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.     

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。     

神经电生理检测对多灶性运动神经病诊断价值的初步研究

目的 探讨神经电生理检查在多灶性运动神经病(MMN)中的诊断价值。方法对16例MMN患者及16名健康对照进行运动神经传导速度和感觉神经传导速度检查，记录刺激引出的复合肌肉动作电位的波幅、波宽、面积、位相和时限，进行对比分析，判定是否有运动神经传导阻滞(CB)或暂时性离散(TD)，并有选择性地进行常规肌电图检查。结果16例患者均可见有一根以上运动神经或至少一根运动神经的一个以上部位出现CB或CD。其中13例双上肢正中神经，尺神经出现CB，3例以正中神经、尺神经的远端出现CB首发，随病情进展出现下肢腓深神经CB。仅有2例感觉神经传导速度稍有减慢，波幅略有降低。16例患者神经受累区域以下所支配肌肉肌电图检查见有神经源性损害。结论MMN是一种以远端神经受累为主的不对称性周围神经病，神经电生理检查对诊断和鉴别诊断．MMN起重要作用，CB是MMN的主要神经电生理表现。     

Expression of differential nitric oxide synthase isoforms in human gastric mucosa infected with Helicobacter pylori

Objective: To study the relationship between nitric oxide synthase ( NOS) expression in human gastric mu-cosa and Helicobacter pylori (H. pylori) infection. Methods: Gastric mucosa samples were obtained from antrum of 33 patients received gastroendoscopy. H. pylori infection was confirmed by Giems staining and bacteria culture under mi-croaerophilic conditions. Expression of iNOS, eNOS and nitrotyrosine were detected by immunohistochemistry. Results: (1) The positive rate of H. pylori infection was 66. 7% (22/33) . (2) iNOS positive staining in inflammatory cells was detected in 77. 3% (17/22) of samples with H. pylori and 27. 3% (3/11) without H. pylori infection (P < 0.01). (3) eNOS expression in inflammatory cells was found in 77. 3% (17/22) of samples with H. pylori and 18.2% (2/11) without H. pylori infection ( P < 0. 01) . (4) Nitrotyrosine expression in inflammatory cells was observed in 59. 1% ( 13/22) of samples with H. pylori and 54.5%(6/11) without H. pylori infection (P>0.05). (5) Moderate a     

鼻内窥镜下咽鼓管导管注药治疗分泌性中耳炎

目的 :探讨鼻内窥镜下咽鼓管导管注药治疗分泌性中耳炎的方法。方法 :回顾分析鼻内窥镜直视下咽鼓管导管注药治疗分泌性中耳炎 36 0例、4 0 0耳的临床资料。结果 :治愈 2 5 2例 ,占 70 % ;好转 90例 ,占2 5 % ;总有效率 95 %。治疗前听力平均损失 4 5 .4± 8.2dBHL ,治疗后平均为 33.0± 8.2dBHL ,差异有高度显著性 (P <0 .0 1)。鼓室功能曲线治疗前B型 32 0耳 ,C型 80耳 ,治疗后转变为A型 30 3耳 ,占 75 .8%。结论 :此法操作简单 ,在直视下进行 ,患者痛苦小 ,不破坏鼓膜的正常生理结构 ,可改善分泌性中耳炎的咽鼓管功能 ,提高听力     

中国92例HIV/AIDS患者HIV-1 gp41 2F5和4E10中和抗体表位变异研究

目的 探讨92例HIV/AIDS患者HIV-1病毒近膜端(membrane proximal external re-gion,MPER)中和抗体2F5和4E10保守表位ELDKWA、NWFDIT氨基酸变异特点,为中国HIV/AIDS患者免疫治疗以及疫苗设计提供数据.方法 Nest-PCR扩增HIV-1 env区gp41段基因,核酸序列测定,翻译为氨基酸与HIV-1 Sequence Database HXB Ⅱ参考株中和抗体表位数据比对,分析2F5、4E10中和表位氨基酸变异情况.结果 92例HIV/AIDS患者HIV-1外膜蛋白env gp41段中和抗体2F5、4E10保守表位氨基酸均存在突变;2F5中和抗体表位主要有E662A(14.1%)、K665S(17.4%)、A667K(16.3%)突变;4E10中和抗体表位主要有N671S(13.0%)、D674S(3.3%)、T676S(16.3%)突变;CRF_B'C亚型与B'亚型的2F5和4E10表位氨基酸突变差异具有统计学意义(P<0-05);CRF_B'C与CRF01_AE亚型2F5表位突变差异具有统计学意义(P<0.05);B'亚型缓慢进展者、HIV感染者和AIDS患者的4E10表位氨基酸突变差异具有统计学意义(P<0.05).结论 92例HIV/AIDS患者HIV.1包膜蛋白env gp41段中和抗体2F5、4E10中和表位氨基酸存在突变,且变异多样化;不同亚型中和抗体保守表位氨基酸位点变异有差异;B'亚型4E10中和抗体表位变异可能与疾病进展有一定联系.     

