心肌缺血预适应中的离子通道

缺血预适应调动机体内源性抗损伤能力，保护缺血缺氧的组织细胞，是近年来心血管领域研究的热点之一。本该对心肌缺血预适应中的离子通道、三磷酸腺苷敏感性钾通道（KATP通道）、L-型钙道道（L-Ca^2 通道）、体积调节性氯通道（Cl vol通道）的特性、作用及其机制作一综述。     

应用局部皮瓣治疗仰趾畸形

目的:探讨烧、创伤后,足背瘢痕挛缩所致仰趾畸形的治疗。方法:术中将足背瘢痕切除,彻底松解挛缩,将弓弦状伸肌腱切除部分或切断,切除部分挛缩的跖趾关节背侧关节囊,使关节复位,克氏针外固定,在拇指内侧或小趾侧,以跖趾关节处为蒂设计逆行皮瓣,转移覆盖外露的跖趾关节,供区及瘢痕切除后创面行全厚或断层皮片修复。结果:本组7例,均采用逆行皮瓣修复,畸形完全纠正,无继发畸形。结论:应用拇指及小趾侧方逆行皮瓣转移,治疗仰趾畸形可达到满意效果。     

谷胱甘肽转硫酶M1基因型与胃癌易感性的研究

目的:探讨中国汉族人群GSTM1基因型与胃癌易患性的关系,为胃癌高危人群的确定和胃癌的一级预防提供分子生物学手段。方法:501例,分为胃癌(GC)组、慢性萎缩性胃炎(CAG)组、慢性浅表性胃炎(CSG)组、胃溃疡(GU)组、十二指肠溃疡(DU)组及正常对照组,采用统一的调查表,调查年龄、性别、学历、职业、吸烟史、饮酒史、饮食习惯、肿瘤家族史等。采用序列特异性引物的聚合酶链反应(PCR-SSP)检测GSTM1基因型测定组的基因型频率,ELISA法测定Hp感染,病例对照研究方法进行流行病学分析。结果:单因素分析显示与胃癌有关联的危险因素为年龄、性别、文化程度、职业、HP感染、吸烟、GSTM1空白基因型,其中大蒜为保护性因素;多因素分析显示与胃癌有关联的危险因素分别为HP感染、GSTM1空白基因型,大蒜仍为保护性因素。HP感染与GSTM1空白基因型对胃癌的发生存在协同作用;吸烟与GSTM1空白基因型存在协同作用。结论:具有GSTM1基因型的个体发生胃癌的危险性增加,该基因型可以认为是胃癌易患性的标志。检测该基因型能够对胃癌高危人群的确定,对胃癌的早期发现和一级预防提供有益的线索。     

Glial S100B Positive Vacuoles In Purkinje Cells: Earliest Morphological Abnormality In SCA1 Transgenic Mice

Spinocerebellar ataxia-1 (SCA1) is caused by the expansion of a polyglutamine repeat within the disease protein, ataxin-1. The overexpression of mutant ataxin-1 in SCA1 transgenic mice results in the formation of cytoplasmic vacuoles in Purkinje neurons (PKN) of the cerebellum. PKN are closely associated with neighboring Bergmann glia. To elucidate the role of Bergmann glia in SCA1 pathogenesis, cerebellar tissue from 7 days to 6 wks old SCA1 transgenic and wildtype mice were used. We observed that Bergmann glial S100B protein is localized to the cytoplasmic vacuoles in SCA1 PKN. These S100B positive cytoplasmic vacuoles began appearing much before the onset of behavioral abnormalities, and were negative for other glial and PKN marker proteins. Electron micrographs revealed that vacuoles have a double membrane. In the vacuoles, S100B colocalized with receptors of advanced glycation end-products (RAGE), and S100B co-immunoprecipated with cerebellar RAGE. In SCA1 PKN cultures, exogenous S100B protein interacted with the PKN membranes and was internalized. These data suggest that glial S100B though extrinsic to PKN is sequestered into cytoplasmic vacuoles in SCA1 mice at early postnatal ages. Further, S100B may be binding to RAGE on Purkinje cell membranes before these membranes are internalized.     

