Kkay小鼠糖尿病肾病时ICAM-1的表达

目的:观察糖尿病肾病时(DN)细胞间黏附分子-1(ICAM-1)表达的变化。方法:22～24周龄:Kkay糖尿病鼠(KA)7只和Kkay非糖尿病鼠(KB)8只,测定血糖,以PAS染色观察各组:DN病变;对肾脏ICAM-1表达进行免疫组化染色和半定量图像分析;并以RT-PCR检测。肾脏ICAM-1 mRNA表达水平。结果:KA组出现明显糖尿病肾脏病变,其肾小球硬化指数(GI)240.00,明显高于KB对照组(118.36,P<0.05);免疫组化显示Kkay小鼠ICAM-1的表达与病理变化一致,其ICAM-1阳性着色面积(15.22％)高于对照组(4.38％,P<0.01),KA组ICAM-1 mRNA表达水平也高于KB组。结论:Kkay小鼠出现糖尿病肾病时伴有ICAM-1表达水平的增高,推测ICAM-1在糖尿病肾病发生发展中起一定作用。     

Smoking delays chondrogenesis in a mouse model of closed tibial fracture healing.

Smoking delays the healing process and increases morbidity associated with many common musculoskeletal disorders, including long bone fracture. In the current study, a murine model of tibial fracture healing was used to test the hypothesis that smoking delays chondrogenesis after fracture. Mice were divided into two groups, a nonsmoking control group and a group exposed to cigarette smoke for 1 month prior to surgical tibial fracture. Mice were euthanized at 7, 14, and 28 days after surgery. The outcomes measured were immunohistochemical staining for type II collagen protein expression as a marker of cartilage matrix and proliferating cell nuclear antigen (PCNA) staining to measure proliferation at the site of injury. Toluidine blue staining and histomorphometry were used to quantify areas of cartilaginous and noncartilaginous fracture callus. Radiographs were analyzed for evidence of remodeling after injury. At day 7 after injury, mice exposed to cigarette smoke had a smaller fracture callus with less cartilage matrix compared to controls. Proliferation was present at high levels in both groups at this time point, but proliferating cells had a more immature morphology in the smoking group. At day 14, chondrogenesis was more active in smokers compared to controls, while a higher percentage of bone was present in the control animals. At day 28, X-ray analysis revealed a larger fracture callus remaining in the smoking animals. Together, these findings show that the chondrogenic phase of tibial fracture healing is delayed by smoking. This study represents, to our knowledge, the first analysis of molecular and cellular mechanisms of healing in a smoking mouse fracture model.     

重症急性胆管炎合并多器官功能不全综合征的内镜治疗时机的探讨

目的探讨多器官功能不全综合征（multiple organ dysfunction syndrome，MODS）阶段的重症急性胆管炎（acute cholangitis severe type，ACST）的内镜治疗时机。方法在采取常规吸氧、抗休克等内科治疗措施稳定生命体征的基础上，对9例进入MODS阶段的ACST行内镜下逆行胰胆管造影术、十二指肠乳头括约肌切开术或电针开窗术、网篮取石术、鼻胆管引流术或胆管内支架引流术。结果9例均于35min内顺利完成内镜治疗，7例进入多器官功能不全临床第1和2阶段于术后1—2周内恢复，2例已进入临床第3阶段于术后2周内死亡。结论对于尚未进入多器官功能不全临床第3阶段的重ACST应尽早行内镜下治疗，对于已经进入多器官功能不全临床第3或第4阶段的病人应以控制器官衰竭、恢复器官功能为主。     

Natural history of extensive Mongolian spots in mucopolysaccharidosis type II (Hunter syndrome): a survey among 52 Japanese patients

BACKGROUND: Recent reports have shown a correlation between extensive Mongolian spots and mucopolysaccharidosis type II (Hunter syndrome). However, a statistical survey of the incidence and natural history of extensive Mongolian spots among the patients with Hunter syndrome is lacking. OBJECTIVES: To determine the prevalence of extensive Mongolian spots, to determine the natural course of the spots according to age in Japanese patients with Hunter syndrome, and to compare them with the results obtained from the patients' brothers who did not have Hunter syndrome. PATIENTS/METHODS: Fifty-two males with Hunter syndrome aged 3 to 40 years were studied. Twenty-five patients were examined in two clinics to determine the existence and characteristics of the spots. We interviewed their families about the spots in their neonates and the natural course of the spots according to their ages. The same survey was done among another 27 patients using a mailed questionnaire to their families. As control, we investigated 21 brothers of the patients by a mailed questionnaire to their families. RESULTS: The extensive Mongolian spots are identified in almost all the infants with Hunter syndrome and disappear extremely later in their life. The lesions had a high incidence of deep-blue hyperpigmentation. Regardless of age, the overall incidence was 78%. All of the brothers who did not have Hunter syndrome had common-type Mongolian spots in neonates, which regressed during their childhood. CONCLUSION: Our results confirm a strong correlation between extensive Mongolian spots and Hunter syndrome for the Japanese population. The presence of extensive Mongolian blue spots should alert the physician to the possibility of Hunter syndrome.     

