胆汁中氨肽酶N的分离、提纯及其促成核作用的初步研究

目的　观察氨肽酶N(APN )在胆石形成中的成核活性。方法　应用伴刀豆凝集素A亲和层析、羟基磷灰石柱层析及高压液相法从胆石症患者胆汁中分离、提纯胆汁中的APN ,并用模拟胆汁观察APN的成核活性。结果　最终APN纯化倍数达 2 94倍 ,酶的活性为12 .9nM·min-1·μg-1,分子量为 130kDa。随后在模拟胆汁观察到APN有明显的促成核活性。结论　APN在胆固醇结石形成中具有促成核作用。     

梗阻性黄疸患者血浆可溶性P-选择素与内毒素、D-二聚体的关系及其意义

目的　研究梗阻性黄疸 (梗黄 )患者血浆可溶性P -选择素 (sP selectin ,sP s)与内毒素 (ET )及D -二聚体 (D d)的关系及其意义。方法　应用ELISA和鲎试剂比色法测定梗黄组、急性胆囊炎组和健康人组血浆sP s ,D d和ET含量。结果　健康人组血浆sP s含量为 (93 .43± 17.65 )ng/ml ,ET (0 .0 0 3 0± 0 .0 0 0 4)EU /ml ,D d(0 .3 9± 0 .2 1)mg/L ;急性胆囊炎组血浆sP s含量为 (2 3 3 .3 2± 82 .12 )ng/ml ,ET (0 .40 12± 0 .15 0 6)EU /ml ,D d(0 .76± 0 .2 7)mg/L ;梗黄组血浆sP s含量为 (3 5 1.90± 93 .83 )ng/ml ,ET(0 .3 814± 0 .14 3 0 )EU /ml ,D d(2 .14± 0 .3 7)mg/L。急性胆囊炎组和梗黄组sP s ,D d及ET均高于健康人组 (P <0 .0 1) ;梗黄组ET与急性胆囊组差异无显著性 ,但梗黄组sP s和D d较急性胆囊炎组高 (P <0 .0 1) ,梗黄组的以上二物质含量呈正相关性 (P <0 .0 1) ;急性胆囊炎组sP s与ET呈正相关性 (P <0 .0 1)。协方差分析表明 ,在相同ET含量时 ,梗黄组sP s高于急性胆囊炎组 (P <0 .0 1) ,且与D d有相关性 ,二者有相同变化趋势。结论　胆道梗阻是ET致血管内皮细胞损伤和血小板活化的敏感性因素 ,梗黄患者血液高凝状态与继发性纤溶反应处于动态平衡 ,提示动态监测血浆sP s和D d变化 ,     

Incidence and Predictors of Cancer Following Kidney Transplantation in Childhood

Cancer risk is increased substantially in adult kidney transplant recipients, but the long‐term risk of cancer in childhood recipients is unclear. Using the Australian and New Zealand Dialysis and Transplant Registry, the authors compared overall and site‐specific incidences of cancer after transplantation in childhood recipients with population‐based data by using standardized incidence ratios (SIRs). Among 1734 childhood recipients (median age 14 years, 57% male, 85% white), 289 (16.7%) developed cancer (196 nonmelanoma skin cancers, 143 nonskin cancers) over a median follow‐up of 13.4 years. The 25‐year cumulative incidences of any cancer were 27% (95% confidence intervals 24–30%), 20% (17–23%) for nonmelanoma skin cancer, and 14% (12–17%) for nonskin cancer (including melanoma). The SIR for nonskin cancer was 8.23 (95% CI 6.92–9.73), with the highest risk for posttransplant lymphoproliferative disease (SIR 45.80, 95% CI 32.71–62.44) and cervical cancer (29.4, 95% CI 17.5–46.5). Increasing age at transplantation (adjusted hazard ratio [aHR] per year 1.10, 95% CI 1.06–1.14), white race (aHR 3.36, 95% CI 1.61–6.79), and having a functioning transplant (aHR 2.27, 95% CI 1.47–3.71) were risk factors for cancer. Cancer risk, particularly for virus‐related cancers, is increased substantially after kidney transplantation during childhood.     