四君子汤总多糖对大鼠小肠上皮株IEC-6细胞增殖的作用

背景:一些实验证明多糖在感染、炎症、细胞间黏附和信号传导、免疫识别、细胞增殖分化及维持细胞正常结构和功能生理、病理等方面均起重要作用。但植物多糖对胃肠道黏膜的保护作用有待进一步研究。目的:观察不同浓度的四君子汤总多糖对大鼠小肠上皮株IEC-6细胞增殖的影响。设计:观察对比实验。单位:广东省中医院中心实验室。材料:①细胞株:正常大鼠小肠上皮细胞株IEC-6(ATCCCatalogNo.RL-1592)由美国ATCC(AmericanTypeCultureCollection)购得,主要来源于小肠隐窝细胞。②试剂和药品:DMEM培养基,牛胰岛素,庆大霉素,胎牛血清,DPBS均为GIBCO公司产品;细胞增殖试剂盒(MTT)为Roche公司产品;消炎痛为Sigma公司产品。四君子汤总多糖按药典处方比例取党参,白术,茯苓和甘草适量,加水浸泡后,煮沸提取4h,重复1次,合并提取液,减压浓缩,高速离心除去不溶物,提取液置玻璃纸中逆向流水透析2h,再于提取液中加乙醇至浓度约80%,保存过夜后分取沉淀,合并所有沉淀,采用Sevag法除去粗多糖中的蛋白,冻干后得到的总多糖。方法:①将IEC-6细胞株于干冰中取出,迅速放入37℃水浴中解冻后,加入已装有DMEM培养液的T-150培养瓶后放入CO2培养箱中,于37℃,饱和湿度,体积分数为0.05的CO2环境下培养。细胞隔天换液1次,每5～7天进行传代,传代比例为1∶7。第15～20代细胞用于实验。②IEC-6细胞以1×104/孔的浓度接种于96孔细胞培养板上,接种后6h,各培养孔内依次加入浓度为50,100,200mg/L四君子汤总多糖,即为四君子汤总多糖3个剂量组。每天定时取出1板,按试剂盒说明书以MTT法进行细胞增殖检测。以未加任何干预措施的IEC-细胞作为正常对照组,在相应时间点以MTT法进行细胞增殖检测。③将IEC-6细胞按1×104/孔的浓度接种于96孔细胞培养板中,接种后次日更换以无血清培养液DMEM,24小时后,各培养板中分别加入消炎痛以及四君子汤总多糖,其中,消炎痛使用浓度为40mmol/L,即为消炎痛组。四君子汤总多糖使用3个剂量分别为50,100,200mg/L,即为四君子汤总多糖50,100,200mg/L组。药物作用20h后,按试剂盒使用说明书进行MTT法细胞增殖检测。以未加任何干预措施的IEC-细胞作为正常对照组,在各相应时间点以MTT法进行细胞增殖检测。主要观察指标:MTT法测定四君子汤总多糖不同作用时间对IEC-6细胞生长的影响结果;MTT法测定四君子汤总多糖对消炎痛所致的IEC-6细胞生长抑制的影响结果。结果:四君子汤总多糖不同剂量于不同的培养时间对IEC-6细胞的生长均有促进作用;IEC-6细胞在给予消炎痛40mmol/L作用24h后,细胞增殖的吸光度明显低于正常对照组(0.17±0.02,0.31±0.03;P<0.01)。当四君子汤总多糖使用浓度为100mg/L时,IEC-6细胞的吸光度明显高于消炎痛组(0.25±0.04,0.17±0.02;P<0.01),虽然未达到正常IEC-6细胞吸光度的水平,但与正常组无明显差异(P>0.05)。结论:四君子汤总糖具有促进IEC-6细胞增殖的作用,它可能通过对小肠上皮细胞增殖的影响而发挥对肠道黏膜吸收和免疫功能的调整作用。     

Obesity in Diabetic Patients Undergoing Coronary Artery Bypass Graft Surgery Is Associated with Increased Postoperative Morbidity

Background: Despite the fact that obesity is a known risk factor for cardiovascular disease, many studies have failed to demonstrate that obesity is independently associated with an increased risk of cardiovascular morbidity and mortality in nondiabetic patients undergoing coronary artery bypass graft surgery. The authors investigated the influence of obesity on adverse postoperative outcomes in diabetic and nondiabetic patients after primary coronary artery bypass surgery.

