肾综合征出血热合并假性球麻痹1例

1　病例报告　患者女 ,46岁 .因发热少尿伴恶心呕吐 4d,声嘶、构音不清、吞咽困难伴饮水呛咳 2 d于 1999- 11- 2 2入院 .患者患病前有鼠类接触史 .查体 :T37℃ ,P80次 / min,Bp15 / 10k Pa,双腋下可见少量出血点 .球结膜充血 度水肿 ,咽充血 ,软腭散在出血点 ,腹平软 ,肝脾未及 ,双肾区叩痛显著 .脊柱四肢无畸形 ,四肢肌张力高 ,肌力弱 ,上肢 3级 ,下肢 2级 .咽反射存在 ,跟膝腱反射亢进 ,膑震挛、踝震挛阳性 ,双侧巴彬斯基征阳性 .化验血常规 :WBC 10 .1× 10 9· L- 1 ,N 0 .82 ,PL T 11收稿日期 :2 0 0 0 -3 -10 ;　修回日期 :2 0 …     

肾综合征出血热多尿期顽固性高钾血症1例

1　病例报告　患者男性 ,46岁 .因发热 6 d后头痛、腰痛 ,少尿 7d,于 1999- 11- 2 0入院 .入院前 13d患者出现发热(40℃ ) ,伴轻度恶心、呕吐 . 7d前热退 ,但出现头痛、腰痛及少尿 (10 0～ 35 0 m L· d- 1 ) .头痛、腰痛为持续性钝痛 ,无放散 .患者发病前有鼠类接触史 .体检 :T 37.5℃ ,P 10 0次 /min,BP19/ 11k Pa.穿刺部位可见瘀斑 .球结膜 °水肿 ,无充血 .心肺无异常 .全腹胀 ,叩诊鼓音 ,肝脾未触及 ,双肾区叩击痛阳性 ,肠鸣音 4次 / min.双上肢前臂轻度肿胀 ,压痛 .神经系统查体无异常 .化验 :11月 2 0日血常规 :WBC15 .6×10 9…     

An abbreviated MLVA identifies Escherichia coli ST131 as the major extended-spectrum β-lactamase-producing lineage in the Copenhagen area

Rapid bacterial typing is a valuable and necessary tool in the prevention and detection of outbreaks. The purpose of this study was to adapt a multilocus variable number of tandem repeats analysis (MLVA) for analysis on a benchtop capillary electrophoresis instrument and compare the modified assay with multilocus sequence typing (MLST) for typing cefpodoxime-resistant Escherichia coli (E. coli). Further, we identified the causative resistance mechanisms and epidemiological type of infection for isolates producing extended-spectrum β-lactamases (ESBLs). A collection of E. coli resistant to cefpodoxime was typed by MLST and a modified MLVA assay using a benchtop capillary electrophoresis instrument. Resistance mechanisms were identified by polymerase chain reaction (PCR) and sequencing. Patient history was examined to establish the epidemiological type of infection for ESBL-producing E. coli. MLVA yielded typing results homologous with MLST and it correctly identified E. coli sequence type (ST) 131 that was accounting for 45 % of all ESBL-producing isolates in the sample collection. The majority (76.7 %) of ESBL-producing isolates was healthcare-related and only 23.3 % of the ESBL-producing isolates were community-onset infections (COI), regardless of the ST. Patients with COI were significantly more often of female gender and younger age compared to healthcare-associated infections (HCAI) and hospital-onset infections (HOI). In conclusion, the modified MLVA is a useful tool for the rapid typing of E. coli and it identified ST131 as the predominating ESBL-producing lineage in Copenhagen. Healthcare-related infections were the predominant infection setting of ESBL-producing E. coli and the demographic characteristics differed between patients with COI and healthcare-related infections.     

《世界华人消化杂志》西安地区编委及作者读者座谈会纪要

<世界华人消化杂志>西安地区编委及作者读者座谈会于2007-12-18在西安交通大学医学院第二附属医院召开(图1).杂志社社长兼总编辑马连生教授、名誉总编辑潘伯荣教授、副总编辑王苑本教授和杨思凤教授及西安地区编委、作者读者共40余人出席会议.     

