HIV抗体筛查的回顾性分析与初筛流程的建立

目的 建立适于微生物科室临床标本人类免疫缺陷病毒(HIV)筛查的流程.方法 对近3年来医院用硒标法和(或)ELISA法初筛HIV阳性与确认结果之间的关系进行回顾性分析.结果 硒标法敏感度为97.75%,ELISA法敏感度为100.00%,两法在真阳性标本中的符合率为97.75%;硒标法和ELISA法单一阳性时,假阳性率约为90.00%,两法均阳性时,假阳性率仅为2.25%;ELISA法吸光度值(OD)＜0.60时.硒标法和确认结果＞96.00%均为阴性.结论 综合以上两法检测特点和初筛结果回顾性分析,科室建立了不同临床标本的HIV初检和复查流程,这对预防HIV医院感染具有积极意义,对其他医院HIV初筛流程的建立也有参考作用.     

荧光引导下脑胶质瘤边界的组织病理学研究

目的 5-氨基乙酰丙酸(ALA)引导的荧光手术已应用于临床恶性脑胶质瘤的治疗,本实验的目的是探讨ALA荧光引导切除脑胶质瘤的荧光边界与侵袭性的关系.方法 对11例胶质母细胞瘤患者麻醉诱导前3h给予口服ALA,术中使用荧光显微镜检测肿瘤荧光,根据有无荧光留取组织标本.利用免疫组化方法检测荧光组与非荧光组组织中侵袭性指标细胞粘附分子CD44(CD44-HCM)、基质蛋白酶-9(MMP-9)和肌腱蛋白(TN)的表达.结果 CD44-HCM、MMP-9和TN在荧光组织与无荧光组织中的阳性表达率有显著差异(P＜0.01),与无荧光的组织相比,荧光组中CD44-HCM、MMP-9和TN表达的阳性率明显增加.结论 ALA诱导的肿瘤荧光边界与脑胶质瘤组织病理学边界相符,进一步表明,荧光引导手术能够有效的切除脑胶质瘤,并且为手术提供客观边界.     

小鼠肺、肝和肾间质树突状细胞的形态与组织分布

目的:了解小鼠肺、肝和肾间质树突状细胞的形态与分布特点。方法:电镜形态学观察及表面分子CD11c、CD205与共刺激分子CD80、CD86和MHC-Ⅱ类分子免疫组织化学标记,观察研究C57BL/6小鼠肺、肝和肾间质树突状细胞的形态和分布特点。结果:间质树突状细胞具有特征性的胞质突起,广泛分布于肺、肝与肾间质中,数量较少,大部分处于非成熟状态,低表达CD205、CD80、CD86和MHC-Ⅱ类分子。结论:间质树突状细胞是脏器免疫微环境的重要组成部分和免疫前哨细胞。     

他山之石 何以攻玉:从脑出血国际临床研究现状看我国的规范化治疗

自发性脑出血病死率和病残率较高,但缺乏有效的治疗策略.我国的脑出血相关研究与国际先进水平存在一定差距.近年国际上一系列临床研究从不同角度探讨脑出血的治疗方式,对我国脑出血研究和规范化治疗具有十分重要的参考价值.我国的脑出血临床治疗经验和研究成果要想走向世界,必须开展高质量的临床试验.四川大学华西医院神经外科正在开展IN...     

牛磺酸对大鼠肝缺血再灌注后小肠损伤的保护作用

目的探讨牛磺酸对大鼠肝缺血再灌注(I/R)后小肠损伤的保护作用。方法将大鼠随机分成假手术组,肝I/R组,牛磺酸预处理+肝I/R组;采用阻断肝动脉、门静脉30min后再灌注的方法,制作肝I/R模型。各组于再灌注3,6,24h分别采血,测定二胺氧化酶(DAO)数值,检测小肠功能;同步切取小肠,测定肠道组织中的SOD及MDA含量,评价肠道自由基损伤程度;切片后行苏木素-伊红(HE)染色,观察病理形态学改变;原位末端标记法(TUNEL)测定细胞凋亡;免疫组化法测定caspase-3表达。结果与假手术组比较,肝I/R组SOD水平明显降低(P<0.05),MDA和DAO水平明显升高(P<0.05),小肠病理损伤严重,凋亡指数明显升高(P<0.05),caspase-3阳性率明显增加(P<0.05)。与I/R组同时间点比较,牛磺酸预处理+I/R组各项指标均明显改善(均P<0.05)。结论牛磺酸对肝I/R后小肠损伤具有保护作用。     