内皮素-1与梗阻性黄疸大鼠应激性溃疡关系的研究

目的　研究梗阻性黄疸 (梗黄 )大鼠应激状态下胃黏膜中内皮素 -1(ET 1)变化及其与胃黏膜血流和胃黏膜损伤程度的关系。方法　动物随机分为 :( 1)实验组 ,梗黄大鼠 ;( 2 )对照组 ,假手术组。两组再分成 5个亚组 ,即不予冷束缚和冷束缚 10 ,3 0 ,60 ,12 0min的应激组 ;( 3 )抗ET 1血清预处理组 ,于成模后行 3 0 ,60 ,12 0min冷束缚前注射抗ET 1血清。放免法检测胃黏膜中ET 1,激光多普勒法测定胃黏膜血流 ,光镜下观察胃黏膜损伤程度。结果　实验组与对照组相比 :胃黏膜中ET 1明显增高 (P <0 .0 1) ,胃黏膜血流明显减少 (P <0 .0 1) ,溃疡指数增加 (P <0 .0 1)。静脉注射抗ET 1血清后 ,胃黏膜血流增加 ( P <0 .0 1) ,溃疡指数下降 ( P <0 .0 1)。结论　内源性ET 1在梗黄大鼠应激性溃疡的发病机制中有一定作用 ;抗ET 1血清对梗黄大鼠应激性溃疡有预防作用。     

Sagittal plane analysis of the open and closed methods in children with displaced supracondylar fractures of the humerus (a radiological study)

OBJECTIVES: The aim of this study was to compare the radiological outcome of open and close reduction and osteosynthesis methods in the treatment of type II and III supracondylar humerus fractures in childhood with respect to the immediate post-operative reduction quality in sagittal plane. METHOD: One hundred and forty four-pediatric patients with type IIb and III supracondylar humerus fractures treated at two centers between 1995 and 2005 were evaluated radiologically within a retrospective study. Seventy-six patients (54 boys, 22 girls, mean age 7.6, range 2-12) were treated by closed reduction and cross percutaneous pinning while 68 (49 boys, 19 girls, mean age 7.3, range 2-13) were treated by open reduction. The reduction quality of the open and closed groups was compared on immediate post-operative lateral radiographs by measuring of lateral humerocapitellar angle, anterior humeral line and anterior coronoid line criteria. The reduction quality was classified excellent, good, fair and poor according to the achievement of three, two, one or none of the criteria, respectively. Reductions classified as excellent and good were introduced as acceptable results. RESULTS: At least one criterion was achieved in all the patients of both the groups. The mean humerocapitellar angle was 30.1 degrees in closed reduction group while the mean of it was 29.8 degrees in open reduced group. Radiograph of 48 (63.1%) patients with closed reduction were found to display the anterior humeral line intersecting the middle one-third of capitellum while this criteria was 45 (66%) in open reduction group. The anterior coronoid line was disturbed in three patients in each of both the groups. The reduction quality was evaluated to be excellent in 32 patients, good in 31, fair in 13 at the closed reduction group while these evaluations were 31, 20 and 17 in open reduction group, respectively. Successful reduction was achieved in 74.9% of the patients in closed reduction group and 75% of the patients in open reduction group. CONCLUSION: It is concluded that there was no significant difference between closed and open reductions of pediatric displaced supracondylar fractures with regard to the radiological criteria of reduction quality in sagittal plane.     

Chemotherapy and Transplantation: The Role of Immunosuppression in Malignancy and a Review of Antineoplastic Agents in Solid Organ Transplant Recipients

It is estimated that solid organ transplant recipients have a two‐ to fourfold greater overall risk of malignancy than the general population. Some of the most common malignancies after transplant include skin cancers and posttransplant lymphoproliferative disorder. In addition to known risk factors such as environmental exposures, genetics, and infection with oncogenic viruses, immunosuppression plays a large role in the development of cancer through the loss of the immunosurveillance process. The purpose of this article is to explain the role of immunosuppression in cancer and to review the classes of chemotherapeutics. The field of anticancer drugs is continually expanding and developing, with limited data on use in transplant recipients. This article aims to provide information on class review, adverse effects, dose adjustments, and drug interactions that are pertinent to the care of transplant recipients.     

