肠道T细胞淋巴瘤临床分析

本文总结报告了3例肠道T细胞淋巴瘤(intestinal T-cell lymphoma，ITCL)的诊治资料，并结合文献复习，发现IT—CL多见于中年男性，以腹痛、血便、发热、体质量下降为主要症状，治疗效果差，预后不良。病理改变以肠道溃疡形成为特点，溃疡形态呈多形性、多灶性、不规则，镜下瘤细胞明显异型、弥漫性浸润，中至大细胞多见。肿瘤细胞呈T细胞表型。ITCL临床少见，缺乏特异性临床表现，极易误诊。故临床医师应重视对ITCL临床病理特征、免疫表型和基因型的研究，注意识别，促其早期诊治。     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.     

质量效益目标责任制管理的探索与实践

医疗质量效益监控和评价的根本依据是医疗质量评价指标，指标的确定及其涵盖内容直接关系到医疗质量管理以及医院核心竞争力。因此，如何构建一套科学、合理、可操作的质量效益指标评价体系，是医院质量管理、质量效益目标责任管理要探索的课题。20世纪90年代初期，我院开始实行以工作量和经济指标为主的经济考核办法，在相当一段时间内发挥了较好的管理效能和效果。随着社会发展和医疗卫生改革的深入，以工作量和经济指标为主的考核办法其作用逐渐趋弱，弊端也日益显露。     

2001年与2004年抗菌药物应用情况比较

目的　了解抗菌药物应用的基本情况。方法　将 2 0 0 1年 3月 14 3 0例住院患者病历与 2 0 0 4年 3月的 2 0 66例住院患者病历进行回顾性调查和对比分析。结果　 2 0 0 1年的 14 3 0例中有 948(66 3 % )例 ,和 2 0 0 4年的 2 0 66例有 10 60例 (5 1.3 % ) ,应用了抗菌药物。结论　定期检查考评 ,严格掌握用药指征 ,是加强抗菌药物应用管理的关键。     

Dissolving agents of human mixed cholesterol stones

Methyl tert-butyl ether which is a powerful cholesterol monohydrate solvent does not completely dissolve mixed cholesterol gallstones when directly infused into the biliary tree. In this work, we compared the effect of various solvents containing different proportions of methyl tert-butyl ether and dimethylsulfoxide in anhydrous and aqueous systems on the in vitro solubilization of human cholesterol stones. The dissolution rates of cholesterol obtained in the presence of methyl tert-butyl ether was markedly decreased when 10 p. 100 water was added. In contrast, the addition of dimethylsulfoxide (30 p. 100) to methyl tert-butyl ether-water system enhanced the stone-solvent contact, improved the cholesterol dissolution rates and left less stone debris. A subsequent dissolution with an alkaline, pH = 8.8, aqueous dimethylsulfoxide-ethylenediaminetetraacetic acid solution strongly reduced the non cholesterol residues. In vivo, nearly complete dissolution of human cholesterol stones implanted in the gallbladder of rabbits was obtained within 8 hours when methyl tert-butyl ether/dimethylsulfoxide (70/30) solvent was infused at a rate of 0.6 ml/h/kg. With methyl tert-butyl ether, only 84 p. 100 of the original stone weight was dissolved. The infusion of these solvents leads to morphological changes in the gallbladder wall with some focal ulcerations. These alterations can be almost completely recovered after two weeks. No histologic evidence of hepatic, duodenal or renal damage was found. We conclude that the mixture methyl tert-butyl ether/dimethylsulfoxide (70/30) constitutes a good solvent for mixed cholesterol stones. Compared with pure methyl tert-butyl ether, the mixed system allows for a more rapid and a more complete dissolution of gallstones.     

环孢霉素A滴眼治疗角膜移植排斥反应

应用0.5％环孢霉素A(cyclosporin A,CsA)滴眼治疗穿透性角膜移植术后发生免疫排斥患者16例(16只眼),治愈9只眼,好转6只眼,无效1只眼。随访5～24个月,其中2只眼因停药复发,1只眼于拆线后复发,继续用药或增加给药次数后治愈。研究表明0.5％CsA滴眼剂治疗术前移植床条件较好,角膜移植术后发生免疫排斥的病例可得到良好疗效;而对术前移植床条件较差,角膜移植术后发生免疫排斥的病例有一定的疗效。作者对眼局部应用CsA治疗角膜移植排斥的疗效和作用机理进行了讨论。     

人碱性成纤维细胞生长因子基因在大肠杆菌中的克隆与表达

应用DNA重组技术将编码人碱性成纤维细胞生长因子（bbFGF）的基因克隆至原核高效表达质粒pBV_(221)的启动子下游。SDS-SAGE、ELISA和NTT活性监测结果表明:该重组质粒pBV-hbFGF在大肠杆菌DH5α中,经42℃诱导后,可表达出有较高生物活性的hbFGF。     

煤烟型大气污染对儿童肺功能的影响

为观察煤烟型大气污染对儿童健康的影响 ,选择了太原市 3个污染程度不同地区的 45 0名儿童进行肺功能测试和问卷调查。研究结果显示 ,儿童呼吸功能表现为重度污染区 <中度污染区 <相对清洁区 ;肺通气功能阻塞性异常率表现为重度污染区 >中度污染区 >相对清洁区 ;Logistic回归分析发现肺通气功能阻塞性异常率与小学生家庭的取暖方式、厨房和卧室是否分开以及污染物的水平有关 ;多元线性回归分析显示重度污染区儿童的FVC、FEF5 0与相对清洁区相比分别减少了 65 80ml、119 2 7ml,中度污染区儿童的FVC、FEF5 0与相对清洁区相比分别减少了 5 7 2 8ml和 114 2 9ml;Ln(SO2 )每升高一个单位 ,FVC和FEF5 0分别减少69 10ml和 119 79ml,Ln(PM1 0 )每升高一个单位 ,FVC、FEF5 0等分别减少了 193 5 0ml和 171 69ml。结果提示 ,太原市煤烟型大气污染对儿童呼吸系统产生了危害。