不同免疫抑制剂对肾移植患者精子参数的影响

目的:研究不同免疫抑制剂对肾移植患者精子运动功能的影响。方法:20例肾移植患者应用以普乐可复(FK506+霉酚酸酯+泼尼松)、17例应用环孢素(CsA+硫唑嘌呤+泼尼松)为主的免疫抑制治疗方案,15例正常男性为对照组。采用计算机辅助的精子分析系统分别检测精子活率、运动参数(前向运动百分率、直线速度VSL、曲线速度VCL、平均路径速度VAP)和精子形态。结果:3组精子活率[(81.7±5.7)%、(79.4±6.8)%、(83.8±6.0)%]、VCL[(24.1±8.6)%、(23.9±4.4)%、(24.8±4.2)%]和VAP[(19.7±6.6)%、(18.6±2.9)%、(21.0±4.0)%]差异均无显著性(P>0.05);FK506组的精子前向性运动百分率[(46.4±8.1)%]和VSL[(15.4±4.6)%]均显著高于CsA组[(33.3±6.4)%、(10.2±2.4)%],畸形率[(67.8±5.7)%]显著低于CsA组[(80.1±5.6%](P<0.05)。结论:FK506和霉酚酸酯的联合应用,有助于肾移植患者精子运动功能及形态的恢复。     

Thrombocytopenia after therapeutic hypothermia in severe traumatic brain injury

Objective: To investigate the clinical characteristics and significance of thrombocytopenia after therapeutic hypothermia in severe traumatic brain injury (TBI). Methods:Ninety-six inpatients with severe brain injury were randomized into three groups: SBC (selective brain cooling) group (n=24), MSH (mild systemic hypothermia ) group (n=30), and control (normothermia) group (n=42). The platelet counts and prognosis were retrospectively analyzed. Results: Thrombocytopenia was present in 18 (75%), 23 (77%) and 15 (36%) patients in SBC group, MSH group and control group, respectively (P<0. 01). Thrombocytopenia, in which the minimum platelet count was seen 3 days after hypothermia, showed no significant difference between SBC and MSH group (P>0.05). Most platelet counts (37 cases, 90 %) in hypothermia group were returned to normal level after 1 to 2 days of natural rewarming. The platelet count in SBC group reduced by 16%, 27% and 29% at day 1, 3 and 5 respectively compared with the baseline value. Good recovery ( GOS score 4-5) rate of thrombocytopenia 1 year after injury for hypothermia group (17 cases, 37%) was significantly lower than that of control group (P < 0.01). Conclusions: Therapeutic hypothermia increases the incidence of thrombocytopenia in severe TBI, and patients with thrombocytopenia after therapeutic hypothermia are associated with unfavorable neurological prognosis.     

双皮瓣法尿道成形术治疗尿道下裂28例

目的：总结双皮瓣法尿道成形一期手术治疗先天性尿道下裂的体会。方法：对28例1—12岁，尿道缺损长度2—7cm的患儿用双皮瓣法行尿道成形一期矫治，探讨手术要点及并发症的预防。结果：术后3例发生尿道外口狭窄，经尿道扩张治愈，无尿瘘发生。均一期治愈。所有病例术后随访0．5—7年，恢复良好。结论：该方法成功率高，适用于各种不同类型的尿道下裂，明显减少了多次手术的痛苦。     

腹腔镜胆囊切除术中出血原因的分析与处理

目的:探讨腹腔镜胆囊切除术(LC)术中出血的原因与处理方法。方法:回顾性分析重庆医科大学附二院2004年12月~2006年3月所行LC术中出血的112例临床资料,总结探讨LC术中出血的原因与处理方法。结果:LC术中出血的原因有主观的和客观的因素,112例患者中5例中转开腹止血,余经重新施夹,电凝,缝扎,止血海绵填塞压迫,纱布压迫止血,肝镰状韧带悬吊等方法,成功地控制了出血。结论:术中出血是LC术中严重且最常见的并发症,分析出血的原因及相应措施,提出预防措施5条。     

阿尔茨海默病中肿瘤坏死因子-α基因多态性及表达

目的探讨肿瘤坏死因子-α(TNF-α)基因多态性与广东地区汉族人群散发性阿尔茨海默病(SAD)发病易感性的关系。方法采用聚合酶链反应-序列特异性引物(PCR-SSP)方法,检测44例SAD病人(AD组)及45例正常老年人(对照组)TNF-α基因的TNF-α1及TNF-α2等位基因频率。按比值比(OR)作疾病关联分析。用放免法检测两组的血清TNF-α含量。结果AD组的TNF-α2基因频率为0．182,明显高于对照组的0．078(OR=2．635,P=0．039)；AD组血清TNF-α含量为(567．85±102．43) ng/L,明显高于对照组的(389．73±56．68)ng/L(P＜0．05)。结论广东地区汉族人群中,TNF-α基因多态性与SAD有关联．TNF-α2等位基因与SAD的易感性有关。     

