Transplantation of an eight-organ multivisceraI graft in a patient with frozen abdomen after complicated Crohn's disease

To report an extended multivisceral transplantation (MVTx) including right kidney and ascending colon in a patient with complicated Crohn's disease (CD). A 36-year old female suffering from short bowel syndrome and frozen abdomen due to fistulizing CD after multiple abdominal operations underwent MVTx of eight organs including stomach, pancreatoduodenal complex, liver, intestine, ascending colon, right kidney, right adrenal gland, and greater omentum in November 2003. Immunosuppression consisted of alemtuzumab, tacrolimus and steroids. The patient was off parenteral nutrition by postoperative wk 3. She experienced one episode of pneumonia. The patient recovered completely and discharged 2.5 mo and was doing well 30 mo after MVTx. This is one of the very rare cases in which a complete mulitivisceral graft of eight abdominal organs was transplanted orthotopically.     

碳酸氢钠预防造影剂肾病——一项随机对照研究

背景：造影剂肾病仍是放射影像学检查的一种常见并发症。在动物急性缺血性肾衰竭模型中，预先使用碳酸氢钠比氯化钠的肾脏保护作用更佳。缺血和造影剂引发的急性肾衰竭均被认为是自由基损伤所致。但是，在人或动物至今尚无评价碳酸氢钠预防造影剂肾病有效性的研究。 目的：在使用放射性造影剂前后用碳酸氢钠或氯化钠进行预防性水化，比较二者的有效性。 设计、地点和病人：一项于2002年9月16日至2003年6月17日进行的前瞻性、单中心、随机试验。119例血清肌酐稳定在≥1．1mg／dL（t≥97．2μmol／L）水平的病人，在应用碘帕醇（370mg碘／mL）造影前后，随机接受了氯化钠静脉滴注（n=59）或碳酸氢钠静脉滴注（n=60），剂量均为154mEq／L。在造影前及造影后第1、2天进行了血清肌酐检测。 干预：病人接受154mEq／L的氯化钠或碳酸氢钠，造影前以每小时3mL／kg的速度静脉滴注1小时，造影后以每小时1mL／kg的速度滴注上述药物6小时。 主要观察指标：造影剂肾病，其定义为在造影后2天内血清肌酐升高tμ25％。 结果：两组病人在年龄、性别、糖尿病发生、种族以及造影剂用量方面无显著差异。碳酸氢钠治疗组病人基线血清肌酐水平稍高于氯化钠治疗组，但亦无显著差异（氯化钠组均值[sD]为1．71[0．42]mg／dL[151．2{37．1}μmol／L]，碳酸氢钠组为1．89[0．69]mg／dL[167．1{61．0}μmol／L]；P=0．09）。氯化钠组8例（13．6％），发生造影剂肾病一级终点，而碳酸氢钠组仅1例（1．7％）（均值差别，11．9％；95％可信区间[CI]，2．6％～21．2％；P=0．02）。随后，又对191例符合研究纳入标准的病人给予了碳酸氢钠治疗并进行随访登记，结果有3例出现了造影剂肾病（1．6％；95％CI，0％～3．4％）。 结论：对于造影剂引发的肾衰竭，在造影前采用碳酸氢钠进行水化治疗比采用氯化钠水化治疗更为有效。     

甲型H1N1流感确诊病例出院标准(试行)

甲型H1N1流感确诊病例同时满足下列条件时,可以出院: 1.体温正常,流感样症状消失≥3 d,无并发症,临床情况稳定;     

丽珠肠乐、参苓止泻汤合治婴幼儿腹泻

目的：探讨丽珠肠乐、参苓止泻汤治疗婴幼儿迁延性或慢性腹泻的疗效。方法：将62例患儿随机分为两组，均补液、维持水电解质及酸碱平衡。治疗组用丽珠肠乐、参苓止泻汤，对照组用蒙脱石。7d为1个疗程，观察两组疗效。结果：治疗组的显效率、有效率、总有效率明显优于对照组（P〈0．01）。结论：丽珠肠乐、参苓止泻汤合治婴幼儿迁延性或慢性腹泻疗效满意。     

Oxygen Reverses Deficits of Cognitive Function and Memory and Increased Heart Rate Induced by Acute Severe Isovolemic Anemia

Background: Erythrocytes are transfused to improve oxygen delivery and prevent or treat inadequate oxygenation of tissues. Acute isovolemic anemia subtly slows human data processing and degrades memory, increases heart rate, and decreases self-assessed energy level. Erythrocyte transfusion is efficacious in reversing these effects of acute anemia. We tested the hypothesis that increasing arterial oxygen pressure (Pao2) to 350 mmHg or greater would supply sufficient oxygen to be equivalent to augmenting hemoglobin concentration by 2-3 g/dl and thus reverse the effects of acute anemia.

