复发性胶质瘤再手术治疗的探讨

目的 探讨复发性胶质瘤患者再手术的效果。方法 对22例复发性胶质瘤患者再手术前的功能状态、两次手术间隔时间及手术切除的程度与术后存活期等资料进行临床和统计学分析。结果 第二次手术前生活能自理或半自理的病人（Kamofsky计分≥60）平均生存期约16月，生活不能自理的病人（Kamofsky计分〈60）平均生存期约6月（P〈0．01）。两次手术间隔时间大于1年者平均生存期约17月，间隔时间小于半年者平均生存期约6月（P〈0．01）。手术肿瘤全切除者平均生存期约15月，次全切除者平均生存期约10月（P〈0．05）。结论 术前功能情况好，手术间隔时间大于1年及术中全切肿瘤者再手术治疗可获得较好效果。     

核医学~(131)Ⅰ诊疗患者的管理方法探讨

目的探讨核医学的~(131)Ⅰ诊疗患者管理。方法分析核医学~(131)Ⅰ诊疗患者的现状,依据国家相关法律法规及标准要求,提出患者管理的必要性。结果提出~(131)Ⅰ诊疗患者的综合管理方法。结论应加强核医学~(131)Ⅰ诊疗患者的管理。     

痧斯病(SARS)

严重急性呼吸道综合征(severe acute respiratory syndrome，SARS)是由SARS相关冠状病毒(SCV)引起的一种新的烈性呼吸遗传染病。急性期重症病例肺部病变为严重的急性间质性渗出性炎，类似呼吸窘迫综合征的病理特征。肺外器官主要为出血坏死性炎。临床诊断是一个动态的过程，随着对SARS认识的加深，诊断标准将会不新完善。文中对命名进行了讨论，中文名建议用痧斯病。     

Effects of Pharmacological Autonomic Blockade on Dual Atrioventricular Nodal Pathways Physiology in Patients with Slow-Fast Atrioventricular Nodal Reentrant Tachycardia

The purpose of this study was to investigate the atrioventricular AV nodal physiology and the inducibility of AV nodal reentrant tachycardia (AVNRT) under pharmacological autonomic blockade (AB). Seventeen consecutive patients (6 men and 11 women, mean age 39 ± 17 years) with clinical recurrent slow-fast AVNRT received electrophysiological study before and after pharmacological AB with atropine (0.04 mg/kg) and propranolol (0.2 mg/kg). In baseline, all 17 patients could be induced with AVNRT, 5 were isoproterenol-dependent. After pharmacological AB, 12 (71 %) of 17 patients still demonstrated AV nodal duality. AVNRT became noninducible in 7 of 12 nonisoproterenol dependent patients and remained noninducible in all 5 isoproterenol dependent patients. The sinus cycle length (801 ± 105 ms vs 630 ± 80 ms, P < 0.005) and AV blocking cycle length (365 ± 64 ms vs 338 ± 61 ms, P < 0.005) became shorter after AB. The antegrade effective refractory period and functional refractory period of the fast pathway (369 ± 67 ms vs 305 ± 73 ms, P < 0.005; 408 ± 56 ms vs 350 ± 62 ms, P < 0.005) and the slow pathway (271 ± 30 ms vs 258 ± 27 ms, P < 0.01; 344 ± 60 ms vs 295 ± 50 ms, P < 0.005) likewise became significantly shortened. However, the ventriculoatrial blocking cycle length (349 ± 94 ms vs 326 ± 89 ms, NS) and effective refractory period of retrograde fast pathway (228 ± 38 ms vs 240 ± 80 ms, NS) remained unchanged after autonomic blockade. Pharmacological AB unveiling the intrinsic AV nodal physiology could result in the masking of AV nodal duality and the decreased inducibility of clinical AVNRT.     

Temporal stability of lipid responses to acute psychological stress in middle-aged men

The purpose of this study was to establish the temporal stability of lipid responses to acute psychological stress. Eighteen men were tested twice an average of 16.2 months apart in identical laboratory reactivity protocols. Total cholesterol, triglycerides, high- and low-density lipoprotein-cholesterol, plasma volume, heart rate, and blood pressure were assessed during rest, serial subtraction, and speech. After correction for changes in plasma volume, significant elevations were recorded for all variables during the speech task, but fewer variables showed changes during the serial subtraction task. Strong intersession associations were found when considering levels of the variables during baseline and stress (rs≥58). Correlations for the change scores ranged from .36 to .52 for the atherogenic lipids and from .39 to .87 for the cardiovascular variables. Little evidence was found for stability of plasma volume changes. There is moderate to high temporal stability of the atherogenic lipids when considering rest and stress levels and small to moderate temporal stability when considering change scores.     

