低剂量短疗程抗胸腺细胞球蛋白治疗肾移植耐激素排斥反应

目的探讨低剂量、短疗程的抗胸腺细胞球蛋白(ATG)治疗肾移植后早期激素耐受性排斥反应的疗效。方法15例肾移植后早期发生的激素耐受性排斥反应患者给予ATG 1 mg.kg-1.d-1,qod,总疗程4~10 d,观察其排斥反应逆转率、术后6mo内排斥反应再次发生率和感染发生率。结果ATG治疗(3.4±1.5)次后,15例患者中12例逆转(80%),肾功能良好;2例(13.3%)治疗有效,未行肾切除;1例(6.67%)无效,血透维持。术后6 mo内3例(20%)再次发生排斥反应,3例(20%)术后40d内发生肺部感染。随访期内受体存活率100%。结论低剂量、短疗程的ATG治疗能有效地逆转肾移植后早期激素耐受性排斥反应,且减少了感染及严重并发症的发生机会。     

Low-dose cyclosporin A therapy in cadaver renal transplantation in children

Abstract. Fifty-one pediatric patients undergoing a first cadaveric kidney transplantation were followed for at least 2 years after grafting. They were divided into two groups: those treated with methylprednisolone plus azathioprine (AZA) and those treated with methylprednisolone plus low-dose cyclosporin A (CyA; median dose 109 mg/m²per day ± 3. 4 mg/kg per day after 1 year). The steroid dosage given was significantly lower in the second group. The 4-year graft survival rate was 68% for the AZA group and 78% for the CyA group. Renal function did not differ significantly in the two groups; after 1, 2, and 3 years, the median 24-h creatinine clearance was 79, 69, and 51 ml/min/1. 73 m² respectively, for the AZA group and 78, 63, and 68 ml/min/1. 73 m² respectively, for the CyA group. Linear growth was similar in the two groups. We conclude that in pediatric patients the results of low-dose CyA immuno-suppression do not differ significantly from those obtained with AZA in terms of graft survival, renal function, or growth.     

小剂量芬太尼在胸科手术全麻复合高胸位硬膜外阻滞中的应用

目的观察胸科手术小剂量芬太尼在全麻复合高胸位硬膜外阻滞中的麻醉作用。方法40例科手术患者随机分为实验组(GE组)和对照组(GA组),GE组为全麻复合高胸位硬膜外阻滞,单纯全麻组为GA组,记录术中麻醉药用量,术毕苏醒时间和血压(BP)、心率(HR)。脑电双频指数(BIS)和白细胞介素-6(IL-6)。结果2组麻醉效果均满意,术毕拔管时间和异丙酚用量GE组显著小于GA组(P<0.05),血压、心率GE组均低于GA组,2组IL-6术后均比术前升高,但2组间无显著性差异,BIS值均在手术应在的常规范围内,但拔管时GE组略高于GA组。结论小剂量芬太尼在全麻复全高胸位硬膜下阻滞下胸科手术中能达到满意的麻醉效果。     

低剂量辐射对铀矿工健康潜在的影响

目的 探讨低剂量辐射对铀矿工人健康的损害作用。 方法 把某铀矿的工作人员按工种是否接触辐射有害因素,同时考虑年龄、性别的构成分为暴露组81人和对照组81人,对两组人员的血象学、肝肾功能、脂质学及甲状腺功能、微核检出率等指标进行检测并分析其差异。 结果 暴露组与对照组白细胞(white blood cell,WBC)、红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、血小板(platelet,PLT)、中性粒细胞百分比、淋巴细胞百分比、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、总蛋白(total protein,TP)、尿酸(uric acid,UA)、胆固醇(cholesterol,CH)、甘油三脂(triglyceride,TG)、高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(low-density lipoprotein cholesterol,LDL-C)等的异常率之间差异无统计学意义(P＞0.05),总胆红素(total bilirubin,TBIL)(38.27% vs.22.22%)、间接胆红素(indirect bilirubin,IBIL)(38.27% vs.22.22%)差异有统计学意义(χ²=4.945,P=0.040),血清游离三碘原氨酸(serum free triiodothyronine,FT3)(51.85% vs.34.57%)差异有统计学意义(χ²=4.930,P=0.039),血清游离甲状腺素(serum free thyroxine, FT4)、血清促甲状腺激素(serum thyroid stimulating hormone,TSH)差异无统计学意义(P＞0.05);暴露组微核检出率为96.29%。 结论 低剂量辐射对铀矿工可产生肝功能、甲状腺功能损害和DNA损伤。     

小剂量氨茶碱持续泵入治疗慢性阻塞性肺疾病急性加重期的疗效

目的：观察小剂量氨茶碱持续泵入治疗慢性阻塞性肺疾病（COPD）急性加重期的临床疗效.方法：COPD急性加重期患者80例,随机分为3组,A组25例,予常规吸氧、化痰及抗菌药物治疗,B组25例,在A组治疗的基础上同时给予葡萄糖（或生理盐水）250 mL＋氨茶碱0.5 g/d静滴（1～2 h内滴完）,C组（30例）在A组治疗的基础上同时给予生理盐水50 mL＋氨茶碱0.5 g微泵推注,2 mL/h,24 h维持,观察3组的COPD症状缓解所需时间、住院时间、住院费用.结果：B组和C组症状缓解所需时间短于A组[（8±3） d 比 （3±2） d 比 （11±3） d,P〈0.05],而C组症状缓解所需时间短于B组;住院时间及住院费用C组均少于A组和B组（均P〈0.05）;而A组和B组在这两项比较中差异无统计学意义（均P〉0.05）.结论：小剂量氨茶碱持续泵入治疗COPD急性加重期患者可明显缓解症状,并且可缩短住院时间及减少住院费用,具有一定的临床治疗价值.     

