以持续高热首发症状的肺鳞癌1例报告

1　临床资料患者 ,男 ,32岁因高热 1个月 ,咳嗽 7天于 2 0 0 2年 11月 13日院。曾于我院门诊抗炎治疗效果不佳。入院时查体 ;体温 39.3℃ ,脉搏 96min- 1,呼吸2 0min- 1,BP130 / 80mmHg ,急性热病容 ,咽部充血 ,双肺呼吸音粗 ,未闻及干湿性罗音。血常规 :白细胞13.4× 10 9L ,中性粒 0 .84 2。肝功能 :ALT83U/L ,GGT179U/L ,CHE395 3U/L。HBsAg (+) ,抗 -HBc(+)。胸部X线示心、肺、隔未见异常。胸部CT示双肺CT未见明显异常 ,少量心包腔积液。B超示少量胸腔积液 ,少量心包腔积液。腹部B超及肝脏CT均提示 :肝硬化 ,脾功能亢进。…     

西安市家庭医生对签约服务认知及满意度分析*

目的从社区家庭医生的视角,探究其对家庭医生签约服务的认知、对所在社区工作的满意度。方法采用随机整群抽样方法,对西安市17家社区卫生服务中心全部103名家庭医生进行调研,运用卡方检验和相关分析对满意度的10个维度及相互关系进行分析。结果有16.4%的家庭医生表示不明确其工作职责,28.21%的家庭医生认为家庭医生工作的价值与意义一般,30.1%的家庭医生对职业发展缺乏信心,不太看好家庭医生的未来发展前景;被调查家庭医生认为居民不愿接受家庭医生签约服务的主要原因是对家庭医生服务能力缺乏信任。推进家庭医生签约服务,应该加强政策宣传,提高家庭医生业务能力,以及提高家庭医生待遇。政策建议加大政府投入,完善经费管理;加强宣传力度,提高认知水平;加强家庭医生人才培养、引进;完善激励机制,调动家庭医生工作积极性;各方联动,完善配套措施。     

高密度脂蛋白防治动脉粥样硬化的新进展

<正> 研究证实,HDL与冠心病风险呈负相关,同时,HDL潜在的抗动脉粥样硬化(AS)功能,使其成为AS性心血管疾病预防和治疗的主要靶向。但是2007年ILLUMINATE研究结果显示,胆固醇酯转运蛋白(CETP)抑制剂torcetrapib虽然能大幅增高HDL-C水平,但是torcetrapib组的死亡人数反而较对照组增多,差异有统计学意义,使研究被迫提前终     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.     

肾移植患者血清中可溶性B7-H3水平的变化及其临床意义

Objective To detect the serum soluble B7-H3 (sB7-H3) in patients before and after renal transplantation, and to investigate the clinical significance. Methods The serum level of sB7-H3 in 34 patients were determined before and 3, 6, 12 months after renal transplantation. Besides, 11 health adults were elected as controls. These 34 patients were divided into two groups according to HLA and/or MICA antibodies using Luminex before operation. After transplantation, all the patients were divided into two groups according to their conditions; group Ⅰ with rejection; group S with stable renal function and no rejection. Results The serum level of sB7-H3 in all 34 patients before operation was significantly higher than health controls [(27. 10 ± 13. 61) μg/L,n = 34 vs (11.61 ±3.77) μg/L,n = 11 ,P ＜0. 01], and significantly higher in patients with antibodies than in those without before operation [(34. 96 ± 17. 37) (μ/L, n = 11 vs (23. 34 ± 9. 75) (μg/L, n = 23, P ＜ 0. 05]. There was no significant difference in the serum level of sB7-H3 between control group and S group after operation (P ＞0. 05). In group Ⅰ, the serum level of sB7-H3 was increased obviously when rejection occurred [(20. 63 ±4. 28) μg/L,n = 12; (18. 95 ±2.98) μg/L,n=6; (28.36 ±19. 83) μg/L,n = 10] , as compared with group S and control group (P＜0. 01), while at the time without rejection, there was no difference among them (P ＞0. 05). Conclusion Monitoring serum sB7-H3 after renal transplantation would be clinically useful in indicating therapeutic effect and outcome of the patients.     

