做最强的自己，与子征战兮路漫长

zhoushengyuanlyUID: 2246479

HYPD
这到底是谁发明的;d:

zhangheng1020UID: 2130513

I don't know

3 days left!

zhangheng1020UID: 2130513

Methicillin-resistant Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus (MRSA), also known as oxacillin-resistant Staphylococcus aureus (ORSA), multiple-resistant Staphylococcus aureus, CA-MRSA (community-acquired MRSA) and HA-MRSA (hospital-acquired MRSA),[1] is a biological agent responsible for difficult-to-treat infections in humans. (MSSA is Methicillin-susceptible Staphylococcus aureus.) MRSA is a variation of Staphylococcus aureus, a common bacterium, which has evolved the ability to survive treatment with beta-lactam antibiotics, including penicillin and methicillin.[2] The organism is especially troublesome in hospital-acquired (nosocomial) infections. In hospitals, patients may be found who have open wounds and weakened immune systems and who are therefore at great risk for infection. Hospital staff who do not follow proper sanitary procedures may inadvertently transfer bacterial colonies from patient to patient.

TreatmentCA-MRSA often results in abscess formation that requires incision and drainage. Before the spread of MRSA into the community, abscesses were not considered contagious because it was assumed that infection required violation of skin integrity and the introduction of staphylococci from normal skin colonization. However, newly emerging CA-MRSA is transmissible (similar, but with very important differences) from hospital-acquired MRSA. CA-MRSA is less likely than other forms of MRSA to cause cellulitis.
Both CA-MRSA and HA-MRSA are resistant to traditional anti-staphylococcal beta-lactam antibiotics such as cephalexin. CA-MRSA has a greater spectrum of antimicrobial susceptibility, including to sulfa drugs, tetracyclines, and clindamycin. HA-MRSA is resistant even to these antibiotics and often is susceptible only to vancomycin. Newer drugs, such as linezolid (belonging to the newer oxazolidinones class), may be effective against both CA-MRSA and HA-MRSA.
Vancomycin and teicoplanin are glycopeptide antibiotics used to treat MRSA infections.[18] Teicoplanin is a structural congener of vancomycin that has a similar activity spectrum but a longer half-life (t½).[19] Because the oral absorption of vancomycin and teicoplanin is very low, these agents must be administered intravenously to control systemic infections.[20] Treatment of MRSA infection with vancomyin can be complicated due to its inconvenient route of administration. Moreover, many clinicians believe that the efficacy of vancomycin against MRSA is inferior to that of anti-staphylococcal beta-lactam antibiotics against MSSA.[21][22]
Several newly discovered strains of MRSA show antibiotic resistance even to vancomycin and teicoplanin. These new evolutions of the MRSA bacterium have dubbed vancomycin intermediate-resistant Staphylococcus aureus (VISA).[23][24] Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are used to treat more severe infections that do not respond to glycopeptides such as vancomycin.[25] MRSA infections can be treated with oral agents, including linezolid, rifampicin+fusidic acid, rifampicin+fluoroquinolone, pristinamycin, co-trimoxazole (trimethoprim-sulfamethoxazole), doxycycline or minocycline, and clindamycin.[26]
On 18 May 2006, a team of researchers from Merck Pharmaceuticals reported in Nature that they had discovered an entirely new type of antibiotic, called platensimycin, and had demonstrated its successful use against MRSA.[27][28]
An entirely different and promising approach is phage therapy (e.g., at the Tbilisi Institute in Georgia), which has a reported efficacy against up to 95% of tested Staphylococcus isolates.[29]
It has been reported that maggot therapy to treat MRSA infection has been successful. Studies in diabetic patients reported significantly shorter treatment times than those achieved with standard treatments.[30][31][32]

zhangheng1020UID: 2130513

Alanine (abbreviated as Ala or A)[1] is an α-amino acid with the chemical formula HO2CCH(NH2)CH3. The L-isomer is one of the 20 proteinogenic amino acids, i.e. the building blocks of proteins. Its codons are GCU, GCC, GCA, and GCG. It is classified as a nonpolar amino acid. L-alanine is second only to leucine, accounting for 7.8% of the primary structure in a sample of 1,150 proteins.[2] D-alanine occurs in bacterial cell walls and in some peptide antibiotics.



Lactic acid (IUPAC systematic name: 2-hydroxypropanoic acid), also known as milk acid, is a chemical compound that plays a role in several biochemical processes. It was first isolated in 1780 by a Swedish chemist, Carl Wilhelm Scheele, and is a carboxylic acid with a chemical formula of C3H6O3. It has a hydroxyl group adjacent to the carboxyl group, making it an alpha hydroxy acid (AHA). In solution, it can lose a proton from the acidic group, producing the lactate ion CH3CH(OH)COO−. It is miscible with water or ethanol, and is hygroscopic.

Lactic acid is chiral and has two optical isomers. One is known as L-(+)-lactic acid or (S)-lactic acid and the other, its mirror image, is D-(-)-lactic acid or (R)-lactic acid. L-(+)-Lactic acid is the biologically important isomer.

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Pyruvate dehydrogenase (E1) is the first component enzyme of pyruvate dehydrogenase complex (PDC). EC 1.2.4.1.

