应重视类似股骨头坏死髋关节疾病的鉴别诊断

股骨头坏死（osteonecrosis of the femoralhead，ONFH）是骨科常见疾病，它由创伤和非创伤两大原因引起，前者主要由股骨颈骨折，髋脱位等造成，而后者在我国主要由皮质类固醇的应用及酗酒两大原因导致。据可靠依据推测，我国需治疗的ONFH患者在500～750万之间，     

移植前使用α干扰素对慢性粒细胞白血病患者非亲缘异基因骨髓移植预后的影响

目的 了解α干扰素（IFN—α）在移植前使用对慢性粒细胞白血病（CML）患者非亲缘异基因骨髓移植（URD—BMT）预后的影响。方法 分析总结行URD—BMT的CML第1次慢性期（CP1）患者53例，其中BMT前未用IFN—α治疗组23例，用IFN—α治疗组30例；其中疗程≤12个月22例，〉12个月8例。采用单因素分析和Cox比例风险模型分析移植前使用IFN—α对CML患者URD—BMT后植入效果、急性移植物抗宿主病（GVHD）发生及患者5年存活率的影响。结果 经Cox模型多元回归分析，患者年龄、性别、确诊至URD—BMT的时间、停IFN—α距URD—BMT时间对生存率无影响；各组的总生存率、无病生存率、非复发死亡率、植活率、复发率、植入失败率、急性GVHD和慢性GVHD发生率差异均无统计学意义均（P〉0．05）。结论 本文资料所列条件下，移植前使用IFN—α不会对URD—BMT产生不利影响。     

Chronic morphine exposure and the expression of heme oxygenase type 2

Heme oxygenase (HO) catalyzes the formation of carbon monoxide (CO) and other products from heme. The CO formed has been shown to function as a neurotransmitter, and may be involved in nociceptive signaling. Heme oxygenase type 2 (HO-2) is the predominant form of HO in the CNS. The expression of nitric oxide synthase (NOS) which catalyzes the formation of a similar neurotransmitter nitric oxide (NO) from arginine is increased in the spinal cords of animals chronically exposed to morphine and other opioids. In these studies, we examined changes in expression of HO-2 which occur in spinal cord tissue of morphine tolerant mice. After 5 days of exposure to morphine, mice were observed to be profoundly tolerant to the analgesic effects of morphine. In experiments using Northern blotting we observed a 2.7-fold increase in HO-2 mRNA in homogenized spinal cord tissue. Additional experiments revealed a 3.1-fold increase in HO-2 protein which seemed to result from the increased expression of HO-2 in neurons in the dorsal horn region of the spinal cord. To complement our expression studies measured HO enzymatic activity in spinal cord homogenates and found a 2.1-fold increase in the tolerant animals. The functional significance of this increased expression and activity is as yet unclear, but may be involved in the acquisition of analgesic tolerance to opioids, dependence on opioids, or perhaps the hyperalgesia reported after chronic exposure to opioids.     

Heroin-induced neuronal activation in rat brain assessed by functional MRI

The present study demonstrates the application of fMRI technology to neuropharmacology and the interaction of drug/receptor in the rat brain. Specifically, we have observed two different types of fMRI signal changes induced by acute i.v. heroin administration in rat brains under conditions of spontaneous and artificial respiration. Under spontaneous respiration, a global decrease in fMRI signal was observed; under artificial respiration, a region-specific increase in fMRI signal was identified and the activation sites are consistent with the distribution of opiate mu-receptors in rat brain as previously reported by autoradiography. Both heroin-induced fMRI signal changes were suppressed by pretreatment of naloxone, an opiate mu-receptor antagonist, and reversed by injection of naloxone following heroin infusion. These results suggest that fMRI has specific advantages in spatial and temporal resolution for studies of neuropharmacology and drugs of abuse.     

Neuroprotection achieved with a novel proteasome inhibitor which blocks NF-kappaB activation

Activated NF-kappaB contributes to cerebral infarction by triggering a neuro-inflammatory response. Rats subjected to 90min middle cerebral artery occlusion developed a cortical infarct of 20+/-4% of hemispheric volume (n = 8). Treatment with the proteasome inhibitor CVT-634 resulted in a significantly smaller infarct of 13+/-2% (n = 7, p<0.01) and 12+/-2% (n = 8, p<0.001) of hemispheric volume at 1 day and 7 days, respectively. Since regional cerebral blood flows for the core and penumbral regions were not affected, we concluded that all animals received the same ischemic insult The reduction in infarction persisted for 7 days. This is the first indication that a proteasome inhibitor can reduce infarct volume in a focal model of cerebral ischemia.     

Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery

BACKGROUND: Given the current practice environment, it is important to determine the anesthetic technique with the highest patient acceptance and lowest associated costs. The authors compared three commonly used anesthetic techniques for anorectal procedures in the ambulatory setting. METHODS: Ninety-three consenting adult outpatients undergoing anorectal surgery were randomly assigned to one of three anesthetic treatment groups: group 1 received local infiltration with a 30-ml mixture containing 15 ml lidocaine, 2%, and 15 ml bupivacaine, 0.5%, with epinephrine (1:200,000) in combination with intravenous sedation using a propofol infusion, 25-100 microg. kg-1. min-1; group 2 received a spinal subarachnoid block with a combination of 30 mg lidocaine and 20 microg fentanyl with midazolam, 1-2-mg intravenous bolus doses; and group 3 received general anesthesia with 2.5 mg/kg propofol administered intravenously and 0.5-2% sevoflurane in combination with 65% nitrous oxide. In groups 2 and 3, the surgeon also administered 10 ml of the previously described local anesthetic mixture at the surgical site before the skin incision. RESULTS: The mean costs were significantly decreased in group 1 ($69 +/- 20 compared with $104 +/- 18 and $145 +/- 25 in groups 2 and 3, respectively) because both intraoperative and recovery costs were lowest (P < 0.05). Although the surgical time did not differ among the three groups, the anesthesia time and times to oral intake and home-readiness were significantly shorter in group 1 (vs. groups 2 and 3). There was no significant difference among the three groups with respect to the postoperative side effects or unanticipated hospitalizations. However, the need for pain medication was less in groups 1 and 2 (19% and 19% vs. 45% for group 3; P < 0.05). Patients in group 1 had no complaints of nausea (vs. 3% and 26% in groups 2 and 3, respectively). More patients in group 1 (68%) were highly satisfied with the care they received than in groups 2 (58%) and 3 (39%). CONCLUSIONS: The use of local anesthesia with sedation is the most cost-effective technique for anorectal surgery in the ambulatory setting.     

应用微柱凝胶法鉴定婴儿ABO及Rh（D）血型

目的 :比较传统试管法和微柱凝胶法全自动血型系统鉴定婴儿ABO及Rh(D)血型的研究。方法 :选取500份婴儿脐带血标本 ,采用试管法和微柱凝胶法进行ABO和Rh(D)血型 ,并选项取40份抗原性减弱的标本采用两种方法比较。结果 :在鉴定婴儿ABO和Rh(D)血型时两种方法差异无显著性。结论 :微柱凝胶法可取代试管法用于婴儿的ABO和Rh(D)血型鉴定。     

RP-HPLC法测定比沙可啶片剂含量及有关物质

目的建立RP-HPLC法测定比沙可啶片剂含量及有关物质。方法色谱柱为Hypersil ODS C18(300mm×4mm,5μm),以乙腈-水(45∶55)为流动相,流速为1.0mL/min,进样量为10μL,检测波长为265nm。结果比沙可啶浓度在0.115～1.150g/L范围内,色谱峰面积与浓度线性关系良好,r=0.9999;线性范围内3个浓度的平均回收率(n=3)分别为99.2%(RSD=0.68%)、99.3%(RSD=0.21%)和99.1%(RSD=0.87%)。样品中有关物质检查符合质量要求。结论该方法简便、快速、准确、重现性好,可用于比沙可啶片剂的含量测定和有关物质检查。     

食管癌术后完整胸胃的排空功能

目的观察保留完整的胸胃在未附加幽门引流术的情况下,对半固体食物的排空过程,探讨完整胸胃的排空规律。方法20例胸段食管癌病人分2组,近期术后组(12例)和远期术后组(8例),另设对照组(健康成年人10例)。观察不同时期病人,在进食试餐后120min内不同时间点的胃排空率(GER)和0～30min及30～120min的胃排空速率(GEV),并进行组间比较。结果近期术后病人的GER与术前相比,餐后5～100min明显快于术前(P<0.05);120minGER无差别(P>0.05);近期术后病人餐后GEV:0～30min加快而30～120min延迟,两个时间段的GEV比较差别显著(P<0.001);远期术后与近期术后病人的GER各时间点比较无显著性差异(P>0.05)。结论食管癌近期术后大部分病人的胸胃对半固体食物排空呈双相,但120min总排空率与术前相比无差别;远期术后病人胸胃对半固体食物的排空与近期术后无差别,食管癌病人手术时不需要常规附加幽门引流术。     

Occupancy of striatal and extrastriatal dopamine D2/D3 receptors by olanzapine and haloperidol.

There have been conflicting reports as to whether olanzapine produces lower occupancy of striatal dopamine D(2)/D(3) receptor than typical antipsychotic drugs and preferential occupancy of extrastriatal dopamine D(2)/D(3) receptors. We performed [(18)F] fallypride PET studies in six schizophrenic subjects treated with olanzapine and six schizophrenic subjects treated with haloperidol to examine the occupancy of striatal and extrastriatal dopamine receptors by these antipsychotic drugs. [(18)F] setoperone PET studies were performed in seven olanzapine-treated subjects to determine 5-HT(2A) receptor occupancy. Occupancy of dopamine D(2)/D(3) receptors by olanzapine was not significantly different from that seen with haloperidol in the putamen, ventral striatum, medial thalamus, amygdala, or temporal cortex, that is, 67.5-78.2% occupancy; olanzapine produced no preferential occupancy of dopamine D(2)/D(3) receptors in the ventral striatum, medial thalamus, amygdala, or temporal cortex. There was, however, significantly lower occupancy of substantia nigra/VTA dopamine D(2)/D(3) receptors in olanzapine-treated compared to haloperidol-treated subjects, that is, 40.2 vs 59.3% (p=0.0014, corrected for multiple comparisons); in olanzapine-treated subjects, the substantia nigra/VTA was the only region with significantly lower dopamine D(2)/D(3) receptor occupancy than the putamen, that is, 40.2 vs 69.2% (p<0.001, corrected for multiple comparison). Occupancy of 5-HT(2A) receptors was 85-93% in the olanzapine- treated subjects. The results of this study demonstrated that olanzapine does not produce preferential occupancy of extrastriatal dopamine D(2)/D(3) receptors but does spare substantia nigra/VTA receptors. Sparing of substantia nigra/VTA dopamine D(2)/D(3) receptor occupancy may contribute to the low incidence of extrapyramidal side effects in olanzapine-treated patients.