女性致密性骨炎血清骨转换生化标志物水平变化研究

背景 致密性骨炎（OCI）和其他疾病有时难以鉴别，探讨血清骨转换生化标志物可为OCI的鉴别诊断提供依据。 目的 探索女性OCI患者的血清骨转换生化标志物的水平变化及临床意义。 方法 回顾性选取2013年6月至2022年2月在北京积水潭医院门诊及住院诊断为OCI的61例女性患者作为观察组，年龄15~50岁，平均（33.8±6.6）岁，病程2周~15年。选择同期61例女性体检健康者作为对照组，年龄15~48岁，平均（35.6±7.6）岁。比较两组一般临床资料和血清骨转换生化标志物水平，并对血清骨转换生化标志物与病情相关指标进行相关性分析。 结果 观察组血清白蛋白（45.4±2.9）g/L低于对照组（46.5±2.8）g/L（t=2.190，P<0.05）。血清骨转换生化标志物比较结果显示，观察组血清1型胶原羧基末端肽β特殊序列（β-CTX）〔0.28（0.23，0.37）μg/L〕、N-端骨钙素（OC）〔13.1（11.2，16.2）μg/L〕、25-羟维生素D3〔25-（OH）VD3〕〔（14.1±5.1）μg/L〕低于对照组〔0.36（0.29，0.48）μg/L，15.6（13.7，17.3）μg/L，（17.5±6.6）μg/L〕（Z=-2.983、-3.255，t=3.081，P<0.05）。长病程亚组OC水平〔14.6（12.4，18.5）μg/L〕高于短病程亚组〔11.7（10.2，14.0）μg/L〕（Z=-2.407，P<0.05）。多孕亚组β-CTX〔0.25（0.22，0.32）μg/L〕、OC水平〔12.2（10.3，15.0）μg/L〕低于非多孕亚组〔0.33（0.26，0.44）μg/L、13.4（12.0，18.8）μg/L〕（Z=-2.486、-1.897，P<0.05）。相关性分析显示，观察组血清1型前胶原氨基端延长肽（tP1NP）与妊娠次数、生产次数均呈负相关（rs=-0.276、-0.298，P<0.05），OC与体质指数（BMI）、视觉模拟评分法（VAS）评分、妊娠次数均呈负相关（rs=-0.284、-0.374、-0.360，P<0.05），25-（OH）VD3水平与BMI呈正相关（rs=0.275，P<0.05）。 结论 女性OCI患者血清OC、β-CTX水平明显降低，可为鉴别其他疾病提供依据；血清OC水平可以反映OCI患者的严重程度，同时OC水平与患者妊娠次数相关；tP1NP与妊娠次数、生产次数相关。     

肝门胆管癌的动态增强CT诊断

目的评价螺旋CT对肝门胆管癌的诊断价值。方法13例肝门胆管癌行螺旋CT平扫及动态增强扫描,并与手术及病理对照分析。结果11例平扫表现为肝门区低密度软组织肿块;2例表现为肝门区胆管不规则增厚,管腔狭窄。增强扫描13例有延迟强化。结论螺旋CT扫描对肝门胆管癌的诊断具有重要意义。     

12例开放性腋动脉损伤的诊治

目的探讨开放性腋动脉损伤的诊治体会。方法1996年-2002年，共诊治12例开放性腋动脉损伤的患者，从受伤到入院时间为3～14h，入院时均处于不同程度的休克状态，桡动脉搏动减弱或消失。在积极抗休克治疗的同时，急诊进行清创、血管神经探查和修复术。其中行腋动脉修补5例，腋动脉直接吻合6例，自体静脉移植修复1例。结果伤后8h内腋动脉再通8例，8～16h内腋动脉再通4例，无病例发生截肢或死亡。术后伤口均Ⅰ期愈合，桡动脉搏动良好。结论对开放性腋动脉损伤早期诊断和及时手术探查是控制休克、获取良好疗效的关键。     

论舒适护理的美学要求

基于舒适护理是人在生理、心理、社会、精神上达到的最愉快的状态，提出舒适护理的美学要求体现在生理、心理、社会和精神舒适等方面。     

应用固定化D-氨基酸氧化酶转化头孢菌素C为7-ACA

D-氨基酸氧化酶（DAAO）是两步酶法催化头孢菌素C（CPC）生成7-氨基头孢霉烷酸（7-ACA）的重要酶之一。利用固定化DAAO催化CPC的转化液中，酮酸中间体随批次的增加逐渐减少，反应至第13批时，转化基本完全。当转化液pH由7．2升至7．6时，终止反应，转化率和收率分别达99．6％和93％。分次补加固定化DAAO，可连续转化132批。     

