哮喘的长期控制治疗

哮喘是一种慢性炎症性疾患,需要长期治疗。到目前为止发表的共5版GINA方案中,哮喘的药物治疗所占篇幅最大,是哮喘治疗的首选、主要疗法。1哮喘治疗目标哮喘的治疗目标是达到并维持哮喘临床控制,即无(或≤2次/周)白天症状;无日常活动受限,包括运动受限;无夜间症状和因哮喘憋醒;无需(或≤2次/周)使用缓解药物;肺功能正常或接近正常;无哮喘急性加重。该治疗目标在大多数哮喘患者中可以实现,这已被GOAL研究所证实。2哮喘急性发作的治疗为适合基层需要,将急性发作简略划分如下。2.1轻度发作可以平卧,说话能成句,有条件的可测PEF、FEV1均>80…     

成人斯蒂尔病24例临床分析

目的 探讨成人斯蒂尔病(AOSD)的临床特点.方法 回顾性分析24例经临床确诊的AOSD患者的临床表现和实验室检查结果.结果 AOSD的临床主要表现为发热、多形性皮疹、关节痛、咽痛、淋巴结肿大、白细胞总数增高、血沉加快、类风湿因子和抗核抗体阴性及血清铁蛋白明显升高.结论 AOSD临床表现无特异性,容易误诊,诊断时应排除其他发热性疾病;发热、皮疹、关节疼痛和白细胞升高是AOSD的主要临床特点,血清铁蛋白可作为疾病活动性指标.     

偏头痛大鼠脑内5-羟色胺1F和诱导型一氧化氮合酶基因的表达变化及针刺的干预效应

目的:前期实验已证实针刺治疗偏头痛疗效优越。观察针刺对偏头痛大鼠脑内5-羟色胺1F和诱导型一氧化氮合酶mRNA表达的调控作用。方法:实验于2005-11/2006-05在中南大学湘雅医院中西医结合研究所实验室完成。①选用SD大鼠40只,按随机数字表法分为4组(n=10),除正常对照组外,其余3组均复制大鼠偏头痛模型。模型对照组只造模,不作其他处理;针刺治疗组造模后进行针刺;针刺预防组针刺后造模电刺激20min。针刺方法:针刺大鼠双侧太冲、阳陵泉穴20min。采用疏密波,电流强度0.3～0.6mA,留针20min,1次/d,共5次。②实验完毕后取脑干及三叉神经节匀浆,采用反转录-聚合酶链反应法测定5-羟色胺1F和诱导型一氧化氮合酶mRNA表达。结果:进入结果分析正常对照组10只,模型对照组、针刺治疗组、针刺预防组各9只,共脱失3只。①与正常对照组比较,模型对照组大鼠诱导型一氧化氮合酶mRNA表达显著增强(P<0.01),5-羟色胺1FmRNA表达显著减弱(P<0.01)。②与模型对照组比较,针刺预防组和针刺治疗组诱导型一氧化氮合酶mRNA表达明显减弱(P<0.01),5-羟色胺1FmRNA表达显著增强(P<0.01)。结论:针刺调控5-羟色胺1F和诱导型一氧化氮合酶mRNA的表达可能是针刺防治偏头痛的分子机制。     

蛋白酶对降低异常精液粘稠度的实验对比研究

目的通过不同蛋白酶类对降低高粘稠度精液的粘稠度效果对比,寻找理想的降低精液粘稠度的药物。方法将高粘稠度精液标本分为两组,A组:31例采用α-糜蛋白酶降低精液粘稠度:B组:32例采用尿激酶降低精液粘稠度;两组均观察用药前后的精子活动力。采用配对t检验和单因素方差分析对所得数据作统计学处理。结果高粘稠度精液用药物(α-糜蛋白酶或者尿激酶)液化精液后,精子的活动力较用药前有明显提高(P<0．001);用药前后精液的粘稠度都存在着明显的差异,精液的粘稠度分别下降44．83％和55．45％(P<0．001);在A组和B组的对比研究中,单因素方差分析检验提示:用药后两组间粘稠度数据有显著的差异(P<0．001￡(?)。结论蛋白酶可以有效地降低异常精液粘稠度的精液,从实验结果提示尿激酶降低精液粘稠度的效果优于α-糜蛋白酶,这有助于临床开展应用性研究和治疗。     

TCD观察动脉瘤性SAH后脑血管痉挛的血流动力学改变

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛的血流动力学改变。方法经CT、DSA证实为动脉瘤性SAH患者179例,床旁经颅超声多谱勒(TCD)在术前、术后1~3d、5~7d、9~11d、12~14d记录并分析大脑中动脉(M CA)的血流参数及频谱改变。结果M CA平均血流速度(Vm)于SAH后1~3d开始升高,5~7d、9~11d达到高峰;L I(血管痉挛指数)为3~6时预后良好;>6时可以出现神经系统功能损害,颅内压增高且有脑血管痉挛(CV S)者预后较差。结论TCD能无创、实时评价SAH后CV S的动态变化,可以推断SAH后CV S的严重程度及临床转归。     

