卡尼汀的生物学作用及在血液透析患者中的临床应用

卡尼汀是长链脂肪酸进入线粒体进行氧化所必需的一种物质，其左旋异构体具有生物活性。正常人可通过饮食摄入和肝、肾合成产生卡尼汀，但尿毒症血液透析患者由于肾脏内源性合成卡尼汀减少，血液透析过程中大量清除，大多存在时间依赖性的卡尼汀缺乏。通过静脉注射、口服、透析液补充外源性左旋卡尼汀有利于纠正脂代谢紊乱，减少促红细胞生成素用量，改善骨骼肌症状和营养状态，提高生活质量。     

国产重组人类促红细胞生成素预防早产儿贫血

目的　观察重组人类促红细胞生成素 (r Hu EPO,商品名宁红欣 )对早产儿贫血的预防作用。　方法　将来自四所医院的 5 1例胎龄小于 35周、体重小于 2 0 0 0 g的早产儿随机分为预防组(31例 )和对照组 (2 0例 )。预防组予 r Hu EPO2 5 0 IU/ (kg·次 ) ,静脉或皮下注射 ,隔日 1次 ,每周 3次 ,共 4周。观察两组早产儿血红蛋白 (Hb)、红细胞压积 (Hct)、网织红细胞 (Ret)、血清铁及促红细胞生成素 (EPO)的动态变化。　结果　两组早产儿生后 Hb、Hct均逐渐下降 ,但预防组下降明显小于对照组 ,经 t检验 ,两组之间差异有显著性 (P<0 .0 0 1)。对照组有 4例输血 ,而预防组无一例输血 ,经精确 χ2检验 ,差异有显著性 (P=0 .0 19)。预防组 1周末 Ret较对照组明显升高 ,差异有显著性 (P<0 .0 5 )。预防组 2周末血清铁低于对照组 ,4周末更甚 ,经比较差异有非常显著性 (P<0 .0 1)。预防组EPO水平较对照组明显上升 ,差异有非常显著性 (P<0 .0 1)。　结论　早产儿预防性应用 r Hu EPO可减轻 Hb、Hct、Ret的下降程度 ,不需要输血和输血次数减少 ,r Hu EPO预防早产儿贫血有一定效果。     

高原地区中毒型菌痢抢救休克、脑水肿51例体会

中毒型菌痢临床表现复杂 ,病情变化快 ,在整个抢救过程中应抓住主要环节 ,尽量诊断分型治疗。休克型以扩充血容量 ,纠正酸中毒基础上加用血管活性药物。脑水肿型以高渗脱水剂为主。混合型在使用扩血管药的基础上 ,采取补液、脱水的原则。     

颈总动脉切除术10例回顾性分析

目的 探讨颈总动脉切除术的适应症和术前准备的一般规律。方法 对我院自1986年～2003年17年问的10例颈总动脉切除术病例进行回顾性分析。其中年龄22～59岁，急诊手术4例，选择性颈动脉切除6例。结果 急诊手术中2例出现中枢神经系统并发症，选择性手术组中1例出现中枢神经系统并发症。除1例因脑转移癌死亡外，随访均健在。结论 行不重建血管的颈总动脉及分歧部切除术，高龄患者须严格掌握适应症，须无脑血管疾病史，术前须进行Matas试验，要有侧支循环建立的客观依据；对年轻患者(30岁以下)可适当放宽手术指征。     

Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy.

