淋巴瘤样肉芽肿与韦格内肉芽肿临床特点的比较

目的 总结淋巴瘤样肉芽肿病(lym phom atoid granulom atosis,LG)与韦格内肉芽肿( egener granulo Wm atosis,W G)的临床特点,从临床上加以鉴别。 方法 回顾性总结我院与北京协和医院 1989 年以来收治的 6 例 LG和20 例 W G 患者的临床资料,并进行比较。 结果 发热、咳嗽及呼吸困难在 LG 中较常见,流涕、鼻衄及关节痛以W G 为多,肺受累以 LG 为多,耳鼻喉、眼及肾病变在 W G 中明显增多,皮肤受损两者相似。W G 患者常有 c-ANCA 阳性及尿沉渣异常。 LG X 线胸片为双侧多发结节,边界不清,多无肺门、纵隔淋巴结肿大; G 则为双侧多发边界清晰W的结节, 易形成空洞, 肺门和纵隔淋巴结可肿大。LG 病理改变为血管中心性淋巴增生性病变, 浸润的细胞主要是小淋巴细胞和不同数量大的不典型淋巴细胞; 而在 W G 中可见坏死性血管炎及大量中性白细胞、浆细胞及少量嗜酸细胞浸润形成的肉芽肿, 部分有多核巨细胞。W G 经治疗后, 多数患者病情缓解; 则疗效不佳。 结论 LG 和 W G 在临 LG床表现、实验室检查、 影像及病理诸方面的差异有利于两者的鉴别诊断。     

护理人力资源危机管理

随着人力资源的社会化和资源配置市场化的形成，人才流动成为现实和可能，人才已成为一种商品、一种资源、一种无形资本，如人才一旦另择良木而牺，将会大大削弱医院竞争的优势。为此，我们对部分三级医院中的护理人力资源管理中存在的两大危机即人员流失危机和人员梯队危机（临时聘用护士占护理人员总数的50％左右）进行分析，从重视育才、用才、留才及内部员工的安定就业、维护品质着手，采取了行之有效的措施，取得了显著的效果。     

硬膜外穿刺针外套管在腹腔镜小儿斜疝高位结扎术中的应用

目的探讨硬膜外穿刺针外套管在腹腔镜小儿斜疝疝囊高位结扎中的应用价值。方法2003年4月-2006年5月,我院对230例小儿斜疝手术应用硬膜外穿刺针外套管代替雪橇钩针实施腹腔镜疝内环口荷包高位结扎术。结果230例手术均获得成功,手术时间：单侧161例8-10 min,嵌顿疝39例15-20 min,双侧30例16-20 min;术后未见有阴囊水肿及睾血疼痛及缺血坏死。术后随访2-6个月111例,6-12个月52例,12-24个月37例,24-36个月30例,无复发。结论硬膜外刺针外套管可替代小儿疝囊结扎专用的雪橇钩针,简便,经济,适合在所有基层医院推广。     

Performance and comparison of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease formulae in estimating glomerular filtration rate in a Chinese Type 2 diabetic population.

AIMS: Our aim was to assess performances of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease (MDRD) formulae in estimating glomerular filtration rate (GFR) in Chinese diabetic populations and their association with vascular risks. METHODS: A total of 1009 patients with Type 2 diabetes were categorized into low estimated GFR groups (GFR < 60 ml/min/1.73 m(2)) and control groups by the two equations. The performances of these formulae were assessed at different stages of kidney function. Carotid artery intima-media thickness (IMT) and the prevalence of diabetic retinopathy or albuminuria were compared among the groups. The ability of these formulae to identify established vascular risk markers using sensitivity, specificity, positive and negative predictive values were also compared. RESULTS: The prevalence of low estimated GFR was 32.7% with the Cockcroft-Gault formula and 5.2% with the MDRD formula, respectively. In low estimated GFR subjects by the MDRD formula, IMT was significantly thicker than those by the Cockcroft-Gault formula (1.2 mm vs. 1.0 mm; P < 0.05), with a higher prevalence of albuminuria (78.4 vs. 52.8%, P < 0.05) and diabetic retinopathy (46.5 vs. 30.5%; P < 0.05). The Cockcroft-Gault formula gave a specificity of 71.7% and a sensitivity of 37.0%, and the MDRD formula gave a specificity of 96.6% and a sensitivity of 7.9% in estimating low GFR relevant for established vascular risks. CONCLUSIONS: These formulae performed differently in Chinese diabetic populations. The simplified MDRD formula is minimally superior to the Cockcroft-Gault formula for its high specificity and positive predictive values in estimating low GFR relevant for vascular risks.     

Analysis on origin and evolution of mumps]

There was a preliminary recognition on mumps during the Qin-Han to Sui-Tang dynasty, laying a foundation for the scholastic development on this topic in later generations. The title of this disease was identified in Song-Jin-Yuan dynasty with gradual deepening on its principle-method-formula-medication system, a great progress of recognition as compared with the previous ages. In the Ming-Qing dynasty, the recognition became even more systematic, with certain breakthrough in the system of principle-method-formula-medication. In modern age, the experiences were inherited and developed to integrate to modern biomedicine, so that the theory and clinical practice become even more perfect.     

