重症胆管炎23例临床治疗分析

目的：探讨急性重症胆管炎患者的手术时机和死亡原因。方法：回顾性分析23例急性重症胆管炎患者的治疗及预后情况。结果：死亡2例（手术死亡及传统治疗死亡各1例）。早期大剂量短期应用糖皮质激素患者休克得到纠正率85％，明显高于未用糖皮质激素患者休克纠正率50％。结论：急性重症胆管炎患者应在出现休克和（或）精神症状之前手术，对已出现休克的患者，应先给予充分的保守治疗，待病情稳定后再手术。贻误手术时机，严重合并症如多器官功能衰竭及高龄是死亡的主要原因。     

Central metabotropic glutamate receptors differentially participate in interleukin-1beta-induced mechanical allodynia in the orofacial area of conscious rats.

The present study investigated the role of central metabotropic glutamate receptors (mGluRs) in interleukin-1beta (IL-1beta)-induced mechanical allodynia and mirror-image mechanical allodynia in the orofacial area. Experiments were carried out on male Sprague-Dawley rats weighing 230 to 280 g. After administration of 0.01, 0.1, 1, or 10 pg of IL-1beta into a subcutaneous area of the vibrissa pad, we examined the withdrawal behavioral responses produced by 10 successive trials of an air-puff ramp pressure applied ipsilaterally or contralaterally to the IL-1beta injection site. Subcutaneous injection of IL-1beta produced mechanical allodynia and mirror-image mechanical allodynia in the orofacial area. Intracisternal administration of CPCCOEt, a mGluR1 antagonist, or MPEP, a mGluR5 antagonist, reduced IL-1beta-induced mechanical allodynia and mirror-image mechanical allodynia. Intracisternal administration of APDC, a group II mGluR agonist, or L-AP4, a group III mGluR agonist, reduced both IL-1beta-induced mechanical allodynia and mirror-image mechanical allodynia. The antiallodynic effect, induced by APDC or L-AP4, was blocked by intracisternal pretreatment with LY341495, a group II mGluR antagonist, or CPPG, a group III mGluR antagonist. These results suggest that groups I, II, and III mGluRs differentially modulated IL-1beta-induced mechanical allodynia, as well as mirror-image mechanical allodynia, in the orofacial area. PERSPECTIVE: Central group I mGluR antagonists and groups II and III mGluR agonists modulate IL-1beta-induced mechanical allodynia and mirror-image mechanical allodynia in the orofacial area. Therefore, the central application of group I mGluR antagonists or groups II and III mGluR agonists might be of therapeutic value in treating pain disorder.     

医院信息系统设计中的安全分析与建模

本文深入到当前的医院信息系统内部,揭示出这些系统中令人不安的却又极其重要的安全问题.通过比较与分析现实中的两个案例,我们逐步构建起有自身特色的可信赖的安全模型并演示了非常具体的实现过程,从而使医院信息系统可以在当今复杂的网络环境中得以生存.     

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.     

Molecular determinants of cetuximab efficacy.

PURPOSE: To investigate whether mRNA expression levels of cyclin D1 (CCND1), cyclooxygenase 2 (Cox-2), epidermal growth factor receptor (EGFR), interleukin 8 (IL-8), and vascular endothelial growth factor (VEGF), all members of the EGFR signaling pathway, are associated with clinical outcome in patients with EGFR-expressing metastatic colorectal cancer (CRC) treated with cetuximab. PATIENTS AND METHODS: Thirty-nine patients with metastatic CRC, refractory to both irinotecan and oxaliplatin, were enrolled on IMCL-0144 and treated with single-agent cetuximab. The intratumoral mRNA levels of CCND1, Cox-2, EGFR, IL-8, and VEGF were assessed from paraffin-embedded tissue samples using laser-capture microdissection and quantitative real-time polymerase chain reaction. RESULTS: There were 21 women and 18 men with a median age of 64 years (range, 35 to 83 years). Higher gene expression levels of VEGF were associated with resistance to cetuximab (P = .038; Kruskal-Wallis test). The combination of low gene expression levels of Cox-2, EGFR, and IL-8 was significantly associated with overall survival (13.5 v 2.3 months; P = .028; log-rank test). Both findings were independent of skin toxicity that was itself significantly correlated to survival. Patients with a lower mRNA amount of EGFR had a longer overall survival compared with patients that had a higher mRNA amount (7.3 v 2.2 months; P = .09; log-rank test). Patients with lower expression of Cox-2 had a significantly higher rate of grade 2 to 3 skin reactions under cetuximab treatment. CONCLUSION: This pilot study suggests that gene expression levels of Cox-2, EGFR, IL-8, and VEGF in patients with metastatic CRC may be useful markers of clinical outcome in single-agent cetuximab treatment.     