PURPOSE: For cancer patients receiving cytotoxic chemotherapy, hepatitis B virus (HBV) reactivation is a well described complication resulting in varying degrees of liver damage. The objectives of this study were to assess the efficacy of the antiviral agent lamivudine in reducing the incidence of HBV reactivation and diminishing morbidity and mortality of cancer patients with chronic HBV infection during chemotherapy. PATIENTS AND METHODS: Two groups were compared in this nonrandomized study. The prophylactic lamivudine group consisted of 65 patients in a phase II study who were treated with lamivudine before and until 8 weeks after discontinuing chemotherapy. The historical controls consisted of 193 consecutive patients who underwent chemotherapy without prophylactic lamivudine. Significant prognosticators for the development of HBV reactivation were determined based on data from the controls. Potential confounding factors were identified between the two groups. The outcomes were compared. RESULTS: In the controls, lymphoma and anthracycline usage were factors identified to be associated with reactivation. The two groups were comparable in most baseline characteristics, although in the prophylactic lamivudine group, there were significantly more patients with lymphoma and receiving anthracyclines. In the prophylactic lamivudine group, there was significantly less HBV reactivation (4.6% v 24.4% in the controls; P <.001), fewer incidences of hepatitis (17.5% v 44.6%; P <.0001) that were less severe (4.8% v 18.7%; P =.0005), and less disruption of chemotherapy (15.4% v 34.6%; P =.0029). The reduction in overall mortality was not statistically different. CONCLUSION: Prophylactic lamivudine significantly reduced the incidence of HBV reactivation and the overall morbidity of cancer patients undergoing chemotherapy.     

Left hemihepatectomy in living donors with a thick middle hepatic vein draining the caudal half of the right liver

Donor safety is the first consideration in living related liver transplantation. Left hemihepatectomy including the middle hepatic vein is a reasonable donor procedure for obtaining a large graft for living related liver transplantation. This procedure, however, needs to be modified in donors with hepatic venous variation. While carrying out donor hepatectomy, we encountered two cases showing a variant form of hepatic venous drainage comprising a thick middle hepatic vein draining segment 6 of the liver. This variation made it necessary to preserve the middle hepatic vein in the donor liver remnant. Failure to recognize such a variant would result in congestion in the remaining right liver of the donor. To guarantee donor safety, evaluation of the drainage area of the corresponding hepatic vein is a matter of great importance in donor hepatectomy.     

Phase II study of neoadjuvant carboplatin and paclitaxel followed by radiotherapy and concurrent cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma: therapeutic monitoring with plasma Epstein-Barr virus DNA.

PURPOSE: To assess the efficacy of neoadjuvant paclitaxel and carboplatin (TC) followed by concurrent cisplatin and radiotherapy (RT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and to monitor treatment response with plasma Epstein-Barr virus (EBV) DNA. PATIENTS AND METHODS: Thirty-one patients with International Union Against Cancer stages III and IV undifferentiated NPC had two cycles of paclitaxel (70 mg/m2 on days 1, 8, and 15) and carboplatin (area under the curve 6 mg/mL/min on day 1) on a 3-weekly cycle, followed by 6 to 8 weeks of cisplatin (40 mg/m2 weekly) and RT at 66 Gy in 2-Gy fractions. Plasma EBV DNA was measured serially using the real-time quantitative polymerase chain reaction method. Results All patients completed planned treatment. Response to neoadjuvant TC was as follows: 12 patients (39%) achieved partial response (PR) and 18 achieved (58%) complete response (CR) in regional nodes; five patients (16%) achieved PR and no patients achieved CR in nasopharynx. At 6 weeks after RT, one patient (3%) achieved PR and 30 patients (97%) achieved CR in regional nodes, and 31 patients (100%) achieved CR in nasopharynx; 29 patients (93%) had EBV DNA level of less than 500 copies/mL. Neoadjuvant TC was well tolerated, and the most common acute toxicity of cisplatin plus RT was grade 3 mucositis (55%). At median follow-up of 33.7 months (range, 7 to 39.3 months), six distant and three locoregional failures occurred. Plasma EBV DNA level increased significantly in eight of nine patients who experienced treatment failure but did not increase in those who did not. The 2-year overall and progression-free survival rates were 91.8% and 78.5%, respectively. CONCLUSION This strategy was feasible and resulted in excellent local tumor control. Serial plasma EBV DNA provides a noninvasive method of monitoring response in NPC.     

