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，     

DNA damage from polycyclic aromatic hydrocarbons measured by benzo[a]pyrene-DNA adducts in mothers and newborns from Northern Manhattan, the World Trade Center Area, Poland, and China.

Polycyclic aromatic hydrocarbons (PAH), of which benzo[a]pyrene is a representative member, are combustion-related environmental pollutants and include known carcinogens. Laboratory animal studies indicate that the dose of PAHs to the fetus is on the order of a 10th that to the mother and that there is heightened susceptibility to PAH-induced carcinogenesis during the fetal and infancy periods. Carcinogen-DNA adducts, a measure of procarcinogenic genetic damage, are considered a biomarker of increased cancer risk. Here we compare the levels of benzo[a]pyrene-DNA adducts as a proxy for PAH-DNA damage measured in maternal blood and newborn cord blood obtained at delivery in four different populations of mothers (total of 867) and newborns (total of 822), representing a 30-fold range of exposure to ambient PAHs. The populations include residents in Northern Manhattan, participants in a study of the effects of the World Trade Center disaster, residents in Krakow, Poland, and residents in Tongliang, China. Mean adduct concentrations in both maternal and cord blood and the proportion of samples with detectable adducts, increased across the populations [Northern Manhattan < World Trade Center (WTC) < Krakow < Tongliang], consistent with the trend in estimated ambient exposure to PAHs (P < 0.001). For mothers, the means in the respective populations were Northern Manhattan (0.21 adducts per 10(8) nucleotides), WTC (0.23 adducts per 10(8) nucleotides), Krakow (0.28 adducts per 10(8) nucleotides), Tongliang (0.31 adducts per 10(8) nucleotides); the corresponding means in the newborns were Northern Manhattan (0.23), WTC (0.24), Krakow (0.29), Tongliang (0.31). The percentage of mothers with detectable levels of adducts in the respective populations were Northern Manhattan (36.8%), WTC (57.5%), Krakow (72.9%), Tongliang (73.4%); the corresponding percentages among the newborns were Northern Manhattan (42.4%), WTC (60.6%), Krakow (71.1%), Tongliang (79.5%). Despite the estimated 10-fold lower PAH dose to the fetus based on laboratory animal experiments, the adduct levels in the newborns were similar to or higher than in the mothers. This study suggests that the fetus may be 10-fold more susceptible to DNA damage than the mother and that in utero exposure to polycyclic aromatic hydrocarbons may disproportionately increase carcinogenic risk. The data support preventive policies to limit PAH exposure to pregnant women and children.     

亚急性甲状腺炎的CT诊断

目的:探讨亚急性甲状腺炎的CT表现和特点,提高对该病影像表现的认识。材料和方法:回顾性分析10例亚急性甲状腺炎CT影像特征及临床资料,共16个病灶,其中9例经手术病理证实,1例临床证实。同时抽取局限型甲状腺癌65例,就部分征象作对照分析。结果:亚急性甲状腺炎局限性3例,弥漫性7例。CT表现分3型:①局限于甲状腺一侧叶的低密度病变,病变甲状腺肿大,峡部可受累,3例;②甲状腺两叶各有一低密度病变,呈不对称肿大,病灶之间有正常甲状腺组织,6例共12个病灶;③甲状腺两叶及岬部均匀肿大,略不对称,1例。CT平扫病变为低密度,增强扫描后呈轻到中度均匀强化(15/16),腺内更低密度结节少见(1/16)。病变处甲状腺边缘模糊(16/16),与正常甲状腺组织界限不清(15/16),而局限型甲状腺癌病灶与正常甲状腺腺组织分界清楚(62/65),两者极不一样(P<0.01)。结论:亚急性甲状腺炎CT表现有一定特点,熟悉这些特点对于诊断及鉴别诊断很有帮助。     

低能级体外冲击波碎石治疗肾鹿角形结石

目的探讨低能级体外冲击波碎石(extracorporeal shock wave lithortripsy,ESWL)治疗肾鹿角形结石的效果. 方法对18例鹿角形结石进行体外冲击波治疗.碎石能级1～3级,冲击次数1 800～3 000次,脉冲间隔60 ～80次/min,工作电压10～12.75 kV. 若结石直径>3 cm,在碎石前预先插入双J管,防止石街形成.对直径>4 mm的残余结石,再次行ESWL,直至结石完全消失. 结果所有病人耐受良好,治疗结束能自行回家.除1例碎石失败外,余17例经ESWL治疗成功.治疗3～9次,至完全排除结石.66例次(66/77,85.7%)术后有1～2次肉眼血尿.5例出现石街,长1.9～5.2 cm,4例石街经再次碎石成功,1例输尿管镜取石. 结论低能级ESWL治疗肾鹿角形结石是一种安全、有效的方法.     

