1例三高病史患者同种异体肝移植手术配合报道

报道1例三高病史患者同种异体肝移植患者的病例资料,归纳总结术中配合要点及护理关注点。特殊患者术前全面评估、术中细致配合是保障肝移植手术成功的保障。     

Lymphome non hodgkinien Ki-1 positif révélé par des ulcérations cutanéomuqueuses et une glomérulonéphrite

Malignant lymphoma particularly of T phenotype can be associated with specific or non specific cutaneous lesions. These cutaneous manifestations can occur at the onset of the disease being sometimes the revealing sign or they can appear during the course of the lymphoreticular malignancies. Glomerulonephritis was also described in lymphoma. Ki- positive large cell lymphoma was recently identified. A new case is reported with lymphadenopathy and intestinal localisation revealed by cutaneous and mucosal ulcerations principally in the mouth and a focal segmental glomerulonephritis with endo- and extracapillary proliferation. The absence of lymphoma in cutaneous and renal lesions and the clinical presentation support the hypothesis of paraneoplastic manifestations, may be related to a vasculitis.     

低频振幅结合功能连接对原发性甲亢患者感觉运动网络的功能MRI研究

目的采用低频振幅(amplitude of low frequency fluctuation,ALFF)与功能连接(functional connectivity,FC)相结合的方法,研究原发性甲状腺功能亢进患者静息状态下脑功能改变。材料与方法 12名未经治疗的甲亢患者为病例组,12名自愿接受扫描的健康人(年龄、性别无显著性差异)为对照组。采集所有被试静息态f MRI数据,采用REST及DPARSF软件分析原始数据,得出全脑ALFF,利用双样本t检验的方法比较病例组和对照组ALFF的变化,并以两组间ALFF值有显著性差异的脑区为感兴趣区(regions of interest,ROI)校正后行FC分析。结果与对照组相比,甲亢患者在双侧尾状核及双侧丘脑ALFF值降低(P0.001)。以上脑区的ALFF值均未发现与T3、T4有显著相关性(P0.05)。FC分析显示,左侧丘脑与双侧感觉运动区(包括中央前回、中央后回)FC增强(P0.001);右侧丘脑与右侧中央前回及中央后回连接增强(P0.001)。结论甲亢患者双侧丘脑的局部活动及其与大脑感觉运动网络的FC模式存在异常,增强的FC可能与代谢损伤所导致运动机能受损而使甲状腺功能异常患者有更强的功能需求有关。     

原发性甲状腺功能亢进症患者血尿酸相关性研究

【目的】探讨原发性甲状腺功能亢进症（甲亢）患者血尿酸（UA）与甲状腺功能水平的相关性。【方法】收集原发性甲亢患者61例,按照血 UA 水平（男性＞420μmol／L ,女性＞360μmol／L ）分为高尿酸血症（ HUA）组、正常尿酸血症（ NUA）组,另外收集同期年龄和性别匹配的健康体检人群作为健康对照组,检测并比较三组甲状腺功能指标[游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH ）水平]、空腹血糖（FBS）、肾功能指标[尿素氮（BUN）、肌酐（Cr）、UA ];肝功能[丙氨酸基转移酶（ALT ）和天冬氨酸氨基转移酶（AST ）]、血脂[三酰甘油（TG）、胆固醇（TC）、高密度脂蛋白（HDL‐C）、低密度脂蛋白（LDL‐C）],分析 UA 与甲状腺功能水平的相关性。【结果】NUA 组 FT3、FT4均明显高于对照组（P ＜0．01）,而 TC 、HDL‐C 、LDL‐C 、TSH 均明显低于对照组（P ＜0．01）,但两组 FBS 、AST 、TG 、BUN 、Cr 、UA 比较差异无统计学意义（P ＞0．05）。与 NUA 组比较,HUA 组 BUN 、UA 、Cr 、FT3、FT4明显升高（P ＜0．05）,TSH 水平明显下降,其差异均有统计学意义（P ＜0．05）;而两组 FBS 、ALT 、AST 、TG 、TC 、HDL‐C 、LDL‐C 比较差异无统计学意义（P ＞0．05）。 UA 与 FT3、FT4呈正相关（P ＜0．05）,与 TSH 呈负相关（P ＜0．05）,血清 Cr 与 FT3、FT4呈负相关（P ＜0．05）。【结论】原发性甲亢患者易合并血 UA 升高,血 UA 水平与患者的高甲状腺激素水平密切相关。     

Foxp3转染小鼠CD4^＋CD25^-T细胞抑制树突状细胞功能

为了研究Foxp3基因表达与CD4^＋T细胞免疫活性的关系,用逆转录病毒转染Foxp3基因,在幼稚CD4^＋CD25^-T细胞内强制性表达FOXP3蛋白,进而研究转染后的CD4^＋CD25^-T细胞对树突状细胞的免疫共刺激分子和免疫功能的影响,并通过Transwell试验研究转染Foxp3的CD4^＋CD25^-T细胞对树突状细胞的作用是否依赖于细胞之间的直接接触。结果表明：通过逆转录病毒载体转染,成功建立了表达Foxp3的CD4^＋CD25^-T细胞模型,转染后1周Foxp3阳性表达的T细胞比例为38%。强制性表达Foxp3的CD4^＋CD25^-T细胞可以在体外发挥免疫抑制作用,可以诱导树突状细胞表面免疫共刺激分子CD80和CD86表达水平的下调。体外淋巴细胞增殖试验结果表明,Foxp3转染小鼠CD4^＋CD25^-T细胞可以抑制树突状细胞对异基因淋巴细胞的活化。结论：转染Foxp3的CD4^＋CD25^-T细胞对树突状细胞发挥的作用依赖于细胞之间的直接接触。     

Biomechanics of a new atraumatic surgical needle holder

It is the purpose of this report to design, develop, and evaluate a needle holder whose jaws improve needle-holding security without altering the geometry of the curved surgical needle. The configuration of the jaws of this new needle holder is curved, conforming to the curvature of the surgical needle. A biomechanical study of this curved surgical needle holder demonstrates that it holds the curved needle securely without needle deformation.     

