Recurrent acalculous cholecystitis and sclerosing cholangitis in a patient with X-linked hyper-immunoglobulin M syndrome.

X-linked hyper-immunoglobulin M (IgM) syndrome (XHIGM) is a rare genetic primary immunodeficiency disease caused by mutations of the CD40 ligand (CD40L) gene with normal or elevated levels of IgM and markedly decreased serum IgG, IgA, and IgE. Liver disease may occur as a clinical manifestation in XHIGM. This complication appears to increase with age. We report an 18-year-old male patient who had recurrent episodes of acalculous cholecystitis (AC) and sclerosing cholangitis (SC). The diagnosis of XHIGM was confirmed by the finding of CD40L expression < 1% of normal and a tyrosine 169 asparaginase (t526a) mutation in exon 5 (the tumor necrosis factor domain) of the CD40L gene. The patient had direct hyperbilirubinemia (direct bilirubin 5.5 mg/dL, total bilirubin 8.7 mg/dL), cholestasis (alkaline phosphatase 1133 U/L, gamma-glutamyl transferase 1019 U/L) and elevated transaminases (aspartate aminotransferase 70 U/L, alanine aminotransferase 101 U/L). Findings on abdominal ultrasound and abdominal computed tomography were compatible with AC. After the fourth episode of cholecystitis, cholecystectomy and liver biopsy were performed. Operative cholangiography revealed poor opacification of the hepatic duct and proximal common bile duct; the upstream intrahepatic bile ducts were not visualized. The biopsy specimen showed marked fibrosis of the portal areas. Enterococcus species was cultured from the bile. Children or adolescents with recurrent AC and SC should be evaluated for an underlying immunodeficiency syndrome such as XHIGM.     

Elimination of malignant clonogenic cells from human bone marrow using multiple myeloid cell-specific monoclonal antibodies and complement.

Single or combined monoclonal antibodies (McAbs) Zh53, Zh820, and Zh2-1 have been used to eliminate malignant clonogenic cells from human bone marrow. The test of cytotoxicity showed that all of these McAbs could express high specific cytotoxic action against HL-60 cells and were selectively complement-dependent cytotoxic to various types of fresh leukemic cells. Clonogenic assay detected that single treatment with antibody and rabbit complement (RC) could reduce clonogenic units of HL-60 cells by more than 2 logs and two treatments reduced clonogenic units by more than 4 logs. However, combination of 2 McAbs could reduce clonogenic units by 4-5 logs. The data suggest that multiple treatments with McAbs and RC or a combination of 2 McAbs are more effective than a single treatment in eliminating clonogenic tumor cells. Treatment of normal human bone marrow with Zh53, Zh2-1 and RC did not produce a loss of normal CFU-GM, but treatment with Zh820 reduced the clonic units of normal CFU-GM by 24%.

     

灯盏花素注射液对大鼠脑缺血-再灌注脑损害的凋亡抑制作用

目的:研究灯盏花素(Bre)对大鼠脑缺血-再灌注引起脑损伤的保护作用。方法:实验选用40只雄性Wistar大鼠,大鼠被随机分成5组:假手术组、对照组、硫酸镁(Mg-SO4)治疗组、灯盏花素治疗和组。自大鼠颈总动脉插入尼龙线栓栓塞大脑中动脉,造成大脑缺血,拔出线栓实现再灌注。脑缺血10min后给予75mg/kg和50mg/kgBre及30mg/kgMgSO4,分别于脑缺血1h,再灌注2h,5h和23h分别进行神经病学评分,并于脑缺血1h,再灌注23h时测定脑梗死面积,用TUNEL法和免疫组化法分别检测脑组织凋亡细胞和Caspase-3阳性细胞的变化。结果:灯盏花素降低脑缺血-再灌注大鼠神经病学评分,缩小脑梗死面积,降低脑组织凋亡细胞和Caspase-3阳性细胞数量,其作用强于硫酸镁。结论:灯盏花素通过抑制细胞凋亡可显著保护大脑缺血-再灌注引起的脑损伤,其作用优于单用硫酸镁。     

Association of the Platelet Glycoprotein Ⅰa C807T Gene Polymorphism With Risk of Myocardial Infarction in Chinese

Objectives To investigate the relationship of the GPIa C807T dimorphism to the risk of myocardial infarction (MI) in Chinese. Methods We did a case-control study including 100 patients and 110 controls with same race. An allele-specific polymerase chain reaction (PCR) was used for genotyping of C807T polymorphism. Results An apparent association was found between the T807 allele and MI among individuals younger than the mean age of 60 years (odds ratio,2.49; 95% confidence interval, 1.08 ～ 6.22 ). The T807 allele remained an independent risk factor for MI when age, sex, smoking, hypertension, diabetes, bodymass index, LDL-cholesterol and HDL-cholesterol were adjusted by logistic regression. Conclusions GPⅠa T807 appears to be an independent risk factor for MI.     

