目的 探讨脑室内注射瘦素后大鼠迷走复合体瘦素受体(Ob-R)表达的变化.方法 将SD大鼠24只随机分为对照组和瘦素干预1 h组(A组)、3 h组(B组)、5 h组(C组),每组6只.给药前1周行侧脑室置管,置管1周后无麻醉状态下对照组侧脑室注射生理盐水,A、B、C组侧脑室注射瘦素,剂量均为3.5 μg/μL.实验结束后取脑组织,用HE染色进行迷走复合体定位,用免疫组化方法测定Ob-R在迷走复合体的表达.结果 A、B、C组Ob-R阳性细胞数分别为(12.49±1.66)、(12.54±2.16)、(12.89±1.86)个,对照组阳性细胞数为(5.66±1.04)个;A、B、C组Ob-R阳性细胞光密度积分分别为(28.41±3.60)、(26.18±6.17)、(24.56±4.14)分,对照组为(16.02±2.06)分;与对照组比较,A、B、C组Ob-R阳性细胞数、阳性细胞光密度积分增多(P均 <0.05).A、B、C三组间Ob-R阳性细胞数、阳性细胞光密度积分比较差异无统计学意义(P均 >0.05).结论 瘦素中枢干预后可刺激迷走复合体上Ob-R的表达上调,瘦素刺激时间与Ob-R水平无关.

Objective To investigate the effects of leptin by means of lateral ventricle injection on proopiomelanocortin in dorsal vagal complexin of rats ,and to explore whether the leptin can adjust proopiomelanocortin in dorsal vagal complex like hypothalamic arcuate nucleus ,so as to find a possible path that leptin plays a role in vagal complex .Methods Thirty-six SD rats were randomly divided into experimental group and control group ,with 18 rats in each group,moreover,the experimental group was redivided into 3 subgroups according to the death time after injection (1h,3h,5h),with 6 rats in each subgroup. The stainless steel catheter was detained in lateral ventricle of rats for 1 week, then the rats were free to resume and domesticated,then the rats in experimental group were given leptin 3.5μg/μl by lateral ventricle injection ,however,the rats in control group were given 0.9% sodium chloride solution 3.5μg/μl.Finally the dorsal vagal complex was located by Hematoxylin-eosin dyeing,and the expression of proopiomelanocortin was detected .Results On 1,3,5h after giving leptin by intracerebroventricular injection , there were no significant differences in the positive expression cell count and positive expression cell integral optical density of proopiomelanocortin in dorsal vagal complex between experimental group and control group (P>0.05).Moreover there were no significant differences in the positive expression cell count and positive expression cell integral optical density of proopiomelanocortin in dorsal vagal complex among the three subgroups (P>0.05).Conclusion Injecting leptin into lateral ventricle of rats can not result in the increase of proopiomelanocortin in dorsal vagal complex .

Objective:To investigate the method of intracerebroventricular administration of conscious rats without anesthesia.Methods:15 femaleSD rats were selected.The tube was placed in the lateral ventricles by the self-made ventricular catheterization system.After the catheterization,the rats recovered freely for 1 week,and the rats were tamed for 5 to 10 minutes every day.From 8 to 10 days after operation,10 μL physiological saline was injected into the lateral ventricle every day without anesthesia.On the 1 1 th day rats were anesthetized after 10 μL intracerebroventricular injection of methylene blue,open all chest and the rats were sacrificed by formaldehydeperfusion though the ascending aorta cannulation.After that the brain tissues were took out.Results:All inner wall of ventricle were stained after 2％ methylene blue was poured in.There was no obvious bleeding or inflammation after hematoxylin and eosin staining (HE staining) in the brain,There was no cerebrospinal fluid in stainless steel conduit placed in the lateral ventricle catheter of 2 rats before insertion.Conclusion:The method of intracerebroventricular administration of rats without anesthesia is simple and feasible,and the rate of success is high.

<正>结核菌素试验是用来测定机体能否引起皮肤迟发型超敏反应的一种试验,以判断机体对结核分枝杆菌有无免疫力,广泛应用于结核病流行病学调查、卡介苗接种、化学预防对象的筛选、临床医学诊断与鉴别诊断等领域。我们在此探

[目的]观察肿瘤患者颈内静脉留置导管期间常见问题,分析发生原因及探究处理对策.[方法]对2008年1月至2010年12月肿瘤放化疗科210例颈内静脉留置导管的肿瘤患者并发症情况及处理措施进行记录观察,并进行回顾性总结.[结果]48例出现了与置管相关的异常情况.导管完全脱出20例,不完全脱出6例,位居不良反应第一位,经过严格消毒处理后回送不完全脱出导管用至患者治疗结束拔出;导管堵塞12例,位居不良反应第二位,经尿激酶溶栓后有10例再通;出血及皮下血肿5例,位居不良反应第三位.经间歇性冰敷减少了出血,48 h后热敷促进血肿吸收.穿刺局部感染3例,菌血症1例,肝素帽内液感染1例,均拔管及应用抗生素治疗痊愈.[结论]肿瘤患者以颈内静脉置管方式给药在给医患带来便利的同时与置管及导管留置相关的并发症问题不可小视,因此导管维护技术的改进与提高永远是护理工作的重点.

