APTT测定值和APTT测定值比率的临床应用价值探讨

目的;探讨APIT测定值(秒)和APIT测定值比率中哪一种是更稳定、更可靠的临床应用指标。方法:将同一标本采用法国STA-Compat全自动血凝仪以及两种手工法同时测定,比较同组标本不同方法的APTT测定值(秒)和APTT测定值比率。结果:手工法(一)与法国STA-Compact全自动血凝仅比较,如APTT值以秒表示,对照组、口服抗凝剂组及肝病组病人同组标本不同方法之间存在显著性差异(P<0.01,P0.10,P>0.50,P>0.05);手工法(二)与法国STA-Compact全自动血凝仪在对照组、口服抗凝剂组及白血病组的比较中,也获得类似的结果。结论:将APTT测定值(秒)转化为病人与对照APTT测定值比率报告,使不同方法结果间更具可比性。在APTT报告的标准化方面,建议将APTT和APTT测定值比率同时报告。     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.     

细胞移植用于心肌修复--细胞心肌成形术的研究进展

由于心肌细胞的增殖能力很低，细胞移植作为一种新的治疗方法用于改善心功能及心肌活力已受到广泛的关注。目前已有胚胎干细胞、骨髓间充质干细胞和内皮干细胞在体外诱导分化为心肌细胞；动物实验中用于心肌移植的细胞有胚胎心肌细胞、造血干细胞、骨髓间充质干细胞、骨骼肌成肌细胞、内皮干细胞、肝干细胞和神经干细胞。其中成肌细胞移植用来改善心肌梗死后的心脏功能，已有临床报道，并取得成功。     

Pulmonary resection for metastases from colorectal cancer

Aim: The prognosis of patients with disseminated colorectal carcinoma is poor except for those with single organ pulmonary or hepatic metastases. The objective of the present study was to evaluate the result of pulmonary metastasectomy for colorectal secondary and to identify the prognostic factors. Methods: This was a retrospective study of 80 patients who had pulmonary metastasectomy for pulmonary secondary from colorectal carcinoma in Queen Elizabeth Hospital, Hong Kong. Results: The overall 5‐year and 10‐year survival rates of the entire cohort were 42.5% and 35.5%, respectively. High premetastasectomy carcinoembryonic antigen (> 20 μg/dL), short disease‐free interval (< 12 months) and incomplete resection were the independent prognostic factors. Neither the characteristics of the primary colorectal tumour nor the number of metastatic nodules had a significant contribution to the long‐term survival. Six patients underwent second pulmonary metastasectomy and three were still free from tumour recurrence after the second operation. Conclusion: Patients with pulmonary metastases from colorectal carcinoma would benefit from pulmonary metastasectomy. High premetastasectomy carcinoembryonic antigen and short disease‐free interval were negative predictive factors for survival. Long‐term follow‐up study is required, as recurrence can occur more than 5 years after pulmonary metastasectomy. Also, whether the survival benefit is due to surgical treatment effect or lead‐time bias remains undecided.     

Reduced expression of CD69 and adhesion molecules of T lymphocytes in asthmatic children receiving immunotherapy

T lymphocytes play a fundamental role in the initiation and regulation of chronic inflammatory responses in patients with asthma. CD69 is an early marker of T‐cell activation. The levels of intercellular adhesion molecule‐1 (ICAM‐1, CD54) and L ‐selectin have been reported to increase in patients with allergic diseases and asthma. The present study was therefore undertaken to investigate the expression of CD69, CD54, and L ‐selectin by T lymphocytes of children with asthma, before and after immunotherapy. Eighteen children newly diagnosed with asthma, 11 good and nine poor responders to immunotherapy, and 16 normal subjects, were enrolled in this study. The percentages of CD69⁺, CD54⁺, and CD62L⁺ cells in T lymphocytes were measured by using flow cytometry. The levels of CD69, CD54, and CD62L in serum and culture supernatants were determined by using enzyme‐linked immunosorbent assay (ELISA). The expression of CD69 and CD54 on CD3⁺ T lymphocytes was significantly higher in children with asthma than in control patients. All the patient groups expressed (spontaneously and following stimulation with phorbol myristate acetate and ionomycin together with mite‐extract proteins) greater amounts of CD69 and CD54 than did control subjects. With long‐term immunotherapy, the percentages of CD69⁺ and CD54⁺ T lymphocytes were significantly lower in patients with a good response to immunotherapy. Our results also showed significantly lower serum L ‐selectin levels following immunotherapy. In conclusion, successful immunotherapy resulted in decreased expression and production of CD69 and CD54. These results may explain, in part, the clinical efficacy of immunotherapy.     

