肺动脉高压的发病机制、治疗进展

肺动脉高压是多种因素导致的内皮功能受损所致,病理机制的研究进展为治疗开辟了新思路,提出了如钾离子通道开放剂、内皮素受体拮抗剂、蛋白激酶C抑制剂、PDE-5抑制剂和血栓素抑制等治疗方法.     

Use of tri-gas incubator for routine culture of Campylobacter species from fecal specimens.

We evaluated a tri-gas incubator for Campylobacter isolation to be used instead of an anaerobic jar. Fecal specimens were cultured in duplicate onto charcoal selective medium and incubated at 43 degrees C for 48 h in two different environments: a tri-gas incubator (Forma Scientific) adjusted to provide an atmosphere of 10% CO2, 10% O2, and the balance N2; and evacuated anaerobic jars with a replacement gas mixture of 10% CO2, 5% O2, and 85% N2. A total of 106 Campylobacter jejuni and 8 Campylobacter coli isolates were obtained from 2,348 stool specimens. Of the positive specimens, 113 isolates came from the incubator and 111 isolates came from the anaerobic jars. An additional 32 previously positive specimens were replated onto charcoal selective medium and retested by both methods. We recovered 27 C. jejuni isolates, 26 isolates by each method. The isolates from the incubator typically produced discrete colonies, while the isolates from the anaerobic jar showed some degree of swarming in colony formation. The tri-gas incubator provided a cost-effective method for culturing Campylobacter spp.     

Metabolic changes after revascularization in a patient with innominate artery occlusion by localized in vivo proton magnetic resonance spectroscopy

Localized in vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been used to measure the metabolic status of the human brain in a non-invasive manner; thus, it is often called "a non-invasive biochemical assay". MRS is more sensitive than magnetic resonance imaging (MRI) in detecting ischemic damage by measuring the metabolic changes that occur prior to the anatomic changes. We report a patient who presented with innominate artery occlusion and symptoms of posterior circulation insufficiency and showed favorable metabolic changes by (1)H-MRS after revascularization. He showed no visible lesion in brain MRI, but in (1)H-MRS, decreased N-acetylaspartate (NAA) signal was noted in a resting state.After revascularization, both symptomatic improvement and recovery of NAA signal were observed. (1)H-MRS may provide valuable clinical information in diagnosis and management of cerebral hypoperfusion at a much earlier stage prior to the anatomic changes.     

Proximal tubular epithelial cell integrins respond to high glucose by altered cell-matrix interactions and differentially regulate matrixin expression

Thickening of the tubular basement membrane (TBM) occurs in diabetic nephropathy, but the effects of high glucose on the functional aspects of proximal tubular epithelial cells are not clearly understood. In the present study, we examined the effects of elevated glucose concentrations on (a) integrin expression by human proximal tubular epithelial cells (HK-2) and integrin-mediated interactions with type IV collagen (colIV) and laminin, major components of TBM; (b) the expression of matrixins/matrix metalloproteinases (MMPs), which is regulated by integrins; and (c) the expression of tissue inhibitors of metalloproteinases (TIMPs). HK-2 cells cultured in 25 mM glucose underwent a reduction of the expression of alpha3, beta1, alpha(v)beta3, and alpha5 integrin subunits, with a concomitant increase of the alpha2 subunit, compared with cells grown in 5 mM glucose. Adhesion experiments demonstrated that high glucose led to increased cell adhesion on either colIV or laminin. Experiments of competition of adhesion using anti-integrin antibodies indicated that HK-2 cells in 5 mM glucose used mainly alpha(v)beta3 and alpha5beta1 integrins to adhere to colIV, whereas in 25 mM glucose they additionally used alpha2beta1. In the case of laminin, a beta1-mediated adhesion was observed when HK-2 cells were in 5 mM glucose, whereas in 25 mM glucose, alpha2beta1 and alpha(v)beta3 were also involved. Elevated glucose concentrations resulted in decreased expression of MMP-9 and MMP-2, whereas an increase in TIMP-1 and a decrease in TIMP-2 expression were observed. We also examined which integrins mediated the expression and secretion of matrixins MMP-2 and MMP-9. Ligation of alpha3beta1 with mAbs resulted in induction of MMP-2 expression and secretion, whereas antibody ligation of alpha(v)beta3 led to down-regulation of MMP-9. The above data implicate integrins of proximal tubular epithelial cells in the regulation of MMPs and in the development of TBM thickening in diabetic nephropathy.     

