食管化学烧伤后狭窄的重建手术

目的探讨食管化学烧伤后狭窄的外科治疗经验及横结肠代食管重建手术的应用价值。方法137例食管化学烧伤后狭窄的患者中112例采用横结肠代食管、保留结肠左动脉升支、胸骨后顺蠕动吻合,其中横结肠咽腔吻合34例,横结肠食管颈部吻合78例;25例采用胸骨后胃咽腔或胃食管颈部吻合。结果无手术死亡病例。手术后发生颈部吻合口瘘14例,吻合口狭窄11例,气管切开4例,经治疗后均痊愈。结论食管化学烧伤后应积极采取食管重建术,采取胸骨后横结肠代食管术,行横结肠食管颈部吻合或结肠咽腔吻合都是适宜的。     

医院感染监控软件的研制

目的研制开发医院感染监控管理系统,实现医院感染管理动态监测,预防医院感染和传染病暴发流行,杜绝医院感染恶性事件发生。方法采用C／S＋B／S架构,与军卫一号信息工程接轨,以Delphi和NET为开发工具,结合Java Script＋ASP＋XML＋web Service等先进开发技术,对HIS中医院感染相关信息进行提取、整合、分析及预警。结果该系统解决了医院感染统计中数据的复杂逻辑关系问题,简化了工作流程,减少了前瞻性干预控制的盲目性,提高了工作效率。结论借助该系统对医院感染各环节及高危因素进行前瞻性监测,能有效降低医院感染发病率,减少漏诊、漏报。     

Iron overload in myelodysplastic syndromes (MDS) - diagnosis, management, and response criteria: a proposal of the Austrian MDS platform

Transfusion-related morbidity is an emerging challenge in chronically transfused patients with low-risk myelodysplastic syndromes (MDS). In these patients, transfusion-induced iron overload may represent a leading medical problem. However, although iron-chelating drugs are available, little is known about optimal diagnostic tools, predisposing factors, and the optimal management of these patients. In the current article, we provide recommendations for the diagnosis, prevention and treatment of iron overload in MDS and propose treatment response criteria. Consensus criteria and resulting recommendations were discussed and formulated by members of the MDS platform of the Austrian Society of Haematology and Oncology in a series of meetings and conferences in 2006 and 2007. These recommendations should facilitate and assist in recognition of iron overload, selection of patients, timing of treatment, drug selection and the measurement of treatment responses.     

Requirement for invariant chain in macrophages for Mycobacterium tuberculosis replication and CD1d antigen presentation

Mycobacterium tuberculosis is an intracellular bacterium that persists in phagosomes of myeloid cells. M. tuberculosis-encoded factors support pathogen survival and reduce fusion of phagosomes with bactericidal lysosomal compartments. It is, however, not entirely understood if host factors that mediate endosomal fusion affect M. tuberculosis intracellular localization and survival. Neither is it known if endosomal fusion influences induction of host immune reactivity by M. tuberculosis-infected cells. Lysosomal degradation of M. tuberculosis appears to be pivotal for making available lipid substrates for assembly into lipid-CD1d complexes to allow activation of CD1d-restricted invariant natural killer T (iNKT) cells. To clarify the role for endosomal fusion in M. tuberculosis survival and induction of host CD1d-mediated immune defense, we focused our studies on the invariant chain (Ii). Ii regulates endosome docking and fusion and thereby controls endosomal transport. Through direct binding, Ii also directs intracellular transport of the class II major histocompatibility complex and CD1d. Our findings demonstrate that upon infection of Ii-knockout (Ii(-/-)) macrophages, M. tuberculosis is initially retained in early endosomal antigen 1-positive lysosomal-associated membrane protein 1-negative phagosomes, which results in slightly impaired pathogen replication. The absence of Ii did not affect the ability of uninfected and infected macrophages to produce nitric oxide, tumor necrosis factor alpha, or interleukin-12. However, induction of cell surface CD1d was impaired in infected Ii(-/-) macrophages, and CD1d-restricted iNKT cells were unable to suppress bacterial replication when they were cocultured with M. tuberculosis-infected Ii(-/-) macrophages. Thus, while the host factor Ii is not essential for the formation of the M. tuberculosis-containing vacuole, its presence is crucial for iNKT cell recognition of infected macrophages.     

Critical role for invariant chain in CD1d-mediated selection and maturation of Vα14-invariant NKT cells

The development and maturation of Vα14 invariant (i)NKT cells in mice requires CD1d-mediated lipid antigen presentation in the thymus and the periphery. Cortical thymocytes mediate positive selection, while professional APCs are involved in thymic negative selection and in terminal maturation of iNKT cells in the periphery. CD1d requires entry in the endosomal pathway to allow antigen acquisition for assembly as lipid/CD1d complexes for display to iNKT cells. This process involves tyrosine-based sorting motifs in the CD1d cytoplasmic tail and invariant chain (Ii) that CD1d associates with in the endoplasmic reticulum. The function of Ii in iNKT cell thymic development and peripheral maturation had not been fully understood. Using mice deficient in Ii and the Ii-processing enzyme cathepsin S (catS), we addressed this question. Ii(-/-) mice but not catS(-/-) mice developed significantly fewer iNKT cells in thymus, that were less mature as measured by CD44 and NK1.1 expression. Ii(-/-) mice but not catS(-/-) mice developed fewer Vβ7(+) cells in their iNKT TCR repertoire than WT counterparts, indicative of a change in endogenous glycolipid antigen/CD1d-mediated iNKT cell selection. Finally, using a Mycobacterium tuberculosis infection model in macrophages, we show that iNKT developed in Ii(-/-) but not catS(-/-) mice have defective effector function. Our data support a role for professional APCs expressing Ii, but no role for catS in the thymic development and peripheral terminal maturation of iNKT cells.     