选择性垂体甲状腺激素抵抗所致TSH甲亢一例的治疗观察

本文报告１例选择性垂体对甲状腺激素抵抗所致ＴＳＨ甲亢。用ＰＴＵ治疗１３个月后，血清ＦＴ＿３、ＦＴ＿４水平持续高于正常，血清ＴＳＨ值波动于２６～６０ｍＵ／Ｌ之间，ＴＲＨ兴奋试验呈过度反应。改用溴隐亭治疗６个月后，血清基础ＴＳＨ及ＴＳＨ对ＴＲＨ反应均恢复正常，血清ＴＴ＿３、ＴＴ＿４水平也随之逐渐下降至正常，甲亢症状控制。Ｄ－Ｔ＿４治疗１１天，血清基础ＴＳＨ值保持正常，对ＴＲＨ无反应，而血清ＦＴ＿４、ＴＴ＿４水平回升至高于正常范围，甲亢复发。我们的观察说明，溴隐亭治疗这类甲亢有效，副作用小，可长期使用。     

Hunger-satiety signals in patients with Graves' thyrotoxicosis before, during, and after long-term pharmacological treatment

Patients with Graves’ thyrotoxicosis lose weight despite increased appetite and food intake, thus suggesting a disturbed balance between energy intake and expenditure. Underlying mechanisms are not fully elucidated. The objective of this study was to investigate whether hormonal factors, known to affect hunger/satiety, change significantly over time as pharmacological treatment turns hyperthyroidism into euthyroidism. For that purpose 11 patients with Graves’ thyrotoxicosis were given thiamazole and I-thyroxine for 18–20 mo. They were investigated on three occasions: Test 1: before pharmacological therapy; Test 2: during medication; Test 3: a few months after conclusion of the pharmacological treatment. Sixteen healthy subjects were also investigated for comparison. The participants were fasted overnight. Blood samples for determination of plasma glucose and serum concentrations of free T₃ and T₄, TSH, albumin, cortisol, insulin, GH, IGF-1, IGFBP-1, leptin, and ghrelin were drawn in the morning from an antecubital vein. Laboratory data obtained in test 1 were statistically compared with those in tests 2 and 3. The study showed that the free T₃ level declined from 42.8±4.3 pmol/L in test 1 to 6.0±0.8 pmol/L in test 2 (85±2% decline), and 5.5±0.3 pmol/L in test 3 (86±2% decline). The free T₄ level fell concomitantly from 65.2±4.8 to 16.6±1.7 and 14.4±1.2 pmol/L. The glucose level was significantly higher during hyperthyroidism (test 1) than during euthyroidism (tests 2 and 3), whereas cortisol, insulin, GH, IGF-1, and leptin levels were similar. The IGFBP-1 level was initially high (48.8±8.5 μg/L in test 1), but with a relative decline in free T₃ of 85±2% (test 2) the IGFBP-1 level declined by 34±13%, and with a free T₃ decline of 86±2% (test 3) the binding protein fell by 39±29%. This brought about increased IGF-1 bioavailability as reflected by a rising IGF-1/IGFBP-1 ratio from 5.1±1.1 to 13.8±2.9 (p<0.01). The ghrelin level was low (2454±304 ng/L) in test 1. It increased to 3127±397 ng/L in test 2 (p<0.05), and to 3348±279 ng/L in test 3 (p<0.01). Conclusion: Both ghrelin secretion and IGF-1 bioavailability are low in patients with untreated thyrotoxicosis, but increase markedly as pharmacotherapy makes them euthyroid. These metabolic changes may be caused by the transition of hyperthyroidism into euthyroidism rather than by the pharmacotherapy per se, since the metabolic changes prevailed also in the posttreatment period.     

提高输尿管镜钬激光治疗输尿管上段结石成功率的体会

目的：总结输尿管镜钬激光治疗输尿管上段结石时减少碎石上移和提高碎石成功率的体会。方法：用输尿管镜钬激光治疗输尿管上段结石71例,对其中35例第4腰椎横突以上结石碎石前预置金属或N—Trap网篮,对15例反流入肾盂〉0．4cm碎石辅以输尿管软镜钬激光碎石。结果：输尿管穿孔1例;原位残留碎石1例;15例〉0．4cm碎石被冲入。肾盂,用输尿管软镜钬激光辅助肾盂内碎石;失败3例。本组输尿管镜钬激光治疗输尿管上段结石一次碎石成功65／71（91．6％）。结论：在输尿管镜钬激光碎输尿管上段结石中,预置金属或N—Trap网篮可以减少碎石反流入肾盂机会,对已反流入肾盂的碎石结合输尿管软镜钬激光治疗,可以提高输尿管镜钬激光治疗输尿管上段结石的一次碎石成功率。