The effects of Sceletium tortuosum in an in vivo model of psychological stress

Aim of the study

Sceletium, and especially Sceletium tortuosum, is traditionally used as masticator and thought to have a sedative effect which may be beneficial to reduce symptoms of anxiety and/or depression. The current study evaluated the scientific merit of these anecdotal claims in an in vivo model of psychological stress.

Materials and methods

Male Wistar rats were administered either placebo, 5 or 20 mg/kg/day of Sceletium tortuosum extract for 17 days by daily oral gavage. 50% of rats were exposed to repeated restraint stress lasting 1 h for the last 3 days of treatment. Rat behavioral changes in response to stress were assessed using the elevated plus maze on the last day of restraint, immediately after the restraint session. Rats were sacrificed 24 h after the last restraint exposure and whole blood collected.

Results

Behavior indicated a limited effect of lower dose Sceletium to decrease restraint stress-induced self-soothing behavior, as well as to decrease stress-induced corticosterone levels. However, increased IL-1β levels argue against the claim that the plant may act as selective serotonin reuptake inhibitor, while this result combined with increased levels of C-reactive protein and prostaglandin E₂ suggest intolerance to the treatment. Decreased IL-2 and increased IL-10 levels in response to Sceletium treatment suggest a suppressive effect on T helper 1 immune function.

Conclusions

Although data indicates a limited positive effect of Sceletium on restraint-induced anxiety, numerous side-effects were evident. More research is required to derive an optimal therapeutic dose.     

小剂量静点硫酸镁中毒一例报告

妇科患者“子痫前期,妊娠合并贫血”小剂量应用硫酸镁注射液引发“镁中毒”一罕见病例。妇产科医师在应用硫酸镁注射液治疗妊娠高血压综合征时应引起重视,小剂量使用硫酸镁注射液亦可导致“镁中毒”。     

The effect of 3-year treatment with 0.25 mg/day of micronized 17beta-estradiol on cognitive function in older postmenopausal women

OBJECTIVES: To evaluate the effect of ultra-low-dose (0.25 mg/d) micronized 17beta-estradiol on cognitive function in older postmenopausal women. DESIGN: Randomized, placebo-controlled trial conducted for 3 years. SETTING: Academic health center in greater Hartford, Connecticut. PARTICIPANTS: Fifty-seven healthy, community-dwelling, older postmenopausal women. INTERVENTION: Women received 0.25 mg/d of micronized 17beta-estradiol (estrogen therapy (ET), n=32) or placebo (n=25); all women who had not had a hysterectomy received 100 mg/d of oral micronized progesterone for 2-week periods every 6 months. MEASUREMENTS: Neuropsychological measures of memory, language, mood, and executive function were collected at baseline, 3 months, and 36 months. Measures of executive function included the Controlled Oral Word Association Test, the Trail Making Test, and the Wisconsin Card Sorting Test. The Boston Naming Test was used to measure language skills. The Symbol Digit Modalities Test was used as a measure of sustained attention. Measures of memory included the Complex Figure Test, Fuld Object Memory Test, and a selected subtest from the Wechsler Memory Scale. Scores from the Geriatric Depression Scale and the Beck Anxiety Inventory were used to assess symptoms of depression. RESULTS: No differences were found between ET and placebo on any of the neurocognitive measures or depression instruments, nor were there any differences when the groups were stratified according to age. CONCLUSION: This small study, which had adequate power to detect change in some but not all domains of cognition tested, revealed that low-dose estrogen neither benefits nor harms cognitive function in older women after 3 years of treatment, but confirmation is needed from larger trials.     

Sufficient prophylactic efficacy with minor adverse effects by intravesical instillation of low-dose bacillus Calmette-Guérin for superficial bladder cancer recurrence

BACKGROUND: Intravesical instillation of bacillus Calmette-Guérin (BCG) is the most efficient strategy for prophylaxis of superficial bladder cancer recurrence. Adverse effects of BCG are major obstacles, but the reduction of BCG dose could minimize these effects. The efficacy and adverse effects of half-dose (40 mg) BCG, Tokyo 172 strain, were prospectively evaluated. METHODS: A total of 93 patients with superficial bladder cancer (pTa or pT1) were sequentially assigned to receive either 40 or 80 mg of BCG after transurethral resection. BCG was administered weekly for 6 weeks postoperatively. Eighty patients observed longer than 12 months after BCG therapy (41, 40 mg group; 39, 80 mg group) were analyzed. RESULTS: BCG therapy course was completed in 71 patients. Tumor recurrence was recognized in 11 of 40 patients in the 40 mg group and in 5 of 31 patients in the 80 mg group. There was no significant difference in tumor recurrence rate between the two groups (P = 0.547). BCG therapy was withdrawn in 1 patient in the 40 mg group and in 8 patients in the 80 mg-group because of BCG-related adverse effects. The morbidity of BCG-related toxicity was significantly higher in the 80 mg group. CONCLUSION: Half-dose of BCG Tokyo 172 strain had a similar efficacy and its toxicity was significantly lower compared to the standard dose. Thus, half-dose of this strain might be suitable, at least for initial BCG therapy, for the prophylaxis of bladder cancer recurrence. Further study would be necessary to clarify the efficacy of low-dose instillation in high-risk patients.