谷氨酰胺在危重病患者中的应用

目的探讨危重病患者中早期经静脉应用谷氨酰胺（glutamine，Gl）的临床价值。方法42例患者随机分成两组（对照组和Gln组），Gln组进行Gln治疗（100mL／d，共7d）。治疗前后检测患者体质量、白蛋白、谷胱甘肽（GSH）、握力的变化和肠功能不全的发生率。结果体质量两组治疗前后比较差异无显著性（P〉0．05）。白蛋白、握力和GSH Gl治疗后非常显著高于治疗前（P〈0．01）；白蛋白对照组治疗后较治疗前显著增高（P〈0．05），但握力和GSH治疗前后均无显著变化（P〉0.05）；肠功能不全的发生率Gln组为4．8％，显著低于对照组（28．6％，P〈0．05）。结论在危重病患者疾病早期通过静脉途径外源性地补充Gln，有效改善了患者的营养状况；使患者血浆中的GSH水平增高，加强了机体的抗氧化能力；减少了患者肠功能不全的发生率。     

检测子宫内膜异位症患者血清中差异表达蛋白的研究

目的：检测子宫内膜异位症（内异症）患者血清中差异表达的蛋白。方法：采用表面增强激光解吸／离子化飞行时间质谱（SELDI—TOF—MS）技术，选用WCX2蛋白质芯片对50例内异症及48例对照组血清标本进行检测以筛选内异症血清中差异表达的蛋白。结果：在Mr 0～50000范围内，检测出106个蛋白峰。内异症患者血清中差异表达的蛋白峰有4个。将发现的差异蛋白峰在Swiss蛋白数据库中搜索，发现Mr 9280蛋白峰与玻璃粘连蛋白Vitronectin相符。Vitronectin属于整合素家族，在内异症的粘附、侵袭、血管形成过程中起重要作用。其他的蛋白峰没有发现与之相匹配的蛋白，提示可能为新的蛋白质。结论：内异症患者血清中存在差异表达的蛋白，其对内异症的早期诊断具有一定的临床意义。SELDI蛋白芯片技术是一种快速、简单易行、样本用量少、高通量、重复性好的分析方法，具有广阔的临床应用前景。     

Pick’s disease with Pick bodies combined with progressive supranuclear palsy without tuft‐shaped astrocytes: A clinical,neuroradiologic and pathological study of an autopsied case

We report clinical, neuroradiologic features, and neuropathologic findings of a 76‐year‐old man with coexistent Pick’s disease and progressive supranuclear palsy. The patient presented with loss of recent memory, abnormal behavior and change in personality at the age of 60. The symptoms were progressive. Three years later, repetitive or compulsive behavior became prominent. About 9 years after onset, he had difficulty moving and became bed‐ridden because of a fracture of his left leg. His condition gradually deteriorated and he developed mutism and became vegetative. The patient died from pneumonia 16 years after the onset of symptoms. Serial MRI scans showed progressive cortex atrophy, especially in the bilateral frontal and temporal lobes. Macroscopic inspection showed severe atrophy of the whole brain, including cerebrum, brainstem and cerebellum. Microscopic observations showed extensive superficial spongiosis and severe neuronal loss with gliosis in the second and third cortical layers in the frontal, temporal and parietal cortex. There were Pick cells and argyrophilic Pick bodies, which were tau‐ and ubiquitin‐positive in neurons of layers II–III of the above‐mentioned cortex. Numerous argyrophilic Pick bodies were observed in the hippocampus, especially in the dentate fascia. In addition, moderate to severe loss of neurons was found with gliosis and a lot of Gallyas/tau‐positive globus neurofibrillary tangles in the caudate nucleus, globus pallidus, thalamus, substantia nigra, locus coeruleus and dentate nucleus. Numerous thorned‐astrocytes and coiled bodies but no‐tuft shaped astrocytes were noted in the basal ganglion, brainstem and cerebellar white matter. In conclusion, these histopathological features were compatible with classical Pick’s disease and coexistence with progressive supranuclear palsy without tuft‐shaped astrocytes.     

