微核试验制片方法的改进

目的简化、优化微核试验方法。方法对微核试验的制片过程进行简化、优化,改进后在细胞培养结束后直接吸弃上清液,然后加入氯化钾溶液进行低渗处理,随后预固定、离心。离心完成后,细胞再固定一次即可滴片。结果改进法玻片背景清晰,细胞染色稍深,但不影响细胞和微核观察。双核细胞数量不少,能够满足计数要求。油镜和高倍镜下,图像更清楚、背景更干净。改进法胞浆完整率、细胞着色率和平均每高倍视野细胞个数与传统方法比较有统计学意义,概率P值分别为0.0051(χ²=7.8375)、0.0140(χ²=6.0437)和0.0025(t=3.0951)。微核细胞率和细胞成团指数与传统方法比较无统计学意义,概率P值分别为0.7749(χ²=0.0817)和0.5152(U=0.0000)。结论改进法制片方法简单易行、结果可靠,试验质量更容易控制,还节省了时间,节省了人力、物力。     

300例慢性前列腺炎患者病原菌检测及复合药敏试验

目的分析慢性前列腺炎(chronicprostatitis,CP)致病菌及复合药敏试验规律,探索治疗方法.方法对300例无菌采集的前列腺液(EPS)标本同时接种需氧菌,厌氧菌、L型菌培养基鉴定并做药敏试验.结果表皮葡萄球菌(58.3%)、丙酸杆菌(29.3%)为CP致病的两大优势菌;二者在致病过程中具有协同作用;表皮葡萄菌随年龄增大而感染率降低,三组间有显著性差异(P＜0.05),L型菌是疾病复发、难以治愈的原因之一;治疗首选利福平、氟哌酸而青霉素、洁霉素几乎是无效的.结论多种形式的细菌检测和复合药敏试验是非常必要的,目前尚无他法替代.     

Deltoid ligament reconstruction with autologous gracilis tendon in chronic medial ankle instability after ankle fracture surgery: A case report

IntroductionThe repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented.Case reportA 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle.DiscussionThe deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability.ConclusionIn the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option.     

Predictive Value of Immune Cell Functional Assay for Non-Cytomegalovirus Infection in Lung Transplant Recipients: A Multicenter Prospective Observational Study

IntroductionImmune cell functional assay (ImmuKnow®) is a non-invasive method that measures the state of cellular immunity in immunosuppressed patients. We studied the prognostic value of the assay for predicting non-cytomegalovirus (CMV) infections in lung transplant recipients.MethodsA multicenter prospective observational study of 92 patients followed up from 6 to 12 months after transplantation was performed. Immune cell functional assay was carried out at 6, 8, 10, and 12 months.ResultsTwenty-three patients (25%) developed 29 non-CMV infections between 6 and 12 months post-transplant. At 6 months, the immune response was moderate (ATP 225–525 ng/mL) in 14 (15.2%) patients and low (ATP < 225 ng/mL) in 78 (84.8%); no patients had a strong response (ATP ≥ 525 ng/mL). Only 1 of 14 (7.1%) patients with a moderate response developed non-CMV infection in the following 6 months compared with 22 of 78 (28.2%) patients with low response, indicating sensitivity of 95.7%, specificity of 18.8%, positive predictive value (PPV) of 28.2%, and negative predictive value (NPV) of 92.9% (AUC 0.64; p = 0.043). Similar acute rejection rates were recorded in patients with mean ATP ≥ 225 vs. <225 ng/mL during the study period (7.1% vs. 9.1%, p = 0.81).ConclusionAlthough ImmuKnow® does not seem useful to predict non-CMV infection, it could identify patients with a very low risk and help us define a target for an optimal immunosuppression.     

放射诊疗设备“重要部件”的界定

对新安装、维修或更换重要部件后的放射诊疗设备进行验收检测,是保证设备正常投入使用的重要技术手段。卫生监督检查发现,医疗机构往往容易忽略使用过程中的验收检测,不对维修或更换重要部件后的放射诊疗设备进行验收检测。但由于没有法律法规或技术标准界定过“重要部件”的定义和范围,很难要求医疗机构改正。本文就放射诊疗设备“重要部件”的界定进行研究和讨论,并对研究结果的实际应用提出建议。     

