地震救援中现场截肢的探讨

目的探讨地震救援中现场截肢手术适应证、手术方法及伦理问题。方法映秀镇地震救援中现场截肢2例共3个肢体，采用局部麻醉，截肢平面靠近压迫物。术后补充等张盐水，补液速度1．5L／h，静脉滴注5％碳酸氢钠溶液150mL。口服头孢克肟胶囊，400mg顿服。结果截肢后2例患者均未出现严重并发症，次日送后方医院行二次截肢。结论灾难救援中现场截肢必须综合考虑，严格掌握适应证，必要的截肢可以挽救伤员生命。     

Ethical considerations for enzyme replacement therapy in neuronopathic Gaucher disease

Elstein D, Abrahamov A, Zimran A. Ethical considerations for enzyme replacement therapy in neuronopathic Gaucher disease. Clin Genet 1998: 54: 179–184. 0 Munksgaard, 1998
Enzyme replacement therapy for Gaucher diseases, the most prevalent lysosmal storage disease, was originally approved by the FDA for type I patients and has proven to be both safe and effective in reducing hepatosplenomegaly and improving the hematological parameters. However, the use of enzyme treatment in both neuronopathic forms has heretofore been on an investigational or trial basis, with reports of progression of neurological deterioration even at very high doses. To date, there are no guidelines for clinicians with regard to enzyme replacement therapy in the neuronopathic forms of metabolic diseases. Herein, we discuss strategies derived from the literature ub-his treatment of very premature babies and from the Jewish Halachic point of view. In conclusion, we describe recommendations for the ethical treatment and/or withdrawal of treatment. as well as practical guidelines for dosage regimens, in children with neuronopathic Gaucher disease.     

分泌粒细胞-巨噬细胞集落刺激因子的重组痘苗病毒转染的瘤苗裂解物抗肿瘤作用

将小鼠粒细胞－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）基因经过同源重组得到表达ＧＭ－ＣＳＦ的重组痘苗病毒，用此痘苗病毒转染小鼠黑色素瘤细胞，制备黑色素瘤瘤苗裂解物（ＧＭ－ＣＳＦＶＭＯ），Ｃ５７ＢＬ／６小鼠皮下接种Ｂ１６－Ｆ１０细胞３天后在注射部位注射瘤苗裂解物，一周后再注射一次。结果发现ＧＭ－ＣＳＦＶＭＯ能够显著地抑制荷瘤小鼠肿瘤结节的生长并明显延长荷瘤小鼠的存活期。用此瘤苗裂解物免疫小鼠两次，间隔一周，免疫一周后给Ｃ５７ＢＬ／６小鼠皮下接种Ｂ１６－Ｆ１０细胞，结果肿瘤结节出现时间明显延长，部分小鼠肿瘤不再生长。经ＧＭ－ＣＳＦＶＭＯ治疗或免疫后小鼠的外周血和脾淋巴细胞对肿瘤细胞杀伤活性明显升高，ＮＫ活性变化不明显。本结果提示，诱导机体特异性细胞免疫可能是瘤苗裂解物的抗肿瘤作用机理之一。     

143例晚期喉癌患者的临床特征及生存分析

目的 总结143例晚期喉癌患者的临床特征,分析预后的影响因素。方法 回顾性分析2010年1月-2016年12月经中国人民解放军总医院治疗的143例晚期喉癌患者的临床资料。其中,男135例(94.4%),女8例(5.6%);年龄35~79岁,中位年龄58岁。依据患者治疗方案不同分为2组:手术联合术后放化疗组106例和非手术综合治疗组37例。收集患者基本临床情况、治疗、随访及生存情况;生存率及单因素生存分析采用Kaplan-Meier法和log-rank检验,多因素生存分析采用Cox比例风险回归模型。结果 143例晚期喉癌患者的5年总体生存率为67.9%。单因素分析显示,影响晚期喉癌患者预后的临床因素有年龄、临床分期、T分期及肿瘤分化程度等(P值均<0.05);Cox模型多因素分析显示,患者年龄、临床分期、肿瘤分化程度及治疗方式是影响预后的独立危险因素(P值均<0.05)。T₄期、临床Ⅳ期患者采用手术联合术后放化疗5年生存率分别为62.2%和59.5%,明显好于非手术综合治疗的18.2%和41.4%,差异均有统计学意义(P值均<0.05)。结论 晚期喉癌患者预后相对较差,影响患者预后的因素包括患者年龄、临床分期、肿瘤分化程度及治疗方式等。对于临床Ⅳ期、尤其是T₄期患者,采取手术联合术后放化疗可以获得相对较好的预后。     

Development and characterization of DNAzyme candidates demonstrating significant efficiency against human rhinoviruses

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Genetic Variability of HIV-1 Protease from Nigeria and Correlation with Protease Inhibitors Drug Resistance

