目的 探讨开放手术辅助经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗血液透析患者上肢动静脉内瘘Ⅰ型合并Ⅱ型狭窄的临床疗效.方法 90例已建立上肢自体动静脉内瘘(autogenous arteriovenous fistulas,AVF)并出现Ⅰ型合并Ⅱ型狭窄接受血透治疗患者,随机分为3组,每组30例,A组:超声引导下PTA,B组:数字减影血管造影(digital subtraction angiography,DSA)引导下PTA,C组:开放手术辅助PTA.比较3组手术成功率、手术前后血管内径、肱动脉血流量、AVF通畅率及术后并发症情况.结果 C组患者手术成功率分别高于A、B组,并发症分别低于A、B组,差异均有统计学意义(P＜0.05);术前3组患者的血管内径、肱动脉血流量比较差异无统计学意义(P＞0.05),术后即刻和术后1周C组分别大于A、B2组,差异有统计学意义(P＜0.05);C组术后6、12月时的AVF通畅率及稳定性分别高于A、B2组,差异有统计学意义(P＜0.05).结论 开放手术辅助经皮腔内血管成形术治疗血液透析患者上肢动静脉内瘘Ⅰ型合并Ⅱ型狭窄的临床疗效显著,能恢复内瘘功能,保证患者有效透析,且操作简单,创伤小,并发症少,可作为部分病例的首选治疗方案.

目的 探讨血清降钙素原(PCT)、白细胞介素6(IL-6)和C反应蛋白(CRP)在全身炎症反应综合征(SIRS)和脓毒血症鉴别诊断中的临床意义.方法 本研究以重症监护病房(ICU)患者为研究对象,共72例,其中脓毒血症30例,SIRS 42例,动态监测其血清PCT、IL-6和CRP水平变化情况.结果 脓毒血症患者血清CRP、PCT和IL-6的水平与SIRS患者相比均有统计学差异.患者在进入ICU后的最初24h内PCT水平＜2 μg/L,可排除脓毒血症(阴性预期值97％).反之,PCT水平＞10 μg/L,很可能为细菌感染引起的脓毒血症(阳性预期值91％).诊断正确率(DOR)提示:PCT能更准确地鉴别诊断SIRS与脓毒血症.结论 在脓毒血症和SIRS鉴别诊断时PCT优于CRP和IL-6.

病例男,24岁,萨尔瓦多籍军人,因充填体脱落并感觉不适来中国驻黎巴嫩维和二级医院口腔科就诊.术前检查:右上颌第一前磨牙充填体脱落,冠大部缺损,已穿髓,髓腔内大量腐质及少量食物残渣,牙髓无活力,叩诊(+),无松动.X片检查清晰显示三根,远颊根及腭根尖周低密度影像,诊断为慢性根尖周炎.征得患者同意,行对侧同名牙根尖片检查,同样为三根影像.处理:去净腐质,充分暴露髓腔,疏通清理根管,插诊断丝拍根尖片测得工作长度近颊、远颊、腭根三根均为20 mm.常规根管预备、清洗、消毒,行冷侧方加压充填,采用多次法完成根管治疗术,术后根尖片示恰填.因患者驻黎维和任务期行将结束,故行氧化锌丁香油水门汀暂封,嘱其回国后行桩冠修复.

目的 探讨Sysmex XT-4000i全自动血细胞分析仪与UF-1000i尿沉渣分析仪在测定脑脊液标本细胞计数中的应用.方法 121例脑脊液标本,分别用XT-4000i与UF-1000i测定其红细胞(RBC)、白细胞(WBC),并与手工计数结果相比较.结果 XT-4000i在RBC＞1 000×106/L、WBC＜1 600×106/L,UF-1000i在RBC＜4 000×106/L、WBC＜1 600×106/L时线性较好.脑脊液WBC数较低时XT-4000i结果更为准确(CV 1.1%～3.0%),RBC数较低时UF-1000i结果更为准确(CV 1.7%～4.9% ),RBC数较高时XT-4000i结果更为准确(CV 3.7%～5.0%).结论 联合应用XT-4000i和UF-1000i可对多数脑脊液标本RBC、WBC进行快速计数测定,有较高临床实用价值.