高效毛细管电泳法测定利多卡因代谢产物单乙基甘氨酰二甲苯胺

目的 :建立一种测定利多卡因代谢产物单乙基甘氨酰二甲苯胺 (MEGX)含量的高效毛细管电泳法。方法 :用50mmol/L硼酸缓冲液 (pH =8.8)为电泳电解液 ,电压 1 2kV ,运行电流 1 8.8～ 2 3 .2 μA ,检测波长 2 1 4nm ,有效毛细管长度 50cm ,管径 50 μm ,氨茶碱为内标 ,展开 1 2min。 8只昆明种小白鼠腹腔注射 0 .2 %利多卡因 4 0mg/kg ,用本法测定其 5h尿液中MEGX累积排泄量。结果 :MEGX迁移时间 7.8min ,氨茶碱迁移时间 1 0 .7min。MEGX含量为 0 .0 62～1 .0mg/ml时 ,其浓度与色谱峰面积线性关系良好 ,r =0 .9991 ,日内、日间变异系数均小于 7.8% ,回收率为98.4 %～ 1 0 1 .6% ,常用 3 0种药物对其无干扰。 8只小鼠MEGX累积排泄量为 ( 2 95.2± 55.2 ) μg ,其中游离型MEGX为 4 4.7% ,结合型为 55.3 %。结论 :该方法简单、快速、灵敏 ,特异性和重现性良好 ,具有较强实用价值。     

组织工程支架材料三维多孔聚乙烯醇水凝胶的制备

目的:制备组织工程支架材料,使其内部具有三维多孔结构,以种植和培养细胞。方法:利用氯化钠在二甲基亚砜/水溶液中的溶解度很小的特点,在聚乙烯醇的二甲基亚砜/水溶液中加入不同量的氯化钠颗粒,搅拌均匀而后迅速冷冻,待聚乙烯醇的二甲基亚砜/水凝胶形成后,将凝胶置于蒸馏水中1周,从而将该凝胶中的二甲基亚砜置换出并且溶出氯化钠,由此得到具有三维多孔结构的聚乙烯醇水凝胶。结果:①聚乙烯醇水凝胶的力学性能包括断裂强度,断裂伸长率,弹性模量等和制孔前相比基本没有变化,仍然符合作为组织工程支架材料的要求。②干燥速率随着孔隙率的增大先是降低后又上升。③水凝胶内部可以清晰地观察到三维孔隙结构,孔隙的大小符合作为组织工程支架材料的要求。结论:实验经过改进工艺方法,得到了具有三维多孔性的聚乙烯醇复合水凝胶。     

去势大鼠腰椎骨密度及血清生化指标改变及运动训练的干预

目的:通过观察切除卵巢骨质疏松模型大鼠骨组织形态、血清生化指标以及骨密度的表达情况,了解运动训练对预防绝经后骨质疏松的生物学作用。方法:实验于2005-01/2006-01在解放军第四军医大学动物中心实验室完成。①实验对象:雌性SD大鼠45只,随机分为正常对照组、单纯去势组以及运动训练组,每组15只。②实验方法:单纯去势组、运动训练组分离出双侧卵巢并结扎,摘除,分层缝合切口。正常对照组大鼠仅行手术进入腹腔,切除少量脂肪组织后关闭腹腔。运动训练组术后2周开始进行跑步训练,跑道速度为15m/min。每日上下午各训练1h。各组动物于术后第12周麻醉下处死采血,收集骨骼标本。③实验评估:苏木精-伊红染色观察第3腰椎骨组织形态;DPX-IQ7040双能X线骨密度仪测定第4腰椎骨密度;甲基百里香酚蓝法测定血清钙水平;硫酸亚铁法测定血清磷水平;磷酸苯二钠法测定血清碱性磷酸酶水平;放免法测定骨钙素水平。结果:单纯去势组和运动训练组各有1只动物死亡。其余动物均进入结果分析。①腰椎骨密度:运动训练组明显高于单纯去势组[(0.2443±0.0202),(0.2004±0.0408)g/cm2,P<0.01]。②血清中生化指标检测结果:运动训练组钙离子、碱性磷酸酶、骨钙素水平明显低于单纯去势组[(2.440±0.232),(3.053±0.172)mmol/L;(1.962±0.173),(2.350±0.195)μkat/L;(23.43±3.78),(27.86±4.43)μg/L,P<0.01]。③骨组织形态:运动训练组骨小梁数目增加,小梁的厚度增加,视野下穿孔的数量少于单纯去势组。结论:经过适量运动训练,大鼠去卵巢后体内骨改建的高转换状态可以得到缓解。     

Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

一种用于筛选降血糖及降血脂药物的动物模型

一种用于筛选降血糖及降血脂药物的动物模型刘京，申竹芳，刘海帆，叶菲，谢明智（中国医学科学院药物研究所，中国协和医科大学北京１０００５０）糖尿病为常见病和多发病，同时伴有多方面的并发症，脂质代谢紊乱即其中之一。这就要求治疗糖尿病时，除控制病人的血糖外，...