人胎胰岛体外预处理和我国的临床胰岛移植

本文报道了多种体外预处理（３７℃培养、２４℃培养与冷冻保存）对人胎胰岛免疫原性的影响，并对我国８３５例Ⅰ型糖尿病胰岛移植临床资料进行了分析。结果显示胰岛的刺激指数较未预处理者显著减低（Ｐ＜０．０５－０．０１）ＨＬＡ－ＤＲ阳性细胞计数与淋巴样细胞计数均较未预处理者显著减少，提示各种预处理均使人胎胰岛免疫原性明显降低。     

The role of paraaortic node irradiation in the treatment of cancer of the cervix

One hundred and twenty-seven patients with previously untreated carcinoma of the uterine cervix underwent pretreatment laparotomy between 1971 and 1980. Thirty-one were found to have paraaortic metastasis. Twenty-seven patients received paraaortic node external supervoltage radiation to the entire paraaortic chain, 4400 cGy, over 4 1/2 weeks, with 600-800 cGy, boost over 1 week, limited to the area of metastasis as marked at laparotomy. Twenty-nine percent (8/27) of the patients with paraaortic node metastases who were irradiated have survived 5 years or more. These patients have FIGO stages IB, IIA, or IIB; all have epidermoid carcinoma. Three of five patients (60%) with microscopic metastasis and five of twenty-two patients (23%) with gross metastasis in the paraaortic lymph nodes are long-term survivors. None of our long-term survivors have suffered late complications. There have been no fatalities from treatment related complications. We present a radiation technique for paraaortic radiation in these patients, and discuss the indications for paraaortic node radiation in cancer of the cervix.     

Dopamine and noradrenaline receptor stimulation: Reversal of reserpine-induced suppression of motor activity

The motor activity of reserpine treated mice was recorded after drug treatments causing stimulation of dopamine or noradrenaline receptors or both. The dopamine receptor stimulating agent apomorphine elicited an activation with stereotypies whereas the noradrenaline receptor stimulating agent clonidine was inefficient. Combined treatment with apomorphine and clonidine induced marked stimulation with jumping. Biochemically, clonidine did not significantly interfere with the metabolism of apomorphine. Administration of metatyrosine, which stimulates dopamine receptors, produced an activation with stereotypies. Administration of -methyldopa, which weakly stimulates dopamine receptors and strongly stimulates noradrenaline receptors, produced a slight activation. When metatyrosine was given in combination with clonidine, or when -methyldopa was given in combination with apomorphine, a substantial activation was found as after treatment with apomorphine plus clonidine. The results indicate that a dopamine receptor activity is of basic importance for motor activity and that changes in noradrenaline receptor activity can markedly affect the motor activity, qualitatively and quantitatively, provided that there is a certain dopamine receptor activity. It can also be concluded that the effects of drugs on the dopamine mechanisms in the corpus striatum and on the noradrenaline mechanisms in the spinal cord are of value in predicting behavioural effects.     

内毒素预处理对内毒素血症大鼠肺损伤的影响

目的探讨内毒素预处理对内毒素血症大鼠肺损伤的保护作用。方法将雄性Wistar大鼠72只随机分成对照组、内毒素组和预处理组,每组24只。每组又按时间分为2 h组、4 h组、6 h组、12 h组4个亚组,每组6只。预处理组首次经腹腔注射脂多糖（LPS）0.25 mg/kg,24 h后再经腹腔注射LPS 0.5 mg/kg,其余两组给予等量生理盐水。第二次腹腔注射72 h后,内毒素组和预处理组经尾静脉一次注射LPS 10 mg/kg,对照组给予等量生理盐水。内毒素组和预处理组在第二次注射LPS后2、4、6、12 h,对照组在注射最后一次生理盐水后2、4、6、12 h,各取6只处死取肺组织免疫组化法检测肺组织白细胞间粘附分子1（ICAM-1）的表达,酶联免疫吸附法检测血清肿瘤坏死因子α（TNF-α）,比色法检测肺组织丙二醛（MDA）和超氧化物歧化酶（SOD）。结果内毒素血症4 h时内毒素组肺组织ICAM-1、MDA和血清TNF-α水平均显著高于对照组[75.07±0.53比11.98±0.56,（3.93±0.42）μmol/g比（1.24±0.27）μmol/g,（478.62±45.58）pg/mL比（26.67±2.38）pg/mL,P〈0.05],肺组织SOD水平显著低于对照组[（6.26±0.31）U/mg比（15.23±0.62）U/mg,P〈0.05]。经内毒素预处理后,预处理组肺组织ICAM-1、MDA和血清TNF-α水平较内毒素组显著降低[42.40±0.44,（2.89±0.49）μmol/g,（376.76±43.67）pg/mL],肺组织SOD水平显著上升至（8.79±0.35）U/mg,差异有统计学意义（P〈0.05）。结论内毒素预处理可减轻内毒素血症时的肺损伤,其机制可能与减少炎症反应和氧自由基生成有关。     

