2型糖尿病患者UAER与心脏结构和功能的关系

目的:探讨老年2型糖尿病患者尿白蛋白排泄率与心脏结构和功能的关系.方法:80例2型糖尿病患者,以UAER20-200μg/min的患者为观察组,以UAER<20μg/min的患者为对照组,通过心脏彩超测量比较两组之间的心脏结构和功能.结果:与对照组相比,观察细LV扩大,LVM增加,LVEF降低.结论:UAER阳性的糖尿病患者在其早期就已发生心脏结构和功能的改变,尿蛋白排泄率与左心室内径和左心室厚度正相关,与左心室射血分数负相关.     

洛伐他汀对人肾小球系膜细胞胰岛素样生长因子-1表达的影响

目的：观察HMG-CoA还原酶抑制剂洛伐他汀对人肾小球系膜细胞胰岛素样生长因子-1(IGF-1)表达及纤维连接蛋白、层连蛋白和Ⅳ型胶原分泌的影响。方法：分别于体外低糖(5．6mmol／L)和高糖(30mmol／L)环境中培养人胎肾小球系膜细胞．用RT-PCR法检测系膜细胞IGF-1 mRNA表达水平,用酶免和放免法测定细胞上清液中纤维连接蛋白、层黏连蛋白和Ⅳ型胶原含量。分别在培养液中加入洛伐他汀或／和西拉普利,观察不同刺激时间和药物浓度对上述基质蛋白指标的影响。选择刺激时间48h和刺激浓度10μmol／L,观察单用或联用洛伐他汀和西拉普利对系膜细胞IGF-1 mRNA表达的影响。结果：高糖环境下肾小球系膜细胞过度增殖,细胞上清液中纤维连接蛋白、层黏连蛋白和Ⅳ型胶原含量增加,IGF-1 mRNA表达明显增加。洛伐他汀和西拉普利均可明显抑制系膜细胞增殖,降低细胞上清液中基质蛋白浓度,IGF-1 mRNA表达亦显著下降。洛伐他汀对IGF-1 mRNA表达的抑制作用略强于西拉普利,但两者联用未显示更强的抑制效果。结论：高糖可刺激人肾小球系膜细胞IGF-1高表达,并增加基质蛋白的分泌,洛伐他汀与西拉普利类似,均可一定程度逆转上述现象,提示他汀类药物可能有益于早期糖尿病肾病的防治。     

城市医院发展面临的主要矛盾及其改革走向

分析了城市医院目前面临的主要问题与矛盾,即投入补偿不足严重制约医院的生存和发展;卫生服务价格政策不合理迫使医院侧支循环;宏观规划及调控政策不配套严重影响正常的医疗秩序;医学高级人才严重不足制约医疗技术水平的提高和医院发展。在此基础上提出了城市医院深化改革的走向及发展对策:完善卫生经济政策,增加城市医院投入;调整卫生收费标准,理顺卫生服务价格;加快高级人才培养,提高队伍整体素质;深化卫生管理改革,全面提高诊疗水平;加强宏观规划调控,健全医疗服务体系。     

Hypofunctioning of sensory gating mechanisms in patients with obsessive-compulsive disorder.

BACKGROUND: In obsessive-compulsive disorder (OCD) patients, functional abnormalities in basal ganglia/precentral circuitries cause cortical hyperexcitability and lack of inhibitory control. These loops can be partly explored by median-nerve somatosensory evoked potentials (SEPs), which functionally reflect the brain responsiveness to somatosensory stimuli. In healthy humans, SEPs' amplitude during voluntary finger movements is lower than during muscular relaxation (i.e., sensory gating). Cortical hyperexcitability in OCD could be eventually responsible for a reduction of sensory gating. This might have pathophysiologic implications for motor compulsions. METHODS: Median-nerve SEPs were recorded in 11 OCD patients and 9 healthy volunteers during muscle relaxation ("Relax") or finger movements of the stimulated hand ("Move"). Latencies and amplitudes of pre- and postcentral SEP components were compared between groups during "Relax" and "Move" conditions. RESULTS: In OCD patients, the responsiveness to sensory stimuli was enhanced for precentral SEPs. Sensory gating ("Relax" vs. "Move") in control subjects involved both pre- and postcentral SEPs, the former being reduced in amplitude by approximately 60%. In OCD patients, sensory gating was spatially restricted to precentral SEP components and was significantly reduced compared with control subjects (approximately 30%). CONCLUSIONS: Enhanced precentral SEPs and hypofunctioning of centrifugal sensory gating in OCD might reflect the inability to modulate sensory information due to a "tonic" high level of cortical excitability of motor and related areas, likely resulting from basal ganglia dysfunction. This might offer new insights into the pathophysiology of OCD.     

