Interferon-induced depressive illness in hep C patients responds to SSRI antidepressant treatments

This paper examines the role of selective serotonin reuptake inhibitors (SSRIs) in the treatment of hepatitis-C virus (HCV) patients who have developed interferon-α induced depression. A 2-year data analysis of HCV psychiatric liaison clinic has been undertaken. The diagnosis, treatment, and progress of those patients who were treated with interferon-α (INF-α) are reported. 53 of the 78 patients enrolled at the HCV Clinic and treated with INF-α were referred for psychiatric consultation. Six patients developed major depressive illness following INF therapy. They were all treated with SSRIs and they made full recovery. This is a significant observation and is concordant with other studies. Its biochemical ramifications are presented. It is concluded that INF-induced depression is fully reversible. A hypothesis is proposed that SSRIs modulate the neuro-protective neurotoxic ratio by possibly inhibiting the indole-2,3-dioxygenase induction of the kynurenine pathway.     

体位改变对胸科手术病人双腔支气管导管位置的影响

目的 探讨体位改变对双腔支气管导管位置的影响。方法 择期开胸手术病人100例，ASAⅠ或Ⅱ级，随机分为两组（n=50）：左双腔支气管导管组（L-DLT组）及右双腔支气管导管组（R—DLT组）。全麻诱导后分别插入左、右双腔支气管导管，用纤维支气管镜（FOB）确定导管位置。病人体位由平卧位改为侧卧位后，用听诊法和FOB再次检查、确定导管位置。记录结果和DLT深度。结果 与平卧位相比，L-DLT组的DLT深度均变浅（P〈0．05）；R-DLT组的置入深度变化男性差异无统计学意义（P〉0．05），女性变浅（P〈0．05）。体位改变后，听诊法判断DLT位置不满意的13例，其中L-DLT组为5例（10％），R-DLT组为8例（16％）。FOB检查导管位移32例，其中L-DLT组管端位移12例（24％），包括严重位移3例（6％）；R—DLT组管端位移20例（40％），包括严重位移7例（14％）。位移率和严重位移率R-DLT组均高于L-DLT组（P〈0．05）。结论 体位改变对DLT位置有较大影响。FOB检查的准确性明显高于听诊法。     

Modified Damus–Kaye–Stansel procedure using aortic flap technique for systemic ventricular outflow tract obstruction in functionally univentricular heart

Damus–Kaye–Stansel procedure is a useful method to relieve the systemic ventricular outflow tract obstruction in functionally univentricular heart. Regurgitation of pulmonary valve and recurrence of systemic ventricular outflow obstruction are the major concerns at the late phase of this procedure. Modification of original Damus–Kaye–Stansel procedure that can prevent the use of prosthetic materials is evaluated. The modified Damus–Kaye–Stansel procedure using aortic flap technique was performed in eight patients with functionally univentricular heart. Patients’ ages ranged from 3 to 28 months (mean 14 months). Follow-up period was 37 months as a mean (9–71 months), and the follow-up was complete. There was no operative mortality and no late death. In addition, there was no recurrence of systemic ventricular outflow tract obstruction throughout the follow-up period. Regurgitation of the pulmonary valve estimated by echocardiography at the latest follow-up was none to trivial in seven patients and mild in one. The modified Damus–Kaye–Stansel procedure using aortic flap technique is a safe, useful and reproducible technique to solve systemic ventricular outflow tract obstruction in functionally univentricular heart, and it can be an alternative for original technique or the so-called double-barrel modification.     