1,6-二磷酸果糖改善兔脑血肿周围组织能量代谢的研究

目的:观察1,6二磷酸果糖(FDP)对血肿周围组织能量代谢的影响。方法:健康大耳白兔随机分成正常组,假手术组,脑出血组和治疗组,其中后3组又按各时间点分成1、6、12、24、48和72h组。两次注血法制作脑出血模型,测定各时点血肿周围组织乳酸含量、三磷酸腺苷(ATP)含量和磷酸果糖激酶(PFK)活性。结果:脑出血组24h后ATP含量有明显下降,治疗组ATP含量明显增高。1、6、12h治疗组乳酸含量降低,且治疗组乳酸峰值延迟至24h。治疗组PFK活性均高于脑出血组。结论:FDP可改善血肿周围组织的能量代谢。     

咀嚼运动前后脑血流变化的研究

目的：观察咀嚼运动前后脑血流的改变，探讨这些变化的意义。材料与方法：应用超产多谱勒探测仪探测咀嚼前和咀嚼10分钟后脑血流的改变，对所测大脑中动脉的收缩期峰流速、舒张期末峰流速、平均峰流速进行对比分析。结果：咀嚼运动后大脑中动脉收缩期峰流速、舒张期末峰流速及平均峰流速较咀嚼运动前均有明显增加。结论：咀嚼运动可使脑血管的血流流速增加，使脑血流量增多，在促进脑的发育及功能的行使方面有重要作用。     

血浆置换治疗移植肾复发性FSGS合并大量蛋白尿的远期观察

目的 探讨血浆置换治疗移植肾复发性局灶性节段性肾小球硬化（FSGS）效果及其对远期预后的影响。方法 6例患者首次肾移植后出现大量蛋白尿或／和血肌酐（Cr）升高、并经移植肾活检确诊为FSGS，在不改变免疫抑制方案的情况下，采用血浆置换治疗，观察血浆置换后1年移植肾的病理改变情况，测定血肌酐和24h尿蛋白定量。结果 6例患者中，2例在血浆置换后1年接近完全缓解，4例部分缓解。患者血浆置换后1年，移植肾的肾小球、肾间质、血管及免疫球蛋白病变的等级与血浆置换前相比，差异均无统计学意义。血浆置换后1年及5年的Cr水平与血浆置换前相比，差异均无统计学意义；24h尿蛋白定量与血浆置换前相比，差异均有统计学意义（P〈0．01，P〈0．05）。结论 血浆置换能快速、有效地缓解移植肾复发性FSGS的病变程度和进程，其效果取决于FSGS诊断的及时性，如果已发展到肾小球硬化的程度，血浆置换亦无法将其逆转。     

Comparative observation of protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure

Objective: To explore the protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure (BUP). Methods : The hearing thresholds of the guinea pigs were assessed with auditory brainstem responses ( ABR). The traumatic levels of tympanic membrane and ossicular chain were observed under stereo-microscope. The rate of outer hair cells (OHCs) loss was analyzed using a light microscope. The changes of guinea pigs protected with barrel and earplug were compared with those of the control group without any protection. Results: An important ABR threshold shift of the guinea pigs without any protection was detected from 8h to 14d after being exposed to BUP with a peak ranging from -64.5 kPa to -69.3 kPa (P<0.01). The rate of perforation of tympanic membrane reached 87.5 % and that of total OHCs loss was 19.46%±5.38% at 14d after exposure. The guinea pigs protected with barrel and earplug had lower ABR threshold and total OHCs loss rate compared with the animals without any protection (P<0.01). All of the tympanic membrane and ossicular chain of the protected animals maintained their integrities. Meanwhile, the guinea pigs protected with the barrel had lower ABR threshold and total OHCs loss rate than those with earplug (P<0.01). Conclusions: The earplug and barrel have protective effects against BUP-induced trauma on auditory organs of the guinea pigs and the protective effects of barrel are better than those of earplug.     

美国处理医疗损伤责任纠纷的法律程序

不论是一般的民事或刑事案件,还是医疗损伤责任案件,法律的具体实施程序实际上都是一个个独立的决策过程。本文介绍了美国医疗损伤责任纠纷的法庭外解决方式、医疗损伤责任纠纷的法庭诉讼程序和其他与医疗损伤责任纠纷相关的法律。