Diagnosis and surgical treatment of multiple endocrine neoplasia

Background Multiple endocrine neoplasia (MEN) is relatively rare. But more patients could be found by detailed examination. We discuss the diagnosis and surgical treatment of MEN. Methods The clinical data of 95 MEN cases were retrospectively analyzed. There were 30 cases of MEN1 including 19 cases from 6 families. The MEN1 gene mutation was detected in 81.48% of cases admitted after 1997. There were 22 cases of primary hyperparathyroidism (PHPT), 10 cases of enteropanceatic tumor including 9 cases of insulinoma, 15 cases of pituitary adenoma, 9 cases of adrenal adenoma, 2 cases of thymic carcinoid. Two patients had 4 glands involved, 3 patients had 3 glands involved, 16 patients had 2 glands involved, and 6 patients had only one gland involved. Three patients had neither clinical symptoms nor biochemical changes, and was diagnosed by MEN1 gene mutation. Six patients presented with nephrolithasis and 6 patients had impaired pancreatic endocrine function. There were 60 cases of MEN2a and 5 cases of MEN2b. 58 cases of MEN2a belongs to 19 kindreds. All MEN2a patients but one presented RET gene mutation in codon 634, and all MEN2b cases had mutation in codon 918. 48 cases of MEN2a had thyroid masses with elevated calcitonin levels. 27 patients had pheochromocytoma including 12 cases of multiple loci and 5 malignancy. 13 patients presented with hyperparathyroidism. 5 MEN2b patients had medullary thyroid carcinoma and mucosal ganglioneuromatosis with Marfanoid. Among them, 3 patients had bilateral pheochromocytoma. Results In MEN1, subtotal parathyroidectomy was performed in 12 patients with PHPT and one patient received parathyroid adenoma enucleation. Insulinomas were enucleated in 4 patients. Two patients underwent thymus tumor extirpation. Total thyroidectomy with bilateral dissection of regional lymph nodes was performed in 16 patients with MEN2a and nodule enucleation was performed in 9 patients. Twenty two MEN2a patients underwent pheochromocytoma enucleation including bilateral adrenal resection in 10 cases. 5 MEN2b patients underwent total thyroidectomy with bilateral lymph node dissection. Among them, 3 cases underwent bilateral adrenal operations. Conclusions MEN varies in symptoms. Germline mutation test is helpful in establishing a diagnosis. Surgical management should be aimed at the improvement of life quality in MEN1 and prevention of the fetal tumors in MEN2.     

模拟ICU提高新护士急救技能的应用探讨

利用模拟ICU对61名新护士进行急救技能的培训,大大提高了护士的心理素质、急救能力、应变能力、沟通和合作能力.     

农村公共卫生投融资机制研究样本抽取的区域分类方法

目的：构建农村公共卫生投融资机制抽样研究的区域分类指标体系,并计算分类标志值.方法：本文在广泛收集我省农村公共卫生投融资方面的资料数据的基础上,运用专家咨询法确立符合本研究领域特征的指标体系和指标权重,并运用极差法对实际数据进行无量纲化处理,采用加权平均法计算出我省14个地州市的区域分类标志值.结果：我省14个地（州、市）的分类标志值虽然极差较大（反映发展不平衡）,但主要分布于（40,70）这一区间内,其中,大于60的有5个地（州、市）,小于50的有5个,在50-60之间的有4个,我们依此将其分为三个类别的区域.结论：经过专家咨询所筛选的9个指标所计算的标志值能够较好地反映一个地区的农村公共卫生投融资的现状,可以作为本研究抽样的依据.     

参麦注射液治疗冠心病心绞痛的临床观察

目的观察参麦注射液治疗冠心病的临床疗效。方法随机选择67例冠心病患者予以参麦注射液治疗,观察其治疗前后的心绞痛、心电图、血液流变学、心率、血压的变化并进行中医证候疗效分析。结果经参麦注射液治疗后,心绞痛疗效总有效率为83.6%,中度心绞痛总有效率为75.0%;心电图显效5例,有效20例,无效10例,总有效率为71.4%。治疗后ST和NST明显改善,与治疗前比较,有统计学意义(p<0.05);中医主要证候如胸闷痛、心悸和气短明显改善。结论参麦注射液表现出良好的改善微循环、止痛、降压并改善中医证候等治疗效果,值得进一步推广应用。     

