经阴道穿刺取卵术中不同镇痛方法的应用效果比较

目的探讨双氯芬酸钠栓与丙泊酚复合地佐辛在经阴道穿刺取卵术中的镇痛效果。方法 2013年2-4月行取卵术的387例患者根据用药情况分为双氯芬酸钠栓组226例（A组）和丙泊酚复合地佐辛组161例（B组）。观察并记录两组在取卵术中的镇痛效果及术后头晕、恶心、呕吐等不良反应情况。结果 B组和A组患者取卵术中镇痛有效率分别为100.00%、99.14%,两者比较差异无统计学意义（χ^2=0.228,P=0.633）。B组患者的头晕发生率、恶心发生率、呕吐发生率、注射部位疼痛发生率和呼吸抑制发生率均较高,与A组比较差异均有显著统计学意义（P〈0.01）。结论经阴道取卵术中使用双氯芬酸钠栓镇痛效果好,不良反应发生率低,对妊娠无影响,使用方便、安全,值得临床推广使用。     

重组Sj31-b的表达及其免疫诊断价值的研究

目的 探讨日本血吸虫重组31KD蛋白片（rSJ31-b)的免疫诊断价值。方法 表达并纯化rSj31-b，用免疫印迹方法（EITB）检测纯化的rSj-b的免疫活性，以rSj31-b-ELISA分别检测慢性日本血吸虫病人及正常人的血清。结果 纯化的重组Sj31-b具有较好的免疫活性；用其rSj31-b－ELISA检测52份慢性日本血吸虫病人血清及83份正常人血清，敏感性和特异性与常规应用的天然抗原SEA（可溶性虫卵抗原）差异无显性。检测治疗12个月后的慢性日本血吸虫病人血清，阴转率85.0%，明显优于SEA－ELISA。结论 rSj31-b具有较好的敏感性和特异性，且有一定的疗效考核价值，可替代SEA用于慢性日本血吸虫病人的诊断。     

尼可地尔预先给药对心肌缺血再灌注兔心肌细胞凋亡的影响

目的观察尼可地尔预先给药对心肌缺血再灌注兔心肌细胞凋亡的影响。方法 雄 性新西兰白兔40只,随机分为5组(n=8),假手术组(Sham组):仅穿线,不结扎;IR组:缺血30 min再 灌注120min;Nic组:缺血前10min静脉注射尼可地尔100μg·kg-1负荷量,随后以10μg·kg-1·min-1的 速率持续静脉输注至缺血前即刻;Nic 5-HD、Nic Gli组:在缺血前20 min静脉注射五羧基葵酸钠或 格列本脲5 mg·kg-1,其余的处理同Nic组。再灌注120 min时处死兔,计算心肌梗塞面积,通过两种染 色方法检测心肌细胞凋亡情况,观察心肌超微结构改变,并用免疫组织化学方法测定活化的caspase-3 蛋白表达。结果与IR组比较,Nic组心肌梗塞面积减小,早期凋亡细胞数减少,活化的caspase-3蛋 白表达下降(P<0．05),与Sham组比较,Nic组心肌仍有一定损伤,但较IR组明显改善。与Nic组比 较,Nic 5-HD、Nic Gli组心肌梗塞面积、早期凋亡细胞数、活化的caspase-3蛋白表达增加(P< 0．05)。结论尼可地尔预先给药对缺心肌血再灌注损伤有一定的保护作用,主要通过开放mito-KATPC 及下调活化的caspase-3蛋白的表达。     

Management of intrabiliary rupture of hydatid cyst of the liver

Thirty-six patients with intrabiliary rupture of hepatic echinococcal cysts were managed between 1974 and 1993. Clinical findings, skin tests, serologic tests, and imaging techniques were used to establish the diagnosis. Twenty-five (69.4%) patients had pain, 24 (66.6%) jaundice 22 (61.1%) fever, 20 (55.5%) chills, 10 (27.7%) malaise, and 7 (19.4%) other symptoms as the major causes of admission. All patients underwent choledochotomy and T-tube drainage. Treatment directed to the cyst was cystectomy and capittonage, cystectomy and drainage, and partial hepatectomy in 22, 12, and 2 patients, respectively. Omentoplasty was added to the treatment in 10 patients. Seven (19.4%) patients had complications. The period of hospitalization for patients with and without complications was 34.6±18.1 and 15.1±2.7, days, respectively. This study indicates that better results are obtained in patients with cystic lesions of the liver by avoiding percutaneous puncture or biopsy, the early use of ultrasonography and computed tomography, evacuation of the cyst together with its germinative membrane and the involved biliary tract under adequate care to avoid spillage into the peritoneal cavity, treating the remaining cavity according to its location, size, and the presence of infection, and decreasing the pressure in the biliary tract by T-tube drainage.

