糖尿病肾病59例临床分析

本文报告糖尿病367例中并发糖尿病肾病59例占16.1％,近十年来,糖尿病人有增多趋势,糖尿病肾病发生率也显著增加,1966～1976年糖尿病住院治疗的才100例,糖尿病肾病发生率为5％,而1977～1986年有267例,糖尿病肾病发生率为20.2％。经用胰岛素等治疗后好转22例,死亡12例,病死亡率为20.3％,糖尿病肾病除严格控制血糖水平外、无特效疗法。出现持续性旦白尿,病情已到中期或晚期,如何早期诊断是我们今后研究的重要课题。     

Alterations of G-protein Coupling Function in Phosphoinositide Signalling Pathways of Rat Hippocampus by Ischaemic Brain Injury

The activation of membrane-associated phospholipase C is rapidly and transiently induced in the central nervous system by a variety of stimuli. Ischaemic brain injury is one of the situations that leads to a dramatic increase in polyphosphoinositide (PPI) turnover. In this study, stimulation of PPI hydrolysis by glutamate (500 μM) was measured in hippocampal slices from rats up to 21 days after an ischaemic insult of 30 min. Ischaemia was induced using the four-vessel occlusion method. PPI hydrolysis elicited by glutamate was significantly increased in the slices prepared from ischaemic rats 24 h after reperfusion, the accumulation of inositol phosphates (InsP_s) and inositol 1,4,5-trisphosphate (InsP₃) was 614±74% ( n = 8) and 182±11% ( n = 9) of the basal level respectively. This potentiation was also observed 21 days after ischaemia. Hyper-responsiveness to glutamate was also accompanied by an increase in AIF⁻₄-stimulated formation of [³H]inositol phosphates. In addition, global ischaemia did not change either high-affinity [³H]glutamate binding in hippocampal membranes or the stimulation of PPI hydrolysis by carbachol or noradrenaline in hippocampal slices. The present results suggest that the increased responsiveness to glutamate is the result, at least in part, of functional changes at the G-protein level, and may contribute to the pathophysiology of ischaemic brain injury or to the regenerative phenomena that accompany ischaemic damage.     

Analysis of Implantation in Assisted Reproduction Through the Use of Serial Human Chorionic Gonadotropin Measurements

Purpose: Our purpose was to examine implantation of singleton pregnancies achieved following various assisted reproductive technologies (ARTs) through the appearance and rising titers of serum human chorionic gonadotropin (hCG) levels. Methods: A total of 114 singleton pregnancies resulting from in vitro fertilization and intrauterine insemination was analyzed. Patients were divided into five groups according to the type of ovarian stimulation protocol [gonadotropin stimulation with/without the use of gonadotropin-releasing hormone agonist (GnRHa), long protocol, or flare-up technique] and to the day of embryo transfer (day 2 or day 3 after oocyte retrieval). Serial serum hCG levels were measured between 10 and 25 days after fertilization and log-transformed. Linear regression analyses were performed and extrapolated to hCG = 10 mIU/ml (hCG ₁₀ ), which was used as an estimate of detectable implantation. The slopes of the regression lines were used to estimate the rising speed of hCG. Results: There were no significant differences in the days of hCG in maternal serum to reach 10 mIU/ml (implantation) or in the slopes of the regression lines for all five studied groups. Conclusions: The appearance of hCG in maternal serum was used to assess the time of clinically detectable implantation. Furthermore, because hCG production is a marker of trophoblastic activity, its serum doubling time was used as an indicator of embryo quality. Results showed that in various ART protocols with and without GnRHa, there were no significant differences in implantation time or embryo quality. Embryo development in early pregnancy follows a preprogrammed-timing schedule and depends mainly on the embryonic age of the health, successfully implanted conceptus.     

孤立性左肝胆管结石并肝管狭窄的外科治疗

目的总结近２０年来孤立性左肝胆管结石并发左肝胆管狭窄的临床治疗体会．方法原发性肝胆管结石１０１８例，年龄２７～７２岁，其中孤立性左肝胆管结石１３３例，手术治疗１１２例，对其临床资料进行回顾性分析，包括各肝管狭窄并发率，术前各项检查确诊率，手术治疗方式，再狭窄率．结果左肝管狭窄的发生率为５９８％，左外肝管和左内肝管分别为８４０％和８４８％，均以重度狭窄为主．狭窄切开整形后高位胆肠吻合术是处理左肝管狭窄的常用手术方式（５２２％），远期再狭窄率为１７１％；左半肝切除术施实率为１９４％，再狭窄率为００％；狭窄整形术和狭窄扩张术的施实率分别为９０％和１９４％，再狭窄率分别为５００％和９２３％．左外肝管狭窄通常采用肝段或肝叶切除术（７８７％），而左内肝管狭窄的处理则通常采用非左半肝切除术（８４８％）．左内肝管狭窄的术前／后影像学确诊率明显低于左肝管和左外肝管，平均确诊率依次２５９％，９３３％和８７９％．结论二级肝管狭窄是孤立性左肝管结石的常见并发症，肝叶或肝段切除术是其首选治疗原则．过多依赖非肝叶／段切除术和不适当的肝段切除术是遗留狭窄和远期疗效差的重要原因     

