Blood transfusion and hepatitis: still a threat?

Summary The incidence of post-transfusion hepatitis (PTH) in recipients of blood products is reviewed. PTH was observed in 10%–12% of recipients of blood products in the United States, 2%–4% in northern Europe and 15%–20% in southern Europe. All studies indicate that 80%–90% of all PTH cases are attributed to non-A/non-B. At least 40% of the patients with PTH non-A/non-B will develop chronic hepatitis or cirrhosis. No specific tests for the detection of the non-A/non-B agent(s) exist. However, several independent studies indicate that part of the donors carrying the infectious non-A/non-B agent have increased levels of alanine amino transferase (ALT). When donors are excluded with elevated ALT values, it is estimated that about 30% of the PTH non-A/non-B cases would be prevented. Some studies indicate that anti-hepatitis B core (anti-HBc) positive donors may carry an increased risk to transmit the non-A/non-B agent, but more recent studies do not confirm this. There is hope that a specific non-A/non-B test will be developed soon.     

黄芪和丹参注射液联用对早期糖尿病肾病血液流变学和肾功能的影响

目的　探讨黄芪和丹参注射液联用对早期糖尿病肾病 (EDN)血液流变学和肾功能的影响。方法　将2 0 0 1- 0 3～ 2 0 0 4 - 0 3广东省东莞市人民医院 16 0例EDN患者随机分为治疗组和对照组各 80例。两组均采用饮食控制和糖尿病常规治疗。治疗组加用黄芪和丹参注射液治疗 ,疗程 4周。结果　治疗组血液流变学各项指标较治疗前显著下降 (P <0 0 5或P <0 0 1) ;尿白蛋白排泄率 (UAER)、血肌酐 (SCr)、尿素氮 (BUN)和血脂明显下降 (P <0 0 5或P <0 0 1) ,且明显优于对照组 (P <0 0 1或P <0 0 5 )。结论　黄芪和丹参注射液联用能改善EDN患者的血液流变学、血脂和微循环 ,减少尿白蛋白的排出 ,减轻肾损害 ,改善肾功能。     

Effect of insulin in vitro on the isolated,perfused alloxan-diabetic rat liver

Summary Withdrawal of exogenous insulin and a subsequent fast (24 h) of alloxan diabetic rats stimulated rates of gluconeogenesis, ureogenesis, ketogenesis, and amino acid release by in situ perfused livers when compared to those from normal, fasted rats. The contribution of liver glycogen to the high rates of gluconeogenesis observed with the diabetic liver could be excluded. Perfusate lactate concentrations remained constant during the period when the elevated rate of gluconeogenesis was observed with diabetic liver. Addition of insulin as a bolus (750 mU) and continuous infusion (12.5 mU/min) to the perfusion medium of diabetic livers resulted in constant perfusate levels of glucose, urea and -amino nitrogen indicating a suppression of the catabolic processes present in the fasted, diabetic liver. The rate of ketogenesis was also slowed by insulin to about half the rate prior to addition of the hormone. These data indicate that insulin has an immediate anti-catabolic effect in the perfused, diabetic liver.     

A Three-dimensional Analysis of Blood Vessels in Bronchioloalveolar Carcinoma

The three-dimensional architecture of blood vessels within lung adenocarcinomas has not been well studied. In 19 cases with bronchioloalveolar carcinoma with central fibrosis, we three-dimensionally examined blood vessel architecture in 150 m thick sections stained with elastin staining and anti-CD34 antibody. We examined four regions: normal alveoli and three regions within the tumor including an area adjacent to the normal alveoli (external area), an area in which tumor cells were replacing epithelial cells (replacement area), and a central fibrotic area (fibrotic area). Elastin staining showed that elastic fibers formed the framework of the alveoli, and the alveolar structure shrank more strongly to the center of the tumor due to folding of alveolar walls invaded by adenocarcinoma cells. We also measured three vessel parameters in these four regions. The vessel diameters were 4.08±1.10 m, 3.95±1.02 m, 5.04±1.56 m, and 6.11±2.23 m, the circumferences of those vessels seen as complete circles were 43.11±12.78 m, 43.71±12.87 m, 95.21±39.32 m, and 126.77±54.65 m; the lengths between vessel bifurcations were 13.28±3.08 m, 13.47±4.58 m, 24.91±9.66 m, and 41.82±28.08 m in the normal alveoli, and the external, replacement, and fibrotic areas, respectively. Blood vessel architecture changed such that the vessels became larger and coarser towards the center of the tumor. Our three-dimensional analysis suggests continuous remodeling of alveolar capillaries rather than angiogenesis within bronchioloalveolar carcinoma.     