热休克预处理对脂多糖所致RAW 264.7细胞迁移的影响

目的 观察热休克预处理对脂多糖所致巨噬细胞迁移的影响.方法 采用ELISA观察脂多糖预处理对RAW264.7巨噬细胞中肿瘤坏死因子α和白细胞介素1β释放的影响;采用趋化实验观察脂多糖处理对RAW264.7巨噬细胞迁移的影响;采用趋化实验观察热休克预处理对RAW264.7巨噬细胞迁移的影响.结果 用500μg/L脂多糖作用RAW264.7巨噬细胞1 h,肿瘤坏死因子α和白细胞介素1β的释放较对照组明显增加(P<0.05);用500μg/L脂多糖处理细胞24 h, RAW264.7巨噬细胞的迁移较对照组明显增加(P<0.05);给予细胞42.5℃热休克预处理1 h后,再予500μg/L脂多糖处理细胞,RAW264.7巨噬细胞迁移较单纯脂多糖处理组明显减少(P<0.05).结论 热休克预处理能抑制脂多糖所致RAW264.7巨噬细胞迁移.     

La chirurgie de première intention a-t-elle encore une place dans le traitement de l’acromégalie ?

Transsphenoidal surgery is currently the first-line treatment of acromegaly. Remission is observed in 80-90% of microadenomas, 50-60% of noninvasive macroadenomas, and less than 20% of invasive macroadenomas. Predictive factors include age, maximal size of the adenoma, cavernous sinus invasion, initial hormone levels and neurosurgeon's experience. Complications are rare, with about 5% definitive diabetes insipidus, and 10% of new anterior pituitary hormone deficits. Somatostatin agonist pretreatment can be proposed, as it decreases tumor volume in about 25% of cases and might reduce the rate of immediate postsurgical complications; however, there is no obvious difference in surgical remission rate whether patients are pretreated or not. Debulking surgery can also be proposed in very large macroadenomas incompletely controlled by somatostatin agonists, or resistant to medical treatment, as it was shown to facilitate somatostatin agonist efficacy in more than 50% of cases.     

获得性梗阻性无精症患者预处理改善经皮附睾穿刺-卵胞浆单精子注射治疗结局的临床研究

目的分析获得性梗阻性无精症患者预处理对经皮附睾穿刺-卵胞浆单精子注射（PESA-ICSI）治疗结局的影响。方法选择2009年1月～2011年6月南京军区福州总医院生殖中心诊断为获得性梗阻性无精症（OA）的患者109例,随机分为两组。预处理组55例,临床检查有附属腺炎症或微生物感染患者先给予抗生素和抗炎治疗,接着给予抗氧化和促进附睾精子成熟治疗2个月（十一酸睾丸酮40mg,p0,qd,维生素C200mg,po,bid,维生素E100mg,po,bid,左卡尼汀1．0g,po,bid）,无附属腺炎症或微生物感染患者,直接抗氧化和促进附睾精子成熟治疗;对照组54例,有附属腺炎症指征患者给予抗炎、抗感染治疗,余未作任何处理。比较两组诊断日与ICSI日精子活动力和ICSI后胚胎发育和临床结局。结果①两组诊断日经附睾穿刺液精子的总活动率和前向运动精子率差异均无统计学意义（P〉0．05）。ICSI日预处理组精子总活动率和前向运动精子率均有提高（P〈0．01）,而对照组无明显变化（P〉0．05）;两组ICSI日精子总活动率和前向运动精子率比较,差异有统计学意义（P〈0．05）。②两组受精率、卵裂率差异无统计学意义（P〉0．05）;预处理组优质胚胎率为67．26％,高于对照组的60．49％,差异有统计学意义（P〈0．05）;预处理组临床妊娠率和植入率分别为47．16％和29．72％,高于对照组的37．25％和23．36％,但差异无统计学意义（P〉0．05）。结论对获得性OA患者进行抗氧化、促进精子成熟的预处理治疗,可以提高精子活动力,能够改善胚胎质量,但是对于ICSI治疗后临床妊娠率和植入率的影响还需要更大样本的观察。     

