重度烧伤患者休克期血浆B型钠尿肽含量变化及意义

Objective To study the plasma content of B-type natriuretic peptide (BNP) in patients with severe burn during shock stage and probe its clinical significance. Methods Forty-two patients aged 18-60 years, with total burn surface area ≥30%TBSA or full-thickness burn area ≥10% TBSA, hospital-ized within 4 hours after burn, were divided into A group (with total burn surface area 30% -50% TBSA or full-thickness burn area 10% -20% TBSA, n = 21 ), and B group (with total burn surface area 50% TB-SA or full-thickness burn area > 20% TBSA, n = 21 ). Twenty patients admitted during the same time for plastic surgery were enrolled as control group. The plasma levels of BNP, creatine kinase (CK), CK-MB, troponin I (Tnl) of all patients were determined on admission. The levels of BNP, Tnl and fluid resuscita-tion volume were examined at 8, 16, 24, 48 post burn hour (PBH) in A and B groups. Analysis of correla-tion between BNP and fluid resuscitation volume was performed. Results On admission: BNP level in A group (68±19 ng/L) and B group (99±38 ng/L) , respectively, was increased as compared with that in control group (17±7 ng/L, P <0.01 ). Tnl level in A group (2.13±0.67 μg/L) and B group (2.98± 0.58μg/L), respectively, was increased as compared with that in control group (0.12 ± 0.03 μg/L, P < 0.01). There was no obvious difference in CK, CK-MB levels among A, B, and control groups ( P > 0.05). BNP levels in A, B groups continuously rose during 8 - 48 PBH, and they were positively correlated with fluid resuscitation volume. TnI level peaked at 24 PBH, and decreased at 48 PBH. Conclusions The plasma level of BNP is sensitive to reflect changes in myocardial ischemia and hypoxia as a rise in level of TnI in shock stage of severe burn, and it was positively correlated with fluid resuscitation volume. BNP can be used to guide fluid resuscitation during shock stage.     

急性脑梗死后血浆NO、NOS、ET含量的动态变化及尼莫地平对其影响

目的　观察急性脑梗死 (ACI)后血浆一氧化氮 (NO)、一氧化氮合成酶 (NOS)、内皮素 (ET)含量的动态变化 ,以及尼莫地平治疗后对其影响。方法　ACI患者 110例 ,随机分成尼莫地平组 (5 0例 ) (在常规治疗基础上用尼莫地平 )和常规治疗组 (6 0例 )。在发病后不同时点动态观察血浆NO、NOS、ET含量 ,并设 5 0例脑动脉硬化患者为对照组。结果　脑梗死后血浆ET含量显著升高 ,直至恢复期 ;NO、NOS先增高后下降 ;尼莫地平组和常规组比较ET有显著差异 (P <0 .0 1) ,NO、NOS差别不显著 (P >0 .0 5 )。结论　NO、NOS、ET参与并影响了ACI后复杂的病理生理过程 ;尼莫地平部分通过对ET含量的影响发挥其对脑梗死的治疗作用     

勃起功能障碍基因治疗研究进展

近年来基因治疗被尝试用于勃起功能障碍(ED)治疗的动物实验,许多研究发现基因治疗方案对各种类型的ED均有一定的治疗作用。特别是在左旋精氨酸-一氧化氮-环磷酸鸟苷通路、离子通道、勃起神经和海绵体血管内皮细胞的修复保护等方面的基因治疗研究显示,基因治疗ED有一定的疗效。但应用基因治疗来治疗ED患者,目前仍有较多的困难,暂时无法应用于临床。本综述旨在对该领域的最新研究进展做一个简单的介绍和展望。     

In-vitro fertilization and the ovarian hyperstimulation syndrome.