多潘立酮在增强结肠运动中的作用

Objective To observe the prokinetic effect of domperidone on colon and compare with that of mosapride and cisapride.Methods ① In viva experiment:forty rats were divided into control,domperidone,mosapride,and cisapride groups with 10 in each group.Stran gauges were planted both in proximal and distal colons and colonic motor activities were recoded in conscious rats.② In vitro experiment:the prokinetics effects of dopamine or dopamine combined with domperidone on the contraction of isolated rat colon strips were recorded by tone-transducers in the thermostatic muscle bath.Results In viva experiments:① in the interdigestive period of resting,activities of rhythimic phasic contraction were recoded in colon at conscious rats,and ② it had been showed that dornperidone significantly enhanced the contraction of colon in dose-dependent manner.Compared with control group,the mean contraction amplitude of proximal colon and distal colon increased by 84.61% ± 7.26% and 76.37 % ± 8.47% in domeridone group,respectively,which was higher than those in mosapride group (50.32%±8.16% and 45.13%±7.16%,respectively),but as same as those in cisapride group (92.55% ± 8.37% and 81.27% ± 9.95%,respectively).In vitro experiments:① perfusion of dopamin (40 mg/ml) could significantly decrease the contraction of isolated colon strip by 91.56% ± 10.24% in comparison with Krebs-Ringer solution,and ① domperidone could block the relaxant effect of dopamin on the isolated colon strip.Conclusions Domperidone can significantly enhance the colonic motor activities via antidopaminergic action.The effects of domperidone are similar as eisapride and greater than mosapride.     

A mild case of nesidioblastosis with diagnostic and therapeutic difficulty

A female infant with nesidioblastosis who showed mild clinical symptoms is reported. In this patient, insulin levels and insulin to glucose ratios (IRI/G) were often normal. Regular milk feedings supplemented with continuous glucose infusion (0.7-2 mg/kg per min) or oral glucose feedings (4.5 mg/kg per min) prevented hypoglycemia. As leucine-sensitivity was diagnosed at 2 months of age, she was started on diazoxide. This was, however, ineffective, and adverse effects appeared. Subtotal pancreatectomy (95%) was therefore attempted at 5 months of age, and persistent normoglycemia as well as normal growth and development followed up to 3 years after the operation. The pancreas showed characteristic signs of nesidioblastosis. The above clinical observation suggests that a patient with nesidioblastosis whose blood glucose level is easily controllable may develop an unexpected episode of hypoglycemia in the presence of a leucine sensitivity. In such a patient, diazoxide or, when it is of no avail, surgical intervention should promptly be instituted to prevent possible neurologic sequelae induced by hypoglycemia.     

系统性红斑狼疮患者血清中4种胶原成分变化的临床意义

目的：探讨活动性系统性红斑狼疮(SLE)患者血清中4种胶原成分的变化及临床意义。方法：采用放射免疫分析法对41例活动期SLE患者及其中伴有沸间质改变、肾脏改变、雷诺征或三者共存者血清Ⅲ型前胶原(PC—Ⅲ)、Ⅳ型肢原(Ⅳ—C)、透明质酸(HA)、层粘连蛋白(LN)进行到定。结果：4种胶原成分均明显高于对照组(P＜0．01或P＜0.05)。结论：4种胶原成分的变化在SLE的诊断、治疗、病情判定、评估预后中，特别是肝、肾、肺病变的监测中具有重要作用。     

纳洛酮与山莨菪碱、躯体刺激对内毒素休克狗血流动力学影响的比较

静脉给予纳洛酮2mg/kg期间可使内毒素休克狗的平均动脉压(MAP)、左心室收缩压(LVSP)及其一阶导数(±dp/dt max)和心力环面积(CFU)增加,但对肾血流量(RBF)、尿量及20h的存活率无明显影响。将本实验结果与山莨菪碱、躯体刺激效应进行比较,表明三者中山莨菪碱对休克动物的循环改善作用最明显。     

子宫内膜癌术前放疗对Bcl-2,bax表达的影响

目的探讨Bcl-2，bax与子宫内膜癌的相关性及术前放疗对其表达影响。方法从2002年10月-2006年10月在我科住院的子宫内膜癌患者中筛选符合纳入标准的病例50倒。取其刮宫内膜癌组织标本、放疗且术后内膜癌标本。分为放疗前组、放疗后组，采用免疫组织化学方法检测Bcl-2，bax的表达，并观察表达的变化。结果BcL-2表达放疗后（64．0％）较放疗前（82．0％）减弱，差异有显著性（P〈0．01）；bax蛋白表达放疗后（76．0％）较放疗前（62．0％）增强，差异有显著性（P〈0．01），结论①子宫内膜癌的发生过程中与癌基因及抑癌基因Bcl-2,bax有密切的关系。②子宫内膜癌患者放疗前后癌组织中Bcl-2，bax表达水平发生了明显的改变，放射治疗可能是通过诱导细胞凋亡起到抗肿瘤作用的。③子宫内膜癌为放射敏感性肿瘤。