Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis.

Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients.     

Neprilysin基因在大鼠体外培养骨髓基质细胞中的表达

目的探讨人Neprilysin基因在小鼠MSCs中的表达情况。方法分离培养小鼠MSCs，采用分子克隆技术构建Neprilysin—pEGFP重组质粒，将此Neprilysin—pEGFP重组质粒用脂质体转染进MSCs中，在荧光倒置显微镜下观察该基因在MSCs中的表达效率。结果经酶切鉴定得到系列正确的重组Neprilysin—pEGFP。Neprilysin可在MSCs中表达且通过脂质体传染的效率是20％。结论获得了表达Neprilysin基因的骨髓基质细胞，为进一步探讨将该细胞用于阿尔茨海默病基因治疗的可能性研究提供了技术基础。     

逍遥散治疗经前期综合征69例

逍遥散出自《太平惠民和剂局方》，由当归、白芍药、柴胡、茯苓、白术、炙甘草、薄荷、煨姜组成。经前期综合征为临床常见的妇科病症，笔者近年来采用逍遥散加减治疗经前期综合征69例，疗效满意，现报道如下。     

Ruptured distal anterior choroidal artery aneurysm.

Ruptured aneurysms of the distal anterior choroidal artery (AchA) are extremely rare and management is dictated by clinical presentation. This report describes a rare patient with a distal AchA aneurysm and subarachnoid and intraventricular haemorrhage. A 60-year-old woman presented with a sudden onset of severe headache and vomiting. No aneurysms could be found on initial angiograms. A repeat angiogram performed 10 days after admission demonstrated an aneurysm in a branch of the cisternal segment of the left AchA without a definite neck. Surrounding vessels showed multifocal stricture and dilatation. Microsurgical clipping was not performed because the patient died suddenly due to pulmonary failure. The aetiology of the aneurysm in this case and surgical strategy are discussed.     

危重症患者的APACHEⅡ评分与中医辨证相关性研究

目的：通过比较不同中医证型的ICU危重症患者的APACHEⅡ评分，同时对比两组死亡率，评价中医辨证在预后判断中的临床意义。方法：对纳入研究的85例ICU危重症患者于入ICU及出ICU时分别进行中医辨证，分为阳类证和阴类证两型，对所有病人进行APACHEⅡ评分，比较两型病人在进入ICU及出ICU时的APACHEⅡ分值，并与死亡率比较。结果：初始为阴类证的患者在入ICU及出ICU时的APACHEⅡ评分显著高于初始为阳类证的患者（P=0．0001及F〈0．05），死亡率亦显著高于阳类证患者（P=0．0369）：治疗后由阳类证转为阴类证患者APACHEⅡ评分较维持阳类证者增高（P=0．0161），而阴类证转为阳类证的患者APACHEⅡ分值较维持阴类证者减低（P=0．0424）。结论：中医证型对危重症的病情程度及预后判断有较好的预测价值，阴类证患者的预后较阳类证患者差，证型转换可能引起预后改变。     

Cause-specific and total mortality in the Canterbury (New Zealand) insulin-treated Diabetic Registry population: a 15-year follow-up study.

AIMS: To establish all-cause and cause-specific death rates, and risk factors for mortality in insulin-treated diabetic individuals living in the province of Canterbury, New Zealand. METHODS: Insulin-treated diabetic subjects (n = 995) on the Canterbury Diabetes Registry were followed up over 15 years and vital status determined. Death rates were standardized and hazard regression was used to model the effects of demographic covariates on relative survival time. RESULTS: There were 419 deaths in 11 226.3 person-years of follow-up with a standardized mortality ratio (SMR) of 2.0 (95% confidence interval (CI) 1.8-2.2). Relative mortality was greatest for the group aged 0-29 years (SMR 3.0 (95% CI 2.4-3.7)). After controlling for diabetes duration and gender, a 10-year increment in age of onset was associated with a 33% decrease in relative hazard (95% CI 29-36%), indicating that excess mortality due to diabetes declines with rising age of onset. After controlling for age of onset and gender, each 10-year increment in duration of diabetes is associated with a 26% decrease in relative hazard (95% CI 24-29%), indicating that with longer survival the mortality hazard approaches the general population hazard. Relative mortalities were increased for cardiovascular, renal and respiratory disease, but not malignancy. Relative mortality from acute metabolic complications was increased in the subgroup with age of onset of diabetes < 30 years and requiring insulin within 1 year of diagnosis. CONCLUSIONS: Mortality rates are high for insulin-treated diabetic individuals relative to the general population.     

体外诱导条件下大鼠骨髓基质细胞骨钙素和Ⅰ型胶原mRNA的表达

目的　研究体外培养大鼠骨髓基质细胞诱导条件下 ,成骨分化标志骨钙素和 型胶原 m RNA水平的表达。方法　采用成骨诱导剂 (含地塞米松 10 - 8mol/ L、β甘油磷酸钠 10 mm ol/ L和抗坏血酸 AA 5 0μg/ml)对培养状态下的不同代大鼠骨髓基质细胞进行成骨诱导 ,提取 RNA,采用 RT- PCR方法 ,以β-肌动蛋白 c DNA为内参照 ,检测骨钙素和 型胶原 m RNA的表达。结果　与对照组相比 ,接受成骨诱导剂作用的大鼠骨髓基质细胞随诱导时间的延长骨钙素和 型胶原 m RNA出现高表达 ,且维生素 D为诱导骨钙素 m RNA表达的必需成分。结论　体外培养的大鼠骨髓基质细胞保持成骨未分化状态 ,无骨钙素和 型胶原 m RNA的表达 ,诱导后可向成骨分化 ,骨钙素和 型胶原 m RNA表达升高     

发育期大鼠高热惊厥前后海马γ-氨基丁酸B受体亚基表达的变化

目的：研究高热惊厥(febrile seizures，FS)对发育期大鼠脑内γ-氨基丁酸(γ-aminobutyric acid，GABA)B受体亚基GABABR1与GABARR2蛋白表达的影响。方法：采用热水浴诱导大鼠高热惊厥模型。隔日诱导惊厥1次，共诱导10次，末次惊厥后24h处死大鼠。发育期大鼠随机分为3组：对照组(n＝24)，1次高热处理组(n＝28)，10次高热处理组(n＝40)。高热处理组根据是否出现惊厥再分为1次高热惊厥组(FS1，n＝16)与1次高热未惊厥组(F1，n＝12)，10次高热惊厥组(FS10，n＝15)与10次高热未惊厥组(F10，n＝13)。采用免疫组化方法观察不同次数高热惊厥大鼠脑内GABABR1与GABABR2蛋白表达的变化。结果：FS10大鼠海马齿状回、CAl-CA3区GABABRl和GABABR2蛋白表达明显低于F10、F1、FSl和对照组；F10大鼠上述脑区GABABRl和GABABR2蛋白表达低于F1、FS1和对照组；F1及FS1大鼠与对照组相比差异无显著性；海马各区GABABR1与GABABR2表达的改变大部分平行，但10次高热惊厥后GABABR2在CA1—CA3区下降更明显，而GABABR1在齿状回下降更明显。结论：反复高热惊厥及反复高热均可使发育期大鼠脑内GABABR亚基蛋白表达降低，高热惊厥的影响较单纯高热更为明显，提示GABABR亚单位与发育期大鼠高热惊厥及其脑损伤密切相关。GABABR1与GABABR2改变的不平行可能与受体亚单位组合的可塑性改变有关，这种改变可能导致抑制功能的改变。