冠状动脉粥样硬化性心脏病病人冠状动脉旁路移置术的治疗效果

①目的 探讨冠状动脉粥样硬化性心脏病(CAD)病人行冠状动脉旁路移置术的治疗效果。②方法 148例CAD病人，体外循环下行旁路移置术(CABG)62例，非体外循环下行旁路移置术(OPCAB)86例。③结果 围手术期死亡3例，8例病人使用主动脉内球囊反搏(IABP)，145例病人术后康复出院。④结论 冠状动脉旁路移置术是治疗CAD的一种安全有效的方法，在掌握手术适应证及技术条件允许情况下应尽量行非体外循环旁路移置术和全动脉化旁路移置术。     

失血性休克复苏及监测指标研究进展

创伤、失血性休克是一古老的临床研究课题。不仅在平时常见，更重要的是与战伤救治密切相关。尽管近10年来取得了一些进展，但复苏时机、复苏目标、液体种类的选择、复苏后继续生命支持以及监测技术等仍是临床以及研究人员面临的重大挑战。本文将就近年来有关上述问题的最新研究进展进行分析和讨论，以期提高对该复杂综合征的认识，为今后的研究提供帮助。     

以问题为中心的病案教学法在临床核医学中的实践

目的 设计以问题为中心的病案小组讨论教学法，在临床核医学核素治疗见习的教学实践中进行验证和评价。方法 总结近几年在临床核医学见习带教中的问题与缺陷；以病案引入问题，教师引导，进行小组讨论；评价教学效果。结果 临床核医学及其教学具有不同于其它临床学科的鲜明特点和规律；经改革的教案，收到学生和教师的良好反馈。结论 以问题为中心的病案小组讨论教学法，切合临床核医学见习实际，有效可行。     

Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial.

Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids (PUFAs), including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents (red blood cell membrane, plasma, etc.) and dietary intake. However, more evidence is needed to support its relation. In this study, we conducted an 8-week, double-blind, placebo-controlled trial, comparing omega-3 PUFAs (6.6 g/day) [corrected] with placebo, on the top of the usual treatment, in 28 patients with major depressive disorder. Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group (P < 0.001). From the preliminary findings in this study, omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder.     

高效液相色谱法测定人肝细胞色素P450 3A4转基因细胞中氨氯地平

目的 :研究氨氯地平经人肝细胞色素 P4 5 0 3A4 (CYP3A4 )的代谢 ,建立反相高效液相色谱的测定人肝转基因细胞 CYP3A4酶 S9孵育液中氨氯地平浓度的方法。方法 :与人肝转基因细胞提取的 S9上清液孵育之后的样品 ,用 3倍量的甲醇沉淀后离心 ,取上清液用 0 .4 5μm微孔滤膜滤过后进样。采用 Hypersil C18柱 ,以乙腈 -磷酸盐缓冲液 (4 5∶ 5 5 ,v/ v,p H4 .5 )为流动相 ,普萘洛尔为内标 ,在 2 5 0 nm波长处测定。结果 :氨氯地平浓度在 0 .2～ 30 .0μg/ ml范围内线性关系良好 ,r=0 .9993,方法平均回收率为 (98.2± 2 .4 ) % (n=5 ) ,日内和日间相对标准偏差(RSD)均小于 10 % ,检测限为 2 0 ng/ ml,定量限为 0 .2 μg/ ml(回收率为 10 4 .0 % ,RSD为 11.4 % ,n=5 )。结论 :建立的反相高效液相色谱方法简便、准确 ,可用于研究氨氯地平在人肝 CYP3A4转基因细胞中的代谢。     

NOV蛋白免疫反应阳性神经元在鲢、鸡和几种哺乳动物脑的比较发育

目的：研究鲢、鸡、牛、犬和大鼠脑肾母细胞瘤过度表达基因（ｎｏｖ）蛋白免疫反应阳性神经元的比较发育。方法：免疫组织化学技术。结果：低等脊椎动物鲢脑仅有少量ＮＯＶ蛋白免疫反应阳性神经元，分布于延髓的一些核团、丘脑前核、丘脑后核、下丘脑背侧核、下丘脑外侧核。鸡脑ＮＯＶ蛋白免疫反应阳性神经元除广泛分布于脑干外，小脑、间脑和大脑纹状体的多数脑区阳性神经元亦较多。哺乳动物牛、犬和大鼠脑ＮＯＶ蛋白免疫反应阳性神经元广泛分布，脑干、小脑、间脑和大脑都检测到强烈阳性信号。结论：ｎｏｖ基因在从低等脊椎动物到高等脊椎动物的进化过程中非常保守，提示它在脑神经元生长、分化及正常生理功能中可能具有重要作用     

