垂体催乳素瘤的诊断和治疗指南

2.药物选择:多巴胺激动剂(dopaminergic agonist,DA),如溴隐亭(bromociptine,BRC)和卡麦角林(cabergoline,CAB),为高催乳素血症和PRL腺瘤患者的首选治疗.药物能使绝大多数病人PRL水平正常和肿瘤体积显著缩小,大量的经验证实药物适用于各种大小的肿瘤.     

Psoriasis vulgaris and human leukocyte antigens

BACKGROUND: Psoriasis vulgaris is a skin disease with a complex immunological and genetic background, triggered by environmental factors. The association of human leukocyte antigens (HLA) and psoriasis has long been reported on population and familial studies. OBJECTIVES: To review and discuss studies on psoriasis vulgaris and HLA, in Caucasian and non-Caucasian populations. METHODS: The major population studies on psoriasis vulgaris and the associated HLA antigens and alleles are described and discussed based on a review of the current literature. RESULTS: Population studies demonstrate the presence of different HLA specificities as well as extended haplotypes in patients with psoriasis, when compared to controls. Some alleles occur in a lower frequency in patients with psoriasis, indicating they could be protection alleles. In all studies which HLA class I was typed, Cw6 or Cw*0602 was present in a significant frequency in patients with psoriasis, mainly when early onset and positive family history were considered. HLA-DRB1*0701 was also present in a higher frequency in patients in different populations. CONCLUSIONS: Different antigens and alleles from both HLA classes I and II were seen in a significantly higher frequency in patients with psoriasis vulgaris. HLA Cw*0602 and DRB1*0701 were represented in different reports, and the former was related mainly to psoriasis type I.     

垂体催乳素瘤的诊断和治疗指南

2005年6月,在San Diego举行了第九届国际垂体研究大会.大会邀请在催乳素瘤治疗领域被认可的国际知名专家,包括内分泌专家和神经外科专家,特定召开专业委员会,对催乳素瘤的诊断和治疗进行探讨,并形成该指南.指南发表在2006年8月的临床内分泌学杂志上(Clinical Endocrinology, 2006, 65: 265-273).     

Effect of blood donation on the establishment of normal ranges of lymphocyte subsets

BACKGROUND: Absolute counts of CD4+ T-lymphocytes are used in the management of patients with human immunodeficiency virus infection. Low absolute counts of CD3+CD4+ cells have also been observed in healthy people–a phenomenon called idiopathic CD4 lymphocytopenia. It is common practice for normal ranges for lymphocyte subsets to be derived from samples taken from blood donors. STUDY DESIGN AND METHODS: A sample of EDTA blood was taken through the donation line tubing, after donation from 565 blood donors in Sydney, Australia, who were selected from a range of age groups. An additional 12 donors provided a predonation sample as well as a postdonation sample. Hematologic assays were performed on two analyzers. Samples were stained for CD3, CD4, CD8, CD19, and CD56 and analyzed on a flow cytometer. RESULTS: Three donors were found to have absolute CD3+CD4+ counts < 300 cells per microL. The percentage of CD3+CD4+ cells was found to increase with age. Both the percentage and the absolute count of CD3+CD8+ cells decreased with age, which resulted in an increased CD4:CD8 ratio with age. Men had consistently higher absolute counts of CD3-CD56+ cells than women. The 12 additional donors all had greater percentages of CD3+CD4+ cells and lower absolute counts for CD3+, CD3+CD4+, CD3+CD8+, CD19+ and CD3-CD56+ cells after donation than they had before donation (p < 0.001). CONCLUSION: It is not satisfactory to base normal ranges for lymphocyte subsets on donor blood, from which the blood sample has been obtained after donation.     

Antigenic profile of human thymus in concurrence with "Clusters of Thymic Epithelial Staining" classification.

We examined the expression of various CD coded or not yet defined antigens in human thymus samples using indirect immunoperoxidase and immunoflourescent techniques. Data obtained are presented in concurrence with Clusters of Thymic Epithelial Staining (CTES) classification for various monoclonal antibodies recognizing CD antigens (CD1, CD1a, CD6, CD9, CD14, CD16, CD29, CD30, CD32, CD44, CD45RB, CD47, CD48, CD49a, CD49b, CD49c, CD49d, CD49e, CD49f, CD51, CD53, CD54, CD56, CD57, CD63, CD85, CD95, CD98, CD102, CD103, CD106, CD109, CD146, CD147, CD148, CD151, CD152, CD158a, CD158b, CD164, CD165, CD166) and for monoclonal antibodies 1B10, 5G7, A4, BD46, BLTZ, HP1C5, IND.64, M72, WU947 whose specifities are not yet defined. Some of the mAbs such as CD49f, IND.64 and BD46 are detected as good markers for specific cell types or compartments. Significance of the presence of these antigens on thymic epithelial cells at certain locations is briefly discussed.     

