大肠杆菌O157:H7对含氯消毒剂连续消毒抵抗力的变化及与质粒pO157关系的研究

目的：了解10代连续消毒中大肠杆菌O157：H7对二氯异氢尿酸钠抵抗力的变化以及抵抗力与质粒pO157的关系。方法：用二氯异氢尿酸钠连续消毒6株大肠杆菌O157：H7 10代对比消毒前后试验菌对二氯异氢尿酸钠的抵抗力、质粒图谱以及质粒酶切图谱，消除原始菌和连续消毒后试验菌的质粒。结果：连续消毒10代后，试验菌对二氯异氢尿酸钠的抵抗力增加，试验菌的质粒图谱则无明显变化，质粒pO157的Cal Ⅰ酶切图谱有一定改变；消除原始菌的小质粒后，细菌对消毒剂的抵抗力不变；消除原始菌的所有质粒后，试验菌对二氯异氢尿酸钠的抵抗力不变；消除连续消毒后试验菌的质粒后，试验菌对二氯异氢尿酸钠的抵抗力降低到原始菌的水平。结论：连续消毒会使试验菌对二氯异氢尿酸钠的抵抗力增加，其原因可能与质粒pO157相关。     

Effect of shunt surgery on spleen size, portal pressure and oesophageal varices in patients with non-cirrhotic portal hypertension

Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic portal hypertension. There is little data on the effect of side-to-side lieno-renal (SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure (SPP) in patients with non-cirrhotic portal hypertension. We evaluated pre- and postoperatively endoscopic grading of varices, splenic size and SPP for predicting shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal fibrosis (NCPF). The EHPVO patients with patent shunts (n= 47) showed significant reduction in SPP (pre-operative 43.56±7.9 vs postoperative 29.96±7.7 cm of saline), splenic size (6.5±2.8 vs 4.00±2.6 cm below costal margin) and varices grades (2.96±0.5 vs 0.92±0.8). Patients with blocked shunt (n= 9) did not show significant reduction in SPP and varices grades. However, there was reduction in spleen size (8.6±3.0 vs 6.3±4.3). In the NCPF group, 28 had patent shunts and showed significant reduction in SPP (46.3±13.5 vs 33.8±7.6 cm of saline), splenic size (9.1±3.3 vs 6.8±4.6 cm below costal margin) and varices grades (2.8±0.7 vs 1.05±0.96). As only two patients with NCPF had blocked shunts, no statistical comparison between patients with patent and patients with blocked shunts could be done. In conclusion, following SSLR, there is a significant reduction in SPP and varices grades in patients with patent shunts. Endoscopic grading of varices can be used to predict shunt patency. However, spleen size is not a good criteria for predicting shunt patency.     

缬沙坦对高糖培养人系膜细胞的调节作用

目的:探讨缬沙坦在糖尿病肾病中的保护作用及其机制。方法:检测缬沙坦对细胞增殖的影响,并用RT-PCR方法测定药物剌激对体外培养人系膜细胞肾上腺髓质素(adrenomedullin,AM)、转化生长因子β-1(TGF-β1)mRNA表达的影响,同时检测细胞上清液AM、血管紧张素Ⅱ(AngⅡ)、TGF-β1、层粘连蛋白(LN)和Ⅳ型胶原含量。结果:沙坦对高糖培养的人肾小球系膜细胞中TGF-β1,AngⅡ,AM、LN和Ⅳ型胶原合成分泌增多的变化具有明显的抑制作用,同时对于系膜细胞增殖过度亦有抑制作用,各组值与高糖对照组比较均差异有显著性(P<0.01)。结论:缬沙坦可通过抑制AngⅡ、TGF-β1的表达、分泌,继而抑制肾小球系膜细胞的增殖过度,并降低基质蛋白的生成和沉积,发挥其肾脏保护作用的。在TGF-β1的表达和分泌下降后,AM的表达和分泌也随之下降。     

白色萎缩合并未分类结缔组织病1例

报告1例白色萎缩合并未分类结缔组织病.患者女,33岁,双小腿出现许多象牙白色萎缩性瘢痕,伴毛细血管扩张,色素沉着,溃疡.皮肤组织病理检查见真皮浅层小血管内皮细胞增生,少数管腔闭锁,血管壁有纤维蛋白样物质沉积和透明变性,给予扩血管,抗凝,血浆置换治疗后好转.     

SURGICAL MANAGEMENT OF EHLERS—DANLOS SYNDROME：FIRST REPORT OF A PEDIGREE IN CHINA

Ehlers－DanlosSyndrome（EDS）isararedisorderaffectingconnectivetissue．Inourknowledge，nopedi－greehasbeenreportedinChina．ThispaperreportsapatientwithtypeⅣEDSandhispedigree，whichwascomplicatedwithseriousvasculardiseases，andtreatedsuccessfullyinourhosp     