Focus cleaning using mini-thoracotomy for cavitary pulmonary tuberculosis or pulmonary tuberculoma: case study of 18 human subjects

Zusammenfassung GRUNDLAGEN: Das Ziel dieser Untersuchung war, die Machbarkeit und Wirksamkeit der Fokus-Sanierung via Mini-Thorakotomie zur Therapie einer kavernösen Lungentuberkulose zu prüfen. METHODIK: Der Mini-Thorakotomie-Zugang wurde in 18 Patienten angewendet (Alter, 25–75 Jahre; median, 47,5 Jahre). Die Patienten hatten eine kavernöse Lungentuberkulose oder ein Lungentuberkulom nach tuberkulostatischer Therapie oder waren Patienten, die auf diese Therapie nicht angesprochen haben. 8 Patienten mit chronischer kavernöser Lungentuberkulose und 10 Patienten mit Tuberkulom haben sich der Fokus-Sanierung, Spülung und Faltnaht unterzogen. ERGEBNISSE: Es gab keine operative Mortalität. Alle Patienten waren klinisch saniert, hatten keinen Nachweis für Bakterien im Sputum, im Röntgen hatten die Lungenschatten abgenommen. Die Dauer der Operation betrug 30–120 min (median, 75 min), der intraoperative Blutverlust war 100–200 ml (median, 153 ml). Der postoperative Spitalsaufenthalt betrug 21–42 Tage (median, 30 Tage). Das Follow-up nach 1–4 Jahren (median, 2,5 Jahre) zeigte keine Komplikation und kein Rezidiv der Grunderkrankung. SCHLUSSFOLGERUNGEN: MTFC ist eine sichere und technisch machbare Methode zur Therapie der Lungentuberkulose oder des Tuberkuloms bei Schonung der Lungenfunktion.     

护理本科生关爱能力调查分析

目的了解护理本科生关爱能力现状,为护理本科生关爱能力的培养提供依据。方法采用关爱能力评价表,对四川省4所医学院校579名护理本科生关爱能力进行问卷调查。结果护理本科生关爱能力评分为189.72±19.57,在各维度中耐心维度得分最高,勇气维度得分最低;不同性别、民族、是否独生子女关爱能力比较,差异无显著性意义（均P〉0.05）;四年级护理本科生关爱能力评分显著高于二、三年级（均P〈0.05）。结论护理本科生关爱能力仍需提高,建议从实践关爱和课程设置等方面提高护理本科生的关爱能力。     

学习英雄高志全,推行"一线工作法"

山西省长治市药品监督管理局在深入学习高志全同志活动中,推行全系统"一线工作法",不仅找到了基层药监部门学习英雄精神与落实"三抓一加强"开创工作新局面的结合点,而且探索出了行之有效的工作方法,正确地回答了学英雄学什么、怎样学的问题.     

pcD2/hVEGF对缺血皮瓣存活的影响

目的 观察并探讨pcD2/hVEGF对缺血皮瓣血循环重建和皮瓣存活率的影响.方法 SD大鼠24只,分2组,每组12只.在鼠背部制作蒂位于尾侧的缺血皮瓣(7cm×1cm).实验组皮下注射pcD2/hVEGF,对照组皮下注射生理盐水,术后7天观察皮瓣存活面积比、单位面积微血管计数和及VEGF基因表达水平.结果 2组中pcD2VEGF组皮瓣存活面积比、单位面积微血管密度与对照组有显著性差异.结论 pcD2VEGF能促进缺血皮瓣存活.     

细胞移植的人嗅鞘细胞培养方法的研究

目的探讨适用于细胞移植的人嗅鞘细胞（OECs）分离与培养的方法。方法无菌条件下取自愿捐献孕5个月流产胎儿的完整嗅球进行嗅鞘细胞提取分离、纯化，并对嗅鞘细胞进行免疫组化染色及纯度检测，观察其形态学特点，检测其免疫组化染色的阳性率。结果本方法分离、培养的嗅鞘细胞大多呈三角形、梭形，有些突起较长，生长活跃，增殖迅速，P75、胶质纤维酸性蛋白（GFAP）免疫组化染色呈阳性，嗅鞘细胞阳性率为95．3％。结论该方法简便易行且不影响细胞功能，适用于细胞移植的研究。