小剂量对比剂CTU在经皮肾镜碎石取石术中的应用研究

目的 探讨小剂量对比剂联合呋塞米注射液和生理盐水CTU新技术对经皮肾镜碎石取石术（PCNL）术前穿刺通道选择的临床应用价值。方法 采用改良的小剂量对比剂CTU检查方案对23例复杂性肾结石患者行小剂量对比剂联合呋塞米注射液和生理盐水CTU检查。在分泌期扫描前进行常规平扫。采用ROI法对23例患者肾结石密度进行测量,以了解复杂性肾结石的密度分布特点;采用ROI法对23例患者分泌期肾实质上极、中部、下极及上组肾盏、中组肾盏、下组肾盏、肾盂CT值进行测量并对测量结果比较,以了解小剂量对比剂CTU肾实质及肾盂肾盏系统内对比剂分泌均匀性;对23例患者复杂性肾结石及PC系统进行分泌期轴位、冠状位MIP及VR重组并对重组图像进行评分,以了解哪种重组方法对肾结石、PC系统显示最佳。结果 23例患者复杂性肾结石密度中位数为1182.41HU,95% CI：548.26~1734.54HU;小剂量对比剂CTU肾实质对比剂分泌均匀;PC系统内对比剂分泌均匀且明显低于复杂性肾结石密度使得复杂性肾结石和PC系统重组的准确性分别达到82.6%和87%;3种重组方案中,冠状位MIP用于描述复杂性肾结石的评分最高。冠状位MIP用于显示肾盂肾盏解剖结构的评分最高。结论 小剂量对比剂CTU三维重组图像可直观显示复杂性结石的空间位置、PC系统的截面与立体解剖结构及其与周围组织的关系,有助于PCNL术前穿刺通道选择。     

瘤体注射IL-2重组腺病毒基因治疗小鼠胶质母细胞瘤及其免疫机制的初步探讨

目的：观察瘤体直接注射IL－2重组腺病毒对G422皮下荷瘤的治疗作用,对体内基因转染效率及治疗的免疫机制进行初步分析。方法：将LacZ,IL-2重组腺病毒直接注射到皮下接种的G422胶质母细胞瘤瘤体,X－gal染色检测基因转染的效率,观察肿瘤的大小和荷瘤小鼠的存活期,采用4h^51Cr释放法检测荷瘤小鼠脾细胞诱导的NK、LAK、CTL的杀伤活性,对治疗后的肿瘤进行常规病理分析。结果：采用瘤体注射腺病毒具有较高的体内基因转染效率,瘤体注射IL－2重组腺病毒对皮下建立的胶质母细胞瘤有一定的治疗作用,肿瘤的生长受抑制,荷瘤小鼠的存活期显延长,但没有长期存活小鼠。IL－2基因治疗组小鼠脾细胞的LAK、CTL杀伤活性显增强,肿瘤局部出现更多的坏死和炎性浸润细胞。结论：采用瘤体直接注射IL－2重组腺病毒对胶质母细胞瘤皮下荷瘤有治疗,其机制可能是增强了宿主的局部和全身抗肿瘤免疫反应。     

中国北方汉族人群HLA-DRB1单核苷酸多态性与脑血管病的关系

目的：研究北方汉族人群脑血管病与HLA-DRB1单核苷酸多态性的遗传关联性,为脑血管病的免疫遗传学研究奠定基础。方法：采用病例对照研究方法,收集160例脑血管病患者和139例健康对照。根据知情同意原则对每例受检者进行身高、体质量、腰围(WC)、腹围(AC)、体质量指数(BMI)等一般指标测量,采集空腹静脉血,检测血白蛋...     