Irritable bowel syndrome and health-related quality of life: a population-based study in Calgary, Alberta.

BACKGROUND: Little is known about the health-related quality of life (HRQOL) of nonclinical samples of people with irritable bowel syndrome (IBS) in Canada. In a pilot survey, the impact of IBS on HRQOL using a population-based, urban sample was examined. METHODS: A random sample of Calgary residents (18 years of age or older), selected by random digit dialing (n=1521), completed a structured questionnaire including ROME II Criteria and Medical Outcomes Study Short-Form 12-Item Health Survey, version 2 (SF-12v2). The mean scale and summary scores of SF-12v2 for those who did and did not meet ROME II criteria and for those who met ROME II criteria with and without visiting a physician in past three months were determined and compared using multiple regression analyses. RESULTS: Of the 951 households successfully contacted, 590 (62%) were willing to participate, of which 437 (74%) individuals were recruited. One hundred ten IBS cases (81 of which were women) and 327 non-IBS controls (180 of which were women) were identified. All of the eight mean scale scores and the two mean summary scores were significantly lower in people with IBS than in those without, whether or not adjusting for demographics. Forty-four of the 110 IBS cases (40%) sought medical help. Significantly lower mean physical component score and three scale scores (general health, social functioning and role physical) were found in those who sought medical help than in those who did not. CONCLUSIONS: People with IBS experience significant impairment in HRQOL, including both physical and mental well-being. People with IBS who seek medical help report worse physical health than those who do not, but their mental health is no different.     

CR、CT、MRI在骨肿瘤诊断中的临床价值

[目的]评价计算机X线摄影（CR）、CT、磁共振成像（MRl）在骨肿瘤诊断中的临床价值。[方法]回顾分析55例经病理证实的影像学资料，其中55例均有CR平片，21例CT扫描，20例做了MRI检查。[结果]55例中51例CR片清晰显示骨质改变，40例CR片清晰显示病灶边界，20例CR片清晰显示骨膜反应，19例CR片清晰显示病灶内有大小不一钙化。21例行CT扫描病例均清晰显示骨质改变、病灶边界、病灶内有大小不一钙化，8例清晰显示骨膜反应。20例做了MRI检查病例均清晰显示病灶边界及软组织肿块，8例显示相应骨髓水肿。[结论]CR片仍为骨肿瘤的首选检查方法，CT较好显示了肿瘤的范围及细微结构，MRI对显示肿瘤的范围、软组织肿块及相应骨髓水肿有明显优势。三者相结合有助于骨肿瘤的诊断。     

CD10表达在甲状腺滤泡性癌和滤泡型乳头状癌诊断中的作用

目的研究CD10表达在甲状腺滤泡性癌和滤泡型乳头状癌诊断中的作用。方法收集70例甲状腺良、恶性病变组织，其中包括15例滤泡性腺瘤、15例腺瘤性甲状腺肿、30例乳头状癌（包括9例滤泡型乳头状癌）和10例滤泡性癌，采用免疫组织化学方法检测CD10在上述组织中的表达。结果9例滤泡型乳头状癌中，7例表达CD10（77．8％），10例滤泡性癌中8例表达CD10（80．0％）；CD10在非滤泡型乳头状癌、滤泡性腺瘤、腺瘤性甲状腺肿和正常甲状腺组织中均不表达。结论对CD10表达的检测有助于对甲状腺滤泡性癌和滤泡型乳头状癌的诊断。     

皮瓣展平法在耳廓再造时扩张皮瓣感染中的应用

目的探索耳廓再造时扩张皮瓣感染的处理方法。方法分析中国协和医科大学整形外科医院外耳冉造中心2003年1月～2005年12月耳廓再造时耳后扩张皮瓣发生感染，经皮瓣展平法处理，感染控制后进行耳再造的12例（12耳）患者的治疗情况。结果12例（12耳）患者手术顺利，术后恢复好，再造耳效果与无感染者无明显差异。结论皮瓣展平法是耳廓再造时扩张皮瓣感染较理想的处理方法。     