Brain-derived neurotrophic factor gene variation influences cerebrospinal fluid 3-methoxy-4-hydroxyphenylglycol concentrations in healthy volunteers

Brain-derived neurotrophic factor (BDNF) has been shown to influence monoamine transmitter synthesis, metabolism and release. We investigated possible relationships between four BDNF gene polymorphisms and cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) in healthy volunteers (n = 132). All BDNF polymorphisms (270 C/T, −633 T/A, Val66Met, and 11757 G/C) were associated with MHPG (P < 0.02), but not with 5-HIAA and HVA concentrations. At a second clinical investigation 8–20 years after CSF sampling 30% of the subjects had experienced various psychiatric disorders. Development of a psychiatric disorder was predicted by low 5-HIAA concentrations (P = 0.01). The results suggest that BDNF gene variation participates in regulation of norepinephrine turnover rates in the central nervous system of human subjects.     

系统性红斑狼疮患者T淋巴细胞亚群及NK细胞变化及其临床意义

目点研究T淋巴细胞亚群及NK细胞的表达与系统性红斑狼疮(SLE)发病机理的关系.方法根据有无并发狼疮性肾炎分为Ⅰ组、Ⅱ组,采用流式细胞术检测两组SLE患者外周血T淋巴细胞亚群和NK细胞的表达变化. 结果与正常对照组比较,SLE患者外周血T淋巴细胞亚群CD3、CD4 T淋巴细胞显著减少,CD8T细胞及NK细胞的表达显著增加,CD4/CD8细胞比值明显下降,尤其在并发狼疮性肾炎组更为显著.结论 T淋巴细胞亚群及其NK细胞的表达异常在SLE尤其在狼疮性肾炎的发生、发展过程中发挥着重要作用.     

沂蒙山区低出生体重儿发生率及相关因素调查

目的调查沂蒙山区低出生体重儿的发生率及其危险因素。方法采用分层抽样法调查了2001年6月~2003年6月临沂市2所医院分娩的低出生体重儿的产科资料,采用Logistic回归分析方法,分析产妇孕前及孕期因素与发生低出生体重儿的相关关系。结果沂蒙山区低出生体重儿的发生率为2.277%,产妇的年龄、孕次、流产次数、产次的增多、多胎、患有妊娠高血压综合征等,可以使低出生体重儿发生的危险性增加;而产前检查次数、分娩孕周与之呈负相关关系。结论沂蒙山区低出生体重儿的发生率低于1998年全国抽样调查水平,低出生体重儿的发生与多种因素有关。     

丙泊酚对大鼠海马CA1区动作电位发放的影响

目的观察丙泊酚对大鼠海马CA1区动作电位(AP)发放的影响。方法断头法分离Wistar大鼠海马半脑,切片机切出400μm厚度的海马脑片。20张脑片分为两组:脂肪乳剂组和丙泊酚组,每组10张。应用电流钳技术,给予大鼠海马CA1区锥体神经元胞体以不同强度的电流刺激:从0nA到0.45nA,以0.05nA递增,共记录10sweeps,不同强度刺激间隔时间为10s,在CA1区神经元胞体记录加入90μl脂肪乳剂或丙泊酚(相当于100μmol/L)前后不同时间、不同刺激强度下AP的发放情况。膜钳制电流为0nA。结果脂肪乳剂没有影响胞体动作电位的数目和幅值;100μmol/L丙泊酚明显减少不同刺激强度下胞体动作电位产生的个数,加入丙泊酚40min后,动作电位基本消失;而且动作电位的幅值随时间而变化,加入丙泊酚前为(113±11)mV,加入丙泊酚后20min内幅值无明显变化,30min后降至(91±5)mV(P<0.05)。结论丙泊酚可能通过抑制钠通道和开放氯通道而减慢神经元动作电位的发放频率和降低其幅值。     

克拉玛依市乙肝疫苗纳入儿童免疫规划后接种率调查与评价

目的评价克拉玛依市乙型肝炎（乙肝）疫苗纳入儿童免疫规划后的工作质量和效果。方法采用按容量比例概率抽样方法随机调查305名儿童乙肝疫苗（HB—VAX）接种情况；开展3岁以下儿童乙肝病毒感染标志的血清学监测；调查在医院出生的2500名新生儿首针HB—VAX接种情况。结果新生儿首针HB—VAX接种率为97．36％，及时接种率为95．12％；儿童首针及时接种率为75．74％，全程及时接种率81．97％，全程接种率88．52％，HB—VAX全程接种率和首针及时接种率均呈逐年上升趋势；HB—V．AX免疫后抗-HBs阳性率为93．45％。结论HB—VAX纳入儿童免疫规划工作后，有效提高了儿童HB—VAX接种率、首针及时接种率和全程及时接种率。但还应重视在家里出生的新生儿和流动儿童HB—VAX接种率的提高。