血半胱氨酸蛋白酶抑制剂C水平对急性脑血管病患者早期肾损害的诊断价值

目的探讨急性脑血管病患者早期肾损害的机制及早期监测指标。方法对194例急性脑血管病患者(包括脑梗死129例,脑出血65例)及60例正常对照者同时测定血半胱氨酸蛋白酶抑制剂C(Cys-C)和血肌酐(SCr)浓度,对其中血Cys-c浓度增高但SCr浓度正常的48例急性脑血管病肾早期损害患者用甘露醇治疗,并检测治疗前后血Cys-c浓度。结果在早期肾损害组,血Cys-c浓度明显高于对照组(P<0.001),而SCr浓度2组无显著性差异(P>0.05)。48例急性脑血管病肾早期损害者经甘露醇治疗后,血Cys-c浓度较治疗前明显降低(P<0.001)。结论血清Cys-c测定有助于早期发现肾功能损害,治疗脑血管病的同时应注意监测肾功能。     

放射线联合p53基因及内皮抑素治疗小鼠前列腺癌皮下移植瘤

Objective To test the hypothesis that p53 gene therapy combined with endostatin can enhance tumor response to radiation therapy of RM-1 mouse xenograft prostate cancer and to investigate its mechanism. Methods A mouse prostate cancer model was established. Then mice with xenograft tumor were randomly divided into group A (control), B (radiation), C (radiation and rAdp53), D (radiation and rh-endostatin) and E (radiation and rAdp53 and rh-endostatin). On day 1, rAdp53 was injected intra-tumorously with 1 × 1010 vp per animal to group C and E. From day 1 to 14, rh-endostatin was given 15 mg/kg intraperitoneally daily to group D and E. On day 4 single fraction of 15 Gy was given to tumors in groups B, C, D and E. Normal saline was injected intra-tumorously or intraperitoneaUy accordingly as control. No treatment was done to group A. Tumor volume was measured daily. Samples were collected on Days 5, 10 and 15. Ki67, CD31, p53 and VEGF were detected by means of immunohistochemistry. Results (1) Radiation alone, radiation combined with intra-tumorous injection of Adp53 and/or intraperitoneal injection of rh-endostatin resulted in tumor growth arrest of RM-1 cells in vivo (P = 0.000). Radiation combined with both rAdp53 and rh-endostatin was the most effective treatment (P < 0.05). (2) All the four treatment groups had a decreased expression of mutant type P53 (P = 0.000). The expression of Ki67 in groups B and C were equal (P 0.05) and increasing (P = 0.000), respectively. Group D had a up-down-up curve (P < 0.05), but group E had a up-down one. On day 5 the expresion of VEGF in group E was the lowest (P < 0.05). An increased expression of MVD compared with the control was shown, and MVD in groups C, D and E were always higher than that in the control (P < 0.05). Conclusions The limitation of radiotherapy could be overcome by combination with beth p53 gene therapy and endostatin on the growth of mouse prostate cancer cell. Radiation, rAdp53 and endostatin have their own role but they can be interacted with each other.     

双侧自发性气胸伴左膈疝1例

患者,女,52岁,因突发呼吸困难5h入院,既往有肺结核病史20a,慢性支气管炎病史10a。X线表现:右肺外带异常透亮,并见压缩肺组织边缘,肺压缩约50%,压缩之肺组织上部见致密斑点影(见图1)。气管纵隔明显左移,左膈明显升高达左胸中部,经透视证实为左膈疝,疝入胸腔组织为胃(见胃泡)。左肺野上部透亮度明显增加,并见清晰光滑边缘,结合透视证实为左肺自发性气胸。双侧胸廓较对称,未见明显塌陷改变。X线诊断:右肺陈旧TB;双侧自发性气胸伴左膈疝形成。讨论:自发性气胸是指在无外伤和人为因素的情况下,肺组织及脏层胸膜突然破裂而引起的胸腔积气。自发…     

Laparoscopic Local Resection Based on Sentinel Node Evaluation for Early Gastric Cancer: A Preliminary Report

We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric cancer.     