氯喹对全肝缺血再灌注大鼠肺损伤的保护作用

目的 探讨氯喹对全肝缺血再灌注大鼠急性肺损伤（Au）的保护作用及其机制。方法 健康SD大鼠90只，雌雄不拘，体重300～350g，随机分为3组：假手术组（A组）、全肝缺血再灌注组（B组）、全肝缺血再灌注＋氯喹组（C组），每组30只。阻断肝门及肝上、肝下下腔静脉20min时开放血流，建立大鼠全肝缺血再灌注模型。C组于缺血前即刻经股静脉注射氯喹10mg／kg，A、B组给予等量生理盐水。于缺血20min、再灌注4h时每组分别处死10只大鼠，抽取门静脉血，测定血浆D-乳酸、内毒素（ETX）、肿瘤坏死因子-a（TNF-a）浓度，另外10只用于观察再灌注48h时大鼠生存率，并在电镜下观察肺组织超微结构的改变。结果 缺血再灌注可导致大鼠缺血期和再灌注期门静脉血D-乳酸、ETX、TNF-a浓度升高，大鼠生存率降低，肺组织超微结构严重受损，氯喹可减弱全肝缺血再灌注导致的上述改变。结论 氯喹对全肝缺血再灌注大鼠ALI有一定的保护作用，通过抑制磷脂酶A2激活，降低肠粘膜屏障通透性升高，降低肠黏膜内毒素移位。     

氯胺酮对离体大鼠心室肌细胞内向整流钾电流的影响

目的观察氯胺酮对离体大鼠心室肌细胞内向整流钾电流(I_(k1))的影响。方法酶解法分离大鼠心室肌细胞,采用全细胞膜片钳技术记录 I_(k1),观察100μmol/L 氯胺酮在不同钳制电压下以及不同浓度(50～5000μmol/L)氯胺酮在-120mV 钳制电压下对大鼠心室肌细胞 I_(k1)的影响。结果 100 μmol/L 氯胺酮抑制 I_(k1),但不改变 I_(k1)翻转电压以及电流-电压曲线的形状；I_(k1)灌流液冲洗后,I_(k1)能够完全恢复。保持电压-40mV、钳制电压-120mV 下5～5000μmol/L 氯胺酮呈浓度依赖性抑制 I_(k1)其 IC_(50)为(162.3±8.4)μmol/L。结论氯胺酮呈浓度依赖性抑制大鼠心室肌细胞 I_(k1),可能延长动作电位时程导致心率变慢。     

Survivin在T细胞非霍奇金淋巴瘤组织中的表达及临床意义

【目的】了解生存蛋白Survivin在T细胞非霍奇金淋巴瘤（T—NHL）中的表达，以及Survivin表达与预后的关系。【方法】用免疫组化S-P法检测83例T细胞NHL组织Survivin表达情况，分析Survivin表达与预后的关系。【结果】Survivin表达阴性10例（12％），表达阳性73例（88％），Survivin表达与病理类型、性别、年龄、B症状、结外病变数、PS、分期、LDH水平、IPI等临床特征均无相关性（P〉0．05）。78例接受了化疗，大多数采用CHOP方案化疗，全组CR率45％，有效率86％，Survivin阴性者CR率60％，阳性者43％（P〉0．05）。中位随访22月（1—76月），全组5年生存率31％，Survivin表达阳性的T—NHL患者5年生存率明显低于Survivin表达阴性患者（21％比70％，P〈0．001）。多因素分析显示Survivin表达是T细胞NHL的独立预后指标。【结论】Survivin在T细胞NHL表达上调，Survivin阳性T—NHL患者5年生存率低于Survivin阴性者，Survivin表达可能为T细胞NHL预后的独立指标。     

