内窥镜辅助下经口咽前路寰枢椎减压术

目的：探讨内窥镜辅助下经口咽前路寰枢椎减压术的临床效果。方法：1998年8月～2004年8月对38例陈旧性寰枢椎脱位患者采用内窥镜辅助下经口咽前入路减压术，其中18例行一期经口咽入路减压和后路枕颈内固定术：15例行经口咽前路寰枢椎复位钢板内固定术；5例不可复型仅行经口咽前入路减压术。结果：平均随访38个月（6～96个月）。术后患者临床症状均明显改善，上颈段脊髓减压改善率达89.3％。发生颅内感染1例，前路钢板松脱1例。结论：与常规减压方法相比，内窥镜辅助下经口咽前路寰枢椎减压手术创伤小，操作精细、准确，术中与助手可协同操作。     

广州地区无偿献血人群人类疱疹病毒8型血清流行病学调查

目的：了解广州地区无偿献血者HHV-8的感染情况，为制定预防策略提供依据。方法：采用ELISA法检测3135名无偿献血者血浆HHV-8IgG抗体。结果：3135名献血者中6名血浆标本被检出HHV-8IgG抗体阳性，均为汉族、男性献血员，总阳性率为0．19％。不同年龄和性别组HHV-8感染率差异无统计学意义。结论：广州地区无偿献血人群HHV-8的感染率较低。     

Monolayer cultures of normal human bone cells contain multiple subpopulations of alkaline phosphatase positive cells

Summary Cytochemical staining of normal human bone cells in monolayer cultures for alkaline phosphatase (ALP) indicated that the cultures contained mixed-cell populations. Time course evaluations of the cytochemical staining revealed, in addition to the ALP-negative cell population, at least two subpopulations of ALP-positive human bone cells with different levels of ALP. A cytochemical method has been developed which separates the ALP-positive cells into high and intermediate ALP subpopulations. In this method, human bone cells were stained for ALP using an azo-dye method and incubating at 4°C for 10 and 30 minutes, respectively. We defined the cell population that stained positively for ALP at 10 minutes as strong ALP-positive cells, and both strong and intermediate cells were stained at 30 minutes. The intermediate cells were determined from the difference between the values at the two time points. The intra- and interassay variations of the assay, with the same investigator in blinded investigations, were both less than 10% and the interobserver variation was approximately 25%. Analysis of the distribution of ALP levels in cells with a laser densitometer confirmed the presence of at least three cell subpopulations. 1,25(OH)₂D₃ treatment increased the proportions of both ALP-positive cell populations, whereas TGF-beta treatment increased only the intermediate ALP-positive cell population. On the contrary, fluoride increased the proportion of the strong ALP cells, and IGF-1 had no effect on the proportions of either ALP-positive subpopulation. When the ALP-specific activity was compared with the percentage of each ALP-positive subpopulations for the cells treated with effectors, the ALP-specific activity correlated with the total ALP-positive and with the strong ALP-positive populations but not with the intermediate ALP-positive subpopulation. In summary, this study represents the first evidence that normal human bone cells in monolayer cultures contained at least two subpopulations of ALP-positive cells, and that bone cell effectors could have differential effects on each cell population.     

Treatment of HTLV-I-associated myelopathy with high-dose intravenous gammaglobulin

Summary Fourteen patients with HTLV-1-associated myelopathy were treated with high-dose intravenous gammaglobulin (IVGG). Ten received 10 g/day of IVGG and 4 received 400 mg/kg of body-weight/day of IVGG for 5 consecutive days. Improvement of spastic paraparesis was observed in 10 within 7 days of the commencement of IVGG. The therapeutic effects were sustained for more than 3 weeks in some patients. There were no side effects. Analysis of factors of relevance to the clinical improvement with IVGG showed that the beneficial response was preferentially found in patients having a high CSF titre of anti-HTLV-I antibodies, a high CSF IgG level and a marked brain MRI abnormality.     

