胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes(T2DM).Methods Bone fracture patients with T2DM were randomly divided into three groups:continuous subcutaneous insulin infusion group(insulin aspart,group CSII,n=20),glargine treatment group(insulin aspart+insulin glargine,group GA,n=20),and NPH treatment(insulin aspart+rh-insulin,group NA,n=20).The levels of fasting plasma glucose(FPG)and the 2 hours postprandial glucose(2h PG),blood glucose fluctuation(BGF),insulin dosage(ID),good effective time(GET),incidence of hypoglycemia,dawn phenomenon and infection,average time of stitches removal(ATSR),average hospitalized length(AHL)of three groups were compared.Results FPG and 2hPG,ID in group CSII[(6.32±1.18)mmol/L,(7.72±1.53)mmol/L,(35.40±1.60)IU]and group GA [(6.25±0.88)mmol/L,(7.32±1.17)mmol/L,(36.20±0.80)IU]were significantly lower than those of group NA [(7.44±1.36)mmol/L,(8.52±0.76)mmol/L,(40.50±2.40)IU,all P<0.05],simulaneously,BGF,GET incidence of complications,ATSR,AHL of group CSII and GA were significantly lower than those of group NA(all P<0.05).There were not significant difference between group CSII and group GA.Compared with group CSII,group GA had less costs in-hospital and better practicability.Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively,safely,rapidly and stablely control hyperglycemia.and might be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.     

Effects of opsonization and gamma interferon on growth of Brucella melitensis 16M in mouse peritoneal macrophages in vitro

Entry of opsonized pathogens into phagocytes may benefit or, paradoxically, harm the host. Opsonization may trigger antimicrobial mechanisms such as reactive oxygen or nitric oxide (NO) production but may also provide a safe haven for intracellular replication. Brucellae are natural intramacrophage pathogens of rodents, ruminants, dogs, marine mammals, and humans. We evaluated the role of opsonins in Brucella-macrophage interactions by challenging cultured murine peritoneal macrophages with Brucella melitensis 16M treated with complement- and/or antibody-rich serum. Mouse serum rich in antibody against Brucella lipopolysaccharide (LPS) (aLPS) and human complement-rich serum (HCS) each enhanced the macrophage uptake of brucellae. Combinations of suboptimal levels of aLPS (0. 01%) and HCS (2%) synergistically enhanced uptake. The intracellular fate of ingested bacteria was evaluated with an optimal concentration of gentamicin (2 microg/ml) to control extracellular growth but not kill intracellular bacteria. Bacteria opsonized with aLPS and/or HCS grew equally well inside macrophages in the absence of gamma interferon (IFN-gamma). Macrophage activation with IFN-gamma inhibited replication of both opsonized and nonopsonized brucellae but was less effective in inhibiting replication of nonopsonized bacteria. IFN-gamma treatment of macrophages with opsonized or nonopsonized bacteria enhanced NO production, which was blocked by N(G)-monomethyl L-arginine (MMLA), an NO synthesis inhibitor. MMLA also partially blocked IFN-gamma-mediated bacterial growth inhibition. These studies suggest that primary murine macrophages have limited ability to control infection with B. melitensis, even when activated by IFN-gamma in the presence of highly opsonic concentrations of antibody and complement. Additional cellular immune responses, e.g., those mediated by cytotoxic T cells, may play more important roles in the control of murine brucellosis.     

人类免疫缺陷病毒包膜糖蛋白V3区对细胞结合能力的研究

目的：研究人类免疫缺陷病毒（ＨＩＶ）不同亲嗜株包膜糖蛋白Ｖ３区结合于靶细胞的能力。方法：合成来源于不同嗜性ＨＩＶ－１Ｖ３区的生物素标记和非标记的多肽。采用流式细胞计数分析生物素化的 Ｖ３多肽对细胞的结合能力以及细胞表面的结合配体。结果：ＨＩＶ－１Ｘ４　亲嗜株ＩＩＩＢＶ３区能结合于多种细胞的表面，包括辅助受体ＣＸＣＲ４；竞争实验结果显示蛋白酶抑制剂能抑制该结合。Ｒ５亲嗜株 ＡＤＡ Ｖ３区只极微弱地结合于外周血单核细胞和表达ＣＣＲ５ 的人星形胶质细胞表面。结论：不同嗜性ＨＩＶ－１Ｖ３区结合于细胞表面的能力不同从亲嗜株Ｖ３区直接结合于细胞表面并被其自身所增强，其靶分子至少包括辅助受体 ＣＸＣＲ４和蛋白酶分子；而Ｒ５亲嗜株 ＡＤＡ Ｖ３区则不结合于 ＣＣＲ５和蛋白酶。     

Determination of serum and organ malondialdehyde (MDA) concentration, a lipid peroxidation index, in Trypanosoma brucei-infected rats

