Sudden total deafness in sickle cell disease

Sickle cell disease is a world-wide problem which has been noted to cause high tone sensorineural hearing loss. We report a case with sudden onset bilateral hearing loss which progressed to total sensorineural deafness. To our knowledge there has been no report of such a case occurring previously.     

CO作用后大鼠肺血管细胞增殖和凋亡状况的研究

目的：通过研究CO和低氧作用后大鼠肺血管细胞增殖和凋亡状况，探讨低氧肺动脉高压的发病机制及防治措施。方法：应用免疫组织化学，原位末端标记及Western杂交等方法检测常压低氧大鼠肺血管壁细胞增殖，凋亡及c-myc基因的表达状况。结果：正常组，低氧和锡原卟啉组，低浓度CO和血晶素组大鼠肺动脉均存在增殖和凋亡的阳性细胞，两类细胞在肺内呈不均匀散在分布，低氧和锡原卟啉组大鼠肺血管增殖细胞数显著升高而凋亡细胞数显著减少，细胞增殖凋亡比值分别为对照组的5倍或4倍，而低浓度CO和血晶素组肺血管增殖细胞和凋亡细胞系数均显著增加，细胞增殖凋亡比值均为1．2，c-myc在低氧和锡原卟啉组大鼠肺内表达显著增加，在低浓度CO和血晶素组大鼠肺内表达减少。结论：增殖和凋亡现象共存在于正常和处理大鼠的肺血管细胞中，也许c-myc等基因的异常表达导致了细胞增殖和凋亡的失衡，进而调节了慢性低氧肺血管结构的改建。     

Sexual attitudes and practices of selected groups in Northern Ireland since the emergence of AIDS.

One hundred and seventeen heterosexual males and females attending a sexually transmitted disease clinic and 57 homosexual males from a local "gay" club were asked to complete a questionnaire regarding their attitudes and sexual practices since the emergence of AIDS. The results show a trend towards increasing partner change rate among heterosexual males. There has been an increase in the practice of insertive anal intercourse by homosexual men with Northern Ireland contacts but no corresponding increase with contacts outside Northern Ireland. The practice of receptive anal intercourse has remained constant. Significant differences in attitudes between homosexual and heterosexual males were expressed with regard to testing of 'at risk groups' (p less than 0.001), in the uptake of testing (p less than 0.01), and in attitudes to sexual practices if they themselves became HIV positive. There was a low level of anxiety amongst heterosexuals regarding risk of HIV infection in the future. Less than 50% of the heterosexual patients attending this clinic use condoms, though more claim to intend to use them in future.     

Knowledge of HIV infection and AIDS, and attitudes to testing and counselling among general practitioners in Northern Ireland.

All 922 general practitioners in Northern Ireland were sent a questionnaire on human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS). Five hundred and ninety four general practitioners (64.4%) returned the questionnaire. Thirty eight respondents (6.4%) knew of an HIV positive patient in their practice and 93.3% felt they should be informed if one of their patients was found to be HIV positive at a genitourinary medicine clinic, even without the patient's consent. Of the respondents, 76.8% were willing to be involved in the management of AIDS patients in their practice in cooperation with hospital colleagues but only 37.5% felt confident to provide AIDS counselling and advice. Of the 368 general practitioners who did not feel confident to provide AIDS counselling and advice, 41.3% felt that they had insufficient knowledge and 79.6% felt uncertain of their counselling skills. The information gathered on the administration of injections, taking blood samples and disposal of needles indicated that further education for general practitioners is required to ensure safety at work.     

Roles of tumour necrosis factor-alpha (TNF-alpha), transforming growth factor-beta (TGF-beta), and IL-10 in the modulation of intercellular adhesion molecule-1 (ICAM-1) expression by macrophages during mycobacterial infection

Profiles of ICAM-1 expression on cultured murine peritoneal macrophages infected with Mycobacterium avium complex (MAC) were examined, with special reference to modulating roles of TNF-alpha, TGF-beta, and IL-10. When macrophages were infected with MAC, ICAM-1 expression, measured by microscopic counting of ICAM-1+ macrophages stained with anti-ICAM-1 antibody, ELISA, and flow cytometric analysis, was rapidly increased, peaking at day 3 (early-phase up-regulation) due to endogenous TNF-alpha, and thereafter gradually declined to the normal level within 1 week or more (late-phase down-regulation). The late-phase ICAM-1 down-regulation was also seen in macrophages phagocytosing heat-killed MAC and those stimulated with lipopolysaccharide but not in macrophages phagocytosing latex beads. ICAM-1 mRNA expression was augmented markedly at day 1 after MAC infection and thereafter decreased. While TNF-alpha and IL-10 production by MAC-infected macrophages was observed during the first 3 days, TGF-beta production was initiated from day 3 and continued until day 14. Exogenously added TGF-beta strongly inhibited the early-phase increase in ICAM-1 expression by infected macrophages, and the blockade of endogenous TGF-beta with anti-TGF-beta antibody markedly inhibited late-phase ICAM-1 down-regulation. Moderate blocking effect was also observed for anti-IL-10 antibody. On the other hand, late-phase ICAM-1 down-regulation was not prevented by the addition of exogenous TNF-alpha. Therefore, TGF-beta and IL-10, especially the former, appear to play active roles in the late-phase down-regulation of ICAM-1 in MAC-infected macrophages during long-term cultivation.     