非小细胞肺癌中细胞周期蛋白D1与E的作用及相互关系

目的 :研究细胞周期蛋白D1与E在非小细胞肺癌 (NSCLC)发生、发展中的作用及相互关系。方法 :免疫组化方法检测 87例NSCLC肿瘤组织中细胞周期蛋白D1、E的表达及PCNA估计增殖指数 (PI) ,并将上述结果与临床病理及预后资料进行对比分析。结果 :87例NSCLC中细胞周期蛋白D1、E阳性率分别为 4 4 .8% (39/87)、4 8.3% (42 /87) ,细胞周期蛋白D1阳性组的PI值显著高于阴性组 (P〈0 .0 5 ) ,细胞周期蛋白E阳性组PI值与阴性组无显著差异 (P〉0 .0 5 ) ;细胞周期蛋白D1阳性组肿瘤直径、淋巴结转移率和生存率均与阴性组有显著差异(P〈0 .0 1、〈0 .0 5、〈0 .0 1) ,细胞周期蛋白E阳性组淋巴结转移率、临床分期和生存率均与阴性组有显著差异 (P〈0 .0 5、〈0 .0 5、〈0 .0 1) ;细胞周期蛋白D1阳性组中细胞周期蛋白E的阳性率显著高于其阴性组 (P〈0 .0 5 ) ;细胞周期蛋白D1与细胞周期蛋白E双阳性组的PI值、肿瘤直径、淋巴结转移率显著高于非双阳性组 (P值均〈0 .0 5 ) ,生存率显著低于非双阳性组 (P〈0 .0 1)。结论 :细胞周期蛋白D1、细胞周期蛋白E均参与NSCLC的发生、发展 ,并影响其预后 ,但两者在其中所起作用不同 :细胞周期蛋白D1是调节NSCLC增殖的主要因素 ,细胞周期蛋白E主要与NSCLC进展有关 ;细胞周期蛋白D1可促     

3种基因工程药物对大鼠动脉阻塞性脑损伤治疗作用的比较研究

目的 :探讨基因工程药物NIF、NHH、TNHH对大鼠动脉阻塞性脑损伤的治疗作用。方法 :用线栓法将24只大鼠制成动脉阻塞性脑缺血损伤模型后分为治疗组 (3组 )和模型对照组 ,每组6只。治疗组静脉给予NIF、NHH、TNHH ,模型组给予生理盐水。分别于术后4、8、24、48、72h进行神经行为学评分 ;术后72h取血测定血清APTT ,判断凝血功能 ;取脑组织行TTC染色 ,计算梗塞灶体积 ;HE染色观察脑组织病理变化。结果 :治疗组各时间点行为学评分均优于模型组 (P<0 05) ,血清APTT比模型组均有明显延长 (P<0 05) ,脑组织梗塞灶体积比模型组小 (P<0 05) ,HE染色脑组织病理变化均较模型组轻。结论 :NIF、NHH、TNHH对大鼠动脉阻塞性脑缺血损伤有明显的保护作用 ,其中以TNHH最优。     

细胞凋亡及增殖细胞核抗原在肝癌组织中的表达及意义

目的探讨经肝动脉化疗栓塞(TACE)后肝癌细胞中增殖细胞核抗原(PCNA)广凋亡细胞比值与肝细胞肝癌分化程度的关系。方法应用原位末端标记法(TUNEL)及免疫组化双染色技术，对60例肝细胞肝癌石蜡包埋组织进行检测。结果不同分化程度癌组织中细胞凋亡和PCNA的阳性率不同。分化程度高，细胞凋亡阳性率高、PCNA阳性率偏低；分化程度低，细胞凋亡阳性率偏低、PCNA阳性率高。随分化程度的降低，PCNA广凋亡细胞的比值显著增加，两者有相关性。结论PCNA/凋亡细胞的比值可作为评估肝细胞肝癌分化程度的指标。