学习障碍患儿血清BDNF水平的研究

目的探讨学习障碍血清脑源性神经营养因子(BDNF)水平的变化,及其与学习障碍病理基础的关系。方法患者组为22例未治疗过且不共患其他疾病的学习障碍患儿,对照组为16例年龄性别匹配正常儿童,以瑞文标准推理测验(SPM)测定智商,BDNF采用酶联夹心免疫吸附法检测。结果LD患者血清BDNF浓度为:平均(4.603±3.620)ng/ml高于对照组(1.843±0.728)ng/ml(t=3.326,P=0.003<0.01)。边缘智商组(4.523±4.618)ng/ml,与正常对照组比较差异有非常显著性(P=0.008<0.01)。结论学习障碍患儿血清BDNF浓度高于正常儿童,边缘智商者升高更明显。     

医学文献检索课中期刊论文分类标引的教学

针对当前的医学文献检索课中忽略期刊论文分类标引教学的问题,总结了几点教学实践,分别从期刊论文分类标引准确的重要性、期刊论文分类标引的步骤及原则、医学期刊论文分类标引的注意事项几个方面进行阐述.     

慢性疼痛与情绪障碍及其干预治疗效应

目的:分析慢性疼痛与情绪障碍之间的关系,探讨心理及药物治疗对慢性疼痛的干预作用。资料来源:应用计算机检索Medline1989-01/2004-05和Embase1989-01/2004-05有关慢性疼痛与情绪障碍关系的文献,检索词“Chronicache,emotionaldisorder,treament”,并限定文章语言种类为English。观察对象为疼痛持续时间超过6个月以上的患者。资料选择:选取有关慢性疼痛与情绪障碍关系及其治疗干预的文献,进行初审,删除陈旧及重复的文献,然后查找余下的文献全文。质量评价主要考察资料的真实性,调查设计是否严密,实施过程是否严格,统计学处理是否合理。资料提炼:共检索到20篇关于慢性疼痛与情绪障碍关系及其治疗干预的文献,11篇文献符合纳入标准。排除的9篇试验中,7篇系重复的同一研究,2篇是Meta分析。资料综合:11篇文献均包括观察组和对照组,其中观察组应用镇痛药合并心理治疗及抗抑郁药,对照组应用镇痛药但未合并心理治疗及抗抑郁药,对两组患者的疗效进行比较分析。结论:慢性疼痛与情绪障碍同时存在,应用镇痛药合并心理治疗及抗抑郁药可以显著缓解患者的疼痛,干预效果优于单纯应用镇痛药者。     

嵌体与全冠治疗牙间食物嵌塞的临床应用比较

目的:比较嵌体与全冠治疗牙间食物嵌塞的临床操作及修复效果.方法:对纳入标准的78例患者随机分组,分别用嵌体和全冠进行修复并进行随访观察,并对两种方法的临床应用效果进行比较.结果:在对牙龈及牙周保护方面,嵌体与全冠有显著性差异;在边缘密合、重塑邻接关系及牙齿敏感方面,二者无显著性差异.结论:嵌体较全冠修复牙间食物嵌塞临床操作简便省时,更有利于保护牙髓及牙周组织健康,美观经济.     

生理盐水肠道冲洗辅助治疗真菌性肠炎效果观察

目的 探讨生理盐水肠道冲洗辅助治疗真菌性肠炎的疗效。方法 将72例真菌性肠炎患者随机分为观察组和对照组各36例，对照组行常规治疗，观察组在此基础上予以温生理盐水（38～41℃）500～7000ml持续肠道冲洗，3～6h／次，1次／d，治疗1～3次。结果 观察组治疗后肠道pH值显著低于治疗前及对照组治疗后（均P〈0．01），治愈率显著高于对照组（P〈0．01）。结论 对真菌性肠炎腹泻患者在常规治疗的基础上，辅以温生理盐水肠道冲洗可显著改善肠道环境，提高治愈率。     

论传统文化对中医证理论形成的影响

证是古人在无数实践经验的基础上，基于外现的相关生命现象，从整体上把握人体内外各部的联系，对收集的各种病象进行逻辑推理而产生的一种整体功能关系失调的病理模型。其始终以中华民族优秀文化为深厚底蕴，蕴含着文学、艺术、历史、地理、天文、农学等多学科知识，呈现出一种极其复杂的文化生态，因此其形成必然受到中国传统文化及其思维方式的熏染。