腹腔镜胆囊切除术与开腹胆囊切除术患者血清白细胞介素-6和C-反应蛋白水平

为了比较腹腔镜胆囊切除术（ＬＣ）和开腹胆囊切除术（ＯＣ）对组织的损伤程度，选择拟行单纯胆囊切除术的患者４０例，分别行ＬＣ和ＯＣ各２０例，用酶联免疫法测定术前２４小时、术后１２、２４及４８小时血清白细胞介素－６（ＩＬ－６）；用散射比浊法测定术前２４小时、术后１２、２４及４８小时血清Ｃ－反应蛋白（ＣＲＰ）。结果显示：两组患者术前２４小时血清ＩＬ－６和ＣＲＰ水平相近（Ｐ＞０．０５）；术后１２、２４及４８小时ＯＣ组血清ＩＬ－６和ＣＲＰ水平分别高于ＬＣ组（Ｐ＜０．０５）；术后４８小时ＬＣ组血清ＩＬ－６和ＣＲＰ降至术前水平（Ｐ＞０．０５），但ＯＣ组仍高于术前水平（Ｐ＜０．０５）。ＯＣ组平均手术时间、切口长度及术后平均住院日均比ＬＣ组长（Ｐ＜０．０５）。结果表明：ＬＣ组织损伤程度比ＯＣ小，而后者平均手术时间和切口长度较长是血清ＩＬ－６和ＣＲＰ反应水平较高的主要原因。     

High levels of interleukin-6 are associated with low tumor burden and low growth fraction in multiple myeloma

Interleukin-6 (IL-6) is a multifunctional cytokine postulated to play a central role as a growth factor for multiple myeloma (MM). We evaluated the spontaneous secretion of IL-6 in supernatants of Ficoll-Hypaque-- enriched bone marrow (BM) cultures from 35 patients with MM. The levels of IL-6 were correlated with biological and clinical characteristics of the disease. High levels of IL-6 production defined a subgroup of patients with low tumor burden as determined by lower serum beta 2- microglobulin (B2M) (P = .02) and lower percentage of myeloma cells infiltrating the bone marrow (P = .003), higher synthetic rates of monoclonal protein (P = .006), and low proliferative compartments as measured by the percentage of Ki-67--positive myeloma cells. Patients with high proliferative fractions (Ki-67--positive myeloma cells > 20%) had significantly lower levels of IL-6 when compared with patients with low proliferative fractions (P = .005). Our findings do not support IL- 6 as a major growth factor for MM, but demonstrate an association of high levels of IL-6 secretion with low tumor cell burden and low proliferative fraction.     

The development of colon innervation in trisomy mice and Hirschsprungs disease

AIM To study the colon innervation of trisomy16 mouse, an animal model for Downssyndrome, and the expression of protein geneproduct 9.5 ( PGP 9.5) in the stenosed segmentof colon in Hirschsprungs disease (HD).METHODS Trisomy 16 mouse breeding;cytogenetic analysis of trisomy 16 mice; andPGP 9.5 immunohistochemistry of colons oftrisomy 16 mice and HD were carried out.RESULTS Compared with their normalIittermates, the nervous system of colon intrisomy 16 mice was abnormally developed.There existed developmental delay of muscularplexuses of colon, no submucosal plexus wasfound in the colon, and there was 5mmaganglionic bowel aparting from the anus intrisomy 16 mice. The mesentery nerve fiberswere as well developed as shown in their normallittermates. Abundant proliferation of PGP 9.5positive nerve fibers was revealed in thestenosed segment of HD colon.CONCLUSION Trisomy 16 mice could serve asaganglionic bowel in the distal part of colon.Abundant proliferation of PGP 9.5 positive fibersresulted from extrinsic nerve compensation,since no ganglionic cells were observed in thestenosed segment of the colon in HD. HD has agenetic tendency.     