Lipid peroxidation was assessed in the sera and various organs of rats experimentally infected with Trypanosoma brucei. Thirty-six adult albino rats divided into 2 groups of eighteen rats each were used in this study. In experiment one, a group of 18 rats were used and they were divided into three groups (A, B and C) of six rats each. Groups B and C rats were infected with 1.54 × 10⁵ trypanosomes per rat intraperitoneally, whereas group A served as uninfected control. The rats were bled on day 0 and subsequently at 7-day intervals for packed cell volume (PCV), sera peroxidation index and parasitaemia. Also, temperature and weight were taken on day 0 and subsequently at 7-day intervals. In experiment 2, 18 rats were also used. Six rats each were sacrificed on days 0, 14 and 28-postinfection. Five rats each were sacrificed on day 14 and day 28 post-infection (PI) from group B, and their organs were promptly collected and washed with normal saline and used for organ malondialdehyde (MDA) concentration. The infection led to an increase in lipid peroxidation index (MDA concentration) of sera samples. The serum MDA concentration of the infected rat group was significantly (p < 0.01) higher than in the uninfected group on days 21 and 28 PI. The increase was however reversed by diminazene aceturate (Berenil; Hoechst, Ireland) treatment at the dosage of 7 mg/kg body weight administered on day 14 PI. The organ lipid peroxidation index also increased significantly (p < 0.05) in the eye, lung and spleen. However, there was no significant (p > 0.05) increase of lipid peroxidation index in the kidney, heart, liver, testes and brain. Also, the mean weekly MDA concentration increased as the disease progressed, the mean weekly temperature and parasitaemia also increased, but the reverse was the case with the mean weekly body weight and PCV which declined as the disease progressed. The findings are indication that oxidative stress plays an important role in the pathology of trypanosomosis.     

丹参注射液与异甘草酸镁抗肝纤维化的临床对比研究

Objective To observe the change of liver function and liver fibrosis indexes of the chronic hepatitis B patients that were treated by Danshen injection(DI) and magnesium isnglyeyrrhizinate(MI). Methods 80 chronic hepati-tis B patients based on the conventional treatment were randomly divided into D1 group(40 patients) and MI group(40 pa-tients). The two groups were used with DI and MI injection for 30 days respaetively and then,the levels of liver function and serum hepatic fibrosis(HA, LN, Ⅳ -C) were detected and compared before and after treatment. Results Treatment by DI and MI could both improve liver function significantly, the effect of Ml group was better than DI group(P < 0.05). Moreover, in improving serum hepatic fibrosis, the effect of DI group was better than MI group (P < 0.05). Conclusions The efficacy of the improvement to hepatic fibrosis DI is better than MI, while in improvement of liver function MI is superior to DI.     

Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings

BackgroundDisseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS).AimTo determine Obstetricians'' approach in diagnosing and treating obstetrics DIC in a RLSMethodA semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC.ResultsA total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient''s financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC.ConclusionDIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.     

B超引导下麦默通装置在乳腺微创外科中的应用

【目的】探讨B超引导下麦默通系统在乳腺微创外科中的应用价值。【方法】在B超引导下采用麦默通装置行微创旋切对36例乳腺肿瘤患者进行诊断及治疗。【结果】10例行穿刺活检,其中恶性4例,明确诊断后均行新辅助化疗。26例乳腺肿块均完整切除。术后1月B超随访无原病灶残留和复发,3例出现术后出血并发症．1～2个月后完全吸收。超声引导成功率100％。【结论】B超引导下麦默通乳腺微创旋切术是一种治疗乳腺肿瘤安全、合理、有效、符合美学观点的诊治方法。     

介入术后健康教育处方应用效果研究

目的探讨查介入术后健康教育处方的应用效果。方法将893例住院行介入手术治疗的患者分为两组：对照组采用传统方法进行健康教育;实验组使用介入术后健康教育处方,整理两组患者发生不安全隐患的例数。依据是否应用介入术后健康教育处方为患者实施健康教育将护理人员分为两组,评估两组护士健康教育知识掌握程度,计算同期合格率。结果实验组患者术后未发生不安全隐患,护士健康教育合格率提高（P〈0．01）。结论使用介入术后健康教育处方,能降低不安全隐患的发生,提高护士健康教育的准确性和合格率。     

某部密闭舱室军事作业环境和人员健康调查评价

目的 评价特殊军事作业人工环境影响因素特征及其对人员健康的影响,为进一步开展控制措施的研究提供依据.方法 采用电磁辐射场强仪、声级计、温湿度计、风速仪、一氧化碳检测仪和二氧化碳分析仪,分别对某部军事作业密闭环境的微波辐射、噪声、温度、湿度、风速、一氧化碳和二氧化碳进行监测分析;采用自觉症状问卷,调查评价作业人员健康...     

The immunology of Leishmania/HIV co-infection

Leishmaniases are emerging as an important disease in human immunodeficiency virus (HIV)–infected persons living in several sub-tropical and tropical regions around the world, including the Mediterranean. The HIV/AIDS pandemic is spreading at an alarming rate in Africa and the Indian subcontinent, areas with very high prevalence of leishmaniases. The spread of HIV into rural areas and the concomitant spread of leishmaniases to suburban/urban areas have helped maintain the occurrence of Leishmania/HIV co-infection in many parts of the world. The number of cases of Leishmania/HIV co-infection is expected to rise owing to the overlapping geographical distribution of the two infections. In Southwestern Europe, there is also an increasing incidence of Leishmania/HIV co-infection (particularly visceral leishmaniasis) in such countries as France, Italy, Spain and Portugal. Studies suggest that in humans, very complex mechanisms involving dysregulation of host immune responses contribute to Leishmania-mediated immune activation and pathogenesis of HIV. In addition, both HIV-1 and Leishmania infect and multiply within cells of myeloid or lymphoid origin, thereby presenting a perfect recipe for reciprocal modulation of Leishmania and HIV-1-related disease pathogenesis. Importantly, because recovery from leishmaniases is associated with long-term persistence of parasites at the primary infection sites and their draining lymph nodes, there is very real possibility that HIV-mediated immunosuppression (due to CD4⁺ T cell depletion) could lead to reactivation of latent infections (reactivation leishmaniasis) in immunocompromised patients. Here, we present an overview of the immunopathogenesis of Leishmania/HIV co-infection and the implications of this interaction on Leishmania and HIV disease outcome.