运用中医理论探讨冠心病的发作时间与护理

目的运用子午流注学说,针对冠心病病例的病情变化与时辰的关系实施择时护理,并观察其疗效。方法将90例冠心痛住院患者随机分为观察组（择时护理）和对照组（随机护理）,对2种护理方式的效果进行比较分析。结果冠心病的反复率方面,观察组低于对照组,且并发症发生率降低（P〈0．01）,有显著性差异。结论在中医理论指导下的冠心病调护,对提高治疗的有效率起到了一定的作用。     

Hybrid Endovascular Aorta Repair with Simultaneous Supra-aortic Branch or Iliac Branch Revascularization

Objective To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. Methods From June 2007 to May 2008, 5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique. Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft. Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type III aortic dissection case. The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft, then total aortic arch and descending artery was occluded with stent-graft. The left carotid artery to the left subclavian artery bypass was created in 1 case, followed by stent-graft deployment. Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route, then hybrid procedure was performed with bifurcated stent-graft. All stent grafts were deployed via a retrograde femoral artery approach in 5 patients. Results Technical success with complete aneurysmal exclusion was achieved in all patients. There was no incidence of encloleak. During a follow-up period of 2 to 10 months, documented perioperative neurologic events did not occur in all patients. One patient suffered from adult respiratory distress syndrome. After received tracheostomy, he recovered later. There was one death resulting from a postoperative myocar- dial infarction. Conclusion Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.     

胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes(T2DM).Methods Bone fracture patients with T2DM were randomly divided into three groups:continuous subcutaneous insulin infusion group(insulin aspart,group CSII,n=20),glargine treatment group(insulin aspart+insulin glargine,group GA,n=20),and NPH treatment(insulin aspart+rh-insulin,group NA,n=20).The levels of fasting plasma glucose(FPG)and the 2 hours postprandial glucose(2h PG),blood glucose fluctuation(BGF),insulin dosage(ID),good effective time(GET),incidence of hypoglycemia,dawn phenomenon and infection,average time of stitches removal(ATSR),average hospitalized length(AHL)of three groups were compared.Results FPG and 2hPG,ID in group CSII[(6.32±1.18)mmol/L,(7.72±1.53)mmol/L,(35.40±1.60)IU]and group GA [(6.25±0.88)mmol/L,(7.32±1.17)mmol/L,(36.20±0.80)IU]were significantly lower than those of group NA [(7.44±1.36)mmol/L,(8.52±0.76)mmol/L,(40.50±2.40)IU,all P<0.05],simulaneously,BGF,GET incidence of complications,ATSR,AHL of group CSII and GA were significantly lower than those of group NA(all P<0.05).There were not significant difference between group CSII and group GA.Compared with group CSII,group GA had less costs in-hospital and better practicability.Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively,safely,rapidly and stablely control hyperglycemia.and might be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.     

Sonographic biometry of spleen among school age children in Nsukka,Southeast, Nigeria

Background

Normative value of spleen size among school age children is important for objective assessment of the spleen.

Objectives

This study was aimed at determining sonographically the normal limits of the spleen size according to age, sex, and somatometric parameters among school age children.

Methods

A cross sectional study was done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6 – 17 years. The subjects were recruited from some primary and secondary schools within Nsukka metropolis and also from out patients in the study centre. A pilot study was done to determine the intra- and inter rater reliability of sonographic measurements of the spleen. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen sizes were obtained with the subject in a right lateral decubitus position.

Results

Measurement of spleen length was reliable while measurement of spleen width was less reliable within and between sonographers. Dimensions of the spleen were not statistically different in boys and girls (p > 0.05). Height correlated best with spleen dimensions.

Conclusions

Normogram of the spleen size with respect to height is important in the determination of some pathology associated with changes in its size.     

D-penicillamine in the treatment of eosinophilic fasciitis: case reports and review of the literature

Eosinophilic fasciitis (EF) is a rare disease characterized by symmetrical thickness and hardening of the skin, especially localized to forearms and thorax, with eosinophilia. Corticosteroids represent the first-line therapy, even if some patients are scarcely responsive and/or may develop important side effects due to long-term treatment. Here, we describe three cases of EF, two of them refractory to previous steroid therapy, successfully treated with D-penicillamine. The present clinical observations together with the updated review of the literature suggest usefulness of D-penicillamine in EF patients, as well as its potential steroid-sparing value.     