人类感染结核分枝杆菌后,产生免疫力的同时也会发生迟发型超敏反应.将一定量的结核菌素注入皮内,如受试者曾感染结核分枝杆菌,则在注射部位出现迟发型超敏反应炎症,判为阳性,未感染结核分枝杆菌的则为阴性.此法可用于检测可疑患者是否曾感染过结核分枝杆菌,接种卡介苗(BCG)后是否阳转以及检测机体细胞免疫功能.

Objective To study the correlation of the results between two kinds of concentrations tuberculin tests and maximum reduce the vaccine inoculum size.Method The concentration of the test liquid of bacillus calmette Guerin-purified protein derivative(BCG-PPD)is 5 IU/ 0.1 mL.The concentration of the dilution is 2.5 IU/0.1 mL,which was diluted by physiological Saline.Take intradermic injection of the test liquid and the dilution in the left and right anti-brachial flexor aspect of 103 patients hospitalized respectively,and observe test consequence after 72 hours.Result The induration diameters were very approximate between two groups after 72 hours by correlation analysis(r=0.987 P=0.000).The negative and positive findings were completely unification between the two groups,Chi-square criterion χ2=0.000(P=1.000).There was no significant difference for classification results between two groups(P>0.05).Conclusion The positive degree of dilution group increased along with the degree of positive test group increasing.The test results of the two groups was unanimously.

目的 探讨两种浓度结核菌素试验结果的相关性,以最大限度减少疫苗接种量.方法 应用卡介菌纯蛋白衍生物(BCG-PPD)试验液度为5 IU/0.1 ml与稀释液(用生理盐水稀释,浓度为2.5 IU/0.1 ml,对79例住院患者进行左右两侧前臂曲侧皮内注射,分别于72 h观察结果.结果 两种浓度结核菌素试验72 h硬结直径非常接近:相关分析r=0.978,P=0.000;两种浓度阴性、阳性结果完全一致,相关性卡方检验:X2=0.000,P=1.000;两种浓度结果分级,一致性检验.KaPPa=0.925,差异无显著意义.结论 稀释组的阳性程度随试验组阳性程度的增加而增加,两组试验结果基本一致.

OBJECTIVE:To investigate how smoking was affecting the prevalence of sleep apnea/ hypopnea syndrome (SAHS) among adults aged over 30 years in Chengde city of Hebei province.METHODS:1168 subjects, over 30 years of age were derived from a random sample from a community-based population in Shuangqiao district of Chengde city. All subjects responded to a questionnaire at their own houses regarding their habits of snoring and smoking. 1168 subjects (95.2%) answered the questions satisfactorily.RESULTS:(1) Among the smoking groups, the prevalence of snoring was 69.09%, higher than that in the nonsmoking groups 45.07% (P = 0.000). (2) In males, the smoking group had a higher prevalence (69.72%) of snoring than in the nonsmoking group (60.80%, P = 0.033). (3) Females in the smoking group had a higher prevalence of snoring (61.80%) than in the nonsmoking group (39.70%, P = 0.011). (4) The prevalence of snoring in males (60.80%) was significantly higher than that in females (39.70%, P = 0.000). (5) The prevalence (69.72%) of snoring in smoking males was similar to that in smoking females (61.80%, P = 0.336). (6) Data from logistic regression analysis indicated that smoking was one of the factors affecting snoring. (7) According to the degree of snoring, 127 moderate and severe snorers were measured by portable PSG for a whole night and the prevalence of SAHS was estimated. According to the AHI > or = 5 and the ESS > or = 9 cutoff-points, the prevalence rates of SAHS in smoking groups were both significantly higher than that in nonsmoking groups (P < 0.001).CONCLUSION:Smoking and snoring among adults aged over 30 years had correlation in our city.

目的:探讨我院产超广谱β-内酰胺酶(extend Spectrum beta-Lactamases,ESBLs)大肠埃希氏菌和肺炎克雷伯菌院内感染的危险因素.方法:收集我院2002年1月-2003年10月院内感染产ESBLs大肠埃希菌和肺炎克雷伯菌住院患者病历42例,对照病历46例;采用卡方检验单因素及非条件多因素Logistic回归分析产ESBLs大肠埃希菌和肺炎克雷伯菌感染的危险因素.结果:产ESBLs大肠埃希菌和肺炎克雷伯菌院内感染的独立危险因素是:消化道插管,前期应用三代头孢菌素,前期应用奎诺酮类药物.结论:对存在以上危险因素的患者,应监测大肠埃希菌和肺炎克雷伯菌ESBLs的产生情况,积极采取相应的消毒隔离措施,合理应用抗菌素.

