许旺细胞基膜管与骨骼肌基膜管两种桥接体对大鼠脊髓损伤修复效果的比较

目的:比较许旺细胞基膜管与骨骼肌基膜管两种桥接体对脊髓损伤的修复效果。方法:实验于2005-08/2006-01在大连医科大学动物实验中心完成。①选取3月龄SD大鼠40只,随机数字表法分成4组:正常对照组、假手术组、许旺细胞基膜管移植组、骨骼肌基膜管移植组,10只/组。②许旺细胞基膜管移植组动物麻醉后,沿左上肢屈侧切开,取正中神经节段约1.0cm,经蒸馏水浸泡、液氮冷冻、生理盐水浸润再复温,挤出胞浆和崩解组织,修整成待移植的许旺细胞基膜管。骨骼肌基膜管移植组动物于左上肢三角肌取材后按类似过程制成待移植的骨骼肌基膜管。③除正常对照组外,其余各组均建立脊髓损伤模型。鼠尾呈痉挛性扑动,麻醉苏醒后左下肢完全瘫痪标志造模成功。④许旺细胞基膜管移植组将许旺细胞基膜管按走行方向植入脊髓切损处。骨骼肌基膜管移植组同法植入骨骼肌基膜管。假手术组、正常对照组不进行任何材料移植。观察动物存活情况、一般状态、伤口愈合、后肢溃疡情况及运动功能恢复等情况。⑤术后通过斜板试验观察大鼠左后肢负重功能恢复情况;并进行动物行为测试评分(满分7分,左后肢失去负重和行走功能为0分);测定皮层体感诱发电位;组织学观察和计算机图像分析半薄切片中轴突数目、直径以及石蜡切片中脊神经节细胞数。结果:40只大鼠全部进入结果分析。①移植术后一般情况:术后3周许旺细胞基膜管移植组、骨骼肌基膜管移植组左后肢有不同程度的运动功能恢复。术后8周动物全部存活,切口愈合较好。非正常对照组动物均发生胸腰段脊柱轻度侧弯畸形。②术后斜板试验结果:与正常对照组大鼠跌落时的木板倾斜度数比较,术后8周许旺细胞基膜管移植组、骨骼肌基膜管移植组大鼠跌落时的木板倾斜度数明显高于假手术组(t=2.378,P<0.05),但低于正常对照组(t=2.421,P<0.05)。③术后行为学测试结果:术后8周许旺细胞基膜管移植组、骨骼肌基膜管移植组行为评分与正常对照组基本相似(t=2.034,P>0.05),明显高于假手术组(t=3.647,P<0.01)。④术后皮层体感诱发电位检测结果:正常对照组可记录到潜伏期为(16.15±1.23)ms、波幅为(30.76±2.61)μV的皮层体感诱发电位波形。术后6周许旺细胞基膜管移植组潜伏期延长、波幅降低,但均优于骨骼肌基膜管移植组[(21.48±2.17),(26.72±1.83)ms;(23.74±2.02),(19.14±1.38)μV;P均<0.05];而假手术组未记录到相应皮层体感诱发电位波形。⑤术后大体及组织学观察结果:许旺细胞基膜管移植组其基膜管与脊髓交界处无明显瘢痕组织形成,移植物中再生轴索较多,辣根过氧化物酶示踪在宿主-移植物交界面头侧的正常脊髓前角内见较多标记神经元,再生轴突直径较粗,髓鞘较厚。骨骼肌基膜管移植组情况与其基本相似,但骨骼肌基膜管与脊髓交界处有少许瘢痕组织形成。⑥术后8周末轴突数目、轴突直径和脊神经节细胞数计算机图像分析结果:许旺细胞基膜管移植组的轴突数目、轴突直径和脊神经节细胞数目与正常对照组基本相似(t=2.116,P>0.05),但明显高于骨骼肌基膜管移植组、假手术组(t=2.494,P<0.05;t=3.573,P<0.01)。结论:许旺细胞基膜管比骨骼肌基膜管更适宜作为治疗脊髓损伤的桥接体材料。     

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。     

Efficacy of a 1‐week rabeprazole triple therapy for eradicating Helicobacter pylori and ulcer healing: an ‘in‐clinical‐practice’ study

