重症肌无力伴发甲状腺异常的临床分析

Objective To analyze the clinical characteristics of myasthenia gravis(MG) associated with thyroid abnormalities.Methods A total of 300 MG patients admitted to the department of neurology from July 2008 to September 2009 were reviewed retrospectively.Based on the thyroid function and abnormality of thyroid related antibodies (thyroglobulin antibody and peroxidase antibody), the patients with MG were divided into two groups (260 cases without thyroid disease and 40 cases with thyroid abnormalities).The different clinical features, the relationship between the antithyroid antibodies and antiacetylcholine receptor antibody (AChRAb) and the distribution of T cell subsets between the two groups were compared.Results ( 1 ) Among the 300 MG patients, 13.3% of them was accompanied with thyroid disease and the most common abnormality was positive thyroid antibody.(2) Between the groups of MG with and without thyroid abnormalities, no significant differences on the sex percentage, age of onset, duration of disease, clinical classification and thymic abnormalities were found ( P ＞ 0.05 ).( 3 ) The blood levels of AChRAb in postsynaptic membrane in the thyroid antibody-positive patients were 1.15 ± 0.11, being much higher than those in the antibody-negative patients ( 1.01 ±0.11 ).(4) The percentage of CD8+ T cells was significantly decreased [(21.63 ±5.17)% vs (24.28 ±5.79)%] and the ratio of CD4+/CD8+ T cells was increased (2.10 ± 0.67 vs 1.81 ± 0.61, P ＜ 0.05 ) in the group of MG with thyroid abnormality as compared with the group of MG with normal thyroid.Conclusion In MG patients the incidence positive thyroid related antibodies was much higher than that of other thyroid abnormalities.It is suggested that there are higher levels of AChRAb in MG coexisting with positive thyroid antibodies and more abnormalities of T lymphocyte subset distribution in MG patients with thyroid disease.     

润阴膏加紫外光照射治疗外阴硬化性苔藓的临床观察

目的：评价润阴膏加紫外光照射治疗外阴硬化性苔藓疗效。方法：将入选的50例外阴硬化性苔藓患者按就诊顺序分为两组,治疗组30例,予润阴膏加紫外光照射。对照组20例,使用30%非那根＋1%丙睾软膏交替涂搽。两组均4周为1个疗程,3个疗程后判定疗效,并观察不良反应,随访3个月。结果：治疗组及对照组有效率分别为96.67%、75%,治疗组疗效明显优于对照组。结论：润阴膏治疗外阴硬化性苔藓,临床疗效显著,值得临床推广。     

早发型与晚发型重症肌无力患者的临床特点分析

objective To compare the clinical characteristics of early-onset and late-onset myasthenia gravis(MG).Methods A total of 819 MG patients admitted in our department during the sanle period were reviewed retrospectively.The patients with MG were divided into two groups by the age of onset, which were the early-onset MG(＜49 years)and late-onset MG(≥50 years).Several clinical features were compared in the two groups including the percentage, initial symptoms, MG types,the positive rates of neostigmine test and repetitive nerve stimulation, thyroid function and thymie abnormalities. Results The more common onset age of MG was 0-49 years(early-onset).In both groups the male and female ratio was presented as the most common type in both groups(41.51%and 51.37% respectively in early-onset and late-onset groups).Type Ⅰ was more common in early-onset group while typeⅡB Was more common in lateonset group(P＜0.05).There Was no significant difference in the positive rates of neostigmine test and repetitive nerve stimulation between the two groups.The thyroid function alnormality ratio was higher in early-onset group. Hyperplastic thymus was common in early-onset group(67.57%)while both hyperplastic thymus and thymoma were common in late-onset group(48.68% and 47.37%).Conclusions The clinical characteristics of early-onset and late-onset myasthenia gravis(MG)Was different in MG type, the positive rate of thyroid function abnormalities and thymic pathologic type.     

抢救急性有机磷中毒时阿托品的用量

抢救急性有机磷中毒时阿托品的用量傅瑞轩陈玉萍急性有机磷农药中毒是职业病临床常见急症。在抢救时首选药物为Ｍ受体阻断剂阿托品和胆碱酯酶复活剂解磷定、氯磷定等。本文拟重点对阿托品使用问题作一讨论。１关于阿托品化阿托品是抗胆碱类药物,作用迅速,静脉注射后１～...     

钾通道开放剂研究的新进展

目的:介绍钾通道开放剂的结构和分类以及最近几年的研究进展.方法:对国内外大量相关文献进行综合分析和整理.结果:以钾通道为靶标,近年来研制出许多钾通道开放剂(KCO),应用于治疗心血管疾病.结论:KCO用于治疗心血管疾病,特别是在抗高血压和心肌保护方面,具有广阔的前景.     