巨噬细胞移动抑制因子与鼻咽癌微血管生成和淋巴结转移的关系

[目的]研究巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MIF)和血管内皮生长因子(vascular endothelial growth factor,VEGF)在鼻咽癌组织中的表达水平及其与肿瘤新生血管的关系,探讨细胞因子在鼻咽癌细胞侵袭转移过程中的作用.[方法]收集1999-2003年期间45例确诊未治的鼻咽原发癌活检组织标本,用LSAB免疫组化法检测鼻咽癌组织中MIF和VEGF表达,计数癌组织中新生血管热区的CD34阳性微血管密度(intratumoral microvessel density,IMD),并将各检测指标与患者的病理及临床资料相联系.[结果]鼻咽原发癌组织中,癌细胞MIF和VEGF的阳性表达率分别为78%(35/45)和71%(32/45),伴有淋巴结转移的癌组织中MIF和IMD水平均高于无淋巴结转移的癌组织,P=0.029,P=0.026,MIF阳性组的IMD计数为(35.1±13.3)/高倍视野,明显高于MIF阴性病例的(20.9±10.2)/高倍视野,P=0.003.以Schmincke型生长方式分布的癌细胞MIF表达水平(67.4%±35.2%)高于以Regaud型方式分布的癌细胞(32.9%±29.7%),P=0.007.癌细胞MIF与VEGF表达以及IMD计数均显示正相关关系,P＜0.05.但癌细胞VEGF的表达与患者性别、年龄、病理组织学分型以及临床分期无统计学显著意义.[结论]MIF在鼻咽癌细胞的淋巴结转移过程中可能具有重要的促进作用,并可能是影响肿瘤性微血管生成和癌细胞VEGF表达的重要因素.     

慢性丙型肝炎患者α干扰素和α干扰素受体1的检测

目的建立检测外周血单个核细胞α干扰素受体1(IFNAR1)及检测诱导表达α干扰素(IFN-α)的方法,评价慢性丙型肝炎患者外周血单个核细胞(PBMC)细胞免疫功能与α干扰素治疗的关系。方法Poly IC体外刺激正常对照组和慢性丙型肝炎病毒(HCV)感染组患者PBMC,利用病毒保护试验研究干扰素治疗前后患者PBMC表达的干扰素抗病毒生物学活性差异;IFN-α治疗前后,RT-PCR检测慢性丙型肝炎患者不同干扰素应答组患者PBMC IFNAR1表达的变化。结果对照组PBMC分泌的干扰素活性显著高于慢性丙型肝炎患者应答组患者(P<0.001);干扰素应答组患者PBMC分泌的干扰素活性随治疗时间延长而增加,治疗1个月后显著高于无应答组患者PBMC分泌的干扰素活性(P<0.01),后者始终处于低下水平;IFN-α治疗期间干扰素应答组患者PBMC IFNAR1水平从治疗前的高表达而逐渐减少,正常对照和干扰素无应答组患者PBMC IFNAR1的表达始终较低。结论慢性HCV感染患者的细胞免疫功能受损,不能正常表达IFN-α,但应答组患者经干扰素治疗后IFN-α表达能力逐渐恢复;干扰素无应答组患者PBMC IFNAR1表达受到严重抑制;慢性丙型肝炎患者PBMCIFN-α活性检测及IFNAR1检测结果也许可以作为干扰素治疗预后的判断指标。     

评估控制性卵巢刺激中预测卵巢反应性的指标

在辅助生育技术的实施中,控制性卵巢刺激(COS)方案是根据患者情况确定的,在用药剂量和启动时间的掌握上非常重要。由于卵巢本身反应性或基础状态的不同,不同年龄及不同病因的患者有着极大的差异,用量适当可避免因启动剂量过大造成卵巢过度剌激(OHSS),或剂量过少造成低反应,卵泡     

Early uptake of 99mTc-C2A in the acute phase of myocardial infarction as a prognostic indicator for follow-up cardiac dysfunction

OBJECTIVE: The C2A domain of Synaptotagmin I is a molecular probe for the specific imaging of cell death. Here we test the hypothesis that the uptake of 99mTc-C2A in the acute phase of an infarction is associated with cardiac dysfunction in follow-ups. METHODS: The left coronary artery was occluded in Sprague-Dawley rats for 0, 10, 20, and 30 min. 99mTc-C2A was injected intravenously at 2 h of reperfusion. Anterior planar images were acquired with one million counts on a gamma camera 3 h after injection. 99mTc-C2A uptake was calculated as the total counts in the left ventricle region minus blood pool signal. The in-vivo signal detected was correlated with wall motion score index at 1 and 3 weeks follow-ups measured by echocardiography. RESULTS: 99mTc-C2A uptake was higher with increased ischemic time (2244+/-852, 4054+/-1223, and 6178+/-1451 for 10, 20, and 30 min ischemia, analysis of variance P<0.001). A significant correlation was found between 99mTc-C2A uptake and wall motion score index at 1 week (R=0.800, P=0.0006) and 3 weeks (R=0.810, P=0.0008). CONCLUSION: In this ischemia/reperfusion model, 99mTc-C2A uptake in the acute phase was associated with functional abnormality at 1 and 3 weeks. This demonstrates the potential diagnostic and prognostic value of 99mTc-C2A as a novel imaging agent.     

迟发性尺神经炎治疗进展

迟发性尺神经炎是发病率仅次于腕管综合征的外周神经嵌压性疾病,发病原因包括肘管自身解剖结构上存在的潜在卡压因素、外伤及肿物等.迟发性尺神经炎保守治疗和手术干预的适应证及疗效各不相同.尺神经解压后深筋膜瓣下带血管前置术在提供柔软的神经床、良好血供、避免复发等方面取得了很好的进展,内镜技术及神经移植亦为该病的治疗提供了新的选择.该文就迟发型尺神经炎的病理、诊断及治疗方面的进展作一综述.