Methods: Thirty-one healthy volunteers, aged 28 +/- 4 yr (mean +/- SD), were tested with verbal memory and standard, computerized neuropsychologic tests before and twice after acute isovolemic reduction of their hemoglobin concentration to 5.7 +/- 0.3 g/dl. Two sets of tests were performed in randomized order at the lower hemoglobin concentration: with the volunteer breathing room air or oxygen. The subject and those administering the tests and recording the results were unaware which gas was administered. As an additional control for duration of the experiment, 10 of these volunteers also completed the same tests on a separate day, without alteration of hemoglobin concentration, at times of the day similar to those on the experimental day. Heart rate, mean arterial blood pressure, and self-assessed sense of energy were recorded at the time of each test.

Results: Reaction time for digit-symbol substitution test increased, delayed memory was degraded, mean arterial pressure and energy level decreased, and heart rate increased at a hemoglobin concentration of 5.7 g/dl (all P < 0.05). Increasing Pao2 to 406 +/- 47 mmHg reversed the digit-symbol substitution test result and the delayed memory changes to values not different from those at the baseline hemoglobin concentration of 12.7 +/- 1.0 g/dl, and decreased heart rate (P < 0.05). However, mean arterial pressure and energy level changes were not altered with increased Pao2 during acute anemia.     

医学微生物实验课的设计与管理

为了培养医学生解决实际问题的能力，训练学生树立创新的意识和严谨的科学作风以及团结协作的精神品德，本文提出了几条关于医学微生物实验课的设计原则，并且提出了几条医学微生物实验室的管理建议，以防止实验室微生物感染事件的发生。     

Dual Exposure to Sevoflurane Improves Anesthetic Preconditioning in Intact Hearts

Background: Anesthetic preconditioning (APC) with sevoflurane reduces myocardial ischemia-reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevoflurane would achieve an outcome similar to that associated with a single exposure to a higher (H) concentration.

Methods: Langendorff-prepared guinea pig hearts were exposed to 0.4 mm sevoflurane once for 15 min (H1-15; n = 8) or 0.4 mm (H2-5; n = 8) or 0.2 mm sevoflurane (L2-5; n = 8) twice for 5 min, with a 5-min washout period interspersed. Sevoflurane was then washed out for 20 min before 30 min of global no-flow ischemia and 120 min of reperfusion. Control hearts (n = 8) were not subjected to APC. Left ventricular pressure was measured isovolumetrically. Ventricular infarct size was determined by tetrazolium staining and cumulative planimetry. Values are expressed as mean +/- SD.

Results: The authors found a better functional return and a lesser percentage of infarction on reperfusion in H2-5 (28 +/- 9%) than in H1-15 (36 +/- 8%; P < 0.05), L2-5 (43 +/- 6%; P < 0.05), or control hearts (52 +/- 7%; P < 0.05).     

Effect of water restrictions on the physiological parameters,psychological behavior and brain c-Fos expression in rat

1 Introduction Exposure to hostile stressors causes a series of coor- dinated responses in the body, such as alterations of neu- roendocrine secretion, immune reaction and behavioral manifestation to maintain homeostasis stability and sur-vival of the organisms. Stressors are divided into two main categories: physical, or systemic, and psychological, or emotional / processive. Each stressor might activate a spe- cific central pathway to induce a special neuroendocrine response, even cause stre…     

Morphine Preconditions Purkinje Cells against Cell Death under In Vitro Simulated Ischemia-Reperfusion Conditions

Background: Morphine pretreatment via activation of [delta]1-opioid receptors induces cardioprotection. In this study, the authors determined whether morphine preconditioning induces ischemic tolerance in neurons.

Methods: Cerebellar brain slices from adult Sprague-Dawley rats were incubated with morphine at 0.1-10 [mu]m in the presence or absence of various antagonists for 30 min. They were then kept in morphine- and antagonist-free buffer for 30 min before they were subjected to simulated ischemia (oxygen-glucose deprivation) for 20 min. After being recovered in oxygenated artificial cerebrospinal fluid for 5 h, they were fixed for morphologic examination to determine the percentage of undamaged Purkinje cells.

Results: The survival rate of Purkinje cells was significantly higher in slices preconditioned with morphine (>= 0.3 [mu]m) before the oxygen-glucose deprivation (57 +/- 4% at 0.3 [mu]m morphine) than that of the oxygen-glucose deprivation alone (39 +/- 3%, P < 0.05). This morphine preconditioning-induced neuroprotection was abolished by naloxone, a non-type-selective opioid receptor antagonist, by naltrindole, a selective [delta]-opioid receptor antagonist, or by 7-benzylidenenaltrexone, a selective [delta]1-opioid receptor antagonist. However, the effects were not blocked by the [mu]-, [kappa]-, or [delta]2-opioid receptor antagonists, [beta]-funaltrexamine, nor-binaltorphimine, or naltriben, respectively. Morphine preconditioning-induced neuroprotection was partially blocked by the selective mitochondrial adenosine triphosphate-sensitive potassium channel antagonist, 5-hydroxydecanoate, or the mitochondrial electron transport inhibitor, myxothiazol. None of the inhibitors used in this study alone affected the simulated ischemia-induced neuronal death.