Nitric oxide plays an insignificant role in direct vasodilator effects of calcium channel blockers in healthy humans

Several experimental studies have suggested that the vasodilatory effects of calcium channel blockers (CCBs) are due in part to an endothelium-dependent mechanism. However, it remains unknown whether CCBs directly augment liberation of endothelium-derived dilator substances such as nitric oxide (NO) in the human vasculature. The aim of this study was to examine whether CCBs of several kinds directly increase the bioavailability of NO in forearm resistance vessels. Twenty-four healthy men (mean age 30 ± 2 years) were randomly assigned to three study groups (n = 8 in each), and each group was assigned one of three first-generation CCBs (nifedipine, nicardipine, diltiazem). Subdepressor doses of CCBs [4, 8, 16, 24, and 36 (diltiazem only) nmol/min; for 2 min in each dose] were infused intra-arterially, and forearm blood flow (FBF) was determined plethysmographically. After control FBF responses to CCBs had been measured, a NO synthase inhibitor (N ^G-monomethyl-l-arginine: l-NMMA) was infused intra-arterially, and the FBF response to CCBs was again determined. Further, as a positive control for NO stimulation, acetylcholine (ACh) was also examined before and after l-NMMA in each group. Systemic blood pressure and heart rate did not change significantly during the study protocol. The FBF responses to these CCBs did not differ before and after NO synthase inhibition by l-NMMA (FBF at maximum doses: nifedipine, 8.0 ± 0.8 vs 7.3 ± 0.7; nicardipine, 7.3 ± 1.5 vs 6.5 ± 1.3; diltiazem, 5.7 ± 0.7 vs 4.2 ± 0.7 ml/min per 100 ml: all not significant), although FBF responses to ACh were significantly reduced by l-NMMA. In conclusion, direct NO liberation does not make a significant contribution to the vasodilation associated with first-generation CCBs in healthy human resistance vessels. Received: July 12, 2001 / Accepted: October 19, 2001     

特发性肺纤维化患者支气管肺泡灌洗液中白细胞介素13的水平及意义

目的　探讨特发性肺纤维化 (IPF)患者支气管肺泡灌洗液 (BALF)和外周血中白细胞介素 13 (IL 13 )水平的变化及其意义。方法　选择 17例IPF患者 (IPF组 )和 8名无器质性肺疾病者 (对照组 )。采用IL 13特异的酶联免疫吸附法测定 (ELISA)法检测 2组BALF和外周血中IL 13的水平 ,分析患者IL 13水平与其肺功能、血气之间的关系。结果　IPF组BALF和外周血中IL 13水平分别为(3 0 1± 86)ng/L、(178± 3 6)ng/L ;对照组分别为 (10 3± 2 4)ng/L、(55± 15)ng/L ,两者比较差异均有显著性 (P <0 0 1)。IPF组BALF中IL 13水平与BALF中性粒细胞数呈正相关 (r =0 786,P <0 0 1) ,与用力肺活量、一秒钟用力呼气容积、肺一氧化碳弥散量及动脉血氧分压均呈一定的等级负相关 (r分别为 -0 898、-0 878、-0 874、-0 890 ,P均 <0 0 1)。结论　IL 13可能在IPF的发病过程中起一定作用 ,并有可能作为判断病变进展情况的一项指标     

一种新型声学造影剂经静脉注射评价正常心肌血流灌注实验研究

目的:评价自行研制的Sigma新一代声学造影剂经周围静脉注射心肌声学显象效果。方法:对10条闭胸犬麻醉后经周围静脉注射Sigma造影剂(1ml/kg)进行心肌声学造影。同时观察其对实验犬心率、血压的影响。结果:注射Sigma造影剂共45次,心肌显影成功率100％,心肌显影强度2级25％(11次)、3级75％(34次)。心肌显影-时间强度曲线,造影前前壁、侧壁、后壁峰值密度(PI)分别为:0.6±0.09、0.7±0.095、0.68±0.07;曲线下面积(AUC)为0.2±0.015、0.22±0.21、0.21±0.02。心肌造影后前壁、侧壁、后壁PI分别为:11.9±1.1、10.9±0.9、10.8±1.0;AUC为13±1.3、11.7±1.05、12.7±1.2,造影前、后PI、AUC差异显著,P<0.01。造影后心率、血压均无影响。结论:Sigma新型声学造影剂具有良好的心肌显象作用,可用于评价心肌血流灌注。     