Mycoplasma pneumoniae pneumonia in hospitalized children diagnosed at acute stage by paired sera

Background Mycoplasma pneumoniae （M. pneumoniae） is a frequent cause of respiratory tract infections. However,there is deficient knowledge about the clinical manifestations of M. pneumoniae infection. We described the clinical and laboratory findings of M. pneumoniae pneumonia in hospitalized children who were all diagnosed by a ≥ fourfold increase in antibody titer.Methods M. pneumoniae antibodies were routinely detected in children admitted with acute respiratory infection during a one-year period. The medical history was re-collected from children whose M. pneumoniae antibody titer increased≥fourfold at the bedside by a single person, and their frozen paired serum samples were measured again for the M.pneumoniae antibody titer.Results Of the 635 children whose sera were detected for the M. pneumoniae antibody, paired sera were obtained from 82 and 29.3% （24/82） showed a ≥ fourfold increase in antibody titer. There were 24 cases, nine boys and 15 girls, aged from two to 14 years, whose second serum samples were taken on day 9 at the earliest after symptom onset; the shortest interval was three days. All children presented with a high fever （≥38.5℃） and coughing. Twenty-one had no nasal obstruction or a runny nose, and five had mild headaches which all were associated with the high fever. The disease was comparatively severe if the peak temperature was ＞39.5℃. All were diagnosed as having pneumonia through chest X-rays. Four had bilateral or multilobar involvement and their peak temperatures were all ≤ 39.5℃. None of the children had difficulty in breathing and all showed no signs of wheezing.Conclusions The second serum sample could be taken on day 9 at the earliest after symptom onset meant that paired sera could be used for the clinical diagnosis of M. pneumoniae pneumonia in children at the acute stage. M. pneumoniae is a lower respiratory tract pathogen. Extrapulmonary complications were rare and minor in our study. High peak temperature （＞39.5℃） is correlated with the severity of M. pneumoniae pneumonia in children.     

碳化二亚胺交联同种异体肌腱修复兔前交叉韧带损伤生物力学实验研究

目的 探讨利用碳化二亚胺(1-3-(dimethylamino)propyl-3 -ethylcarbodiimide methiodide,EDC)交联并肝素化的方法对同种异体肌腱进行预处理改善其修复韧带损伤效果,为临床应用提供实验基础和理论依据.方法 采用冷冻干燥法获得兔同种异体肌腱,应用EDC交联并肝素化方法进行...     

hVEGFA基因重组腺病毒载体的构建及其转染效率的研究

目的:应用AdEasy复制缺陷型腺病毒载体系统构建携带hVEGFA基因的重组腺病毒载体.方法:采用分子克隆技术,从PCR2.1-hVEGFA质粒中克隆出hVEGFA基因的编码序列,酶切、连接后,插入腺病毒系统中的穿梭载体pAdTrack-CMV,获得重组质粒pAdTrack-CMV-hVEGFA,将其转化含有腺病毒骨架载体pAdeasy-1的大肠埃希菌BJ5183,进行同源重组,获得重组子pAdeasy-1-hVEGFA.鉴定后,将pAdeasy-1-hVEGFA转染人胚肾细胞(HEK293A细胞),获得含hVEGFA基因的重组腺病毒(rAd-hVEGFA).反复感染HEK293A细胞扩增腺病毒,50%组织培养感染量法(TCID50)检测病毒滴度,荧光显微镜观测绿色荧光蛋白(GFP)的表达.结果:成功构建出含有hVEGFA基因的腺病毒载体rAd-hVEGFA,转染HEK293A细胞后出现绿色荧光蛋白表达,证明腺病毒载体rAd-hVEGFA 转染成功,通过反复感染HEK293A细胞获得大量病毒.结论:成功构建含有hVEGFA基因的腺病毒载体rAd-hVEGFA,可为缺血性脑血管疾病的基因治疗提供基因载体.     

麻醉学住院医师培训模式的构建与实施

麻醉和手术过程是一个极其复杂的病理生理过程,现代医学的发展对麻醉学医师提出了更高的要求,麻醉学医师的培养是医学教育中非常重要的方面.在当今的医疗体制下,医生的综合素质如非技术性技能日益显示出其重要性.北京协和医院麻醉科作为卫生部首批麻醉学专业住院医师规范化培训基地,提出并实施了"典型案例+情景模拟+以问题为基础学习(problem-based learning,PBL)"培训模式,取得了良好效果,为培养综合素质优良的麻醉学医师发挥了积极作用.