Activation of phospholipase D by interleukin-8 in human neutrophils

Interleukin 8 (IL-8), a member of the C-X-C branch of the chemokine superfamily, stimulated the breakdown of 1-O-[3H]alkyl-2-acyl-sn- glycero-3-phosphocholine ([3H]EAPC) and the formation of 1-O-[3H]alkyl- 2-acyl-phosphatidic acid ([3H]-EAPA) in human polymorphonuclear leukocytes (PMN) in the presence of cytochalasin B. In addition, the mass of diradyl-PA was increased with similar kinetics. In the presence of ethanol, 1-O-[3H]alkyl-2-acyl-phosphatidylethanol ([3H]EAPEt) was formed at the expense of [3H]EAPA formation, indicating the activation of phospholipase D by the cytokine. The effect was time- and concentration-dependent, reaching a plateau at 30 seconds with the maximally activating concentration of 120 nmol/L IL-8. Preincubation of cells with 1 microgram/mL Bordetella pertussis toxin inhibited the breakdown of [3H]EAPC and [3H]EAPA formation, indicating a role for a pertussis toxin-sensitive guanosine triphosphate-binding protein. Formation of phosphatidic acid (PA) correlated with activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, the oxidative burst enzyme, with both events occurring in the same concentration range. Inhibition of PA formation, by the presence of ethanol, also inhibited the oxidative burst stimulation by IL-8. Pretreatment of PMN with 10 nmol/L platelet-activating factor potentiated both [3H]EAPA accumulation and activation of NADPD oxidase by IL-8. Collectively, these data show that IL-8 stimulates the metabolism of choline-containing phosphoglycerides in human PMN and support a role for PA in the signaling mechanisms used by IL-8 to stimulate PMN function.     

盐酸塞利洛尔合成工艺改进

目的:合成盐酸塞利洛尔,并进行工艺改进。方法:革除溴化反应,对醚化反应进行了优化。结果:使合成路线缩短一步,醚化收率比文献值提高20％以上。结论:该路线较适合于工业化生产。     

The assessment and risk stratification of psychological morbidity in critical care survivors

