肺移植中供体肺的保存

由于近年来肺移植的广泛研究和应用，研究肺保存的方法日趋多样化、复杂化。尖端科技的应用已使研究进入分子水平。但与此同时，大量病例已进入临床，成功的经验日趋定型。肺保存的温度已基本控制在１０℃左右，亦有部分学者认为４℃～８℃为最佳。肺缺血保存时间在２４ｈ内最好，最长不应超过４８ｈ。另外大量实验和临床经验证实低Ｋ＋灌洗液（ＬＰＤ、ＬＰＵＷ等）可能是肺动脉灌注中能够最佳保护肺组织的灌洗液。在未来的研究中，各种细胞因子、组织因子及缺血损伤机制在肺保存中的作用将成为主攻方向     

右肺叶切除术后新叶间裂的X线表现

对32例行右肺叶切除术前后的正侧位胸片的叶间裂及新叶间裂进行了系统观察,探讨右肺部分新叶切除术后叶间裂的表现,借以判断余肺膨胀度及提高对肺叶重分布的认识。结果全部病例新叶间裂表现以侧位片为主,右上肺切除后新叶间裂相似于左斜裂,右中肺切除后新叶裂表现为从后上方至前下方较水平的细线影,右下叶肺切除后新叶间裂呈两型,Ⅰ型为类似左斜裂形态,但上缘起点较低。Ⅱ型为从中部向下方倾斜的细线影。分析在右侧位胸片上新叶间裂的形成和表现,对肺叶重分布作出客观的认识。     

肺脏中的一氧化氮和一氧化氮合成酶

一氧化氮合成酶（ＮＯＳ）广泛分布于肺组织，催化左旋精氨酸生成一氧化氮（ＮＯ）；ＮＯ参与肺组织的生理功能；ＮＯ的生成异常与某些肺疾病发生有关；ＮＯＳ抑制剂和吸入ＮＯ是治疗某些肺疾病的有效措施。     

电视胸腔镜手术在肺切除术中的应用

目的 探讨胸腔镜辅助小切口在肺切除术中的应用价值。方法 在第7肋间腋中线作1．5cm切口，插入胸腔镜。在第5肋间腋前线和腋中线间作约6cm小切口，行肺切除术17例，其中肺楔形切除术3例、肺叶切除术14例。结果 术后17例中肺癌14例(腺癌12例、鳞癌2例)，肺炎性假瘤1例，肺结核球2例，PTNM分期包括Ia9例、Ib1例、Ⅱa2例、Ⅱb2例。随访5～37月，除1例死于肝转移外，其余均健在。结论 胸腔镜手术在肺切除术中的应用，有利于肺孤立性小结节的诊治，可作为早期肺癌外科治疗的一种手段。     

肺部内皮素的生理病理学意义

肺部内皮素（ＥＴ）及其受体含量丰富，它们对肺通气和肺循环起重要的调节作用。肺内ＥＴ合成、分泌和代谢的异常与许多肺部疾病的发病密切相关。抑制ＥＴ的合成、阻断ＥＴ的作用，对一些肺部疾病有重要的防治意义     

70%氧对大鼠肺切除后肺增生的影响

为检验高浓度氧对肺切除后肺增生的影响,将大鼠右肺3个叶切除后置于空气或70%氧箱中,2周后行左肺电镜及显微测量学观察。开胸而不切除肺者作为对照组。肺切除后Ⅰ、Ⅱ型肺泡上皮细胞、毛细血管内皮细胞、间质细胞和基质各总体积均较对照组增加100～200%;毛细血管和Ⅰ型上皮总表面积各增40%。吸70%氧对肺增生无显著抑制作用,但较单纯肺切除组Ⅱ型上皮和间质细胞体积密度各增加78%和54%,Ⅱ型上皮和成纤维细胞显著增多,出现间质水肿、中性白细胞聚集和Ⅱ型上皮线粒体异常。作者认为70%氧对大鼠肺切除后肺增生无显著影响,但并非完全无害。     

内毒素肺损伤肺淋巴变化的实验研究

本实验应用清醒绵羊内毒素肺损伤模型对内毒素致伤后肺淋巴液的变化作了研究。内毒素致伤后,肺动脉压(Ppa)、肺微血管压(PMV)、肺淋巴流量(QL),淋巴白蛋白/血浆白蛋白比值(LA/PA)、淋巴胶体渗透压(π_(i))和肺微血管滤过系数(Kf)均明显增加。压力和通透性变化对QL的影响之比,在Ⅰ期(0～2h)和Ⅱ期(2～6h)分别为1∶0.53和1∶2.31。提示了PMV增高为Ⅰ期肺水肿形成的主要因素,通透性增加为Ⅱ期的主要因素。     

CT图像肺结节自动检测

肺癌是对人类生命健康危害最大的恶性肿瘤之一。计算机辅助诊断系统对肺部CT图像进行自动分析后,可提示医生可疑肺结节,从而克服医生在诊断中的一些主观因素,为此本文提出了一种基于胸部CT图像的可疑肺结节自动检测算法。首先,根据胸部组织的特殊结构,利用一种新的分割算法提取出肺实质部分;在此基础上提取出灰度与结节相近的感兴趣区域,包括结节、肺血管、支气管;然后,以已标记的结节数据作为样本集,计算结节的面积、灰度均值、灰度方差、圆形度、形状矩、体积、球形度等特征值,利用最近邻法建立分类器判别函数;最后,计算测试集感兴趣区域的上述特征,对其进行判别、分类,并标记出结节。试验结果表明,该算法综合考虑了肺结节特征,具有较高的准确度。     

46例肺肿瘤肺吸入／灌注显像肺亲肿瘤显像观察

本文报告了46例经病理确诊为肺肿府患者的肺^99mTc-PYP吸入及^99mTc-MAA灌注的显像结果，发现43例病人患侧肺均有不同程度的通气、灌注受损，46例中有11例行肺灌注断层显像(SPECT)，其检测出最小的肿瘤为2．5cm，另有3例患者患肺通气、灌住功能略高于对侧，这其中有2例为COPD患者，对侧肺有相应病变，1例可能是肿瘤痛变范围太小，46例患者中有21例同时行^99mTc-MIBI素肿瘤显像，其中19例阳性，这19例中17例为恶性肿瘤，作者认为肺通气、灌注显像除了能观察肿瘤的解剖病变位置外，亦可同时提供患者的分肺通气、灌注功能情况，SPECT的应用可提高对肺小肿瘤的检出率，^99mTc-MIBI亲肿瘤显像可帮助术前判断肺肿物的良、恶状况所有这些核素检查的联合应用对肺部肿瘤的诊断将提供一个较为全面的解剖。功能及定性的信息。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.