有机磷中毒患者出现局部荨麻疹19例浅析

笔者在七年来的医护工作中,遇19例有机磷农药中毒患者,经静柱大剂量、高浓度阿托品及同时快速输液致注射局部出现荨麻疹,为引起同道的注意,兹分析如下。 临床资料 本组19例,男6例,女13例。年龄16～59岁,平均22岁。均为口服有机磷农药致重度中毒患者。治疗中均以阿托品定时静注抗毒,同时根据病情给予解磷定、20％甘露醇输液等治疗。在以每次20～50毫克(每小时     

Rotarex治疗股腘动脉支架内再狭窄的现状及展望

支架内再狭窄（ISR）是股腘动脉（FP）疾病介入治疗术后面临的一个重要临床问题。初次置入支架的FP-ISR发生率较高,并且反复的ISR往往需要多次后续手术治疗。前期的研究集中在球囊血管成形术、搭桥手术、覆膜支架、药物球囊、减容治疗,但最佳治疗方案仍有争议。近期的治疗方案已转向两种或多种方法的联合治疗。其中以Rotarex斑块切除术加减容为基础的联合治疗成为FP-ISR治疗的一种新选择。笔者就Rotarex联合治疗应用于FP-ISR的安全性和有效性进行分析,并讨论未来的前景。     

旋毛虫肌幼虫期外泌体的分离和小RNA鉴定

目的 分离纯化旋毛虫肌幼虫分泌的外泌体,并进行鉴定,为研究旋毛虫免疫逃逸机制提供新的线索。方法 采用超速离心法提取旋毛虫肌幼虫期外泌体,通过透射电子显微镜、纳米颗粒跟踪分析、免疫印记和小RNA测序对其进行鉴定。结果 旋毛虫肌幼虫期外泌体为有膜的泡状物,直径约80～200 nm,表达外泌体特异性标记蛋白CD63和Enolase,含1 266个已知的miRNA。结论 经形态、粒径及标记蛋白分析证实成功分离旋毛虫肌幼虫期外泌体,同时构建旋毛虫肌幼虫期外泌体的小RNA文库,鉴定出多种功能性小RNA,为深入研究旋毛虫肌幼虫期外泌体内小RNA分子的应用提供数据。     

华支睾吸虫成虫虫体与排泄-分泌物抗原在ELISA检测中的评价

目的:探讨华支睾吸虫成虫可溶性抗原和排泄-分泌物抗原ELISA检测的临床诊断价值。方法:分别以虫体可溶性抗原和排泄-分泌物抗原作为诊断抗原,采用间接ELISA检测方法检测感染者(来自流行区,粪便虫卵检测阳性)血清107份和健康人(来自非流行区,粪便虫卵检测阴性)血清50份,计算其敏感性、特异性和符合率,并进行两种诊断抗原间的统计学比较与评价。结果:可溶性抗原的敏感性为58.88%,特异性为98%,符合率为71.34%;排泄-分泌物抗原的敏感性为87.85%,特异性为100%,符合率为91.72%。经统计学分析,两者敏感性和符合率差异具有统计学意义(P<0.05)。特异性差异无统计学意义(P>0.05)。结论:作为诊断抗原,排泄-分泌物抗原优于可溶性抗原。排泄-分泌物抗原具有较高的敏感性与特异性,对于华支睾吸虫感染具有较高的诊断价值。     

长效托宁和氯磷定伍用治疗急性有机磷农药中毒的临床观察

为探讨救治急性有机磷农药中毒 ( AOPP)安全、有效、简便、易行的新方法 ,2 0 0 1年 2月至 2 0 0 2年 1 2月 ,我们选用长效托宁与氯磷定伍用治疗 AOPP,并与阿托品和氯磷定伍用者进行对照。现分析如下。1　资料与方法1 .1　临床资料　本组 1 66例 ,男 5 8例 ,女 1 0 8例 ;平均年龄 39.2岁。中毒药物为 1 60 5 4 3例 ,辛硫磷 2 0例 ,乐果 64例 ,氧化乐果 39例。参照《职业性急性有机磷农药中毒的诊断及处理原则》病情分级[1] ,中毒轻度45例 ,中度 5 7例 ,重度 64例。随机分为治疗组 85例及对照组 81例 ,两组临床资料无明显差异。1 .2　治…     

顺行针法治疗肱二头肌长头腱鞘炎57例

2010-07—2012-04,笔者运用顺行针法治疗肱二头肌长头腱鞘炎57例,结果如下。1资料与方法1.1一般资料本组57例,均为我院骨伤科门诊患者,男21例,女36例;年龄32～75岁,平均47.5岁;病程2个月～3年,平均4.5个月;其中左侧25例,右侧32例。1.2诊断标准依据《新编实用骨科学》[1]确诊。1.3治疗方法患者坐位,以0.3 mm×50 mm针灸针于肩关节前上方结节沟上端斜刺进针,此处多有明显压痛,     

