小儿发作性抽搐应警惕甲状旁腺功能减退症

1病例资料【例1】男,14岁。因发作性抽搐半年入院。患儿于半年前上体育课时突发抽搐,无大小便失禁,呼之能应,持续数分钟后自行缓解,之后能回忆当时情况。此后间断出现上述症状,常有手足麻木、疼痛,在外院就诊,按癫治疗无效。近1个月发作频繁,每日1~2次,抽搐时手足舞动的幅度逐渐增大,躯干亦出现不可控制的扭动,口角歪斜,语言不清,近4天每次抽搐时间可长达数小时。病程中不伴头晕、头痛、视物旋转,无发热、恶心、呕吐。查体:意识清楚,表情淡漠,反应较迟钝,面部轻度水肿。颈软,双侧甲状腺未触及肿大、震颤,听诊未闻及血管杂音。心肺及腹部检查…     

艾滋病合并卡氏肺孢子虫肺炎107例

目的:探讨艾滋病患者合并卡氏肺孢子虫肺炎(PCP)的诊断及治疗.方法:对我院感染科2009年6月至2010年5月432例艾滋病中确诊的107例PCP病例进行回顾性分析.结果:85例患者有发热、咳嗽、咳痰或呼吸困难;动脉氧压＜ 70 mmHg 16例;乳酸脱氢酶(LDH)升高者91例;胸片肺纹理增多、增粗和(或)毛玻璃样改变67例、肺小结节或斑片状阴影36例、胸片正常3例,液气胸1例;CD4+ T细胞＜ 50 cells/μL 86例.107例中19例找到肺孢子虫.治疗药物为复方磺胺甲恶唑,93例治愈,12例死亡,2例转ICU.结论:PCP诊断标准是找到病原体,其检出率低,目前仍以临床诊断为主.艾滋病患者合并PCP发病率高,特别是CD4+T细胞＜ 50 cells/μL者,AIDS患者应尽早高效逆转录抗病毒治疗(HAART),提高患者免疫力减少机会性感染,一旦临床考虑合并PCP应尽早复方磺胺甲噁唑治疗,减少病死率.     

艾滋病患者马尔尼菲青霉菌优势株酵母相全长cDNA文库的构建和初步分析

Objective To construct a full length cDNA library of the dominant strain of Penicillium marneffei (PM) in yeast phase isolated from AIDS patients in Guangdong province and screen UniGenes as well as full-length genes, so as to establish the foundation for the study of PM's functional genes and pathogenic mechanisms. Methods CloneMiner cDNA construction kit was utilized to extract mRNA of the dominant PM strain isolated from AIDS patients in Guangdong province. The mRNA was reversed into cDNA, then cloned into a pDONR222 vector by BP recombination to obtain an Uncut cDNA library, which was homogenized later to construct a normalized cDNA library with the principal of saturation hybridization for DNA genome. 2000 clones were chosen randomly to make a bi-directional sequencing and analyzed with bioinformatics for screening UniGenes and full-length genes. Results The total clone number of the Uncut cDNA library was 1.16 × 107 cfu/mL, with a recombination rate of 95% and an average insertion element being over 1 kb. The total clone number of the normalized cDNA library was 1.18 × 106 cfu/mL, with a recombination rate of 95% and an average insertion element being over 1 kb as well. 1945 genes which DNA length were longer than 1 kb were obtained by sequencing and merged into 1360 UniG enes, of which 632 genes were full-length ones. Conclusions The full-length cDNA library of the dominant strain of PM from AIDS patients in Guangdong province possesses good quality.Meanwhile, the technical routine presents high efficiency in obtaining full-length genes and establishing a gene expression spectrum, which can contentedly meet the needs of future experiments.     

马尔尼菲青霉菌溶血磷脂酶基因的识别和序列分析及功能预测

Objective To identify the gene encoding lysophospholipase from the full length cDNA library of Penicllium marneffei (PM) in yeast phase and predict the structure and function of its deduced protein, to provide with theoretical evidences for further experiments. Methods The PM full-length cDNA library in yeast phase was screened to identify the gene encoding lysophospholipase with the help of NCBI on-line analytical tool. Then, by utilizing the software package of Vector NTI suite 8.0, the protein deduced by the gene was analyzed to predict its corresponding structure and functions, and its molecular cladogram was constructed. Results The gene was composed of 1014 base pairs in the length and was presumed to be the full-length gene encoding lysophospholipase by Blastx, with a complete open reading frame (ORF) comprised of 729 base pairs encoding 243 amino acids with relative molecular weight being 26 800 and the predicted isoelectric point being S.49. The deduced protein included 47.7% hydrophobic amino acids, 26.8% hydrophilic amino acids, 12.7% acid amino acids and 12.8% basic amino acids. The protein had 2 potential casein kinase Ⅱ phosphorylation site, 3 potential protein kinase C phosphorylation site and 7 N-myristoyl site. Conclusions The amino acid sequence belongs to this kind of protease with lysophospholipase-like domain. The protein is most close to Coccidioides posadasii in genetic relationship. A novel gene encoding lysophospholipase is successfully found and the work has made necessary preparations for further research on the gene's function.     

艾滋病合并腹部结核的CT表现

目的 研究艾滋病(AIDS)合并腹部结核的CT表现.方法 回顾性分析33例经病理、病原学证实及临床诊断艾滋病合并腹部结核的腹部CT扫描表现.结果 33例AIDS合并腹部结核患者腹部CT示腹部淋巴结肿大23例(69.7%,23/33);肝脾肿大10例(30.3%,10/33);脾内多发低密度结节14例(42.4%,14/33),其中脾内弥漫粟粒状低密度结节9例(27.3%,9/33);肝内低密度结节7例(21. 2%,7/33),其中肝脓肿1例(3.0%,1/33);腹膜及大网膜增厚5例(15.2%,5/33),其中伴腹腔积液2例(6.1%,2/33);回盲部肠壁不规则增厚4例(12.1%,4/33);腰椎骨质破坏伴椎旁脓肿及左腰大肌脓肿1例(3.0%,1/33),腰大肌脓肿1例(3.0%,1/33).结论 AIDS合并腹部结核常表现肝脾结核、腹部淋巴结结核、肠结核及腹膜结核等,CT对病灶的检出有重要意义.     

