老年人肝内胆汁郁积16例临床分析

总结16例老年人肝内胆汁郁积患者的临床资料,并与26例中青年患者进行比较.结果表明,药物和病毒性肝炎是引起老年人肝内胆汁郁积的常见原因,尤以药物所致者显著增多.老年患者中男性占绝大多数.两年龄组胆汁郁积型肝炎患者的临床表现、病程经过和预后等并无明显差别,但由于老年患者常伴随多种疾病,特别是胆囊结石,使病情趋于复杂,极易误诊为胆石引起的肝外阻塞性黄疸.因此,对老年黄疸患者应尽早超声探查肝胆系统.以确立肝内胆汁郁积的诊断.     

高氟对成年男性生殖内分泌功能的影响

为了探讨高氟对成年男性生殖功能的影响，对地方性氟中毒重病区的31名成年男性（20～55岁）及26名对照人群的有关生殖内分泌指标进行了检测，结果显示：高氟区人群血清黄体生成素（LH）、卵泡刺激素（FSH）较对照组明显升高（P＜0．001）；血清睾酮（T）水平则显著降低（P＜0．01），表明高氟状态能够影响成年男性的生殖内分泌功能。     

Anatomical Variations in Stylopharyngeus Muscle Insertions Suggest Interindividual and Left/Right Differences in Pharyngeal Clearance Function of Elderly Patients: A Cadaveric Study

The stylopharyngeus plays a critical role in the clearance of the piriform recess. We dissected 78 sides of the pharynx from 55 donated cadavers and observed histology of another seven sides of the pharynx from seven cadavers. The stylopharyngeus consistently comprised (1) a descending muscle bundle surrounding the piriform recess and (2) an additional short sheet inserting into the tonsillar bed. Histologically, the former bundle connected to a thick fascia providing the lateral glossoepiglottic fold, extending along the submucosa of the piriform recess, and covering the thyroid cartilage, whereas the latter sheet intermingled with other pharyngeal wall muscles at and near the tonsillar bed. Notably, in 44.4% of female specimens, the additional sheet occupied a greater proportion in cross section than the descending muscle bundle. Given the different directions, the additional sheet seemed to check clearance function of the descending bundle for the piriform recess. Thus, particularly in women, interindividual differences in pharyngeal clearance were likely to depend on whether the additional sheet is strong or weak. Chin down in combination with tilting and rotating the head may represent effective exercises of the stylopharyngeus that could compensate for the disadvantages of additional insertion.     

Elevated C-reactive protein levels are associated with endothelial dysfunction in chronic cocaine users

OBJECTIVE: To examine the relationship of the serum C-reactive protein (CRP) and endothelial function and their associations with coronary artery calcification, lipid profile and cardiac changes. METHODS: The analyses for serum lipids and CRP, echocardiography, spiral computed tomography scans and endothelial function assay were performed in 53 participants with a history of chronic cocaine use. RESULTS: There were no statistically significant differences in demographic characteristics and drug use between CRP normal (<1.9 mg/l) and abnormal groups. The brachial artery diameter percentage changes in the third scan (immediately after deflation of cuff) and the fourth scan (90 s after deflation of cuff) were significantly associated with the CRP levels (the third: beta=-0.054, S.E.=0.027; P=0.028; the fourth: beta=-0.065, S.E.=0.026; P=0.016). The multiple regression models showed that CRP was the only significant predictor of artery diameter changes (%) in these two scans. The CRP abnormal group had more coronary artery calcification (calcium scores >5, 16.7 vs. 0%; P=0.036) and more cardiac diastolic dysfunction expressed as deceleration time >240 ms (16.7 vs. 0%; P=0.036). CONCLUSIONS: Elevated serum CRP levels are associated with endothelial dysfunction, coronary artery calcification and cardiac diastolic dysfunction in chronic cocaine users.     

河南省首次从人体内分离出E.coli O26:H11

目的 研究一株从腹泻病人体内分离出的Ecoli O26：H11。方法 血清凝集采用玻片法，生化鉴定采用VITEK32全自动细菌分析系统GNI 卡进行鉴定，并对该株E．coli O26：H11进行多重PCR鉴定、Vero细胞毒性试验、ESBL试验和21种抗生素的药敏试验，并结合NCCLS标准进行判定。结果 血清凝集反应中O26抗原和H11抗原都呈强凝集，且不自凝；生化反应呈现大肠杆菌的典型反应；rfp O157基因、stx1基因和stx2基因均为阴性，hlyA基因和meA基因为阳性；Vero细胞毒性试验阴性；ESBL，试验阳性；对多种抗生素具有耐药性。结论 该株E．coli O26：H11为一不产类志贺氏菌毒素的菌株，但ESBL阳性，具有多重耐药性。     

肺癌累及食管的外科治疗(附18例报告)