Neurochemical studies on the mesolimbic circuitry of antinociception

Previous studies using the technique of microinjection into brain nuclei indicated that the periaqueductal gray (PAG), nucleus accumbens, habenula and amygdala play an essential role in pain modulation and that these nuclei possibly act through a ‘mesolimbic neural loop‘ to exert an analgesic effect, in which Met-enkephalin (MEK) and β-endorphin (β-EP) have been implicated as the two major opioid peptides involved in antinociception. In the present study performed in rabbits, intracranial microinjection was supplemented with push-pull perfusion and radioimmunoassay to determine whether the release of enkephalins (ENK) and β-EP was increased in these nuclei when the putative neural circuit was activated by morphine administered into one of the nuclei. The results showed: (1) microinjection of morphine into the PAG increased the release of ENK and β-EP in the N. accumbens, and vice versa; (2) microinjection of morphine into the N. accumbens increased the release of ENK and β-EP in the amygdala, and vice versa; (3) morphine microinjected into the PAG caused an increase in the release of ENK and β-EP in the amygdala and vice versa, although the release of ENK in PAG was statistically not significant. These results indicate that PAG, N. accumbens and amygdala are connected in a network served by a positive feedback circuitry.     

利福喷汀治疗耐利福平肺结核的疗效分析

目的分析增加利福喷汀的用药剂量对利福平耐药肺结核的疗效，以评价利福喷汀在治疗利福平耐药患者中的作用。方法根据药敏结果选取耐利福平肺结核患者101例，分为治疗1组（利福平低耐），治疗2组（利福平高耐），两组治疗方案中均含利福喷汀，对照组（利福平高耐）治疗方案中不合利福喷汀。观察治疗后3、18个月疗效。结果治疗1组在各阶段的痰菌阴转率、病灶吸收和空洞闭和情况明显优于治疗2组和对照组，两组差异有统计学意义；治疗2组的痰菌阴转率、病灶吸收和空洞闭和情况略优于对照组，两者差异无统计学意义。结论对利福平耐药的患者尤其在利福平低度耐药病例中，可以选择增加利福喷汀用药剂量的方案进行治疗，在利福平高度耐药病例中利福喷汀的作用不能确定。     

中药内外并用抗尖锐湿疣复发的临床研究

目的：观察中药消疣丸/消疣擦剂内服外用防止尖锐湿疣复发的作用.方法：应用免疫学方法，检测患者治疗前后外周血T淋巴细胞亚群CD3、CD4、CD8的百分率和CD4/CD8的比值.结果：局部消除疣体后中药消疣丸/消疣擦剂内服外用对防止尖锐湿疣复发有显著疗效，痊愈率为99.66%，复发率为3.33%，与对照组相比有显著差异（P〈0.05）.结论：中药内服外用抗尖锐湿疣复发效果好。     

急性阑尾炎行腹腔镜手术与开放手术的对比分析

目的对比急性阑尾炎经腹腔镜切除(LA)与传统开腹切除(OA)的手术效果及优缺点。方法回顾性分析我院2004年10月—2007年10月160例急性阑尾炎(LA组80例,OA组80例)的手术情况,并对其临床资料进行统计、对比、分析。结果LA与OA的手术时间无显著性差异,LA术后疼痛程度、术后住院时间、术后切口感染等方面明显优于OA。结论LA是安全可靠的,与OA相比,具有创伤小、恢复快、并发症少和住院时间短的优势,可作为急性阑尾炎的首选手术方式。     

脑梗死急性期患者基质金属蛋白酶-9临床研究述评

本文总结近5年有关脑梗死急性期患者MMP-9的临床研究,分析发现MMP-9随脑梗死急性期病程进展呈现先升高后逐渐下降至正常水平的动态变化趋势,其表达水平与脑梗死体积大小、病情严重程度、神经功能缺损程度及近期预后有密切关系,与临床分型和中医辨证存在一定相关性,并就进一步深入研究MMP-9与疾病和中医证候的关系提出建议.