选择性iNOS抑制剂对肝硬化大鼠门脉高压性胃黏膜病变的影响

目的:探讨选择性诱导型一氧化氮合酶抑制剂氨基胍(aminoguanidine,AG)对肝硬化大鼠门脉高压性胃黏膜病变的防治作用及其机制.方法:将SD大鼠30只随机分为对照组( n =10)、模型组( n = 10)和AG组( n = 10),予400mL/L CCl4皮下注射12 wk建立肝硬化大鼠模型,AG组为皮下注射CCl4同时予AG饮用.观察比较各组大鼠胃黏膜形态及组织学变化,应用免疫组化法检测胃黏膜诱导型一氧化氮合酶(iNOS)的表达,并测定胃黏膜溃疡指数、门静脉压力.结果:AG组胃黏膜病变程度较模型组减轻,溃疡指数明显低于模型组(3.00±2.31 vs 10.60±3.47,P<0.01);模型组胃黏膜iNOS吸光度、面密度值均较对照组增高(0.64±0.04 vs 0.25±0.03;0.344±0.068 vs 0.017±0.008,均P<0.01),AG组胃黏膜iNOS吸光度值、面密度值(0.46±0.09,0.159±0.021)均较模型组明显下降(均P<0.01).AG组门脉压力较模型组降低.结论:AG可在一定程度上减轻门脉高压性胃黏膜病变,其机制可能主要通过抑制胃黏膜iNOS表达.     

815例不稳定型心绞痛中医证候的因子分析

目的：探讨不稳定型心绞痛（unstable angina,UA）中医证候规律,并初步建立证候诊断标准。方法：多中心前瞻性收集815例经冠状动脉造影证实的UA患者,采用因子分析对其四诊信息进行中医证候非线性降维研究。结果：在提取的5个公因子中,F1为心肾阴虚,F2为心脾两虚,F3为痰瘀互阻,F4为气虚血瘀,F5为阳虚寒凝。其中以F4气虚血瘀所占比例最大,并且初步建立了各个证候的诊断条件。结论：气虚血瘀是UA的核心病机。因子分析能够帮助进行中医证候的分类研究和初步建立证候诊断标准。     

乳杆菌活菌制剂预防外阴阴道假丝酵母菌病的疗效观察

目的探讨乳杆菌活菌制剂对预防外阴阴道假丝酵母菌病的复发是否有效。方法将200例单纯性外阴阴道假丝酵母菌病病人随机分为两组,每组100人,观察组用乳杆菌活菌胶囊(定君生)联合硝酸咪康唑栓(达克宁栓)治疗;对照组单一应用硝酸咪康唑栓治疗,对治疗后1个月、3个月的临床效果以及阴道分泌物(10%KOH悬滴法)进行比较,观察其复发率的差别。结果观察组与对照组的近期治愈率无明显差别,3个月的复发率有明显差别,观察组的复发率明显低于对照组。结论乳杆菌活菌制剂能够预防外阴阴道假丝酵母菌的复发,治疗中无不良反应。     

Treatment of cerebrospinal fluid leak after spine surgery

Owing to the complexity of spinal surgery, there is a great prevalence of dural tear causing cerebrospinal fluid (CSF) leakage. Many studies focused on suture repair for dural tear to stop CSF leak. Now some new treatment strategies have shown a promising effect that is listed as follows: 1) creating watertight dural closure to stop CSF leak with the help of dural substitute material; and 2) retarding CSF leak by changing pressure difference, including reducing the subarachnoid fluid pressure, increasing the epidural space pressure and both. In fact several methods mentioned above are usually combined to treat CSF leak. However, no update review summarized the relevant studies implemented in recent years. In this review, the authors would compare the effects of different dural closure techniques, and introduce the latest treatment methods and mechanisms.     

Functional and phenotypic properties of peripheral T cells anergized by autologous CD3(+) depleted bone marrow cells

