肾移植术后乙型肝炎病毒拉米夫定耐药的治疗

目的:观察肾移植术后乙型肝炎病毒患者发生拉米夫定耐药后,应用新一代核苷类抗乙型肝炎病毒药物阿德福韦和恩替卡韦的治疗效果。方法:选择2001-05/2006-09于南方医科大学南方医院器官移植科就诊的乙型肝炎病毒感染并发生病毒多聚酶催化域YMDD基序变异,对拉米夫定耐药的肾移植患者4例,患者均知情同意。定期复查血清丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、乙型肝炎病毒DNA定量及乙型肝炎病毒YMDD变异情况,先后采用拉米夫定、阿德福韦及恩替卡韦进行治疗,并观察其治疗效果。结果:①4例患者分别随访16,26,63,67个月,移植肾功能良好。②4例患者分别在服用拉米夫定14,24,51和62个月(术后12个月)时出现乙型肝炎病毒YMDD变异,乙型肝炎病毒DNA升高至105～109拷贝/mL,肝功能异常。2例加用阿德福韦3个月后撤除拉米夫定,单用阿德福韦治疗,乙型肝炎病毒DNA均降为104拷贝/mL,肝功能正常,其中1例单用阿德福韦9个月后乙型肝炎病毒YMDD变异转阴,另1例单用阿德福韦2个月,乙型肝炎病毒YMDD变异仍为阳性;2例停用拉米夫定,直接换为恩替卡韦,其中1例2个月后肝功能正常,乙型肝炎病毒DNA阴性,乙型肝炎病毒YMDD变异阴性,另1例服药2个月后肝功能正常,乙型肝炎病毒DNA降为104拷贝/mL,乙型肝炎病毒YMDD变异仍为阳性。结论:新型抗乙型肝炎病毒药物阿德福韦和恩替卡韦可有效抑制拉米夫定耐药的乙型肝炎病毒复制,有利于乙型肝炎病毒阳性肾移植患者长期存活。     

贲门失弛缓症术后并发食管旁疝致胃底绞窄坏死1例

介绍1例贲门失弛缓症Heller术后16 a并发食管旁疝致胃底绞窄坏死的病例．报告本例患者的详细病历资料和诊治经过．患者起病5 d后剖胸探查,发现胃底疝入左侧胸腔并绞窄坏死,行近端胃大部切除,修复食管裂孔．术后随访1 a无复发．食管旁疝发生嵌顿时,应立即插入胃管减压．如减压不成功或症状不改善,应急诊手术探查．     

颈外动脉栓塞用顺铂白蛋白微球的研究

用乳化化学交联法制备出适合于颌面部鳞癌殒外动脉栓塞用顺铂白蛋白微球;外观呈黄色粉末状,收率80±5%,显微观察呈圆球体,平场粒径56.3μm:药物含量为14.02～14.2%,包封率97.08～97.95%。对其体外释药、灭菌、稳定性及分散溶媒的处方进行了探讨。通过动物实验表明该微球可以达到理想的栓塞效果,并保证能在局部组织停留,有利于提高抗癌药物的疗效,降低毒副作用。     

用二维核磁共振法研究肿足蕨碱的结构

从金星蕨科植物山东肿足蕨(Hypodematium sinense Iwatsuki)的全草分得一种新化合物,通过¹H-¹H COSY谱,¹H-¹³C COSY谱和远程¹H-¹³C COSY谱确定其结构是一种具有苯基取代苯并氮杂环辛四烯新型骨架的生物碱,命名为肿足蕨碱(hypodematine)(Ⅰ)。     

Fish oil and mental health: the role of n-3 long-chain polyunsaturated fatty acids in cognitive development and neurological disorders

Epidemiological and experimental studies have indicated that consumption of more n-3 long-chain polyunsaturated fatty acids may reduce the risk for a variety of diseases, including cardiovascular, neurological and immunological disorders, diabetes and cancer. This article focuses on the role of marine n-3 long-chain polyunsaturated fatty acids in brain functions, including the development of the central nervous system and neurological disorders. An overview of the major animal studies and clinical trials is provided here, focusing on fatty acid supplementation during pregnancy and infancy, and prevention and management of Alzheimer's disease, schizophrenia, depression and attention deficit hyperactive disorder. Although an optimal balance in n-3/n-6 long-chain polyunsaturated fatty acid ratio is important for proper neurodevelopment and cognitive functions, results from randomized controlled trials are controversial and do not confirm any useful effect of supplementation on development of preterm and term infants. The relationship between fatty acid status and mental disorders is confirmed by reduced levels of n-3 long-chain polyunsaturated fatty acids in erythrocyte membranes of patients with central nervous system disorders. Nevertheless, there are very little data supporting the use of fish oil in those patients. The only way to verify whether n-3 long-chain polyunsaturated fatty acids are a potential therapeutic option in the management and prevention of mental disorders is to conduct a large definitive randomized controlled trials similar to those required for the licensing of any new pharmacological treatment.     

Hyperresponsiveness of Migraine Patients to the Hypotensive Action of Bromocriptine

SYNOPSIS
Migraine frequently induces hypotension, which has a large postural component. Since pain and other symptoms of the migraine syndrome have been suggested to be central in nature, an involvement of the dopaminergic pathways within the central nervous system that mediate hypotensive responses, might be postulated in migraine patients. In the study, a test dose (2.5 mg) of bromocriptine, a brain dopamine agonist, induced an intense hypotensive reaction in migraineurs, but not in controls. During bromocriptine-induced hypotension, serum dopamine β-hydroxylase activity did not change. The fall of blood pressure, due to bromocriptine, in migraine patients could be considered as an indirect expression of brain dopamine receptor supersensitivity caused by a deficiency of dopamine and or endogenous morphine-like substances. This mechanism is compatible with the hypothesis which considers migraine as a clinical condition of chronic natural opioid abstinence.     

Renal and urinary glycosaminoglycans in an experimental model of chronic renal failure in rats

The present paper reports the glomerular and renal individual glycosaminoglycan levels in an experimental model of chronic renal failure (CRF) that was induced in Wistar rats by five-sixths mass ablation. Glycemia, body weight, blood systolic pressure and urinary excretions of creatinine, albumin and glycosaminoglycans were measured for 12 weeks. At the end of the experiment, the weight and the glycosaminoglycan composition of the kidneys were determined. In control rats, heparan sulfate was the main glycosaminoglycan found both in whole kidney and isolated glomeruli, with trace amounts of dermatan sulfate. Isolated glomeruli presented higher heparan sulfate concentrations than whole kidney (expressed as mg/g dry weight). In CRF rats, albuminuria appeared from the 2 week on, and dermatan sulfate and chondroitin sulfate contents of the kidney increased, whereas heparan sulfate levels remained unaltered. Changes in urine glycosaminoglycans (heparan sulfate, chondroitin sulfate and dermatan sulfate) were not statistically significant. The increase in glomerular dermatan sulfate and chondroitin sulfate observed in this experimental model could be related to the mechanisms involved in the glomerulosclerosis and proteinuria that occur in CRF.