胰岛素样生长因子-Ⅰ对软骨细胞凋亡的抑制

目的:探讨胰岛素样生长因子-Ⅰ(IGF-Ⅰ)对软骨细胞增殖及白细胞介素-1(IL-1)诱导软骨细胞凋亡的影响,揭示其抗损伤作用机制,为关节软骨损伤治疗提供理论依据。方法:分离培养人胚胎关节软骨细胞,采用四氮甲基唑蓝(MTT)法测定不同含量软骨细胞增殖活性的变化,利用光镜、电镜、DNA电泳及流式细胞仪测定作为凋亡检测指标。结果:IGF-Ⅰ呈剂量依赖式促软骨细胞增殖,当IGF-Ⅰ含量达50μg/L时,促软骨细胞增殖作用达最大值。IL-1组光镜、电镜下可见典型的细胞凋亡形态学改变,琼脂糖凝胶电泳示特征性的DNA梯状条带,IGF-Ⅰ处理组未见明显凋亡征象。流式细胞仪检测发现,IGF-Ⅰ处理后软骨细胞凋亡率显著降低。结论:IGF-Ⅰ能促进软骨细胞增殖,对IL-1诱导的软骨细胞凋亡具有保护作用。     

儿童及少年期首发精神障碍患者的随访

目的了解儿童及少年期情感障碍和精神分裂症的临床特征.方法收集1984年至1999年之间在本院就诊患者中符合DSM-Ⅲ情感障碍和精神分裂症诊断的儿童及少年期首次发作病例64例,年龄5～17岁.入组时进行基线评定,然后长期随访.至随访结束,对两组疾病进行对照分析.结果58例（91%）完成随访,平均随访时间12.4年.儿童少年期入组诊断为情感障碍者36例,至成年随访结束时,92%诊断为情感障碍,8%诊断为精神分裂症;儿童少年期入组诊断为精神分裂症者22例,至成年随访结束时,32%诊断为情感障碍,68%诊断为精神分裂症.儿童少年期情感障碍患者在成年期诊断为精神分裂症者明显高于精神分裂症患者修改诊断为情感障碍（χ^2=22.852,P＜0.001）.儿童少年期精神障碍至成年期的诊断一致性较低（Kappa=0.62）.儿童及少年期发作的情感障碍与精神分裂症比较,起病年龄低、发作次数少、社会关系良好和较好的社会功能.情感障碍的精神症状多与精神分裂症重叠,但精神分裂症出现频率较高的情感不协调、注意力分散、关系妄想、情感迟钝、被洞悉感等症状,在情感障碍患者中始终未存在.结论儿童及少年期的情感障碍在症状学上与精神分裂症有许多相似之处,是导致误诊的重要原因.但儿童少年期精神分裂症存在的一些核心症状可能是两者鉴别诊断的症状学指标.     

抗感染中心静脉导管应用引发过敏性休克1例

抗感染中心静脉导管是由Arrow公司提供的一种含有氯已定醋酸盐与磺胺嘧啶银的导管(简称抗感染导管)。有关文献[1]报道,导管加抗生素可显著降低导管感染的发生。我科近几年使用抗感染导管逐渐增多,主要用于各种化疗及免疫低下的病人。抗感染导管发生过敏性休克极其罕见,至今国内未见报告。2004年5月我科1例病人在应用抗感染中心静脉导管后引发过敏性休克,现报告如下。1临床资料病人,男,68岁,因确诊为“急性单核细胞白血病半月余,反复咳嗽伴发热十余天”于2004年5月1日来我院就诊。2004年5月12日09:00在20%利多卡因局麻下行右侧颈内静脉置管,…     

李振华教授调理脾胃用药规律探讨

李振华教授，生于1924年，河南省洛宁县人。著名中医脾胃学专家，全国片批名老中医。国务院特殊津贴专家，原中华中医药学会常务理事、第七届全国人大代表，曾任河南中医学院院长，从事中医临床与教学六十余载，长于内科杂病，晚年潜心于脾胃学说研究，著有《中国传统脾胃病学》等，并负责研究河南省重点科研项目“脾胃气虚本质的研究”及“七五”国家重点科技攻关项目“慢性萎缩性胃炎脾虚证临床及实验研究”，且均荣获河南省科技进步成果奖。经过多年临床实践，李老整理总结出调理脾胃的用药规律。提出通过药物件味归经，以及药效应用与脾胃的生理、病理特点相结合的川药大法。     

加强医学计量促进医疗质量提高

主要叙述医学计量的特点,“医用三源”强制检定的重要性,加强医学计量是建设现代化医院,提高医疗质量的技术保证。     

Evaluation of inpatient clinical training in AIDS care.