OBJECTIVE: To determine the efficacy and tolerability of a 1‐week treatment regimen consisting of rabeprazole and two antibiotics, clarithromycin and amoxicillin, in the eradication of Helicobacter pylori in an ‘in‐clinical‐practice’ setting. METHODS: Patients selected had unequivocal evidence of H. pylori infection based on urease test and histology of antral and corpus biopsies obtained at endoscopy. Patients with complicated ulcers were not included. Patients received rabeprazole 10 mg b.i.d., clarithromycin 500 mg b.i.d. and amoxicillin 1 g b.i.d. for 1 week and were assessed for successful eradication at least 4 weeks after completion of therapy by repeat gastroscopy and gastric biopsies. Eradication was defined as absence of bacteria in both antral and corpus biopsies tested by histology and urease test. Ulcer patients did not receive continued acid suppression therapy following the 1‐week course of treatment. RESULTS: The study recruited 205 patients of whom 25 were not compliant with the medications or defaulted on follow‐up and were therefore not included in the per‐protocol analysis. Eradication of H. pylori was successful in 166/180 of patients on per‐protocol analysis (92.2% [95% CI: 87.3, 95.7]) and in 169/205 patients on intention‐to‐treat analysis (82.4% [95% CI: 80.5, 90.2]; P = 1.000). There were 47 patients with active ulcers: DU 27, GU 18, DU/GU 2. Overall, ulcer healing was achieved in 42 of 44 (95.5%) patients who had successful eradication of H. pylori infection, but ulcers did not heal in any of the three patients (DU 2, GU 1) who did not eradicate the infection. Of the total group, 199 were assessed for compliance and side‐effects of treatment. Side‐effects were in general mild and tolerable. Of 14 patients who were not compliant with medication, 4 (2.0%) attributed it to side‐effects of treatment (increased abdominal pain, dizziness and taste disturbances) and the remaining 10 did not give specific reasons. The most common side‐effect was bitter taste, reported by 39.2% of patients. Other side‐effects, such as giddiness, increased abdominal pain, lethargy, loose bowel motions and skin rash, were mild and found in only a small percentage of patients. CONCLUSIONS: The rabeprazole 1‐week triple therapy with amoxicillin and clarithromycin is effective in eradicating H. pylori in an ‘in‐clinical‐practice’ setting. The treatment was well tolerated by patients. Good ulcer healing was achieved with short‐course H. pylori eradication therapy without the need for continued acid suppression.     

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．     

Carcinomatous involvement of the hilum and mediastinum: computed tomographic and magnetic resonance evaluation

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in 20 patients who had primary lung tumors, and the results were correlated with findings at surgery and pathologic evaluation. Both studies demonstrated a similar ability to detect hilar and mediastinal tumor. MR imaging detected more enlarged nodes in the mediastinum, but in several patients these enlarged nodes did not contain tumor. Consequently, MR imaging has a slightly higher false-positive rate in the evaluation of the mediastinum. Both modalities were highly sensitive, with specificity limited by the presence of enlarged benign lymph nodes in this series of patients.     

Torsion of the upper lobe in pneumothorax

A rounded density is occasionally seen hanging down from the hilus in the presence of a large pneumothorax. To find an explanation for this appearance, the authors obtained a right-sided bronchogram on a baboon, after which they induced pneumothorax on the same side. This experiment demonstrated that the rounded density is formed by a twisted and atelectatic upper lobe.     

顺铂壳聚糖微球的制备及特性研究

对顺铂壳聚糖微球的制备、载药量、大小及分布、形态及表面状态、体外释放及降解性进行了研究。微球用乳化-化学交联技术制备,平均粒径为74.80μm,顺铂含量为20.83%±0.36%。电镜扫描显示,微球球形圆整,表面粗糙。生理盐水中放置1h微球轻微溶胀,其体外释药符合一级方程,微球经⁶⁰Co辐射灭菌达到无菌要求。犬肝动脉栓塞后一个月,病理切片可见栓塞区仍有壳聚糖微球存在。     

去氢紫堇碱对兔血小板TXB2及主动脉6—Keto—PGF1 PGF1α含量的影响

去氢柴堇碱(dehydrocorydaline,DHC)是从罂栗科植物延胡索块茎中提取的一种季胺类生物碱(其结构式如下)。实验证实延胡索治疗冠心病的有效成分为DHC。DHC对心血管系统的药理研究也有报道。近年的实验证明DHC有升高血小板内cAMP含量的作用并抑制ADP诱导的血小板第四因子(PF_4)的释放。本实验通过观察DHC对体内血栓形     

Prediction of postoperative pulmonary function in the patient undergoing pneumonectomy using combined pulmonary function test and ventilation/perfusion scintiphotography

A method to predict postoperative lung function following pneumonectomy has been used in 11 patients. Preoperative unilateral lung function can be predicted by combining the preoperative information on lung volumes obtained by spirometry with the distributional information obtained from ventilation and perfusion scintigrams in order to estimate lung function after pneumonectomy. There was a high degree of correlation between predicted and measured lung function for both FEV1 (r = 0.81, p less than 0.050, and FVC (r = 0.81, p less than 0.05). The postoperative FEV1 and FVC were within 200 ml of the predicted value in most of the patients. A more accurate and easy prediction of postoperative lung function is obtained using unilateral perfusion rather than ventilation scintigrams. We suggest that the combined the results of simple spirometric data and a quantitative right-vs-left perfusion lung scan using radioactive Tc-99m provides a simple non-invasive and accurate method for the pre-operative functional evaluation of the high risk patient.