50例弥漫大B细胞淋巴瘤的细胞遗传学和预后比较

目的:对50例弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的细胞遗传学及预后进行比较分析?方法:采用荧光原位杂交法(FISH)对所有DLBCL患者的石蜡组织进行p53?bcl-2?bcl-6及c-myc基因的检测,对其进行阳性率比较?以3例正常的扁桃体组织的石蜡切片作为阴性对照组?结果:经Cox模型似然比检验结果筛选,DLBCL患者的P53蛋白可作为独立的预后因素?p53蛋白检测为阳性者死亡风险高于p53蛋白检测为阴性者?结论:p53蛋白可作为DLBCL患者独立的预后因素,在疾病诊断初期即进行细胞遗传学检测可对DLBCL的预后进行准确分析?     

经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果

目的 总结多中心应用食管超声引导、经胸微创小切口、非体外循环(CPB)下封堵室间隔缺损(VSD)的临床经验和近、中期随访结果.方法 432例病儿,男235例,女197例;年龄3个月～15岁,平均(3.2±1.9)岁;体重4.0～26.0 kg,平均(13.3±5.6)kg.膜周部VSD 351例,嵴上或嵴内型VSD 57例,肌部VSD 24例(17例多发VSD).VSD直径3～12 mm,平均(5.3±1.6)mm.膜周部VSD,经剑突下或胸骨下端3～4 cm小切口进胸;嵴内或嵴上VSD,经胸骨左缘第3肋间2～3 cm小横切口进胸.暴露右心室表面,在食管超声引导和实时监测下,穿刺右心室游离壁,导引钢丝经右心室腔穿过VSD到达左心室腔,沿导引钢丝导入输送鞘管建立轨道.通过输送鞘管直接将封堵器安放在VSD部位.经食管超声多切面反复评估封堵器的位置和与周边组织的关系,若无异常情况即可释放封堵器.结果 432例中417例封堵成功(96.5%),15例(3.5%)术中改为常规CPB手术.封堵成功者中,选用对称伞238例(57.1%),偏心伞179例(42.9%).13例(3.1%)发生新的微量至轻度三尖瓣反流,11例(2.6%)术后发生不完全右束支传导阻滞,3例(0.7%)术后发生一过性完全性房室传导阻滞.术后383例(91.8%)病儿在2 h内拔除气管插管,3～5天出院.术后416例(96.2%,416/432例)随访12～38个月,平均(19.3±11.6)个月,无近、中期死亡.1例术后6个月发生完全性房室传导阻滞.其余无明显异常.结论 应用食管超声引导、经胸微创非CPB下封堵VSD技术,是一种相对简单有效的治疗方法,近、中期临床结果满意,但远期结果需要进一步观察.

Abstract：

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.     

老年与非老年组多发性骨髓瘤的临床细胞遗传学和预后的比较

目的 研究老年多发性骨髓瘤(multiple myeloma,MM)的细胞遗传学、临床因素与预后的相互关系.方法 采用添加细胞因子的改良72 h培养法制备染色体标本,用R显带技术,对64例MM进行核型分析.结果 29例65岁以下MM患者中,发现有异常核型7例,发生率24.14%(7/29);伴多发性骨破坏13例,发生率44.83%(1 3/29).35例65岁以上的老年MM患者中,发现有异常核型16例,发生率45.71%(16/35);伴多发性骨破坏22例,发生率62.85%(22/35).结论 老年组与非老年组MM患者在细胞遗传学、骨破坏程度、骨髓浆细胞百分比的差异均有统计学意义.     

基于磁共振波谱技术的直接法餐后低密度脂蛋白胆固醇下降原因探究

目的:探究直接法测得的血低密度脂蛋白胆固醇（LDL-C）餐后水平低于空腹水平的原因。方法:选择中南大学湘雅二医院2017年11月至2019年5月的85名受试者进行前瞻性研究。取受试者空腹和进食后2、4 h的血清样本,分别用直接法和磁共振波谱技术（NMRS）检测样本的血脂水平,并用酶联免疫吸附法检测前蛋白转化酶枯草溶菌素...     

山青之片对大鼠血脂影响的实验研究

目的:观察山青之片的抑制血脂升高作用。方法:将SD大鼠随机分为对照组和低、中、高剂量给药组。低、中、高剂量分别0.2g/kg、0.4g/kg、1.2g/kgBW/d。经口给药30天后采血,检测血清TC、TG、HDL-C三项血脂指标。结果:与对照组相比,中、高剂量组能明显抑制大鼠血清TC及TG含量的升高,有显著性差异(P<0.05)。结论:一定剂量的山青之片可能具有抑制血脂升高的作用。     

2001～2005年安徽枞阳县血吸虫病疫情

枞阳县位于长江下游安徽段北岸,属湖沼型洲滩亚型血吸虫病流行区.有16个乡镇（县直）的111个村为血吸虫病流行村,江、湖、洲滩,内陆均有钉螺分布.     

抗心磷脂抗体与ST段抬高型心肌梗死PCI术后心脏扩大的相关性研究

目的探讨抗心磷脂抗体（ACLA）与ST段抬高型心肌梗死PCI术后心脏扩大及心功能不全的临床关系。方法145例ST段抬高型心肌梗死患者于发病1周行PCI手术,3个月后测定抗心磷脂抗体,复查超声心动图,检测左心房（LA）、左心室（LV）、射血分数（EF）、二尖瓣E峰峰值流速／二尖瓣A峰峰值流速（E／A）等值。结果AcLA—I蜘和ACLA—IgM水平,无心脏扩大心梗组为0．90±0．22和0．98±0．24,显著高于健康对照组的0．80±0．38和0．84±0．36（P〈0．05）;有心脏扩大心梗组为1．16±0．31和1．29±0．34,显著高于无心脏扩大心梗组（P〈0．05）。有心脏扩大心梗组AcLA阳性率为71．43％,显著高于无心脏扩大心梗组的40．45％（P〈0．05）。结论sT段抬高型心肌梗死PCI术后心脏扩大患者存在自身免疫机制,测定ACLA对预测sT段抬高型心肌梗死PCI术后心脏扩大以及心功能不全有一定的临床意义。     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.