血管细胞黏附分子-1和P-选择素对急性冠脉综合征的预测价值

目的研究血清可溶性血管细胞黏附分子-1、P-选择素水平在急性冠状动脉综合征中的特点，探讨其对急性冠脉综合征的预测价值。方法用酶联免疫吸附法检测21例急性心肌梗死（AMI），23例不稳定型心绞痛，22例稳定型心绞痛（SAP）和20例健康对照者血清sVCAM-1、sP-选择素水平。结果ACS患者血清（UAP）sVCAM-1、sP-选择素水平均高于非ACS患者，AMI患者血清sVCAM-1浓度及sP-选择素水平较UAP患者升高（均P〈0．05）。以x±2s为临界值联合检测ACS的灵敏度为73．4％，特异度为84．2％。结论ACS患者血清VCAM-1、P-选择素水平升高，提示与ACS的发生有关，是动脉粥样硬化斑块不稳定的标志，可以作为ACS的预测指标。     

肾综合征出血热患者血清胱抑素C的动态变化及临床意义

目的：探讨血清胱抑素C（Cys-C）在肾综合征出血热（HFRS）各期的动态变化及临床意义。方法 HFRS患者28例为观察组,分别测定发热期、低血压休克期、少尿期、多尿期血清肌酐（Crea）及Cys-C含量,同时选取28例健康体检者为对照组,观察Crea及Cys-C的动态变化。结果 Crea在低血压休克期、少尿期、多尿期较对照组有显著升高,差异具有统计学意义（P〈0.05）,而在发热期及恢复期无明显升高;Cys-C在临床各期均显著增高,差异具有统计学意义（P〈0.05）。结论与Crea相比, Cys-C在HFRS发病期升高更早,恢复期下降更慢,为监测肾综合征出血热患者肾功能变化的灵敏标志物。     

肾综合征出血热患者血清β2微球蛋白的变化及其临床意义

目的：为探讨肾综合征出血热（HFRS）损害的敏感指标。方法：采用放免法检测50例HFRS患者发热期,少尿期、多尿期血清β_2微球蛋白（Sβ_2m）,同期测定血尿素氮（BUN）和肌酐（Cr）,与50例健康献血员作对照。结果：HFRS患者发热期、少尿期、多尿期血清Sβ_2m的含量分别为：4．76±1．32mg/L、10.82±6.48mg／L、3．85±1．42mg/L,对照组血清Sβ_2m含量为1．78±0．60mg/L,与HFRS发热期患者相比较有极显著性差异（P＜0．001）,且血清Sβ_2m与BUN和Cr的变化成正相关。结论：血清Sβ_2m可作为判断病情和早期评估预后的重要指标     

创伤患者早期血清可溶性E-选择素水平及其临床意义

目的：探讨血清可溶性E－选择素（sE-selectin简称血清sE-选择素）在创伤早期的变化及其临床意义。方法：应用双抗体夹心ELISA法分别检测30例创伤患者及20例健康人血清sE-选择素水平。结果：创伤早期血清sE-选择素水平明显高于正常对照（P＜0．01）；重症组血清sE-选择素水平明显高于轻症组（P＜0．01）。结论：初步研究表明血清sE-选择素水平在创伤后升高，并与创伤严重程度密切相关，检测血清sE-选择素水平对创伤病情判断有一定的参考价值。     

川芎嗪对哮喘患儿外周血P选择素的调节作用

目的观察川芎嗪对哮喘患儿外周血P选择素的调节作用。方法选择40例哮喘急性发作期患儿,随机分为哮喘治疗组和哮喘对照组。哮喘治疗组在哮喘对照组常规治疗的基础上加用川芎嗪治疗。双抗体夹心ELISA法检测两组患者治疗前后血清P选择素水平的变化。结果哮喘治疗组治疗后血清P选择素较治疗前明显下降（P〈0．01）。而哮喘对照组治疗前后血清P选择素水平比较无统计学差异（P〉0．05）。哮喘治疗组的临床有效率明显高于哮喘对照组（P〈0．05）。结论川芎嗪治疗哮喘的临床疗效确切,其作用机制与抑制血清P选择素的作用有关。     

腹膜透析患者瘦素水平与营养状况的关系

目的了解腹膜透析（CAPD）患者血清瘦素、炎症因子与营养状况的关系。方法以30例CAPD患者和30例健康者为研究对象，采用ELISA法测血清瘦素水平，同时检测C反应蛋白（CRP）、IL-6、TNF—α、胰岛素、白蛋白（Alb）水平，并用营养评估法（SGA）评估营养状况。结果（1）CAPD患者血清瘦素和胰岛素水平明显高于正常人（P〈0．01）。（2）CAPD患者血清CRP、IL-6和TNF-α水平明显高于正常人（P〈0．01）。（3）CAPD患者的营养状况较正常人差，Alb水平明显低于正常人（P〈0．01）。（4）CAPD患者血清瘦素和胰岛素水平问均呈明显正相关（P〈0．01），炎症因子与Alb之间均呈显著负相关（P〈0．01）。炎症因子之间呈明显正相关（P〈0．01）。结论CAPD患者血清瘦素、炎症因子均与营养状况关系密切。     

