是一种依赖于烟酰胺腺嘌呤二核苷酸（ nicotinamide-adenine dinucleotide, NAD）的去乙酰化酶,其可对组蛋白和非组蛋白发挥去乙酰化作用从而调节能量代谢、细胞衰老及凋亡等众多生命过程。在多种血管相关性疾病中,SIRT1通过对相关因子去乙酰化增加细胞能量供应、减少细胞凋亡、减轻炎症反应、抵抗氧化应激、改善血管内皮细胞功能,从而在血管相关性疾病中发挥重要作用。该文旨在对SIRT1在缺血性脑卒中、动脉粥样硬化及肿瘤这3种常见血管相关性疾病中的作用的研究进展及相应的信号通路进行综述。     

应用以案例为基础的教学法提高皮肤外科教学效果的探索

目的将以案例为基础的教学法(CBL)应用于皮肤外科教学中,并探讨其效果及可行性。方法以第四军医大学西京医院烧伤与皮肤外科2013年32名进修生为教学对象,随机分为CBL组和对照组,每组各16名。CBL组采用CBL教学法,对照组采用传统教学法进行皮肤外科学授课,对两组教学效果进行比较。结果两组理论考试成绩比较,CBL组中优秀者9名,良好者6名,及格者1名,无不及格者;而对照组测试优秀者5名,良好者7名,及格者3名,不及格者1名。CBL组优秀率高于对照组(56.2%比31.2%),差异有统计学意义(P<0.05)。而在病例分析与手术操作技能考核中,CBL组中优秀者10名,良好者5名,及格者1名,无不及格者;而对照组中优秀者6名,良好者4名,及格者4名,不及格者2名,CBL组优秀率高于对照组(62.5%比37.5%),差异有统计学意义(P<0.05)。结论 CBL教学法有利于学生学习观念的转变,能明显提高其自主学习能力,值得在皮肤外科临床教学中应用推广。     

Quantitation of ferritin iron in plasma, an explanation for non- transferrin iron

In 33 patients with thalassemia and idiopathic hemochromatosis, plasma ferritin protein levels ranged from 36 to 5,850 micrograms/L. The iron content of this ferritin as determined by immunoprecipitation ranged from undetectable amounts to 507 micrograms/L. The mean iron content of ferritin protein in those and other subjects with plasma ferritin concentrations of over 1,000 was 6.8% +/- 2.7%. Plasma transferrin was usually saturated with iron in patients with measurable ferritin iron, but exceptions occurred. In studies using electrophoretic separation, it was shown that some ferritin iron moved to transferrin during in vitro incubation, whereas exchange in the opposite direction was extremely limited. Because some plasma ferritin iron was measured by the standard colorimetric plasma iron determination, these observations (a) indicate that plasma ferritin contains a significant amount of iron (b) indicate that a significant proportion of nontransferrin iron in individuals with nontransferrin iron as detected by standard plasma iron and total iron-binding capacity measurements is due to the presence of ferritin, and (c) suggest that large amounts of ferritin iron may affect the saturation of plasma transferrin.     

Cytotoxic T-cell clones derived from pluripotent stem cells (CFU-GEMM) of patients with Hodgkin's lymphoma

Pluripotent stem cells (CFU-GEMM) give rise to multilineage hemopoietic colonies in culture. The cellular composition revealed that mixed colonies contain cells of different myeloid lineages and mononuclear cells with T-cell surface antigens. T lymphocytes of primary colonies and replated secondary clones from 5 patients with Hodgkin's lymphoma (stage I--II) were identified by their reaction with the monoclonal antibody OKT-8. Replated secondary clones do act functionally as cytotoxic cells using K562 as target cells. Evidence for a common progenitor of myeloid and lymphoid cells is provided by analysis of individual secondary colonies with the use of OKT-3, OKT-4, OKT-8, VIM- D5, and IgM + D antibodies for each individual clone. Primary mixed and replated secondary colonies revealed OKT-8-positive cells. No reaction with OKT-3, OKT-4, VIM-D 5, or IgM + D was observed. In mixed colonies grown from putative bone marrow transplant donors, only OKT-3-positive cells could be observed. Secondary replated colonies did not stain for OKT-8 and failed to lyse 51Cr-labeled K562 cells.     