C基因截短的HBV复制与包装

目的 探讨C基因截短型HBV变异体的复制与包装。方法 采用分子克隆、人工定点突变等技术构建C基因截短型HBV变异体质粒，用脂质体法转染HepG2细胞，提取细胞内及培养上清液中DNA分别进行Southem杂交，PCR及实时定量荧光PCR分析。结果 经DNA测序及酶切鉴定证实C基因截短型HBV质粒载体构建成功；C基因截短型HBV为复制缺损型，与辅助质粒共转染HepG2细胞，可在细胞内及培养上清液中检测到HBV各种DNA构型；DNA定量分析提示C基因截短型HBV的包装效率较野生型HBV提高3～40倍。结论 C基因截短型HBV变异体为复制缺损型，单独转染后不能在肝细胞内包装与复制，但在缺失包装信号ε的相应辅助病毒辅助下可有效复制并包装成子代病毒颗粒分泌到胞外，且包装效率大大提高。     

儿童拒绝上学问题的研究进展

拒绝上学(SR)是儿童常见的心理行为问题之一,主要表现为儿童不愿上学或对学习、学校不感兴趣,甚至完全拒绝去学校。目前越来越多研究表明大多数拒绝上学儿童伴有焦虑、抑郁等情绪问题,对其学业、家庭、人际关系等各方面产生广泛且负面的影响。本文主要综述儿童拒绝上学的定义、评估方法、病因、治疗及预后,有助于临床医生进一步探究拒绝上学儿童的病因并及时地进行评估与干预,帮助其改善临床结局,尽早重返校园。     

侵袭性牙周炎患者疱疹病毒感染和外周血病毒载量

目的分析不同严重程度侵袭性牙周炎(AGP)患者疱疹病毒(HV)感染情况和外周血病毒载量。方法选取2014年12月-2019年12月济南市市中区人民医院口腔科收治的2600例AGP患者,根据病变程度分为轻度AGP组(n=82)、中度AGP组(n=578)、重度AGP组(n=1940),以同期100名健康人群为对照组。入组后,检测龈沟液HV病毒感染情况和血浆单纯疱疹病毒1型(HSV-1)、EB病毒(EBV)、人类巨细胞病毒(HCMV)、人类疱疹病毒6型(HHV-6)载量、牙周特征和血炎症因子水平。结果AGP患者牙周菌斑指数(PLI)、探诊深度(PD)、附着丧失(AL)、出血指数(BI)高于对照组(P<0.05),HSV-1、EBV、HCMV、HHV-6感染率和病毒载量高于对照组(P<0.05),白细胞(WBC)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)高于对照组(P<0.05);随着AGP病情严重程度增加,HSV-1、EBV、HCMV、HHV-6感染率和病毒载量、PLI、PD、AL、BI、WBC、PCT、IL-6、TNF-α和CRP均增加(P<0.05)。结论HV感染率和病毒载量与AGP患者血清炎症因子水平和牙周特征随病情严重程度增加而升高。     

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas diagnosed by endoscopic ultrasonography-guided fine-needle aspiration

Undifferentiated carcinoma with osteoclast-like giant cells, also formerly known as osteoclast-like giantcell tumor, is a rare neoplasm of the pancreas and usually diagnosed after pancreatectomy. The presence of non-neoplastic osteoclast-like giant cells is the histological hallmark of this tumor and the diagnosis is usually not difficult on tissue sections. However there have been relatively few reports regarding the cytological features of this type of tumor in literatures.1-4 Here we.