[ 本帖最后由 zhangheng1020 于 2007-10-22 10:44 编辑 ]

zhangheng1020UID: 2130513

causesIt is an inherited disorder which usually affects infants, but in rare cases, teenagers and adults, as well. In the case of the disease, mutations in mitochondrial DNA cause degradation of motor skills and eventually death.
Mitochondria are some of the most important organelles in animal cells as they provide energy for the cell's function. In humans, their primary function is to convert the potential energy of glucose and fatty acids into that of adenosine triphosphate. The energy in the ATP is then used to carry out virtually all of the cell's metabolic functions. Mitochondria are also unique in that they carry their own type of DNA, mitochondrial DNA, or mtDNA. The information stored in the mtDNA is used in the creation of new mitochondria.
When improper mutations of the mtDNA cause the mitochondria to fail to function properly, a person is at risk for number of disorders, including Leigh's disease. In the case of Leigh's Disease, crucial cells in the brain stem have mutated mtDNA which creates poorly functioning mitochondria. This causes a chronic lack of energy in the cells, which in turn affects the central nervous system and inhibits an individual's motor skills.
[edit] PresentationThe disease is most noted for its degradation in a person’s ability to control their movements. Other symptoms include loss of appetite, vomiting, irritability, continuous crying (in infants), and seizures. As the disease progresses in adults, it may also cause general weakness, kidney failure and heart problems.
[edit] TreatmentIt is a very rare disorder which affects only a small portion of the population, and as of yet, there is no cure for Leigh's disease. It usually affects infants under 2 years of age, but, in rarer cases, teenagers and adults as well. It is currently treated with Vitamin B1, or thiamin, but even with treatment, infants rarely live longer than two or three years after the onset of the disease. In cases of older people, the disease takes longer, but is still almost always fatal.
[edit] X-linked Leigh's diseaseThere is another form of this disease called the X-linked Leigh's disease which is not a mutation in the oxidative phosphorylation enzymes (which are both on the mtDNA and the nuclear DNA). The X-linked Leigh's disease is a mutation of a gene encoding part of the pyruvate dehydrogenase complex, located on the X chromosome.

zhangheng1020UID: 2130513

http://www.dxy.cn/bbs/actions/archive/post/423929_1.html
http://www.dxy.cn/bbs/post/view? ... 2&age=0#5262273
http://www.dxy.cn/bbs/actions/archive/post/7532674_2.html?tpg=1


others
http://www.dxy.cn/bbs/post/view? ... 2&age=0#4884318

zhangheng1020UID: 2130513

http://www.ecfmg.org/2008ib/ibcert.html
http://www.ecfmg.org/2008ib/ibfaq.html
https://iwa2.ecfmg.org/overview.asp

arthur_bUID: 181606

https://bbs.gter.net/viewthre ... ;highlight=%2Bsinge

zhangheng1020UID: 2130513

Symbols And Units

1.        Force is measured in Newton (N). One Newton (kgm s-2) is the force required to accelerate a mass of 1 kg with an acceleration of 1 m s-2. The acceleration due to gravity is generally accepted as g or G= 9.8067 or 9.807 m s-2.
2.        Joule established already in 1848 that mechanical work and heat ener­gy were interchangeable. The commonly used unit of energy is the calorie (cal), which is the energy, required to raise the temperature of 1 gram (g) of water from 14.5 to 15.5oC. Work is force times distance, and it is measured as Newton-meter or Joule (J). The Joules equivalent has been determined to be 4.187 J ca­l-1.
3.        Finally, work-rate or power is calculated as work­ per second (s). The power unit 1 W equals 1 J s-1.
4.        Pressure is measured as force per area unit that is inN m-2 or Pascal.
In the gravity field of the earth G or g equals 9.807 m s-2. Blood and sea water has a relative density of 1033 kg m-3. A 10 m high sea water column resting on one square m, corresponds to the following pressure: (10 m × 1033 kg m-3 × 9.807 m s-2) =
101 306.3 (kg m s-2) m-2.This is 101 306.3 N m-2or 101.3 kPa (= 1 atmosphere). The classical concept is that 1 atmosphere equals 760 mmHg. Accordingly, 1 Torr or 1 mmHg equals (101 306.3 Pa/760 =) 133.3 Pa. In this book pressures are given in Pa (or kPa) together with mmHg.
5.        Concentrationis mass per volume unit. Squared brackets around a substance or C denote concentration. The international unit is mM = mmol l-1 = mol m-3.
6.        A prefix scale for different units is used as follows: milli = m = 10-3; micro = m = 10-6; nano = n = 10-9; pico = p = 10-12; femto = f = 10-15.
International Symbols
(Fed.Proc. 9: 602-605, 1950).
This is a precise short-cut for intellectual transfer used by all physiologists.
A dash next to any symbol (-) indicates a mean value. A dot next to any symbol (.) denotes a time derivative. Small letters in a suffix denote gas dissolved in blood, whereas large letters denote gas in air. The symbol is often the first letter in the English word.