冠状动脉病变与大动脉弹性的相关性研究

目的:将临床常用的血压测定和外周动脉超声技术相结合,研究冠状动脉(冠脉)病变与大动脉弹性的相关性。方法:对所有入选病例行冠脉造影(CAG)检查,用Gensini法行冠脉病变评分,并根据CAG结果分为冠心病(CHD)组和正常对照组。于CAG前或后进行双侧颈动脉和心脏彩色多普勒检查,并测量血压、血糖、血脂、身高和体重。结果:CHD组与正常对照组比较,反映动脉弹性的脉压(PP)、PP指数(PI)、颈总动脉平均管壁张力(CWS)差异有统计学意义(P<0.01);反映早期动脉粥样硬化(CAS)的颈总动脉内-中膜增厚与SBP、PP、PI正相关,与CWS负相关,且与CWS及SBP的相关程度最高(标准回归系数为-0.799和0.392);反映冠脉AS程度的冠脉评分与PI、PP正相关,与CWS负相关,且与CWS和PP的相关程度最高(标准回归系数为-0.462和0.236)。结论:AS病变可致动脉弹性下降;早期AS与中央动脉弹性下降有关;冠脉硬化病变及其病变程度与颈动脉弹性密切相关。     

Nitroglycerin-induced improvement in exercise tolerance and hemodynamics in patients with chronic rheumatic heart valve disease.

Nitroglycerin reduces elevated left ventricular filling and pulmonary arterial pressures in resting patients with rheumatic valve disease and reduces symptoms when given over long periods to patients with primary myocardial disease. To determine whether nitroglycerin may prove effective therapeutically in ambulatory patients with heart valve disease, its effects on hemodynamics and exercise capacity were studied in 11 severely symptomatic adults who were already receiving optimal treatment with digitalis and diuretic agents. Seven had predominant mitral valve disease, one had predominant aortic insufficiency and three had equally severe mitral and aortic valve disease. Maximal exercise capacity was assessed with graded treadmill exercise after placebo and after nitroglycerin (0.5 mg sublingually) administered in random sequence to each patient. Exercise capacity (exercise time to limiting fatigue or dyspnea) increased from a mean of 8.3 minutes after placebo to 9.8 minutes after nitroglycerin (P less than 0.005). Eight patients were studied hemodynamically during further intense treadmill exercise. Pulmonary arterial pressure was significantly lower (P less than 0.05) after nitroglycerin than after placebo (mean 44 versus 56 mm Hg), but cardiac output was greater after nitroglycerin (5.0 versus 4.6 liters/min, P less than 0.005). Thus, nitroglycerin appears to increase exericse tolerance and improve the hemodynamic response to exercise in patients with heart valve disease and may be valuable in the long-term pharmacologic therapy of such patients.     

Blood rheology and cardiovascular risk factors in type 1 diabetes: relationship with microalbuminuria.

Whole blood and plasma viscosity, erythrocyte aggregation and deformability, plasma fibrinogen, lipids, lipoproteins, apolipoproteins, and measures of blood glucose control were compared between 21 Type 1 diabetic patients with microalbuminuria (overnight albumin excretion rate 30-200 micrograms min-1) and 21 patients with albumin excretion below this range matched for age, sex, and duration of diabetes. Patients with microalbuminuria had significantly higher glycosylated haemoglobin (9.4 +/- 1.6 (+/- SD) vs 7.9 +/- 1.8% (normal range 5.0 to 7.6%)), total-cholesterol (5.6 +/- 1.1 vs 4.6 +/- 1.3 mmol l-1), apolipoprotein B (0.82 +/- 0.21 vs 0.66 +/- 0.14 g l-1), and apolipoprotein B:A1 ratio (0.58 +/- 0.18 vs 0.50 +/- 0.15) than those without microalbuminuria (all p less than 0.05). HDL-cholesterol was also raised (1.71 +/- 0.46 vs 1.43 +/- 0.37 mmol l-1, p less than 0.05). Lipoprotein(a) concentration was possibly higher in the microalbuminuric group (median (95% Cl) 105 (82-140) vs 72 (52-114) mg l-1, p = 0.06). No differences were seen in any of the rheological measurements. These results confirm the presence of potentially atherogenic lipoprotein changes in Type 1 diabetic patients with microalbuminuria, but suggest that altered blood rheology does not predate the development of nephropathy.