肝细胞内糖原含量与肝脏缺血再灌注损伤关系的实验研究

目的　探讨细胞内糖原含量与肝脏缺血再灌注损伤之间的关系及其相关机理。方法　对3组糖原含量显著不同的兔肝脏缺血再灌注过程中的组织形态学、肝脏酶学、组织ATP含量及细胞膜Na K ATP酶,Ca2 ATP酶活性进行观察。结果　糖原含量高的肝脏,其细胞能量代谢旺盛、细胞膜Na K ATP酶及Ca2 ATP酶活性强、组织结构及功能损伤轻。结论　缺血前增加肝糖原负荷可显著减轻肝脏缺血再灌注损伤程度。     

肝脂质代谢异常在兔胆道不全梗阻并感染致胆囊胆红素钙结石过程中的作用

目的　探讨肝脏脂质代谢异常在胆道不全梗阻并感染致兔胆囊胆红素钙结石过程中的作用。方法　 49只兔随机分为 3组 :结石A组 ( n =15 )和结石B组 ( n =2 2 )及正常对照组 (C组 ,n= 12 ) ,通过胆道不全梗阻并感染构建兔胆囊胆红素钙结石模型。检测以下项目 :( 1)血浆甘油三酯(TG ) ,磷脂 (PL ) ,总胆固醇 (TCh ) ,游离胆固醇 (FCh) ,高密度脂蛋白及其亚组分胆固醇 (HDL Ch ,HDL2 Ch及HDL3 Ch)的浓度 ;( 2 )胆汁FCh和甘氨酸胆酸 (GCA )及甘氨酸脱氧胆酸 (GDCA )的浓度。结果　 ( 1)与C组比较 ,A组及B组的血浆PL均明显升高 (P <0 .0 5 ,P <0 .0 1) ,A组血浆TG明显升高 (P <0 .0 5 ) ;( 2 ) 3组间血浆TCh及FCh差异无显著性 (P >0 .0 5 ) ,B组的血浆HDL Ch ,A组及B组的血浆HDL2 Ch均显著低于C组 (P <0 .0 1) ,而A组及B组HDL3 Ch则显著高于C组 (P<0 .0 1,P <0 .0 5 ) ;( 3 )B组胆汁GCA及A组和B组胆汁GDCA显著低于C组 (P <0 .0 5 ,P <0 .0 5 ,P <0 .0 1) ,但 3组间GCA /GDCA比值差异无显著性 (P >0 .0 5 ) ;( 4 )A组及B组胆汁中的FCh较C组显著升高 (P <0 .0 5 )。结论　兔胆道不全梗阻并感染可引起肝脏HDL合成减少与成熟障碍 ,造成胆固醇的转运及代谢异常 ,从而导致胆汁酸分泌减少 ,胆汁中胆固醇浓度升高。提     

胰腺癌和慢性胰腺炎趋化因子的表达及其意义

目的　目的探讨胰腺癌和慢性胰腺炎组织中白细胞介素8 (IL 8 )、单核细胞趋化蛋白1(MCP 1 )和巨噬细胞炎性蛋白1α(MIP 1α)的表达及其生物学意义,并探讨三者在胰腺癌中表达的相互关系。方法　采用ABC免疫组织化学法检测5 1例胰腺癌和1 0例慢性胰腺炎手术切除标本的上述各项指标。结果　胰腺癌IL 8,MCP 1和MIP 1α表达阳性率及其评分明显高于慢性胰腺炎(P< 0. 0 1 )。高分化腺癌的IL 8显著高于低分化腺癌(P < 0. 0 5 );未转移癌三者阳性率及评分明显低于伴转移病例(P< 0. 0 5或P < 0. 0 1 )。结论　IL 8,MCP 1,MIP 1α三者表达均为反映胰腺癌发生发展、生物学行为、转移发生及其预后的重要化学趋化因子;三者可能存在着相互影响和共同调控的作用途径。     

急性重症胆管炎患者胆汁中内皮素及降钙素基因相关肽的检测及意义

目的 探讨急性重症胆管炎（ACST）患者胆汁中内皮素（ET）及降钙素基因相关肽（CGRP）浓度的变化及意义。方法 采用放射性免疫分析法检测了55例ACST患者术中、术后7、14d胆汁中ET及ERCP的浓度。结果 ACST患者术中胆汁ET的浓度显著高于对照组（P＜0．01－0．001）,病情严重程度不同的两组病例术中胆汁ET的浓度差异也有显著性（P＜0．05）;术后胆汁中ET的浓度逐渐下降。术中胆汁CGRP的浓度显著低于对照组（P＜0．01）,术后胆汁中CGRP的浓度逐渐升高。结论 ET参与了ACST肝胆系统的病理损害过程,胆汁中ET的浓度与ACST病情严重程度呈正相关;胆汁中ET与CGRP二者间的平衡紊乱可能在ACST肝胆系统的病理损害过程中具有重要意义。     