A:
a	=	Solubility: The Bunsen solubility coefficient (ml STPD per ml fluid per 760 mmHg)
A	=	Alveolar gas
AA	=	arachidonic acid
Ach	=	acetylcholine
ACTH	=	adrenocorticotropic hormone
Ad	=	adrenaline
ADH	=	antidiuretic hormone
ADP	=	adenine diphosphate
AIDS	=	acquired immunodeficiency syndrome
AMP	=	adenine monophosphate
AMPA	=	special glutamate receptors
ANF	=	atrial natriuretic factor
ANH/ANP	=	atrial natriuretic hormone/peptide
AP	=	action potential
AR	=	absolute refractory period
ASA	=	acetylsalicylic acid
ATP	=	adenine triphosphate
ATPS	=	ambient temperature, pressure, saturated with water vapour
AV node	=	atrioventricular node

B:
BB	=	buffer base
BD	=	base deficit
BE	=	base excess
BMR	=	basal metabolic rate
BSA	=	body surface area
BTPS	=	body temperature and ambient pressure, saturated with water vapour

C:
C	=	concentration of gas in blood. Squared brackets around a substance also denote concentration
Cal	=	calorie
Cv_CO2	=	concentration of CO2 in mixed venous blood
CA	=	carbonanhydrase
cAMP	=	cyclic adenine monophosphate
CBF	=	cerebral bloodflow
CBG	=	corticosteroid binding globulin
CCh	=	carbacholine
CCK	=	cholecystokinin
cGMP	=	cyclic guanosine monophosphate
CNS	=	central nervous system
CSF	=	cerebrospinal fluid
COLD	=	chronic obstructive lung disease
COMT	=	catechol-O-methyl transferase
C peptide	=	connecting peptide
CRH	=	corticotropin releasing hormone
CVP	=	central venous pressure

D:
D	=	diffusion capacity
Da	=	Daltons (MW units)
DAG	=	diacylglycerol
1, 25-D3	=	1,25-dihydroxy-cholecalciferol
25-OH-D	=	25-hydroxy-cholecalciferol
DIT	=	di-iodine-thyronin
DM	=	Diabetes mellitus
DMNV	=	dorsal motor nucleus of the vagus
DMPP	=	dimethylphenylpiperazine
DNA	=	deoxyribonucleic acid
DOPA	=	dihydroxy-phenylalanine
2,3-DPG	=	diphosphoglycerate
DPPC	=	dipalmitoyl phosphatidylcholine

E:
E	=	expiration
Enet	=	mechanical net-efficiency of external work
EAA	=	excitatory amino acids
ECG	=	electrocardiogram
ECF	=	extracellular fluid
ECV	=	extracellular fluid volume
EDIP	=	end-diastolic intraventricular pressure
EDRF	=	endothelium-derived relaxing factor
EDTA	=	ethylene-diamine-tetra-acetate
EEG	=	electroencephalogram
EF	=	excretion fraction
EGF	=	epidermal growth factor
e.p.	=	equilibrium potential
EPSP	=	excitatory postsynaptic potential
ER	=	endoplasmic reticulum
ERBF	=	effective renal blood low
ERPF	=	effective renal plasma flow
ERV	=	expiratory reserve volume
ESV	=	end systolic volume

F:
F	=	fraction of gas in dry air or force
f	=	respiratory frequency (breath/min)
FABP	=	fatty acid binding protein
FAD	=	flavine adenine dinocleotide
FADH2	=	flavine adenine dinucleotide (reduced)
FFA	=	free fatty acids
FGF	=	fibroblast growth factor
FRC	=	functional residual capacity (= RV + ERV)
FSH	=	follicle stimulating hormone
FU	=	Flow units in ml of blood (100 g tissue)-1 min-1

G:
G	=	Gibbs energy (free, chemical energy)
GABA	=	gamma-aminobutyric acid
GFF	=	glomerular filtration fraction
GFR	=	glomerular filtration rate (normal 118-120 ml min-1)
GH	=	growth hormone
GHIH	=	growth hormone inhibiting hormone
GHRH	=	growth hormone releasing hormone
GIP	=	gastric inhibitory peptide orglucose-dependent insulin-releasing peptide
GLP	=	glucagon-like peptide
GnRH	=	gonadotropin releasing hormone
GLUT	=	glucose transporter
GRP	=	gastrin releasing peptide
GTP	=	guanosine triphosphate

H:
H	=	heat content (enthalpy; all energy when the pressure-volume work is zero)
Hb	=	haemoglobin (haemoglobin F = foetal haemoglobin)
HBF	=	hepatic blood flow
hCG	=	human chorionic gonadotropin
HDL	=	high density lipoprotein
HGF	=	hepatocytic growth factor
HGH	=	human growth hormone
HIP	=	hydrostatic indifference point
HIV	=	human immunodeficiency virus
hPL	=	human placental Lactogen
HPLC	=	high pressure liquid chromatography
HSS	=	hepatocyte stimulating substance

I:
I	=	inspired gas
ICSH	=	interstitial cell stimulating hormone
ICV	=	intracellular fluid volume
IDDM	=	insulin-dependent diabetes mellitus
IDL	=	intermediate density lipoprotein
IGF	=	insulin-like growth factor
IGF-BP	=	IGF-binding protein
IP3	=	inositol triphosphate
IRV	=	inspiratory reserve volume
ISF	=	inter­stitial fluid (tissue fluid)
Iso	=	isoprenaline
ISS	=	interpreted signal strength
i.v.	=	intravenous
J:
J	=	flux of a substance (mol min-1) through an area unit
J	=	Joule
JG	=	juxtaglomerular
K:
K	=	Kelvin degrees of temperature