肱骨髁上骨折合并肱动脉损伤的诊治

目的：为探讨肱骨髁上骨折合并不同类型肱动脉损伤的诊断与治疗。方法：采用交区克氏针固定骨折，应用机械扩张、血管探查、修补、吻合等措施修复肱动脉。结果：16例于术中探查肱动脉，有断裂伤、刺破伤及顽固性痉挛，均采用手术治疗，使前臂血运得到恢复，骨折得到固定。本组除1例因伤后24小时入院出现前臂缺血性肌挛维、1例因严重粉碎性骨折术后肘关节活动中度受限外，14例均恢复良好，结论：肱骨髁上骨折台井脏动脉损伤的后果严重，但通过及时诊断和有效手术治疗、预后良好。     

立体定向适形放疗对中晚期肝癌的疗效观察

目的评价立体定向适形放疗对中晚期肝癌的治疗效果。方法对中晚期肝癌患者经立体定向适形放疗及肝动脉 栓塞化疗（ＴＡＥ）后癌块最大直径、血清甲胎蛋白（ＡＦＰ）及血白细胞、肝功能的变化情况进行对比分析。立体定向适形放 疗组（Ａ组）２１例,其中肝功能Ｃｈｉｌｄ Ａ级１３例、Ｂ级８例,癌块直径小于５ ｃｍ ２例、大于１０ ｃｍ ６例、５～１０ ｃｍ １３例。 ＴＡＥ组（Ｂ　组）２０例,Ｃｈｉｌｄ Ａ级 １２例、Ｂ级 ８例,癌块直径小于 ５ ｃｍ ５例、大于 １０ ｃｍ ３例、５～１０ ｃｍ １２例。结果两组 瘤体平均直径缩小值、瘤体直径缩小率、血ＡＦＰ降低率、白细胞减少发生率及肝功能改变发生率分别为,Ａ组：（２．５８±１．８０）ｃｍ、 ６６．６７％、８６．６％、１９．０５％和９．５２％;Ｂ组：（１．２０±０．６８）ｃｍ、３０％、４３．７５％、５０％和６０％。两组差异有显著性意义。结论立体定 向适形放疗是治疗不能手术的中晚期肝癌较好的方法之一,且副反应发生率低。     

Retrospective study of functional outcomes and disability after non-ischaemic vascular causes of spinal cord dysfunction

Objective: Describe demographic characteristics, functional outcomes and disability following rehabilitation for non-ischemic vascular spinal cord dysfunction (SCDys).Design: Retrospective, open cohort, case series.Setting: Tertiary rehabilitation unit, Victoria, Australia.Participants: Patients with non-ischemic vascular SCDys admitted over a 21-year-period (01/01/1995–31/12/2015) were identified using International Classification of Diseases codes.Outcome Measures: Demographic characteristics, etiology, neurologic classification, length of stay (LOS), and complications. On admission and discharge, the following were collected: functional independence measure (FIM) motor subscale, details on bowel, bladder, mobility, living arrangement, and support services.Results: 36 patients (female 58%; mean age 69 ± 16 years) were identified. The main causes of non-ischemic vascular SCDys were epidural hematoma (39%), dural arteriovenous fistula (17%), and arteriovenous malformation (11%). 22 cases (61%) were iatrogenic. Most (86%) had incomplete paraplegia. Urinary tract infection was the most common complication (64%). Median LOS in rehabilitation was 68 days. Significant improvement in FIM motor scores was observed from admission (median 25, interquartile range [IQR] 20–38) to discharge (median 69, IQR 38–77) (P < 0.001). On discharge, 4 patients (11%) walked >100 m unaided, 6 (17%) walked >100 m with assistive device, 10 (28%) walked >10 m with assistive device, 15 (41%) were wheelchair dependent and 1 (3%) patient remained non-mobile. 20 patients (56%) were discharged home, 8 (22%) to nursing home, and 8 (22%) transferred to another hospital.Conclusion: Most patients returned home with significantly improved functional outcomes compared to rehabilitation admission, but with the majority having ongoing major disabilities based on FIM motor scores.     

胰肾联合移植长期存活的临床研究（附5例报告）

目的 提高糖尿病、糖尿病肾病患者的生活质量,方法 于1998-12/2000-01对5例糖尿病、糖尿病肾病患者施行了胰肾联合移植术,结果 5例患者肾功能恢复正常;其中2例患者分别于8wk,23wk发生急性排斥反应一次,经抗排斥治疗后逆转,2例术后2wk发生纯红再障（pure red cell aplasia,PRCA),1例手术后第15日供胰动脉血栓形成,切除胰腺,经1a以上观察,4例患者健康存活,胰肾功能良好。结论 胰肾联合移植是目前治疗糖尿病、糖尿病肾病最有效的手段。     

脑梗塞患者脂蛋白(A)水平与肾脏早期损害

为探讨脑梗塞患者脂蛋白（Ａ）水平与肾脏早期损害的关系,应用ＥＬＩＳＡ法及化学显色终点法分别检测４０例梗塞患者血清ＬＰ（Ａ）水平和尿氨基葡萄糖苷酶活力。结果表明,脑梗塞组血ＬＰ（Ａ）及ＮＡＧ均明显高于正常对照组,且ＬＰ（Ａ）值与尿ＮＡＧ活力呈正相关。