胰岛素增敏剂曲格列酮对人卵巢颗粒细胞芳香化酶活性的抑制作用

为探讨曲格列酮(troglitazone,TGZ)对人卵巢颗粒细胞芳香化酶(P450arom)活性的调节作用，以不同剂量的TGZ和(或)维甲酸类X受体(RXR)激动剂(LG100268，LG)处理来源于体外受精患者的卵巢颗粒细胞24h，然后测定细胞的芳香化酶活性和P450arom mRNA水平。结果发现，TGZ处理颗粒细胞24h可引起剂量依赖性的芳香化酶活性下降；LG单独作用可以抑制芳香化酶活性，但与TGZ合用对芳香化酶的抑制作用更明显；RT-PCR结果显示，随着芳香化酶活性的下降，P450arom mRNA表达水平也降低。表明TGZ可能是通过过氧化物酶体增殖物激活受体γ(PPARγ)：RXR异二聚体组成的核受体系统直接抑制卵巢颗粒细胞芳香化酶活性。     

PRKCG mutation (SCA-14) causing a Ramsay Hunt phenotype.

Progressive myoclonic ataxia, also referred to as Ramsay Hunt syndrome, is characterized by a combination of myoclonus and cerebellar ataxia, infrequently accompanied by tonic-clonic seizures. Its differential diagnosis overlaps with progressive myoclonic epilepsy, a syndrome with myoclonus, tonic-clonic seizures, progressive ataxia and dementia. In patients with progressive myoclonic epilepsy, specific diseases can frequently be recognized, but the diagnostic yield in progressive myoclonic ataxia is much lower. We describe a patient who presented with multifocal myoclonus in his thirties and who later developed cerebellar ataxia and focal dystonia. His father was similarly affected. Genetic studies revealed a mutation in the protein kinase C gamma (PRKCG) gene, known to cause spinocerebellar ataxia type 14 (SCA-14). This case illustrates that both myoclonus and dystonia are part of the clinical spectrum in SCA-14 and that myoclonus can even be the presenting symptom. We suggest that SCA-14 should be considered in the differential diagnosis of progressive myoclonic ataxia.     

DSA—Control of implanted devices for arterial hepatic perfusion

In contrast to conventional film angiography, the perfusion pattern of hepatic arterial chemotherapy was consistently visualized by DSA in 40 patients with implanted Infusaid pump or Port-A devices. Incomplete perfusion of a liver region by the cytotoxic agent was recognized by DSA as accurately as by nuclide scintigraphy. Furthermore, DSA appeared to be more sensitive in determining aberrantly perfused extrahepatic regions; this was especially true when there was a nonligated right hepatic artery. Specific details of vascular lesions and associated complicating events also could be satisfactorily analyzed by DSA only.     

Technetium-99m sestamibi scintigraphy for the assessment of lower extremity ischaemia in peripheral arterial disease

Technetium-99m sestamibi was used for functional investigation of the muscle perfusion of lower extremities in 35 patients with peripheral vascular disease. The aim was to test what useful information could be obtained by additional imaging of the legs in patients referred for risk stratification with dipyridamole myocardial scanning. Posterior images were acquired over the thighs and calves after postocclusive reactive hyperaemia and at rest. Inter- and intraextremity ratios and differences between the stress and rest data were used for the assessment of abnormal circulation. Arteriography was performed in every case, and surgical procedures or transluminal angioplasty in 31 patients. To estimate diagnostic accuracy, the results of^99mTc-sestamibi scintigraphy were compared with those of angiography and the functional consequences of revascularization procedures. The sensitivity and specificity of^99mTc-sestamibi scintigraphy were 55% and 25%, respectively, with an overall accuracy of 50%. Apparently methodological error was not responsible for these poor results. Instead, a paradoxically high uptake of the radiopharmaceutical in muscles supplied by significantly stenosed vessels was identified as the main source of both false-negative and false-positive results. This phenomenon resembles the findings of a previous study involving delayed administration of thallium-201 after exercise. In conclusion,^99mTc-sestamibi scintigraphy has not proved sufficiently reliable to help in the management strategy for patients with peripheral vascular disease.     

Scintigraphic evaluation of hepatic blood flow after intrahepatic portosystemic shunt (TIPS)

In patients with liver cirrhosis a transjugularly placed intrahepatic portocaval shunt (TIPS) is a non-surgical portosystemic device which aims to reduce portal venons pressure. In comparison with Doppler sonography, we evaluated in 28 patients the diagnostic impact of liver perfusion scintigraphy (with technetium-99m diethylene triamine penta-acetic acid) in the assessment of changes in the hepatic blood flow after TIPS shunting. The arterial and portal contributions to hepatic flow were calculated from the areas under the biphasic timeactivity curve. In the course of TIPS shunting, patency is threatened by reocclusion. Angiography is the gold standard for TIPS shunt reassessment. However, there is a need for a less invasive diagnostic procedure, such as scintigraphy or Doppler sonography, for the early detection of shunt insufficiency. Scintigraphy demonstrated that prior to TIPS shunting the portal venons contribution to hepatic perfusion was reduced to 29.2%, this reduction being due to portal hypertension. After TIPS placement a significant increase in portal venous perfusion was observed (38.2%;P<0.02). TIPS shunt occlusion was identified in patients by a significant reduction in the scintigraphically measured portal venons contribution to hepatic blood flow. Hepatic perfusion scintigraphy appears to be a valuable method to determine the immediate effect of TIPS on hepatic blood flow. Post-TIPS follow-up studies of hepatic haemodynamics by liver perfusion scintigraphy appear able to contribute to the detection of TIPS shunt occlusion before the clinical consequences of this complication have become apparent.     