L:
LAT	=	lactic acid threshold
LBNP	=	lower-body-negative-pressure
LES	=	lower oesophageal sphincter
LH	=	luteinizing hormone
LHRH	=	luteinizing hormone releasing hormone
LPL	=	lipoprotein-lipase
LDL	=	low density lipoprotein
LTH	=	prolactin
LVET	=	left ventricular ejection time

M:
MAO	=	monoamine oxidase
MAP	=	mean arterial pressure/mean aortic pressure
MeCH	=	metacholine
MEOS	=	microsomal ethanol oxidation system
MG	=	monoglycerides
2MG	=	2-monoglyceride
MIH	=	Muller inhibiting hormone
MIT	=	mono-iodine-thyronin
mM	=	mmol l-1
MR	=	metabolic rate
MSH	=	melanocytic stimulating hormone
MW	=	molecular weight (in Daltons)

N:
N	=	Newton
NA	=	noradrenaline
NAD	=	nicotinamide adenine dinucleotide
NADH2	=	nicotinamide adenine dinucleotide (reduced)
NANC	=	non-adrenergic, non-cholinergic
NBB	=	normal buffer base/neutral brush border
NGF	=	nerve growth factor
NIDDM	=	non-insulin-dependent diabetes mellitus
NMDA	=	N-methyl-D aspartate
NOS	=	nitric oxide synthase
NSAID	=	non-steroid anti-inflammatory drug

P:
P	=	partial pressure of gas in air or blood
PAH	=	para-amino hippuric acid
PCV	=	packed cell volume
PDE	=	phosphodiesterase
PDGF	=	platelet derived growth factor
PEF	=	peak expiratory flow
PG	=	prostaglandins
PG2	=	prostacyclin
PGE2	=	prostaglandin E2
PIF	=	prolactin inhibiting factor
PIP2	=	phosphatidyl-inositol diphosphate
PB	=	barometric pressure
Pc'CO2	=	partial pressure of CO2 in end-capillary blood
PIO2	=	partial pressure of O2 in inspired air in trachea
PaO2	=	partial pressure of O2 in arterial blood
POMC	=	pro-opiomelanocortin
PP	=	pancreatic polypeptide/ pulse pressure amplitude
PRL	=	prolactin
PRU	=	pressure resistance unit
PTH	=	parathyroid hormone
PVR	=	pulmonary vascular resistance

Q:
Q°	=	Cardiac output (l min-1)
QRS	=	the ventricle complex of the ECG
R:
R	=	ventilatory exchange ratio (pulmonic)
R	=	Gas constant
RAS	=	reticular activating system
RBF	=	Renal bloodflow
RC	=	respiratory controller/ respiratory centres
REM	=	rapid eye movements
RES	=	reticulo-endothelial system
RIA	=	radio-immuno assay
RMP	=	resting membrane potential
RNA	=	ribonucleic acid
RPF	=	renal plasma flow
RPM	=	revolutions per minute
RQ	=	respiratory quotient (metabolic)
RR	=	relative refractory period
RV	=	residual volume

S:
S	=	entropy (the tendency to spread in a maximum space)
S	=	saturation degree
SA	=	specific activity
SAmode	=	sinoatrial node
SB	=	standard bicarbonate concentration
SBE	=	standard base excess
SDA	=	specific dynamic activity
SR	=	sarcoplasmic reticulum
SS	=	steady state/ stimulus strength
STPD	=	standard temperature and pressure, dry (0oC, 760 mmHg)
STN	=	solitary tract nucleus
sv	=	stroke volume

T:
T	=	tension (force)
T	=	temperature
T3	=	Tri-iodo-thyronine
T4	=	tetra-iodo-thyronine
TBA	=	thyroxine-binding albumin
TBG	=	thyroxine-binding globulin
TBPA	=	thyroxine-binding prealbumin
TBV	=	total blood volume
TCA	=	tri-carboxylic acid
TEV	=	total erythrocyte volume
TFGF	=	transforming growth factor
TG	=	triglycerides
TGF	=	tubuloglomerular feedback
TH	=	total haemoglobin content
TLC	=	total lung capacity (=RV+VC)
TP	=	threshold potential
TPVR	=	total peripheral vascular resistance
TRH	=	thyrotropin-releasing hormone
tRNA	=	transfer RNA
TSH	=	thyroid-stimulating hormone
TV	=	tidal volume
TxA2	=	thromboxane A2

V:
v dash	=	linear mean velocity
V°	=	volume velocity of gas
V	=	volume
V°A	=	expired alveolar ventilation (l min-1)
VC	=	vital capacity (=IRV+TV+ERV)
VD	=	dead volume
W	=	Watts (J s-1)
W	=	external work (with pressure-volume work zero)

