心脏移植术后肾功能衰竭的围手术期处理(附2例报告)

目的报告2例原位心脏移植术后肾功能衰竭的发生及治疗经过,探讨其围手术期处理的初步经验和要点.方法我院自2000年12月一2002年12月共对4例终末期心脏病患者施行同种异体原位心脏移植术,4例均为男性,采用标准原位心脏移植术,术后应用三联免疫治疗的方法抗排异.结果4例患者均获得手术成功,术后未发现超急性排斥反应或急性排斥反应,2例术后1周左右并发急性肾功能衰竭,应用床边连续肾脏替代(CRRT)治疗后,1例存活22d,1例完全康复,随访半年患者心功能恢复Ⅰ～Ⅱ级(NYHA),生活质量良好.结论心脏移植手术后肾功能损害较常见,围手术期的肾功能保护非常重要,如符合手术指征,及早手术治疗是抢救成功的关键.     

TNF alpha and Fas mediate tissue damage and functional outcome after traumatic brain injury in mice.

Tumor necrosis factor-alpha (TNFalpha) and Fas are induced after traumatic brain injury (TBI); however, their functional roles are incompletely understood. Using controlled cortical impact (CCI) and mice deficient in TNFalpha, Fas, or both (TNFalpha/Fas-/-), we hypothesized that TNFalpha and Fas receptor mediate secondary TBI in a redundant manner. Compared with wild type (WT), TNFalpha/Fas-/- mice had improved motor performance from 1 to 4 days (P<0.05), improved spatial memory acquisition at 8 to 14 days (P<0.05), and decreased brain lesion size at 2 and 6 weeks after CCI (P<0.05). Protection in TNFalpha/Fas-/- mice from histopathological and motor deficits was reversed by reconstitution with recombinant TNFalpha before CCI, and TNFalpha-/- mice administered anti-Fas ligand antibodies had improved spatial memory acquisition versus similarly treated WT mice (P<0.05). Tumor necrosis factor-alpha/Fas-/- mice had decreased the numbers of cortical cells with plasmalemma damage at 6 h (P<0.05 versus WT), and reduced matrix metalloproteinase-9 activity in injured brain at 48 and 72 h after CCI. In immature mice subjected to CCI, genetic inhibition of TNFalpha and Fas conferred beneficial effects on histopathology and spatial memory acquisition in adulthood (both P<0.05 versus WT), suggesting that the beneficial effects of TNFalpha/Fas inhibition may be permanent. The data suggest that redundant signaling pathways initiated by TNFalpha and Fas play pivotal roles in the pathogenesis of TBI, and that biochemical mechanisms downstream of TNFalpha/Fas may be novel therapeutic targets to limit neurological sequelae in children and adults with severe TBI.     

我省医学临床教学基地建设的现状与思考

对我省医学临床教学基地评审结果进行分析，就大部分基地教学意识不强、教学设施不完善、教学条件有待改善、师资队伍素质水平不高等问题进行了阐述，并针对存在的问题提出建议和思考，从建章立制规范管理、加强建设、提供保障、重视培训、提高素质、强化管理、创新机制等方面进行探索，希望能使我省医学临床教学基地质量得以提高、完善，为我省培养一流的医学专业人才奠定基础．     

Management of bacterial peritonitis and exit‐site infections in continuous ambulatory peritoneal dialysis*

SUMMARY: Peritonitis and exit‐site infections remain the most important limitations to the delivery of continuous ambulatory peritoneal dialysis (CAPD). Contamination of the peritoneum, from endogenous or exogenous sources, is responsible for most peritonitis episodes. Patients usually present with a cloudy bag, although other causes should be distinguished. Clinical suspicion of peritonitis should be followed rapidly by microbiological examination and empirical treatment. Microbiological confirmation allows for subsequent treatment based on sensitivities. Other interventions such as catheter removal may be appropriate in some patients. Exit‐site infections should also be identified and treated early. Peritonitis may be further prevented by adequate exit‐site care, hygienic methods, and techniques to minimise early contamination of the exit site. Mupirocin may also have a role in preventing infections caused by Staphylococcus aureus.     

蝌蚪提取液诱导人早幼粒白血病细胞分化的实验研究

目的 :探讨蝌蝌提取液 (T871)对白血病细胞的诱导分化作用。方法 :利用细胞生长曲线、形态学观察、细胞免疫化学及原位mRNA杂交和完整细胞原位斑点印迹技术 ,观察了T871诱导HL 60细胞分化的作用和分化过程中癌基因c myc、c myb表达的变化。结果 :T871能抑制HL 60细胞的增殖 ,形态学表现为类似单核 /巨噬细胞 ,同时T871还能使HL 60细胞的NBT还原能力、ANAE活性显著增强 ,同时伴有癌基因c myc、c mybmRNA表达的下调。结论 :T871能诱导HL 60细胞向单核 /巨噬细胞方向分化 ,c myc、c myb癌基因可能参与了此过程     

促通技术治疗偏瘫的疗效观察

应用促通技术治疗偏瘫20例，治疗前后对患者的肢体运动功能分别进行Brunnstrom评定和Fugl-Meyer评分。结果显示经促通技术治疗后患者的肢体运动功能明显恢复（P＜O.001），且Brunnstrom评定与Fugl-Meyer运动积分密切相关。本组治愈率为35％，有效率为100％。促通技术是一种有效的治疗偏瘫的方法。     

蜂花粉醇提物对小鼠体外生成过氧化脂质的影响

组织器官的衰老与过氧化脂质的生成密切相关，本实验证明蜂花粉醇提物有明显的对抗小鼠肝、肾、脑组织在体外生成过氧化脂质的作用，证明蜂花粉具有延缓衰老的作用。     

运动训练对雄性大鼠垂体─性腺轴功能的影响

本研究通过使用自己制造的大鼠流动水游泳池，对雄性大鼠进行了６周递增负荷的游泳训练，以此来探讨运动训练对大鼠垂体－性腺轴功能的影响，结果显示：与安静对照大鼠相比，训练大鼠的一般状态较差，血清睾酮水平显著降低（Ｐ＜０．０５），血清睾酮／皮质酮比值平均降低了３０％以上；而血清ＬＨ和ＦＳＨ水平未见明显变化。通过对大鼠睾丸组织ＬＨ／ＣＧ受体的测定，显示运动训练虽未引起其最大结合量的改变，却能使其解离常数显著升高（Ｐ＜０．０５）。提示此种训练可能通过降低睾丸ＬＨ／ＣＧ受体对垂体分泌ＬＨ的亲和力，从而影响睾酮的合成。     

Traumatic or septic aortic regurgitation: diagnosis by oesophageal echocardiography

Severe aortic regurgitation was discovered in a young man 21 days after blunt chest trauma and after a prolonged febrile state with positive blood cultures. Using transoesophageal echocardiography (TEE), it was possible to make the differential diagnosis between traumatic rupture and endocarditis as the cause of valvular insufficiency. The use of TEE in the initial evaluation of severe thoracic trauma with an unclear clinical picture is recommended. This method is easy to use at the bedside and gives precise information on the aortic valve and the ascending aorta.