替拉万星(telavancin):一种新型脂糖肽类抗菌药

替拉万星(telavancin,TD-6424)是万古霉素的衍生物,用于治疗耐药革兰阳性菌,特别是MRSA感染。本文对替拉万星作用机制、抗菌活性、药动学、药效学、临床适应证和不良事件等作一简要介绍。一、作用机制     

Stratum corneum lipids liposomes for the topical delivery of 5-aminolevulinic acid in photodynamic therapy of skin cancer: preparation and in vitro permeation study

Background  

Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) is a skin cancer therapy that still has limitations due to the low penetration of this drug into the skin. We have proposed in this work a delivery system for 5-ALA based on liposomes having lipid composition similar to the mammalian stratum corneum (SCLLs) in order to optimize its skin delivery in Photodynamic Therapy (PDT) of skin cancers.     

The inflammatory response in drug-induced acute urticaria: ultrastructural study of the dermal microvascular unit

BACKGROUND: Drug exposure is one of the main aetiologies of urticaria and represents the second most common cause in acute urticarias. Studies involving the ultrastructural aspects of urticaria are relatively rare in the literature. Most of the articles published report on skin biopsies of experimentally induced urticaria, and acute urticaria has been studied even less from a morphological point of view. OBJECTIVES: The aims of this study were to observe ultrastructural cell characteristics in five patients with drug-induced acute urticaria and possible aspects of the inflammatory skin response. METHODS: Clinical manifestations, light microscopy and transmission electron microscopy were evaluated. RESULTS: With light microscopy, a mild perivascular lymphocyte-monocyte infiltrate was observed with few neutrophils and dermal oedema in skin biopsies of five patients. With electron microscopy, a mild vascular dilatation was observed, with platelets in the lumen and several lymphocytes and dendritic cells close to the superficial dermal vessels. Some mast cells appeared normal, whereas others were granule-depleted. In some areas, mast cells, lymphocytes and satellite dendritic cells were closely associated, as well as some macrophages. A significant number of plasma cells, eosinophils and polymorphonuclear neutrophils were not observed; however, the presence of lymphocytes and macrophages was significant. The epidermis and the dermal-epidermal junction were preserved, except for a discrete oedema in keratinocytes. CONCLUSIONS: The ultrastructural aspect of drug-induced acute urticaria is similar to that observed in urticaria caused by Urtica dioica, intradermal histamine and cold urticaria. The presence of the cellular triad with mast cells, dendritic (or satellite) cells and lymphocytes suggests a functional interaction of these cells. These findings support the possible existence of mechanisms in the dermis that may participate in protective and/or injurious vasocentric immune reactions.     

Very low birthweight infants: outcome in a sub-Arctic population

Objective : To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. Subjects and methods: All live born infants ( n = 536) with birthweight ≤1500g born during 1978–89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow-up recordings to 4 y of age at maternal and child health centres. Stillborn infants ( n = 269) with birthweight ≤1500g during the same period were also registered. Results : The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks'gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy-five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4y. The likelihood of survival was independently related to female gender. The trend for survival to 4y of age did not increase significantly. Thirty children suffered from cerebral palsy (8.7% of survivors, 5.6% of live births) and the cerebral palsy rate for infants with birthweight 751-1000 g decreased. The proportion of survivors considered to be normal or mild disabled increased and the part suffering from moderate or severe disability decreased significantly. Conclusions : In spite of long distances and unfavourable climatic conditions VLBW infants can be adequately cared for in this sparsely populated region of Norway.     

卵清白蛋白特异性T细胞克隆的建立及T细胞受体使用情况分析

目的：体外建立可长期培养的抗原特异性T细胞系及克隆，并分析其T细胞受体的使用情况。方法：用卵清白蛋白（OVA）免疫BALB／c小鼠，取淋巴结细胞在体外用抗原原复刺激建立抗原特异性T细胞系，通过能限稀释法进行克隆，应用锚定PCR方法分析其特异的T细胞受体的应用。结果：建立了H－2^d限制的OVA特异性T细胞系，获得了3株特异性较高的T细胞克隆，T细胞系中TCR AV11S4和BV4S1应用频率最高，3株T细胞克隆的TCR均为AV5S2和BV2S1，这些T细胞所使用的TCRα链和β链在CDR3区有明显的共性，结论：获得了卵清白蛋白特异的T细胞系和克隆，且其T细胞受体的应用有一定的限制性。     

Red cell antibody problems in 1000 liver transplants

Liver transplant patients frequently require large amounts of blood. The frequency and nature of their red cell (RBC) antibody problems were examined. Records were reviewed in 496 adults and 286 children undergoing 1000 consecutive transplants. Twenty-two percent of adults and 14 percent of children had RBC alloantibodies. Antibodies of potential clinical significance were found before transplant in 6.3 percent of adults and 1.0 percent of children; despite immunosuppression, they appeared 1 to 5 weeks after transplant in an additional 7.5 and 5.2 percent respectively. These antibodies probably represented secondary immune responses. Of 58 transplant patients with prior potentially significant antibodies, 8 required 7 to 110 units of antigen-untyped blood after 8 to 28 units of antigen-negative blood; of these patients, one had subsequent hemolysis. Positive direct antiglobulin tests in 24 percent of adults and 10 percent of children were most often thought to be due to nonspecific adsorption of IgG. Anti-recipient ABO antibodies developed in 22 of 60 (37%) evaluable ABO-unmatched grafts; 13 cases had associated hemolysis. In all, 36 percent of adults and 20 percent of children had diverse RBC antibody problems. Resolution of these problems is an important part of the laboratory support necessary for a liver transplantation program.     

急性心肌梗死后的延迟冠状动脉内支架植入治疗

目的　评估急性心肌梗死后梗死相关冠状动脉内支架植入的临床疗效。方法　 15 4例急性心肌梗死患者 ,平均年龄 (6 1± 12 )岁于发病后平均 13天行冠状动脉内支架术 ,所有患者常规服用肠溶阿司匹林和噻氯匹定。观察住院期和随访期的临床事件。结果　 15 4例患者共植入 173个支架 (平均 1 1个 /例 )。支架植入的指征 :选择性初发病变 (denovo)占 2 4 3 % ,急性或濒危闭塞占13 9% ,有发生闭塞高危因素的病变占 6 1 8%。所用支架主要为Nir支架 (2 6 % )、Multi Link支架(19% )、XT支架 (13% )、Crossflex支架 (10 % ) ,等等。支架植入时最大球囊充盈压力为 (12± 2 )大气压。平均残余狭窄 (7± 8) %。住院期间无一例死亡、心肌梗死和需重复再通治疗 ,但术后“微坏死(micronecrosis)”率为 1 3%。术后 6个月病死率为 3 9% ,Q波型或非Q波型心肌梗死率为 1 9% ,支架内再狭窄而行再次冠状动脉腔内成形术率 6 1%。总的无心脏事件存活率为 89 6 %。结论　心肌梗死后行冠状动脉内支架术是安全的 ,并能改善患者的近期预后 ,但其远期疗效尚需进一步研究。