Renal Allograft Biopsies with Borderline Changes: Predictive Factors of Clinical Outcome

The clinical outcome and appropriate management for patients showing 'borderline changes' on allograft biopsy after renal transplantation is still controversial. In an attempt to identify predictive factors of clinical outcome of patients with such lesions, we reviewed the clinical course of 91 patients with borderline changes. Multivariate analysis revealed significant and independent effects of histological stage (i + t < or = or > 2) and time to borderline changes (< or = or > 3 months after transplant) on serum creatinine levels at 1 year from borderline changes episodes (respectively, p = 0.04 and p = 0.02) and only a significant effect of time to borderline changes on serum creatinine levels at 2 years (p = 0.005). Renal function at 1 year and 2 years as 5- and 8-year graft survival were not significantly different in the group of patients treated with antirejection therapy (T group, n = 49) compared with the untreated group (UT group, n = 42). This study strongly suggests that borderline changes with histological score (i + t) > 2 and late episodes of borderline changes should be considered to be of poor prognosis.     

Detailed pathological changes of human lumbar facet joints L1–L5 in elderly individuals

Facet joints play an important role in intervertebral load transmission and are crucial for rotational kinematics. Clinically, the role of facet joints as a possible source of low back pain is seen as controversial and at present is not sufficiently investigated. In this study, human lumbar facet (zygapopyhysial) joints from donors with advanced age were analyzed macroscopically, for degenerative changes. The aim was to determine the extent and morphology of degenerative changes in these joints. Lumbar facet joints (L1–L5) of 32 donors were studied (mean age 80.1±11.2 years). Joint capsules were carefully removed and joint surfaces (5 zones) examined using magnifying glasses and probes. In the result, the majority of facet joints showed cartilage defects of varying extent. Defects were located mostly at the margins of the articular surface, the central zone being relatively well preserved. Defect localization was different between superior (most cartilage defects in superior zone) and inferior (most defects inferiorly) facets. Further, defects were more severe caudal (level of L5) and in older persons. Osteophytes were present in up to 30%, located mostly at the latero-dorsal enthesis of the joint capsule on the superior facet. In conclusion, most margins of the articular facets are subject to degenerative changes in the lumbar spine of elderly persons, the topographical pattern being different in superior and inferior facets. This observation can be explained by the segmental motion patterns during extension/flexion movements of the facets. Sometimes, due to the marginal extension, it is obvious that not all changes can be assessed by CT or MRI.     

细胞间黏附分子-1在实验性自身免疫性脑脊髓炎大鼠中表达的动态变化及作用

目的探讨细胞间黏附分子-1(ICAM-1)在实验性自身免疫性脑脊髓炎(EAE)大鼠中表达的动态变化及其作用。方法分别取免疫后第4、6、8、10、12、14、16、18、20天EAE大鼠脑和脊髓制成石蜡切片,行HE染色和ICAM-1半定量免疫组化分析。结果免疫后第8天ICAM-1表达即出现明显上调,早于临床症状的发生;随免疫后时间的延长,ICAM-1表达呈逐渐增高后缓慢下降的变化趋势,并且与EAE大鼠病情评分呈显著正相关(r=0.57,P=0.003)。结论ICAM-1的表达上调可能在EAE发病中具重要作用。     

四氯化碳两种途径亚急性实验染毒时某些肝酶指标的对比研究

本文用CCl_41.356g/kg和5.87g/kg分别对大鼠进行皮下和呼吸道静式染毒,为期8周亚急性中毒试验,研究临床常用血清肝酶指标的变化。结果发现:CCl_4除使大鼠体重增长减慢外,第1周起出现肝细胞脂变、浊肿,进而坏死、纤维增生和肝硬化;肝糖元及SHD酶活性减少或消失,G-6-P酶活性先升高后降低的病理形态和组织化学的改变。与此同时或稍后出现SGPT和SGOT活性升高,持续至第8周。停药两周,肝病理改变趋于恢复,SGPT和SGOT活性也恢复至接近正常,两肝酶与病理改变相平行。AKP酶活性第4周后才升高;ChE酶似有先升高后降低趋势,但无明显差异性;γ-GT酶变化不规则。提示CCl_4亚急性中毒时,SGPT和SGOT酶活性升高与肝损关系较密切,可作临床早期诊断指标。血清AKP和ChE酶亦一定程度反映肝损的发展情况,可供作临床观察病情发展的辅助指标。     