吗啡对机械通气病人的应用

为获得病人在接受呼吸机期间充分的镇静、良好的耐管并与呼吸机合拍达到满意的治疗效果，对６０例不同年龄的患者在进行呼吸机支持治疗期间，采用平均０４５ｍｇ／（ｋｇｄ）的吗啡量持续微量泵静脉注入，间断辅助安定的方法．用药后连续２ｈ观察血压、心率、呼吸、意识等变化．结果：在用药期间病人血压、心率、呼吸平稳，保持清醒，安静耐管，解决了病人与呼吸机拮抗的矛盾．结果表明：该法在临床上有广泛使用价值     

异体胸腺的解剖、组织学及吻合血管移植治疗晚期恶性骨肿瘤的研究

本文对20例20～36周引产死胎胸腺进行了解剖学,组织学观察,并应用吻合血管胎儿胸腺移植治疗晚期恶性原发及继发骨肿瘤12例。结果表明,胎儿胸腺的血供主要来自胸廓内动脉,其次为甲状腺下动脉和心包膈动脉胸腺支,7～8个月胎儿胸腺静脉血管壁较厚,适合作血管吻合,胸腺细胞发育成熟,组织结构正常,已有分泌胸腺素及转化免疫细胞的功能,在解剖学,组织学,免疫学方面均具备了良好的移植条件。12例接受吻合血管胎儿胸腺移植的晚期恶性骨肿瘤患者,其临床症状、体征、X线、免疫指数均有明显改善,患者生存6个月至37个月以上。     

Haloperidol-sensitive (+)[3H]SKF-10,047 binding sites (sigma sites) exhibit a unique distribution in rat brain subcellular fractions

The distribution of haloperidol-sensitive (+)[3H]N-allylnormetazocine ((+)[3H]SKF-10,047) binding sites (sigma sites) in subcellular fractions of rat brain homogenates was extensively characterized. In synaptosomal fractions, enriched in choline acetyltransferase activity, sigma sites were present in lower concentrations than in whole brain homogenates. On the other hand, microsomal and myelin fractions were found to be enriched in sigma sites. A similar pattern of enrichment was seen for 5'-nucleotidase activity, a general plasma membrane marker. However, subsequent experiments in which microsomes were subfractionated on linear sucrose gradients led to the recovery of sigma sites over a significantly lower density range than 5'-nucleotidase activity or ATP-stimulated [3H]ouabain binding, an additional plasma membrane marker. In addition, previously reported distributions of a number of other subcellular markers, including those for endoplasmic reticulum, were found to contrast with the observed distribution of sigma sites. It is concluded that rat brain sigma sites are not concentrated at synaptic regions of plasma membrane. However, the possibility that sigma sites are localized to specialized areas of nonsynaptic plasma membrane cannot be excluded.     

高脂血症患者C—反应蛋白含量的变化及氟伐他汀对它的影响

OBJECTIVE: To observe the changes of C-reactive protein (CRP) level and its relationship with blood lipids, and the effects of fluvastatin on CRP and the lipids in patients with hyperlipidemia. METHODS: Serum levels of cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C) and lipoprotein(a)[Lp(a)] were measured by enzyme assay, and plasma CRP level by immunonephelometry before and after fluvastatin treatment (20 mg/d for 4 weeks) in patients with hyperlipidemia. RESULTS: CRP levels were above normal in 90.3% hyperlipidemia cases in spite of the various accompanying diseases. Fluvastatin treatment significantly reduced TC (-7.49%), TG (-14.32%), LDL (-13.88%), VLDL (-18.48%) and TC/HDL(-13.50%) levels (P<0.01), and also brought down Lp(a) concentration (-13.81%). CRP levels was very effectively reduced after the treatment (-15.92%, P<0.001). No association between basal CRP levels and basal lipids and Lp(a) concentrations was observed. Positive correlation of CRP, however, was observed after fluvastatin treatment with TC/HDL (r=0.62, P=0.041) and Lp(a) (r=0.320, P=0.011), while inverse relations were noted between CRP and HDL (r=-0.288, P=0.023). CONCLUSION: CRP levels increases markedly in patients with hyperlipidemia, a fact that is independent of the accompanying diseases. In addition to modulating blood lipid levels, fluvastatin also reduces CRP level, the latter possibly serving as an independent predictive factor for atherosclerotic cardiovascular diseases and also as an indicator for estimating the effectiveness of the treatment.