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Resumen Treinta y seis pacientes con ruptura intrabiliar de un quiste equinocóccico fueron manejados entre 1974 y 1993. Se utilizaron los hallazgos clínicos, pruebas cutáneas, pruebas serológicas y técnicas de imagenología para establecer el diagnóstico. Como causa principal de la hospitalización, 25 (69.4%) pacientes presentaban dolor, 24 (66.6%) ictericia, 22 (61.1%) fiebre, 20 (55.5%) escalofríos, 10 (27.7%) malestar general y 7 (19.4%) otros síntomas. La totalidad de los pacientes fue sometida a coledocotomía y drenaje con tubo en T. El tratamiento específico contra el quiste consistió en cistectomía y capitonaje, cistectomía y drenaje y hepatectomía parcial en 22,12 y 2 pacientes, respectivamente. Se añadió omentoplastia en 10 pacientes; 7 (19.4%) de los casos desarrollaron complicaciones. El período de hospitalización en los pacientes con y sin complicaciones fue de 36.6±18.1 y 15.1±2.7 días, respectivamente. El presente estudio indica que se logran mejores resultados en el manejo de las lesiones quísticas del hígado evitando la punción o biopsia percutáneas; utilizando precozmente el ultrasonido y la tomografía computadorizada; practicando la evacuación del quiste junto con su membrana germinativa y del tracto biliar afectado bajo con meticuloso cuidado para evitar la contaminación de la cavidad peritoneal; haciendo tratamiento de la cavidad residual de acuerdo con su ubicación, tamaño y la presencia de infección; y disminuyendo la presión en el tracto biliar mediante drenaje con tubo en T.

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Résumé Trente-six patients ayant une rupture dans les voies biliaires d'un kyste hydatique ont été traités entre 1974 et 1993. Les données cliniques, les tests cutanés, sérologiques et des techniques d'imagerie ont été utilisées pour arriver au diagnostic. Vingt-cinq (69.4%) patients se sont plaints de douleur, 24 (66.6%) d'ictère, 22 (61.1%) de fièvre, 20 (55.5%) de frissons, 10 (27.7%) de malaise et 7 (19.4%) d'autre symptômes comme motif d'hospitalisation. Tous les patients ont eu une cholédochotomie et un drainage par drain de Kehr. Le traitement du kyste a été une kystectomie associé à un capitonnage, une kystectomie associé à un drainage et une hépatectomie partielle chez 22, 12 et deux patients, respectivement. On a ajouté une omentoplastie chez 10 patients. L'évolution a été compliquée chez sept (19.4%) patients. La durée d'hospitalisation avec et sans complications a été de 3.6±18.1 et 15.1±2.7 jours, respectivement. Cette étude indique que de meilleurs résultats sont obtenus lorsque l'on s'abstient de la ponction percutanée ou de biopsie percutanée, lorsque l'on utilise l'échographic et la tomodensitométrie pour le diagnostic à un stade précoce, lorsque l'on évacue le kyste et enlève la membrane germinative et la portion de la voie biliaire intéressée, sans déversement du contenu dans la cavité péritonéale, lorsque l'on traite la cavité résiduelle selon son site, la taille du kyste et la présence d'infection, et lorsque l'on diminue la pression dans la voie biliaire par un drainage externe.