鹿瓜多肽注射剂质量评价与标准优化

通过探索性研究对鹿瓜多肽注射剂质量现状及存在问题进行评价,并对现行质量标准进行优化。首先,对影响终产品新鲜度的因素进行考察。建立丹磺酰氯柱前衍生-HPLC 法测定鹿瓜多肽注射剂中 8 种生物胺的含量,结果显示个别企业的样品中检出较高浓度的尸胺；采用免疫亲和柱净化-柱后光化学衍生-HPLC -FLD 法测定鹿瓜多肽注射剂及中间提取液中黄曲霉毒素 B₁、B₂、G₁ 和 G₂ 的含量,并采用自动电位滴定法测定甜瓜子原料的酸价和过氧化值,结果表明部分企业生产原料甜瓜子存在霉变、酸败等问题,应在新鲜度方面给予重视。其次,优化了鹿瓜多肽注射剂质量标准中高分子量物质和多肽含量测定的方法。采用 Tricine-SDS-PAGE 电泳法代替凝胶色谱法测定高分子量物质,提高了测定的准确性；采用试剂盒法代替福林酚法测定多肽含量,该法操作简便、专属性更强,适用于大批量样品的快速测定。最后,对鹿瓜多肽注射剂质量标准中缺失的溶血与凝聚、生物学活性测定项目进行研究。建立直接观察法结合酶标仪测定法考察溶血与凝聚反应,结果各企业样品均无溶血与凝聚现象；采用 CCK-8 法考察鹿瓜多肽注射剂对 THP-1 细胞增殖的抑制作用,以此评价其抗炎活性,结果显示鹿瓜多肽注射剂对 THP-1 细胞具有增殖抑制作用,各企业样品的体外抗炎效果具有一定差异。探索性研究结果显示,鹿瓜多肽注射剂原材料、中间产品及终产品的安全性均存在一定隐患,表明本品的整体质量水平一般,且现行质量标准存在缺陷,亟待提高。     

Intravascular ultrasound correlates of corrected TIMI framecount

The TIMI frame count (TFC) is an index of coronary blood flow, and a correction in TFC (CTFC) for left anterior descending artery (LAD) has also been proposed. However, the relationship between TFC and intravascular ultrasound (IVUS) parameters of culprit coronary arteries has not been reported. The aim of this study was to investigate IVUS-derived correlates of TFC before and after stenting, and to assess the validation of its correction for LAD. The study population was comprised of 38 patients with acute coronary syndrome or stable coronary artery disease studied by IVUS before and after stenting (LAD 21, circumflex 8, right coronary artery 9). For LAD, CTFC was calculated by dividing the TFC by 1.7. Preintervention luminal % area stenosis was 82 +/- 12.3%. Pre- and postintervention target lesion lumen areas were 1.8 +/- 0.5 mm2 and 8.5 +/- 0.5 mm2 (P<0.0001), and CTFC were 35.3 +/- 16.8 and 16.9 +/- 4.3 (P<0.0001), respectively. In the 76 IVUS studies, CTFC showed a good correlation to luminal % area stenosis (r = 0.69, P<0.001), and a good and negative correlation to target lesion lumen area (r = -0.70, P<0.001). Postprocedural improvement in CTFC showed a modest correlation to acute lumen gain (r = 0.5, P<0.05). With respect to culprit arteries, pre and postintervention IVUS parameters and CTFC, and net CTFC change after stenting were not different (P>0.05). However, uncorrected TFC of LAD was significantly higher than both the CTFC of LAD and TFC of the other two coronary arteries (P<0.05). We conclude that CTFC is closely correlated to target lesion luminal area and luminal % area stenosis whereas a modest correlation is present between improvement in CTFC and acute luminal gain due to stenting. Results from different coronary arteries with comparable IVUS parameters seem to support the validity of a correction in TFC.     

Evaluation of subjects with a moderate cup to disc ratio using optical coherence tomography and Heidelberg retina tomograph 3: Impact of the disc area

Aim:

The aim was to evaluate subjects with a moderate cup to disc ratio using optical coherence tomograph (OCT) and Heidelberg retina tomograph (HRT) 3.

Settings and Design:

We included 80 patients with early glaucoma and 80 nonglaucomatous subjects with moderate cup/disc ratio (range of 0.5–0.8) to this cross-sectional study.

Subjects and Methods:

We compared results of color-coded algorithms of HRT 3 (Moorfields regression analysis [MRA] and Glaucoma probability score [GPS]) and OCT. All outputs are classified into three categories: Within normal limits (WNLs), borderline and outside normal limits (ONLs). Diagnostic accuracies of algorithms were determined using the highest sensitivity criteria.

