养血益肾法的临床应用心得

1 用于特发性血小板减少性紫癜 竺某某，男，45岁，农民，2006年4月19日初诊。患者患特发性血小板减少性紫癜已有12年。近几年有反复发作趋势，每因劳累而发作。4月前因过度劳累后出现全身大小不等的紫癜，经住院治疗37天，仍未见好转，遂求治于中医。诊见：患者面呈满月脸，全身皮肤有瘀点、瘀斑，     

多囊卵巢综合征患者卵巢间质胰岛素样生长因子受体的表达

目的：探讨肥胖及非肥胖多囊卵巢综合征（ＰＣＯＳ）患者卵巢间质胰岛素样生长因子（ＩＧＦ－Ⅰ）受体基因的定量表达。方法：用逆转录基因扩增技术（ＲＴ－ＰＣＲ），检测３５例ＰＣＯＳ患者（肥胖组１５例，非肥胖组２０例）及２０例正常妇女（对照组）卵巢间质细胞ＩＧＦ－Ⅰ受体ｍＲＮＡ的表达量（灰度比值）。并对ＩＧＦ－Ⅰ受体基因ｍＲＮＡ逆转录的ｃＤＮＡ产物进行限制性内切酶酶切分析。结果：ＰＣＯＳ两组ＩＧＦ－Ⅰ受体基因的表达量显著高于对照组，ＰＣＯＳ两组灰度比值为１．１８４±０．２４０，对照组灰度比值为０．９９９±０．０８６（Ｐ＜０．００１）。非肥胖组（１．２３８±０．３８７）明显大于肥胖组（１．０５８±０．１０９，Ｐ＜０．１）。酶切分析证实，３组ＩＧＦ－Ⅰ受体基因扩增片段相同，ＰＣＯＳ两组未发现明显的碱基突变存在。结论：ＰＣＯＳ患者卵巢间质ＩＧＦ－Ⅰ受体基因呈过度表达。且ＰＣＯＳ非肥胖患者局部ＩＧＦ－Ｉ受体表达高于ＰＣＯＳ肥胖患者。     

小叶锦鸡儿的抗炎作用

小叶锦鸡儿可明显对抗角叉菜胶、热烫及巴豆油所致的炎症,抑制小鼠毛细血管通透性、单核巨噬细胞系统的吞噬功能、肉芽组织增生及大鼠炎症部位PGE₂的合成和释放。     

Cannabinoid receptor down-regulation without alteration of the inhibitory effect of CP 55,940 on adenylyl cyclase in the cerebellum of CP 55,940-tolerant mice

The objective of this study was to determine whether the development of tolerance to CP 55,940, a potent cannabinoid agonist, was due to changes in the receptor or second messenger system. ICR mice treated with CP 55,940 (2 mg/kg) twice a day for 6 and one-half days developed a high degree of tolerance to the pharmacological effects of CP 55,940. The ability of CP 55,940 to produce motor hypoactivity, hypothermia and immobility was reduced 163-, 97- and 19-fold, respectively. Evaluation of 3H-CP 55,940 binding to rat brain membranes indicated no difference in receptor affinity between the vehicle- and CP 55,940-treated animals. However, these binding studies revealed a 50% decrease in receptor number in the cerebellum of the CP 55,940-tolerant mice. Although cAMP is generally considered to be the second messenger for cannabinoid receptors, little difference was observed in the inhibitory effects of CP 55,940 on adenylyl cyclase activity in cerebellum between vehicle and drug-treated mice. However, there was an increase in receptor mRNA which suggests a compensation for receptor loss. There are several possible explanations for these results. There may be sufficient spare receptors such that CP 55,940-tolerant mice are capable of producing a maximal effect on the second messenger system. On the other hand, one could conclude that cannabinoid receptor down-regulation does not account for the development of tolerance to all of the effects of CP 55,940 in mice.     