BACKGROUND: Studies of outpatient clinical training in AIDS care have shown positive effects on residents' knowledge, attitudes and intentions. In this study, residents' knowledge, attitudes and intentions regarding the care of HIV-infected patients were used as outcome measures to evaluate the effectiveness of a 1-month residency training in an AIDS inpatient unit. METHODS: From April 2000 through April 2001, 33 internal medicine residents completed pretest-posttest questionnaires evaluating changes in their knowledge, attitudes and intention to care for HIV-infected patients. Of these 33 residents, 25 participated in a posttest interview, reflecting on their learning experience during the 1-month clinical rotation. RESULTS: At the posttest, residents were significantly more accurate in assessing HIV-associated risk (p < 0.001), and were significantly more knowledgeable about the necessary protective equipment to prevent HIV transmission (p < 0.01). Residents were significantly less concerned about the risk of infection (p < 0.01) and interpersonal concerns (p < 0.05). Residents' reluctance to care for HIV-infected patients was significantly lower (p < 0.05), as was their tendency to avoid invasive procedures or treatment of HIV-infected patients (p < 0.001). Residents designated after their training were more likely to practice universal precautions and less likely to be afraid and to stereotype HIV-infected patients. They also reported gaining insight into HIV diseases and patients' multifaceted needs, and appreciating the importance of teamwork in AIDS care. CONCLUSION: A 1-month AIDS residency training can effectively enhance residents' HIV-related knowledge, attitudes and intention to care for patients infected with HIV.     

Immunohistochemical study of lymph nodes in patients with cat scratch disease.

BACKGROUND/PURPOSE: Bartonella henselaeis the causative agent of cat scratch disease (CSD), manifesting as fever and acute regional lymphadenopathy. Although serologic testing is the reference method for diagnosis, successful use of immunohistochemical (IHC) stain of regional lymph nodes for the diagnosis of CSD has been reported. To determine the characterization and diagnostic potential of IHC in lymphadenopathy of CSD, lymph nodes were excised from patients with suspected CSD for further evaluation. METHODS: Polyclonal antibody-based IHC studies were performed for the detection of B. henselae. Between January 2001 and December 2004, the reference laboratory of the Center for Disease Control, Taiwan, received a total of 377 sera from 352 reported suspected CSD cases. Twenty-three formalin-fixed paraffin-embedded lymph nodes from 16 patients and two skin biopsies from two patients suspected of having CSD were included in this study. Nine of them were serologically confirmed to have CSD and the others were seronegative but suspected to have CSD by the attending physicians. Seven lymph node specimens were obtained from tuberculosis patients for comparison. RESULTS: We demonstrated that the microorganisms existed in the cytoplasm of histiocytes within the granulomatous lesions in nine lymph nodes and one skin biopsy. Among the nine lymph nodes with IHC (+) stains, three were seronegative. On the other hand, three cases were IHC (+) and six cases were IHC (-) among nine seronegative patients. In addition, two seronegative patients with skin biopsy showed one IHC (+) and one IHC (-). CONCLUSION: IHC can contribute to the etiologic diagnosis of B. henselaelymphadenopathy when serology and molecular techniques are not available.     

368例0～5岁婴幼儿骨源性碱性磷酸酶活性测定结果分析

目的：探讨骨源性碱性磷酸酶活性测定对小儿佝偻病的诊断价值。方法：采用全血干化学和免疫浓缩技术检测血液中骨源性碱性磷酸酶活性，并与临床诊断为佝偻病的结果进行比较。结果：368例中BALP〈200U／L113例，占30．7％，（200～250）U／L120例，为32．6％，〉250U／L135例，为36．7％。3月～组与2岁～组BALP检测结果比较统计学上无差异（P〉0．05），2岁一组与4～5岁组比较统计学上有显著性差异（P〈0．05），3月～组与4～5岁组比较统计学上差异显著（P〈0．001）。根据临床表现诊断为佝偻病的92例，为36．1％，临界组与阳性组中诊断为佝偻病的结果进行比较统计学上有显著性差异（P〈0．001）。结论：BALP检测方法简单，对小儿佝偻病的早期诊断、疗效观察及预防具有现实的临床意义。     

听觉诱发电位在无痛人流手术麻醉中的应用研究

目的 观察异丙酚复合氯胺酮在无痛人流术中对听觉诱发电位指数（auditory evoked potentials index．AAI）的影响。方法 选择门诊无痛人流患者56例，随机分成异丙酚（Ⅰ组，n=28）和异丙酚复合氯胺酮（Ⅱ组，n=28）。记录给药前、后，整个手术过程度术毕苏醒过程中各时点的AAI值、OAA／S评分、平均动脉压．（MAP）、心率（HR）及血氧饱和度（SpO2）以度异丙酚用量、苏醒时间度质量。结果 两组AAI值和OAA／S评分在给药后及整个手术期间均明显降低，与自身给药前相比，有非常显著差异（P〈0．01）；Ⅱ组AAI下降的时间度恢复时间滞后于Ⅰ组，AAI值与OAA／S评分有良好的相关性。两组在给药后MAP均有下降，与给药前相比，有显著性差异（P〈0．05）；而HR和SpO2无明显变化。Ⅱ组与Ⅰ组相比，Ⅱ组异丙酚用量明显少于Ⅰ组。苏醒时间长于Ⅰ组；苏醒质量无显著性差异。结论 AAI能较好的反映异丙酚的镇静水平。同时也可反映异丙酚复合氯胺酮后的总体镇静程度。但反映速度滞后，需结合临床进行整体判断。氯胺酮对AAI的影响不大。氯胺酮不干扰异丙酚引起的AAI值的变化。     

可调节携便式镇痛泵

现有的镇痛泵是用于手术后,为患者解除或者减轻患者的疼痛而设计的。一个特殊的原因,为使镇痛泵能用于长期受疼痛折磨的患者,为适应这类患者要自由活动和长期使用的需要,在现有镇痛泵的基础上,经过研究、改造,成功的研制出可调节携便式镇痛泵,经临床使用获得良好的效果,并获得国家实用新型专利(专利号:200420059087.1)。