蕲蛇酶减轻大鼠局灶性脑缺血再灌注损伤的实验研究(Ⅱ)

目的 从病理形态学观察蕲蛇酶对大鼠局灶性脑缺血再灌注损伤的保护作用并探讨其机制。方法 采用线栓法制备大鼠大脑中动脉栓塞后再灌注模型，光镜及电镜观察缺血3h恢复血流再灌24h后脑组织形态学变化。TTC染色观察脑梗死面积，免疫组织化学方法检测脑组织碱性成纤维细胞生长因子（bFGF）的表达。用药组分别在缺血即刻或再灌即刻静脉给予不同剂量的蕲蛇酶，观察比较模型组和蕲蛇酶所有给药组之间上述指标的变化。结果 缺血即刻给蕲蛇酶4U／kg组较再灌即刻给蕲蛇酶同剂量组显著减小梗死灶（P〈0．001），减轻脑组织病理改变，并使脑组织中bFGF蛋白表达明显增多。结论 蕲蛇酶对脑缺血再灌注损伤的神经保护作用可能与脑组织中bFGF表达增高有关；提示该药早期使用更为有效。     

Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients

Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.     

米非司酮对妊娠中期胎儿心脏超微结构的影响

目的:探讨米非司酮对妊娠中期胎儿心脏超微结构的影响。方法:将计划引产孕妇随机分为两组:对照组(水囊组)10例,实验组(米非司酮+水囊)15例。实验组按孕龄分为实验Ⅰ组(10例,16~22周),实验Ⅱ组(5例,23~28周)。实验组口服米非司酮100mg,连服3天,行水囊引产,对照组只行水囊引产。胎儿娩出后取心肌组织进行样本制备,然后在电镜下观察组织的超微结构。结果:细胞肿胀、空化,细胞膜不完整,闰盘分离,部分细胞连接消失。细胞核多呈不规则形,核内染色质凝聚呈块状,部分细胞核空化,核周围可见脂褐素。大部分肌丝断裂,肌节结构消失,少数可辩残留肌节结构,其间可见少量核糖体,但各带结构不清。线粒体肿胀,高度空化,嵴断裂,细胞基质局部空化。毛细血管内皮细胞肿胀。心肌组织细胞的超微结构有改变,且孕龄越小,超微结构改变越明显。结论:米非司酮可以引发胎儿心脏的缺血缺氧性改变。     

经肝动脉As2O3碘化油化疗栓塞 对兔肝移植瘤生长及转移的影响

目的观察As2O3与碘油联合经肝动脉化疗栓塞术后对兔VX2肝移植瘤生长及转移的作用.方法 40只家兔肝内肿瘤种植后2周,随机分为5组,经肝动脉插管分别给予不同处理,实验设生理盐水灌注组、As2O3灌注组、单纯碘油栓塞组、阿霉素碘油栓塞及As2O3碘油栓塞组,As2O3的用量为2 mg/kg.肿瘤种植后5周,测量动物体重,所有动物均处死,取出肝脏及双肺标本,测定肝脏的重量,计算肝移植瘤的体积、坏死面积,观察肝内、双肺及其他器官肿瘤转移的发生率.结果肿瘤植入后5周,各处理组动物体重均有明显的下降,肝脏重量增加,计算的肝指数各组分别为9.8±2.2、9.7±2.1、8.5±2.0、8.4±2.1、6.4±1.2;肿瘤体积分别为(35.5±7.6) cm3、(32.2±9.7) cm3、(21.2±8.5) cm3、(20.9±11.3) cm3、(11.8±4.0) cm3,栓塞治疗组与非栓塞治疗组间差异有统计学意义,As2O3碘油栓塞治疗组与其他组相比差异有统计学意义.平均坏死率各组间差异无明显的统计学意义.双肺转移结节的数目各组分别为52.4±32.2、51.8±26.3、54.8±29.2、53.5±30.7、19.6±17.0;转移结节的直径各组分别为(3.8±1.2) mm、(3.6±1.1) mm、(3.9±1.3) mm、(3.5±1.6) mm、(2.2±0.7) mm.As2O3碘油栓塞治疗组与其他各组相比差异有统计学意义(P<0.05).结论 As2O3与碘油联合经肝动脉栓塞治疗,可抑制肝移植瘤的生长及肺转移.     

肾病综合征患者腺苷脱氨酶活性的变化及意义

通过检测对激素不同反应、不同病情的肾病综合征（NS）患者的血清及淋巴细胞内腺苷脱氨酶（ADA）的活性变化，观察ADA活性与临床疗效的关系。     

Remote-controlled catheter ablation of accessory pathways: results from the magnetic laboratory.