Nutritive Equivalents And Enthalpy
Nutritive equivalents for oxygen are:
Carbohydrate 37 mmol oxygen g-1, fat 91 mmol oxygen g-1 , and protein 43 mmol oxygen g-1. On a mixed diet 20 kJ of energy is transferred per litre STPD of oxygen used; the RQ is 0.8.
Nutritive equivalents for carbon dioxide are:
Carbohydrate 37 mmol g-1, fats 64 mmol g-1, and protein 34 mmol g-1.
Metabolic enthalpies (heat energy liberated in the body per g combusted nutrient) in kJ g-1 substance: Protein 17, fat 39 and carbohydrate 17.5.
Essential Atomic And Molecular Weights
These are given in g mol-1 (or Daltons, Da) throughout the text. Calcium 40; Carbon 12; Glucose 180; Helium 4; Hydrogen 1; Nitrogen 14; Oxygen 16; PAH 194.2; Phosphorus 31; Potassium 39; Sodium 23; Xenon 131.
Physical Constants And Conversion Factors
Acceleration due to gravity (standard 1 G): 9.81 m/s2.
Avogadro's constant: 6.02 1023 molecules mol-1 .
Diffusion coefficients for most molecules: 10-10 m2 s-1 per molecule.
Energy (J = N m = Volts Coulomb): 1 cal = 4.187 J.
Farad = Coulomb/Volts.
Faraday's constant: 96 487 (104) Coulomb/mol monovalent ion.
Molar gas constant (R): 8.31 J mol-1 per degree Kelvin (K).
Specific heat capacity of the human body: 3.47 kJ kg-1  oC-1.
Energy transfer by evaporation of 1 kg of water at the usual skin temperature: 2436 kJ.
Pressure (Pascal = Pa = N m-2): 1 mmHg = 1 Torr = 133.3 Pa.
Surface tension of body warm water: 0.07 N m-1.
Temperature conversion between degrees of Fahrenheit (oF) and degrees of Celsius (oC): (oF) = 9/5 (oC) + 32.
Calculated Partial Pressures
The partial pressures of respiratory gasses are calculated in the alveoli and in the surrounding air of a healthy person, resting at sea level (101.3 kPa = 760 mmHg or Torr = 1 atmosphere).
The water vapour tension in a fluid (air or liquid) of the temperature 310 K (37oC) is 6.27 kPa or 47 mmHg. At 293 K (20oC) the tension is 2.4 kPa or 18 mmHg. The alveolar gas fractions are: FAO2 = 0.15, and FACO2 = 0.056. The composition of atmospheric air is: FIO2 = 0.2093 and FICO2  = 0.0003.
PO2 = FO2 (101.3 - 6.27) kPa.
PAO2 = 13.3 kPa (100 mmHg); PaO2 = 12.7 kPa (95 mmHg); PvO2 = 6 kPa (45 mmHg).
PACO2 = 5.3 kPa (40 mmHg) ; PaCO2 = 5.3 kPa (40 mmHg); PvCO2 = 6.1 kPa (46 mmHg).

[ 本帖最后由 zhangheng1020 于 2007-10-24 12:01 编辑 ]

zhangheng1020UID: 2130513

:o 我和某人打赌，要２个月魔鬼 训练一下。暂时这个帖子作为我的牢骚帖。

打赌内容:rolleyes:

１２个月不用中文，这是最后的一个中文帖。我已经删除了我的中文输入:loveliness: 。

２每天完成USMLE 专业课的阅读，目前是PATHOLOGY/ ANATOMY / PHYSIOLOGY。做不完不准吃饭睡觉放屁看帅哥～～～:mad

３ 坚持两个月早晨跑步:mad

--------------------------------------------------------------------------------------------------------------------------------

大家监督，我已经加油，

[fly];d: ;d: 让两个月以后老变态郁闷致死吧 ;d: ;d: [/fly]

１我确实删除了我的中文输入，但是，自从我发现在线拼音输入，我的中文写作就继续了～～没有做到。

２很努力的看了，但是最后总是坐着睡着了～～算做到一半吧。

３ ８月到９月中旬在跑步，后来下雨停２天，早晨起来要看书，跑步太奢侈了，就改成每天下午或者晚上游泳。但是运动量一样的。～～算完成了吧。

zhangheng1020UID: 2130513

[ 本帖最后由 zhangheng1020 于 2007-10-25 12:03 编辑 ]

zhangheng1020UID: 2130513

Sequela
From Wikipedia, the free encyclopedia
• Ten things you may not know about Wikipedia •
Jump to: navigation, search

A sequela, (IPA /sɪ'kwi:lə/) (plural sequelæ) is a pathological condition resulting from a disease, injury, or other trauma. Chronic kidney disease, for instance, is sometimes a sequela of a food-borne illness; post-traumatic stress disorder may be a psychological sequela of rape.

Sequelae of traumatic brain injury include headache and dizziness, anxiety, apathy, depression, aggression, cognitive impairments, personality changes, mania, psychosis. These may also result from ECT (Electro convulsive therapy).