胰腺癌糖胺聚糖及其组成成分测定的意义

目的探讨胰腺癌糖胺聚糖(GAG)含量及组成成分含量变化的临床意义.方法采用生化分析及免疫组化方法对30例胰腺导管癌和2例正常胰腺组织中GAG的含量及成分进行检测.结果胰腺癌中GAG含量(3.05mg±0.75mg/湿组织g)明显高于正常胰腺组织(1.39mg±0.01mg/湿组织g),(P<0.05).随着肿瘤细胞分化程度的降低,透明质酸(HA)和硫酸软骨素(CS)的含量逐渐增多,硫酸乙酰肝素(HS)逐渐减少.结论胰腺癌组织中的GAG含量和功能均与正常组织不同,这可能是导致胰腺癌早期容易发生浸润转移的生物学特性的物质基础.     

Crystalglobulinemia causing cutaneous vasculopathy and acute nephropathy in a kidney transplant patient

We present a rare case of crystalglobulinemia causing cutaneous vasculopathy and acute nephropathy in a 66-year-old female kidney transplant recipient. The patient presented with acute kidney injury (AKI), volume overload, anuria, retiform purpura, and blue-black necrosis of her toes. She received a living kidney transplant 7 months earlier with baseline creatinine of 0.6 mg/dl. Transplant kidney biopsy showed massive pseudo-thrombi filling glomerular capillary lumina. Electron microscopy of thrombi revealed an ultrastructural crystalline pattern of linear and curvilinear bundles with ladder-like periodicity typical of crystalglobulin-induced nephropathy. Similar crystalline pseudo-thrombi were detected ultrastructurally in a skin biopsy specimen, indicating systemic involvement. She required several sessions of hemodialysis. Plasmapheresis was initiated to decrease the number of circulating crystalglobulins. In order to treat the underlying paraproteinemia, the patient was started on bortezomib and dexamethasone. After treatment with five cycles of bortezomib, the patient's free kappa to lambda ratio improved to 2.35 from 5.52. Acute kidney injury (AKI) and the cutaneous vasculopathy gradually improved with treatment. This is an extremely rare occurrence of crystalglobulin in a living kidney transplant recipient.     

23 COX-2和 HER-2在结直肠癌中的表达及其意义

为研究COX 2和HER 2在结直肠癌中的表达及其临床意义以及两者的相互关系，笔者采用免疫组化法检测123例结直肠腺癌及其中的25例淋巴结转移灶组织、12例远癌肠黏膜组织、15例结直肠腺瘤性息肉组织COX 2和HER 2的表达情况。结果示，COX 2在远癌组织、腺瘤性息肉、腺癌中的高表达率分别为0%，33.3％，81.3％，三者差异有统计学意义（P<0.001）;腺癌中COX 2的高表达与Dukes分期、淋巴结转移和浸润层次有关;HER 2的高表达在腺癌（67.5％）与腺瘤性息肉（80.0%）之间差异无统计学意义，但均高于远癌肠黏膜（33.3%）（P<0.05）;HER 2的胞膜高表达与浸润层次有关;在淋巴结转移灶中COX 2和HER 2具有相关性(χ2=3.949，P<0.05，c=0.3693）。提示 COX 2在正常组织、腺瘤性息肉及腺癌中的表达逐步上调;COX 2可能是结直肠癌发生的早期事件;COX 2的高表达及HER 2胞膜的高表达均与肿瘤侵袭性增高有关。     