静脉用药调配中心全静脉营养液处方分析

目的对郑州人民医院近3个月全肠道外营养液（TPN）处方设计进行分析,为TPN临床合理应用提供参考。方法汇总郑州人民医院近3个月TPN处方并就其配方的成分组成进行统计分析。结果郑州人民医院近3个月TPN处方669张,设计基本合理,但仍存在非蛋白热卡不足、含氮量偏低等问题,经审核排除不合格用药处方张数55张,占总处方数的8.22%。结论临床医生应针对患者的营养状况准确,合理的设计TPN配方,提高临床营养治疗的安全性和有效性,同时药师应通过审方来进一步保证处方的合理性。     

原发结肠何杰金氏病的X线诊断

原发结肠何杰金氏病少见,发病率明显低于非何杰金氏淋巴瘤。本文报告了我院二十年来所获共七例,侧重于X线改变进行了讨论。X线改变有以下几个特征:①病变范围较大,通常累及末端回肠;②排钡后肠管收缩受限;⑧粘膜改变呈网状,皂泡状或脑回状。     

C-erbB-2、MMP2在乳腺癌中的表达及相互关系探讨

目的 :探讨癌蛋白 (C erbB 2 )和基质金属蛋白酶 (MMP2 )在乳腺浸润性导管癌中的表达及相互关系。方法 :应用免疫组织化学S -P法对 5 6例乳腺浸润性导管癌的C erbB 2和MMP2的阳性表达进行检测分析。结果 :5 6例中有 37例 (6 6 % )C erbB 2过表达 ,39例 (6 9.6 % )MMP2过表达 ,C erbB 2和MMP2同时阳性表达者 32例(5 7 1% )。两者阳性率均随组织学分级升高而上升 ,但各级间未见明显差异 (P >0 .0 5 )。在转移组中 ,88.9% (2 4 /2 7)的病例C erbB 2过表达 ,85 .2 % (2 3/ 2 7)MMP2过表达 ,两者的过表达与转移呈正相关关系 (PC erbB 2 =0 .0 0 1,PMMP2 =0 .0 15 )。C erbB 2和MMP2阳性配对分析表明 ,两者间阳性表达互为正相关 (P <0 .0 0 5 ,r=0 .5 1)。结论 :在乳腺浸润性导管癌中 ,C erbB 2和MMP2的过表达提示转移增加 ,可以作为乳腺癌的预后指标。     

Diagnosis and surgical treatment of multiple endocrine neoplasia

Background Multiple endocrine neoplasia (MEN) is relatively rare. But more patients could be found by detailed examination. We discuss the diagnosis and surgical treatment of MEN. Methods The clinical data of 95 MEN cases were retrospectively analyzed. There were 30 cases of MEN1 including 19 cases from 6 families. The MEN1 gene mutation was detected in 81.48% of cases admitted after 1997. There were 22 cases of primary hyperparathyroidism (PHPT), 10 cases of enteropanceatic tumor including 9 cases of insulinoma, 15 cases of pituitary adenoma, 9 cases of adrenal adenoma, 2 cases of thymic carcinoid. Two patients had 4 glands involved, 3 patients had 3 glands involved, 16 patients had 2 glands involved, and 6 patients had only one gland involved. Three patients had neither clinical symptoms nor biochemical changes, and was diagnosed by MEN1 gene mutation. Six patients presented with nephrolithasis and 6 patients had impaired pancreatic endocrine function. There were 60 cases of MEN2a and 5 cases of MEN2b. 58 cases of MEN2a belongs to 19 kindreds. All MEN2a patients but one presented RET gene mutation in codon 634, and all MEN2b cases had mutation in codon 918. 48 cases of MEN2a had thyroid masses with elevated calcitonin levels. 27 patients had pheochromocytoma including 12 cases of multiple loci and 5 malignancy. 13 patients presented with hyperparathyroidism. 5 MEN2b patients had medullary thyroid carcinoma and mucosal ganglioneuromatosis with Marfanoid. Among them, 3 patients had bilateral pheochromocytoma. Results In MEN1, subtotal parathyroidectomy was performed in 12 patients with PHPT and one patient received parathyroid adenoma enucleation. Insulinomas were enucleated in 4 patients. Two patients underwent thymus tumor extirpation. Total thyroidectomy with bilateral dissection of regional lymph nodes was performed in 16 patients with MEN2a and nodule enucleation was performed in 9 patients. Twenty two MEN2a patients underwent pheochromocytoma enucleation including bilateral adrenal resection in 10 cases. 5 MEN2b patients underwent total thyroidectomy with bilateral lymph node dissection. Among them, 3 cases underwent bilateral adrenal operations. Conclusions MEN varies in symptoms. Germline mutation test is helpful in establishing a diagnosis. Surgical management should be aimed at the improvement of life quality in MEN1 and prevention of the fetal tumors in MEN2.