In Nigeria, the most populous country in Africa, the characterization of HIV-1 strains has been limited. In this study we evaluated the genetic diversity of the protease coding region, one of the anti-retroviral therapy target, and investigated the presence of mutations related to resistance to HIV protease inhibitors. We analyzed samples collected during 1996 and all patients were anti-retroviral drug na¨ves. Ten samples were evaluated by sequencing of the protease gene. The majority, 80%, were classified as subtype A and the two others were unclassified-divergent strains, something in between A and G subtypes. The gag region from these outliners were sequenced and the phylogenetic analysis classified them as subtype G. The protease amino acid consensus sequence of the Nigerian subtype A are in complete agreement with the consensus A differing from the USA subtype B consensus in 10 positions (L10V, I13V, K14R, I15V, K20I, M36I, R41K, P63L, H69K and L89M).The secondary substitutions associated with protease inhibitor resistance were observed in all Nigerian sequences at the positions L10V, M36I and L89M. The majority of sequence variation was concentrated in the interval between aminoacids 70–90 where the protease substrate binding region is located.     

认知疗法治疗强迫症的对照研究

目的　探讨认知疗法治疗强迫症的疗效。方法　对 6 0例符合 CCMD-2 -R诊断标准 ,且 Y-BOCS量表评分≥ 1 6分的强迫症病人 ,随机分到认知治疗组 ( 30例 )和氯丙咪嗪组 ( 30例 ) ,两组在氯丙咪嗪常规治疗的同时 ,其中一组加用认知治疗 ,共治疗 8周。在治疗前、后两组均进行临床疗效评估和 Y-BOCS量表评分。结果　认知治疗组痊愈 1 1例、显效 1 6例、有效 3例。氯丙咪嗪组痊愈 6例、显效 1 4例、有效 1 0例。两组痊愈和显效比较有显著差异 ( P<0 .0 5 )。 Y-BOCS量表减分率 :认知治疗组 5 4 .90 % ,氯丙咪嗪组 4 2 .33% ,两组比较有显著差异 ( P<0 .0 5 )。结论　认知疗法配合药物治疗强迫症比单用氯丙咪嗪治疗强迫症疗效更好     

Pneumonien bei akuten Leukämien

Summary Acute leukaemia was complicated by pneumonia in 38 (34.8%) of 109 patients treated between 1979 and 1983; in 39.5% of the patients pneumonia occurred more than once. In 23 patients (60.5%) pneumonia occurred during cytostatic therapy, and 25 patients (65.8%) had less than 1000 mm² granulocytes. Antibiotic therapy had no or only little effect in 70%. A total of 21 patients (55.3%) died of pneumonia. In 15 patients a direct relationship could be seen between pneumonia and the bacterial spectrum in the sputum. A prevalence of gram-negative bacteria was found (24 of 40 bacteria isolated, especially Enterobacteriaceae (19). Fungi were cultivated in 10 cases. Each of the typical pneumonia bacteria was only seen once respectively. It is most important that therapy begin immediately, even before the bacteria have been identified. Only then is there hope that the survival time of patients with acute leukaemia can be influenced.

     

外源性IL-4基因表达对K562细胞增殖及死亡的影响

目的：观察外源性ＩＬ－４对Ｋ５６２增殖及死亡的影响。方法：用逆转录病毒载体将ＩＬ－４ｃＤＮＡ导入Ｋ５６２细胞,检测其增殖反应,用流式细胞依及ＤＮＡ片段凝胶电泳检测细胞增殖周期及凋亡情况,用台盼蓝排除法计数死亡细胞。结果：高表达ＩＬ－４的Ｋ５６２细胞增殖反应明显低于表达株。亲代Ｋ５６２株;前者２过程中死亡细胞百分率明显升高且可被ＩＬ－４单克隆抗体阻断,但其自发凋亡细胞数及增殖周期均无改变。结论Ｌ：外     

The SCMC test: a reliable monitor for antispermatozoal antibodies

Seventeen couples (13%) were selected from a group of 129 infertilepatients according to the following criteria: (i) unexplainedinfertility for 3 years and (ii) <50% shaking spermatozoaduring SCMC testing. The couples were tested for sperm antibodiesafter a complete diagnostic work-up schedule. Post-coital testswere performed during the first menstrual cycle of the wife,followed by SCMC and sperm antibody titre testing. Ten malesand seven females were thus treated with 96 mg methylprednisolone.Nine (52%) of the 17 with sperm antibodies achieved a pregnancy.The results of the SCMC test were in all the cases indicativeof the actual sperm antibody titre. Reduction of the antibodytitre and a decrease in the percentage of shaking spermatozoaas detected by the SCMC test correlated well with the pregnancyrate amongst the patients.