Eight patients who developed severe ovarian hyperstimulation syndrome (OHSS) were identified among 1302 patients undergoing in-vitro fertilization (IVF) over a 1 year period (prevalence of 0.6%); 63% had ultrasonically diagnosed polycystic ovaries (PCO) and 75% were undergoing their first attempt at IVF. Pretreatment with a superactive luteinizing hormone-releasing hormone (LHRH) analogue significantly increased the prevalence of severe OHSS (1.1% versus 0.2%, P less than 0.05) compared with ovarian stimulation with clomiphene citrate and human menopausal gonadotrophin (HMG). The mean serum oestradiol concentration on the day of human chorionic gonadotrophin (HCG) administration was 8200 +/- 2300 pmol/l. A mean of 19.6 +/- 6.8 follicles had been aspirated and 13.1 +/- 7.7 oocytes recovered at transvaginal ultrasound-directed oocyte recovery. All patients had an embryo transfer and luteal support in the form of HCG. The clinical pregnancy rate was 88%, multiple pregnancy rate 71% and implantation rate 63.5 +/- 41.3%. In a group of seven patients who were hospitalized for moderate OHSS during the same period, peak oestradiol levels were significantly lower than in those with severe OHSS (P less than 0.05). Of the group with moderate OHSS, 57% had PCO, the clinical pregnancy rate was 100% and multiple pregnancy rate 43%. Patients with ultrasound-diagnosed PCO have an increased risk of developing OHSS and the dose of HMG administered to them should be minimized. In patients at risk of developing OHSS, progesterone instead of HCG should be used for luteal support. Transfer of a maximum of two embryos or freezing all embryos for transfer in a subsequent cycle may reduce the likelihood of multiple pregnancy.     

The hepatitis B immunization programme in Singapore

A voluntary immunization programme to prevent perinatal transmission of hepatitis B virus (HBV) infection in Singapore was implemented on 1 October 1985 as an integral component of the national childhood immunization programme. Up to April 1988, a total of 68,845 mothers who attended government maternal and child health clinics were screened for the disease. Of these, 2432 (3.5%) were positive for hepatitis B surface antigen (HBsAg) and 904 (1.3%) for hepatitis B e antigen (HBeAg). Virtually all the babies born to carrier mothers completed the full immunization schedule; and in addition, those of HBeAg-positive mothers were given a dose of hepatitis B immunoglobulin at birth. The hepatitis B immunization programme was extended on 1 September 1987 to cover all newborns. About 90% of the 15,943 babies delivered in government institutions from September 1987 to April 1988 were immunized at birth, with the subsequent doses being administered at maternal and child health clinics at 4-6 weeks and 5 months later. More than 85% of the children given the full course of plasma-derived and yeast-derived hepatitis B vaccine from birth continued to have protective antibody to HBV two years after immunization. The programme is being closely monitored to assess the duration of immunity and the need for booster doses, while seronegative adults are also being encouraged to be vaccinated.     

围产儿与儿童胸腺的病理改变

The most outstanding pathological changes of perinatal babies and children, based on the review of the autopsy files in the 1st Affiliated Hospital of West China University of Medical Sciences, are lymphocytic depletion, and reticuloepithelial cell swelling and/or fusiform malformation in the cortex, while in the medulla apoptosis is more prominent. We suppose that these alterations are due to immaturity of cortical thymocytes, and in the diseased condition, they are easily affected by extraordinary factors, especially the influence of corticosterone inducing acute severe necrosis, so the number of lymphocytes are obviously diminished. But, in the medulla, as intact mature lymphocytes exist, physiological phenomenon such as apoptosis is rather prominent in it. While in the medulla, Hassall's corpuscles have various characteristic changes, such as cornification, calcification, fusion, cystic change and disintegration. Besides, we observed a new alteration in the thymus defined as vacuolization. All the above pathological changes reached the peak in the 28- day group; there after, they might become either worse or better according to the condition of the disease and growth of the body. However, these are still problems to be further studied separately.     

卫生院改革中的"软法"运行现状及功能实现

乡镇卫生院改革是一项关乎农村稳定、农民安康的工程。从既有的工作轨迹及发展趋势来看,这项改革是在以“两办(中共中央办公厅、国务院办公     

基于64层CT对心脏体模冠脉狭窄成像的客观评估方法

本文设计了一种心脏冠脉狭窄程度的客观评估方法，并自行开发了工具软件对图像数据进行自动处理和计算。此后，本文采用该方法对四组心脏动态体模冠脉狭窄成像的数据进行了分析，对该客观评估方法各方面的特性进行了检验和评定。