重型颅脑损伤开颅术中急性脑膨出原因及防治

目的探讨重型颅脑损伤开颅术中急性脑膨出原因及防治。方法对术中出现急性脑膨出的46例病人进行回顾性分析。结果导致脑膨出的主要原因有迟发性颅内血肿、急性弥漫性脑肿胀、低血压、低血氧及较大回流静脉的损伤。结论术中出现急性脑膨出的病因是多方面的，针对不同的病因采取相应的措施，可以减轻脑组织的损害，降低病死率。     

Survey of the definition and screening of neonatal hypoglycaemia in Australia

Objective : To determine the approach to identifying neonatal hypoglycaemia and the definition of neonatal hypoglycaemia used by neonatal paediatricians in Australian Level 3 neonatal intensive care units (NICU).
Methodology : A questionnaire was sent to the 101 neonatal paediatricians in the 22 Level 3 NICU in Australia asking their method of screening for, and definition of, neonatal hypoglycaemia.
Results : Responses were received from 70 neonatal paediatricians, including all 22 directors. A bedside glucose meter is used in 19 of 22 NICU to screen for hypoglycaemia, whilst one NICU uses a glucose analyzer and another NICU uses a visual colour comparison method. One NICU does not screen, but has blood glucose measured in a satellite laboratory. If the screening method suggests hypoglycaemia, 62 of 63 neonatal paediatricians proceed to blood glucose determination in a laboratory, mostly using plasma samples. Based on the laboratory measurement, the definition of neonatal hypoglycaemia ranged from <1.1 to 3.0 mmol/L.
Conclusions : The majority of neonatal paediatricians in Australian NICU screen for neonatal hypoglycaemia using a bedside glucose meter. There is a wide range in the definition of neonatal hypoglycaemia from <1.1 to 3.0mmol/L.     

Treatment of ras-induced cancers by the F-actin-bundling drug MKT-077

A rhodacyanine dye called MKT-077 has shown a highly selective toxicity toward several distinct human malignant cell lines, including bladder carcinoma EJ, and has been subjected to clinical trials for cancer therapy. In the pancreatic carcinoma cell line CRL-1420, but not in normal African green monkey kidney cell line CV-1, it is selectively accumulated in mitochondria. However, both the specific oncogenes responsible for its selective toxicity toward cancer cells, and its target proteins in these cancer cells, still remain to be determined. This study was conducted using normal and ras-transformed NIH 3T3 fibroblasts to determine whether oncogenic ras mutants such as v-Ha-ras are responsible for the selective toxicity of MKT-077 and also to identify its targets, using its derivative called "compound 1" as a specific ligand. We have found that v-Ha-ras is responsible for the selective toxicity of MKT-077 in both in vitro and in vivo. Furthermore, we have identified and affinity purified at least two distinct proteins of 45 kD (p45) and 75 kD (p75), which bind MKT-077 in v-Ha-ras-transformed cells but not in parental normal cells. Microsequencing analysis has revealed that the p45 is a mixture of beta- and gamma-actin, whereas the p75 is HSC70, a constitutive member of the Hsp70 heat shock adenosine triphosphatase family, which inactivates the tumor suppressor p53. MKT-077 binds actin directly, bundles actin filaments by cross-linking, and blocks membrane ruffling. Like a few F-actin-bundling proteins such as HS1, alpha-actinin, and vinculin as well as F-actin cappers such as tensin and chaetoglobosin K (CK), the F-actin-bundling drug MKT-077 suppresses ras transformation by blocking membrane ruffling. These findings suggest that other selective F-actin-bundling/capping compounds are also potentially useful for the chemotherapy of ras-associated cancers.     

Two cases of tongue cancer treated with intra- and peri-tumoral injection of recombinant interleukin-2 alone: immunohistochemical considerations to clinical tumor response

SUBJECTS AND METHODS: Two cases with stage II tongue cancer who exhibited different responses to intra-and peri-tumoral administration of rlL-2 alone are presented. Special consideration is given to the relationship between tumor responses to rlL-2 and clinicopatholog-ical and immunohistopathological findings.
RESULTS: The patient who responded completely to treatment showed an exophytic tumor growth pattern, low-grade cancer invasion, and predominant infiltration of CD8⁺ lymphocytes over CD4⁺ lymphocytes in cancer cell nests. The non-responder showed endophytic tumor growth, high-grade cancer invasion, and uniform distribution of both CD4⁺ and CD8⁺ lymphocytes in cancer cell nests.
CONCLUSIONS: Distribution of adequate amounts of T lymphocytes subsets may be necessary in order for good tumor response to biotherapy with rlL-2; other clinical and histopathological variables predicting the effect for cancer chemotherapy remain to be identified.     

