慢性移植肾失功后的移植肾切除手术分析

目的:分析总结因慢性移植肾失功而行移植肾切除手术患者的临床治疗经过,进一步探讨这类手术的安全性和适应证。方法:以慢性移植肾失功患者76例为研究对象,年龄23~72(36.6±13.5)岁,以上患者发生慢性移植肾失功的时间为术后11~91(35.8±24.6)个月,转入血液透析的时间为3~33(10.4±6.2)个月。76例患者均实施了移植肾切除手术,移植肾切除术后随访时间为6个月~5年。结果:平均手术时间50(35~180)min;术中平均出血量450(200~2 600)ml,平均输血量300(400~2 400)ml,其中67例进行了自体血液回收后输血。术后平均引流量250(20~1 100)ml,平均住院时间11(5~23)d。术后主要并发症:切口血肿8例,切口感染10例,消化道出血7例,心衰7例,肺部感染5例,肾上腺危象2例,下肢跛行2例。死亡4例。多数患者的体重指数、血红蛋白及血清白蛋白含量较术前有所提高。结论:慢性移植肾失功后的移植肾切除手术为高风险手术,应积极做好术前准备,同时加强围手术期护理,以降低手术并发症的发生率;积极适时地切除已经完全失功了的移植肾,有助于改善患者身体素质,避免免疫抑制的不良反应,同时有利于减轻患者本人及社会的经济负担。     

Purification of hemopoietic progenitor cells from human marrow using a fucose-binding lectin and cell sorting

Human peripheral blood granulocytes, but not lymphocytes, erythrocytes, or monocytes, bound the fucose-binding lectin from Lotus tetragonolobus (FBP), and this binding was competitively inhibited by the sugar alpha- L-fucose. The fluorescence-activated cell sorter was used to study the appearance of this receptor on human marrow cells during granulocyte differentiation and to prepare fractions enriched for granulocyte- macrophage progenitor cells (granulocyte-macrophage colony-forming cells--GM-CFC). Cell binding of fluoresceinated FBP increased for bone marrow cells in the sequence--lymphocytes, blast cells, promyelocytes and myelocytes, monocytes, and polymorphonuclear cells. Selection of cells with appropriate low-angle or high-angle light scatter characteristics achieved a 10-fold or 2-3-fold enrichment of progenitor cells, respectively. By selecting cells with intermediate fluorescence intensity, a further 2-3-fold enrichment for GM-CFC was obtained. Cell sorting using the optimal selection of these three parameters produced up to 36-fold enrichment of the progenitor cells from human bone marrow. The most enriched fraction was composed of 23% progenitor cells (colony- and cluster-forming cells) with a yield of 36%. In populations most highly enriched by GM-CFC, immature cells (blast cells, promyelocytes, and myelocytes) made up 95% of the cells present.     

Sebaceous carcinoma of the lip: Comparing normal lip and cheek anatomy with the imaging features of a rare cutaneous malignancy

Sebaceous carcinoma is a rare cutaneous malignancy, commonly affecting the eyelids. This case highlights a patient who presented with sebaceous carcinoma of the right upper lip with extensive involvement of the soft tissues of the head and neck. As part of the initial investigation, ultrasound was requested. This case demonstrates the ultrasound features of sebaceous carcinoma as well as revising the normal ultrasound anatomy of the upper lip and muscles of the cheek.     

Escherichia coli DnaJ and GrpE heat shock proteins jointly stimulate ATPase activity of DnaK.

The products of the Escherichia coli dnaK, dnaJ, and grpE heat shock genes have been previously shown to be essential for bacteriophage lambda DNA replication at all temperatures and for bacterial survival under certain conditions. DnaK, the bacterial heat shock protein hsp70 analogue and putative chaperonin, possesses a weak ATPase activity. Previous work has shown that ATP hydrolysis allows the release of various polypeptides complexed with DnaK. Here we demonstrate that the ATPase activity of DnaK can be greatly stimulated, up to 50-fold, in the simultaneous presence of the DnaJ and GrpE heat shock proteins. The presence of either DnaJ or GrpE alone results in a slight stimulation of the ATPase activity of DnaK. The action of the DnaJ and GrpE proteins may be sequential, since the presence of DnaJ alone leads to an acceleration in the rate of hydrolysis of the DnaK-bound ATP. The presence of GrpE alone increases the rate of release of bound ATP or ADP without affecting the rate of hydrolysis. The stimulation of the ATPase activity of DnaK may contribute to its more efficient recycling, and it helps explain why mutations in dnaK, dnaJ, or grpE genes often exhibit similar pleiotropic phenotypes.     

介入封堵与外科手术治疗主动脉窦瘤破裂的疗效及安全性

目的比较介入封堵与外科手术治疗主动脉窦瘤破裂(RSVA)的疗效及安全性。方法选取RSVA患者22例,介入封堵治疗10例(介入组),外科手术治疗12例(手术组)。术后随访6—24个月,比较两组临床症状、是否存在残余分流、有无瓣膜反流、封堵器有无移位、肺动脉压变化及心功能状态。结果介入组均完全封堵;与术中比较,术后肺动脉收缩压、肺动脉平均压均降低,差异均有统计学意义(P均0.05);术后即刻造影示少量残余分流1例。手术组完全封堵率为91.67%(11/12);术后出现较大的残余分流和严重低心排量综合征各1例。两组随访期内均未发生右心衰竭、栓塞、感染性心内膜炎、主动脉瓣反流、溶血和死亡等。结论介入封堵治疗主动脉窦瘤破裂与外科修补疗效相当,且具有较好的安全性。     

Tolerance to beta 2-agonists in patients with chronic obstructive pulmonary disease

Eleven patients with severe COPD were examined to determine whether tolerance to beta 2-agonists developed after long-term inhalation therapy with these agents. Before the study all patients were on regular treatment with inhaled salbutamol for six months. At the beginning of the study, response of FEV1 to inhaled salbutamol was measured. Dose-response curves were measured after three weeks of treatment with ipratropium bromide and again after a three-week course of inhaled salbutamol. After ipratropium bromide treatment, responses to low doses of salbutamol tended to be larger than after salbutamol treatment, but differences were not significant. Three hours after the last inhalation of salbutamol the FEV1 was lower on days 1 and 42 than on day 21. We conclude that long-term inhalation therapy with beta 2-agonists in patients with COPD decreases the duration of the bronchodilation produced by the same agents but does not affect the peak response.