We have previously demonstrated that bone marrow cells (BMC) inhibit the generation of autologous Epstein-Barr virus (EBV) -specific cytotoxic T lymphocytes (CTL). It was also observed that CD3(+) cells obtained after 7 days of culture in the presence of autologous BMC could be used as inhibitors of EBV-CTL generation. In the present study, we examined these BMC induced regulator CD3(+) T cells with respect to phenotype, function, and T-cell activation pathways. We also questioned if the CD3(+) regulatory cell function is mediated by their direct effect on peripheral T cells or on the ability of antigen presenting cells (APC) to stimulate peripheral T cells. To answer this, CD3(+) cells from peripheral blood lymphocytes (PBL) were cultured with either CD3-depleted BMC or with CD3-depleted PBL. The CD3(+) cells were then isolated with immunomagnetic beads, designated as T(BM) and T(PBL), and were compared in functional studies. There was an increase in the expression of CD25 on T(BM) cells. The T(BM) cells also expressed less CD122 and a decreased number of CD3 molecules per cell. Both T(BM) and T(PBL) cell populations responded to mitogen (PHA) to the same magnitude. However, when stimulated through the CD3 complex with anti-CD3 monoclonal antibody (mAb), the T(BM) cells had a significantly decreased response than did T(PBL). The addition of IL-2 to these latter cultures augmented, but could not fully restore, the response. Additionally, stimulation of T(BM) cells with allogeneic cells failed to produce cytotoxic T cells. These "anergized" T(BM) and "nonanergized" (control) T(PBL) cells were added as third-party cells to a CTL generating culture of autologous PBL stimulated with allogeneic cells. The T(BM) cells exhibited suppressor function and inhibited the generation of CTL, in contrast with T(PBL). The effect of T(BM) cells on direct and indirect antigen presentation pathways demonstrated that T(BM) primarily effected indirect, but not direct, alloantigen presentation. To further explore the cytoplasmic T-cell activation events that occurred after the coculture of the PBL T cells with BMC, the levels of zeta-associated protein 70 (ZAP70) and extracellular receptor-activated kinase (ERK) were determined. There was a decrease in ZAP70 levels in the T(BM), which correlated with its reduced expression of cell surface CD3 and the attenuated response to anti-CD3 mAb activation. However, the activity of ERK was equally expressed by T(BM) and T(PBL). It, therefore, appears that the culturing of peripheral T cells with (non-T) BMC anergizes these cells (which become refractory to stimulation through the T-cell receptors), and induces immune suppressor function. These in vitro observations may provide a mechanism by which infused donor BMC serve to downregulate T-cell immunity.     

低浓度环孢素A免疫抑制剂方案应用于肾移植患者的回顾性分析

目的:研究低浓度环孢素A免疫抑制剂方案在肾移植患者中的应用效果.方法:对133名接受肾移植手术的患者进行回顾性分析,根据应用的吗替麦考酚酯(MMF)剂量和环孢素血药浓度不同,将其分为三组:高环孢素浓度-高MMF剂量组、高环孢素浓度-低MMF剂量组和低环孢素浓度-高MMF剂量组. 监测全血环孢素浓度、血肌酐、尿素氮浓度、血脂以及其他并发症的发生情况. 对各组间的差异进行对比分析.结果:应用低环孢素浓度-高MMF剂量免疫抑制剂方案的患者与应用其他方案的患者相比排斥反应的发生率无明显差异,术后感染、代谢异常、药物副作用的发生明显低于其他方案组.结论:应用低环孢素浓度-高MMF剂量免疫抑制剂方案可以有效的预防排斥反应的发生,同时降低了不良反应的发生.     

症状性双侧椎动脉闭塞侧支代偿与预后分析

【摘要】
目的 探讨症状性双侧椎动脉闭塞患者侧支代偿与临床表现及预后的关系。
方法 本研究采用回顾性研究方法,连续纳入2006年9月～2011年11月首都医科大学附属天坛医院收住的双侧椎动脉闭塞患者共10例,收集患者的临床资料、侧支代偿分级及预后情况,分析侧支代偿与预后的关系。
结果 双侧椎动脉闭塞患者脑梗死发生比例高（6/10）,病情重,预后差（mRS≥3,5/10）。闭塞病变多位于椎动脉V1段起始处（13/20）,其次是V4段（6/20）,V3段（1/20）。侧支代偿不充分组入院时及随访结束时脑梗死所占比例较侧支代偿充分组均较高（2/4 vs 4/6;2/4 vs 5/6）,差异无显著性（P=0.43,P=0.30）。侧支代偿不充分组较代偿充分组入院病情重（mRS≥3者分别为1/4 vs 4/6;NIHSS评分≥4者分别为0/4 vs 1/6;P=0.24,P=0.60）,预后差（mRS≥3者分别为1/4 vs 4/6）,差异无显著性（P=0.24）。
结论 双侧椎动脉闭塞患者发生脑梗死比例高,病情重,预后差。侧支代偿程度可能影响双侧椎动脉闭塞患者的临床表现。     

Poor Insight in Schizophrenia Patients in China: a Meta-Analysis of Observational Studies

Psychiatric Quarterly - Poor insight exists in all phases of schizophrenia and is associated with poor clinical prognosis and adverse psychosocial functioning. This is a meta-analysis examining the...