胰岛素样生长因子-Ⅰ对软骨细胞凋亡的抑制

目的:探讨胰岛素样生长因子-Ⅰ(IGF-Ⅰ)对软骨细胞增殖及白细胞介素-1(IL-1)诱导软骨细胞凋亡的影响,揭示其抗损伤作用机制,为关节软骨损伤治疗提供理论依据。方法:分离培养人胚胎关节软骨细胞,采用四氮甲基唑蓝(MTT)法测定不同含量软骨细胞增殖活性的变化,利用光镜、电镜、DNA电泳及流式细胞仪测定作为凋亡检测指标。结果:IGF-Ⅰ呈剂量依赖式促软骨细胞增殖,当IGF-Ⅰ含量达50μg/L时,促软骨细胞增殖作用达最大值。IL-1组光镜、电镜下可见典型的细胞凋亡形态学改变,琼脂糖凝胶电泳示特征性的DNA梯状条带,IGF-Ⅰ处理组未见明显凋亡征象。流式细胞仪检测发现,IGF-Ⅰ处理后软骨细胞凋亡率显著降低。结论:IGF-Ⅰ能促进软骨细胞增殖,对IL-1诱导的软骨细胞凋亡具有保护作用。     

路志正教授"知常达变"辨治妇科病经验撷萃

路志正教授从事中医临床多年,不仅对内科杂病有丰富的临床经验,对妇科疾病的诊疗,亦很有特色。笔者于2003年有幸侍诊左右,耳濡目染,略有所得,不揣浅陋,举述验案二则。健脾祛湿行水治疗闭经、不孕患者某,女,32岁,已婚,2003年10月9日初诊。主诉:月经稀少10余年,闭经2年。患者15岁     

常温与低温体外循环心脏直视手术对细胞因子及补体的影响

目的探讨常温及低温体外循环心脏直视手术对细胞因子及补体的影响。方法选择先天性和风湿性心脏病患者40例,随机分为常温组及低温组各20例,分别于术晨、体外循环结束时及术后1、4、7、14 d抽取患者静脉血标本,测定血浆TNF、IL-2、C3、C4值。结果两组术前各项检查指标无显著差异。(1)两组术后1~4 d的IL-2水平较术前显著下降,至术后7 d恢复正常。体外循环结束至术后4 d,低温组IL-2显著低于常温组。(2)体外循环结束时以及术后1、4、7 d,常温组TNF水平显著低于低温组。两组体外循环结束时及术后1、4 d均高于术前,常温组至术后7 d、低温组术后14 d恢复正常。(3)体外循环结束时及术后1、7 d,常温组C3水平高于低温组,术后4 d两组无差别;常温组及低温组于体外循环结束时、术后1、4 d均低于术前,至术后7 d常温组恢复正常,低温组至术后14 d恢复至术前水平。(4)两组体外循环结束时及术后1、4 d C4水平均低于术前。体外循环结束时、术后1 d,常温组C4水平高于低温组。结论常温体外循环心脏直视手术对细胞因子及补体的影响显著轻于低温组,因而对术后机体的恢复优于低温方法。     

骨髓转移癌的骨髓象诊断及临床分析

目的 探讨临床表现及骨髓象改变在骨髓转移癌患者诊断中的意义。方法 对41例骨髓转移癌患者的临床资料及骨髓象进行分析，观察主要临床改变。结果 所有病例均在髓片可找到多少不等的成团、成簇的转移癌细胞，且形态学可见明显异常改变。结论 对明确诊断为恶性肿瘤的患者常规骨髓穿刺涂片可早期发现骨髓转移，多部位或多次穿刺涂片可提高阳性发现率。     

Surgical Management of PICA Aneurysm and Incidental Facial Nerve Schwannoma: Case Report.

We report a patient with a posterior inferior cerebellar artery (PICA) aneurysm and an incidental facial nerve schwannoma at the cerebellopontine angle (CPA). A 46-year-old woman presented with the sudden onset of a severe headache, nausea, and vomiting. She had no other abnormal neurological symptoms and signs. Computed tomography (CT) showed hemorrhage in the fourth ventricle. Cerebral angiography demonstrated an aneurysm arising from the tonsillomedullary segment of the left PICA. A facial nerve schwannoma was incidentally found as the aneurysm was being clipped. The aneurysm was clipped via a left transcondylar approach. Subsequently, the schwannoma (2 x 3 x 2 mm) was resected from the facial nerve fascicles, and the facial nerve was preserved. Postoperatively, the patient developed mild to moderate dysfunction of the facial nerve (House-Brackmann grade III [H-B III]) but her hearing was intact. Both a facial nerve schwannoma involving the CPA and an aneurysm involving the PICA can be managed through the transcondylar approach. An asymptomatic facial nerve schwannoma can be resected safely with minimal facial nerve dysfunction.     

