前列腺素E1对大鼠肝脏缺血再灌注损伤的保护作用

目的 探讨前列腺素E1（PGE1）对肝脏 因再灌注损伤的保护作用。方法 制作常温下大鼠部分肝叶缺血再灌注模型，于缺血前经门静脉给予PGE1，45min后恢复血流灌注，并于1h后取门静脉血测定血清谷草转氨酶（GOT）、谷丙转氨酶（GPT）、乳酸脱氢酶（LDH）、肿瘤坏死因子－α（TNF－α）及内皮素1（ET－1），同时取缺血肝叶行病理组织学检查。结果 缺血再灌注组GOT、GPT、LDH及TNF－α和ET－1均明显高于正常对照组，PGE1组则明显低于缺血再灌注组。PGE1组的肝脏病理组织学改变明显轻于缺血再灌注组，并接近正常对照组。结论 PGE1对肝缺血再灌注具有保护作用。     

胱蛋白酶抑制剂C和内生肌酐清除率与肾脏病理变化的关系探讨

目的　了解血胱蛋白酶抑制剂 (cystatin)C和内生肌酐清除率 (Ccr)与肾脏病理变化的关系。 方法　选择 1999年 1月～ 2 0 0 3年 2月因各种肾脏疾病收治入院行肾穿刺活检术的患儿共 12 4例 ,入院后查血cys tatinC和Ccr ,并行肾穿刺活检术以了解肾脏病理变化 ,然后通过相关及多元线性回归分析了解血cystatinC和Ccr与肾脏病理变化的关系。结果　血cystatinC与肾脏病理变化的复相关系数 (R) =0 .6 91(P <0 .0 1) ,血cys tatinC与肾脏病理变化之间存在直线关系 ,其回归方程为Y =0 .6 0 5 +0 .30 7X1+0 .4 93X2 (F =5 5 .18,P <0 .0 1)。Ccr与肾脏病理变化的R =0 .4 0 5 (P <0 .0 1) ,Ccr与肾脏病理变化之间亦存在直线关系 (F =11.89,P<0 .0 1)。结论　血cystatinC比Ccr更能反映肾脏病理变化的严重程度。血cystatinC和Ccr均与肾间质的变化密切相关 ,尤以血cystatinC更敏感。因此 ,血cystatinC可作为判断肾脏疾病预后的重要参考指标 ,以及时了解肾脏病理变化采取有效的治疗。     

Obesity in Diabetic Patients Undergoing Coronary Artery Bypass Graft Surgery Is Associated with Increased Postoperative Morbidity

Background: Despite the fact that obesity is a known risk factor for cardiovascular disease, many studies have failed to demonstrate that obesity is independently associated with an increased risk of cardiovascular morbidity and mortality in nondiabetic patients undergoing coronary artery bypass graft surgery. The authors investigated the influence of obesity on adverse postoperative outcomes in diabetic and nondiabetic patients after primary coronary artery bypass surgery.

Methods: A retrospective cohort study of patients undergoing primary coronary artery bypass surgery (n = 9,862) between January 1995 and December 2004 at the Texas Heart Institute was performed. Diabetic (n = 3,374) and nondiabetic patients (n = 6,488) were classified into five groups, according to their body mass index: normal weight (n = 2,148), overweight (n = 4,257), mild obesity (n = 2,298), moderate obesity (n = 785), or morbid obesity (n = 338). Multivariate, stepwise logistic regression was performed controlling for patient demographics, medical history, and preoperative medications to determine whether obesity was independently associated with an increased risk of adverse postoperative outcomes.

Results: Obesity in nondiabetic patients was not independently associated with an increased risk of adverse postoperative outcomes. In contrast, obesity in diabetic patients was independently associated with a significantly increased risk of postoperative respiratory failure (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.41-3.61; P < 0.001), ventricular tachycardia (OR, 2.27; 95% CI, 1.18-4.35; P < 0.02), atrial fibrillation (OR, 1.56; 95% CI, 1.03-2.38; P < 0.04), atrial flutter (OR, 2.38; 95% CI, 1.29-4.40; P < 0.01), renal insufficiency (OR, 1.66; 95% CI, 1.10-3.41; P < 0.03), and leg wound infection (OR, 5.34; 95% CI, 2.27-12.54; P < 0.001). Obesity in diabetic patients was not independently associated with an increased risk of mortality, stroke, myocardial infarction, sepsis, or sternal wound infection.     

A preliminary study of the relationship between antibiotic administration and changes in bacteriological profile of wound infection in a burn unit

Objective:To investigate the relationship between antibiotic administration and the changes in bacteriological profile in a burn unit. Methods: The data of consumption of different kinds of antibiotics, including total antibiotic consumption [expressed as the number of defined daily doses (DDD)] as well as pathogen identification, were collected in a 8-year period. The constituent ratios of different kinds of antibiotics in total antibiotic consumption to isolation rates of various species of bacteria were calculated, and their correlation was analyzed. Results: Within this period, it was found that the aminoglycosides and first generation cephalosporins were used less frequently, while the polypeptides, carbopenem and macrolides were used proportionally more. At the same time, the isolation rates of Staphylococcus aureus, Acinetobacter sp, Enterobacter cloacae, Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus were gradually increased. The constituent ratios of predominant pathogens were correlated to the different kinds of antibiotics consumption in the burn unit. Conclusion: The results suggested that the consumption of different antibiotics was closely related to the trends of emergence of bacterial isolates from infected burn wounds. The result might imply that to regulate the administration of certain antibiotics might help decrease the emergence of certain pathogenic bacteria in burn infections.     

