川崎病并发冠状动脉病变的早期防治

目的探讨川崎病(KD)并发冠状动脉病变患者的早期防治方法与效果。方法将我院2004年1月~2014年7月接诊的川崎病并发冠状动脉病变患者42例作为研究对象,随机均分为研究组与对照组,各自21例。其中对照组患者早期单用阿司匹林防治,而研究组患者则采取静注丙种球蛋白并予以阿司匹林治疗。观察记录两组患者心脏彩超与实验室检查结果,并对比分析。结果经心脏彩超检查治疗前后可知,研究组治疗前彩超正常患儿治疗后转为异常有1例,而对照组则出现5例,组间对比差异有统计学意义(P0.05);两组患者治疗前实验室指标无显著性差异,但治疗后研究组在实验室指标上皆明显低于对照组,更趋于正常范围,组间对比差异有统计学意义(P0.05)。结论静脉滴注丙种球蛋白用于早期防治川崎病并发冠状动脉病变患者可取得比较良好的效果,防治效果显著,同时能明显改善患者的实验室指标,值得借鉴。     

新诊断糖尿病成年男性患者性激素结合球蛋白的变化及其意义

目的 观察新诊断糖尿病成年男性患者性激素结合球蛋白（SHBG）的变化,探讨其与IR及胰岛早相分泌功能的关系. 方法 纳入新诊断糖尿病男性患者56例为糖尿病组,另选健康成年男性38名为正常对照组,测定SHBG,进行精氨酸刺激试验. 结果 两组SHBG、胰岛素抵抗指数（HOMA-IR）差异有统计学意义（P＜0.01）.相关分析显示,SHBG与HOMA-IR呈负相关（r=-0.219,P＜0.05）.Logistic回归分析显示,SHBG是IR的唯一有效自变量（β=-0.75,P＜0.05,OR=0.47）.二元Logistic回归分析得出HOMA-IR是糖尿病的危险因素,SHBG是糖尿病的保护因素.胰岛2 min分泌高峰值与HOMA-IR呈正相关（β=0.567,P＜0.05）. 结论 新诊断糖尿病成年男性患者存在血清SHBG降低,SHBG与HOMA-IR呈负相关.SHBG是新诊断糖尿病成年男性患者的独立保护因素.胰岛β细胞第一时相分泌功能减退与IR相关,与SHBG无相关性.     

Cryptorchidism and endocrine disrupting chemicals

Prospective clinical studies have suggested that the rate of congenital cryptorchidism has increased since the 1950s. It has been hypothesized that this may be related to environmental factors. Testicular descent occurs in two phases controlled by Leydig cell-derived hormones insulin-like peptide 3 (INSL3) and testosterone. Disorders in fetal androgen production/action or suppression of Insl3 are mechanisms causing cryptorchidism in rodents. In humans, prenatal exposure to potent estrogen diethylstilbestrol (DES) has been associated with increased risk of cryptorchidism. In addition, epidemiological studies have suggested that exposure to pesticides may also be associated with cryptorchidism. Some case-control studies analyzing environmental chemical levels in maternal breast milk samples have reported associations between cryptorchidism and chemical levels. Furthermore, it has been suggested that exposure levels of some chemicals may be associated with infant reproductive hormone levels.     

Thyroid effects of endocrine disrupting chemicals

In recent years, many studies of thyroid-disrupting effects of environmental chemicals have been published. Of special concern is the exposure of pregnant women and infants, as thyroid disruption of the developing organism may have deleterious effects on neurological outcome. Chemicals may exert thyroid effects through a variety of mechanisms of action, and some animal experiments and in vitro studies have focused on elucidating the mode of action of specific chemical compounds. Long-term human studies on effects of environmental chemicals on thyroid related outcomes such as growth and development are still lacking. The human exposure scenario with life long exposure to a vast mixture of chemicals in low doses and the large physiological variation in thyroid hormone levels between individuals render human studies very difficult. However, there is now reasonably firm evidence that PCBs have thyroid-disrupting effects, and there is emerging evidence that also phthalates, bisphenol A, brominated flame retardants and perfluorinated chemicals may have thyroid disrupting properties.     