对十四年“毕业综合考试”方法的回顾与探讨

本文回顾分析了我院14年来采用“毕业综合考试结构成绩”(下称“结构成绩”)的做法与体会。“结构成绩”由毕业理论考试成绩、临床操作考试成绩、图象考试成绩三个板块组成。其分别占毕业成绩的40％、50％和l0％,体现了医学教育实践性很强的特点;培养了学生的分析综合能力及临床思维能力;实现了对学生知识结构、智力结构和能力结构的整体培养目标要求;避免了一次考试的偶然性;能全面的反映学生的实际水平和能力,受到了师生的普遍欢迎。     

临床试验中使用安慰剂的伦理学问题

临床治疗研究采用随机双盲安慰剂对照试验日渐增多,安慰剂 伦理问题应值得重视。临床治疗试验首先应当遵循医学人体试验的医德原则即药物临床试验;其次应以世界医学会赫尔辛基宣言为准则,严格掌握安慰剂对照的适用指征,并分析了安慰剂效应的产生机制,对国内安慰剂对照例用情况及有关伦理学问题进行分析讨论。     

Cardiac output measurement by the thermodilution method: An in vitro test of accuracy of three commercially available automatic cardiac output computers

Objective To describe the accuracy and the reproducibility of the thermodilution flow measurements obtained using 3 commercially available cardiac output computers commonly used in intensive care units.Design An experimental in vitro study. Twelve different values of control flow (Qctr) were measured (Qmsr) using 3 different cardiac output computers (Abbott Critical Care System, Oximetrix 3 SvO₂/CO Computer, Baxter Oximeter/Cardiac Output Computer SAT-1^TM; American Edwards Laboratories, 9520 A Cardiac Output Computer). Standard equipment and techniques were employed, taking account of the specific weight and heat of warm water relative to blood. In addition, separate sets of measurements were performed in order to investigate the effect on Qmsr of some variables which may influence the indicator loss (time for injection, depth of immersion of the catheter, temperature of the injected fluid).Setting Our laboratory, inside the intensive care unit.Measurements and results The analysis of the linear regression of Qmsr versus Qctr (r values between 0.992 and 0.984; residual standard deviation values comprised between 0.24 and 0.49 l/min; intercepts and slopes not significantly different from identity line), the values of the percentage errors (PE=[Qctr–Qmsr]·100/Qctr; PE mean values 7.9, 5.0 and 13.1), and those of the coefficients of variability (CV=standard deviation mean value, %; CV mean values 5.4, 5.8 and 4.6), show a good level of accuracy and reproducibility of the measurements. Our data confirm previously reported results. Furthermore, the cumulative effect of variables capable of influencing the indicator loss, even if corrected according to the calculation constant the manufacturers provide, was found to result in statistically significant changes of Qmsr.Conclusion The accuracy and reproducibility of the automatic cardiac computers tested is sufficient for practical clinical purpose. It may also depend on the modality of injection of the cooling bolus, which may significantly influence the effective indicator losses.     

中药蒲公英的质量标准研究

用ＨＰＬＣ法测定蒲公英中咖啡酸和绿原酸的含量。采用 ＨＰ Ｈｙｐｅｒｓｉｌ Ｃ_１８色谱柱,２００ ｍｍｘ ２． １ｍｍ,５μｍ,流动相：甲醇－磷酸盐缓冲溶液（ｐＨ＝４． ２） ２３： ７７,检测波长：３２３ ｎｍ,柱温：４０℃,流速：１．０ ｍＬ／ｍｉｎ。该法咖啡酸平均回收率 ９９．８０％,ＲＳＤ ２．１４％;绿原酸平均回收率９９．５４％,ＲＳＤ ２．６９％。本法稳定可靠,为药典建立蒲公英药材的质量标准提供了依据。     

山慈菇抑制镉诱发遗传损伤研究

采用活体小鼠骨髓嗜多染红细胞（ＰＣＥ）微核试验（ＭＮＴ）,观察中草药山慈菇（ＢｕｌｂｕｓＩｐｈｉｇｅｎｉａｅ）水溶性提取物的诱变作用及对镉（Ｃｄ）、环磷酰胺（ｃｐ）的抗诱变作用。结果表明：山慈菇可以诱发微核（ＭＮ）产生,但其诱变作用不强;山慈菇对Ｃｄ及ｃｐ的诱变作用具有明显的抑制效果,并对Ｃｄ的抑制作用明显强于对ｃｐ的抑制作用。