袍甲螨属在我国首次发现及一新种记述（蜱螨亚纲：袍甲螨科）

本文记述了新种三歧袍甲螨Ｅｒｅｍａｅｏｚｅｔｅｓｔｒｉｆｕｒｃｕｓｓｐ．ｎｏｖ，模式标本采自广东省珠海海滨土壤中，保存于白求恩医科大学生物学教研室。     

开放手术观察腰椎间盘突出症溶核失败45例分析

目的 通过开放手术观察分析椎间盘髓核化学溶解术治疗腰椎间盘突出症失败原因。方法 收集溶核失败的腰椎间盘突出症45例行开放手术治疗。结果 术中见45例硬膜外脂肪完全消失，43例髓核未见溶解，2例髓核溶解呈糊状但未被吸收，21例伴有侧隐窝狭窄，15例突出物与神经根粘连，20例黄韧带增厚，2例椎管骨性狭窄，14例突出物钙化。结论 腰椎间盘突出症病变间隙合并有侧隐窝狭窄、神经根粘连、椎管狭窄、突出物钙化等，不是溶核治疗的适应证。     

多重PCR归化法平行检测HBV和HCV的研究

目的：建立一种多重PCR归化法并应用于对HBV、HCV平行检测。方法：利用PCR反应5′端允许添加非互补序列的原理，运用内外两对引物，经过2轮扩增，使目的产物均带上共有序列，再以共有序列为引物进行扩增，实现多重扩增。比较和筛选四种核酸提取方法。运用正交优化法，优化并确定最佳扩增条件。对28份血标本进行对比试验，并进行质量评价。结果：归化多重PCR方法对于HBV、HCV病毒合并感染患者的诊断敏感性为83.5%，诊断特异性为70.0%，诊断指数为153．3％，诊断效率为72．2％；对HBsAg阳性患者的HBV DNA的诊断敏感性为78．6％，诊断特异性为80．0％，诊断指数为158．6％，诊断效率为79．2％。对抗－HCV阳性患者的HCV RNA的诊断敏感性为75．0％，诊断特异性为90．0％，诊断指数为165．0％，诊断效率为83．3％。结论：多重PCR归化法在多基因扩增或多种病原体的同时平行检测领域具有较大应用潜力。该方法实用、准确、可靠，对HBV HCV的防治具有实际意义。     

肩锁钩板治疗不稳定性锁骨外侧段骨折的临床研究

目的：比较肩锁钩板和传统克氏针内固定治疗不稳定性锁骨外侧段骨折的疗效。方法：54例不稳定性锁骨外侧段骨折的患者接受了手术治疗，内固定分别是锁骨钩板或克氏针，根据国外的锁骨外侧段骨折肩部功能评价标准进行6－12个月的术后随访，随访结果运用统计学方法进行分析处理，结果：克氏针内固定组的手术优良率为77．3％，并发症发生率为27．3％，骨折愈合率为81．8％；锁骨钩板内固定组的手术优良率为100％，并发症发生率为3．1％，骨折愈合率100％。两组数据统计学差异有显著性，结论：在不稳定性锁骨外侧段骨折的手术治疗中，锁骨钩板较传统克氏针内固定有较高的手术优良率和骨折愈合率，且并发症的发生率较低，因此，它是一种疗效满意的内固定方法。     

Innervation of the trapezius muscle: is cervical contribution important to its function?

OBJECTIVE: To study the effect of the cervical plexus and the accessory nerve to the function of the trapezius muscle. STUDY DESIGN AND SETTING: Eighteen adult male Sprague-Dawley rats were randomly divided into three groups. The neurotomies were performed in the left sides and the right sides served as within-subject controls. In group A, the accessory nerve was transected. The C2-5 were transected in group B, and both of the accessory nerve and C2-5 were cut in group C. The electrophysiologic, myophysiologic, and histologic changes of the muscles were measured. RESULTS: There were significant differences (P < 0.05) between the three groups in the recovery rates of the transverse area of the muscles. The CMAP recorded from the experimental sides in group B were similar to the control sides. The values of the maximum tension of the tetanus contraction between the two sides showed no differences either (P > 0.05). CONCLUSION: The accessory nerve supplies the most important motor input to the trapezius. Motor innervations of the cervical plexus are not very significant.     

腔内三重双J管引流技术治疗输尿管狭窄

目的探讨腔内三重双J管引流技术治疗输尿管狭窄的可行性. 方法 2000年3月～2003年6月,对27例输尿管狭窄采用输尿管腔内置入3根相同大小的双J管引流,术后留置10～12周. 结果 27例随访2～24个月,平均18个月.26例拔管后无腰胀、发热等症状.IVP示引流通畅,患肾积水排空好,无输尿管狭窄.1例术后6个月复查IVP,肾积水仍无改善,改开放手术.本组治疗成功率96%(26/27). 结论腔内三重双J管引流技术治疗输尿管狭窄可行.