前路一期病变椎体切除并重建治疗胸腰椎结核并后凸畸形

目的:观察前路一期病变椎体切除、人工椎体或钛网融合器植骨替代、椎体钉板或钉棒系统内固定治疗连续两个及以上节段胸腰椎结核并后凸畸形的疗效。方法:34例病变累及连续两个及两个以上椎节的胸腰椎结核患者,术前后凸Cobb角27.8°￣65.4°(38.6°±10.3°),一期行前路病变椎体切除,椎间撬拔撑开复位,人工椎体或钛网融合器植骨替代,辅以椎体钉板或钉棒系统短节段邻近椎节内固定,重建脊柱稳定性,术后均给予短疗程化疗。观察术后局部疼痛缓解、脊髓神经功能恢复、后凸畸形矫正及脊柱稳定性情况。结果:患者术后局部疼痛缓解,术前伴有脊髓神经损伤的12例患者术后神经功能均有不同程度恢复。影像学检查示脊柱内固定物位置良好,椎体序列恢复良好,椎间高度恢复。后凸Cobb角矫正至2.1°￣14.2°(7.5°±8.3°),平均矫正31.2°±8.5°。随访18￣54个月,平均35个月。末次随访时后凸矫正度丢失4.3°±3.8°,均无结核复发。结论:连续两个及两个以上节段的胸腰椎结核采用前路一期行病变椎体切除有利于病灶彻底清除,减少复发;也有利于椎管彻底减压。前路椎体替代、植骨内固定重建脊柱稳定性可更好地纠正和预防脊柱后凸畸形。     

经外踝入路关节内环锯法行踝关节融合术

[目的]介绍经外踝入路关节内环锯法行踝关节融合术的方法与临床效果。[方法]利用环锯(14mm、16 mm、18 mm)对20例踝关节严重病损病人行关节融合术,均采用踝关节外侧入路,腓骨下段截骨并下翻显露关节,利用环锯关节内融合即原锯心骨旋转90°原位回植,外踝骨块螺钉固定旁靠植骨。术后关节予以石膏固定。[结果]经随访6个月~4 a,平均26个月。术后2周刀口Ⅰ期愈合,4周可见骨痂形成,12周病人疼痛明显缓解或消失,足部外形改善。X线片示胫距关节牢固融合。[结论]采用经外踝入路关节内环锯法行踝关节融合术,方法简单,融合率高。其优点为:切口显露良好;对胫距关节干扰小,保证了关节的正常高度和下肢长度;锯心骨原位回植无需再次植骨,外踝旁靠植骨提高了植骨强度。     

细胞分化帮助剂提高低浓度As2O3对肝癌细胞凋亡作用的体外实验

目的 研究细胞分化帮助剂（CDA-Ⅱ）促进低浓度三氧化二砷（As2O3）对肝癌细胞株HepG-2，BEL-7402凋亡的协同效应。方法 用四甲基偶氮唑蓝（MTT）法检测单用CDA-Ⅱ或As2O3和联用对肝癌细胞株HepG-2，BEL-7402生长及抑制率的影响；用乳酸脱氢酶（LDH）法检测药物对细胞膜的毒性反应；流式细胞仪（FCM）分析细胞周期和凋亡率变化。结果 单用CDA-Ⅱ和As2O3分别为3．0mg／ml和50μmol／L时，肝癌细胞株BEL-7402，HepG-2发生凋亡达到最大值，而联用5μmol／LAs2O3＋1mg／mlCDA-Ⅱ可达到同样效果；结果显示：该浓度下HepG2的抑制率可达88％；BEL-7402的抑制率在100％；LDH检测表明联用比单用As2O310μmol／L更安全。流式细胞仪结果显示凋亡率联合组为40．2％，明显高于单用组As2O3（11．3％）或CDA-Ⅱ（8．7％）。结论 细胞分化帮助剂1mg／mlCDA-Ⅱ联用5μmol／LAs2O3可促进肝癌细胞株HepG-2，BEL-7402凋亡，可以明显降低As2O3的使用浓度，减少对正常细胞的毒副作用。二者联用具有协同作用。     

Restless legs syndrome: diagnosis and review of management options

Restless legs syndrome (RLS) is one of the commonest movement disorders affecting sleep and also daytime functioning. The prevalence may be 8%–10% of the white Caucasian population. The diagnosis is simple and is based on a well-validated clinical questionnaire, yet misdiagnosis is common and the condition remains underdiagnosed and consequently inappropriately treated, often causing great distress to the sufferers. In spite of robust evidence for effective treatment of RLS, patients may often be told to “put up with the symptoms” and suffer the consequence of years of poor sleep which may lead to major lifestyle changes. This review addresses the diagnostic issues, the differential diagnosis, and the evidence base for treatment of the common condition.