成人肠套叠40例临床分析

目的 探讨成人肠套叠的临床特点及诊治措施。方法 对1971—2001年收治的40例成人肠套叠诊治经过进行回顾性分析。结果 成人肠套叠临床表现主要是腹痛、腹胀、呕吐、腹部肿块、血便或便秘。全组病例有腹痛、腹块、血便三联症者仅占17．4％(7／40)。急性肠套叠者易发生肠绞窄，慢性肠套叠者多表现为不全性肠梗阻，早期易于误诊。本组39例行手术治疗，治愈37例，死亡1例；另1例钡灌肠复位成功。结论 B超检查对早期诊断有帮助。肠道肿瘤、息肉、炎症和解剖学异常为本病的主要诱因。肠切除术是根除病因、防止复发的主要手段。     

女性甲状腺功能状态与乳癌的关系

目的　了解女性甲状腺功能状态与乳癌的关系。方法　１９９２ 年１ 月～１９９８ 年１ 月对１ ８２０ 名无甲状腺疾病史妇女，６３ 名原发性甲状腺机能减退妇女和１６８ 名原发性甲状腺机能亢进妇女的乳癌发生情况进行了调查。结果　甲状腺功能减退者，乳癌发生率高于正常人。结论　甲状腺功能减退是乳癌发生的危险性因素。     

5 LOXmRNA和VEGFmRNA在胰腺癌中的表达及其临床意义

目的研究5脂氧合酶（5-LOX）在胰腺癌中的表达及其与血管内皮生长因子（VEGF）的关系.方法用RT-PCR检测5-LOXmRNA和VEGFmRNA在35例胰腺癌新鲜组织中的表达.结果5-LOX mRNA和VEGF mRNA在胰腺癌组织中的表达率分别为74.3%及60%,均与胰腺癌的临床分期有关;VEGF还与胰腺癌的分化程度有关.5-LOX mRNA和VEGF有协同作用（P＜0.05）,呈密切正相关（r=0.5 35,P＜0.01）.Ⅲ～Ⅳ期5-LOX mRNA表达明显高于Ⅰ～Ⅱ期（P＜0.05）.结论5-LOXmRNA和VEGFmRNA在胰腺癌中表达增高,与临床分期有关.5-LOXmRNA和VEGFmRNA表达呈正相关.     

乌司他丁治疗急性胰腺炎的实验及临床研究

目的 探讨乌司他丁对急性胰腺炎（AP）时炎症介质、细胞因子产生的影响和其对AP的治疗效果。方法 分别观察实验性AP大鼠和临床AP患者血清肿瘤坏死因子α、一氧化氮、氧自由基和淀粉酶的变化,以及乌司他丁对临床AP症状、体征和胰腺CT影像学变化的影响。结果 乌司他丁可使实验性AP大鼠和临床AP患者血清肿瘤坏死因α、一氧化氮、氧自由基和淀粉酶含量明显下降;并可明显控制临床AP患者的症状和体征,对AP的治疗有效率达90%。结论 乌司他丁可明显抑制AP时炎症介质、细胞因子的产生,是治疗AP的有效药物。     

成人肠套叠的诊断和治疗:附58例报告

目的 探讨成人肠套叠的发病机制及诊断和治疗方法。方法 回顾性分析58例成人肠套叠的临床表现、类型、诊断及治疗方法。结果 阵发性腹痛55例，恶心呕吐34例，腹部包块38例。引起套叠原因主要是炎性水肿(11例)、良性肿瘤(15例)和恶性肿瘤(10例)。55例接受手术治疗，3例行钡灌肠复位。58例均康复出院。结论 成人肠套叠多由器质性病变引起，其发生由多个因素共同作用所致；诊断主要依据临床表现和辅助检查；治疗以手术为主。     

胆总管结石的诊疗进展

随着诊疗设备和技术的不断更新和发展,目前胆总管结石的诊疗方向沿着更加安全性、微创性、高效性的理念发展.本文通过查阅并总结相关文献,就胆总管结石诊疗方法方面的新进展做一综述.     

Women in midlife: stress, health and life satisfaction

Midlife is filled with challenges and unique stressors for women, which necessitate a greater understanding of the factors that influence their life satisfaction. This study examined the relationship of family strains/changes and weight to life satisfaction, as mediated by family coping, physical activity, sleep and health stress. The findings indicated that women in midlife, who experienced more stressful life changes and had higher body mass index scores, slept fewer hours and had greater health stress, which resulted in lower life satisfaction. These results have implications for family health professionals and programmes that deal with family and health problems, including sleep, weight and stress.