高血胆固醇症病人体内铁贮水平与心肌灌注 左心室功能的相关研究

目的评价血清铁参数与高血胆固醇症(HCL)病人心肌灌注、室壁运动异常及血管造影显示的冠状动脉疾病(CAD)程度的相互关系.方法选择38名具有高血胆固醇症(LDL-C＞3.38mmol/L)从未治疗过的男性病人(平均年龄59±6岁)作为HCL组和32名年龄匹配而胆固醇水平正常(NCL)的男性为NCL组,进行冠状动脉造影并在10d内行SPECT检查,应用99mTc-甲氧基异丙基异氰(MIBI)进行静息/负荷门控断层心肌灌注显像、室壁运动功能图像分析;同时测定血清铁参数、血脂及常规血液学参数.结果在HCL组发现血清铁蛋白(SF)与心肌灌注系数(r=0.70,P＜0.01),可逆系数(r=0.66,P＜0.01)和室壁运动系数(r=0.53,P＜0.05)之间呈显著性相关;而总铁结合力与灌注系数之间呈一弱(负)相关(r=-0.52,P＜0.05).在NCL组铁参数与灌注系数及室壁运动系数之间无显著性相关.多元回归分析证实血清铁蛋白水平是决定HCL病人中心肌灌注的独立因素(β=0.55,P＞0.05).铁参数与两组通过冠状动脉造影(CAG)进行评分所定义的CAD程度无关.结论体内铁贮水平升高与HCL病人心肌灌注和功能异常的严重性和程度有着密切的关系,但与CAD的造影显示的病变范围无关.血清铁蛋白水平增高,可增加铁介导的氧化应力和LDL过氧化作用,导致HCL相关的血管内皮功能紊乱并进一步损伤心肌灌注和室壁运动功能.     

西藏地区农牧民生活习俗与包囊虫病的关系调查

目的　探讨西藏地区农、牧民生活习俗与包囊虫病的关系。方法　自制问卷对 7个县 2 40个家庭 163 1名成员与包囊虫感染有关的生活习俗进行调查分析。结果　饭前便后洗手的人仅有 16 1%,餐具一般都用天然水洗 ,大部家庭用天然绵羊绒擦洗茶具。大多数人都喝过河溪水 ,池塘水 ,人人都吃半生不熟的肉 ,半数以上的吃生肉和生血肠 ,绝大多数人喝未经消毒的鲜牛、羊奶。 10 0 %家庭养狗 ,所有人员与狗、羊、牛、马接触密切。包囊虫病人占调查人数 0 43 %( 7/ 163 1) ,有典型症状者占 0 67%( 11/ 163 1)。结论　当地居民感染包囊虫与不良生活习俗有关     

Mechanisms of opioid-induced tolerance and hyperalgesia.

Opioid tolerance and opioid-induced hyperalgesia are conditions that negatively affect pain management. Tolerance is defined as a state of adaptation in which exposure to a drug induces changes that result in a decrease of the drug's effects over time. Opioid-induced hyperalgesia occurs when prolonged administration of opioids results in a paradoxic increase in atypical pain that appears to be unrelated to the original nociceptive stimulus. Complex intracellular neural mechanisms, including opioid receptor desensitization and down-regulation, are believed to be major mechanisms underlying opioid tolerance. Pain facilitatory mechanisms in the central nervous system are known to contribute to opioid-induced hyperalgesia. Recent research indicates that there may be overlap in the two conditions. This article reviews known and hypothesized pathophysiologic mechanisms surrounding these phenomena and the clinical implications for pain management nurses.     

Ventricular rate smoothing for atrial fibrillation: a quantitative comparison study.

AIMS: To quantitatively compare the ventricular rate-smoothing (VRS) effects of different ventricular pacing (VP) protocols for atrial fibrillation (AF). METHODS AND RESULTS: Using a recently developed open-source model that can simulate the ventricular response in AF and VP, the performance of fixed-rate pacing and four previously published VRS algorithms were assessed by the mean RR (mRR), the root mean square of successive RR differences (RMSSD), the percentage of ventricular senses (VS%), and the percentage of short RR intervals (sRR%). All pacing protocols cause rate-dependent reduction of RMSSD, VS%, and sRR% with or without shortening of mRR compared to spontaneous AF. Fixed-rate pacing was more sensitive to the intrinsic rate than the VRS algorithms. The performance was generally comparable between different VRS algorithms, although higher mRR and VS% can be achieved at the expense of larger RMSSD and sRR%. CONCLUSION: The effect of VP on ventricular rhythm in AF depends on both intrinsic rate and the aggressiveness of the pacing protocol. Adequate rate control is necessary for effective operation of the VRS algorithm. Choosing VRS algorithm should balance between the beneficial effects of rate regularization and the negative effects of increasing heart rate and percentage of VP.     

血小板活化与冠心病关系的研究进展

病理性血小板活化与血栓性疾病密切相关,在心血管疾病中,这一病理生理过程不仅与冠心病的发生、发展有着非常重要的联系,而且对于该病的治疗策略的优化和近、远期预后等方面都有直接的影响。