目的 探讨某三甲综合医院护理人力资源现状,探索合理使用护理人力资源,提高医院管理水平,降低医疗成本.方法 对该医院各普通科室、普通病区的注册护士进行问卷调查和访谈,然后对数据进行统计分析研究.结果 临床一线的注册护士主要为聘用护士,占到80.34％,他们的学历、职称普遍偏低,25岁以下的占到57.94％.结论 临床的主要注册护士学历、职称结构均偏低,年纪比较轻,从事护理工作时间较短,可以看出护士的基本素质比较低、流动性比较大,护理队伍的结构不合理、素质不高,需合理调整政策,改善不良状况.

Objective To investigate the clinical features of and gene mutations in a Chinese Han pedigree with piebaldism. Methods Clinical data were collected with informed consent from a pedigree with piebaldism, processed and documented. A clinical genetic analysis was conducted and pedigree chart was drawn. Genomic DNA was extracted from the peripheral blood of 14 patients and 40 unaffected individuals in the family as well as 50 unrelated human controls, and subjected to the amplification of 21 exons and flanking sequences of the KIT gene by PCR. Sequence analysis was performed by Mutation SurveyorTM. Results There were 73 members in the family, and of them, 14 were diagnosed with piebaldism according to typical clinical features. Piebaldism was inherited in an autosomal dominant pattern in this family. A heterozygous 4-base insertion mutation 1900insATGA in exon 13 of KIT gene was identified in all the 14 affected family members, which resulted in a frame-shift mutation at codon 634 and produced a premature translation termination codon. This mutation was undetected in either the unaffected family members or unrelated controls. Up to the time of this writing, this mutation had not been previously reported. Conclusion The novel mutation 1900insATGA in the KIT gene may be the cause of clinical phenotype of piebaldism in the family.

Objective To investigate the coagulation change and its clinical significance in patients with deep venous thrombosis(DVT).Methods The contents of aPTT,PT,TT,Fbg and INR were measured by American IL automatic analyzer(ACL TOP).Results ACL TOP was used to detect the aPTT,PT,TT,Fbg and INR in 92 patients with deep venous thrombosis and the results of aPTT,PT,TT,Fbg,INR were significantly abnormality.The contents of aPTT 26.6±2.93 s and Fbg 4.86±1.71 g/L in group of 38 pretherapy group were significantly difference than those of curing and normal controls.Conclusion To investigate the coagulation change of patients with DVT and prethrombotic state(PTS) decision and antithromb therapy were con-sanguineously correlative to the high-frequency.

Objective To explore the diagnostic valve of color Doppler ultrasonography in calf muscle venous diseases.Methods Seventy-eight patients with calf muscle veniplex diseases were examined by color Doppler ultrasonography in the study.Among the 78 cases,53 were dilation and valvular incompetence of calf muscle veniplex,and the other 25 cases were thromboses of calf muscle veniplex.Results Color Doppler ultrasnography could not only clearly demonstrate the size and position of calf muscle veniplex diseases,but also the lesion feature.Conclusion Color Doppler ultrasonography is a simple harmless diagnostic method of first choice to calf muscle veniplex diseases.

Objective To study the efficacy and safety of short-term oral administration of terbinafine combined with topical application of econazole in the treatment of tinea pedis.Methods An open-labelled, randomized, controlled and parallel clinical trial was carried out. A total of 124 patients with clinical and mycological diagnosis of tinea pedis were divided into two groups. The trial group was treated with oral terbinafine 250 mg daily, and 1% of econazole ointment twice daily, continuously for 7 days. The control group was treated with 1% of econazole ointment twice daily and oral vitamine C (as placebo) 0.1g daily. Efficacy and safety were compared. Results At the end of treatment, the clinical cure rate of the trial group was significantly lower than that of the control group (χ2 =23.03, P<0.01), and there were no significant differences in effective rate and mycological clearance rate between the two groups (χ2=0.33, P>0.05; χ2=0.03, P>0.05). Four weeks later after the end of treatment, the clinical cure rate, the effective rate and the mycological clearance rate of the trial group were significantly higher than that of the control group (χ2=17.21, P<0.01; χ2=14.56, P<0.01; χ2=23.03, P<0.01), and the recurrence rate was significantly lower than that of the control group (χ2=14.04, P<0.01). The incidence of adverse events in the trial group was not significantly different from that in the control group. Conclusion Short-term oral administration of terbinafine combined with topical application of econazole is safe, well tolerated and effective in the treatment of tinea pedis.