CaMKⅡ活性抑制降低内质网应激诱导的大鼠心肌细胞死亡

目的探讨钙/钙调蛋白依赖性蛋白激酶（CaMK）Ⅱ与内质网应激诱导的大鼠心肌细胞死亡的相关性。方法以成年SD大鼠心肌细胞为研究对象,使用毒胡萝卜素、衣霉素和brefeldin A诱导心肌细胞内质网应激,用碘化丙啶染色评价心肌细胞存活率,观察心肌细胞死亡情况。Western blot检测葡萄糖调节蛋白（GRP）78和DNA核苷酸序列CCAAT增强子结合蛋白（C/EBP）同源蛋白（CHOP）的表达。通过GRP78和CHOP上调评价内质网应激反应。结果毒胡萝卜素、衣霉素和brefeldin A呈时间和剂量依赖方式诱导内质网应激反应和心肌细胞的死亡（P〈0.01）,使GRP78和CHOP蛋白表达上调（P〈0.05）,KN93和AIP阻断CaMKⅡ活性后,GRP78和CHOP蛋白表达与各自的未阻断对照组相比下调（P〈0.05）,内质网应激反应减弱,内质网应激诱导的细胞死亡减少（P〈0.05）。结论毒胡萝卜素、衣霉素和brefeldin A诱导的内质网应激可能是通过CaMKⅡ依赖途径介导大鼠心肌细胞死亡。CaMKⅡ可能是治疗心肌梗死或防治心衰的新靶点。     

胎儿电子监护仪在产科的应用(附701例分析)

应用胎儿电子监护仪对产前、产时的儿率进行临护,对当优生优育和围产期保健是十分重要的.临床实践表明[1],胎儿电子监护的优越性在预告正常胎儿方面比其他任何技术都要好,与血气分析和单纯听诊相比,假阴性率低,预告胎儿好坏的准确率可达90%以上,现将我院胎儿电子监护仪前后两年内接受与未接受的孕妇组的围产儿病死率分析如下.     

70例衰退型精神分裂症病人停药前后临床症状对照分析

对７０ 例长期住院的住院衰退型精神分裂症病人停用抗精神病药物６ 个月，停药前后分别用阳性症状评定量表（ Ｓ Ａ Ｐ Ｓ） 及阴性症状评定量表（ Ｓ Ａ Ｎ Ｓ） 评分。结果显示，除怪异行为、阳性思维形式障碍的评分有明显升高外，其它各组症状的评分均无显著变化，提示对多数无明显阳性症状衰退型精神分裂病人停用抗精神病药物是可行的。     

埃他卡林对K_(ATP)通道亚型选择性作用的研究

目的建立特异性表达以K ir6.x和SUR亚单位组成的不同KATP通道亚型的细胞模型,研究KATP通道开放剂埃他卡林对KATP通道亚型的选择性作用特点。方法利用脂质体转染的方法将编码KATP通道亚单位K ir6.x-pcDNA3、SUR-pcDNA3基因和编码绿色荧光蛋白pEGFP-N1基因共同转染到HEK-293细胞中,免疫组化法鉴定细胞上K ir6.x和SUR蛋白的表达,并采用膜片钳全细胞记录技术,以KATP通道特异性激动剂吡那地尔和二氮嗪为对照,分析埃他卡林对特定刺激条件下对K ir6.x和SUR共同转染的细胞上诱发的钾电流的影响,并观察KATP通道特异性拮抗剂格列苯脲的阻断作用。结果在共同转入KATP通道两亚单位基因的HEK-293细胞上,有K ir6.x和SUR蛋白的表达。在共同表达K ir6.1/SUR2B的细胞上,埃他卡林(100μmol.L-1)、吡那地尔(100μmol.L-1)及二氮嗪(200μmol.L-1)均具有增强诱发电流的效应,给药前后-100 mV时电流值由(-88.0±30.8)pA分别增至(-2042.6±127.3)pA,(-1431.9±142.4)pA及(-1104.7±228.9)pA,三者的作用均能被格列苯脲所阻断。相同条件下,在共同表达K ir6.2/SUR2A的细胞上,埃他卡林和吡那地尔能增强诱发电流,此作用对格列苯脲敏感;而二氮嗪对该电流无影响。相反,在共同表达K ir6.2/SUR1的细胞上,二氮嗪能增强诱发电流,此作用对格列苯脲敏感;而埃他卡林和吡那地尔对该电流无影响。结论不同结构钾通道开放剂对不同亚型KATP通道作用不同,埃他卡林与吡那地尔作用相似,能选择性作用于K ir6.1/SUR2B和K ir6.2/SUR2A型KATP通道,对K ir6.2/SUR1型无影响。     

医学院新入校大学生心理求助行为调查研究

目的考察新入校大学生在处理心理问题时的求助倾向。方法以医学院新入校的本科大学生为对象,用问卷调查的方式进行。结果受试者在寻求他人帮助时,更倾向于向关系密切的人求助;男生较女生更倾向于自己解决问题。结论面对的问题不同,大学生首选的求助对象有明显区别。