F344大鼠树突状细胞的分离与培养

目的　研究F344大鼠树突状细胞(DC)的分离与培养方法。方法　取大鼠四肢骨骨髓细胞悬液,经梯度离心法得到DC ,加入白细胞介素(IL) - 4、粒细胞巨噬细胞集落刺激因子(GM CSF) ,全RPMI 16 4 0培养,经倒置显微镜、电镜及流式细胞仪鉴定细胞纯度及成熟度。结果　细胞培养的第8天,经倒置显微镜、电镜观察DC出现典型形态;流式细胞仪检测第4天OX6 2阳性率为8 .92 %、主要组织相容性复合物(MHC) Ⅱ为2 0 . 90 %、CD86为16 98% ;第8天OX6 2阳性率为5 8. 0 7%、MHC Ⅱ为6 0 . 4 9%、CD86为6 2 . 94 % ;第15天OX6 2阳性率为84 . 6 8%、MHC Ⅱ为88 .0 3%、CD86为6 2 . 80 %。结论　用该方法得到的DC纯度可达80 %以上,为进一步研究其在肿瘤研究中的应用打下基础。     

重组人生长激素2种制剂人体生物等效性研究

目的:评价重组人生长激素(rhGH)注射液(2种规格:T1和T2)与注射用rhGH冻干粉针剂(参比制剂,R)的人体生物等效性。方法:运用随机、单盲、三阶段交叉方法分别对24名健康男性志愿者单次皮下注射0.2IU·kg-1的R,T1和T2。测定不同时间点生长激素血药浓度,并进行相关药动学参数分析。结果:T1,T2的AUC0～24的90%置信区间分别落在R的103.4%～116.5%和105.7%～119.6%范围内,T1的AUC0～24的90%置信区间落在T2的91.9%～103.7%范围内;T1和T2的cmax的90%置信区间分别落在R的91.9%～114.0%和103.7%～127.2%范围内,T1的cmax的90%置信区间亦落在T2的81.6%～97.4%的范围内。tmax在R及T1,T2间无统计学差异(P>0.05)。结论:T1,T2与R具有生物等效性。     

岗梅根清喉颗粒的制备及临床疗效观察

目的研究岗梅根清喉颗粒的制备方法,并观察其临床疗效。方法与草珊瑚含片对照比较,观察其治疗咽喉炎症的临床疗效,并进行动物急性毒性试验。结果符合颗粒的质量要求。动物试验LD50>1208g生药/kg。治疗组与对照组总有效率均在85%以上,两者对咽喉炎症均具有明显的治疗作用。结论本颗粒组方合理,工艺可行,无毒性;临床疗效满意。     

肝内外胆管结石切开取石术的临床护理

肝胆管结石是肝胆外科较常见的急腹症之一,做好患者术前、术后护理对减轻患者心理负担,减少手术后并发症,提高治疗效果有非常重要意义.自2005年12月至2006年12月我科共收治肝内外胆管结石手术患者142例,取得了良好的治疗效果,现将术前、术后护理体会总结如下.     

Plackett-Burman联用Box-Behnken响应面法优化马来酸桂哌齐特脂质体的制备及表征

目的 制备并评价马来酸桂哌齐特脂质体(CM-Lip).方法 采用逆向蒸发法制备CM-Lip,以包封率为考察指标,结合鱼骨图分析法和Plackett-Burman(PBD)设计,筛选影响包封率的关键因素;采用Box-Behnken响应面法,对影响CM-Lip包封率的关键因素药物与磷脂比、水合时间、油相(乙醚∶乙醇)与水相...     

促渗剂对白头翁素体外经皮渗透的影响

目的：考察几种常用促渗剂对白头翁素体外经皮渗透性能的影响,为白头翁素经皮给药系统的开发提供参考。方法：采用TK-6A型透皮扩散仪,供应室加含不同促进剂的白头翁素样品,用人皮进行体外经皮渗透实验；以HPLC测定一定时间点接受室中药物浓度,求算累积渗透量及稳态透皮速率。结果：白头翁素饱和水溶液的稳态渗透速率为(1.17±0.03) μg·cm^-2·h^-1,含30%、50%乙醇和3%月桂氮酮-5%聚山梨酯20、30%乙醇-3%月桂氮酮-5%聚山梨酯20的白头翁素溶液稳态渗透速率为(9.30±0.32),(18.56±0.58),(7.29±0.35),(13.77±0.16) μg·cm^-2·h^-1,分别使白头翁素的经皮渗透速率提高了7.9,15.9,6.2,11.8倍。结论：乙醇和月桂氮酮能显著促进白头翁素的经皮渗透,白头翁素有望开发成经皮给药制剂。