卵母细胞体外成熟预防卵巢过度刺激综合征的应用

目的:探讨卵母细胞体外成熟预防卵巢过度刺激综合征(ovarian hyperstim- ulation syndrome,OHSS)的效果。方法:51例IVF长方案超排卵过程中出现OHSS早期征象时,按患者意愿分成两组,实验组于当天注射人绒毛膜促性腺激素(hCG)36h后取卵,经体外培养成熟行体外受精、胚胎移植;对照组则继续按常规用药方案及受精方案行胚胎移植。测定两组出现OHSS早期征象当日的E_2、统计FSH用药天数、用药量、受精率及临床妊娠率。结果:实验组与对照组在出现OHSS早期征象当日的血E_2水平、受精率、优质胚胎率、临床妊娠率无统计学差异;但实验组的FSH总用量、FSH用药天数、获卵数方面显著低于对照组(P<0.05)。实验组1例发生中度OHSS,对照组则发生3例重度OHSS和2例中度OHSS,重度OHSS发生率差异极显著(P<0.01)。结论:超排卵过程中,出现OHSS早期征象时改行卵母细胞体外成熟培养技术可有效地降低OHSS的发生率。     

抗生素相关性腹泻死亡6例分析

采用回顾性调查的方法,对2006年医院感染病例中发生抗生素相关性腹泻（AAD）病例的临床资料进行分析。结果显示,住院病人发生AAD 42例,占医院感染病例的13.86%,死亡6例,死亡率达14.29%,占该年度医院感染死亡病例的15.79%。抗生素相关性腹泻,特别是伪膜性结肠炎,直接威胁病人的生命安全,已成为医院感染的突出问题;防治的关键是合理使用抗菌药,联合应用微生态制剂可起到防治作用。     

四氢小蘖碱对豚鼠心肌细胞钙通道的影响

目的探讨四氢小蘖碱(THB)对豚鼠单个心肌细胞钙通道的作用.方法利用膜片钳全细胞记录方法检测四氢小蘖碱对豚鼠心肌细胞钙离子电流峰值的变化.结果当钳制电位为-40mv ,去极化至0mv,保持时间为250ms,THB1 μmol·L-1和10μmol·L-1使心肌细胞钙电流峰值分别从(300.75±54.69)PA和(420.45±94.45)PA降至(176.75±27.16 )和(155.58±82.23)PA(P<0.01),其下降百分率分别为41.23%和63.02%,给药前后钙电流(Ica)的翻转电位不变,其最大激活电位为0mv,给药后经台氏液冲洗,Ica峰值逐渐恢复.结论 THB对心肌细胞钙通道具有阻滞作用,并呈浓度依赖性.     

经皮切吸治疗腰椎间盘突出症远期疗效下降原因探讨

目的　分析经皮切吸治疗腰椎间盘突出症远期疗效下降的原因 ,探讨改进措施。方法　对 34例经皮切吸治疗的病例进行分类、对比和近、远期疗效观察 ,结合CT检查了解远期病例椎管内改变。结果　该项技术治疗的腰椎间盘突出症的近期优良率 91 18% ,远期优良率下降至 70 83% ,近远期疗效有显著差异 (P <0 0 5 )。除已公认的因素外 ,还应注意 :①优先选择病程短、单纯局限性膨出的病例 ,病程大于 3年和腰椎间盘后外侧突出型不作经皮切吸的首选。②对切吸头进行技术改进 ,有利于增加切吸量。③椎管造影检查同期作切吸可以更好的指导切吸效果。结论　该项技术的指征、操作方法有待进一步规范。     

A portable, economic drainage device to prevent pocket hematoma of pacemakers

Objective： To make up a portable, economic drainage device to prevent the development of pocket hematoma and avoid the additional therapies of pocket hematoma. Methods： Between 2003 and 2006, a total of 265 devices were implanted at our institution. The 89 high-risk patients were determined by the predictors ofhematoma occurrence （marasmatic elder, inevitable oral antiplatelet/anticoagulation therapy, venous pressure increased by other comorbidity, the deficiency of the clotting mechanism for hepatic diseases, or incognizable severe intraoperative bleeding）, and other 186 patients were included in non-high-risk group The 89 high-risk patients were randomized into treatment and control subgroups by sortition. Surgical procedures differed only by the application of the portable, economic drainage device prior to wound closure in treatment subgroup. Results： The incidence of pocket hematoma was 4.3% in treatment subgroup, 18.6% in control subgroup and 2.7% in non-high-risk group, leading to 2, 6 and 3 patients＇ prolonged hospitalization, respectively. The additional cost due to pocket hematoma was lower （1.5 times） in the treatment group compared to the control group. There wasn＇t antidromic infection and delayed cure of the skin incision with the use of our drainage device within 6 months. Conclusion： Our portable drainage device was made up easily and quickly. It could decrease the total cost of hospitalization, did not increase the other adverse events and seemed to be suitable for such patients with a tendency to develop pocket hematoma undergoing the implantation of pectoral pacemakers, implantable cardioverter defibrillator, or cardiac resynchronization therapy .     