松果腺切除对长期游泳老龄小鼠MDA影响的对比研究

为研究长期游泳运动老龄小鼠脂质过氧化水平的降低是否与刺激了松果腺释放褪黑素有关,将松果腺切除12月龄昆明种小鼠分为手术组(n=36)、非手术组(n=36)和假手术组(n=12),前2组又各分为对照组、60min组和60min+3%体质量负荷组,对其血清中的MDA浓度进行对比研究.结果:雄性小鼠非手术组中MDA浓度60min组及60min+3%负荷组均显着低于手术同负荷组(P<0.05,P<0.01).雌性小鼠,非手术组60min组MDA浓度显着低于手术组(P<0.05).而在60min+3%负荷组,手术组要显着低于非手术组(P<0.05).提示:长期运动训练降低血清脂质过氧化水平,可能与交感神经兴奋性升高刺激松果腺内褪黑素的合成和释放有关;如果选择负荷不当,会对松果腺机能产生抑制,而对机体抗氧化能力的提高产生负面影响.     

循证护理学在实践中的应用

循证护理的核心思想是任何护理决策都要建立在临床客观证据的基础上。护理过程中应进一步开展临床试验研究，以提供更好的护理依据。对临床护理工作中存在的同一问题有不同研究结果的情况，要用系统评价的方法进行分析，得出综合可靠的结论。作举例说明循证护理的实施方法。     

深插胃镜诊断十二指肠乳头以下病变的临床价值

目的 探讨深插胃镜对十二指肠乳头以下病变的诊断价值。方法 回顾性分析行胃镜检查[深插至十二指肠空肠曲(屈氏韧带附近)]的320例患者的临床资料、操作方法及检查结果。结果 320例患者中，深插至十二指肠升部成功率为93．12％，其中最多可以观察到十二指肠空肠以下8～10cm，所用时间约3～15min，发现十二指肠降部及以下病变85例。结论 深插胃镜对十二指肠乳头以下部位病变具有较好的诊断及治疗价值。     

Choice of general practice for postgraduate training among medical graduates and undergraduates in Nigeria

A questionnaire survey of career choices was carried out among 112 medical graduates, after one year's internship (group I), during their National Youth Corps programme in Kaduna, Lagos, Cross River and Oyo states of Nigeria, and 365 final-year medical undergraduates (group 2) in the colleges of medicine in the corresponding states. A total of 13% in group I and 40% in group 2 were undecided as regards their first choice. Obstetrics and gynaecology was the most popular first choice in both groups. General practice ranked fifth among group I, but displaced surgery to rank second among group 2. The differences were statistically significant. A total of 41% of group I and 46% of group 2 preferred to work in a teaching hospital, reflecting the high preference for surgical specialties. Twenty-six per cent and 33.7% of respondents in groups 1 and 2 respectively wished to own their own practice or work in the private sector. General practice is a new specialty and its growth is supported by a national postgraduate training programme. A shift towards general practice is seen compared with previous studies of career preference among Nigerian medical graduates and students. This may be due to a changing balance of supply and demand in the medical work-force, or a better assessment of the nation's health problems and manpower needs.     

Granulomatous jellyfish dermatitis

The induction of a granulomatous inflammation by jellyfish toxins is rare. More typically, acute toxic and urticarial reactions are seen. An 11-year-old boy developed a striated urticarial erythema on the left cheek after contact with a gelatinous mass while swimming in the sea in Croatia. After initial erosion, a striated induration developed in the area of contact. Histological examination revealed a granulomatous inflammation with some eosinophils. While topical steroid-based antiinflammatory and antibacterial therapy over several weeks was not effective, topical therapy with tacrolimus 0.1% for two two-week treatment periods led to healing of the skin changes with a slight scar. There was no clinical recurrence after 5 month of follow-up.