zhangheng1020UID: 2130513

Patau syndrome, also known as trisomy 13, is a chromosomal abnormality, a syndrome in which a patient has an additional chromosome 13 due to a non-disjunction of chromosomes during meiosis. The extra chromosome 13disrupts the normal course of development, causing the characteristicfeatures of Patau syndrome. Like all non-disjunction diseases (Down syndrome, Edwards syndrome,etc...) the risk of disease in the offspring increases with maternalage at pregnancy. Patau syndrome affects approximately 1 in 15,000 livebirths.
Causes
Most cases of Patau's syndrome result from trisomy13, which means each cell in the body has three copies of chromosome 13instead of the usual two copies. A small percentage of cases occur whenonly some of the body's cells have an extra copy of chromosome 13,resulting in a mixed population of cells with a differing number ofchromosomes, such cases are called mosaic Patau.
Patau syndrome can also occur when part of chromosome 13 becomesattached to another chromosome (translocated) before or at conception.Affected people have two copies of chromosome 13, plus extra materialfrom chromosome 13 attached to another chromosome. With atranslocation, the person has a partial trisomy for chromosome 13 andoften the physical signs of the syndrome differ from the typical Patausyndrome.
Most cases of Patau syndrome are not inherited, but occur as randomevents during the formation of reproductive cells (eggs and sperm). Anerror in cell division called non-disjunction can result in reproductive cells with an abnormal number of chromosomes. For example, an egg or spermcell may gain an extra copy of chromosome 13. If one of these atypicalreproductive cells contributes to the genetic makeup of a child, thechild will have an extra chromosome 13 in each of the body's cells.
Mosaic Patau syndrome is also not inherited. It occurs as a random error during cell division early in fetaldevelopment. As a result, some of the body's cells have the usual twocopies of chromosome 13, and other cells have three copies of thechromosome.
Patau syndrome due to a translocation can be inherited. Anunaffected person can carry a rearrangement of genetic material betweenchromosome 13 and another chromosome. This rearrangement is called abalanced translocation because there is no extra material fromchromosome 13. Although they do not have signs of Patau syndrome,people who carry this type of balanced translocation are at anincreased risk of having children with the condition.
PrognosisMost embryos with trisomy 13 do not survive gestation and arespontaneously aborted. Of those surviving to term gestation,approximately 82-85% do not survive past 1 month of age, and 85% do notsurvive past 1 year of age.[1] Certain malformations, especially holoprosencephalyand other central nervous system malformations, yield a more graveprognosis. Of those infants that survive past 1 year, most have fewmajor malformations, but the prognosis remains poor, owing to multiplefactors including long term neurological disability, feedingdifficulty, and frequent pneumonia and other respiratory infections. Currently there are over 66 survivors of some form or another of Trisomy 13.

Manifestations and physical findingsOf those embryos that do survive to gestation and subsequent birth, common anomalies include:

• mental & motor retardation
• polydactyly (extra digits)
• microcephaly
• low-set ears
• holoprosencephaly (failure of the forebrain to divide properly).
• heart defects
• structural eye defects, including microphthalmia, Peters anomaly, cataract, iris and/or fundus (coloboma), retinal dysplasia or retinal detachment, sensory nystagmus, cortical visual loss, and optic nerve hypoplasia
• cleft palate or hare lip
• meningomyelocele (a spinal defect)
• omphalocele (abdominal defect)
• abnormal genitalia
• abnormal palm pattern
• overlapping of fingers over thumb.

chinese information

http://www.dxy.cn/bbs/actions/archive/post/1220223_1.html

http://www.dxy.cn/bbs/post/view?bid=197&id=9296424&tpg=1&ppg=1&sty=1&age=0#9296424
漫舞天涯
                 女性患者，36岁，G3P1，孕15周，常规超声检查。
既往体健，第一个孩子已12岁，健康。
4x9 said
                 女性患者，36岁，G3P1，孕15周，常规超声检查。
既往体健，第一个孩子已12岁，健康。
诊断：全前脑畸形　
　　　奇动脉　
　　　羊膜带综合征
　　　羊水过多
　　　眼距窄
　　　是否有体内大动脉畸形（１３，１４图）没看明白．
依据：典型的单一丘脑，重度的脑积水（此病往往有颜面畸形，此病人虽然　　　无单眼畸形，但眼距过窄．
　　　羊膜带综合征．羊水多与奇动脉是胎儿畸形的姐妹（不知这样说对不对）．遇到胎儿畸形要注意是否有上述病伴行．

tjf1 said
考虑：全前脑(第6、7、8图示未见脑中线、丘脑融合、大量脑积水)。
           眼距过近。
           鼻子较大、形态异常(鼻骨短小或缺如，第3、4、16、17图中示)。
           小下颌可能。
           单脐动脉(第11、12图示)。
           羊膜、绒毛膜未融合(大部分二维图中均可见到)。

符合13-三体综合征，最后一图中胎儿双上肢可见，未见明显形态异常，双下肢图中未示。图13及图14中的血流没看明白，高手指教下？谢谢。

漫舞天涯
经引产证实：   

１前脑无裂畸形：无叶全前脑、单一侧脑室高度扩张，丘脑融合，胼胝体缺如等。　
２颜面部多发畸形：眼距过近，眼眶窄小，小下颌  ，鼻骨缺如，大鼻单空状。小耳低位。
３ 颈部水肿
4部分肠管壁可见质硬的钙化灶
5 单一脐动脉　
6 羊膜-绒毛膜未融合
  

临床综合考虑为13-三体综合征。   

[ 本帖最后由 zhangheng1020 于 2007-10-25 13:47 编辑 ]

zhangheng1020UID: 2130513

Coombs test
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Coombs test (also known as Coombs' test, antiglobulin test or AGT) refers to two clinical blood tests used in immunohematology and immunology.