全程分期式健康教育对Miles术后患者生活质量的影响

目的探讨全程分期式健康教育对Miles术患者生活质量的影响.方法将80例行Miles术的直肠癌患者随机分为观察组与对照组各40例.观察组采用全程分期式健康教育,对照组采用传统的手术前后宣教.两组均在出院前,出院后1、3、6个月发放Miles术患者生活质量问卷,在出院前发放护理工作满意度调查表进行调查.结果观察组出院前自理能力、造口情况、心理状况及护理工作满意度显著优于对照组(P＜0.05,P＜0.01),出院时间显著缩短(P＜0.05);出院后观察组自理能力、造口情况等及生活质量总分均显著优于对照组(P＜0.05,P＜0.01).结论全程分期式健康教育能有效提高Miles术患者的近期和远期生活质量.     

降钙素防治骨质疏松模型兔的人工假体无菌性松动的实验研究

[目的]探讨降钙素对已行人工假体植入骨质疏松模型免的假体无菌性松动防治作用的实验研究。[方法]将30只假体植入模型的骨质疏松症兔随机分成实验组和对照组，各15只。实验组给予鲑鱼降钙素治疗（6U／kg，肌注，隔日1次），而对照组给予等量的生理盐水肌注，持续治疗半年。两组均分别于术前、术后4、8、12和24周检测假体周围感应区（ROI）骨密度（BMD）；于术前及术后4、12、24周行血清骨代谢指标检测：骨特异性碱性磷酸酶（BALP）、骨钙素（BGP）、抗酒石酸酸性磷酸酶-5b（TRAP-5b）；所有动物于术后24周处死，分别行假体拔出实验与扭转实验测定和假体周围骨组织形态计量学分析。[结果]术后24周，实验组假体周围局部感兴趣区BMD增加近5％，而对照组假体周围局部感兴趣区BMD下降了6％，两组比较有显著性差异（P〈0．01）；骨代谢指标中，术后24周实验组的BALP、BGP稍有下降，但组内无显著性差异（P〉0．05），而TRAP-5b有明显下降（P〈0．05），这些指标与对照组比较差异显著（P〈0．05或P〈0．01）；生物力学检测显示，实验组的假体拔出实验较对照组提高了约50％，扭转实验提高近1倍，且两组比较差异显著（P〈0．01）；骨组织形态计量学显示，实验组中反映骨吸收的Oc．No／Tb．Pm、ES／BS明显减少；反映骨量和微结构的％Tb．Ar、Tb．N明显增多，而Tb．Sp明显变窄：反映骨形成与骨矿化的OS／BS、MAR、BFR／TV及％L．Pm也均明显增多；这些指标与对照组比较差异显著（P〈0．01或P〈0．05）。[结论]鲑鱼降钙素能明显减少人工假体周围骨量的丢失和抑制骨溶解；并加快假体周围的骨形成，提高骨密度，促进生理性骨矿化；还能改善骨质量，促进骨微结构改变，提高骨的生物力学特性并增加假体四周的支撑力。其对骨质疏松症兔的假体松动有明显的预防和治疗作用。这对临床预防和治疗人工关节的无菌性松动有很好的指导意义。     

游离腓骨皮瓣移植Ⅰ期修复胫骨创伤性骨髓炎骨皮缺损

[目的]探讨游离腓骨皮瓣移植Ⅰ期修复胫骨创伤性骨髓炎合并骨皮缺损的方法和疗效。[方法]对156例胫骨创伤性慢性骨髓炎合并骨皮缺损患者，在行病灶清除的基础上行游离腓骨皮瓣移植，Ⅰ期修复骨皮缺损。[结果]经术后6—60个月的随访，皮瓣全部成活，发生静脉危象6例，再次吻合成功；伤口Ⅰ期愈合140例，Ⅱ期愈合13例，遗留窦道3例；骨髓炎复发2例。移植腓骨全部愈合，愈合时间2—6个月，平均3．2个月。[结论]慢性骨髓炎合并骨皮缺损可应用显微外科技术Ⅰ期修复。但是在感染的基础上进行手术，有一定的风险，严格掌握适应证。