溃疡性结肠炎内镜、病理特点及其临床意义

目的探讨溃疡性结肠炎内镜及病理组织学检查的临床特点及其意义。方法采用分级的方法描述219例活动期溃疡性结肠炎以及53例治疗后临床症状完全缓解者的内镜、病理组织学特点。运用Spearman等级相关系数进行相关分析。结果本组219例活动期溃疡性结肠炎内镜分级主要分布在Ⅱ～Ⅲ级，占59．8％。病理组织学分级主要分布在Ⅲ～Ⅳ级，占79．9％（r=0．1692，P=0．0122）。经治疗后4周～8个月间，53例临床症状完全消失。内镜分级由治疗前的Ⅲ～Ⅳ级向Ⅰ～Ⅱ级转归，而病理组织学分级Ⅳ级为22．7％（r=0．3007，P=0．0287）。内镜分级与病理组织学分级两者间均无相关性。结论本组内镜及病理组织学分级描述溃疡性结肠炎病情以及疗效有不一致性。早期诊断以及近期疗效的判断不仅应依靠临床症状及内镜检查所见，更应结合病理组织学检查。     

7例疑似感染性心内膜炎患者艾滋病的早期临床识别及护理对策

目的早期识别以发热为首要表现而收治心血管内科的艾滋病患者。方法对以发热为首要临床表现的172例感染性心内膜炎(IE)和7例艾滋病(AIDS)患者进行临床表现和实验室检查的对比。结果IE患者中,稽留热型、心脏彩超显示有赘生物的形成、血培养呈阳性的比例明显高于AIDS患者,而血中淋巴细胞进行性减少、痰培养有真菌感染的比例明显低于AIDS患者。结论对以发热为首要表现而收治心内科的患者,需要注意其有无AIDS的临床特性,及早对部分患者进行HIV病毒检验,以早期识别AIDS患者。     

重度苯妥英钠中毒的药学监护

目的首先确定中毒药物,然后通过测定血药浓度以了解中毒程度,为重度苯妥英钠中毒患者临床抢救治疗提供依据。方法间隔一定时间采集患者静脉血,萃取血中药物,在211 nm处以反相高效液相色谱法定性,明确中毒药物并测定血药浓度。结果在苯妥英中毒患者中最高血药浓度为68.94 mg.L-1,接近治疗浓度上限的3.5倍。结论患者为重度中毒,危及生命,需临床药师与临床医师积极配合,施行全程药学监护。     

Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK(-/-) mice.

Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.     

30例无精子症精道造影临床分析

目的：探讨经皮输精管穿刺精道造影对诊断无精子症的价值。方法：对30例采用经皮输精管穿刺精道造影的无精子症患者临床资料进行回顾性分析总结。结果：精道异常的发现率73％，以生殖道感染炎症所致精道阻塞多见。结论：经皮输精管穿刺精道造影是一项渗断无精子症安全、有用的方法。     

慢性阻塞性肺疾病中西医发病机制的研究进展

慢性阻塞性肺疾病（简称慢阻肺，chronic obstructive pulmonary disease，COPD）是一种常见的呼吸系统疾病，发病率高，在湖北、北京和辽宁三个地区农村102230名成年人调查发现，15岁以上人口COPD的发病率高达3％。COPD呈缓慢进行性发展，严重影响人们的劳动能力和生活质量。但以往对此病重视不够，或仅限于急性加重期和疾病晚期的研究，忽视了疾病发展早期的预防和治疗。虽然国内外均制定了相应的治疗规范，但目前的措施尚不能有效阻止COPD患者肺功能的下降。所以可以说目前没有确实有效的疗法。主要原因是其发病机制尚不清楚。因此将近几年COPD发病机理的某些研究进展综述如下，以期在此基础上研究开发出相应的治疗药物。     

Pick’s disease with Pick bodies combined with progressive supranuclear palsy without tuft‐shaped astrocytes: A clinical,neuroradiologic and pathological study of an autopsied case

We report clinical, neuroradiologic features, and neuropathologic findings of a 76‐year‐old man with coexistent Pick’s disease and progressive supranuclear palsy. The patient presented with loss of recent memory, abnormal behavior and change in personality at the age of 60. The symptoms were progressive. Three years later, repetitive or compulsive behavior became prominent. About 9 years after onset, he had difficulty moving and became bed‐ridden because of a fracture of his left leg. His condition gradually deteriorated and he developed mutism and became vegetative. The patient died from pneumonia 16 years after the onset of symptoms. Serial MRI scans showed progressive cortex atrophy, especially in the bilateral frontal and temporal lobes. Macroscopic inspection showed severe atrophy of the whole brain, including cerebrum, brainstem and cerebellum. Microscopic observations showed extensive superficial spongiosis and severe neuronal loss with gliosis in the second and third cortical layers in the frontal, temporal and parietal cortex. There were Pick cells and argyrophilic Pick bodies, which were tau‐ and ubiquitin‐positive in neurons of layers II–III of the above‐mentioned cortex. Numerous argyrophilic Pick bodies were observed in the hippocampus, especially in the dentate fascia. In addition, moderate to severe loss of neurons was found with gliosis and a lot of Gallyas/tau‐positive globus neurofibrillary tangles in the caudate nucleus, globus pallidus, thalamus, substantia nigra, locus coeruleus and dentate nucleus. Numerous thorned‐astrocytes and coiled bodies but no‐tuft shaped astrocytes were noted in the basal ganglion, brainstem and cerebellar white matter. In conclusion, these histopathological features were compatible with classical Pick’s disease and coexistence with progressive supranuclear palsy without tuft‐shaped astrocytes.     

急性血吸虫病致免疫复合物肾病15例

1998～2004年本所共收治急性血吸虫病引起免疫复合物肾病患者15例，报告如下。     

现代医院自律与维权的对策

加强医院的自律与维权,将有助于改善当前医患之间的紧张关系,增进彼此间的信任。文章系统分析了医院自律与维权的现状,提出了医院自律与维权的原则,阐述了现代医院自律与维权的对策。     

神经修复导管的材料学及制备方法

目的:综合分析近年来国内外神经修复用导管材料以及制备方法的研究近况。资料来源:应用计算机检索ElsevierScience1996-01/2005-12有关神经修复及神经导管方面的文献,检索词分别为“nerveconduit,nerveguide,nerveregeneration”,限定文献语言种类为English。同时计算机检索清华数字期刊库、万方数据库1996-01/2005-12有关神经修复及神经导管方面的文献,检索词为“神经修复,导管”,限定语言种类为中文。资料选择:对检索到的神经再生、神经修复及神经导管方面的相关信息进行整理,选取针对性强的文章。同一领域的文献则选择近期发表或权威杂志的文章。资料提炼:共收集120篇关于神经修复、神经导管的文献,纳入23篇符合标准的文献。资料综合:用神经导管桥接断离神经是神经修复的重要方法之一,制备神经导管的材料按其降解性能分为生物不可降解材料和生物可降解材料,任何一种材料都有其优缺点,发展复合材料将是制备导管的主要方向。结论:虽然影响神经再生的因素还有许多,如神经生长因子、雪旺细胞等,但是新型的导管及制备方法将会有利于神经修复进一步发展。