Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia

BACKGROUND: Equilibration of hemoglobin concentration after transfusion has been estimated to take about 24 hours, but some studies have shown that earlier measurements reflect steady-state values in persons who have not bled recently. This study was aimed at assessing the changes over time in hemoglobin concentration after transfusion in acutely anemic patients because of recent bleeding. STUDY DESIGN AND METHODS: Thirty-two normovolemic patients recovering from an acute bleeding episode who were no longer thought to be bleeding and who received a 2- unit red cell transfusion were studied. At baseline and 15, 30, 60, and 120 minutes and 24 hours after transfusion, hemoglobin concentration and hematocrit values were measured. RESULTS: The administration of 2 units of packed red cells elicited a 24-hour increase of 22.4 +/− 6.8 g per L in hemoglobin concentration. Hemoglobin values were not different at any of the defined posttransfusion times. Hematocrit levels experienced similar changes over time. Agreement between 15-minute and 24-hour values was excellent, as only 6 percent of patients exhibited a clinically significant difference (> 6 g/L) between the hemoglobin measurements. CONCLUSION: Hemoglobin and hematocrit values rapidly equilibrate after transfusion in normovolemic patients who are recovering from an acute bleeding episode. This fact would allow a rapid assessment of the effects of transfusion and of the recurrence of bleeding in patients remaining at risk.     

经皮冠状动脉腔内成形术对急性心肌梗塞行早期血运重建

１２例急性心肌梗塞患者应用经皮冠状动脉腔内成形术进行早期血运重建，１１例梗塞相关血管再灌注血流为ＴＩＭＩ３级，残留狭窄１５．５±８．８％，１例并发血管内膜夹层形成行紧急冠状动脉旁路移植术，术后死亡。结果认为急性心肌梗塞早期直接进行经皮冠状动脉腔内成形术可实现稳定有效的血运重建，有利于减少心肌梗塞面积及心脏泵功能损害、降低再梗塞率和病死率。     

L-arginine reverses the antinatriuretic effect of cyclosporin in renal transplant patients

BACKGROUND: Cyclosporin has been shown to facilitate renal vasoconstriction and to have an antinatriuretic effect. The existence of an interference of cyclosporin with the vasodilating properties of endothelium mediated by nitric oxide production could mediate these effects. On the other hand, the infusion of the nitric oxide precursor L-arginine has been shown to induce renal vasodilatation and to facilitate natriuresis in normal volunteers. We have investigated the renal effects of the administration of an infusion of L-arginine in renal transplant patients chronically treated with cyclosporin. To facilitate the analysis of the data the effects of the administration of a similar dose of cyclosporin on renal function during the infusion of a vehicle were also investigated during the administration of a vehicle of L-arginine. DESIGN: Ten male renal transplant patients, chronically treated with cyclosporin and with a stable renal function were studied during 2 consecutive days after the administration of the usual morning dose of cyclosporin. The first day they received an intravenous infusion of vehicle and the second the infusion of graded doses of L-arginine (50, 100, 150 mg/kg/h) during 3 consecutive h. RESULTS: The first day, after cyclosporin administration a significant fall (P < 0.01) was observed in natriuresis and kaliuresis in the absence of changes in renal plasma flow and glomerular filtration rate. After the administration of L-arginine significant (P < 0.01) increases of renal plasma flow, glomerular filtration rate, and natriuresis were seen. The increase in blood levels of cyclosporin after its administration did not differ between days 1 and 2. CONCLUSION: These results indicate that L-arginine facilitates renal vasodilatation and natriuresis in renal transplant patients. Furthermore, the observed increase in sodium excretion could indicate that L-arginine counteracts the antinatriuretic effect of cyclosporin.      

胆汁返流性胃炎胃粘膜超微结构研究

为探讨胆汁返流性胃炎的发病机理和应用中药治疗此病的效果，作者进行了胃粘膜超微结构观察。在治疗前、后取胃粘膜做光、电镜检查，发现本病胃粘膜变化突出的特点是淋巴细胞侵入腺细胞内，溶解腺细胞，破坏细胞间联接装置，使腺腔破溃，腺管萎缩。以上变化可占全部病例的８７．５％。另一特点是腺细胞内出现微囊（８例中有４例），这在慢性胃炎尚未见有电镜观察报道。作者认为胆汁返流性胃炎可以是慢性萎缩性胃炎的前驱，而腺体萎缩的原因是由于淋巴细胞的浸润破坏；这为由细胞介导引起的胃腺细胞损伤提供了形态学依据。     

Cerebrospinal fluid purine metabolites after complex febrile convulsions

Adenosine monophosphate, inosine monophosphate, inosine, adenosine, guanosine, adenine, guanine, hypoxanthine, xanthine and uric acid were determined in cerebrospinal fluid (CSF) of 15 children after complex febrile seizures (CFS) and in 27 after simple febrile seizures (SFS), and compared with those in a control group of 63 children. There was no statistically significant difference between the groups for any of these metabolites, suggesting that CFS and SFS neither significantly disturb the metabolism of nucleotides, nucleosides or bases nor significantly deplete neuron adenosine triphosphate levels.     