Genomic structure and evolution of the ancestral chromosome fusion site in 2q13-2q14.1 and paralogous regions on other human chromosomes

Human chromosome 2 was formed by the head-to-head fusion of two ancestral chromosomes that remained separate in other primates. Sequences that once resided near the ends of the ancestral chromosomes are now interstitially located in 2q13-2q14.1. Portions of these sequences had duplicated to other locations prior to the fusion. Here we present analyses of the genomic structure and evolutionary history of >600 kb surrounding the fusion site and closely related sequences on other human chromosomes. Sequence blocks that closely flank the inverted arrays of degenerate telomere repeats marking the fusion site are duplicated at many, primarily subtelomeric, locations. In addition, large portions of a 168-kb centromere-proximal block are duplicated at 9pter, 9p11.2, and 9q13, with 98%-99% average sequence identity. A 67-kb block on the distal side of the fusion site is highly homologous to sequences at 22qter. A third ~100-kb segment is 96% identical to a region in 2q11.2. By integrating data on the extent and similarity of these paralogous blocks, including the presence of phylogenetically informative repetitive elements, with observations of their chromosomal distribution in nonhuman primates, we infer the order of the duplications that led to their current arrangement. Several of these duplicated blocks may be associated with breakpoints of inversions that occurred during primate evolution and of recurrent chromosome rearrangements in humans.     

The mast cell: distribution and maturation in the peritoneal cavity of the adult rat.

In the peritoneal cavity of the adult rat mast cells at the four stages of progressive maturation (and corresponding increase of sulphation of granules) are best demonstrated in free peritoneal fluid. Of the 0.1-0.2x10(6) cells in the free fluid, 26% are at stage 1 of maturation (all granules are stained by Alcian blue). 24% at stage 2 (majority of granules are stained by Alcian blue, minority by safranin), 20% at stage 3 (majority of granules are safranin-positive), and 30% at stage 4 (all granules are safranin-positive). Peritoneal washings yield a mean of about 1.3-1.8x10(6) mast cells of which 16% are at stage 1, 24% at stage 2, 34% at stage 3 and 26% at stage 4. The greater number recovered by washing, compared with the number in free peritoneal fluid, suggests that a substantial number of mast cells lie on the surface of the peritoneal membranes.     

取腱器配合腓肠肌筋膜瓣翻转术治疗跟腱断裂疗效观察

目的介绍利用取腱器切取腓肠肌筋膜瓣,翻转缝合断裂跟腱的临床效果。方法选取2008年1月~2012年12月我院跟腱断裂病人21例,男15例,女6例,平均年龄33.5岁,为剧烈运动后跟腱撕裂伤,均采用手术治疗。俯卧位,跟腱断裂部位纵行手术切口,马尾状撕裂部位梳理整齐后编织缝合,根据需要腱膜的长度于切口近端相应部位作纵行小切口,用取腱器取筋膜条,自皮下隧道牵出远端切口,翻转,光滑面朝后加固缝合断裂跟腱。术后长腿石膏固定4周,短腿石膏固定2周。结果 21例患者均获得术后随访,平均随访时间2.3年(1~5年)。根据Arner Lindholm评分标准,优16例,良4例,差1例,优良率95.2%。结论取腱器微创小切口下取腓肠肌腱膜方法具有小切口,创伤小,美观等优点,术后正规康复功能锻炼后临床效果良好。     

大鼠中缝大核突触囊泡在电针后的变化及其图象分析

应用透射电镜和图象分析方法,对电针后大鼠中缝大核突触前终扣内突触囊泡的数量以及突触前终扣内容物的量的变化进行了研究。结果表明:电针后,中缝大核突触前终扣内圆形清亮囊泡和颗粒囊泡的数量明显减少,突触囊泡聚集并向突触活性带集中。图象分析结果:电针后,突触前终扣内容物的量较对照组明显减少,而且内容物分布不均匀并在突触膜附近集中。本实验为针刺镇痛的理论研究提供了形态学依据。     

Subtle translocation (18;21) confirmed by FISH in a patient with Down syndrome

The patient presented with the typical features of Down syndrome: hypotonia, brachycephaly, flattened occiput, bilateral prominent medical epican-thic folds, flat nasal bridge, protruding tongue, low-set dysplastic ears, short broad hands, bilateral clinodactyly and simian crease. The karyotype of this child was originally reported as normal. High-resolution chromosomes revealed extra material on the long arm of chromosome 18. The mother's karyotype showed a reciprocal translocation between the long arm of 18 and the long arm of 21 at band q23 and q22.1, respectively. FISH performed separately with two different 21q cosmid probes gave two signals on the mother's metaphases and three signals on the prob-and. These findings confirmed that the proband is trisomic for the long arm of chromosome 21 at loci D21S65 and D21S19.