早期激素干预对急性一氧化碳中毒大鼠迟发性脑病的预防作用

目的观察早期激素干预对急性一氧化碳中毒大鼠迟发性脑病（DEACMP）的预防作用。方法将132只雄性Wistar大鼠随机分成3个实验组：CO中毒组（COP组）、CO中毒＋地塞米松10 mg/kg组（DSMS-10组）和CO中毒＋地塞米松30 mg/kg组（DSMS-30组）,每组40只。另设健康对照组（NC组）,12只。实验组按150 ml/kg腹腔内注射CO制备急性一氧化碳中毒动物模型,健康对照组大鼠注射等体积的空气。在中毒后30 min内DSMS-10组腹腔内注射地塞米松剂量为10 mg/kg/d,共7 d;DSMS-30组腹腔内注射地塞米松剂量为30 mg/kg/d,共7 d;NC组和COP组则注射等剂量生理盐水。监测中毒后90 min、7 d、14 d、21 d各组大鼠血清中髓鞘碱性蛋白（MBP）的含量,并在上述各时间点处死大鼠取脑组织,行HE及MBP免疫组化染色。采用Morris水迷宫实验评估动物的智力状态。结果 Morris水迷宫实验结果显示,COP组中有8只大鼠被判定为迟发性脑病;DSMS-10组中有6只被判定为迟发性脑病;而DSMS-30组和对照组未出现迟发性脑病。COP组大鼠血清中MBP含量增高最显著,DSMS-10组也有增高,DSMS-30组接近正常。差异在中毒后90 min、7 d最明显。病理学检查显示COP组中发生迟发性脑病的大鼠在中毒90 min~21 d后脑海马、皮质下出现神经元损伤、髓鞘碱性蛋白脱失等病理改变,上述病理改变在各实验组中均可观察到,但以COP组大鼠病变程度最重,DSMS-30组最轻。结论10 mg/kg地塞米松可降低急性一氧化碳中毒大鼠迟发性脑病的发生率。30 mg/kg地塞米松则可避免迟发性脑病的发生。     

左旋门冬酰胺酶及地塞米松致儿童高血糖症的护理

急性淋巴细胞白血病患儿在接受左旋门冬酰胺酶(L—ASP)及地塞米松联合化疗的过程中，可出现血糖升高等并发症，笔对12例发生此并发症患儿的医疗及护理过程进行了总结，结果显示此种药物性血糖升高是可逆的，同时。只要通过精心的治疗和护理，可避免酮症酸中毒或低血糖等并发症的出现，确保化疗效果。     

1,6-二磷酸果糖和地塞米松对家兔失血性休克缺血-再灌注损伤的影响

目的　在家兔失血性休克模型上 ,探讨心肌缺血再灌注损伤机制 ,比较 1,6二磷酸果糖(FDP)和地塞米松 (DXM)对心肌缺血再灌注的保护作用。方法　按照 Wiggers改良法制作兔失血性休克模型。4 8只家兔随机分成 3组 : 组为对照组 ; 组为休克前给药组 (又分为 FDP 、DXM 及 FDP DXM 3组 ) ; 组为再灌注时给药组 (又分为 FDP 和 DXM 2组 )。观察血浆肌酸激酶 (CK)、心肌肌钙蛋白 I(c Tn I)含量及心肌细胞凋亡情况。结果　各组 CK、c Tn I基础值均无统计学差异 ;与对照组相比 , 组 CK、c Tn I及心肌细胞凋亡指数下降或明显下降 (P<0 .0 5或 P<0 .0 1) ; 组在休克时间点均无统计学意义 ,而再灌注时间点有下降或下降趋势 ,有统计学差异 (P<0 .0 5或 P<0 .0 1) ;与 FDP 和 DXM 组相比 ,FDP 和DXM 组的 CK和 c Tn I上升幅度均有减慢趋势 ,以 FDP组减慢趋势更加明显 ;休克给药组间比较 ,FDP DXM 组的 CK和 c Tn I上升幅度均减慢。结论　 FDP和 DXM对失血性休克引起的缺血再灌注损伤均有保护作用 ,但 FDP仅在缺血开绐给药才能充分发挥其效应 ,二者联合用药对心肌保护有更好的效果。     

炎性抑制与蛛网膜下腔出血后头痛的关系

目的探讨蛛网膜下腔出血(SAH)后头痛的发生是否与蛛网膜下腔炎性改变有关,同时观察地塞米松的免疫抑制作用对头痛的疗效.方法将80例意识清醒、能主诉头痛的SAH患者随机分为4组:单独应用甘露醇治疗组(甘露醇组)、在应用甘露醇基础上行脑脊液置换组(置换组)、地塞米松鞘内注射组(鞘内组)和静脉注射组(静脉组),观察各组患者的止痛效果.结果各组的总有效率分别为:甘露醇组27.27%、置换组66.67%、鞘内组92.36%、静脉组30.00%,鞘内组疗效与其他组疗效的差异有显著性意义,且头痛缓解时间显著延长( P<0.01).结论发生质变的血性脑脊液引起的蛛网膜下腔广泛免疫炎性反应是导致头痛的重要原因,鞘内注射地塞米松治疗SAH后头痛效果显著.     