Abstract：

Practice of anesthesia is very challenging due to the complicated athophysiological changes during the surgery, while improved surgical techniques and enhanced expectation of life quality make anesthesia even more challenging. The residency training program of anesthesiologist is critical to the improvement of integrity level of anesthesia. During the medical training, non-technical skills necessary for effective anesthetic practice should be centered. Peking Union Medical College Hospital, as one of the most important medical training centers of anesthesiologist, has established a new training modality which is "typical case + scenario simulation + problem-based learning". This new training modality is believed to enhance the comprehensive quality of anesthesiologists.     

蒲元和胃胶囊联合伊托必利治疗功能性消化不良的临床分析

目的探讨蒲元和胃胶囊联合伊托必利治疗功能性消化不良的临床效果。方法选取该院近2年收治的80例功能性消化不良患者随机分为观察组与参考组,分别给予不同治疗方法治疗,比较两组患者治疗效果。结果观察组患者治疗总有效率为95%,参考组治疗总有效率为72.5%,差异有统计学意义（P〈0.05）,患者临床症状积分改善程度明显大于参考组（P〈0.05）,两组不良反应发生率比较差异无统计学意义（P〉0.05）。结论蒲元和胃胶囊联合伊托必利治疗功能性消化不良可有效改善临床症状。     

尿激酶改善长时间热缺血肾脏功能的实验研究

目的 探讨尿激酶对长时间热缺血(warm ischemia,WI)肾脏的形态和功能恢复的影响.方法 30只家兔按随机数字表法分为3组:假手术、热缺血组(WI组)、热缺血+尿激酶治疗组(WI+UK组).夹闭左侧肾动、静脉90 min模拟热缺血过程,HCA液冷灌注及肾脏血流复灌,模拟自体原位肾移植.比较各组血肌酐(Cr)、肾脏组织病理改变(HE、Masson染色)和免疫组化检测血栓调节蛋白(thrombomodulin,TM).结果 与假手术组比较,WI组和WI+UK组术后Cr水平明显升高(P＜0.05),术后35 d Cr水平WI+UK组[(118.99±17.18) μmol/L]明显低于WI组[(165.34±8.38) μmol/L,P＜0.01].WI组肾小球内大量微血栓形成,肾小管水肿、坏死;WI+UK组肾小球未见血栓,肾小管未见异常.WI组TM表达明显高于假手术组(P＜0.01),WI+ UK组明显低于WI组(P＜0.05).结论 热缺血90 min后有明显的微血栓形成,导致肾脏结构破坏及肾功能下降.尿激酶治疗后微血栓溶解,有利于肾脏结构和功能恢复.     

埃索美拉唑肠溶片联合莫沙必利治疗反流性食管炎的疗效及生活质量的临床研究

目的探讨埃索美拉唑肠溶片联合莫沙必利对反流性食管炎的疗效及生活质量。方法选取2010年1月~2014年1月我院治疗的反流性胃炎患者100例为研究对象,随机分为观察组和对照组,每组50例,观察组予埃索美拉唑肠溶片20 mg口服,每日2次,莫沙必利5 mg,饭前30 min吞服,每日3次,对照组予铝碳酸镁1 g,饭前60 min嚼服,每日3次,莫沙必利5 mg,饭前30 min吞服,每日3次,治疗2个月后比较两组的临床疗效及两组患者治疗前的临床症状评分,以及两组患者治疗后的生活质量各项评分。结果观察组与对照组治疗后的总有效率比较,差异有统计学意义(96%vs 78%,P<0.05)。治疗8周后,两组患者的临床症状评分均较治疗前及治疗4周后显著降低(P<0.05),且观察组患者治疗8周后的临床症状评分显著低于对照组(t=2.723,P<0.05)。治疗后观察组患者的生活质量各项评分分别显著高于对照组(P<0.05)。结论埃索美拉唑肠溶片联合莫沙必利可以提高反流性食管炎的疗效,改善患者的临床症状及生活质量。