     

脂蛋白脂肪酶单克隆抗体的制备及特征分析

用牛奶纯化的脂蛋白脂肪酶(LPL),一分子量为56KD,免疫Balb/c小鼠,利用杂交瘤技术,建立了30余株分泌抗朱LPL单克隆抗体的杂交瘤细胞。对其中2E_5、2G_(10)、6D_7、8D_2、7F_4进行特征分析表明:①其抗体类别均为IgG,亚类分别为IgG_1、TgG_(2b)、IgG_(2b)、IgG_1、IgG_1;②抗体效价(细胞培养上清)5×10~(-2)——2×10~(-3);③5种单抗可认为识别三个不同的抗原表位;④Western—blot及Dot—blot结果显示各单抗均能识别纯化的LPL,与人奶均无交叉反应,与牛奶显示不同的结合特性。     

Treatment of intracerebral arteriovenous malformations with isobutyl 2- cyanoacrylate: initial clinical experience

From November 1976 to September 1979, 46 patients with intracranial arteriovenous malformations or fistulas participated in a clinical study using isobutyl 2-cyanoacrylate (IBCA), with tantalum, for palliative or preoperative occlusion of the blood supply to the abnormalities. Although failure to obtain satisfactory position of a functioning microcatheter precluded deposition of IBCA 10 times, a total of 51 of a possible 62 feeding vessels were occluded with the tantalum-impregnated glue. The technique, results, and complications are discussed in light of the clinical follow-up, which varied from 12 to 48 months.     

螺内酯对阵发性心房颤动发作的影响

目的观察螺内酯对阵发性心房颤动(AF)的抑制作用及对心房结构和功能重构的影响。方法选择因Ⅲ度房室传导阻滞植入双腔起搏器的阵发性AF患者96例,分为两组,治疗组(48例)给予螺内酯20 mg/d,对照组(48例)不予螺内酯治疗。随访12个月,观察研究前后血浆醛固酮(Ald)浓度、AF发作情况、左房结构和功能变化。结果治疗组应用螺内酯12个月后Ald水平较前明显降低(5.30 ng/dl vs 7.70 ng/dl,P<0.01),AF发作次数及AF负荷明显减少,左房内径、左房最大容积、左房最小容积及左房收缩期前容积均减小,左房射血分数增高(P均<0.01)。与对照组相比,上述指标亦有显著差异(P均<0.05)。结论醛固酮受体拮抗剂——螺内酯能够抑制阵发性AF患者心房结构和功能的改变,减少AF发生率及持续时间。     

Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents

The aims of our study were: (1) to evaluate the frequency of asymptomatic fatty liver disease (FLD) using both Doppler and B-mode ultrasound (US) in overweight and obese adolescents; (2) to compare metabolic findings of fatty liver (FL) assessed by two methods; and (3) to evaluate metabolic predictors of FL shown by these methods. Fifty-nine overweight and obese adolescents aged between 9.0 and 17.0 years and 41 non-obese healthy adolescents were included in this study. B-mode and right hepatic vein Doppler ultrasonography (US) were performed and anthropometric indices, lipid profiles, and adiponectin levels were evaluated in all adolescents. HDL-C levels were significantly lower in patients with FL detected by Doppler US compared to patients without FL (p < 0.05). HDL-C levels were inversely correlated with presence of FL assessed by two methods (r = −0.285, p = 0.004; r = −0.328, p = 0.001, respectively) and adiponectin levels were correlated with presence of FL only detected by B-mode US (r = −0.263, p = 0.008). Adiponectin levels were significantly lower in patients with FL than those without FL assessed by B-Mode US (p = 0.049). Multiple regression analysis revealed that HDL-C levels was the most important predictor of FL assessed by Doppler US (p = 0.027), while body mass index was the determinant of FL assessed by two methods (p < 0.001) in asymptomatic overweight and obese adolescents. It was found that FLD, identified by both B-mode and Doppler US, is seen frequently in asymptomatic overweight and obese adolescents. Elevated BMI is associated with increased risk of FL assessed by two ultrasonographic methods. When using Doppler US, low HDL-C levels can be used as a good predictor for presence of FLD in overweight and obese adolescents.     

鸡贫血病毒vp3基因的克隆和分子特征

目的 获得来源于浙江地区鸡组织中的鸡贫血病毒(CA)vp3基因并分析其变异情况.方法 根据GenBank登录的vp3序列设计特异引物,利用PCR方法从鸡组织中获得7个CAV的vp3基因克隆,将其克隆到载体进行测序.结果 40份鸡血清中共检出CAV阳性16份,阳性率40.0％.序列测定结果表明,vp3基因长366 bp,...