Lethal effect of mononuclear cells derived from human umbilical cord blood differentiating into dendritic cells after in vitro induction of cytokines on neuroblastoma cells

BACKGROUND: Dendritic cell is the most major antigen presenting cell of organism. It is proved in recent studies that human umbilical cord blood mononuclear cells induced and cultured in vitro by recombinant human granulocyte-macrophage colony stimulating factor (rhG-MCSF) and recombinant human interleukin-4(rhIL-4) can generate a great many dendritic cells and promote the lethal effect of T cells on human neuroblastoma, but it is unclear that whether the lethal effect is associated with the most proper concentration of dendritic cells. OBJECTIVE: To investigate the lethal effect of human umbilical cord blood mononuclear cells induced in vitro by cytokines differentiating into dendritic cells on human neuroblastoma, and its best concentration range. DESIGN: Open experiment. SETTING: Department of Pediatrics, the Medical School Hospital of Qingdao University. MATERIALS: The study was carried out in the Shandong Provincial Key Laboratory (Laboratory for the Department of Pediatrics of the Medical School Hospital of Qingdao University) during September 2005 to May 2006. Human umbilical cord blood samples were taken from the healthy newborn infants of full-term normal delivery during October to November 2005 in the Medical School Hospital of Qingdao University, and were voluntarily donated by the puerperas. Main instruments: type 3111 CO2 incubator (Forma Scientific, USA), type 550 ELISA Reader (Bio-Rad, USA). Main reagents: neuroblastoma cell line SK-N-SH (Shanghai Institute of Life Science, Chinese Academy of Sciences), RPMI-1640 culture fluid and fetal bovine serum (Hyclone), rhIL-4 (Promega, USA), rhG-MCSF (Harbin Pharmaceutic Group Bioengineering Co.Ltd), rat anti-human CD1a monoclonal antibody and FITC-labeled rabbit anti-rat IgG (Xiehe Stem cell Gene Engineering Co.Ltd). METHODS: ① Human umbilical cord blood mononuclear cells obtained with attachment methods differentiated into human umbilical cord blood dendritic cells, presenting typical morphology of dendritic cells after in vitro induction by rhG-MCSF and rhIL-4. ② Different concentrations of dendritic cells[ dendritic cells: neuroblastoma cells=20∶1,50∶1,100∶1（2×108 L-1，5×108 L-1，1×109 L-1）], 1×109 L-1 T cells and 1×107 L-1 neuroblastoma cells were added in the experimental group. 1×109 L-1 T cells and 1×107 L-1 neuroblastoma cells were added in the control group. ③ Main surface marker CD1a molecules of dendritic cells were detected with indirect immunofluorescence, and the percent rate of dendritic cells was counted with ultraviolet light and expressed as the expression rate of CD1a+ cells. ④ Single effector cells and target cells were respectively set in the experimental group and control group to obtain the lethal effect. The lethal effect of dendritic cells on neuroblastoma cells was indirectly evaluated by detecting cellular survival with MTT assay. The lethal effect(%)=（1-A experimental well-A effector cell well/A target cell well）×100%.⑤The experimental data were presented as Mean ±SD, and paired t test was used. MAIN OUTCOME MEASURES: ① Morphological characters of dendritic cells in the process of induction and differentiation. ②CD1a+ cellular expression rate. ③Lethal effect of dendritic cells on neuroblastoma cells. RESULTS: ①Morphological characters of dendritic cells in the process of induction and differentiation: On the 15th day after human umbilical cord blood mononuclear cells were induced by rhG-MCSF and rhIL-4, typical morphology of dendritic cells could be seen under an inverted microscope. ②Expression rate of CD1a+ cells was （43.12±5.83）%. ③Lethal effect of dendritic cells on neuroblastoma cells: Lethal effect of dendritic cells stimulated T cells in each experimental group ( dendritic cells: neuroblastoma cells=100∶1,50∶1,20∶1 respectively) on neuroblastoma cells was significantly higher than that in control group[（31.00 ±4.41）%，（30.92±5.27）%，(33.57±5.35)%,(26.23±5.20)%, t=3.51，2.98，4.24, P < 0.01）; But the lethal effect of dendritic cells on neuroblastoma was significantly lower when their ratio was 100∶1 and 50∶1 in comparison with 20:1 （t=2.01，2.36, P < 0.05）, and no significant difference in lethal effect existed between the ratio at 100∶1 and 50∶1（t=0.06,P > 0.05）. CONCLUSION: Dendritic cells differentiated from human umbilical cord blood mononuclear cells after in vitro induction of cytokines can promote the lethal effect of T cells on neuroblastoma cells. The lethal effect is associated with the concentration of dendritic cells within some range.     