显微内窥镜下治疗腰椎间盘突出症和腰椎管狭窄症

目的探讨显微内窥镜(MED)治疗腰椎间盘突出症和腰椎管狭窄症的临床效果。方法MED下切除增生内聚的关节突、肥厚的黄韧带及突出的椎间盘，彻底解除对硬膜、神经根的压迫。结果随访324例，按中华骨科学脊柱学组腰背痛手术评定标准，优297例，良14例，差13例，疗效优良率达96．0％，结论MED损伤小、恢复快、疗效好。     

新生儿颅内出血的临床分析

目的 为探讨各种类型新生儿颅内出血的早期诊断方法，明确其临床特点与CT的关系。方法 对176例经CT证实有颅内出血新生儿的临床资料进行回顾性分析。结果 176例患儿中缺氧所致123例(72．6％)，产伤21例(11．9％)，新生儿出血症22例(12．5％)，早产儿10例。患儿有意识障碍者156例(88．6％)，惊厥98例(55．68％)，肌张力改变113例(64．2％)，原始反射减弱或消失104例(59％)，贫血16例。CT示：SAH121例。占68．75％，为NICH最常见类型；SDH17例，IPH13例，IVH5例，混合性出血20例。结论 根据临床表现考虑NICH者应做头颅CT或头颅B超检查。Cr是确诊的最佳手段，能正确显示出血部位、范围、程度及区分各种类型，头颅B超对早产儿、低出生体重儿的IVH、IPH检出率高。     

FⅧ-RAg VEGF在翼状胬肉中表达和微血管密度检测及其意义

目的 检测第Ⅷ因子相关抗原(FⅧ-RAg)和血管内皮生长因子(VEGF)在翼状胬肉中的表达及微血管密度(MVD),探讨其在翼状胬肉发生发展中的作用.方法 应用免疫组化Elivision法检测20例翼状胬肉、10例正常结膜中FⅧ-RAg和VEGF的表达,并检测MVD.结果 20例翼状胬肉和正常结膜中VEGF的阳性表达率分别为90%,20%.VEGF阳性表达两组间差异有统计学意义P＜0.01.FⅧ-RAg的阳性表达率分别为80%、30%,FⅧ-RAg阳性表达两组间差异有统计学意义,P＜0.05,翼状胬肉和正常结膜中微血管密度(MVD)分别为45.85±11.06、23.64±6.87,两组间差异有统计学意义,P＜0.001.结论 VEGF、FⅧ-RAg在翼状胬肉中的高表达,MVD升高,提示有新生血管化的发生,可能与翼状胬肉的发生、发展和术后复发有关.     

阀门植入术治疗儿童青光眼的进展

儿童青光眼作为一种严重的潜在性致盲眼病,因儿童患者的特殊性,治疗困难,效果不佳.近年来,随着阀门植入手术的日益开展,有关青光眼阀门应用于儿童青光眼治疗的相关报道日渐增多.与其他手术方式相比,阀门植入手术对婴幼儿难治性青光眼显示出较好的疗效和安全性,表现在结膜下瘢痕较小,滤过泡壁纤维化少、渗透性更好,从而能够长期有效地控制眼压.它能够很好避免因瘢痕形成所致的滤过失败,并且滤过泡渗漏和感染等严重并发症的发生率也明显降低.但目前还缺乏有关于此的大样本、长期疗效和安全性研究.     

体重指数、腰围、腰臀比与血压、血糖、血脂关系的探讨

目的 探讨体重指数(BMI)、腰围(WC)、腰臀比(WHR)与代谢性因素的关系.方法 对镇江市居民基线资料的1108例对象按BMI、WC、WHR分组.在正常体重、超重、肥胖;腰围正常、腰围过大;腰臀比正常、腰臀比过大各组中,比较收缩压(SBP)、舒张压(DBP)、血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的水平.结果 不论男性女性组,超重肥胖、腰围过大组,血压、血糖、血脂水平与正常组比较均明显升高;腰臀比过大组与正常组比较,男性组TG、FBG明显升高;HDL-C明显降低;女性组TG、FBG、SBP明显升高,HDL-C明显降低.结论 BMI、WC、WHR指标与代谢性因素密切相关;BMI、WC在提示肥胖程度方面优于WHR指标.     

Buccal mucosal graft for urethral reconstruction.

Urethral reconstruction with graft substances, such as skin and bladder mucosa, has been previously used when primary anastomosis cannot be achieved. However, stricture and meatal prolapse are associated with these grafts. We report the use of buccal mucosa for the reconstruction of urethral defects in 3 patients. One patient with failed operation for hypospadias received tube buccal mucosal graft for urethral replacement. Two patients with urethral necrosis and stricture received onlay buccal mucosal graft. All patients were disease-free during follow-up (range, 12 to 49 months; mean, 36 months). One patient had a pinhole fistula that was successfully managed with simple repair. This technique appears to be useful for urethral reconstruction when a local graft is not available, even in patients with complicated conditions.