经左颈静脉肝内门腔静脉支架分流术（附12例报告）

为解决肝硬变门脉高压患者在经颈静脉肝内门腔静脉支架分流术中右颈静脉窄或闭的难题，我们做了经左颈静脉途径完成肝内门腔分流术的尝试。自１９９３年７月至１９９５年８月，共１７８例ＴＩＰＳＳ操作中发现１２例右颈静脉狭窄或闭塞。其方法为经左颈内静脉穿刺、插管入路。     

高血糖对非胰岛素依赖型糖尿病患者红细胞（Ca~（2＋）－Mg~（2＋））－ATP酶的影响

为了解高血糖对非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者红细胞膜（Ｃａ２＋－Ｍｇ２＋）－Ａｒｐ酶的影响，采用改良的Ｈａｎａｈａｎ和Ｌｕｔｈｒａ法测定了红细胞膜（Ｃａ２＋－Ｍｇ２＋）－ＡＴＰ酶活性。结果表明，ＮＩＤＤＭ患者红细胞膜（Ｃａ２＋－Ｍｇ２＋）－ＡＴＰ酶活性降低，且与空腹血糖、糖化血红蛋白、果糖胺及红细胞变形指数呈负相关，后者与红细胞内Ｃａ２＋浓度呈正相关。说明（Ｃａ２＋－Ｍｇ２＋）－ＡＴＰ酶活性下降时，红细胞变形能力降低，可能与患者红细胞膜蛋白的过度糖化及细胞内Ｃａ２＋浓度的增高有关。     

直肠癌患者手术前后MG—Ags的表达及临床意义

用免疫放射法测定31例直肠癌患者血清MG-AgS水平,并与26例结肠息肉组进行对比。结果发现:直肠癌组术前血清MG-AgS水平显著高于对照组(P＜0.01);手术前后血清MG-AgS水平差异显著,术前高于术后(P＜0.01);术前MG-AgS水平与病理分期关系密切,随病理分期增加而升高;术后复发组血清MG-AgS水平高于无复发组(P＜0.01)。提示MG-AgS测定有助于直肠癌的诊断、治疗和对预后的估计。     

“强力”饮料对大鼠心肌组织化学的影响

“强力”饮料是增强体质的强壮饮料,内含多种氨基酸、微量元素和维生素。临床观察和动物试验已证明可改善人和动物的运动能力。30支Wistar雄性大鼠随机地分为三组:实验Ⅰ组、实验Ⅱ组和对照组。实验Ⅰ组每日服“强力”饮料,实验Ⅱ组每日服水。观察10天后,实验组Ⅰ和Ⅱ配对进行最大游泳试验。左心肌进行了下述组化反应:糖原:Akpase,ACPase ATPase和SDH。结果说明实验Ⅰ组和Ⅱ组的糖原,AKPase和ACPase之间存在明显的差异。结论为强力饮料可能改善或延缓大鼠运动时心肌缺血。     

PBL-CBL整合教学在内分泌科轮转临床医学专业学位研究生培养中的应用

目的 探讨以问题为基础的学习（problem-based learning,PBL）-以案例为基础的学习（case-based learning,CBL） 整合教学在内分泌科轮转临床医学专业学位研究生培养的效果。方法 将80名在内分泌科轮转的临床医学专业学位研究生随机分为试验组（采用PBL-CBL整合教学）和对照组（采用传统教学）,每组40人,轮转期为3个月。记录两组学生入科和出科时专业考试成绩,并通过问卷调查分析自信心、学习主动性和人际交往能力。采用SPSS 20.0进行t检验、卡方检验。结果 两组学生基线情况一致,经过3个月的转轮期后,与入科前相比,试验组学生的出科考试成绩、自信心、学习主动性和人际交往能力明显提升,差异均有统计学意义（P<0.001）。结论 PBL-CBL整合教学效果优于传统教学,有助于提高临床医学专业学位研究生在内分泌轮转的学习能力和成绩,值得推广。