Heterogeneity of chemosensitivity of esophageal and gastric carcinoma

Esophageal and gastric cancer have a poor prognosis, and chemotherapy is rarely of long-term benefit. This may be related in part to heterogeneity of chemosensitivity and to constitutive resistance to individual cytotoxic drugs. This study aimed to demonstrate the degree of heterogeneity of chemosensitivity between tumors. We have examined the heterogeneity of chemosensitivity in esophageal and gastric cancer specimens (n=85) using an ex vivo ATP-based chemosensitivity assay (ATP-TCA). A variety of chemotherapeutic agents were tested. Sixty-four specimens were endoscopic biopsy samples; the remainder were from resection specimens. Cells were obtained from 62 specimens (73%). Eight assays were infected due to contamination/infection of the biopsy material, giving an evaluability rate of 87%. Analysis of the data showed considerable heterogeneity of chemosensitivity. The most active single agents identified by the assay were mitomycin C (56% sensitivity) and 5-fluorouracil (5-FU; 42% sensitivity). Exposure of tumor cells to combinations of drugs showed ECF (epirubicin, cisplatin, 5-FU) and mitomycin C+5-FU to be moderately active regimens. Other experimental drug combinations showed greater activity. There is a marked heterogeneity of chemosensitivity in esophageal and gastric cancers. The degree of heterogeneity observed suggests that the ATP-TCA could be used to individualize chemotherapy by selecting agents for particular patients. This approach provides the rationale for a trial of ATP-TCA-directed therapy to determine whether individualization of chemotherapy might improve patient response and survival.     

Inhibition of high K+-induced contraction by the ROCKs inhibitor Y-27632 in vascular smooth muscle: possible involvement of ROCKs in a signal transduction pathway

In the isolated rat aorta, a ROCKs (rhoA-dependent coiled coil serine/threonine kinases) inhibitor, Y-27632, inhibited the contractions induced not only by receptor agonists but also by high K(+) with the similar IC(50) values (0.8 - 4.9 microM). However, Y-27632 did not inhibit the increment of cytosolic Ca(2+) concentration ([Ca(2+)](i)) due to these stimulants. The Y-27632-induced inhibition of contraction was accompanied by an inhibition of myocin light chain (MLC) phosphorylation, although inhibition of contraction was stronger than that of MLC phosphorylation during the initial phase of contraction. Y-27632 had no effect on the myocin light chain kinase (MLCK) activity. This inhibitor also did not directly change the phosphatase activity. These results suggest that Y-27632 is a selective inhibitor of ROCKs with no direct inhibitory effect on [Ca(2+)](i), calmodulin, MLCK, or phosphatase. Y-27632 disrupted the actin filament network and decreased the filamentous actin, implying that the stronger inhibition by Y-27632 on early phase of contraction than MLC phosphorylation may be explained by this effect. These results suggest that the high K(+)-induced MLC phosphorylation and contraction are mediated not only by the classical Ca(2+)/calmodulin-dependent MLCK system but also by a novel MLC phosphorylation pathway involving ROCKs. One of the possibilities is that high K(+) activates ROCKs to inhibit myosin phosphatase resulting in an augmentation of MLC phosphorylation and contraction.     

Afferent and efferent lymph-collecting vessels of the submandibular nodes with special reference to the lymphatic route passing through the mylohyoid muscle

BACKGROUND: Although metastasis of cancer in the oral region to the submandibular node is well described, there has been no anatomic representation of lymph vessels penetrating the oral floor and draining into the node. MATERIALS AND METHODS: Ninety specimens were obtained from formalin-fixed, donated cadavers. Histologic observations using serial sections followed the macroscopic observations. RESULTS: In 19 of 90 specimens, we found afferent collecting lymph vessels exiting from the mylohyoid surface and draining into the preglandular submandibular node. In 3 of the 19 specimens, collecting vessels passing through the narrow muscle gap with or without arteries, veins, and nerves were identified histologically. The postglandular submandibular node was not evident in the drainage route. CONCLUSIONS: Although it carries a low incidence, because of the direct lymphatic route or pathway between the oral region and preglandular submandibular node, the pathologically positive supraomohyoid node sometimes seems to be found even in elective neck dissection. However, we speculate that sentinel node investigation would reveal the much more critical role of the jugulodigastric node not only as the actual sentinel node but also as the common terminal node along the various drainage routes from the oral region.