宫颈癌及其癌前病变组织NET-1基因蛋白的表达及意义

目的:探讨宫颈癌及其癌前病变组织中NET-1基因蛋白的表达及意义。方法:应用免疫组化S-P法对50例宫颈鳞癌组织、36例宫颈上皮内瘤样病变(CINⅠ～Ⅲ级)及5例正常宫颈组织中的NET-1基因蛋白进行检测。结果:NET-1基因蛋白在正常宫颈组织中不表达,在CINⅢ中表达显著高于CINⅠ和CINⅡ(均P<0.01);在CINⅢ和宫颈癌中的表达阳性率分别为78.57%、76.00%,两组比较无显著差异(P>0.05);NET-1表达阳性率及阳性强度与宫颈癌淋巴结转移呈显著正相关(P<0.01)。结论:NET-1过表达可能是宫颈癌发生的早期分子事件,可作为CIN病情监测、处理的辅助指标;NET-1高表达赋予了癌细胞更显著的侵袭、转移潜能。     

肝动脉栓塞致胃粘膜损伤的实验研究

目的研究肝动脉栓塞致胃粘膜损伤的机制．方法日本大耳白兔３２只，随机分为３组：正常组８只，假手术对照组８只，肝动脉栓塞组１６只．用超液态碘油制兔部分肝动脉栓塞模型．在手术前后，用放免法测定其血浆中内皮素（ＥＴ）水平，直接穿刺门静脉测压，激光多谱勒血流仪测定其胃粘膜血流量（以电压Ｖ表示），并观察胃粘膜组织形态学改变．结果肝动脉栓塞术后３ｄ和６ｄ兔血浆ＥＴ（ｎｇ／Ｌ，２１５±３５，２１５±４７）显著高于假手术对照组（１５５±２８，１４６±２８，Ｐ＜００１）．肝动脉栓塞术后６ｄ，其门静脉压力（ｋＰａ，１０９±０１０）明显高于对照组（０８５±００７，Ｐ＜００５）．胃粘膜血流量（３６４Ｖ±０７７Ｖ）显著低于正常组（４８１Ｖ±０４２Ｖ，Ｐ＜００５）和假手术对照组（４６５Ｖ±０３２Ｖ，Ｐ＜００５）．胃粘膜损害发生率（６８８％）显著高于对照组（２５０％，Ｐ＜００５）．结论肝动脉栓塞可使其血浆ＥＴ水平明显升高，门静脉压力增加，胃粘膜血流量下降，从而导致胃粘膜损伤     

Sonographic determination of spleen to left kidney ratio among Igbo school age children of south east Nigeria

Background

Clinical determination of mild splenomegaly is notoriously inaccurate.

Objectives

To determine sonographically the spleen to left kidney ratio according to age and somatometric parameters among school age children in a tropical environment.

Methods

A cross sectional study and convenience sampling were done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6–17 years at the University of Nigeria Medical Centre, Nsukka. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen and left kidney lengths were obtained using appropriate techniques. The weight and height of the subjects were obtained with the participants wearing light weight street clothes without shoes.

Results

Measurement of spleen and left kidney lengths were reliable within and between sonographers. The spleen and left kidney lengths were not statistically different in boys and girls (p > 0.05). The spleen to left kidney ratio according to age and somatometric parameters is constant at about 1.13 with 1.3 as the upper limit of normal in the studied population.

Conclusion

Sonography can be used to detect mild splenomegaly if the spleen to left kidney ratio is greater than 1.3 in the absence of renal disease among school age children.     

早期自然流产患者蜕膜组织中ICAM-1/Mac-1的表达

目的 通过观察细胞间黏附分子-1(ICAM-1)和巨噬细胞分化抗原-1(Mac-1)在早期自然流产患者蜕膜组织中的表达,探讨ICAM-1/Mac-1与早期自然流产的关系.方法 采用免疫组化方法检测早期自然流产患者35例和同期妊娠的30例健康妇女蜕膜组织中ICAM-1、Mac-1的表达,用激光共聚焦显微镜(CLSM)双标检测二者关系并加以分析.结果 早期自然流产患者蜕膜组织基质细胞ICAM-1、Mac-1蛋白表达强度高于对照组(Z=-3.056,P=0.002;Z=-2.132,P=0.033);流产组蜕膜腺体细胞ICAM-1、Mac-1蛋白表达强度略低于对照组(Z=-1.978,P=0.048;Z=-1.973,P=0.048);共聚焦显微镜下ICAM-1和Mac-1在早期自然流产组和对照组的蜕膜组织均有部分重叠表达.结论 ICAM-1和Mac-1在早期自然流产患者蜕膜组织基质细胞的高表达和腺体细胞的低表达可能与早期自然流产的发生有关.