北京农村居民健康状况及卫生服务需求调查

目的了解北京农村居民健康状况及卫生服务需求特点。方法从昌平区、顺义区、大兴区、房山区随机抽取25～64岁农民1605人进行统一问卷调查。结果农民高血压自报患病率为22．4％，超重和肥胖率为56．1％；现在吸烟率为34．4％，缺乏运动率为41．6％；家庭主要经济支出为学生上学(35．3％)，建房(25．4％)和疾病(21．2％)；54．9％家庭医疗费用支出占总收入的10％以上；最关心的健康问题主要是慢性疾病防治(70．2％)；最希望获得的健康知识是慢性病预防知识(72％)；希望获得健康知识的途径是广播和电视(81％)；家庭最希望获得的医疗保健服务是方便看病和获得药物(73．8％)。结论慢性病给农民带来沉重负担，并成为农民关心的主要健康问题。     

Association of the expressions of platelet-derived growth factor receptor and c-Fos with the biological characteristics of bladder cancer.

OBJECTIVE: To elucidate the relation of platelet-derived growth factor receptor (PDGFR) and c-Fos protein expressions with human bladder transitional epithelial cell carcinoma (BTCC). METHODS: The expressions of PDGFR and c-Fos were investigated in 11 normal bladder tissue samples, 14 adjacent non-carcinoma tissues and 43 BTCC tissues by means of SP immunohistochemical technique. RESULTS: The c-Fos expression was found in the cell nuclei and cytoplasm, and PDGFR in the nuclear membrane, cytoplasm, and cellular membrane. PDGFR and c-Fos were detected in 81.40% and 48.83% of the BTCC tissues respectively, at the rates both significantly higher than those in normal and adjacent non-carcinoma tissues (P<0.05). Correlation between the expression of c-Fos and the tumor grading was noted (P<0.05). The expressions of PDGFR and c-Fos in tumor blood vessels were significantly higher than those in normal vessels. CONCLUSIONS: The expressions of PDGFR and c-Fos might be involved in the development of BTCC, possibly related to the angiogenesis of the tumors. c-Fos expression can indicated the cell proliferative status of the BTCC.     

颈动脉狭窄在脑保护装置下的支架置入治疗

目的探讨颈动脉狭窄患者支架治疗中的脑保护装置的有效性和安全性及治疗意义。方法对14例颈动脉狭窄患者进行血管内支架治疗。全部应用了脑保护装置(滤网型)。结果14例患者成功地释放了18枚自膨式支架。其中2例发生微栓子脱落轻度卒中,治疗1～3d完全恢复,颈动脉狭窄6例出现短暂性心率减慢和低血压。随访期所有患者均未发生脑梗死。结论在支架治疗中,脑保护装置的应用可减少治疗中的神经并发症,是一种有效和安全的治疗方法。     

腹腔镜胆总管切开取石术后内置管引流与T管引流临床研究

目的 :比较分析腹腔镜胆总管切开取石术后内置管引流与T管引流两种方法对患者康复的影响。方法 :回顾性总结分析 1999年以来行腹腔镜胆总管切开取石术后内置管引流的 2 6例患者临床疗效 ,并与同期行T管引流的 31例患者进行了比较。结果 :内置管引流组术后无胆汁丢失 ,较T管引流组痛苦小、胃肠功能恢复快。两组比较 ,手术时间无明显差异 ,术后开始进食时间分别为 13.8± 3.4,35 .5± 6 .8h ,(P <0 .0 5 ) ,恢复肠蠕动时间为 30 .5± 5 .6 ,43.8± 7.4h ,(P <0 .0 5 ) ,抗生素平均使用天数 3.5± 0 .6 ,6 .4± 1.1d ,(P <0 .0 5 ) ,术后输液量 45 5 0± 5 84,135 0 0± 12 5 0ml,(P <0 .0 1) ,术后平均住院日 4.6± 1.7,9.6± 2 .4d ,(P <0 .0 1) ,平均住院费用 815 0± 910 ,5 0 0± 12 70元 (P <0 .0 5 ) ,恢复日常工作时间 12 .8± 2 .5 ,2 7.4± 6 .9d ,(P <0 .0 5 )。结论 :腹腔境胆总管探查、内置管引流术后胆总管一期缝合避免了T管引起的并发症 ,大大减轻了患者的痛苦 ,缩短了输液时间和住院时间 ,减少了抗生素的用量 ,值得推广应用。