Results:

The sensitivities of global MRA, GPS and OCT were 0.75, 0.925 and 0.725, respectively, in average disc area group and 0.85, 1.0 and 0.425, respectively, in large disc area group. The specificities of global MRA, GPS and OCT were 0.55, 0.15 and 0.85, respectively, in average disc area group and 0.425, 0.025 and 0.80, respectively, in large disc area group. Area under receiver operating characteristic curve (AUROC) of global MRA, GPS and OCT were 0.667, 0.617 and 0.792, respectively, in average disc area group and 0.746, 0.576 and 0.627, respectively, in large disc area group. AUROC of global MRA and OCT combination in the average and large disc area groups were 0.828 and 0.825, respectively.

Conclusions:

In contrast to GPS and OCT algorithms, diagnostic performance of MRA algorithm increased in large disc area group. Combining MRA and OCT algorithms produced satisfactory diagnostic performance in subjects with an average and large disc area.     

Spontaneous echo contrast in the descending aorta in patients without aortic dissection: associated clinical and echocardiographic characteristics

OBJECTIVE: To evaluate the frequency, clinical and echocardiographic correlates of spontaneous echo contrast in the descending aorta in the absence of dissection. METHODS: Prevalence of spontaneous echo contrast in the descending aorta in the absence of dissection, and its clinical and echocardiographic correlates were investigated in 1,199 consecutive patients who underwent transesophageal echocardiography. RESULTS: Spontaneous echo contrast in the descending aorta was detected in 54 (4.5%) patients. Patients with spontaneous echo contrast in the descending aorta had an older age (60.6+/-8 vs. 40.6+/-14.2 years, p=0.0001), an increased prevalence of male gender (66.7 vs. 43.9%, p=0.001), an increased diameter of ascending aorta (4.2+/-1.0 vs. 3.3+/-1.1 cm, p=0.0001), an increased diameter of descending aorta (3.1+/-0.9 vs. 2.1+/-0.4 cm, p=0.0001), a higher prevalence of aortic wall calcification (9.3 vs. 0.5%, p=0.00001), complex plaque in the descending aorta (13 vs. 0.7%, p=0.0001), left ventricular dysfunction (7.4 vs. 2.1%, p<0.05), a lower incidence of severe aortic regurgitation (0 vs. 3.5%, p<0.05), a lower peak flow velocity in the descending aorta (28+/-9 vs. 51+/-21 cm/s, p<0.00001), and a lower maximal shear rate in the descending aorta (51+/-29 vs. 105+/-47 s(-1), p<0.00001) compared with patients without spontaneous echo contrast in the descending aorta. However, prevalence of atrial fibrillation, mitral valve disease, intracardiac spontaneous echo contrast and/or thrombus and embolic event were not different between patients with and without spontaneous echo contrast in the descending aorta (p>0.05). Shear rate, diameter of the descending aorta, aortic wall calcification, complex plaque in the descending aorta, absence of severe aortic regurgitation and male gender were independent variables of spontaneous echo contrast in the descending aorta. CONCLUSIONS: Spontaneous echo contrast in the descending aorta is a local and flow dependent phenomenon relates to aortic dilation, atherosclerosis, and decreased shear rates in the descending aorta. However, in this study, spontaneous echo contrast in the descending aorta was not found to be associated with embolic events.     

Serum anti-p53 antibodies do not occur in patients with heart failure due to idiopathic dilated and ischemic cardiomyopathies

BACKGROUND: P53 is a key protein which controls cell cycle arrest and apoptosis in response to DNA damage. Auto-antibodies against p53 have been detected in some cancer patients and also in patients with autoimmune diseases. In these patients, the main cause of anti-p53 antibody occurrence was considered to be increased intracellular p53 protein in cancer cells and autoreactive lymphocytes, respectively. Intracellular p53 also increases with cardiomyocyte apoptosis during heart failure and autoreactive lymphocytes play a role in the course of idiopathic dilated cardiomyopathy (IDC) and ischemic cardiomyopathy (ICM). Based on these observations, we hypothesized that anti-p53 antibody response may also occur in patients with heart failure due to ICM and IDC. AIM: The aim of this study was to evaluate anti-p53 antibodies in the serum of patients with heart failure due to IDC and ICM. METHODS: 70 eligible patients with heart failure and severe left ventricular systolic dysfunction (mean fractional shortening 12.03 +/- 3.93%) were included in the study. The aetiology of heart failure was IDC in 26 patients and ICM in 44 patients, according to the angiographic and echocardiographic findings. RESULTS: Anti-p53 antibodies were not detected in any of the patients. CONCLUSION: Anti-p53 antibodies do not occur in patients with heart failure due to IDC and ICM, possible explanations are discussed in the text.