16例应激性溃疡的临床诊治体会

目的 报告应激性溃疡的临床诊治体会。方法 全组16例,男12例,女4例。术前均无溃疡病史,血红蛋白检查均正常。术后早期应用糖皮质激素9例,出血前发生肺不张、严重呼吸道感染、呼吸功能不全6例,低血容量休克5例,急性重症出血坏死性胰腺炎4例,食管癌、贲门癌术后6例,严重烧伤(80％(?)Ⅱ°)1例。14例保守治疗,2例保守治疗无效而手术治疗。结果14例经治疗后(2例手术治疗)痊愈出院,2例死亡。结论 应激性溃疡大出血患者多病情危重,难以忍受二次手术,死亡率约为50％,因此应采取有效的保守治疗,对于保守治疗无效、大出血休克或胃肠穿孔者应及时手术治疗。     

Comparison of LightCycler-based PCR,COBAS amplicor CMV monitor,and pp65 antigenemia assays for quantitative measurement of cytomegalovirus viral load in peripheral blood specimens from patients after solid organ transplantation

In order to evaluate the LightCycler-based PCR (LC-PCR) as a diagnostic assay technique, a classical pp65 antigenemia assay and the commercially available COBAS Amplicor CMV Monitor (CACM) assay were compared to the LC-PCR assay for the detection and quantitation of cytomegalovirus (CMV) load in 404 parallel specimens of peripheral blood from 66 patients after solid organ transplantation. A good correlation existed among these three assays (r congruent with 0.6, P < 0.0001). The LC-PCR assay was the most sensitive (54% of specimens positive) compared to the CACM (48.6%) and the pp65 antigenemia (26%) assays. The LC-PCR assay detected all samples found positive by using both the CMV pp65 antigenemia assay and the CACM assay. The LC-PCR also had the widest dynamic range (from 250 to 10(7) DNA copies/ml of plasma). No cross-reactions were found among CMV and Epstein-Barr virus, varicella-zoster virus, or herpes simplex virus in the LC-PCR by using amplification with specifically designed primer pairs. Precision, expressed as the coefficient of variation, was <3% with standard DNA from cell cultures and between 6.55 and 14.1% with clinical specimens in repeat LC-PCR runs. One run of the LC-PCR took half of the time required for the semiautomated CACM procedure. Because of its sensitivity, specificity, cost-effectiveness, and simplicity, the LC-PCR assay could replace the pp65 antigenemia and the CACM assays as the preferred technique for the surveillance, diagnosis, and monitoring of response of CMV diseases in high-risk populations.     

In vivo expression and immunological studies of the 42-kilodalton carboxyl-terminal processing fragment of Plasmodium falciparum merozoite surface protein 1 in the baculovirus-silkworm system

The 42-kDa carboxyl-terminal processing fragment of Plasmodium falciparum merozoite surface protein 1 (MSP-1(42)) is an anti-erythrocytic stage malaria vaccine candidate. In this study, MSP-1(42) was expressed by using the Bombyx mori nuclear polyhedrosis virus-silkworm expression system, and the antigenicity and immmunogenicity of the recombinant protein, Bmp42, were evaluated. The average yield of Bmp42, as determined by a sandwich enzyme-linked immunosorbent assay (ELISA), was 379 microg/ml of infected silkworm hemolymph, which was >100-fold higher than the level attainable in cell culture medium. N-terminal amino acid sequencing revealed that Bmp42 was correctly processed in silkworm cells. Data from immunoblotting, as well as from the inhibition ELISA, suggested that the conformational B-cell epitopes of MSP-1(42) were recreated in Bmp42. Immunization of rabbits with Bmp42 in complete Freund's adjuvant generated high-titer antibody responses against the immunogen. Specificity analyses of the anti-Bmp42 antibodies using several recombinant MSP-1(19) proteins expressing variant and conserved B-cell epitopes suggested that the anti-Bmp42 antibodies recognized primarily conserved epitopes on MSP-1(19). Furthermore, the anti-Bmp42 antibodies were highly effective in inhibiting the in vitro growth of parasites carrying homologous or heterologous MSP-1(42). Our results demonstrated that the baculovirus-silkworm expression system could be employed to express biologically and immunologically active recombinant MSP-1(42) at elevated levels; thus, it is an attractive alternative for producing a protective MSP-1(42) vaccine for human use.     