Characteristics of depressed patients with elevated levels of dysfunctional cognitions

The characteristics of subjects with elevated scores on both the Dysfunctional Attitudes Scale and Cognitive Bias Questionnaire were studied in a sample of 72 depressed inpatients. In comparison with low cognitive dysfunctional subjects (n =48), subjects with elevated dysfunctional cognitions (n =24) revealed greater severity of depression, more hopelessness, higher frequencies of automatic thoughts, less social support, and overall poorer social adjustment. Furthermore, the data suggest that age of depression onset, duration of current depressive episode, and number of previous depressive episodes are associated with elevated levels of dysfunctional cognitions. There were no differences between high and low dysfunctional cognitive groups with respect to DSM-III melancholic diagnosis or response on the dexamethasone suppression test. This study was supported by NIMH Grants MH31640, MH35945 and by Biomedical Research Support Grant S07RR0517. The authors thank Marilyn Foulke and Dorothy Lampal for their valuable assistance in the completion of this project.     

Treatment of AL Amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement 2020 Update

Immunoglobulin light chain (AL) amyloidosis is a clonal plasma cell disorder leading to progressive and life-threatening organ failure. The heart and the kidneys are the most commonly involved organs, but almost any organ can be involved. Because of the nonspecific presentation, diagnosis delay is common, and many patients are diagnosed with advanced organ failure. In the era of effective therapies and improved outcomes for patients with AL amyloidosis, the importance of early recognition is further enhanced as the ability to reverse organ dysfunction is limited in those with a profound organ failure. As AL amyloidosis is an uncommon disorder and given patients’ frailty and high early death rate, management of this complex condition is challenging. The treatment of AL amyloidosis is based on various anti–plasma cell therapies. These therapies are borrowed and customized from the treatment of multiple myeloma, a more common disorder. However, a growing number of phase 2/3 studies dedicated to the AL amyloidosis population are being performed, making treatment decisions more evidence-based. Supportive care is an integral part of management of AL amyloidosis because of the inherent organ dysfunction, limiting the delivery of effective therapy. This extensive review brings an updated summary on the management of AL amyloidosis, sectioned into the 3 pillars for survival improvement: early disease recognition, anti–plasma cell therapy, and supportive care.     

哮喘病人外周血CD4+ T淋巴细胞自噬现象的观察

摘要：目的观察分离培养的哮喘病人外周血CD4^＋T淋巴细胞的自噬现象。方法密度梯度离心法、尼龙棉柱法及磁分离法分离哮喘病人外周血CD4^＋T淋巴细胞，分空白组及地塞米松（DXM）组，培养72h后用流式细胞仪检测自噬细胞比例变化。结果DXM组与空白组72h自噬细胞发生率有显著性差异。结论DXM可诱导哮喘病人外周血CD4^＋T淋巴细胞自噬。     

酚妥拉明和地塞米松对吸入性损伤大鼠肾脏损伤的保护作用及其机制

目的：观察酚妥拉明和地塞米松重度吸入性损伤大鼠肾脏损害的保护作用及其机制。方法：７２只大鼠随机分为３组,对照组腹腔注射重盐水,Ａ组腹腔注射酚妥拉明,Ｂ组腹腔注射地塞米松,另取６只非致伤大鼠作伤前值测定,再取６只致伤大鼠,伤后３０分名贵作伤后值测定。结果：对照组尿素氮（ＢＵＮ）,再二醛（ＭＤＡ）、ＭＤＡ／超氧化物歧化酶（ＳＯＤ）及组织含水量增增高,血中ＮＯ水平升高,肾组织中ＮＯ水平变化不如血中明显,     

术中应用地塞米松对儿童扁桃体切除术后疼痛的影响

目的：探讨术中应用地塞米松对儿童扁桃体切除术后疼痛的影响。方法：选取我院2015年1月至2018年6月行双侧扁桃体切除术的50例患儿为研究对象,按来院先后顺序编号,单号入实验组,双号入对照组,分为实验组和对照组各25例。两组患儿均采用相同麻醉方案,实验组术中应用地塞米松0.5 mg/kg,最大剂量8.0 mg,加入100 mL生理盐水中静脉滴注,分别记录患儿手术结束拔管后2、4 h、术后第1、2、3天每天8点患儿咽部疼痛程度并评分。结果：实验组术后4 h、术后第1、2天疼痛程度小于对照组（P<0.05）;术后2 h和术后第3天,两组疼痛程度比较差异无统计学意义（P>0.05）。结论：术中应用地塞米松能有效减轻儿童扁桃体切除术后疼痛。