肺炎患者血清可溶性E、P选择素的变化及意义

目的探讨社区获得性肺炎(community acquired pheumonia,CAP)患者血清可溶性E、P选择素(soluble E-selectin,sE-选择素,soluble P-selectin,sP-选择素)的变化及意义。方法使用ELISA双抗体夹心法动态检测25例CAP患者治疗前后及10例健康对照组血清sE-选择素、sP-选择素的水平。结果肺炎组治疗前sE-选择素水平、sP-选择素水平明显高于对照组(tsE=3.307,P<0.01;tsP=3.995,P<0.01);肺炎组治疗后,sE-选择素、sP-选择素水平均较治疗前有明显下降(tsE=5.039,P<0.01;tsP=5.707,P<0.01);治疗后两者水平与对照组相比差异均无统计学意义(tsE=1.146,P=0.26;tsP=0.070,P=0.994)。sE-选择素水平与中性粒细胞计数呈正相关(r=0.598,P<0.01),而sP-选择素与中性粒细胞计数无明显相关(r=0.029,P=0.804)。结论sE-选择素、sP-选择素参与肺炎的发生发展过程,动态检测血清sE-选择素、sP-选择素水平有助于判断CAP病情及转归。     

短暂性脑缺血发作与P-选择素和氧化型低密度脂蛋白

目的探讨短暂性脑缺血发作与P-选择素（P-selectin）和氧化型低密度脂蛋白（OX-LDL）的关系。方法测定52例短暂性脑缺血发作患者发病24h内血浆P-选择素和ox-LDL的水平,并与32例健康正常人对照。结果短暂性脑缺血发作患者P-选择素和ox-LDL水平明显高于对照组（P〈0．01）;p-选择素水平与ox-LDL水平呈正相关（P〈0．01）;短暂性脑缺血发作伴梗死灶者P-选择素和ox-LDL水平高于无梗死灶者（P〈0．05）。结论P-选择素和ox-LDL在短暂性脑缺血发作的发生发展中起一定作用。     

急性脑梗死患者血清白细胞介素-6、白细胞介素-8及脂联素水平变化及意义

目的探讨急性脑梗死（ACI）患者的血清IL-6、IL-8及脂联素水平变化。方法采用ELISA法检测98例急性脑梗死患者血清白细胞介素6（IL-6）、白细胞介素8（IL-8）及脂联素含量,并与98例健康对照组比较分析。结果急性脑梗死组血清IL-6、IL-8水平明显升高,而脂联素水平则显著降低,两组差异均有统计学意义（均P〈0．01）;血清IL-6和IL-8水平随梗死体积增大和神经功能缺损程度加重而升高,脂联素水平则降低;血清脂联素水平与血清IL-6、IL-8水平呈显著负相关（r=-0．733,r=-0．715;均P〈0．05）,IL-6与IL-8呈显著正相关（r=0．830,P〈0．01）。结论血清IL-6、IL-8及脂联素水平反映了病情轻重及神经功能缺损程度,与脑梗死的临床变化有较密切关系。     

光量子血疗对寻常型银屑病患者血清TNF—α、IL-6及IL-8的影响

目的观察光量子血疗治疗寻常型银屑病的疗效及对寻常型银屑病患者血清中细胞因子水平的影响。方法光量子血疗治疗前后对银屑病患者皮损进行PASI评分。采用ELISA法检测银屑病患者治疗前后和正常对照者血清中TNF-α、IL-6及IL-8的表达水平变化。结果光量子血疗治疗110例寻常型银屑病患者有效率为80．35％,治疗后PASI评分显著下降（P〈0．01）,患者血清中TNF-α、IL-6及IL-8水平明显高于正常对照组（P〈0．01）,治疗后其表达水平较治疗前明显下降（P〈0．01）,患者体内TNF-α、IL-6及IL-8表达水平与PASI积分呈正相关（P〈0．01）。结论光量子血疗对寻常型银屑病有良好的治疗作用,血清TNF-α、IL-6及IL-8在银屑病的发病中有重要意义。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

A fetus with meckel-gruber syndrome associated with isomerism

Abstract. Meckel-Gruber syndrome (MKS) is an autosomal recessive lethal malformation. As far as we know, the rate of incidence for the syndrome is 0.02 per 10,000 births. It is estimated that Meckel-Gruber syndrome accounts for 5% of all neural tube defects in Finland. Objective. The aim of this study is to present a case of a fetus with Meckel-Gruber syndrome associated with complete left isomerism. Method. The fetus was obtained after medical interruption of the pregnancy during the fifteenth gestational week. The mother was 36 years old and in a consanguineous marriage. The antenatal ultrasound examination revealed a polymalformative syndrome, leading to a postmortem examination. The fetopathological study of the fetus was conducted at the Centre for Maternity and Neonatology, Tunis, Tunisia, in 2008. Results. The female fetus had a significantly deformed ballooning abdomen, pes equinovarus, flexion of the wrist and a total posterior cleft palate. The central nervous system abnormalities were occipital encephalocele, cystic dilatation of the fourth ventricle, agenesis of corpus callosum and hydrocephalus. The study of the internal organs found dextrocardia, irregular lobulation of the lungs, left isomerism, and polysplenia. The microscopic examination revealed bilateral cystic dilation of the kidneys, fibrous proliferation of the liver and ectasic dilatation of the billiary ducts, representing a ductal plate malformation of the liver. Conclusion. The case is diagnosed with Meckel-Gruber syndrome associated with complete left isomerism, cleft palate and possibly Dandy-Walker syndrome.