伽玛刀治疗颅内软骨肉瘤四例报道及文献回顾

目的 探讨伽玛刀放射外科治疗颅内软骨肉瘤的临床疗效. 方法 回顾性分析天津医科大学第二医院神经外科伽玛刀中心自2004年11月至2012年1月收治的4例软骨肉瘤患者诊治过程.4例患者均行手术切除并经病理证实,其中男1例,女3例;年龄26～36岁,平均31.3岁.肿瘤体积0.6～25.4 cm3,平均13.8 cm3;边缘剂量15～20 Gy,平均17.3 Gy;中心剂量30～40 Gy,平均35 Gy;靶点数4～19个,平均10个.本组随访时间5～28个月,平均14.5个月. 结果 1例左侧乳突及颈静脉孔区患者及1例鞍区患者治疗后分别随访19个月、9个月,肿瘤未见增大,生存良好;1例右侧眶颅沟通患者随访28个月后复发,后两次行手术治疗,效果不佳,于伽玛刀治疗后56个月死亡;1例左侧鞍旁患者治疗后5个月肿瘤复发,伴脑积水,随后失访.4例均未出现任何与伽玛刀治疗相关的并发症. 结论 伽玛刀治疗定位精确度高,疗效可靠且对周围组织损伤小,可作为术后残留软骨肉瘤辅助治疗方法.     

股骨转子间骨折3种内固定方法的疗效比较

目的探讨不同内固定治疗股骨转子间骨折的临床疗效。方法 97例股骨转子间骨折患者按治疗方法分为3组:动力髋螺钉固定组(A组)37例,解剖锁定钢板固定组(B组)36例,Gamma钉固定组(C组)24例。分析各种方法的疗效及优缺点。结果手术时间:A组为(102±19)min,B组为(75±15)min,C组为(71±11)min;A组与B、C组比较差异均有统计学意义(P<0.01),B组与C组比较差异无统计学意义(P>0.05)。出血量:A组为(501±134)ml,B组为(212±38)ml,C组为(198±31)ml;A组与B、C组比较差异均有统计学意义(P<0.01),B组与C组比较差异无统计学意义(P>0.05)。术中X线暴露次数:A组为(7±3)次,B组为(8±3)次,C组为(8±2)次;3组间两两比较差异无统计学意义(P>0.05)。术后髋关节功能Harris评分优良率:A组83.78%,B组88.88%,C组87.50%。结论 Gamma钉具有手术耗时少、术中X线透视时间短、创伤小、术后内固定稳定性强、并发症少、骨折愈合快、患肢功能恢复快等优点,可以作为治疗股骨转子间骨折优选内固定方法;解剖锁定钢板结合微创技术治疗股骨转子间骨折也有较大的适用范围;动力髋螺钉操作简单,适宜应用于无严重骨质疏松的A1型和A2转子间骨折。     

Treatment of Steroid‐Resistant Acute Renal Allograft Rejection With Alemtuzumab

Steroid‐resistant renal allograft rejections are commonly treated with rabbit antithymocyte globulin (RATG), but alemtuzumab could be an effective, safe and more convenient alternative. Adult patients with steroid‐resistant renal allograft rejection treated with alemtuzumab (15–30 mg s.c. on 2 subsequent days) from 2008 to 2012 (n = 11) were compared to patients treated with RATG (2.5‐4.0 mg/kg bodyweight i.v. for 10–14 days; n = 20). We assessed treatment‐failure (graft loss, lack of improvement of graft function or need for additional anti‐rejection treatment), infections during the first 3 months after treatment and infusion‐related side effects. In both groups, the median time‐interval between rejection and transplantation was 2 weeks, and approximately 75% of rejections were classified as Banff‐IIA or higher. Three alemtuzumab‐treated patients (27%) experienced treatment failure, compared to eight RATG treated patients (40%, p = 0.70). There was no difference in the incidence of infections. There were mild infusion‐related side‐effects in three alemtuzumab‐treated patients (27%), and more severe infusion‐related side effects in 17 RATG‐treated patients (85%, p = 0.013). Drug related costs of alemtuzumab‐treatment were lower than of RATG‐treatment (€1050 vs. €2024; p < 0.01). Alemtuzumab might be an effective therapy for steroid‐resistant renal allograft rejections. In contrast to RATG, alemtuzumab is nearly devoid of infusion‐related side‐effects. These data warrant a prospective trial.