反应停治疗难治性多发性骨髓瘤6例

目的：探讨反应停治疗难治性多发性骨髓瘤(MM)的临床疗效。方法：对6例难治疗性多发性骨髓瘤应用反应停治疗后的临床资料进行分析，并结合文献复习，为该病的治疗提供一条思路。结果：1例患者达完全缓解；1例患者达部分缓解；1例进步，血清M蛋白减少35％、骨痛明显减轻、血沉降低40％、血红蛋白上升20g／L；2例无效；1例死亡。结论：反应停对多发性骨髓瘤有较好的疗效，不良反应可以耐受且不产生骨髓抑制：抗血管新生是其主要疗效机制。     

内毒素血症时大鼠脂多糖结合蛋白的变化及其意义

目的　探讨内毒素血症时大鼠肝组织中脂多糖结合蛋白mRNA的表达、血浆中脂多糖结合蛋白 (LBP)含量的变化及其意义。方法　经大鼠尾静脉注入内毒素 (5mg/kg)建立内毒素血症动物模型 ,检测不同时点模型鼠肝组织中LBPmRNA的表达 ,同时检测血浆中LBP、内毒素、TNF α及IL 6含量的变化 ,并与对照组相比较。另取肝组织在电镜下观察其病理学改变。结果　随着内毒素血症时间的延长 ,内毒素组大鼠肝组织LBPmRNA的表达明显增强 ,血浆中LBP、TNF α和IL 6含量也明显增加 ,与对照组比较差异有高度显著性 (P<0 .0 1)。电镜观察见肝细胞脂肪变 ,线粒体空化 ,枯否氏细胞数量增多、体积增大、吞噬功能增强。结论　内毒素血症时 ,大鼠肝组织中LBPmRNA表达明显增强 ,血浆中LBP含量也明显增加。由此提示 ,增高的LBP可能在脂多糖介导的枯否氏细胞激活及产生、释放各种炎性介质中可能起了重要作用。     

多发性硬化和其他神经系统疾病脑脊液寡克隆区带的初步观察

作者用聚丙烯酰胺凝胶电泳法对165例神经系统疾病患者进行了脑脊液的寡克隆区带(O-B)检测,观察到多发性硬化及散发性脑炎患者的O-B检出率较高,非炎性神经系统疾病患者仅少数出现O-B。本法取材少,脑脊液不需浓缩,方法简便,检出率高,适合临床应用。     

改进时间差攻击疗法治疗多重耐药阴沟肠杆菌的探究

[目的]研究利用改进的时间攻击疗法治疗多重耐药阴沟肠杆菌引起的感染的效果，并考究其与亚胺培南/西拉司丁治疗及传统时间攻击疗法的药物经济学成本/效果比。[方法]将38例明确诊断为产ESBLs阴沟肠杆菌感染且药敏结果皆为：对哌拉西林、环丙沙星、氧氟沙星、左旋氧氟沙星、庆大霉素、妥布霉素、头孢他啶、头孢噻肟、头孢哌酮、头孢曲松、头孢哌酮/舒巴坦、替卡西林/克拉维酸等皆耐药，而对亚胺培南/西拉司丁敏感的患者随机分为改进组、对照组、传统组。改进组患者先与磷霉素4g＋5%葡萄糖100ml于30min静脉滴注完毕后，再过30min立即给予阿米卡星0.4g＋0.9%NS250ml静脉滴注，上述治疗每日1次。对照组患者给予亚胺培南/西拉司丁1g＋0.9%NS250ml静脉滴注，每日3次。传统组患者先与磷霉素2g＋5%葡萄糖50ml静脉给予1h完毕后，立即给予阿米卡星0.2g＋0.9%NS100ml静脉滴注，上述治疗每日2次。疗程最长限为10d，其余检查治疗3组相同。考察3组的细菌清除率以及细菌清除所需的药物费用、不良反应的比较。[结果]改进组细菌清除率与对照组、传统组差异无统计学意义，并且改进组、传统组无不良反应，对照组有1例二重感染；而且改进组与对照组、传统组的细菌清除药物治疗费用差异有统计学意义。[结论]利用磷霉素＋阿米卡星的改进时间攻击差疗法能很好的治疗多重耐药的阴沟肠杆菌引起的感染，并且与采用亚胺培南/西拉司丁治疗方案及传统的时间攻击疗法相比具有较好的成本/效果比。     

Control accuracy and response time in multiple-state myoelectric control of upper-limb prostheses. Initial results in nondisabled volunteers

In myoelectrically operated prosthetic systems control performance decreases with an increasing number of possible movements. A test has been designed that allows quantification of two related qualities of performance. A predefined amount of training was given to 40 nondisabled volunteers without previous prosthetic experience. After training they attempted the test. The two parameters measured were the response time and the control accuracy corresponding to the different movements. It is concluded that even with a very limited amount of training fairly complex control systems can be operated with acceptable performance.     