丙种球蛋白治疗危重早产儿临床分析

目的 为评估IVIG治疗危重早产儿的临床疗效。方法 将危重早产儿116例采取随机分为治疗组和对照组，对照组给常规综合治疗，治疗组在常规综合治疗措施上，加用IVIG静脉滴注，比较治疗组与对照组患儿病情平稳率及死亡率。结果 IVIG治疗危重早产儿病情平稳率第5天达75．8％第10天达93．3％，而对照组分别为50％和70．4％；病死率治疗组为6．4％，对照组为11．1％，均优于常规对照组。结论 危重早产儿用IVIG治疗疗效较满意，值得推广。     

Patency of the infarct-related coronary artery — a pertinent factor in late recovery of myocardial fatty acid metabolism among patients receiving thrombolytic therapy?

The decrease in mortality among patients receiving thrombolytic therapy for myocardial infarction is greater than would be expected from the improvement in left ventricular contractile function alone; thus some additional advantage of recanalization of the infarctrelated coronary artery probably exists. Changes in the post-infarction myocardial metabolic state with respect to artery patency have not been studied with a gamma camera previously. A single-photon emission tomography scan using the fatty acid analogue para-¹²³I-iodophenylpentadecanoic acid was performed at rest before hospital discharge on nine patients with first anterior myocardial infarction. All patients had received intravenous thrombolytic therapy at the beginning of the insult. The semiquantitative analysis of the left ventricle included a total of 44 segments in each patient. The test was repeated 3 months later, with the patients divided into two groups: six patients had an angiographically patent left anterior descending coronary artery (group A), and three an occluded artery (group B). In group A the number of myocardial segments with abnormal (<70% of maximum) fatty acid uptake was initially 20.2±4.7 (mean±SD) and was reduced to 11.3±6.1 during the follow-up (95% confidence interval of the decrease 16.0–1.7 segments). In group B the number of these aberrant segments was fairly constant (21.7±13.1, initial test, and 21.3±13.3, retest). Our preliminary results suggest that even when thrombolytic therapy fails to prevent myocardial infarction, myocardial fatty acid metabolism has a better change of recovering if the relevant coronary artery has regained its patency. This finding emphasizes the need for further study to establish whether a direct link exists between myocardial metabolic state and patient survival after infarction.     

γ—干扰素对过度增生的血管平滑肌细胞癌基因表达的抑制作用

本实验建立了兔腹主动脉球囊扩张（ＢＡ）动物模型。以地高辛标记的Ｃ一ｆｏｓ、Ｃ一ｍｙｃ，Ｎ一ｒａｓ癌基因探针进行ＢＡ术后血管段组织的原位杂交，以生物素标记的Ｃ一ｆｏｓ、ｃ一ｍｙｃ、Ｎ一ｒａｓ探针对经ＢＡ组织培养液刺激的、培养的血管平滑肌细胞（ＳＭＣ）进行细胞的原位杂交。结果显示：（１）ＢＡ术后再狭窄的血管段中ｃ一ｆｏｓ、ｃ一ｍｙｃ、Ｎ一ｒａｓ三种癌基因表达均增高，而且表达颗粒主要分布于粥样斑块中，中膜平滑肌层颗粒稀少。正常血管段无这三种癌基因表达。（２）经ＢＡ组织培养液刺激的ＳＭＣ胞浆中充满ｃ一ｆｏｓ，ｃ一ｍｙｃ癌基因表达颗粒。Ｎ一ｒａｓ癌基因表达主要位于细胞核膜部位。未给ＢＡ组织液刺激的ＳＭＣ未见以上癌基因表达。γ—干扰素可以部分抑制其表达。     

Gallium scintigraphy in patients with adult T-cell leukemia lymphoma

Gallium scintigraphy was evaluated in 25 patients with adult T-cell leukemia lymphoma (ATLL). Anterior and posterior images were obtained at 72 h after administration of 3 mCi ⁶⁷Ga-citrate using a gamma camera (Maxi-Camera 400T, General Electric Co.) with a medium energy standard parallel hole collimator. Abnormally high accumulations were observed in 17 out of 25 cases (superficial lymph node, 8; hilar and mediastinal lymph node, 7; paraaortic lymph node, 2; lung, 9; liver, 1; bone, 1). There were 10 malignant lesions detected by ⁶⁷Ga scintigraphy in 9 out of 17 cases (superficial lymph node, 1; hilar and mediastinal lymph node, 6; paraaortic lymph node, 1; liver, 1; bone, 1). White blood cell count and serum LDH levels were raised in patients with abnormally high accumulations of ⁶⁷Ga. In conclusion, ⁶⁷Ga scintigraphy seemed to be a useful examination to detect malignant lesions in patients with ATLL.     

Salivary gland 99mTc-scintigraphy: a grading scale and correlation with major salivary gland flow rates

Sequential salivary gland scintigraphy with 99mTc-technetium pertechnetate (Tc-99) is a safe, minimally invasive test for study of major salivary glands. However, its relationship to salivary function has not been investigated in detail. We have investigated the relationship between major salivary gland flow rates and Tc-99 scans and developed a new rating scale using scans of a control group with normal salivary function. Salivary flow rates and Tc-99 scans were obtained from healthy, non-medicated subjects (n = 33) and from xerostomic patients (n = 22). There were significant differences between the groups for salivary flow rates and Tc-99 ratings. Significant correlations were found between salivary flow rates and Tc-99 ratings in the control and xerostomic groups. The Tc-99 rating scale proved reliable in assessing salivary dysfunction, and showed a high inter-examiner correlation. These results demonstrate the usefulness of salivary gland scintigraphy in assessing major salivary gland flow rates and the utility of a new rating scale.