病毒感染与闭塞性细支气管炎研究进展

摘要 闭塞性细支气管炎（bronchiolitis obliterans, BO）是少见的慢性细支气管炎和小气道的肺部疾病。关于BO的病因、机理、临床表现及治疗预后等方面均未完全明确,近年来相关研究日益增多。尤其是病毒感染与BO的关系越来越引起人们的重视。儿童呼吸道病毒感染后引起的BO的早期诊断治疗对BO的预后有一定帮助。本文就病毒感染与儿童BO的一些研究进展作一综述。关键词 毛细支气管炎;闭塞性;儿童;病毒     

Detection and characterization of focal liver lesions with contrast-enhanced ultrasonography in patients with hepatitis C-induced liver cirrhosis

Background: Hepatitis C virus (HCV)-associated liver cirrhosis provides a major preneoplastic condition for hepatocellular carcinoma (HCC). Ultrasonography (US) is usually used for screening of HCC, but needs improvement.

Purpose: To assess whether use of a second-generation ultrasound contrast agent can improve characterization of focal liver lesions and detection of HCC in HCV-infected patients with liver cirrhosis.

Material and Methods: In total, 96 US studies in 49 HCV-infected patients with liver cirrhosis were performed. The patients were first examined with a baseline US. After this, a diagnostic decision was made and recorded. The patients were then re-examined with contrast-enhanced ultrasound (CEUS), and the diagnostic triage was repeated. The patients were followed up for at least 1 year.

Results: On baseline US, indeterminate focal lesions were found in 27 examinations. After CEUS, a confident diagnosis of HCC was made in eight of these examinations. In an additional eight US examinations, diagnosis of regenerative/dysplastic noduli was established. In one patient with no detectable focal lesion at baseline examination, an indeterminate malignant lesion was detected with CEUS. This lesion was further investigated with computed tomography and diagnosed as HCC.

Conclusion: Our study indicates that the use of CEUS significantly improves diagnostic confidence. CEUS improves the detection of HCC in patients with HCV-induced liver cirrhosis. Also, CEUS makes it possible to rule out malignancy in many cases where baseline US shows indeterminate focal lesions. In low-endemic countries, the use of CEUS in screening for HCC may be considered.     

正常与缺血性心肌梗死及心肌肥厚大鼠超声心动图参数变化趋势比较

目的 通过对正常和心血管疾病状态下的大鼠进行连续超声心动图检测,获得客观准确的大鼠心脏超声参数的变化趋势。方法 建立缺血性心肌梗死和压力负荷增高诱导心肌肥厚的大鼠模型,分别在术前、术后1、2和4周进行超声心动图检测,在相同时间点对正常大鼠进行超声心动图检测,并记录超声参数数据。结果 正常大鼠各心脏参数随时间的变化均有所升高,属正常生长状态。心肌梗死大鼠心脏变化以心室重构和功能障碍为主,心室内径和心室容积随时间变化显著增加,射血分数和短轴缩短率显著降低,差异均有统计学意义（P＜0.05）。心肌肥厚大鼠心脏变化以形态改变为主,左室前、后壁厚度随着时间的延长显著增加,收缩末期容积显著下降,射血分数和短轴缩短率代偿性升高,差异均有统计学意义（P＜0.05）。结论 应用超声心动图可获得正常和疾病状态下较为客观准确的大鼠心脏超声数据,为后续应用大鼠实验模型研究各种心血管疾病提供了数据参考。     

三步正骨手法整复尺桡骨中下段双骨折的多中心临床研究

目的：比较观察三步正骨手法整复及髓内针内固定治疗尺桡骨中下段双骨折的疗效。方法：随机分实验组105例和对照组105例，实验组接受拔伸旋转、夹挤分离和折顶回旋三步正骨手法复位加小夹板外固定，对照组接受手术开放复位，髓内针内固定治疗。结果：随访6个月，骨折解剖对位及近解剖对位情况，对照组优于实验组；骨折愈合及功能恢复情况，实验组均优于对照组。结论：应用三步正骨手法整复尺桡骨中下段双骨折，有利于伤肢功能恢复并能减少骨折延迟愈合、不愈合的发生。     

手术室内镜器械清洗方法的改进与评价

目的探索快速有效的内镜器械清洗方法,促进内镜器械的规范清洗。方法将240件污染内镜手术器械随机均分为四组,对照组按《内镜清洗消毒技术操作规范》标准流程清洗;实验1组按标准流程清洗,其多酶浸泡时间3 min;实验2、3组采用改进流程,即多酶超声6 min(实验2组)和多酶超声3 min(实验3组)清洗,采用Pro-tect M检测和杰力试纸分别检测清洗效果。结果 Pro-tect M检测及杰力试纸检测结果阳性率:对照组45.0%和40.0%,实验1组45.0%和43.3%,实验2组15.0%和18.3%,实验3组20.0%和33.3%。四组比较,差异有统计学意义(P0.05,P0.01)。结论严格按规范流程清洗内镜器械,多酶浸泡时间由6 min缩短到3 min不影响清洗效果,但清洗效果均不满意。改进流程多酶超声6 min和多酶超声3 min其清洗效果均优于按规范清洗,缩短了清洗时间,提高了效率,建议临床采用改进流程清洗内镜器械。     

主动脉瓣膜间质细胞体外诱导钙化的实验研究

目的体外培养、诱导主动脉瓣膜间质细胞钙化,并观察其表型变化。方法使用胶原酶消化法从新鲜猪主动脉瓣膜上分离并体外原代培养主动脉瓣膜间质细胞,行免疫荧光染色细胞鉴定。取4~8代间质细胞,随机分为两组,实验组:以含甘油磷酸、维生素C、地塞米松的钙化培养基进行钙化诱导培养2周;对照组:以标准培养基培养2周。在光学显微镜下行钙化结节计数,茜素红染色观察并半定量检测钙沉积含量;采用实时荧光定量逆转录聚合酶链反应(RT-PCR)检测间质细胞α-平滑肌肌动蛋白(-αSMA)及钙化相关因子(骨钙素、骨桥蛋白、核心结合因子)的基因表达。结果从猪主动脉瓣膜上成功分离并体外培养瓣膜间质细胞,-αSMA及波形蛋白(vimentin)染色阳性,血管性血友病因子(vWF)染色阴性。间质细胞钙化诱导培育2周可成功诱导钙化,自发形成钙化结节,实验组钙化结节(156.25±17.38个/孔vs.2.50±1.29个/孔)和钙沉积(17.52±2.04 vs.1.00±0.22)显著高于对照组(P0.05);实时RT-PCR提示:实验组-αSMA、骨钙素、骨桥蛋白、核心结合因子等表达均较对照组明显升高(P0.05)。结论体外诱导钙化的瓣膜间质细胞呈现相对激活状态,表型向收缩表型和成骨表型转化,可能为瓣膜钙化的病理基础。