肠出血性大肠杆菌(Enterohemorrhagic E.col,EHEC)是一种重要的肠道病原微生物,感染后可引发婴幼儿腹泻、出血性结肠炎(hemorrhagicolitis, HC)、溶血性尿毒症综合征(hemolytic uremic syndrome, HUS)及血栓性血小板减少性紫癜(Thrombotic thrombocytopenic purpura, TTP),严重者可导致死亡.

Enterohemorrhagic Escherichia coli(EHEC) O157,an emerging pathogen,causes severe hemorrhagic colitis and the life-threatening extraintestinal complication of hemolytic uremic syndrome(HUS).The interplay between bacterium and ruminant host probably palys its main role in promoting infection and pathopoiesis.The adherence of EHEC on intestinal epithelial cells is believed to be the first step for developing these diseases.The adhesion is mainly mediated through the type Ⅲ secretion system(TTSS).EHEC employ a TTSS to deliver effector virulence proteins translocated intimin receptor(Tir) and Tir-cytoskeleton coupling protein(TccP) into host cells in order to produce ‘attaching and effacing’(A/E) lesions.Research in TTSS and translocated receptor protein of EHEC O157:H7 will help us to understand the nosoges’s of this disease.

目的利用麦默通抽吸旋切系统取得乳腺增生症活检组织进行的病理诊断资料,分析比较该组病变组织学与超声声像图的相应关系,并发现早期癌变倾向,选择合理治疗方案。方法应用Aucson公司Sequoia512型彩超诊断仪,发现可疑病变,在超声引导下应用麦默通旋切系统活检。结果术前超声提示乳腺小肿快的82例(乳腺腺瘤32例,乳腺增生症的41例,囊肿4例;导管扩张5例病人)。病理结果为纤维腺瘤27例伴非典型增生的4例;各型乳腺腺病48例伴不同程度非典型增生的9例;腺病伴导管潴留3例:导管扩张症3例;乳癌2例。结论超声引导麦默通抽吸旋切系统对小病灶穿刺准确、创伤小、操作安全等优点,彩色多普勒超声能直观地显示乳腺小病灶,并且对其二维声像并结合彩色多普勒血流特点及血流参数的分析有利于乳腺病变的定位和分辨病灶细微差别,从而多角度分析声像图与组织学的相应关系。

Objective To discuss the diagnosis value of Colored Doppler for emergent cases in department of gynecology and obstetrics.Methods The sonograms of 168 cases with various emergencies proved by operation and pathological examination in department of gynecology and obstetrics were collected and an analysis was made;follow-up was made to 48 cases receiving no surgical treatment so as to study the curative effect.Results Out of the 168 emergent cases proved by operation and pathological examination,there were 109 cases with ectopic pregnancy,11 cases with corpus luteum breaking,9 cases with the torsion of ovary cysts and polycystic ovary,29 cases with incomplete abortion and missed abortion,4 cases with trophoblastic tumor and 6 cases with hydrosalpinx.Out of the 46 cases receiving no surgical treatment,there were 19 cases with pelvic inflammation,5 cases with fetal distress,22 cases with extrauterine pregnancy,1 case with pregnancy combined with calculus of ureter.The follow-up showed changes in sonograms.Conclusions Ultrasound can provide basis for diagnosis in the emergent cases in department of gynecology and obstetrics;it is of certain clinical value in punctuation guided by ultrasound for those cases receiving expectant treatment and in follow-up.

目的利用麦墨通抽吸旋切系统取得乳腺增生症进行的病理资料,分析比较该组病变组织学与超声声像图的相应关系,并发现早期癌变倾向,选择合理治疗方案。方法应用Aucson公司Sequoia 512型彩超诊断仪,发现可疑病变,在超声引导下应用麦默通旋切系统活检。结果术前超声揭示乳腺腺瘤的32例,乳腺增生症的41例,囊肿4例,导管扩张的5例病人。病理结果如下:纤维腺瘤27例伴非典型增生的4例;各型乳腺腺病48例,伴不同程度非典型产生的9例;腺瘤伴导管渚留3例;导管扩张症3例;乳瘤2例。结论超声引导麦默通抽吸旋切系统对小病灶穿刺准确、创伤小、操作安全等优点,彩色多普勒超声能直观地显示乳腺小病灶,并且对其二维声像并结合彩色多普勒血流特点及血流参数的分析有利于乳腺病变的定位和分辨病灶细微差别,从而多角度分析声像图与组织学的相应关系。