Along with the ageing population, there is an expanding number of critical care survivors in the community. This group is at risk for both physical and psychological morbidity following their stay. Factors that predispose patients to commonly reported sequelae such as post-traumatic stress disorder, anxiety and depression remain incompletely elucidated. A tool to identify and stratify survivors at discharge may improve outcomes by allowing early and targeted intervention. Looking forward, the identification of aspects of practice associated with long-term adverse consequences should allow us to evolve our current protocols in a way that provides long-term benefit for patients.With the recent focus on improving long-term quality of life for survivors of critical illness has come the requirement for practical ways of identifying people at risk of doing poorly [1]. Over the last decade or so it has been established beyond reasonable doubt that a significant proportion of patients who have survived admission to an ICU experience long-term psychological consequences. Such consequences can include anxiety, depression and post-traumatic stress disorder [2]. In addition many patients suffer from deficits in cognitive function that may be transient or prolonged [3].What is less clear is the true proportion of individuals who experience these post-ICU phenomena. The literature that has formed our understanding of this proportion is predominantly from studies based around intensive care medicine follow-up clinics. Such studies are vulnerable to enrolment bias because the proportion of patients attending clinics is often very modest. Follow-up studies thus often report only 10 to 20% of the potentially available population and there must therefore be substantial imprecision around estimates of the prevalence of post-intensive care discharge phenomena. Of course at an individual level we cannot anticipate why one patient may turn up for their clinic appointment and another not. From our own experience it seems that many patients do not return to clinic because they are either too well and have returned to work, or they feel too unwell and prefer not to return to hospital. This may be exacerbated by those individuals who are experiencing post-traumatic stress phenomena in whom avoidance is a major feature.An important exception to this general summary of the literature is the paper by Dorothy Wade and colleagues published last year in Critical Care[4]. This paper was exceptional both in its thoroughness and in its retention of patients in their initial enrolled cohort for the duration of the study. We can thus have some confidence in the precision of their observations around the identification of risk factors. In many respects their study design is a useful model for future work, but it is resource intensive and hinges around establishment of firm relationships between researchers (or clinicians) and patients and their families whilst they are still very much part of the intensive care population.In the United Kingdom, the National Institute for Health & Clinical Excellence established a guideline for the rehabilitation of critically ill patients some time ago [5,6]. One of the major issues identified in this extensive review (which was chaired by one of the authors of this commentary, SJB) was that we lacked practicable tools to identify patients during their hospital stay who were at risk of poor quality rehabilitation and recovery.The paper by Schandl and colleagues, to which this current commentary is linked [1], describes the early stages of development of a novel tool with which critical care survivors might be stratified at discharge into groups at varying risk of subsequent psychological morbidity. Risk groups were thus identified by regression analysis in a prospectively collected cohort of mixed intensive care patients. Data were assimilated during admission and on departure from critical care, and psychological morbidity (anxiety, depression and post-traumatic stress disorder) was assessed by a structured questionnaire 2 months after ICU discharge. Twenty-one candidate variables were identified based on previous literature and a conceptual model that is not thoroughly described in the paper. A multiple regression model was developed with six factors subsequently identified as being significantly associated with risk of poor outcome. Based on post-hoc classification of risk into low-risk, medium-risk and high-risk groups, psychological morbidity was experienced in 12%, 50% and 63% of these groups, respectively.For a training dataset, the receiver operating characteristic curve in the paper seems reasonably impressive. However, what this paper lacks is a prospective application of the model to a novel validation dataset. As the authors point out in their conclusion, this is needed before we can have real confidence in their observations. In addition, the outcomes were determined using frequently deployed screening questionnaires, The Hospital Anxiety and Depression Scale and the Post Traumatic Stress Scale – 10, which arguably may be a little oversensitive in this population.The utility of any predictive tool is underpinned by there being some modification of treatment that could be applied, which would beneficially alter outcomes. The predictive factors identified by Schandl and colleagues seem to hinge largely on elements determined prior to an ICU survivor’s admission: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, being unemployed or on sick leave at ICU admission, as well as agitation and appearing depressed in the ICU. Wade and colleagues came at the problem from a somewhat different direction [4]. Their study identified rather more factors that might be tractable during an ICU stay – but things were described and measured differently and there was probably overlap between the studies in terms of a priori potential risk factors and outcome measures; overall, many of the outcome measures themselves move in the same direction – that is, they are co-linear [7]. This co-linearity illustrates the difficulties of drawing this literature together in a way that informs future design of studies or indeed clinical systems [7].Whilst Schandl and colleagues have made some headway in assimilating their own data into a clinically applicable tool, the lack of validation and the identification of new factors leave it firmly in the development stage. However, the ability to identify those survivors at significant risk may benefit them by allowing for increased surveillance and early intervention to reduce subsequent morbidity. Furthermore, the identification of risk factors that are associated with particular treatments or protocols should allow us to modify what we do to reduce adverse long-term consequences.     

STABILIZATION OF THORACOLUMBAR SPINAL INJURIES

Spinal Cord injury cases are being managed in Base Hospital Delhi Cantt since Oct. 97. 27 cases of thoracolumbar injuries were admitted in this hospital during the period Oct 97 to Aug 99. 20 patients underwent surgical treatment (9 thoracic and 11 lumbar) and 7 were treated conservatively. All these operations were done within 3 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications to surgery included stable fracture, bed sores, any focus of sepsis and generalized bone disorders. Transpedicular fixation with Dyna-lok system was done in 10 cases, universal spinal system was applied in 6 cases and Harrington instrumentation was carried out in 4 cases. Decompression laminectomy was done in all cases. Patients with incomplete cord injury showed neurological improvement and early rehabilitation was possible after surgery.KEY WORDS: Harrington instrumentation, Pedicle screw and plate, Spine trauma, Thoracolumbar fractures