[Objective] To evaluate the role of L-selectin in the development of airway inflammation in chronic obstructive pulmonary disease(COPD)and its clinical significance. [Methods] The positive expression rates of L-selectin in peripheral blood leukocyte were quantitatively analyzed by flow cytometry in 38 case of COPD (observe group) and 30 healthy subjects (control group), PaO2, PaCO2 and FEV1% were compared. [Results] Compared with control group, the expression rates of L-selectin in observe group were significantly reduced (P0.01). The expression rate of L-selectin of granulocyte have positive correlation with FEV1% and PaO2 (r=0.602,r=0.671, P0.01), and negative correlation with PaCO2 (r=-0.427, P0.01). [Conclusion] L-selectin participates in development of airway inflammation in COPD, and examination of L-selectin of peripheral blood leukocyte can estimate the degree and prognosis of COPD.

目的探讨结核菌素试验结果不同时间判定的相关性.方法对呼吸科107例住院患者常规进行结核菌素试验后,分别于24 h、48 h、72 h观察记录结果,与判定标准对比.结果 24 h与48 h、72 h比较P<0.01,差异有显著意义;48 h与72 h比较P>0.05,差异无显著意义.结论 24 h判定结果不能取代72 h,而48 h的判定结果在某些情况下可作为72 h判定结果的参考.

Objective To study co-relationship among the results of tuberculin test measured at different time. Method Observe and compare the results of tuberculin test from 107 patients in 24 hours, 48 hours, 72 hours with the standardized results. Result There was significant difference in tuberculin test between 24 hours results, 48 hours results and 72 hours results (P<0. 01). There was no significant difference in tuberculin test between 48 hours results and 72 hours results (P<0. 01). Conclusion The results measured by 24 hours couldn't replaced by 72 hours, but could do by 48 hours in a sense.

[病例1]患者女,55岁,主因发作性胸部不适3个月入院.患者3个月前体力活动时出现心前区不适,自觉乏力,无明显咳嗽咳痰,近3个月颜面肿胀,体重增加约15公斤,入院15天后上述症状加重,伴咳嗽咳痰.

血糖测定对于糖尿病的诊断和治疗监控有很重要的临床意义,采静脉血用生化分析仪检测血糖是公认的测定方法,但此方法采血量较多,测试时间较长,不便于一日多次监测,不适于病人快速等结果的要求.近年来,ADVANTAGE型血糖仪以其快速、简便的特点受到了医护人员的欢迎,很多临床科室都已配备.

慢性阻塞性肺疾病(COPD)是一组包括慢性支气管炎、阻塞性肺气肿、晚期支气管哮喘的慢性肺部疾病.反复感染、气道痉挛、呼吸肌疲劳、痰粘稠不易咳出,是其临床主要表现,严重影响患者的生活质量.

尿潴留是指膀胱内充满尿液而不能自行排出,膀胱容量可增大至3 000 mL～4 000mL,使下腹部呈膨隆状态.清醒病人主诉下腹部胀痛、憋尿感;意识模糊病人呈现躁动不安、下腹部叩诊实音.留置导尿是解决尿潴留的有效手段,按传统理论方法,留置导尿首次放尿量不超过1 000 mL,以防腹压骤降[1].临床工作中发现,肝性脑病尿潴留病人首次放尿500 mL,则第2次放尿就出现肉眼血尿,须行止血治疗2 d～3 d后肉眼血尿才消失.现对我科肝性脑病尿潴留留置导尿病人首次放尿量进行观察,采用首次缓慢放尿100mL～200mL,并间歇放尿,效果满意,结果如下.

目的分析168例糖尿病酮症(DKA)诱因,针对性的做好糖尿病(DM)患者健康教育.方法回顾性分析2000年1月至2003年10月在我科住院的165例DKA诱因.结果DM知识缺乏、保健知识缺乏、自我管理能力弱是导致DKA发生的主要诱因.结论DM患者的健康教育是DM治疗的重要组成部分,是减少酮症再发的重要举措.

患者男性,73岁,因咳嗽、咳痰、喘息5年加重20天入院,冬季发作,持续时间逐年延长,无咯血.无关节炎病史.曾于当地诊为慢性支气管炎.1年前因症状复发于当地检查胸部CT发现左主支气管及左下叶支气管狭窄,来我院做纤维支气管镜检查见左下叶支气管开口处粘膜聚拢,纤维支气管镜不能通过,心脏彩超提示二尖瓣、主动脉瓣狭窄兼关闭不全,三尖瓣关闭不全,作放射性核素显象提示左肺上叶通气灌注不良,复查胸部CT见左主支气管狭窄,管壁凹陷合并钙化,隆突下淋巴结不大,诊断为风湿性心脏联合瓣膜病,呼吸道淀粉样变性的可能性大,病人出院.