失功能高密度脂蛋白的诊断方法新进展

既往流行病学认为,高密度脂蛋白胆固醇(HDL-C)水平与冠心病风险呈负相关,血清HDL-C是预测心血管事件发生率的重要指标.NCEPATPⅢ把HDL-C＜40 mg/dl当作冠心病的独立危险因素;认为每升高1 mg/dl就能降低2%～3%冠心病发病率.但升高HDL水平就能很好的降低冠心病的风险吗?CETP抑制剂torcetrapib虽然能升高HDL-C水平,但研究结果却发现其增加了患者心脏事件发生率和全因死亡率[1].     

高血压病患者心血管功能变化特点的研究

目的 应用脉搏波检测技术探讨高血压病患者心血管功能的改变.方法 将106例高血压病患者按血压水平分为高血压病1、2、3级组,并将62例健康体检者设为正常对照组,分别检测各组心血管功能.结果 与正常对照组相比,高血压病组、高血压病1级组、高血压病2级组、高血压病3级组患者的每搏输出量[(114±25)ml、(117±24)ml、(111±21)ml、(112±31)ml比(95±25)ml]、心脏指数[(5.1±0.9)L/min·m2、(5.2±0.8)L/min·m2、(5.4 ±0.8)L/min·m2、(4.8 ±0.8)L/min·m2比(4.6±1.0)L/min·m2]、左心室舒张末压[(18±7)mm Hg(1mm Hg=0.133 kPa)、(15±6)mm Hg、(20±4)mm Hg、(20±8)mm Hg 比(12±4)mm Hg]、肺毛细血管楔嵌压[(18±7)mm Hg、(15±6)mm Hg、(20±4)mm Hg、(20±8)mm Hg比(12 ±4)mm Hg]、平均动脉压[(131±16)mm Hg、(119±6)mm Hg、(132±8)mm Hg、(151±13)mm Hg比(95±11)mm Hg]、肺动脉压[(30±11)mm Hg、(26±10)mm Hg、(33 ±7)mm Hg、(34±13)mm Hg比(20±7)mm Hg]、还原血黏度[(4.33±0.94)mPa·s、(4.10±0.85)mPa·s、(3.95±0.69)mPa·s、(5.08±0.90)mPa·s比(3.76±0.73)mPa·s]等均增高(P＜0.05);血管弹性扩张系数[(0.65±0.34)、(0.68±0.35)、(0.57±0.22)、(0.66±0.40)比(0.49±0.28)]、血管顺应度[(1.10±0.31)、(1.30±0.29)、(0.94±0.15)、(0.90±0.23)比(1.39±0.21)]较正常对照组明显降低(P＜0.01).结论 脉搏波检测技术作为临床心血管功能的检验手段之一,具有一定的应用价值.     

呋喃西林与生理盐水气囊上冲洗预防呼吸机相关性肺炎的对比

0引言2005-05／2007-08,我们对中心ICU行气管切开机械通气的患者,在常规治疗的基础上,对气管切开气囊上滞留物进行吸引并用两种不同的冲洗液进行冲洗,对VPA的预防取得了一定的效果．     

运用新的体视学方法研究大鼠胼胝体及胼胝体额区有髓神经纤维

目的 建立定量研究胼胝体体积及胼胝体额区有髓神经纤维的体视学方法 .方法 运用卡瓦列里原理计算胼胝体和胼胝体额区体积.采用随机抽样原则在胼胝体额区切取组织块,用"球切法"保证满足三维空间内各向同性抽样原则后,用超薄切片机切取60 nm厚的超薄切片,在透射电子显微镜下从每张切片随机拍摄4个视野.使用无偏计数框计算胼胝体额区有髓神经纤维长度密度,使用等距测试点计算胼胝体额区有髓神经纤维体积密度.胼胝体额区内有髓神经纤维的长度密度和体积密度分别乘以胼胝体额区的体积就得到了胼胝体额区内有髓神经纤维的总长度和总体积.测量所有被无偏计数框计数的有髓神经纤维的直径.与纤维断面的最长轴相垂直的所有横轴中最长的1条横径为其直径.结果 大鼠胼胝体的体积为(70.67±5.64)mm3,胼胝体额区体积为(15.29±1.62)mm3,胼胝体额区有髓神经纤维的总长度为(16.01±2.28)km,胼胝体额区有髓神经纤维的总体积为(9.11±0.44)mm3,胼胝体额区有髓神经纤维髓鞘的总体积为(3.91±0.40)mm3.胼胝体额区有髓神经纤维的直径为(0.58±0.05)μm.结论 本研究建立了定量研究胼胝体体积和胼胝体额区内有髓神经纤维总长度、总体积和有髓神经纤维直径的研究方法 .