肝移植术后患者血清胆汁酸代谢的检测及临床意义

目的:评价肝移植术后患者血清总胆汁酸水平、胆酸/鹅脱氧胆酸比值在肝移植术后发生排斥反应及肝功能延迟恢复时的变化规律。方法:选择2004-01/2004-12在大连医科大学器官移植中心进行肝移植手术的患者28例,同时收集大连医科大学附属二院门诊健康体检者和肝硬化患者血清学标本各12例作为对照,所有观察对象均知情同意。采用高效液相色谱检测肝移植术后患者血清中不同种类胆汁酸及总胆汁酸水平,也与常规肝功能监测指标谷草转氨酶和总胆红素加以比较,对肝移植术后患者血清指标与肝功能恢复之间的关系进行综合评价。结果:所有观察对象均进入结果分析,无脱落。①肝硬化组、肝移植组术前患者的血清总胆汁酸水平显著高于正常对照组(P<0.05)。②肝移植患者术后发生排斥反应或肝功能延迟恢复时,血清总胆汁酸水平较术前明显升高(P<0.05),胆酸/鹅脱氧胆酸比值明显降低(P<0.05),且比谷草转氨酶、总胆红素的变化提前发生,随着供肝功能的恢复它们将逐渐恢复正常。结论:总胆汁酸及胆酸/鹅脱氧胆酸比率可以作为肝移植术后发生排斥反应及肝功能延迟恢复的早期诊断指标,其对于肝移植术后急性排斥反应的早期诊断、早期治疗有重大意义。     

心肌梗死后不同时间移植骨髓间充质干细胞对心脏功能修复的作用

目的:观察心肌梗死后不同时间点移植骨髓间充质干细胞对梗死心肌修复的影响,寻找细胞治疗的有效移植时间窗。方法:实验于2006-04/10在郑州大学基础医学院完成。①实验动物:清洁级6周龄雄性SD大鼠81只,1只用于获取骨髓间充质干细胞,剩余80只随机数字表法分为细胞移植组、培养液对照组,再按心肌梗死后1d及1,2,3周进行移植的时间各分为4个亚组,10只/组。②实验方法:获取、培养大鼠骨髓间充质干细胞,培养至第3代接近70%融合时,加入5-溴脱氧尿嘧啶体外标记,调整细胞密度为4×1010L-1备用。两组大鼠均结扎左冠状动脉前降支建立心肌梗死模型。细胞移植组各亚组按对应时间点在心肌梗死中央及四周移植骨髓间充质干细胞悬液50μL/点(2×106个),培养液对照组各亚组于相同部位移植L-DMEM培养液,50μL/点。③实验评估:移植前和移植3周后检测心功能;苏木精-伊红、免疫组织化学染色观察心肌梗死区组织及细胞变化。结果:共79只大鼠进入结果分析。①骨髓间充质干细胞的生长特点:刚分离的细胞为圆形。5d后有集落形成,细胞呈梭形、纺锤形或多角形,胞核较大。传代后细胞体积较原代细胞增大,生长速度加快。②心肌梗死后不同时间移植骨髓间充质干细胞的心功能比较:与移植前比较,移植3周后细胞移植组各亚组左室射血分数、短轴缩短率均有所改善(P<0.05),以心肌梗死后2周细胞移植组最为明显(P<0.01);培养液对照组各亚组左室射血分数、短轴缩短率均下降(P<0.05)。③梗死心肌组织学观察:细胞移植组心肌梗死区及周边可见核蓝色深染的细胞,排列整齐,梗死区瘢痕化减轻。④骨髓间充质干细胞在心肌组织中的分化:细胞移植组梗死心肌内可见大量BrdU标记阳性的骨髓间充质干细胞,胞核呈棕黄色,对心肌特异性肌钙蛋白T呈阳性表达。结论:心肌梗死后早期移植骨髓间充质干细胞能够改善心功能,以2周内进行细胞移植的效果较佳。     

Pattern of sodium handling and its consequences in patients with preascitic cirrhosis

The initial abnormalities in the renal sodium handling in patients with cirrhosis before developing ascites remain unknown. The aim of this study is to further characterize sodium metabolism and the effects of sodium loading in preascitic cirrhosis. Eight male, preascitic patients with cirrhosis and 6 volunteers had their daily urinary sodium excretion level measured while on a strictly metabolically controlled diet, first consisting of 20 mmol then of 200 mmol sodium per day each for 7 days. Central blood volume, plasma norepinephrine, and atrial natriuretic factor levels were measured during each diet. Preascitic patients with cirrhosis had significantly less daily urinary sodium excretion on both diets. Volume expansion in the patients with cirrhosis was indicated by significantly greater weight gain and higher atrial natriuretic factor levels for each diet. Patients with cirrhosis had central blood volume expansion (1725 ± 54 mL/m²) compared with controls (1495 ± 81 mL/m²; P = 0.03) on a low-sodium diet. This increased significantly in the controls (1864 ± 164 mL/m²; P = 0.04) on a high-sodium diet, associated with suppression of plasma norepinephrine, but not in the patients with cirrhosis (1679 ± 107 mL/m²; P > 0.05). Failure of further central blood volume expansion in the patients with cirrhosis on high-sodium diet in the presence of significant weight gain suggests maldistribution away from the effective arterial blood volume. This study provides further reasons why preascitic patients with cirrhosis might benefit from sodium restriction.     

