肾上腺嗜铬细胞瘤术中血NMN和MN的动态变化

目的 研究嗜铬细胞瘤切除手术中,患者间羟去甲肾上腺素(NMN)和间羟肾上腺素(MN)的动态变化规律.方法 23例肾上腺肿瘤患者(肾上腺嗜铬细胞瘤14例和非肾上腺嗜铬细胞瘤9例),分别于麻醉诱导后、开始切皮时、探查肿瘤时、切除肿瘤时、麻醉结束时的5个时间点进行采血,利用高效液相色谱法测定血液样本中NMN和MN的水平.结果 肾上腺嗜铬细胞瘤患者的NMN水平,在手术中各时间点有明显统计学差异(P<0.05),而MN无明显差异(P>0.05);非肾上腺嗜铬细胞瘤患者的NMN和MN水平,在手术期间各时间点均无统计学差异(P>0.05).结论 肾上腺嗜铬细胞手术中,患者血NMN在不同时间点有明显变化,而MN相对稳定.提示术中麻醉诱导和探查是手术成功的关键,MN是诊断肾上腺嗜铬细胞瘤较为稳定的监测指标.     

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.     

硬段含量对嵌段聚脲结构与性能的影响

以端氨基聚醚、异佛尔酮二异氰酸酯(IPD I)、二乙基甲苯二胺(DETDA)为主要原料,制备了一组硬段含量不同的IPD I基聚脲。通过FT-IR、DSC、SEM以及拉伸等测试手段,研究了硬段含量对聚脲羰基氢键化程度、微观结构及其力学性能的影响。结果表明:随着硬段含量的增加,脲羰基氢键化程度增加;软段相的微相分离率降低,硬段有序程度增大。硬段含量为35%时材料的力学性能较佳。     

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。     

以组蛋白去乙酰化酶为靶标的抗癌药物研发进展

基因表达的精确控制是细胞增殖分化和器官正常生长和发育的基础。基因转录和激活程序依赖于组蛋白乙酰化酶(histone acetylase，HAT)和组蛋白去乙酰化酶(histone deacetylase，HDAC)的协同作用。当HDAC过度表达并被转录因子募集，就会导致特定基因的不正常抑制，从而导致癌症及其他疾病。目前以HDAC作为抗癌靶点的研究方兴未艾，现综述HDAC类似蛋白(HDLP)的晶体结构和当前存在的HDAC抑制剂的作用机制、结构种类、研发状况和构效关系，以及新的HDAC抑制剂CS055的研发策略。     

萘哌地尔治疗慢性前列腺炎68例

目的观察萘哌地尔治疗慢性前列腺炎的疗效,探讨其作用机制。方法将136例慢性前列腺炎患者随机分为两组各68例,治疗组口服萘哌地尔25mg,每晚睡前服用1次,同时合用左氧氟沙星0.2g,早晚各1次;对照组仅口服左氧氟沙星0.2g,早晚各1次,均治疗6周。比较两组治疗前后前列腺液常规检查、前列腺炎症状评分、平均尿流率、最大尿流率、最大尿道闭合压、最大尿道压和残余尿量的变化。结果治疗组在降低前列腺液中白细胞计数、前列腺炎症状评分、最大尿道闭合压、最大尿道压和残余尿量以及提高平均尿流率和最大尿流率方面均优于对照组(P<0.05)。结论萘哌地尔可降低尿道压力,减少前列腺内尿液反流,明显改善前列腺炎患者症状,尤其适用于并发有功能性尿路梗阻症状的患者。