Mesoatrial shunts for Budd-Chiari syndrome and inferior vena cava thrombosis: angiographic and hemodynamic evaluations

When inferior vena caval obstruction complicates the Budd-Chiari syndrome, conventional portosystemic shunts are not possible. The mesoatrial shunt has been devised to enable portal and sinusoidal decompression in these patients. Findings in 12 patients with Budd-Chiari syndrome and inferior vena caval obstruction in whom a mesoatrial shunt was performed are reported. Preoperative inferior vena cavography with pressure measurements is essential to determine the appropriate shunt procedure. Postoperatively, shunt patency is assessed with superior mesenteric arterial portography. Where possible, transvenous catheterization of the shunt is performed to confirm patency and assess hemodynamic function.     

The North American Experience with Photopheresis

Photopheresis or extracorporeal photochemotherapy (ECP) is a novel immunomodulatory therapy based upon pheresis of light-sensitive cells. Whole blood is removed from patients who have previously ingested the photosensitizing agent 8-methoxypsoralen (8-MOP) followed by leukapheresis and exposure of the 8-MOP containing white blood cells (WBCs) extracorporeally to an ultraviolet A (UVA) light source prior to their return to the patient. In 1988, the Food and Drug Administration (FDA) approved photopheresis for the treatment of cutaneous T-cell lymphoma (CTCL). Treatment of CTCL with photopheresis has been reported in over 300 patients worldwide. Photopheresis has also demonstrated encouraging results in the treatment of solid organ transplant rejection, graft versus host disease, scleroderma, and other autoimmune diseases although fewer patients have been studied. This review will focus on the North American experience with photopheresis.     

Adverse reactions to xenon-enhanced CT cerebral blood flow determination

Fourteen institutions performed 1,830 computed tomographic (CT) cerebral blood flow (CBF) examinations with 32% inhaled stable xenon. Respiratory rate delay greater than 10 seconds occurred in 3.6% of patients, with 83% of the delays lasting 10-15 seconds. There was no incident of prolonged respiratory difficulty. Headache (0.4%), seizures (0.2%), nausea and vomiting (0.2%), and change in neurologic status (0.1%) were uncommon, and there were no transient ischemic attacks. The CT CBF method with 32% inhaled stable xenon is thus associated with an acceptably low incidence of adverse reactions.     

犬内皮与平滑肌细胞的短期静态联合培养

目的:为获得组织工程化自体血管,观察体外静态培养条件下犬内皮细胞与平滑肌细胞联合培养组织学及形态学的特征。方法:实验于2004-07/2005-06在首都医科大学宣武医院外科院级实验室完成。①实验材料:雄性杂种犬,3个月龄,体质量8～12kg。②实验方法:贴块法及酶解法对犬内皮细胞及平滑肌细胞进行原代分离培养及扩增,将第Ⅱ代平滑肌细胞以1×109L-1的密度种植于胶原膜上培养13d,再将第Ⅱ代内皮细胞接种于生长平滑肌细胞的胶原膜上2d。③实验评估:行苏木精-伊红染色同时扫描电镜和透射电镜观察平滑肌细胞和内皮细胞在胶原载体上联合培养后的形态。结果:苏木精-伊红染色见平滑肌细胞较均匀的分布于支架材料表面及内部;扫描电镜下,平滑肌细胞可以在胶原载体材料上生长,增殖明显并在短期内形成多层细胞。内皮细胞与平滑肌细胞联合培养2d就可在平滑肌细胞层表面获得连续的单层内皮细胞层。结论:在短期静态培养条件下犬的血管平滑肌细胞和内皮细胞可以在胶原载体材料上形成具有两层细胞结构的组织工程化动脉血管组织片。     

自体造血干细胞的体外净化

目的:综合分析自体造血干细胞体外净化的方法。资料来源:应用计算机检索Medline 1991-01/2003-12有关自体造血干细胞体外净化方法的文章,检索词“purging,HSCT”,并限定文章语言种类为English。同时计算机检索CNKI数据库1991-01/2003-12有关自体造血干细胞体外净化方法的文章,检索词“体外净化,PUVA”,并限定文章语言种类为中文。资料选择:对相关资料进行整理,选取同一领域、不同方面的文献,以近期发表或权威杂志的文章优先。资料提炼:共检索到42篇有关自体造血干细胞体外净化方法的文献,其中24篇文章符合要求。排除18篇,其中15篇系重复同一研究,3篇为Meta分析。资料综合:自体造血干细胞的体外净化方法很多,如物理方法、生物学方法、药物方法、免疫净化、基因净化等。每种净化方法都有其各自的优势和不足,如淋巴系统疾病可以采用免疫净化;慢性粒细胞白血病患者可考虑反义技术;大多数患者则均可以考虑药物净化的方法。结论:针对不同的疾病,可以选择不同的净化方法,还可以将几种净化方法联合起来,其效果和方法的改进也在不断的研究探索中。     