目的 探讨肺癌累及食管的外科治疗的可行性。方法 对18例肺癌累及食管的患者施行手术治疗，14例手术切除肺肿瘤及扩大切除部分食管，其中7例仅切除局部受累的食管肌层，5例行受累段食管切除、胃食管吻合术，2例切除大部受累肌层，部分肿瘤残留；4例病人单纯探查。患者术前、后辅助化或(和)放疗。结果 该组无手术死亡。14例切除组患者1年生存率可达78．6％。9例正在随访中，最长者为34个月，单纯探查组无1例生存过1年。结论 肺癌单纯累及食管者，经术前辅助化疗后，手术切除肺及受累食管是可行的，大部分患者的近期效果理想，远期效果仍在观察。     

冠心病患者应用紫杉醇与国产雷帕霉素洗脱支架的随机对照研究

目的:观察冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架后临床不良心血管事件的发生率。方法:本研究为随机开放平行对照研究,共入选患者168例,雷帕霉素支架组83例,紫杉醇支架组85例。两组患者在年龄,性别组成,吸烟比例,糖尿病比例,血压水平,总胆固醇水平,冠状动脉病变支数,冠状动脉病变积分(Gensini法),左心室射血分数均无统计学上的差异。术后严格要求患者服用阿司匹林和噻氯匹定或氯比格雷9个月。通过门诊或电话随访术后患者临床不良心血管事件的发生率,部分患者进行了冠状动脉造影复查。结果:平均随访10.6个月,失访患者3例(包括2例雷帕霉素支架组患者与1例紫杉醇支架组患者),失访率为1.79%。在随访的81例雷帕霉素支架组共7例(8.64%)发生了临床不良心血管事件。在随访到的84例紫杉醇支架组8例(9.52%)患者发生了不良心血管事件。以上2组患者不良心血管事件发生率差异无统计学意义(卡方检验P>0.05)。雷帕霉素支架组冠状动脉造影再狭窄率为200%(3/15),紫杉醇支架组冠状动脉造影再狭窄率为25%(6/24),两组之间无统计学差异(P>0.05)。结论:短期临床随访结果表明,冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架临床心血管事件的发生率较低,两组无统计学差异。冠状动脉造影复查两组再狭窄率无统计学差异     

乐胃煎逆转胃癌前病变AgNOR及细胞图像分析

目的研究乐胃煎逆转胃癌前病变不完全结肠型肠化和／或中度异型增生的疗效．方法胃镜病理证实为不完全结肠型肠化和／或中度异型增生４６例．治疗组３０例用乐胃煎，对照组１６例用德诺（Ｄｅ＿Ｎｏｌ）．治疗前后胃镜活检胃窦固定部位粘膜标本作ＡｇＮＯＲ染色及细胞图像分析．结果乐胃煎对不完全结肠型肠化及中度异型增生总有效率均高于Ｄｅ＿Ｎｏｌ，分别为７２％比２５％（Ｐ＜００５）和８９５％比４４４％（Ｐ＜００５）．乐胃煎治疗前后，ＡｇＮＯＲ计数分别为７３０±１１６和４８１±１５０（Ｐ＜００１），Ｄｅ＿Ｎｏｌ组为７７３±０９２和７０５±１０２（Ｐ＜００１）．两组治疗前后ＡｇＮＯＲ计数差值均数相比，统计学上也有显著性差异，分别为２５２±１５４和０６９±０４８（Ｐ＜００１）．乐胃煎组中２０例作细胞图像分析，治疗后各参数（长轴、短轴、核浆比、结构异型指数等）均有不同程度的降低，有显著性差异．结论乐胃煎确有较好地逆转胃癌前病变的功效．     

鞣酸蛋白酵母散对幼年大鼠腹泻的治疗作用及其机制研究

目的 研究鞣酸蛋白酵母散的治疗作用及其与保护肠黏膜、促进其修复的关系。方法 将48只21 d SD大鼠随机分为6组：对照组、模型组、蒙脱石散（阳性药,0.8 g/kg）组和鞣酸蛋白酵母散低、中、高剂量（0.1、0.3、0.9 g/kg）组。除对照组外,所有动物用4 g/kg番泻叶水煎剂连续ig 2周后,ig给药,对照组和模型组给予等体积的蒸馏水,每天2次,给药5 d。记录各组大鼠稀便率和腹泻指数。经治疗后,取各组大鼠空肠做苏木精-伊红染色和免疫组化,分别观察肠黏膜组织结构的改变和肠黏膜增殖细胞核抗原（PCNA）表达的变化。同时,刮取大鼠空肠黏膜分别测定DNA、总蛋白和IL-6的表达水平。结果 与模型组比较,经高剂量的鞣酸蛋白酵母散治疗后,大鼠稀便率和腹泻指数显著降低（P<0.001）,空肠绒毛结构基本恢复正常,空肠黏膜DNA含量显著增加（P<0.05）,PCNA表达显著增加（P<0.001）,IL-6表达减少。中剂量的鞣酸蛋白酵母散可改善大鼠腹泻,但对其他指标没有显著影响。而低剂量的鞣酸蛋白酵母散则无作用。结论 鞣酸蛋白酵母散对幼年大鼠腹泻有治疗作用,并可促进肠黏膜修复。