艾滋病合并非结核分枝杆菌肺病的胸部影像表现

目的 探讨艾滋病合并非结核性分枝杆菌肺病的胸部影像表现.方法 10例艾滋病合并非结核性分枝杆菌肺病患者均行胸部X线检查,其中7例行胸部HRCT检查.结果 10例患者X线胸片显示:9例有明显病变,1例只有轻微病变;6例为双肺受累,4例为单肺受累(其中右肺3例,左肺1例);其中5例为大面积实变并空洞形成(4例伴对侧肺野散发病灶).在病变形态上有斑片状渗出实变(6例)、大片状(叶、段分布)实变(5例)、空洞(5例)、小结节病灶(3例)、粟粒病灶(2例)、纤维索条(1例).7例患者HRCT显示:斑片状渗出实变(7例)、小结节病灶(6例)、大面积(肺叶、段)实变(5例)及随实变吸收消散而出现的空洞、支气管扩张(各5例),纵隔淋巴结肿大(4例),磨玻璃密度影(3例),粟粒病灶及树芽征(各2例),胸腔积液、心包积液、纤维索条(各1例).结论 大面积实变合并空洞、结节病灶、支气管扩张及纵隔和肺门淋巴结肿大是艾滋病合并非结核性分枝杆菌肺病的胸部影像特点.     

离心力辅助硫酸氢氯吡格雷晶型I的制备及其稳定性(英文)

硫酸氢氯吡格雷的几个已报道的晶型中,相对于晶型II,晶型I的热稳定性较差,在高温高湿条件下会自发地转变为晶型I I,因而晶型I在生产中难以得到热稳定性好的产品。本文提出利用离心力辅助析晶的方法能生产出高纯度,稳定性好的晶型I产品。所得到的产品分别用粉末X射线衍射仪(PXRD),差示扫描热量仪(DSC)和扫描电镜显微镜(SEM)进行了表征。结果显示:离心力辅助析晶比用传统反溶剂析晶方法得到的晶型I结晶度有明显增加,晶粒生长得更大更完整。通过长期稳定性实验,证明新工艺所得到的产品具有较好的热稳定性,在高温高湿的环境下能长时间储存不变质。     

骨科大手术患者加速康复——围手术期的中医人文关怀思考

骨科大手术患者围手术期病情复杂,心理、生理应激反应大,并发症多且重,加速康复是术后治疗主要目的,人文关怀在骨科大手术后快速康复管理策略给予强调和重视,是实现快速康复的重要措施。中医人文关怀护理内涵与"生物-社会-心理"医学模式和叙事医学的精神完全符合,且具有较强的实践性,骨科大手术患者围手术期可采用中医人性化护理措施。     

HSP70-hom单核苷酸多态性与高血压的关系

目的探讨HSP70-hom(2437 T/C)单核苷酸多态性的人群分布特点及其与高血压的关系。方法通过流行病学调查收集样本。采用聚合酶链反应限制性片段长度多态性的方法检测样本HSP70-hom单核苷酸多态性。总计1291例(男446例,女845例),其中高血压组359例(男138例,女221例),对照组455例(男134例,女321例),另外排除糖尿病、肝、肾、心脏病、肿瘤史者等477例。结果 HSP70-hom单核苷酸多态性的人群分布情况为基因型CC 6%、CT 38%和TT 56%,等位基因C 25%和T 75%,在男女性别之间3种基因型的分布具有统计学差异(χ~2=7.96,P=0.029),等位基因的分布也具有显著差异(χ~2=3.97,P=0.046)。男性高血压组和男性对照组CC+CT和TT基因型的分布差异显著(χ~2=4.25,P=0.039),等位基因C和T的分布也具有统计学意义(χ~2=4.769,P=0.029),而女性高血压组与女性对照组CC+CT和TT基因型及等位基因C和T的分布均无统计学差异。结论 HSP70-hom单核苷酸多态性与男性高血压发病有关,TT基因型和T等位基因可能是其易感因素。     

椎管内麻醉禁忌证者剖宫产术的麻醉管理

目的 探讨有椎管内麻醉禁忌证者剖宫产术全麻的安全方法.方法 待手术医师消毒铺单,护士清点计数等一切准备就绪后开始麻醉诱导,静注地塞米松10 mg、氯胺酮1 mg/kg、丙泊酚1 mg/kg、琥珀胆碱2 mg/kg后,快速诱导气管插管;产妇意识消失后,立即开始手术.胎儿取出后,静脉追加芬太尼0.1 mg、维库溴铵4 mg,丙泊酚(靶控3.0～3.5 μg/ml)静脉泵入维持麻醉.同时手术医师于子宫壁注射缩宫素10 mg.连续监测产妇术前、术后BP、HR、SpO2,观察新生儿1 min、5 min的Apgar评分.结果 手术顺利,产妇术中血压、心率等生命体征平稳,子宫收缩良好.麻醉诱导开始至胎儿娩出4～6 min,所有新生儿1 min、5 min的Apgar评分均≥8分.结论 氯胺酮1 mg/kg、丙泊酚1 mg/kg、琥珀胆碱2 mg/kg用于有椎管内麻醉禁忌证者的剖宫产术全麻,产妇生命体征平稳,对新生儿无明显影响.