Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

急性心肌梗塞患者红细胞磷脂水平测定

本文测定了第１－７天急性心梗塞患者红细胞磷脂主要组分含量。结果表明，急性心肌梗塞患者红细胞膜的神经鞘磷含量较正常人明显增高；磷酯酰胆硷，磷脂酰丝氨酸、磷脂酰乙醇胺含量却较正常人明显降低。这说明急性心肌梗塞患者存在红细胞磷脂代谢紊乱，这时心肌缺血的重可能产生不良影响。     

我院护士工作评估体系及其应用

目的应用护士工作评估体系,激励护士不断自我完善.方法以自我评估、面对面交流、同事间评估、设立目标和建立护士档案为主要内容的评估.一般为每年1次.结果每年护士评估的覆盖率为100%.提供了上下级面对面交流的机会,每名护士都熟悉评估的程序并自觉参与.结论护士评估体系是护理管理的重要组成部分,它使管理者有机会关注到每名护士的成长需要及成长目标,指导我们能动地利用人力--这一最宝贵的资源.     

Association of the GNAS1 gene variant with hypertension is dependent on alcohol consumption.

The beta-adrenoceptor (beta-AR)-stimulatory guanine nucleotide-binding (Gs) protein system has been shown to play important roles in the cardiovascular system. The gene encoding the alpha-subunit of Gs proteins (GNAS1) is a candidate genetic determinant for hypertension. Because alcohol consumption is known to affect blood pressure partly through the beta-AR-Gs protein system, we examined the possible interaction between GNAS1 T393C polymorphism and drinking status in the association with hypertension in the present study. As a result, a non-significant but reasonable trend supporting the presence of an interaction was shown (p = 0.076). In line with this trend, the T393C polymorphism significantly interacted with drinking status in the association with systolic blood pressure (p = 0.028). Moreover, supporting the presence of an interaction, T allele carriers consistently had a higher probability of hypertension, higher systolic blood pressure, and higher diastolic blood pressure than CC homozygotes in non-drinkers and light drinkers. In contrast, CC homozygotes consistently had a higher probability of hypertension, higher systolic blood pressure, and higher diastolic blood pressure than T allele carriers in moderate to heavy drinkers. The present study also showed a significant interaction between the T393C polymorphism and drinking status in the association with pulse pressure (p = 0.026), reflected by a significant association between the T393C polymorphism and pulse pressure in moderate to heavy drinkers (p = 0.026). These findings may be helpful in conducting further molecular and biological studies on the relationship among the effects of alcohol, the beta-AR-Gs protein system, and hypertension.     

老年急重症胆管炎临床分析

目的：探讨重症胆管(ACST)患者的临床特点及死亡原因。方法：分析我院近十五年来收治46例ACST的治疗情况。结果：手术41例．非手术5例，死亡9例，其中手术治疗死亡6例。结论：老年ACST患者，伴发病多，死亡率高，及时就诊，早期应用大量激素，选择适宜手术方法是降低死亡率的关键。     

IL-2R 在急性细胞性排异反应的同种异体尸体移植肾组织中的检测及意义

为探讨白介素－２受体（ＩＬ－２Ｒ，即ＣＤ２５）在同种异体肾移植急性细胞性排异（ＡＣＲ）临床诊断的作用，着重观察移植肾发生（ＡＣＲ）和无ＡＣＲ时，其间质浸润细胞中ＩＬ－２Ｒ阳性细胞数的变化，及其与间质浸润的淋巴细胞的关系。作者选择同期行异体肾移植，且无并发症患者１７例，采用ＰＡＰ四层免疫酶标法，检测移植肾组织中间质浸润细胞中ＩＬ－２Ｒ阳性细胞数的变化。结果显示：无ＡＣＲ的肾组织中，ＩＬ－２Ｒ阳性细胞仅轻度增加，当移植肾出现ＡＣＲ时，ＩＬ－２Ｒ阳性细胞数的增加十分显著，并与间质浸润的ＣＤ８密切相关。作者认为ＩＬ－２Ｒ对于ＡＣＲ的诊断及鉴别诊断具有一定的临床应用价值。     

国产达美康治疗Ⅱ型糖尿病的临床观察

本文应用国产达美康对71例NIDDM患者进行了临床观察,同时以优降糖做对照。结果显示:达美康降糖效果与优降糖相当,降血脂方面优于优降糖,并可降低全血粘度,而对照组无此变化,提示达美康在降低血粘度、改善微循环、防治糖尿病性微血管病变上有它独特的作用。结果表明达美康是治疗NIDDM安全而有效的口服降糖药。     

聚氨酯避孕套临床前使用可行性和可接受性分析

目的 对使用新型聚氨酯(Pu)男用避孕套的可行性和可接受性进行初步观察。方法 对30对健康已婚夫妇为期6周360次使用国产PU避孕套的效果进行问卷调查。结果 避孕套总破裂率(临床破裂 非临床破裂)为2．22％，临床滑脱率为16．5％，使用观察期间无意外妊娠发生。结论 新型PU避孕套的破裂率和滑脱率分别相近于和高于报道的乳胶避孕套使用情况，感官指标反映PU避孕套具有良好的可接受性。     

335例退行性骨关节病直流感应电康复总结

报告335例退行性骨关节病变,均经 x 线摄影证实,用直流感应电治疗。痊愈62例,占18.51%;显效115例,占34.33%;好转139例,占41.49%;无效19例;占5.67%。总有效率94.33%。有复发者再经治疗仍可收到效果。并对作用机制进行了探讨。     

经胸小切口在食管癌切除手术中的应用

目的探讨经胸小切口治疗食管癌手术的地位和可行性。方法对132例不同分期的食管癌行经胸小切口根治性手术,全部采用颈部吻合。结果切口平均长度13.0±2.0 cm,开关胸时间、开胸时出血量、术后伤口疼痛、呼吸功能受限及患肢活动等方面有显著差异,在手术时间、淋巴结清扫、术中出血及术后胸腔引流和常规手术无差异。结论经胸小切口食管癌根治手术安全、可行,并且有创伤小、恢复快等优点,便于推广应用。