麻黄碱预注在老年患者无痛胃镜中的应用

目的观察麻醉诱导后预注麻黄碱在老年患者无痛胃镜检查中的应用效果。方法将150例老年患者(年龄≥60岁),ASA分级Ⅰ～Ⅱ级,随机均分为A、B、C三组。三组诱导前静脉注射利多卡因0.08 mg/kg,以丙泊酚2 mg/kg和麻黄碱80μg/kg混合液行麻醉诱导。A组患者在麻醉诱导前1 min先静脉注射芬太尼1μg/kg,C组在诱导后2 min单次预注麻黄碱70μg/kg,患者入睡、睫毛反射消失后开始胃镜检查。观察三组患者麻醉诱导前(T1)、麻醉诱导后2 min(T2)、麻醉诱导后5 min(T3)、麻醉诱导后10 min(T4)的收缩压(SBP)、舒张压(DBP),心率(HR),血氧饱和度(SpO2),各组患者麻醉效果、苏醒质量和苏醒时间及呛咳、呕吐、呼吸抑制、低血压、心动过缓等不良反应。结果 A、B两组T2、T3时刻SBP、DBP和HR较基础值(T1)显著降低,差异有统计学意义(P<0.05),而C组SBP、DBP和HR在各时间点比较差异无统计学意义(P>0.05),组间比较T4时刻差异无统计学意义(P>0.05)。C组低血压、心动过缓和呼吸抑制发生率分别为2%、2%、0,明显低于A组的26%、8%及8%,B组的20%、6%、2%。与A、B两组比较,C组苏醒时间平均缩短1.6 min,苏醒质量优于A、B两组。各组麻醉效果比较差异无统计学意义(P>0.05)。结论老年患者无痛胃镜检查中应用丙泊酚与麻黄碱混合液诱导后预注麻黄碱可显著减轻对循环及呼吸系统的抑制程度,血流动力学稳定,同时能缩短苏醒时间,提高苏醒质量,减少不良反应的发生率,麻醉安全性高。     

小剂量甘露醇预处理对垂体瘤手术患者术后恢复质量的影响

目的观察小剂量甘露醇预处理对垂体瘤手术患者术后恢复质量的影响。方法 40例ASAⅠ-Ⅱ级择期经蝶入路垂体瘤摘除患者,随机分为甘露醇预处理组（M组）与对照组（C组）,每组20例。麻醉前15min两组患者分别于15min内静脉输注20%甘露醇0.5g/kg或等容积的生理盐水。采用静吸复合麻醉,呼气末异氟醚浓度为1MAC。拔管后30min内采用OAAS法进行苏醒质量评分,拔管后3 h内采用MMSE测试法进行认知功能测试。结果两组患者术后均平稳拔管,M组苏醒时间、拔管时间显著短于C组（P〈0.05）;拔管后两组患者OAAS评分均逐渐增加,M组拔管后10min OAAS评分显著高于C组（P〈0.05）;两组患者拔管后认知功能逐渐恢复,M组在2h内恢复到术前水平,而C组3 h内恢复到术前水平,M组拔管后1和2 h认知功能评分显著高于C组（P〈0.05）。结论小剂量甘露醇预处理可明显缩短垂体瘤手术患者术后苏醒时间和拔管时间,加速患者术后认知功能恢复。