AIMS: This study evaluates feasibility, safety, and efficacy of magnetic remote-controlled accessory pathway (AP) ablation. METHODS AND RESULTS: The novel magnetic navigation system (MNS) (Niobe, Stereotaxis) creates a steerable magnetic field (0.08 T) controlling the distal magnetic tip of an ablation catheter. In conjunction with a catheter advancer system (Cardiodrive, Stereotaxis) remote catheter ablation is enabled. Conventional electrophysiology study identified AP conduction in 59 patients (37 males, 36+/-14 years, 60 APs). First generation 1-magnet tip (1-M) (group I, n=18), second generation bipolar 3-magnet tip (3-M) (group II, n=27), and third generation quadripolar 3-magnet tip catheters (3-M quad.) (group III, n=14) were used for magnetic remote-controlled ablation. Successful AP ablation was achieved in 67% (group I), 85% (group II), and 92% (group III). A significant decrease of median [IQR: Q1-Q3] fluoroscopy time and dosage was observed: 21.2 [12.1-33.8] min, 1110 [395-3234] microGym2 (group I); 6.5 [4.4-15.4] min, 290 [129-489] microGym2 (group II), and 4.9 [3.4-8.0] min, 129 [74-270] microGym2 (group III). Mean procedure time (217+/-67 min; 182+/-68 min, and 172+/-90 min) significantly decreased in group III. Median number [Q1-Q3] of radiofrequency current applications in groups I, II, and III was 4 [2-9], 4 [2-6], and 2 [2-4], respectively. No complications occurred. CONCLUSION: Remote AP ablation is safe and feasible using the novel MNS. Introduction of the 3-magnet quadripolar ablation catheter significantly improved the efficacy of the procedure.     

Triptolide inhibits T cell activation and proliferation via multiple pathways

Triptolide is potent immunosuppressive has been reported to inhibit autoimmunity, compound isolated from Chinese herbal medicine. Triptolide allograft attributed to the suppression of T cells via NF - kB rejection and GVHD, and its efficacy was previously pathway and apoptosis. In the present study, we detailedly analyzed Triptolide＇ s function on murine primary T cell. We found that Triptolide could inhibit T cell activation and proliferation by dramatically down - regulating cell division and cell cycle. Triptolide inhibited T cell activation in a dose- dependent manner, and the inhibition was mediated by both NF- kB pathway and AP - 1 pathway.     

氨苯砜综合征诊治探讨——附6例报告

目的：探讨氨苯砜综合征的诊治要点：方法：对6例氨苯砜综合征患者的临床资料进行回顾性分析。结果和结论：6例氨苯砜综合征患者均为中青年，从服药到出现症状的时间较长，为9～55日.6例患者均以高热起病，起病急骤、凶险，病初均有麻疹紫癜样皮疹，皮疹多形，严重者出现尼氏征阳性或阴性的大疱和（或）全身性红皮病样皮疹；均有浅表淋巴结肿大；多数患者有血液系统损害；并均有肝损害：确诊后及时停氨苯砜，给予足量肾上腺皮质激素和（或）大剂量免疫球蛋白静脉注射，以及支持对症处理，住院12～80（中位数53）日，4例痊愈，1例病情得到控制，另1例因治疗第2日自动出院放弃治疗，死于肝功能衰竭？提示氨苯砜综合征需要及时、正确处理，否则预后不良.     

老年患者不稳定性股骨转子间骨折的术式选择

目的探讨不同的内固定方式在老年患者不稳定性股骨转子间骨折治疗中的应用。方法参照Evans分型,85例老年患者股骨转子间骨折,不稳定性77例,稳定性8例,分别应用不同内固定治疗,其中Gamma钉20例、重建钉25例、动力髋部螺钉(DHS)和动力髁部螺钉(DCS)40例。结果术后随访79例,均获得骨折愈合,愈合时间4～7个月,平均5.2个月,其中大于5°髋内翻者有12例。根据患者骨折愈合、关节活动、主观感觉与生活能力恢复等因素制定疗效评定标准,优良率为84.8%(67例)。未发生因本手术所致内科合并症加重或患者死亡。结论髋内翻是老年患者不稳定性股骨转子间骨折内固定术后的主要并发症。Evans分型对选择内固定具有指导意义。结合老年患者骨质疏松情况,针对不同骨折类型选用适当的内固定器械,可以提高不稳定性转子间骨折的疗效。     

变异髋臼初次全髋人工关节置换术前设计及临床意义

目的:探讨变异髋臼初次全髋人工关节置换术中髋臼假体的正确放置位置及手术疗效。方法:对34例(38髋)接受全髋关节置换的髋臼变异的各类髋关节疾病进行术前设计,其中男20例,女14例,平均年龄56.1岁(29~75岁)。股骨头坏死继发骨性关节炎15例(19髋),髋臼发育不良继发骨性关节炎12例,创伤性骨关节炎5例,髋关节融合术后1例,髋关节人工股骨头置换术后1例。结果:术后患者均获得随访,平均随访11个月(5~38个月)。根据Harris髋关节功能评分评定,优(>90分)12髋,良(80~90分)23髋,尚可(70~79分)3髋,失败0髋(<70分)。评定结果:术前Harris评分平均47.9分,术后平均90.3分。结论:对于髋臼解剖结构异常的髋关节疾病患者行全髋人工关节置换时,通过术前对髋臼正确位置的设计,使髋关节中心置于正确的位置上,既可简化术中操作的难度,又可以使臼杯假体得到牢固固定及良好的骨覆盖,有利于人工全髋关节的长期疗效。