海岛中学生心理卫生特点及相关因素分析

目的 了解海岛中学生的心理健康状况及其相关因素。方法 随机分层整群抽取海岛城镇2243名中学生，采用自制的一般情况问卷、90项症状清单及艾森克人格问卷进行测试，用SPSS软件包进行统计分析。结果 海岛城镇中学生中的非独生子女比独生子女、高中生比初中生、女生比男生、家庭居住在渔农村比居住在城镇的中学生心理健康水平要低。他们的心理障碍的发生率和SCL-90各项因子分与国内大陆某些地区的报道有所不同，本文中学生的个性特征与SCL-90各项因子分的相关分析表明海岛城镇中学生的心理健康状况与性格的内外倾向、掩饰作用呈负相关，与心理变态倾向、情绪稳定性呈正相关。本文男女生的心理障碍的发生率为16％～47％，以强迫症状为最显著。结论海岛中学生心理障碍的发生率较高，并且与大陆其它地区中学生心理健康状况有所不同。     

生物活性陶瓷与细胞外基质骨形成对Ca、P、ALP影响

目的：通过钙(Ca)、磷(P)及碱性磷酸酶(ALP)评价，探讨生物活性陶瓷及细胞外基质与骨细胞相互作用机理，为骨替代材料成骨效应提供依据。方法：选用多种材料进行蒸馏水及血浆接触，体外成骨细胞培养及体内骨诱导试验。采用原子吸收，钼蓝比色及速率法分析化学性能，血浆、细胞冻溶液及组织匀浆中Ca、P、ALP的变化规律。结果：材料组体内、外接触Ca、P、ALP值高于对照组。细胞外基质复合材料组高于相应的非复合材料组。TGF-β1加材料高于BMP复合材料组，而不同材料有所不同，TCP材料高于其它材料。结论：生物活性陶瓷材料均有不同程度的Ca、P离子释放，细胞外基质及Ca、P离子可提高成骨细胞活性，异位骨形成及ALP活性。     

脑创伤致迟发性脑梗死临床分析

目的探讨脑创伤后迟发脑梗死的发生机制,临床诊断及救治措施。方法对32例经影像学证实为颅脑创伤后迟发脑梗死患者的临床资料进行回顾分析。结果出院时按GOS标准评价:恢复良好12例、中残5例、重残4例、植物生存3例,死亡8例,其中非手术治疗20例,存活14例,死亡6例,死亡率30%;手术治疗12例,存活10例,死亡2例,死亡率17%。结论及时诊断与合理有效的治疗是提高脑创伤后迟发性脑梗死的治愈率及提高患者生存质量的关键。     

腰椎间盘突出症治疗方法与肌电图变化的相关性研究

腰椎间盘突出症(lumbar disc herniation，LDH)是导致腰腿痛的主要病因，本研究对具有典型临床症状、相应体征及MR或CT等影像学资料确诊的LDH，采用规范化非手术治疗，经规范化保守治疗无效者选用手术治疗，治疗前后均行肌电图(elec-tromyograptly，EMG)检查，旨在探讨肌电图变化与治     

立体定向开放显微手术治疗脑内致痫小病灶

目的脑内致癫痫小病灶术前、术中的精确定位和病灶切除,是手术治疗效果的关键。探讨立体定向开放微创手术,皮层电极监测下切除脑内致痫小病灶的手术方法。方法53例症状性癫痫病例,CT、MR I检查有脑内小病灶(直径在0.5~3.0 cm),24 h视频脑电图确认致痫灶为脑内单发病灶。ASA 601S型立体定向仪CT引导辅助全麻环钻开颅,导针穿刺放置导管引导,显微镜下手术分离、切除病灶,皮层脑电图确认将致痫灶切除。结果病灶全切率达96.2%,术后50例得到随访,随访时间5~12个月,平均6.3个月,癫痫消失45例,脑电图检查记录到癫痫波11例,临床癫痫发作5例。因肺癌死亡3例。结论CT立体定向引导,显微手术切除颅内致痫小病灶,术中皮层电极确认将致痫灶切除,是一种定位精确、微创、安全、有效的治疗方法。