铀作业人员的微循环改变

对铀作业者１９９例及无毒物接触史的正常人１０１例行甲襞微循环检测。结果，铀作业人员甲襞微循环有改变，其加权积分值大于对照组。主要表现在管袢数减少（Ｐ＜０．０１）、管径增粗（Ｐ＜０．０１）、毛细血管运动增加（Ｐ＜０．０１）、乳丛增多（Ｐ＜０．０１）。通过对铀致微循环改变的机理试以分析，提出这种微循环改变是铀中毒的病理表现，亦是铀中毒的重要发病环节；提示铀中毒治疗中应注重改善微循环。     

Antigens of virulent and attenuated Rickettsia tsutsugamushi.

We studied the antigens present in L929 mouse fibroblast or rabbit testicular cells, which had been infected or not with a prototype strain of Rickettsia tsutsugamushi, the causal agent of scrub typhus, and its attenuated variant. Immunoblotting revealed four antigens, designated 1, 1a, 2 and 3, which appeared to be specifically associated with infection with this organism. Antigens 1 and 1a had similar mol. wt of about 60 kD and antigen 2 and 3 had mol. wts of 45 kD and 28 kD respectively. Whereas antigen 1a, 2 and 3 were common to infection with either the virulent or the attenuated strains of the organism, antigen 1 was only detected in cells infected with the virulent strain and was reactive only with the antiserum raised against cells infected with that strain. In addition, two antigens were also detected by crossed immunoelectrophoresis, one of which was similarly associated with infection with the virulent strain as antigen 1, while the other was common to infection with either of the strains. It seems that the antigenic cross reaction between the two strains may account, in part at least, for the protection of mice against infection with the virulent strain afforded by the attenuated strain, while the loss or modification of antigen 1 might be associated with attenuation of the organism with respect to its virulence to mice.     

Fine-needle aspiration cytology of pseudoangiomatous stromal hyperplasia of the breast

Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon lesion usually found in premenopausal women. Histologically, it is characterized by complex, anatomosing, empty slit-like spaces in a dense collagenous stroma. These pseudoangiomatous spaces are lined by monomorphic spindle cells of myofibroblastic differentiation. Cytological features of PASH are rarely discussed and reported, and may pose diagnostic challenge to surgical pathologists. Two cases of PASH are reported with emphasis on the FNAC features and cytologic differentiation from other benign fibroepithelial lesions.     

Saliva as a diagnostic specimen for testing respiratory virus by a point-of-care molecular assay: a diagnostic validity study

Objectives

Automated point-of-care molecular assays have greatly shortened the turnaround time of respiratory virus testing. One of the major bottlenecks now lies at the specimen collection step, especially in a busy clinical setting. Saliva is a convenient specimen type that can be provided easily by adult patients. This study assessed the diagnostic validity, specimen collection time and cost associated with the use of saliva.

Lithium activates mammalian Na+/H+ exchangers: isoform specificity and inhibition by genistein

Replacement of external NaCl with LiCl induced cytoplasmic alkalinization in CCL-39 cells and rat L6 myoblasts expressing the endogenous Na+/H+ exchanger isoform NHE1. This Li+-induced alkalinization is due to activation of the Na+/H+ exchanger because it was completely inhibited by 100 microM ethylisopropylamiloride (apparent Kd=1 microM) and because it did not occur in exchanger-deficient PS120 cells. The effect of Li+ was not mimicked by Na+, K+, Cs+ and choline+. Li+ caused cytoplasmic alkalinization in PS120 cells expressing NHE1 or NHE2, but not NHE3, when Li+ was added to cells at a concentration high enough to saturate their external transport sites as predicted from Li+ affinities. Li+ did not induce phosphatidylinositol (PI) turnover or intracellular Ca2+ mobilization. Li+-induced alkalinization was not affected by protein kinase C down-regulation, loss of glycogen synthase kinase 3beta caused by antisense oligonucleotide treatment, or pretreatment with calphostin C, pertussis toxin, MEK inhibitor PD98059 and PI3-kinase inhibitor LY294002. However, it was markedly suppressed by the tyrosine kinase inhibitor genistein (10 microM). Thus, externally added Li+ activates NHE1 and NHE2 via a mechanism possibly involving a tyrosine kinase, causing an increase in cytoplasmic pH that could potentially affect various cell functions.