抗酸染色在结核病病理诊断中的价值

目的探讨抗酸染色在结核病病理诊断中的意义。方法回顾性分析2000--2012年兰州军区兰州总医院病理诊断结核病并有抗酸染色结果的914例（男485例,女429例）患者的病理资料。使用SPSS20．0软件进行统计学处理,以X2检验对计数资料进行统计分析,PG0．05为差异有统计学意义。结果914例结核病患者结核分枝杆菌抗酸染色阳性率为31．95％（292／914）。支气管结核和肠结核患者结核分枝杆菌抗酸染色阳性率分别为48．24％（41／85）和58．06％（18／31）,高于肺结核抗酸染色阳性率（33．33％,72／216）,差异均有统计学意义（矿值分别为5．777、7．159,P值均G0．05）;结核性胸膜炎（19．78％,18／91）、脊柱结核（16．52％,19／115）和关节结核阳性率（12．00％,6／50）低于肺结核患者结核分枝杆菌抗酸染色阳性率（33．33％,72／216）,差异均有统计学意义（X2值分别为5．676、10．640和8．916,P值均G0．05）。男、女患者结核分枝杆菌抗酸染色阳性率分别为30．93％（150／485）和33．10％（142／429）,性别对抗酸染色结果差异无统计学意义（X2=0．494,P〉0．05）。结论抗酸染色仍是诊断结核病的有效确切手段,病变部位不同,抗酸染色阳性率亦有差异。     

平消胶囊联合丙氨瑞林治疗子宫肌瘤的临床研究

目的探讨平消胶囊联合丙氨瑞林治疗子宫肌瘤的临床有效性与安全性。方法选取2015年12月—2017年12月津中医药大学第一附属医院收治的子宫肌瘤患者90例,根据患者入院顺序分成对照组和治疗组,每组各45例。对照组患者肌肉注射注射用丙氨瑞林,150μg/次溶解于2 m L生理盐水;治疗组在对照组基础上口服平消胶囊,5粒/次,3次/d。两组患者均连续治疗12周。观察两组患者临床疗效,同时比较治疗前后两组患者子宫肌瘤体积、月经量及生活质量、血清胰岛素样生长因子Ⅰ(IGF-Ⅰ)、血清胰岛素样生长因子Ⅱ(IGF-Ⅱ)、抗缪勒管激素(AMH)和性激素水平。结果治疗后,对照组和治疗组临床有效率分别为80.00%和95.56%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者子宫肌瘤体积和月经量均显著降低(P0.05),生活质量评分显著升高(P0.05),且治疗组患者各指标明显优于对照组(P0.05)。治疗后,两组患者血清IGF-I、IGF-II、AMH、雌二醇(E2)、促卵泡刺激素(FSH)和黄体生成素(LH)水平均显著降低(P0.05),且治疗组IGF-I、IGF-II、E2、FSH和LH水平明显低于对照组,AMH水平高于对照组(P0.05)。结论平消胶囊联合丙氨瑞林治疗子宫肌瘤临床有效率高、安全性好,同时还能够改善患者的生活质量,具有一定的临床推广应用价值。     

Blood use in patients undergoing repeat coronary artery bypass graft procedures: multivariate analysis

BACKGROUND : The prevailing clinical opinion is that patients undergoing repeat coronary artery bypass graft (CABG) operation require more blood transfusions than do patients undergoing primary CABG operation. To determine the extent of this increased demand and the variables responsible for it, the cases of 196 patients who had undergone primary procedures and 65 patients who had had repeat procedures at the same institution were reviewed. STUDY DESIGN AND METHODS : To analyze the differences in transfusion requirements for these two groups, the following data were obtained: number of transfusions given between the time of surgery and the time of hospital discharge; preoperative hemoglobin (Hb), hematocrit (Hct), prothrombin time, and platelet count; Hb and Hct at hospital discharge; time the patient was on cardiopulmonary bypass; number and type of grafts; estimates of intraoperative blood loss; and chest-tube blood shed during the first 48 hours after surgery. RESULTS : The groups were comparable with respect to age, body weight, preoperative Hb and Hct, number of grafts, and aspirin exposure. Patients in the repeat group had 35-percent greater blood loss and required 75-percent more blood components than did the patients undergoing primary procedures. The mean number of blood components transfused per patient was as follows: red cells, 3.8 +/? 0.5 units in repeat patients and 2.2 +/? 0.2 units in primary patients (p = 0.002); platelets, 2.9 +/? 0.9 vs. 1.1 +/? 0.2 (p = 0.043); fresh-frozen plasma, 1.6 +/? 0.4 vs. 0.8 +/? 0.1 (p = 0.044). Analysis of variables by regression method for repeat patients showed a predictive effect of blood loss (p < 0.0001), prolonged time on cardiopulmonary bypass (p < 0.0001), preoperative Hb (p = 0.0003), and aspirin exposure (p = 0.0094) on red cell transfusion rate in repeat patients (R-square = 0.7778, Prob > f = 0.0001). CONCLUSION : Repeat CABG patients have higher transfusion rates. These findings may be attributed to the increased microvascular bleeding, prolonged time on cardiopulmonary bypass, lower preoperative Hb, and the use of preoperative antiplatelet medications.