Spinocath导管针用于老年病人连续腰麻及术后镇痛的临床效果

目的 评价 Spinocath导管针用于老年病人连续腰麻及术后镇痛的临床效果。方法选择行前列腺电切术的老年病人60例,年龄 60～80岁,ASAI～Ⅱ级,随机分为两组,每组 30例。Ⅰ组连续腰麻组;Ⅱ组连续硬膜外组。两组都选择L2-3或L3-4做穿刺点。I组插入24G Spinocath导管针,两组局麻药均为0 5％布比卡因。I组负荷剂量为1.5～2.5ml,Ⅱ组负荷剂量为8—13ml,手术时间如超过2h,再注入l/3负荷剂量。两组术后都接微量输液泵进行术后镇痛,镇痛药液均为0.125％布比卡因+0.0006％芬太尼,I组负荷量为0、5ml,背景剂量为0.5ml/h,PCA单次注药0.5ml,锁定时间为8min。Ⅱ组负荷量为2ml,背景剂量为2ml/h,PCA剂量为2ml,锁定时间为15min。两组术后镇痛时间均为50h。观察术中阻滞感觉神经的时间,平面扩散范围,运动神经阻滞程度（改良Bromage评分,MBS）、血压及心率下降程度,术中辅助用镇痛镇静药情况,术后镇痛VAS评分及副作用发生情况。结果 与Ⅱ相比,I组阻滞感觉神经显效时间明显缩短,MBS评分明显升高（P<0.01）。给药后5min血压的下降程度明显降低（P<0.05）;病人辅助用芬氟合剂量明显减少（P<0.01）;VAS评分显著降低;恶心、呕吐、腰背痛的发生率明显降低（P<0.01）,而头痛发生率无明显差别。结论Spinocath导管针用于老年病人连续腰     

青蒿琥酯诱导瘢痕成纤维细胞凋亡的实验研究

目的探讨青蒿琥酯（artesunate，Art）诱导皮肤瘢痕成纤维细胞凋亡的作用及机制。方法取自愿捐献的人耳垂增生性瘢痕，采用组织块贴壁法进行细胞培养。经免疫组织化学染色鉴定后，取第3～5代成纤维细胞，采用含60、120和240mg／LArt培养液各5ml培养作为实验组，仅加入等量的培养液作为对照组。于倒置显微镜及透射电镜观察，采用流式细胞仪观察细胞凋亡及细胞周期。另取第3～5代成纤维细胞，实验组采用30、60和120mg／LArt培养液，对照组仅加入等量的培养液，观察细胞内钙离子的变化。结果原代成纤维细胞呈典型的梭形贴壁生长，免疫组织化学鉴定细胞波形蛋白呈阳性表达；倒置显微镜下观察Art在60～240mg／L浓度范围内抑制成纤维细胞生长且呈剂量及时间依赖性，细胞出现凋亡征象；透射电镜观察，各实验组出现染色质浓缩，沿着核膜排列，甚至核碎裂现象。细胞周期分析显示各实验组与对照组比较，凋亡细胞比例、处于G0～G1、S、G2～M期细胞数差异均有统计学意义（P〈0．05），实验组均出现典型的凋亡峰，且随药物浓度增加，峰值越大。Art在30～120mg／L作用成纤维细胞24h可引起细胞内钙离子浓度持续增加，与对照组比较，差异有统计学意义（P〈0．05）。结论Art通过作用于成纤维细胞周期诱导细胞凋亡，细胞内钙离子浓度升高可能是其诱导成纤维细胞凋亡的机制之一。     

小叶买麻藤中买麻藤甲素的结构研究

从小叶买麻藤[Gnetum parvifolium(Warb.)C.Y.Cheng]茎的乙酸乙酯部分得到五个成分,经理化常数测定、光谱(UV,IR,MS,~1HNMR,~(13)CNMR和2D-NMR)分析和衍生物制备,确定买麻藤甲素为一个新的2-苯基苯并呋喃类化合物,结构为2-(3′,5′-二羟基-4′-甲氧基苯基)_-3-甲氧基5-羟基苯并呋喃。另外三个鉴定为异丹叶大黄素、白黎芦醇和β-谷甾醇.还有一个化合物正在鉴定中。     

氨力农及抑肽酶对瓣膜置换术患者围术期白细胞粘附分子表达的影响

OBJECTIVE: To explore the effect of amrinone and aprotinin on expression of leukocyte adhesion molecule in patients with prosthetic valve replacement during perioperative period. METHODS: Thirty-two patients undergoing valve replacement were randomized to control group, the first aprotinin group, the second aprotinin group, and amrinone combined with aprotinin group; each group consisted of eight cases. In the first aprotinin group, 3 x 10(6) units of aprotinin was added to the priming solution of the extracorporeal circulation (ECC). In the second aprotinin group, 3 x 10(6) units of aprotinin was added to the priming solution of ECC, which was combined with 1 x 10(6) units of aprotinin for intravenous bolus. In the amrinone combined with aprotinin group, 3 x 10(6) units aprotinin was added to the priming solution of the ECC and amrinone began with a bolus of 1 mg/kg followed by a maintenance intrusion of 8 micrograms/kg.min. The control group received an equivalence without aprotinin. Venous blood samples were drawn before the operation, at the end of the ECC, 1 hour after the end of the ECC, and one day after the operation, respectively. Flow cytometry was used to demonstrate the expression of leukocyte adhesion molecule CD11b/CD18. RESULTS: Before ECC, there were no differences of the levels of CD11b+/CD18+ in all groups (P > 0.05). One hour after the ECC, the level of CD11b+/CD18+ in group B was lower than that in group A, the level of CD11b+/CD18+ in group C was lower than that in group B, and the level of CD11b+/CD18+ in group D was higher than that in group C, but no significant difference between groups was noted (P > 0.05). CONCLUSION: Although amrinone and aprotinin have anti-inflammatory activity, the pump prime which was added aprotinin alone or aprotinin combined with amrinone might fail in preventing the expression of leukocyte adhesion molecule CD11b/CD18 completely in patients with prosthetic valve replacement during ECC perioperative period.