复方保元煎对绝经后CHD患者脂代谢和血流变影响的研究

目的:研究复方保元煎对绝经后冠心病(CHD)患者脂代谢、血流变的影响。方法:观察180例患者,随机分为治疗组102例,对照组78例。治疗组采用中药复方保元煎治疗,对照组采用维尼安治疗,分别于治疗前后测定脂代谢、血流变指标。结果:治疗后两组脂代谢、血流变指标均有不同程度的改变。治疗组在降低总胆固醇(TC)、甘油三酯(TG),低密度脂蛋白(LDL-C)、载脂蛋白B(apoB)、血流变指标优于对照组(P<0.05或P<0.01)。结论:复方保元煎能改变血脂代谢、调节血黏度,对预防和逆转绝经后的CHD的发生和发展有积极的治疗作用。     

CD4+ lymphocyte subsets in the cerebrospinal fluid of multiple sclerosis and non-inflammatory neurological diseases

Summary We studied paired cerebrospinal fluid (CSF) and peripheral blood (PB) samples from 18 inactive multiple sclerosis (MS) patients and 10 with non-inflammatory neurological diseases. By means of a dual-colour cytofluorimetric micromethod we were able to count 1500 cells on average in each CSF sample. We found a significant reduction of CD45RA+ and CD4+CD45RA+ cells in the CSF of MS patients. Similarly, CD45RA+ and CD4+CD45RA+ CSF/PB ratios were lower compared with controls. The reduction of suppressor-inducer T-cells did not correlate with CD8+ cell levels in the CSF. The CD4+ subset ratio (CD4+CD45RA–/CD4+CD45RA+) was significantly increased in the CSF of MS patients. Our data suggest that the reduction of CD4+CD45RA+ cells in the PB is not due to a segregation of such cells in the CSF. Conversely, CSF changes reflect changes in the PB similar to these found for other T-cell subsets.     

Intrathecal synthesis of IgG subclasses in multiple sclerosis and in acquired immunodeficiency syndrome (AIDS)

Serum and cerebrospinal fluid (CSF) of 50 neurological patients (24 multiple sclerosis (MS), ten acquired immunodeficiency syndrome (AIDS) and 16 other neurological diseases (OND)) and ten controls were analyzed by enzyme-linked immunosorbent assay (ELISA) for IgG subclass quantification and for the calculation of intrathecal synthesis (ITS). Total IgG was determined by two methods: electroimmunodiffusion (EID) and ELISA. A highly significant correlation was established between both methods. The existence of ITS was proved by the IgG/albumin ratio, the IgG index, Tourtellotte's formula, and Schuller's formula. In AIDS patients all IgG subclasses showed an increase in the CSF, whereas in sera only the IgG1 was significantly increased. CSF of MS patients showed a predominant increase of IgG1 whereas no significant modification of IgG subclasses was observed in sera. In most of the AIDS patients there was an ITS of IgG1, IgG3 and IgG4, but rarely (3/10) IgG2. In contrast, a polyclonal ITS of IgG was exceptional (1/24) in MS patients. No significant correlation could be established between clinical data and IgG subclass ITS in MS. The variations of each IgG subclass in serum and in ITS were not significantly correlated. Measurement of each IgG subclass and calculation of ITS seems essential in order to analyze any subclass antibody repertory inside the central nervous system.     

MODS患儿血清磷酯酶A2的变化及意义

目的：探讨磷酯酶A2（PLA2）在多脏器功能障碍综合征（MODS）患儿中的作用及意义。方法：结合危重病例评分，采用ELISA法检测26例MODS患儿血清PLA2含量，并与健康体检儿童20例对照。结果：多脏器功能障碍综合征患儿血清PLA2含量明显高于正常对照组，P＜0．01，并与危重病例评分成正相关。结论：PLA2参与MODS的病理生理过程，与危重病的病情有关，并可作为早期预警多脏器功能障碍综合征的实验参数。     

药物的定量构效关系的方法学研究——改进的逐步回归算法

在定量的构效关系研究中,多重回归分析选人的参数,多是用穷举所有方程实现的。本文提出一种改进的逐步回归算法,计算实例表明,是个行之有效的方法。