The two Coombs tests are:

    * Direct Coombs test (also known as direct antiglobulin test or DAT).
    * Indirect Coombs test (also known as indirect antiglobulin test or IAT).

The direct Coombs test is used to detect red blood cells sensitized with igG alloantibody, IgG autoantibody, and complement proteins. It detects antibodies bound to the surface of red blood cells in vivo. The red blood cells (RBCs) are washed (removing the patient's own plasma) and then incubated with antihuman globulin (also known as "Coombs reagent"). If this produces agglutination of the RBCs, the direct Coombs test is positive.

The indirect Coombs test is used in prenatal testing of pregnant women, and in testing blood prior to a blood transfusion. It detects antibodies against RBCs that are present unbound in the patient's serum. In this case, serum is extracted from the blood, and the serum is incubated with RBCs of known antigenicity. If agglutination occurs, the indirect Coombs test is positive.[1]
MechanismThe two Coombs tests are based on the fact that anti-human antibodies, which are produced by immunizing non-human species with human serum, will bind to human antibodies, commonly IgG or IgM. Animal anti-human antibodies will also bind to human antibodies that may be fixed onto antigens on the surface of red blood cells (also referred to as RBCs), and in the appropriate test tube conditions this can lead to agglutination of RBCs. The phenomenon of agglutination of RBCsis important here, because the resulting clumping of RBCs can bevisualised; when clumping is seen the test is positive and whenclumping is not seen the test is negative.
Common clinical uses of the Coombs test include the preparation of blood for transfusion in cross-matching, screening for atypical antibodies in the blood plasma of pregnant women as part of antenatal care, and detection of antibodies for the diagnosis of immune-mediated haemolytic anaemias.
Coombs tests are done on serum from venous blood samples which are taken from patients by venipuncture.The venous blood is taken to a laboratory (or blood bank), wheretrained scientific technical staff do the Coombs tests. The clinicalsignificance of the result is assessed by the physician who requested the Coombs test, perhaps with assistance from a laboratory-based hematologist.

Schematic showing the direct and indirect Coombs tests.


[edit] Direct Coombs TestThe direct Coombs test (also known as the direct antiglobulin test or DAT) is used to detect if antibodies or complement system factors have bound to RBC surface antigens in vivo. The DAT is not currently required for pre-transfusion testing but may be included by some laboratories.
[edit] Examples of diseases that give a positive direct Coombs testThe direct Coombs test is used clinically when immune-mediated hemolytic anemia(antibody-mediated destruction of RBCs) is suspected. A positive Coombstest indicates that an immune mechanism is attacking the patient's ownRBC's. This mechanism could be autoimmunity, alloimmunity or a drug-induced immune-mediated mechanism.
[edit] Examples of alloimmune hemolysis

• Hemolytic disease of the newborn (also known as HDN or erythroblastosis fetalis)
  • Rhesus D hemolytic disease of the newborn (also known as Rh disease)
  • ABO hemolytic disease of the newborn (the indirect Coombs test may only be weakly positive)
  • Anti-Kell hemolytic disease of the newborn
  • Rhesus c hemolytic disease of the newborn
  • Rhesus E hemolytic disease of the newborn
  • Other blood group incompatibility (RhC, Rhe, Kid, Duffy, MN, P and others)
• Alloimmune hemolytic transfusion reactions

[edit] Examples of autoimmune hemolysis

• Warm antibody autoimmune hemolytic anemia
  • Idiopathic
  • Systemic lupus erythematosus
  • Evans' syndrome (antiplatelet antibodies and hemolytic antibodies)

• Cold antibody autoimmune hemolytic anemia
  • Idiopathic cold hemagglutinin syndrome
  • Infectious mononucleosis
  • Paroxysmal cold hemoglobinuria (rare)

[edit] Drug-induced immune-mediated haemolysis

• Methyldopa (IgG mediated type II hypersensitivity)
• Penicillin (high dose)
• Quinidine (IgM mediated activation of classical complement pathway and Membrane attack complex, MAC)

(A memory device to remember that the DAT tests the RBCs and is used to test infants for haemolytic disease of the newborn is:
Rh Disease; R = RBCs, D = DAT.)
[edit] Laboratory methodThe patient's red blood cells (RBCs) are washed (removing the patient's own serum) and then incubated with antihuman globulin (also known as Coombs reagent). If immunoglobulin or complement factors have been fixed on to the RBC surface in-vivo, the antihuman globulin will agglutinatethe RBCs and the direct Coombs test will be positive. (A visualrepresentation of a positive direct Coombs test is shown in the upperhalf of the schematic).
[edit] Indirect Coombs testThe indirect Coombs test (also known as the indirect antiglobulin test or IAT) is used to detect in-vitroantibody-antigen reactions. It is used to detect very lowconcentrations of antibodies present in a patient's plasma/serum priorto a blood transfusion. In antenatal care, the IAT is used to screenpregnant women for antibodies that may cause hemolytic disease of the newborn. The IAT can also be used for compatibility testing, antibody identification, RBC phenotyping, and titration studies.
[edit] Examples of clinical uses of the indirect Coombs test[edit] Blood transfusion preparationMain article: blood transfusion
The indirect Coombs test is used to screen for antibodies in the preparation of blood for blood transfusion. The donor's and recipient's blood must be ABO and Rhesus D compatible. Donor blood for transfusion is also screened for infections in separate processes.