重组2型腺相关病毒-转化生长因子β3对实验性肝纤维化大鼠肝脏组织病理学和Ⅰ型胶原表达的影响

Objective To investgate the effects of TGF β 3 on rat hepatic fibrosis. Methods The TGF β 3 cDNA was cloned into rAAV2 vector. Rats were randomly divided into four groups: normal control group, model group, negative control group and TGF β 3 group. Hepatic fibrosis was induced by hypodermic injection of 40% CCI4. Recombinant AAV2-TGF β 3 viral particles were injected via the vena caudalis one week before CCh treatment. Rats were executed 8 weeks after CCI4 treatment, global histological change was observed after HE staining, the distribution of the collagen fibers was observed after masson staining, his-tochemistry was done to observe the expression of collagen Ⅰ; The positive area rate of the collagen fibers and the average optical rate of collagen Ⅰ were quantified. Results HE staining indicated that collagen fibers were reduced in the TGF β 3 group. Masson staining shown that the collagen fibers were distributed around the blood vessel, in the portal area and disse space. Compared to the model group (13.2%±2.2%) and negative control group (12.3%±1.5%), the collagen fibers in liver tissues of TGF β3 group (7.7% ± 1.5%) were significantly decreased (q = 9.456, P < 0.01; q = 8.217, P < 0.01). Histochemistry indicated that the collagen fibers of liver tissues of TGF 15 3 group (0.185±0.033) were significantly higher than those in the model group (0.252±0.042) and the negative control group (0.230±0.029), (q = 6.228, P < 0.01; q = 4.346, P < 0.01). Conclusion TGF β 3 alleviates the damage to hepatic cell and the level offibrosis in CCI4 treated rats and inhibits the expression of collagen Ⅰ.     

联合应用口服水剂和水灌肠肠道充盈法的MSCT研究

目的：评价口服水剂、水灌肠及两者联合应用充盈肠道后,使用MSCT显示成人正常肠道的能力。材料和方法：将43名非肠道病变志愿者分别采用口服水剂法(21例)、水灌肠法(12例)、双重法(口服水剂和水灌肠联合应用,10例)充盈肠道,然后行MSCT平扫和增强扫描并进行图像重建,对小肠和大肠各肠段充盈状态进行评价。结果：口服水剂法回肠充盈良好,水灌肠法大肠充盈良好,双重法回肠及大肠均充盈良好。口服水剂法小肠充盈优于水灌肠法,与双重法无显著差异,大肠充盈状态水灌肠法明显优于口服水剂法,与双重法无显著差异。结论：口服水剂和水灌肠联合应用可以在MSCT同时较好地充盈显示小肠和大肠,而两种方法单独使用则仅能分别充盈显示小肠和大肠,需要根据显示目的选择相应的充盈方法。     

甾体避孕药不增加血栓栓塞性疾病危险(病例对照研究)

本文采用1:3病例对照研究方法,对甾体避孕药的使用与血栓栓塞性疾病(急性心肌梗塞、脑栓塞、脑血栓形成和深静脉血栓形成)间的关联进行多因素分析。结果提示在我国广泛应用的甾体避孕药(主要为国产Ⅰ号避孕药)并不增加血栓栓塞性疾病的危险性。用药和停药时间的长短与血栓栓塞性疾病的发生无关,并与高血压病之间亦不存在协同作用。     

妇科阴道流血的鉴别及护理对策

目的探讨有关阴道异常流血的鉴别及有关护理的问题.方法在护理工作中通过对妇科异常阴道流血的原因进行分析鉴别,并采取相应的护理措施.结果总结出针对性护理方面的异同点.结论对提高护士的护理诊断能力,加强工作的计划性和预见性,及时做好急救准备有着重要的意义.     

原发性甲状腺鳞状细胞癌3例报告

笔者报告3例原发性甲状腺鳞状细胞癌临床资料。3例均行手术切除，并经病理检查确诊。1例术后0.5年死于肺部转移;1例1年后出现骨、胸膜转移后失访;1例生存3年，情况良好。提示：该肿瘤恶性程度高，预后差，应予重视。     

131Ⅰ treatment for differentiated thyroid cancers: new vision needed for further development

早在20世纪40年代初,国外学者就开始采用放射性碘治疗甲状腺疾病[1],其中Seidlin等采用放射性碘成功消除了甲状腺癌转移灶为很有影响的研究报道.国内在20世纪60年代起开始应用放射性碘治疗甲状腺癌,经过多年的临床实践,131Ⅰ治疗分化型甲状腺癌(DTC)已发展成对该病术后后续治疗的首选治疗或经典治疗方法.