刺五加注射液及抗凝剂对糖尿病足的早期干预治疗

目的观察刺五加注射液及抗凝剂(潘生丁、肠溶阿斯匹林)对糖尿病足早期干预治疗的影响。方法将符合1999年WHO诊断标准的100例糖尿病合并早期足病变的患者分为两组:干预治疗组50例,对照组50例。在控制血糖、血压、糖尿病教育的基础上,干预组予以静滴刺五加注射液及口服抗凝剂(潘生丁、肠溶阿斯匹林)治疗,对照组为口服VitB1、VitB6、复方丹参片治疗。观察治疗前后两组患者足背动脉搏动、皮肤颜色、温度,痛、温、触觉等相关指征,血糖、HbA1c、血TG、TC、HDL-C,及血流变学、眼底病变、心脑血管事件发生率等。结果干预组糖尿病足病变治疗好转率高,恶化发展率低,心脑血管事件发生率少。血脂、血流变学、下肢血管多普勒彩超及眼底病变等好转改善明显,与对照组比较差异有统计学意义(P<0.05或P<0.01)。结论刺五加注射液及抗凝剂(潘生丁、肠溶阿斯匹林)对糖尿病足病变的早期干预治疗疗效显著,有重要的临床意义。     

Two novel gastric cancer-associated genes identified by differential display

AIM To clone novel gastric cancer-associated genes and investigate their roles in gastric cancer occurrence.METHODS A method called differential display was used which allows the identification of differentially expressed genes by using PAGE to display PCR-amplified cDNA fragments between gastric cancer cells and normal gastric mucosa cells. These fragments were cloned into plasmid vector pUC18. Homology analysis was made after sequencing these fragments.RESULTS Two novel genes were identified compared with sequences from GenBank. One was registered with the AD number AF 051783. In situ hybridization showed that these two novel genes expressed specifically in gastric cancer tissues.CONCLUSION The two novel genes obtained by differential display were confirmed to be gastric cancer-associated genes using in situ hybridization.     

7例肝细胞体内移植患者临床护理需求的探讨

目的观察肝细胞体内移植术的有效性与安全性,探讨相应的护理需求。方法从自愿捐献者的肝脏内分离纯化肝细胞,制成悬液,经股动脉插管行脾动脉灌注移植,观察治疗后肝衰竭患者的肝功能恢复率、恢复时间、治疗不良反应及患者心态变化,针对不良反应及患者心理给予完善护理,建立肝细胞体内移植术护理规范。结果7例肝衰竭患者治疗后,4例临床治愈,有效率为57.1%,胆红素、凝血酶原活动度改善50%以上的发生时间约在术后4周。术后患者不同程度出现恶心、呕吐(57.1%),少量腹水(57.1%),肝性脑病(42.9%),发热(42.9%),穿刺点皮下血肿(28.6%),肺部真菌感染(14.3%)。术后71.4%的患者有焦虑情绪。经过相应的临床及心理护理,症状均有不同程度的改善。结论肝细胞体内移植可延长终末期肝病患者生存期,但病情明显改善所需时间约4周,防治肝性脑病、预防穿刺点皮下血肿及运用心理护理消除患者焦虑情绪是重要的护理需求。     

非穿透性小梁切除术治疗开角型青光眼

目的 研究非穿透性小梁切除术治疗开角型青光眼的手术效果。方法 对20例26眼开角型青光眼行非穿透性小梁切除术,术后观察眼压、结膜滤枕及前房反应等情况,随访1～12个月。结果 术后各期平均眼压均低于术前平均眼压,差异有显著性(P<0.05)术。前平均眼压26.26mmHg,术后3个月、6个月、9个月、12个月平均眼压分别为15.47mmHg、16.89mmHg、19.14mmHg、18.50mmHg。16眼结膜形成滤性手术典型滤过泡,10眼结膜疏松无滤过泡形成。26眼均无前房出血,术后前房反应轻。结论 非穿透性小梁切除术能有效地降低开角型青光眼的眼压,术后并发症少,可作为此类青光眼病人手术的选择。     

结构蛋白及血管形成因子在体表海绵状静脉畸形中的表达及意义

目的：研究结构蛋白及血管形成因子（VEGF）在体表海绵状静脉畸形（cavernous venous malformation,CVM）中的表达及意义。方法：1996－2000年CVM病理样本25例，取正常中、小型静脉各12例。采用Envision法免疫组化染色观察Ⅳ型胶原、纤维连接蛋白（Fn）、层粘连蛋白（Ln）及VEGF、血管生成素－1（Ang-1）等血管形成因子的表达，半定量分析结果。结果：Ⅳ型胶原、Fn和Ln在海绵状静脉畸形与中、小静脉中的分类似，但表达量明显较少。畸形组织和小静脉VEGF表达明显强于中型静脉，小静脉Ang-1表达明显强于静脉畸形和中型静脉。结论：Ln及VEGF表达变化可能是海绵状静脉畸形形成发展的重要因素。Ang-1表达减少可能参与海绵状静脉畸形的血管塑形障碍的发生。     