不同剂量的曲安奈德玻璃体腔注射联合光凝治疗视网膜分支静脉阻塞合并黄斑水肿的疗效观察

目的比较不同剂量的曲安奈德(TA)行玻璃体腔注射联合光凝治疗视网膜分支静脉阻塞(BRVO)合并黄斑水肿的疗效。方法本研究纳入缺血型BRVO患者78例78眼,病程均3月,将所有患者随机分为2组,A组40例(40眼),行玻璃体腔注射TA 2 mg,B组38例(38眼)行玻璃体腔注射TA 4 mg,2组患者均于2周后行视网膜局部光凝及黄斑区格栅样光凝治疗。分析比较2组治疗前后眼前节、最佳矫正视力(BCVA)、光学相干断层扫描(OCT)的改变。结果 A组、B组治疗前后BCVA及黄斑中心凹厚度(CMT)均较治疗前明显改善(P均0.05)。A组与B组间治疗后BCVA及CMT差异无统计学意义(P0.05)。A组、B组治疗前眼压比较无统计学差异(P0.05)。治疗后2周A组眼压与治疗前比较差异无统计学意义(P0.05),B组眼压与治疗前比较明显升高(P0.05);治疗后2周,B组眼压较A组显著升高(P0.05)。治疗后1,3,6月B组眼压与A组比较差异无统计学意义(P0.05)。结论不同剂量的TA玻璃体腔注射联合光凝治疗BRVO合并黄斑水肿均可起到持久的疗效,小剂量的TA玻璃体腔注射明显减少TA所引起的并发症,效果更佳。     

白血病患者造血干细胞移植前单次全身照射的预后分析

Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.     

新型国产覆膜支架腔内修复肾下型腹主动脉瘤的临床对照研究：近-中期随访结果与单中心经验总结

BACKGROUND: Limited by the high financial burden of stent-graft and proof of evident-based medicine, the popularization of endovascular abdominal aortic aneurysm repair, a mini-invasive method, is impeded in China. In order to reduce costs, development of domestic-made stents is imperative, but the relative research is still rare. OBJECTIVE: To compare the effect of domestic-made stent-graft (Percutek) and Gore Excluder in the endovascular abdominal aortic aneurysm repair. METHODS: From January to November 2014, there were 32 male patients with infrarenal abdominal aortic aneurysm, aged 56-79 years old with mean age of (70.2±6.9) years, admitted in the Vascular Surgery Department of the Affiliated Hospital of Qingdao University. Clinical data were collected and retrospectively analyzed. There were 11 cases undergoing domestic-made stent-graft repair and 21 undergoing Gore Excluder repair. Aortic CT angiography was performed at 1 and 6 months after surgery, and every 6 months thereafter to evaluate the effect of the two modalities. RESULTS AND CONCLUSION: Domestic-made stent-grafts were successfully implanted into the 11 patients, and there were 1 case of late type I endoleak, 1 of type II endoleak, 1 of iliac occlusion and 1 of death after surgery. Totally 11 stent-graft trunks, 18 iliac stent-grafts, 1 Cuff, and 1 bare metal stent were implanted in the domestic-made stent-graft group (2.8 stents/case). Totally 21 patients were subjected to Gore Excluder repair with the success rate of 90%, and 2 cases of intraoperative I type endoleak (10%), 2 of postoperative I type endoleak and 2 of postoperative II type endoleak were observed. Totally 21 stent-graft trunks, 28 iliac stent-grafts and 3 Cuff were implanted in the Gore Excluder group (2.47 stents/case). These results suggest that the novel domestic-made stent-graft has achieved a satisfactory outcome in endovascular abdominal aortic aneurysm repair, showing no significant differences in related indicators with the Gore Excluder; however, the long-term outcomes still need to be further studied.     

Hd-OCT测量正常青少年黄斑部视网膜厚度的研究

目的 应用频域OCT（Hd-OCT）测量正常青少年黄斑部视网膜厚度范围。方法 选择2018年1月~2019年1月我院眼科门诊查体的青少年345例（528眼）,均行光学相干断层成像仪（Zeiss Hd-OCT）进行测量,比较不同性别和眼别黄斑区分区视网膜厚度（A1~A9）。结果 Hd-OCT扫描检查的345例青少年黄斑区的OCT扫描形态呈两边高,中间低的特点。不同性别相同区域视网膜厚度比较,差异无统计学意义（P＞0.05）。不同眼别相同区域视网膜厚度比较,差异无统计学差异（P＞0.05）。黄斑中心区域内（直径1 mm）最薄,黄斑的内环区域（直径1~3 mm）最厚,外环区域（直径3~6 mm）较内环区域（直径1~3 mm）薄。在直径为1~3 mm的内环区,黄斑区视网膜厚度值依次为A5＞A4＞A2＞A3。在直径为3~6 mm的外环区,黄斑区视网膜厚度值依次是A9＞A6＞A8＞A7。结论 Hd-OCT测量青少年黄斑区视网膜厚度有一定临床意义,可以建立青少年黄斑视网膜厚度的正常值数据库,为青少年黄斑发育的评估、黄斑疾病的定量检查、治疗后随访提供参考依据。