• Antibody screening

A blood sample from the recipient and a blood sample from every unit of donorblood are screened for antibodies with the indirect Coombs test. Eachsample is incubated against a wide range of RBCs that together exhibita full range of surface antigens (ie blood types).

• Cross matching

Main article: cross-matching
The indirect Coombs test is used to test a sample of the recipient's serum against a sample of the blood donor's RBCs. This is sometimes called cross-matching blood.
[edit] Antenatal antibody screeningThe indirect Coombs test is used to screen pregnant women for IgG antibodies that are likely to pass through the placenta into the foetal blood and cause haemolytic disease of the newborn.
[edit] Laboratory methodThe IAT is a two-stage test. (A cross match is shown visually in thelower half of the schematic as an example of an indirect Coombs test).
[edit] First stageWashed test red blood cells (RBCs) are incubated with a test serum. If the serum contains antibodies to antigens on the RBC surface, the antibodies will bind onto the surface of the RBCs.
[edit] Second stageThe RBCs are washed three or four times with isotonic saline andthen incubated with antihuman globulin. If antibodies have bound to RBCsurface antigens in the first stage, RBCs will agglutinate whenincubated with the antihuman globulin (also known Coombs reagent) in this stage, and the indirect Coombs test will be positive.
[edit] TitrationsBy diluting a serum containing antibodies the quantity of theantibody in the serum can be gauged. This is done by using doublingdilutions of the serum and finding the maximum dilution of test serumthat is able to produce agglutination of relevant RBCs.
[edit] Coombs reagentCoombs reagent (also known as Coombs antiglobulin or antihuman globulin) is used in both the direct Coombs test and the indirect Coombs test. Coombs reagent is antihuman globulin. It is made by injecting human globulin into animals. Coombs reagent contains animal antibodies specific for human immunoglobulins and human complement system factors. More specific Coombs reagents or monoclonal antibodies can be used.
[edit] Enhancement MediaBoth IgM and IgG antibodies react strongly with their antigens. IgG antibodies are most reactive at 37°C. IgM antibodies are easily detected in saline at room temperature as IgM antibodies are able to bridge between RBC’s owing to their large size, efficiently creating what is seen as agglutination. IgG antibodies are smaller and require assistance to bridge well enough to form a visual agglutinationreaction. Reagents used to enhance IgG detection are referred to aspotentiators. RBCs have a net negative charge called zeta potentialwhich causes them to have a natural repulsion for one another.Potentiators reduce the zeta potential of RBC membranes. Commonpotentiators include low ionic strength solution (LISS), albumin,polyethylene glycol (PEG), and proteolytic enzymes.
[edit] History of the Coombs testThe Coombs test was first described in 1945 by Cambridge immunologists Robin Coombs (after whom it is named), Arthur Mourant and Rob Race.[2] Historically, it was done in test tubes. Today, it is commonly done using microarray and gel technology.
[edit] References
Coombs试验                                        取自 KeyinWiki                                                                                                跳转到: 导航, 搜索
                                                1945年，英国免疫学家coombs等人发明了能检测红细胞表面抗体的一种新试验，故称之，亦即抗人球蛋白试验。这是诊断免疫溶血性贫血的主要方法。最早和现在常用的抗人球蛋白试剂是广谱抗血清，即抗igg+抗补体。国外研究发现，如采用特异的抗igg、igm或抗补体的试剂，红细胞表面的抗体是igg和补体约占40%，单纯igg占35%，单纯补体占10%，极少数病例是iga或igm。补体几乎都是c 3 b，即未激活的c 3 。coombs直接试验：将洗涤过的红细胞2%混悬液加入coombs试剂，混和后离心一分钟促进凝集。如果肉眼或显微镜下能见到红细胞凝集，即为阳性，说明红细胞表面有不完全抗体或补体。阳性结果可见于自体免疫溶血性贫血、输血反应、某些药物或疾病引起的免疫溶血性贫血。coombs间接试验：先将受试的血清加入等量5%适当的正常红细胞(rh阳性的o型红细胞)，在37℃温育30～60分钟，以促使血清中的半抗体结合于红细胞上(致敏)，将红细胞充分洗涤，以后同直接试验。如果红细胞发生凝集而正常对照(未经与受检血清温育的正常红细胞)不凝集，即为阳性，表明受试的血清中存在不完全抗体。
[项目名称]抗人球蛋白试验
此项化验分直接试验和间接试验，主要用于自身免疫性溶血性贫血(aiha)的筛选和分型。
[别名]coombs’试验(库姆试验)
[英文缩写]coombs
[参考值]直接和间接coombs’试验均为阴性
[临床意义]
(1)阳性见于aiha，直接coombs’试验较间接试验对aiha更有诊断价值。用特异性单价抗血清可将aiha分为三型：igg／c3阳性，占67％；单独igg性，占20％；单独c3性，占13％；
(2)药物免疫性溶血性贫血及同种免疫性溶血性贫血也可阳性。
(3)coombs’试验阴性有时并不能排除aiha。
[要求]用肝素或edta抗凝血做直接coombs’试验，血清做间接coombs’试验。

[ 本帖最后由 zhangheng1020 于 2007-10-25 17:15 编辑 ]