超声检查对乳腺实性肿块内血液动力学研究

目的　评价多普勒血流显像技术检测乳腺实性肿块内血流对乳腺实性肿块的定性诊断。方法　对乳腺实性肿块患者 97例进行超声检查及肿块内血流检测 ,并与术后组织病理学诊断对照。结果　 2 4例乳腺恶性肿块 2 2例测及动脉血流 ,收缩期最高峰速 (PSV)平均值 (30 .2 8± 2 0 .13) cm/s,阻力指数 (RI)平均值 0 .84 9±0 .0 98,73例乳腺良性肿块 4 4例测及动脉血流 ,收缩期最高峰速 (PSV)平均值 (2 0 .4 4± 11.4 3) cm/s,阻力指数 (RI)平均值 0 .6 12± 0 .0 98。当以 PSV=12 cm/s为乳腺良、恶性肿块的界限时 ,PSV诊断乳腺良、恶性肿块的敏感性率和特异性率分别为 87.5 %及 5 7.5 % ,当以 RI=0 .70为乳腺良、恶性肿块的界限时 ,RI诊断乳腺良、恶性肿块的敏感性率和特异性率分别为 87.5 %及 87.7%。二者敏感性率无显著差异 ,而 RI诊断乳腺恶性肿块的特异性率明显高与 PSV,差异具有显著性 (P<0 .0 1)。结论　用多普勒血流显像技术检测乳腺实性肿块的异常血流的 RI对乳腺实性肿块的性质预测具有一定的临床意义     

渔船网绳绞伤致拇指旋转撕脱伤9例

目的 改进拇指旋转撕脱性离断再植方法，提高再植速度，缩短离体指体的缺血时间。方法 通过对9例拇指旋转撕脱性离断的临床显微解剖，将拇指主要动脉损伤分成轻、中、重三度，采用先修复动脉的修复方法。根据指神经撕脱伤的特点及第1指掌侧总神经的解剖特点直接修复两侧指神经。改变肌腱的缝合部位，减少肌腱的粘连。结果 临床应用9例全部成活。经6～12个月随访，再植手指均获得满意的外形和功能。结论 拇指旋转撕脱性断指再植的改进方法实用、简单、快速、成活率高。     

Endothelial exosomes contribute to the antitumor response during breast cancer neoadjuvant chemotherapy via microRNA transfer

The interaction between tumor cells and their microenvironment is an essential aspect of tumor development. Therefore, understanding how this microenvironment communicates with tumor cells is crucial for the development of new anti-cancer therapies. MicroRNAs (miRNAs) are small non-coding RNAs that inhibit gene expression. They are secreted into the extracellular medium in vesicles called exosomes, which allow communication between cells via the transfer of their cargo. Consequently, we hypothesized that circulating endothelial miRNAs could be transferred to tumor cells and modify their phenotype. Using exogenous miRNA, we demonstrated that endothelial cells can transfer miRNA to tumor cells via exosomes. Using miRNA profiling, we identified miR-503, which exhibited downregulated levels in exosomes released from endothelial cells cultured under tumoral conditions. The modulation of miR-503 in breast cancer cells altered their proliferative and invasive capacities. We then identified two targets of miR-503, CCND2 and CCND3. Moreover, we measured increased plasmatic miR-503 in breast cancer patients after neoadjuvant chemotherapy, which could be partly due to increased miRNA secretion by endothelial cells. Taken together, our data are the first to reveal the involvement of the endothelium in the modulation of tumor development via the secretion of circulating miR-503 in response to chemotherapy treatment.     

转人内皮抑素基因双歧杆菌液抑制血管生长的实验观察

目的：研究转人内皮抑素基因双歧杆菌液对血管生长的抑制作用，并观察其对动物移植性肝癌Heps的抑瘤作用。方法：以小鼠移植性肝癌Heps建立肿瘤模型；分别进行灌胃和尾静脉注射给药，同时用转人内皮抑素基因双歧杆菌液做鸡胚绒毛尿囊膜（CAM）实验，在解剖显微镜下计数血管条数，用图像分析仪定量分析血管密度。实验动物处死后，称瘤重并计算抑瘤率。结果：转基因双歧杆菌液高、中、低3个剂量组的抑瘤率分别为49.78%、45.81%和30.41%；普通双歧杆菌组抑瘤率为10.9%，尾静脉注射转基因双歧杆菌组抑瘤率为58.3%；CAM实验显示转基因双歧杆菌液可明显抑制血管的生成。结论：转基因双歧杆菌有良好的抑制血管生长和抑制肿瘤生长的作用，且其作用有量效关系。     

中国大学生的人性观与美国常模比较研究

目的：探讨中国大学生的人性特点。方法：使用人性的哲学量表对192名中国大学生进行调查，并与美国常模进行比较。结果：（1）中美大学生在值得信任，意志力与理性，独立性方面没有显著差异，但中国男女大学生之间在值得信任方面存在显著差异，中国女大学生信任度较低。（2）中美大学生在利他主义方面存在显著差异，中国大学生有更强的利他意识。（3）中美大学生在人性复杂性，人性变异性得分均偏高，但两者仍存在显著差异，中国男女大学生在人性复杂性方面存在极显著差异，结论：不同文化背景的大学生在人性观点看法迥异。     

中西医结合治疗系统性红斑狼疮疗效观察附:41例病例报告

目的 探寻中西医结合治疗系统性红斑狼疮（SLE）的新方法。方法 采用中药滋阴清热解毒活血法配合小剂量激素与单纯应用激素疗法进行对照研究。结果 在总体疗效评估，病情评分，临床症状与体征的改善，实验异常指标的恢复，激素开始和最终用量以及治疗随访等一系列指标的比较方面，治疗组均优于对照组（P＜0．01或P＜0．05）。结论 中药滋阴清热解毒活血配合小剂量激素疗法对SLE的疗效，优于单纯激素疗法。