外伤性迟发性血胸五例延误诊断分析

外伤迟发性血胸临床少见，由于对本症认识不足，常延误诊断，甚至造成严重后果。现对我院近年遇见的５例分析如下。１　病例资料【例１】　女，４５岁。车祸致胸椎损伤并截瘫２小时入院。Ｘ线胸片示：胸４压缩性骨折并全脱位，无血气胸征象。局麻下后路手术复位，Ｄｉｃｋ钉固定。术后病情稳定，呼吸平稳。第３天出现心悸、胸闷、气短，考虑为脊神经受损引起的呼吸抑制所致，第５天上述症状加重，并逐渐发展为呼吸困难。听诊左侧呼吸音降低，胸穿抽出暗红色不凝血液，胸腔闭式引流效果不佳，４天共引出积血４５０ｍｌ。ＣＴ检查血胸已凝固，…     

科素亚对高血压病患者胰岛素抵抗的影响

目的：探讨科素亚对高血压病患者胰岛素抵抗的关系。方法：选２５ 例高血压病患者取空服静脉血测定血脂、血尿酸、血浆肾素、血管紧张素Ⅱ，并行口服葡萄糖耐量试验，测血糖及血浆胰岛素， 之后服用科素亚５０～１００ ｍ ｇ／ｄ，共４ 周，于第４ 周重复上述检查及葡萄糖耐量试验，并用血糖、血浆胰岛素来计算空腹血浆胰岛素与血糖比值（Ｉ／Ｇ）、糖耐量曲线下面积（ＡＶＣＢＧ）、胰岛素释放曲线下面积（ＡＶＣＩＳ）来比较治疗前后有无显著差异。结果：科素亚治疗后高血压病患者血糖及血浆胰岛素、，血糖比值（Ｉ／Ｇ）、，糖耐量曲线下面积、，胰岛素释放曲线下面积均较服药前明显下降。结论：科素亚能改善高血压病患者胰岛素抵抗     

国人conneXin 2 6基因突变与先天性感音神经性耳聋的相关性研究

目的探讨国人耳聋人群中connexm26基因的突变频率和位点.方法收集15例有遗传性耳聋家族史的病例和252例散发性先天性耳聋病例血液样本,使用PCR-SSCP方法分析connexin26基因编码区突变.同时采用PSDM和BsBsiYI酶切的方法,直接检测异常connexin26基因35delG的突变.结果检出突变样本46例,其中散发耳聋患者中38例,突变率为15.1%;有家族史的聋儿15例中8例,突变率为53.3%.46例中5份有相似的异常电泳带,PCR产物直接测序,其形式为79位G→A的突变;另外在散发耳聋患者中还发现2例251delT和233delC,PDSM分析未发现有35delG的突变.结论国人先天性耳聋患者中存在着connexin26基因的高突变率,但突变热点与国外报道的不同,推测connexin26基因突变有明显的种族特异性.     

模拟失重对人体骨骼肌体积和肌内乙酰胆碱/肌酸比值的影响及等张运动对肌萎缩的作用

目的：研究模拟失重对人体骨骼肌体积和肌内乙酰胆碱／肌酸（Cho/Cr)比值的影响，并观察卧床期等张肌肉锻炼的抗肌萎缩作用。方法：10名健康青年男性志愿者，进行卧床3周的模拟失重试验，将其随机分为卧床对照组（5人）和卧床运动训练组（5人）。使用核磁共振成像和磁共振波谱观察卧床前后右侧大腿骨骼肌体积，肌四头肌体积和比目鱼肌内Cho/Cr的变化，使用REV9000等速测力系统测试其膝关节伸肌相对峰力矩的变化。结果：两组受试者卧床后右侧大腿骨骼肌体积、肌四头肌体积和膝关节伸肌相对峰力矩除Cho/Cr外均较卧床前显著下降，以股四头肌体积变化最显著。对照组与训练组间差异无显著性意义。结论：模拟失重对人体下肢骨骼肌短期内即可出现以伸肌为主的萎缩和膝关节伸肌相对峰力矩的下降。本组数据未能显示出等张运动对抗肌萎缩有显著的作用。     

Treatment of Non-Small Cell Lung Cancer （NSCLC） Using CT in Combination with a PET Examination to Minimize the Clinical Target Volume of the Mediastinum

OBJECTIVE To decrease radiation injury of the esophagus and lungs by utilizing a CT scan in combination with PET tumor imaging in order to minimize the clinical target area of locally advanced non-small cell lung can-cer, without preventive radiation on the lymphatic drainage area. METHODS Of 76 patients with locally advanced non-small cell lung cancer (NSCLC), 32 received a PET examination before radiotherapy. Preventive radiation was not conducted in the mediastinum area without lymphatic metastasis, which was confirmed by CT and PET. For the other 44 patients, preventive radiation was performed in the lymphatic drainage area. PET examinations showed that the clinical target volume of the patients was decreased on average to about one third. The radiation therapy for patients of the two groups was the same, i.e. the dose for accelerated fractionated irradiation was 3 Gy/time and 5 time/week. The preventive dose was 42 to 45 Gy/time, 14 to 15 time/week, with 3-week treatment, and the therapeu- tic dose was 60 to 63 Gy/time, 20 to 21 time/week, with a period of 4 to 5 weeks. RESULTS The rate of missed lymph nodes beyond the irradiation field was 6.3% and 4.5% respectively in the group with and without PET exami- nation (P = 0.831). The incidence of acute radioactive esophagitis was 15.6 % and 45.5% in the two groups respectively (P = 0.006). The incidence of acute radiation pneumonia and long-term pulmonary fibrosis in the two groups was 6.3% and 9.1%, and 68.8% and 75.0%, respectively (P = 0.982 and P = 0.547). CONCLUSION The recurrence rate in the lymph nodes beyond the tar-get area was not increased after minimizing the clinical target volume (CTV), whereas radioactive injury to the lungs and esophageal injury was reduced, and especially with a significant decrease in the rate of acute radioactive esophagitis. The method of CT in combination with PET for minimizing the mediastinal CTV is superior to the conventional preventive radiation of the mediastinum.