早期DSA检查对蛛网膜下腔出血的临床意义

蛛网膜下腔出血（subarachnoid hemorrhage，SAH）是临床发病率和死亡率均较高的急性脑血管病之一，并呈逐年增高趋势。随着神经介入影像学的发展，对急性SAH患早期（72h内1开展数字减影血管造影（digital subtraction angiography．DSA）检查，使SAH的早期病因诊断及病因治疗成为可能，患的预后也得到显改善。我院自2003年1月至2006年4月收治96例SAH患行早期DSA检查并给予相应的病因治疗．取得较好的临床疗效。现将有关资料与临床治疗总结报道如下。[第一段]     

Uncooked rice of relatively low gelatinization degree resulted in lower metabolic glucose and insulin responses compared with cooked rice in female college students

Cooking processes that gelatinize granules or disrupt structure might increase the glucose and insulin responses because a disruption of the structure of starch by gelatinization increases its availability for digestion and absorption in the small intestine. We hypothesized that the uncooked form of rice, which has a relatively low degree of gelatinization even though in powder form, would result in lower metabolic glucose and insulin responses compared with cooked rice (CR). To assess the effects of the gelatinization of rice on metabolic response of glucose and insulin, we investigated the glucose and insulin responses to 3 rice meals of different gelatinization degree in female college students (n = 12): CR (76.9% gelatinized), uncooked rice powder (UP; 3.5% gelatinized), and uncooked freeze-dried rice powder (UFP; 5.4% gelatinized). Uncooked rice powders (UP and UFP) induced lower glucose and insulin responses compared with CR. The relatively low gelatinization degree of UPs resulted in low metabolic responses in terms of the glycemic index (CR: 72.4% vs UP: 49.7%, UFP: 59.8%) and insulin index (CR: 94.8% vs UP: 74.4%, UFP: 68.0%). In summary, UPs that were less gelatinized than CR induced low postprandial glucose and insulin responses.     

王成荣治疗子宫内膜异位症“火热致瘀”理论探讨

王成荣研究员长于以中医药诊治子宫内膜异位症（EMT），根据其临床经验认为“火热致瘀”是EMT的基本病因、病机，且火热与瘀血互为因果、恶性循环，致使EMT病程缠绵不愈、反复复发。王老据此提出“清热解毒、化瘀散结”的治疗法则，为治疗EMT开辟了另一思路和理论。     

HPLC法测定滑膜炎颗粒中原儿茶醛的含量

目的建立滑膜炎颗粒剂中原儿茶醛的含量测定方法质量。方法采用高效液相色谱法对方中原儿茶醛进行含量测定。结果高效液相色谱法测定结果表明原儿茶醛在0．1005～1．005μg范围内呈线性关系，平均加样回收率为99．22％；RSD为0．72％。结论本法简便，重现性好、结果可靠，可作为控制滑膜炎颗粒剂的质量方法。     

荧光示踪法研究逆行岛状皮瓣静脉回流

目的探讨采用荧光示踪法研究逆行岛状皮瓣静脉回流的可行性，并初步观察静脉回流规律。方法20只新西兰大白兔，每只取耳静脉血0．ImL，分离RBC并用FITC标记。流式细胞仪检测已标记的RBC阳性率及荧光强度，倒置荧光显微镜观察其形态。取20只新西兰大白兔，在动物双侧后肢内侧分别建立4cm&#215;3cm隐动、静脉逆行岛状皮瓣模型（n=10）和顺行岛状皮瓣模型（n=10），血管蒂长3cm。将一侧后肢随机设定为实验组，皮瓣制备后注射已标记的RBC悬液5pL；对侧为对照组，不注射示踪剂。实验组按顺行和逆行皮瓣分成两组，即顺行皮瓣组和逆行皮瓣组，每组10个；再根据注入示踪剂途径不同，分为动脉和静脉2个亚组，每亚组5个皮瓣。注射示踪剂5S后取下皮瓣立即冷冻，取连续的3张冰冻切片（5～7pm），其中2张行HE染色和GENMED染色，另]张不染色直接压片，荧光显微镜观察荧光分布。结果流式细胞仪分析FITC标记的RBC阳性率在99％以上，荧光强度均≥10。；倒置荧光显微镜下标记的RBC呈均匀分布的绿色荧光，荧光强度均匀、稳定。冰冻切片显示实验组皮瓣蒂部均出现荧光，对照组未见荧光。顺行岛状皮瓣组荧光主要分布在静脉腔、静脉壁、动脉内膜和外膜；逆行岛状皮瓣组荧光分布在动脉内膜、外膜和静脉壁。结论荧光示踪剂可用于静脉回流研究，顺行岛状皮瓣静脉主要通过静脉腔、静脉壁、动脉内膜和外膜回流；逆行岛状皮瓣静脉主要通过动脉内膜、外膜和静脉壁的“迷宫式途径”回流。