经尿道绿激光汽化联合电切割治疗前列腺增生的应用与创伤评价

目的:应用定量指标白细胞介素6和C-反应蛋白评估经尿道绿激光联合电切割手术对机体的创伤程度,进而评价其治疗老年前列腺增生的可行性。方法:选择2005-06/2006-04在解放军第四军医大学西京医院住院的良性前列腺增生患者98例(年龄>60岁),分别行开放性手术(28例)、经尿道绿激光汽化合并电切割术(PVP TURP组,33例)和经尿道绿激光汽化术(PVP组,37例)。绿激光汽化采用美国Laserscope公司生产的非接触式绿激光治疗系统,额定输出汽化功率为80W,电凝功率为30W。用酶联免症吸附法测定3组患者手术前2h,术后24,48h血清中白细胞介素6和C-反应蛋白水平。结果:98例患者全部进入结果分析。①血清白细胞介素6水平:术前2h3组比较差异不显著(P>0.05),术后24和48h均明显高于术前(P<0.05);术后24,48h开放性手术组高于PVP组和PVP TURP组[24h:(5.97±1.35),(1.81±1.64),(2.44±1.45)μg/L,P<0.05;48h:(1.63±0.86),(0.77±0.51),(0.80±1.46),P<0.05]。②血清C-反应蛋白水平:术前2h3组比较差异不显著(P>0.05),术后24和48h均明显高于术前(P<0.05);术后24,48h开放性手术组高于PVP组和PVP TURP组[24h:(62.38±13.65),(10.03±4.05),(28.57±9.8)mg/L,P<0.05;48h:(118.85±20.82),(38.86±8.35),(69.44±13.66),P<0.05];PVP TURP组高于PVP组(P<0.05)。结论:在这3种术式中,开放性手术对机体的创伤最大,机体急性时相反应最显著,经尿道绿激光汽化术合并电切割术对机体创伤较轻,可用于治疗老年前列腺增生症。     

Aggressive polyfibromatosis: A 10 year follow-up

Polyfibromatosis syndrome is a condition characterized by the occurrence of several cutaneous fibrotic conditions including Dupuytren's contracture and keloid formation. A 10 year follow-up of a patient with an aggressive type of polyfibromatosis associated with erosive arthropathy is presented. The underlying pathogenesis and management of this uncommon condition is discussed.     

Recombinant human stem cell factor enhances myeloid colony growth from human peripheral blood progenitors

Peripheral blood hematopoietic progenitors (PBHP) are capable of colony growth in vitro. The effect of stem cell factor (SCF), interleukin-6 (IL-6), and basic fibroblast growth factor (bFGF) on myeloid colony proliferation of PBHP was determined. PBHP purified by positive selection with CD34-specific antibody were plated in semisolid agarose with reported plateau doses of interleukin-3 (IL-3), granulocyte- macrophage colony-stimulating factor (GM-CSF), and granulocyte colony- stimulating factor (G-CSF) to enhance myeloid colony growth. Experiments then were done to examine colony growth in response to SCF or with SCF and bFGF and/or IL6. SCF alone in the absence of any other growth factors did not support colony growth. SCF at a determined optimum concentration of 100 ng/mL added to the combination of IL-3, GM- CSF, and G-CSF enhanced colony growth and size relative to proliferation in response to the latter three factors alone (from 78 to 188 total colonies/10(4) PBHP plated and from 10 to 93 large [> 200 cells] colonies/10(4) PBHP plated). Furthermore, addition of bFGF and/or IL-6 to the combination of optimum concentrations of SCF, IL-3, GM-CSF, and G-CSF further enhanced colony number and size in a dose- dependent fashion. Using the optimum combination of all growth factors, we determined that the number of myeloid colony-forming PBHP in whole blood was similar between individuals at about three colonies per milliliter whole blood. We conclude that progenitors capable of responding to the early-acting growth factor, SCF, are represented in PBHP and that the number of circulating myeloid colony-forming PBHP is likely a regulated parameter that may have an important biologic function.     

Doctor–patient concordance during HIV treatment switching decision‐making

Objectives

The aim of the study was to explore levels of doctor–patient concordance during the making of decisions regarding HIV treatment switching and stopping in relation to patient health‐related outcomes.

Methods

Adult patients attending five HIV clinics in the United Kingdom were requested to complete the study questionnaire, which included a Concordance Scale, and measures of symptoms [Memorial Symptom Assessment Short Form (MSAS) index], quality of life (EuroQol), satisfaction, adherence and sexual risk behaviour. Clinical health measures (HIV viral load and CD4 cell count) were also obtained. A total of 779 patients completed the questionnaire, giving a response rate of 86%; of these 779 patients, 430 had switched or stopped their HIV treatment and were thus eligible for inclusion. Of these patients, 217 (50.5%) fully completed the Concordance Scale.

Results

Concordance levels were high (88% scored between 30 and 40 on the scale; score range 10–40). Higher concordance was related to several patient outcomes, including: better quality of life (P=0.003), less severe and burdensome symptom experience (lower MSAS‐physical score, P=0.001; lower MSAS‐psychological score, P=0.008; lower MSAS‐global distress index score, P=0.011; fewer symptoms reported, P=0.007), higher CD4 cell count (at baseline, P=0.019, and 6–12 months later, P=0.043) and greater adherence (P=0.029).