心房颤动治疗的未来发展方向——混合消融

心房颤动是临床常见的心律失常,已有研究证明其与严重不良心脑血管事件(心力衰竭、脑卒中和心肌梗死)有关,目前全球心房颤动的患病人数超过了3 300万,预计未来40年内其患病率将增加1倍以上。多年来,医学相关人员在探究心房颤动的病理生理机制及开创改进其治疗方法等方面付出了大量努力。目前心房颤动的治疗管理仍是临床医学上的一个难题,尽管心房颤动治疗的手术消融和导管消融技术已逐渐趋于成熟,但对于心房颤动最佳的治疗方式、消融能量的选择尚无统一定论。导管消融通常需要多次手术且成功率低,而手术消融术后不良事件发生率较高。近年来,鉴于心脏外科医生和电生理学家之间的密切合作,结合导管及微创手术消融诞生了一种治疗心房颤动的新型策略——混合消融模式。混合消融克服了导管消融和微创手术消融的缺点,减少了不良结局,在治疗持续性心房颤动,尤其是长期持续性心房颤动上取得了可观的成效。本文主要通过回顾心房颤动消融的研究进展,对比分析目前混合消融模式治疗心房颤动的现有研究成果,归纳总结这种新型心房颤动治疗策略的优势与挑战,以期为临床心房颤动的治疗提供更多选择。     

The Broiler Chicken as a Model for Immunotoxicity Assessment: 1. Standardization of in Vitro Immunological Assays

The Broiler Chicken as a Model for Immunotoxicity Assessment.1. Standardization of in Vitro Immunological Assays. BAECHER-STEPPAN,L., NAKAUE, H. S., MATSUMOTO, M., GAINER, J. H., AND KERKVLIET,N. I. (1989). Fundam. Appl. Toxicol. 12, 773–786. Thebroiler chicken was developed as an alternative animal modelto laboratory rodents for immunotoxico-logic assessment. Invivo treatment with 100–200 mg/kg cyclophosphamide (CY)was used as a known immunosuppressive treatment to standardizethe assay systems. Protocols for assessing specific immunologicalfunctions were developed in specific pathogen-free (SPF) broilersto measure lymphocyte blastogenesis to T-cell (concanavalinA and phytohemagglutinin) and B cell (Staphylococcus aureuscells) mitogens, delayed-type hypersensitivity (Dm) to tuberculin,natural killer (NK) cell cytotoxicity, plaque-forming cell (PFC)response to sheep red blood cells (SRBC), and serum antibodytiters to SRBC. CY was an effective immunosuppressant in thebroiler system for assessment of lymphocyte responsiveness tomitogenic stimulation, DTH reactivity, and the antibody responceto SRBC as assessed by PFC and serum antibody titers. NK cytotoxicitywas not altered on a cellular level following treatment withCY at a dose that preduced greater than 75% depletion of spleencellularity. However, under these conditions, it must bc assumedthat the capacity of CY-treated birds to mediate NK effectorfunctions would be reduced. These results demonstrate the applicabilityof the broiler chicken as an animal model for immunotoxicitytesting.     

艾芬地尔干预后氯化锂-匹罗卡品致(癎)大鼠的慢性期脑电图特征

目的:了解艾芬地尔干预对氯化锂(LiCl)-匹罗卡品(Pilo)致(癎)大鼠脑电图随时间变化的特征.方法:通过腹腔注射LiCl-Pilo建立癫(癎)动物模型.60只雄性Wistar大鼠分为对照组、模型组和艾芬地尔干预组,分别在造模后第7、15、30、60天四个时间点观察各组大鼠行为、脑电图改变,每一个时间点5只大鼠.结果:对照组无NFDA1性发作,经过4-20天的潜伏期后,干预组及模型组的脑电图波幅及频率骤然减低,在慢性期干预组较模型组的波幅逐渐增高,频率逐渐增快,但仍未达发作当时的水平,且两组间比较差异无统计学意义.干预组较模型组更早更快趋于正常化.结论:艾芬地尔在LiCl-Pilo致(癎)大鼠模型中具有抗惊厥作用,慢性期脑电图有特征性改变.     

尿VEGF、ET检测对2型糖尿病患者早期肾脏微血管损伤的诊断价值

目的探讨尿血管内皮生长因子（VEGF）、内皮素（ET）对2型糖尿病患者早期肾脏微血管损伤的诊断价值。方法按尿微量蛋白排泄率把76例2型糖尿病患者分为无肾病、早期肾病、临床肾病3组。采用放射免疫法（RIA）和酶联免疫吸附试验（EHSA）测定尿VEGF、α1-微球蛋白（α1-MG）、β2-微球蛋白（β2-MG）、免疫球蛋白G（IgG）、ET水平。结果2型糖尿病患者尿VEGF、ET与对照组比较差异有统计学意义（t≥2．29，P〈0．01），且其水平随病情加重而明显升高；与α1-MG、β2-MG、IgG、Alb、糖化血红蛋白（HbAlc）呈正显著相关（r≥0．309）．而与空腹血糖（FBG）无明显相关（r≤0．06）。结论VEGF、ET参与糖尿病微血管病变的发生、发展；尿VEGF、ET是诊断2型糖尿病患者早期肾脏微血管损伤的敏感指标，对糖尿病肾病的早期诊断和肾功能损害程度的判断有一定的临床诊断价值。     

上皮间质转化(EMT)及其分子机制

上皮细胞受到细胞外因子刺激后向间质细胞转化的现象与肿瘤的浸润转移密切相关。在此过程中上皮细胞的极性丧失，迁移和运动能力增强，同时上皮表型丢失而逐渐获得间质表型。参与这一过程的细胞内信号转导途径有受体酪氨酸激酶Ras-MAPK途径，Src激酶，Rho家族激酶，PI3K/AKT途径，Wnt信号通路，转录因子等。