Methods: A retrospective cohort study of patients undergoing primary coronary artery bypass surgery (n = 9,862) between January 1995 and December 2004 at the Texas Heart Institute was performed. Diabetic (n = 3,374) and nondiabetic patients (n = 6,488) were classified into five groups, according to their body mass index: normal weight (n = 2,148), overweight (n = 4,257), mild obesity (n = 2,298), moderate obesity (n = 785), or morbid obesity (n = 338). Multivariate, stepwise logistic regression was performed controlling for patient demographics, medical history, and preoperative medications to determine whether obesity was independently associated with an increased risk of adverse postoperative outcomes.

Results: Obesity in nondiabetic patients was not independently associated with an increased risk of adverse postoperative outcomes. In contrast, obesity in diabetic patients was independently associated with a significantly increased risk of postoperative respiratory failure (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.41-3.61; P < 0.001), ventricular tachycardia (OR, 2.27; 95% CI, 1.18-4.35; P < 0.02), atrial fibrillation (OR, 1.56; 95% CI, 1.03-2.38; P < 0.04), atrial flutter (OR, 2.38; 95% CI, 1.29-4.40; P < 0.01), renal insufficiency (OR, 1.66; 95% CI, 1.10-3.41; P < 0.03), and leg wound infection (OR, 5.34; 95% CI, 2.27-12.54; P < 0.001). Obesity in diabetic patients was not independently associated with an increased risk of mortality, stroke, myocardial infarction, sepsis, or sternal wound infection.     

中澳咸阳农村卫生综合项目乡镇卫生院院长管理培训效果调查

目的：评估中澳农村卫生综合项目乡镇卫生院院长管理知识培训效果。方法：采用问卷调查、焦点组访谈、个人深入访谈、现场走访等方法进行现况调查。结果：多数卫生院院长在管理基础知识的收获、分析问题的能力、观念的转变、管理行为的改变、员工士气的提高、卫生服务的改善方面都有所提高；被调查的三所中心乡卫生院的所有职工都认为所在卫生院近半年来的工作总体上有所改进；病人及周围居民对三所卫生院的总体满意度都在55％以上。结论：乡镇卫生院管理培训效果良好。     

在音乐缭绕中痊愈

你是否曾经因为它血脉贲张浑身发抖过．你是否因为它心潮起伏热泪盈眶过？如果这世界上没有它．你怕么？当天堂的圣歌响起．即使面对死亡．你也无所畏惧，它以它温柔的手．抚平你心里和肉体的伤……它让你不痛。[编者按]     

Mind-Refreshing Acupuncture Therapy for Facial Spasm, TrigeminalNeuralgia and Stubborn Facial Paralysis

Facial spasm, trigeminal neuralgia and stubborn facial paralysis are commonly seen in clinic. The authors have obtained quite good therapeutic results for the above diseases by using the mind-refreshing acupuncture therapy. These are introduced in the following.     

急性胰腺炎患者vW因子的变化及其临床意义

目的　探讨急性胰腺炎患者血浆vW因子的变化及其临床意义。方法　采用双抗体夹心固相酶免疫法测定 3 5例急性胰腺炎患者和 3 0名健康献血者的血浆vW因子水平 ,对其进行相关性分析。结果　急性胰腺炎患者入院后 2 4h血浆vW因子水平为 2 15 .0 %± 2 3 .4% ,显著高于正常对照组 10 7.5 %± 2 9.6% (P <0 .0 0 1) ;重症急性胰腺炎患者血浆vW因子显著高于轻型急性胰腺炎患者 (P <0 .0 1) ;血浆vW因子预测重症AP的敏感性、特异性和准确性分别是 91.7%、87.0 %和 88.7%。结论　急性胰腺炎患者存在血管内皮损伤 ;测定急性胰腺炎患者血浆vW因子水平可早期预测病情的严重程度