Conclusions

High levels of doctor–patient concordance in HIV treatment decision‐making are associated with greater adherence and better physical and psychological functioning. More research is needed to establish a causal relationship between concordance and these outcomes.     

胎盘早剥产妇、新生儿血及脐血中组织因子和组织因子途径抑制物的变化

目的:检测胎盘早剥产妇血、新生儿血及脐血组织因子及组织因子途径抑制物蛋白的变化,以及这些变化对其凝血功能的影响。方法:收集2006-10/2007-04在中山大学附属第一医院产科的胎盘早剥产妇血(足月或早产不限)、分娩胎儿的脐带血及新生儿血标本各11例,4例为足月产,其余均为胎龄29～36周早产标本,男婴5份,女婴6份。正常对照15份来自同期广州市妇婴医院产妇及分娩胎儿。标本收集时间母亲血为分娩前24h内、脐血为分娩即刻、新生儿血为出生后2h内抽取,排除标准为产妇本次分娩前无血液系统疾病史,未使用过对凝血功能产生影响的药物,采用酶联免疫吸附方法测定血浆组织因子及组织因子途径抑制物抗原水平,并与正常分娩产妇对照组进行比较。病理及正常标本均经产妇及家属知情同意后获得。结果:①胎盘早剥产妇血、新生儿血及脐血血浆中组织因子测定值明显高于正常对照组(P<0.05)。②胎盘早剥产妇血、新生儿血浆及脐血中组织因子途径抑制物测定值较正常分娩产妇降低,差异具有显著性意义(P<0.01)。③胎盘早剥产妇血、新生儿和脐血组织因子途径抑制物/组织因子比值均较正常分娩产妇明显降低(P<0.01)。结论:胎盘早剥时产妇血、脐血及新生儿血促凝血活性增强,抗凝血活性降低,与其高凝状态相关。     

膳食补充剂黑醋与红曲单用及联用对中老年人血脂的影响

目的:观察并比较黑醋与红曲单用及联用对中国中老年人降低血脂的效能。方法:试验于2003-10/11在大连医科大学中日合作医药科学研究所进行。选择30名年龄为45￣65岁的中老年人。30名受试者被随机分为3组,每组10人,分别服用黑醋丸6粒,红曲丸6粒或黑醋 红曲丸6粒,1次/d,连续4周;3种膳食补充剂黑醋丸、红曲丸及黑醋 红曲丸由含有不同剂量的黑醋固形物、红曲粉末K-F、柠檬酸钠、大豆油、蜂蜡、脂肪酸甘油脂组成(由日本国第一药品工业株式会社提供)。各组服用剂量分别为每天黑醋固形物360mg,红曲粉72mg及黑醋固形物360mg 红曲粉72mg。服用2和(或)4周后,检测血脂和血糖,同时用血清样品检测肝功与肾功能。实验结果用SPSS统计软件进行方差分析。结果:30名中老年人全部进入结果分析。①受试者连续3d每日营养素摄入量:3组之间热量、胆固醇、膳食纤维、宏量或微量营养素摄入量差距均无显著性。②血清脂质浓度和计算的脂质比:2,4周血清三酰甘油含量,黑醋 红曲组低于基础值(分别下降(24.6±4.9)%,(27.6±3.4)%,P<0.05);红曲组与基础值比较,差异无显著性[分别下降(6.5±3.4)%,(11.6±4.5)%];黑醋组与基础值比较,差异无显著性[分别下降(10.2±7.3)%,(12.4±8.2)%]。2,4周血清胆固醇、低密度脂蛋白胆固醇含量,黑醋 红曲丸、红曲丸和黑醋丸组均比基础值降低,差异无统计学意义。3种膳食补充剂对血清高密度脂蛋白胆固醇及计算的脂质比值无明显改变。血糖含量无变化。未发现对受试对象产生明显不良反应。结论:服用黑醋 红曲丸能明显降低受试者血清三酰甘油含量。黑醋与红曲合用对高脂血症者可能有健康效益。     

人参皂甙Rb_1和Rg_1对小鼠中枢神经递质受体和脑内蛋白质合成的影响

应用放射配基结合法测定了人参皂甙Rb_1和Rg_1对α_1,α_2,β肾上腺素能受体、M胆碱能受体、5-羟色胺、多巴胺及GABA等七种受体的作用。结果均不能证明它们对这七种受体有亲和力。但给动物ip药物连续5天,Rb_1和Rg_1均能使中枢M胆碱受体密度显著增高。Rb_1及Rg_1还能显著增加脑内蛋白质的含量。上述实验结果对解释人参的中枢作用提供了重要证据。     

楤木根皮中皂甙化学成分的研究

楤木根皮中的主要成分是皂甙。将总皂甙以柱层析分离,得到三个化合物(Ⅰ～Ⅲ),经光谱分析和化学方法证明,Ⅰ为楤木皂甙A(araloside A);Ⅱ为银莲花甙(narcissiflorine);Ⅲ是3-O-[β-D-吡喃葡萄糖-(1→2)-β-D-吡喃木糖-(1→)2)-α-L-阿拉伯糖]-齐墩果酸。Ⅲ为一新皂甙,命名为楤木皂甙D(araloside D)。