Active production of anti-human T-lymphotropic virus type I (HTLV-I) IgM antibody in HTLV-I-associated myelopathy

We investigated the presence of anti-human T-lymphotropic virus type I (HTLV-I) IgM in sera and cerebrospinal fluid from patients with HTLV-I-associated myelopathy (HAM) by Western blot analysis. Analyses of 36 serum samples revealed that most patients (31/36; 86.1%) had anti-HTLV-I IgM, whereas only four of 23 (17.4%) HTLV-I carriers had it. In studies of cerebrospinal fluid, anti-HTLV-I IgM was detected in 24 of 36 (66.7%) HAM patients, whereas none was detected in nine HTLV-I carriers. The differences were statistically significant (p less than 0.01). These results suggest that persistent active replication of HTLV-I occurs in the central nervous system as well as in the peripheral blood of HAM patients, and may contribute to the development of HAM.     

重视医学信用伦理的研究与开发

医疗行业市场化是必然趋势。在医疗行业市场化进程中，医学伦理道德除了道德价值之外，还含有积极的经济内涵。医学伦理道德也是重要的医疗资源，通过参与医疗市场资源的配制和运作，也可以产生经济效益，转化为医疗资本。医疗行业要重视医学伦理道德资源的开发。信用伦理是在市场经济条件下形成的，这是医学伦理学所面临的新课题。笔者认为，不说谎、不期诈，兑现承诺，保证医疗质量，发扬医学人道主义，是医学信用伦理的四项基本标准。     

Increased occurrence of free immunoglobulin light chains in cerebrospinal fluid and serum in human immunodeficiency virus-1 infection

The presence of free immunoglobulin light chains (FLCs) in the cerebrospinal fluid (CSF) and sera of patients with human immunodeficiency virus-1 (HIV-1) infection, multiple sclerosis (MS), and neurologically healthy control individuals was investigated by paying special attention to ensure that only truly free light chains would be detected. The FLCs were extracted by specifically binding them to Sepharose-coupled anti-FLC monoclonal antibodies, and thereafter they were electrophoresed and immunoblotted with monoclonal antibodies to both light chain (LC) isotypes. A frequent occurrence of kappa and lambda FLCs was found in both CSF and sera of HIV-1 infected patients. In HIV-1 infection and in MS, the frequency of FLCs of the CSF was equal. In healthy controls, only occasional weak FLCs were observed in either CSF or serum. FLC bands of the CSF from patients with HIV-1 infection tended to be more intensive than those of the appropriately diluted sera. Both intrathecal synthesis of FLCs and their transudation from sera through the impaired blood-brain barrier (BBB) may contribute to this. Increasing severity of general HIV-1 infection was accompanied by an increase of FLC intensity in sera. A qualitative demonstration of FLC in the CSF may be meaningful only in the absence of altered BBB function.     

5例胸腰段脊柱前路手术并发症分析

目的：分析胸腰段脊柱前路手术入路并发症，以提高胸腰段脊柱前路手术的水平，方法：对近4年来我科53例胸腰段脊柱前路手术出现的5例并发症进行回顾性分析，探讨并发症发生的原因。结果；本组病例1例发生腹膜后乳糜液漏，1例切口疝，1例气胸，2例深静脉血栓栓塞，经过积极治疗，全部治愈。结论：胸腰段脊柱前路手术并发症的发生大多数和术者对该段解剖知识，手术操作，认识程度和经验有关，可以避免或及早发现。     

人原发性肝癌中p16基因表达及CpG岛甲基化状态的研究

目的　进一步探讨人原发性肝癌中 p16基因 m RNA转录水平变化与其基因启动子区 Cp G岛甲基化的关系 ,及其在肝癌发生中的意义。方法　采用狭缝印迹杂交检测 2 0例人原发性肝癌及相应的癌旁、远癌组织及 2例正常人肝组织中 p16基因 m RNA表达水平 ,以甲基化特异性 PCR分析各组织中 p16基因启动子区 Cp G岛的甲基化状况 ,并进行统计分析。结果　 2 0例人原发性肝癌中 14例 (70 % ) p16 m RNA水平比远癌组织显著降低 ;13例 (6 5 % )显示 p16基因启动子区 Cp G岛甲基化 ,其中 84 .6 % (11例 )伴 p16 m RNA转录水平降低。结论　人原发性肝癌中存在高频率的 p16基因表达失活 ,其主要机制可能是启动子区 Cp G岛甲基化抑制了基因的转录 ,在人原发性肝癌的发生发展中有重要作用。其临床诊断和治疗意义有待进一步深入研究。