含链霉素短程化疗方案的痰结核菌转阴时间观察

目的对比短程化疗含链霉素(SM)、乙胺丁醇(EMB)两组方案在抗结核治疗中的效果。方法选初治菌阳肺结核100例,予含SM方案(2HRZS/7HR)化疗50例,含EMB方案(2HRZE/7HR)化疗50例。每月检查痰结核菌一次(涂片三次,培养一次)。停药后继续追踪两年。结果痰菌2个月内转阴者,SM组29例,占63%;EMB组18例,占38%,p<0.05,有显著性差异。需延长强化期者:SM组16例,占35%;EMB组26例,占55%,p<0.05,有显著性差异。复发病例,SM组2例,占4%;EMB组3例,占6%,p>0.05,无显著性差异。结论使用含SM方案化疗的病例其痰菌转阴时间比含EMB方案短。     

急性冠脉综合征患者强化抗栓治疗研究进展

急性冠脉综合征（ACS）是冠心病的严重类型,ACS患者不仅病死率较高,还存在缺血事件（如缺血性卒中、心肌梗死）复发风险。血小板聚集及血栓形成是导致ACS的重要原因。为降低缺血事件的发生风险,临床推荐ACS患者接受阿司匹林联合强效P2Y12抑制剂的双联抗血小板治疗12个月。然而在标准双联抗血小板治疗下,ACS患者残余缺血风险（经抗栓治疗后仍残留的缺血事件发生风险）仍旧较高。因此为进一步降低缺血事件发生风险,临床对强化抗栓方案的研究也逐渐增多。本文通过总结强化抗栓治疗方案的作用机制及其最新研究进展,发现延长双联抗血小板治疗时间、三联抗血小板治疗、双通道抑制（抗血小板联合抗凝治疗）等强化抗栓治疗方案可降低缺血事件发生风险,为进一步指导临床个体化抗栓治疗及明确最佳抗栓策略提供了参考。     

Microsatellite analysis in Turner syndrome: parental origin of X chromosomes and possible mechanism of formation of abnormal chromosomes.

Turner syndrome is a chromosomal disorder in which all or part of one X chromosome is missing. The meiotic or mitotic origin of most cases remains unknown due to the difficulty in detecting hidden mosaicism and to the lack of meiotic segregation studies. We analyzed 15 Turner patients, 10 with a 45,X whereas the rest had a second cell line with abnormal X-chromosomes: a pseudodicentric, an isochromosome, one large and one small ring, and the last with a long arm deletion. Our aims were: to detect X cryptic mosaicism in patients with a 45,X constitution; to determine the parental origin of the abnormality; to infer the zygotic origin of the karyotype and to suggest the timing and mechanism of the error(s) leading to the formation of abnormal X chromosomes from maternal origin. Molecular investigation did not revealed heterozygosity for any microsatellite, excluding X mosaicism in the 45,X cases. Parental origin of the single X chromosome was maternal in 90% of these patients. Three of the structurally abnormal Xs were maternally derived whereas the other two were paternal. These results allowed us to corroborate breakpoints in these abnormal X chromosomes and suggest that the pseudodicentric chromosome originated from post-zygotic sister chromatid exchange, whereas the Xq deleted chromosome probably arose after a recombination event during maternal meiosis.     

Fertility of ejaculated and testicular megalohead spermatozoa with intracytoplasmic sperm injection

In this study the fertility and outcome of intracytoplasmic sperm injection (ICSI) using megalohead spermatozoa from the ejaculates and testicles was evaluated. Seventeen males with megalohead and pinhead sperm forms in their ejaculate were studied in 22 cycles. A high number of sperm heads without tails and abundant round spermatid forms were commonly observed. Round-headed spermatozoa were seldom accompanied by these severely abnormal spermatozoa. The majority of megalohead spermatozoa were observed to have multiple tails, were predominant in the sample, and were used for ICSI. Ejaculated megalohead spermatozoa were used for ICSI in 15 cycles, while testicular spermatozoa were used in seven cycles where there were no vital spermatozoa or spermatozoa of low vitality in the ejaculate. The same abnormal morphology was observed in the testicles as in the ejaculated spermatozoa in the same males. Mean (+/- SD) low motility 4.7 +/- 5.6% and sperm count (3.8 +/- 4.19 x 10(6)) were common findings in these severely teratozoospermic patients. A low fertilization rate (43.2%) was achieved by using megalohead sperm forms (group I, n = 17) in comparison with the control group (60.2%) which had zero normal sperm morphology according to strict criteria (group II, n = 30) (P <0.01). Furthermore, a low pregnancy rate (9.1%) was obtained in the megalohead sperm group in comparison with the control group (40%) (P <0.05). Low fertilization and pregnancy rates may be due to a high incidence of chromosomal abnormalities from severely defective spermatozoa in the ejaculate. Couples should be counselled and warned about possible low fertilization and pregnancy rates with ICSI when only pinhead and megalohead forms with a high number of sperm heads without tails are present in the ejaculate.