人工建立褪黑素节律对妇科手术后病人睡眠质量的影响

目的 评价人工建立褪黑素节律对妇科手术后病人睡眠质量的影响.方法 择期行妇科手术病人18例,年龄25～50岁,体重45～80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为3组(n=6):空白对照组(C组)、安慰剂对照组(P组)和褪黑素组(M组).分别于术前1d、手术当天和术后第1天的21:00熄灯前10 min时,M组口服褪黑素胶囊6mg;P组口服安慰剂.术中采用连续硬膜外麻醉,术后采用病人硬膜外自控镇痛.分别于手术当天和术后第1天的6:00、10:00、14:00、16:00、18:00、20:00、22:00、0:00、3:00时,留取尿液,采用放射免疫法测定褪黑素浓度.分别于术前1d、手术当天和术后第1天的21:00至次日6:00时,监测多导睡眠图,计算总睡眠时间、睡眠潜伏期、Ⅰ期睡眠时间、Ⅱ期睡眠时间、Ⅲ期睡眠时间、Ⅳ期睡眠时间、快速眼动睡眠时间、慢波睡眠时间和总清醒次数.记录病人对术前1d、手术当天和术后第1天的夜间睡眠质量评分(0分为基本无睡眠,10分为睡眠良好).结果 与C组和P组比较,M组手术当天和术后第1天的6:00、0:00和3:00时尿液褪黑素浓度升高,手术当天的总睡眠时间和Ⅰ期睡眠时间延长,手术当天和术后第1天的夜间睡眠质量评分升高(P＜0.05).结论 人工建立褪黑素节律可改善妇科手术后病人的睡眠质量.     

Outputs and cost of HIV prevention programmes for truck drivers in Andhra Pradesh, India

Background  

HIV prevention programmes for truck drivers form part of the HIV control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and use of resources.     

胶质母细胞瘤14号染色体杂合性丢失的初步研究

目的 寻找胶质母细胞瘤（glioblastoma,GBM)14号染色体上可能存在肿瘤抑制基因的杂合性丢失（loss of heterozygosity,LOH)aqfa,为发现和定位肿瘤抑制基因提供线索和依据。方法 应用聚合酶链反应方法,采用荧光标记引物和377型DNA序列自动分析仪,分析了20例GBM患者14号染色体上14个微卫星多态性标记的LOH。结果 在50％（10／20）GBM患者的14号染色体上观察到LOH,在38．2％（81／212）可提供信息位点存在LOH。14p和14q的LOH率分别为32％（6／19）、50％（10／20）。在位于14q31-32．3的D14S65位点、14q21-24.1的D14S63－D14S74位点间区域检测到了较高LOH率,分别为57．1％、46．7％－47．1％。在所测位点均未检测到微卫星不稳定（microsatellite instability,MI)。结论 染色体14q上等位基因的丢失可能在GBM分子水平发病机理中起着重要作用,14q31-32.3的D14S65位点、14q21-24.1的D14S63－D14S74位点间区域可能存在与GBM相关的肿瘤抑制基因。     

LIFE-THREATENING TARDIVE DYSKINESIA

SUMMARY We present the case of a patient with severe tardive dyskinesia that led to dehydration. Clinicians need to recognise that tardive dyskinesia is a potentially life-threatening condition, and familiarise themselves with its management.     

Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review

To determine the risks when the primary methotrexate (MTX) treatment of cervical pregnancy has an unsatisfactory outcome, we conducted a Medline search on relevant literature published from January 1983 to June 1997. The search yielded 28 publications of 48 cases of cervical pregnancy. These and four new cases from our institutions were used in our study. A cervical pregnancy that presented with a serum beta-human chorionic gonadotrophin concentration of > or = 10,000 mIU/ml [odds ratio (OR) 10.82, 95% confidence interval (CI) 2.59, 45.14], gestational age at > or = 9 weeks (OR 6.44, 95% CI 1.46, 28.52), embryonic cardiac activity (OR 14.29, 95% CI 2.95, 76.92), and crown- rump length of >10 mm (OR 13.33, 95% CI 1.46, 120.48) was considered to be associated with a higher unsatisfactory rate of primary MTX treatment. A concomitant feticide was found to enhance the therapeutic effect of MTX treatment if embryonic cardiac activity was evident (OR 0.13, 95% CI 0.02, 0.68). Administration of a high dose of MTX did not seem to be more effective than a lower one. Our findings supported some previous observations and, more importantly, provided useful clinical information in selecting appropriate candidates for MTX treatment in cases of cervical pregnancy.      

Management of chylous ascites following laparoscopic presacral neurectomy

Chylous ascites is an extremely rare complication of laparoscopic presacral neurectomy (LPSN), and treatment is still controversial. Four patients undergoing LPSN for dysmenorrhoea or chronic pelvic pain were complicated with chylous ascites. Two were successfully treated with bipolar cauterization and one, after the failure of initial treatment by bipolar cauterization, was then effectively managed by compression with Gelform and closure of the peritoneum of the presacral area by suture through laparoscopy. The fourth patient had persistent chyle leakage from the drainage tube after electrocauterization and was finally cured by conservative management including removal of the drainage tube and a low-fat diet for 3 weeks. Chylous ascites has not been reported in laparoscopic presacral neurectomy. Management that is quick, effective and subjects the patients to the least amount of suffering is still unresolved. Repeated laparoscopy can be considered to identify the possibility of injury to lymphatic vessels, to relieve abdominal distention due to chyle accumulation, and to apply electrocauterization or compression with Gelform and closure of the peritoneum. Conservative treatment with a low-fat diet may need a longer time. The use of a drainage tube may provide negative pressure allowing a continuous leakage of chyle. However, more controlled study is required to identify the most proper and effective management.