长期住院慢性精神分裂症患者的生活质量

目的:评估长期住院的慢性精神分裂症患者的生活质量,并分析影响因素。方法:纳入2004-01/08在北京回龙观医院住院的慢性精神分裂症患者163例。以年龄、性别、受教育程度为匹配条件,按照2∶1的比例选择本院职工及医院所在社区内82例健康自愿者为对照组。采用健康状况调查问卷进行生活质量评价:包括36个条目,归纳为8个分量表:生理机能,生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能和精神健康。分数越高,表明该方面的功能状况越好,生活质量越高。结果:发放调查问卷245份,收回有效问卷245份。①精神分裂症患者健康状况调查问卷各维度评分均低于对照组,两组比较差异有显著意义。②相关分析发现长期住院的慢性精神分裂症患者健康状况调查问卷评分与阳性与阴性症状量表评分、副反应量表呈负相关(P<0.05～0.001)。健康状况调查问卷评分与性别呈正相关(P<0.05～0.001),与年龄、婚姻状况、病期、住院时间、目前状态、躯体疾病呈负相关(P<0.05～0.001)。结论:长期住院的慢性精神分裂症患者的生活质量低下,影响因素包括精神病状态、药物副反应、年龄、性别、病期、住院时间、婚姻状况、躯体疾病。     

The inter‐rater reliability between nurse‐assessors clinically assessing infection of chronic wounds using the WUWHS criteria

The aim of this study was to determine the inter‐rater reliability between one expert‐nurse and four clinical‐nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi‐experimental design was used to collect the data. In comparison to phase 1 in which ‘open questions’ were asked, in phase 2 a pre‐printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter‐rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate. In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter‐rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect‐ and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre‐printed form than making use of an ‘open questions’ form. To provide this with a higher level of evidence, there is need for more well conducted studies.     

常压模拟高住低练对红细胞相关指标和促红细胞生成素、低氧诱导因子-1mRNA表达影响的研究与进展

目的:常压模拟高住低练训练法是近年来提出来的一种新型的高原训练方法,可以解决传统高原训练中存在的不足。就高住低练训练法对红细胞相关指标和促红细胞生成素、低氧诱导因子-1基因表达的影响作一综述,旨在促进高住低练训练法在中国的发展和应用,使其更好地为运动员竞技水平的提高服务。资料来源:应用计算机检索PubMed1972-01/2005-12的相关文章,同时根据相关的参考文献检索了部分文章,检索词“simulated living high-training low training(HiLo),indices of red blood cell,effect;erythropoietin(EPO)、Hypoxia inducible factor-1(HIF-I),Gene”限定语言种类为English,同时计算机检索http://cnki.hunnu.edu.cn1996/2006的相关文章,限定文章种类为中文,检索词“:高住低练,红细胞相关指标,影响,促红细胞生成素,低氧诱导因子,基因。”资料选择:对资料进行初审,选取实验包括常压模拟高住低练运动模型中关于红细胞相关指标和促红细胞生成素基因、低氧诱导因子-1基因表达的影响方面的文献,查找相关文献的全文,判断是否确实是相关研究。纳入条件:①随机对照实验研究。②实验包括对照组与干预组。排除条件:①综述文献。②重复的同一研究。资料提炼:共查找到90篇相关研究文章,38篇符合纳入标准。排除的52篇系为同一研究和综述文献。资料综合:Levine在高住低练训练法的试验发现:高住低练训练组最大摄氧量平均增加了5%,红细胞平均增加了9%,运动能力得到改善,而对照组无论是最大摄氧量、红细胞、还是运动能力均无显著性变化。②高住低练训练法能促使低氧诱导因子-1的产生而对促红细胞生成素的调控,使促红细胞生成素的产生和血红素浓度的变化,促红细胞生成素增加引起红细胞量和Hb浓度的增加;血红素浓度增加可以提高血液运输氧的能力和组织氧化能力。居住在适宜高度(大于2000～2500m),通过持续增加促红细胞生成素的量,诱导红细胞和血红素浓度的增加,改善氧运输能力、提高最大摄氧量,可以有效地提高运动成绩。③高住低练训练法引起低氧诱导因子-1mRNA表达,其如何对促红细胞生成素进行调控和信号的转达,高住低练训练法导致血液成分变化对运动能力的影响等问题的研究。可以更清楚地认识高住低练训练法对机体运动能力影响的机制,为提高运动成绩提供帮助。结论:高住低练训练法可促进促红细胞生成素、低氧诱导因子-1基因表达和红细胞的生成,提高血红蛋白浓度和红细胞比容,而有效地提高运动员的运动能力。