影响急性白血病诱导缓解的因素分析

目的：分析影响急性白血病诱导缓解的因素。方法：总结６４例急性白血病的治疗情况,分析判断包括年龄、白血病类型、骨髓原始加幼稚（或早幼粒）细胞比例、周围血白细胞计数、有无肝脾肿大等因素与完全缓解（ＣＲ）率的关系。结果：不同年龄、周围血白细胞计数的ＣＲ率差异有显著意义（Ｐ＜０．０５）。白血病类型、骨髓原始加幼稚（或早幼粒）细胞比例、有无肝脾肿大的ＣＲ率差异无显著意义（Ｐ＞０．０５）。结论：高龄（≥６０岁）和高白细胞急性白血病（周围血白细胞计数≥１００×１０９／Ｌ）,ＣＲ率低,预后差。     

牛骨形态发生蛋白复合煅烧骨治疗骨缺损的实验研究

目的 :验证从牛皮质骨中提取的骨形态发生蛋白 (bBMP)的异位诱导成骨能力 ,探讨煅桡骨 (SB)作为其载体对骨缺损的治疗作用。方法 :①将bBMP植入 1 6只balb/c小鼠肌袋内 ,每周宰杀 4只行细胞学检查 ,连续 4周。② 1 6只新西兰大白兔手术造成双侧桡骨 1cm缺损 ,分别植入bBMP -SB和SB进行自身对照 ,分批宰杀后行X -线照片和组织学检查。结果 :植入肌袋内的bBMP术后一周即可诱导软骨细胞形成 ,2周时可见编织骨 ,4周时可见小梁骨及骨髓成形。而骨缺损实验中 ,bBMP -SB组在软骨诱导、小梁骨的形成数量、骨折愈合等方面均明显优于单纯SB组。结论 :①bBMP有强大的异位诱导成骨能力 ;②bBMP -SB复合骨可促进骨缺损愈合     

Creating a model to predict time intervals from induction of labor to induction of anesthesia and delivery to coordinate workload

BackgroundInduction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available.MethodsPatients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type.ResultsA total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution’s specialty personnel are most available.ConclusionsTime to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.     

Regurgitation and aspiration

Regurgitation and aspiration remains one of the major complications of general anaesthesia. Aspiration is defined as oropharyngeal or gastric content entering the airway below the level of the vocal cords. This can cause morbidity and mortality by direct effects of the particulate, acid-related damage and bacterial pneumonia. It occurs largely in patients with risk factors although occasionally in patients that are low risk. Anaesthetic technique should be adjusted depending on the patient's risk of aspiration with rapid sequence induction considered in high-risk patients. Recognition and appropriate management of aspiration is essential.     

Liver transplantation for acute liver failure in a SARS-CoV-2 PCR-positive patient

Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies.     

Induction of follicular growth and production of a normal hormonal milieu in spite of using a constant low dose of luteinizing hormone in women with hypogonadotrophic hypogonadism

This study was designed to examine ovarian performance, i.e.follicular growth, normal steroidogenesis and luteal phase function,following the administration of multiple increasing doses ofhuman follicle stimulating hormone (FSH) with a constant lowdose of luteinizing hormone (LH) in women with isolated hypogonadotrophichypogonadism. Human meno–pausal gonadotrophin (HMG) wasused in the first treatment cycle, starting with 150 IU of LHand 150 IU of FSH per day, for 7 days. The dose was increaseddaily with 75 IU of LH and 75 IU of FSH for another 7 days ifno response was detected by serial ultrasound measurements andserumoestradiol determinations. In the second treatment cycle,a constant dose of 75 IU of LH (using HMG) was administeredper day and up to 150 IU of FSH (using urofollitrophin) wassupplemented. If no response was detected after 7 days of treatment,the dose of FSH was increased. For the final stage of ovulationinduction, human chorionic gonadotrophin (HCG) was administeredin the presence of at least one follicle >17 mm in diameterbut with no more than three follicles >16mm in diameter.To verify the adequacy of the luteal phase, a pharmacokinetic/pharmacodynamicstudy of -HCG, oestradiol and progesterone was performed followingthe second treatment cycle only. Ovarian stimulation using aconstant dose of 75 IU of LH and increasing doses of FSH upto 225 IU, resulted in normal follicular growth and hormonalmilieu. Both women showed normal luteal phase oestradiol andprogesterone production and both women conceived following thesecond treatment cycle     

Golgi-like demonstration of “dark” neurons with an argyrophil III method for experimental neuropathology

Summary A silver method is proposed for the selective, well-contrasted and reproducible demonstration of dark neurons in frozen, vibratome and paraffin sections cut at a thickness of 5 to 200 m from aldehyde-fixed brains. The Golgi-like staining of the dendrites enables asorting of dark neurons according to characteristic neuron classifications. The staining procedure includes an esterification with 1-propanol, a treatment with diluted acetic acid and development. The esterification strongly increases the argyrophilia of both dark neurons and mitochondria. Unwanted co-staining of mitochondria is suppressed by the acetic acid treatment, while a special developer is used to render the staining controllable. The applicability of the method to experimental neuropathology is demonstrated by Golgi-like staining of dark neurons in rat brains exposed, before transcardial perfusion-fixation and delayed autopsy, to various pathological conditions including ischemia, hypoglycemia, trauma, status epilepticus, deafferentation and poisoning with kainic acid, colchicine and sodium azide, respectively.     

阴沟肠杆菌Amp C酶的诱导性及对酶抑制剂的敏感性研究

目的 探讨阴沟肠杆菌Amp C酶的特性及对酶抑制剂的敏感性,方法 用琼脂稀释法研究第四代头孢菌素头孢吡肟,第三代头孢菌素头孢他啶,头孢噻肟与β-内酰胺酶抑制剂舒巴坦联合对10株头孢他啶耐药菌的体外抗菌活性。应用紫外法和反转录多聚酶链反应（RT－PCR）研究临床常用β-内酰胺类抗生素对AmpC酶的诱导作用以及3种抑制剂对Amp C酶的抑制作用。结果 舒巴坦不能增强头孢他啶的抗菌作用,第四代头也菌素头孢吡肟对头孢他啶耐药菌有较好的抗菌活性。亚胺培南对Amp C酶的诱导作用较强,酶抑制剂R0481220具有较好的抑制作用,结论 产Amp C酶的阴沟肠杆菌引起的感染可考虑选用第四代头孢菌素头孢吡肟进行治疗。     

阴道内放置PGE_2用于足月妊娠引产351例疗效观察

目的　比较 PGE2 阴道栓剂及催产素静滴引产的效果。方法　将 5 85例同样条件孕妇 ,随机分两组 ,分别给PGE2 阴道栓剂和催产素静脉滴注引产。结果　前列腺素组及催产素组引产成功率分别为 96 .3%和 79.92 % ;临产发动时间及总产程分别为 (2 .70± 0 .6 3) h,(3.0 1± 3.41) h和 (3.91± 0 .71) h,(6 .0 3± 3.5 0 ) h;剖宫产率分别为6 .8%和 18.18% (P<0 .0 1) ,有显著差异。结论　 PGE2 栓剂用于足月妊娠引产效果显著、安全、方便 ,对促宫颈成熟意义重要 ,可缩短住院天数 ,减少住院费用。