Polymorphism of renin-angiotensin system genes in progressive IgA nephropathy

Summary: Clinical studies revealed that angiotensin converting enzyme (ACE) inhibitor reduces proteinuria and attenuates progressive decline in renal function in IgA nephropathy. Recent studies by us and others have demonstrated that the homozygote of the D allele (DD) of the ACE insertion/deletion (I/D) polymorphism is a potential risk factor for poor prognosis in IgA nephropathy, and that this deletion polymorphism predicts the therapeutic efficacy of ACE inhibition on proteinuria and, potentially, on progressive deterioration of renal function in patients with the nephropathy.     

一种胰岛素抵抗的糖尿病特殊类型报告

报告５例对胰岛素抵抗的糖尿病特殊类型病例，其均具有胰岛素应用指征，但使用胰岛素后血糖却反而上升，逐渐增加胰岛素用量，则血糖值亦呈上升趋势。对该类病人的治疗，首先停用胰岛素，改用自制中药制剂及优降糖、降糖灵治疗，取得了良好效果。     

Clinicopathologic and mucin histochemical analyses of 90 cases of ovarian mucinous borderline tumors of intestinal and müllerian types

Clinicopathologlc and mucin histochemical characteristics of 90 cases of ovarian mucinous borderline tumors (MBT) of Intestinal (IMET) and müllerian types (MMBT) were studied to determine whether IMBT and MMBT constitute distinct tumor subtypes. The IMBT (77 cases, 78 lesions) contained goblet cells, absorptive cells and endocrine cells, which represented Intestinal differentiation. The average diameter of IMBT was 13.4 cm. Five patients (6.5%) had stage III disease wtth pseudomyxoma perltonel and one of them died from tumor. Approximately 50% of IMBT demonstrated gastrointestinal characteistics on mucin histochemistry. The MMBT (13 cases, 14 lesions) consisted of mumus columnar cells and eosinophilic cells, with no Intestinal differentiation. MMBT accounted for 15.2% of MBT. MMBT averaged 8.4 cm in diameter, and 29% were associated with endometriosls of the ipsilateral ovary. All patients with MMBT had stage I disease, and none suffered from pseudomyxoma peritonel. All patients whose follow-up data were available were alive and well, without evidence of tumor recurrence. The mucin histochemical findings in MMBT resembled those of noml endocervix. Results of the present study suggest that IMBT and MMBT have different characteristics and constitute distinct subtypes of MBT.     

Cell surface phenotype of in vitro proliferating lymphocytes in HTLV-I-associated myelopathy (HAM/TSP)

The in vitro proliferation of peripheral blood lymphocytes (PBLs) without any mitogenic stimulation is one of the hallmarks of human T lymphotropic virus type I (HTLV-I) infection. Recent evidence suggests a difference in the degree of the phenomenon between HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and asymptomatic HTLV-I carriers (AC). In this article, we demonstrated several alterations in the features of the in vitro transformed lymphocytes between patients with HAM/TSP (n = 16) and AC (n = 8). The percentages of total CD8+ and CD8+CD28+ cells were significantly increased in the in vitro proliferating T lymphocytes derived from the patients with HAM/TSP when compared to those from AC. HAM/TSP was segregated from AC by the high degree of the proliferation of CD8+CD28+ cells. The expression of HTLV-I-specific antigens on the cultured PBLs was detected only in the subjects which showed low CD8+CD28+/CD4+ ratio of the in vitro proliferating lymphocytes. These findings suggest that this phenomenon distinguishes HAM/TSP from AC, not only in quantity but also in quality.     

核仁形成区嗜银蛋白定量对结肠癌分型、分级的诊断意义

对１１４例不同类型和级别的结肠癌进行银染核仁形成区嗜银蛋白（Ａｇ－ＮＯＲｓ）形态定量研究．结果表明，Ａｇ－ＮＯＲｓ数量、大小和分布在结肠未分化癌和印戒细胞癌组与管状腺癌和粘液腺癌组比较，有明显差异．管状腺癌随分化程度的降低，Ａｇ－ＮＯＲｓ的数量、形态、大小和分布也发生等级性变化．结果提示，Ａｇ－ＮＯＲｓ形态定量的数量、形态、大小和分布４项指标对结肠癌分型有一定意义，对管状腺癌分级有较好的诊断价值。     

Criminal Responsibility in Amphetamine Psychosis

Abstract: Historical changes in forensic psychiatric evaluation on criminal responsibility and proceedings in psychopathological findings of amphetamine psychosis are reviewed at first. The classification of amphetamine related mental disorders are proposed in 6 types. Among them, the clinical characteristics and psychopathological features of “Anxiety-situational reaction type” (Fukushima) are described. According to some reasonable grounds, offenders diagnosed as anxiety-situational reaction type should be evaluated as diminished responsibility in place of irresponsibility. Finally, two cases of murder committed under the influence of amphetamine, are reported in detail.