非甾体类抗炎药胃粘膜损伤及预防实验研究

目的了解并比较不同非甾体类抗炎药(NSAID)对胃粘膜的损害及其机制,观察临床常用药物西咪替丁(泰胃美)、铝碳酸镁(胃达喜)及硫糖铝(舒克菲)对NSAID性胃粘膜损害的预防保护作用.方法分别以萘丁美酮(瑞力芬)、吲哚美辛(消炎痛)、乙酰水杨酸(阿斯匹林)复制大鼠NSAID性胃粘膜损伤模型(n=8),以光镜和扫描电镜观察损伤及预防应用西咪替丁、铝碳酸镁及硫糖铝后胃粘膜形态学改变,同时测定胃粘膜血流(GMBF),6-酮-前列环素F1α(6-kto-PGF1α),血栓素B2(TXB2)水平.结果吲哚美辛和乙酰水杨酸引起明显胃粘膜损害,平均损伤指数(LI)分别为2.13±0.46,2.06±0.71,萘丁美酮组胃粘膜损害则轻微(LI=0.38±0.52,P＜0.01).预防用药后吲哚美辛所致胃粘膜损害减轻(LI分别为1.04±0.76,1.12±0.35和0.98±0.57,与吲哚美辛组相比P＜0.01),GMBF增加(分别为2.89±0.80,3.07±0.33,3.43±0.49,与吲哚美辛组相比显著增加,P＜0.01),6-keto-PGF1α,TXB2抑制减弱.结论细胞保护性前列腺素合成抑制为NSAID性胃粘膜损伤的主要机制.萘丁美酮作为新型NSAID,有着较高的胃肠道安全性.     

Methods for Examination an Explanted Coronary Sinus Lead Stabilized with a Coronary Stent

The aim of our investigation was to test the suitability of a novel method for the analysis of the integrity of an explanted pacemaker lead stabilized by a stent. A coronary sinus lead has been explanted 27 months after implantation and has been examined by optical‐, confocal‐, x‐ray‐, and scanning electron microscopy. Several surface injuries were found on the insulation. Based on the surface characteristics, it is possible to define and differentiate the source of damages as well as to measure the extent of injuries. Impedance of the explanted lead has also been measured and electronic integrity has been verified. (PACE 2013; 36:e27–e30)     

认知暴露疗法治疗创伤后应激障碍

目的:探讨认知暴露疗法结合药物治疗创伤后应激障碍(post-traumaticstressdisorder,PTSD)的效果。方法:于2003-06/2004-06选择第四军医大学西京医院心身科、西安交通大学第一医院和西安市精神卫生中心的门诊和住院PTSD患者20例。均符合美国精神疾病诊断与统计手册第四版PTSD诊断标准。将20例患者按随机数字表法分为结合治疗组和药物治疗组,每组10例。一组采用认知暴露疗法结合药物干预,另一组采取单纯药物干预。认知暴露疗法方案:向患者讲解创伤应激的有关知识、呼吸再训练、放松训练、创伤记忆暴露、自我重复、认知治疗。治疗次数固定,共7次心理治疗会谈。药物治疗方案:①苯二氮革类药物:罗拉,0.5～1.0mg,3次/d,口服。②抗抑郁药物,盐酸氟西汀,20mg,1次/d。于治疗前24h内、临床治愈后24h内、治疗结束后第91天进行PTSD症状清单量表(主要包括3个分量表:再体验、回避和高激惹)、症状自评量表(包括9个因子,分别是躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性,还有一个其他项目,共计为10个因子)、贝克抑郁问卷、状态-特质焦虑问卷、汉密顿抑郁量表、汉密顿焦虑量表评定。各量表评定分数越高症状越严重。结果:随访期间无一例失访。①PTSD症状清单量表总分及其回避、高激惹两个分量表评分变化在两组之间无差异,而两组间创伤性再体验分量表评分差异有显著性意义(F=5.502,P<0.05);量表总分及回避、高激惹两个分量表评分组内比较差异有显著性意义(F=8.912,9.399,6.007,P<0.01),创伤性再体验分量表评分则无显著差异;两两比较结果发现,量表总分在3个测量点间差异均有显著性意义(t=2.342,3.547,3.124,P<0.05),表明治疗后比治疗前症状显著改善,随访时有显著回升,但仍显著好于治疗前;创伤性再体验分量表评分治疗后显著低于治疗前(t=2.804,P<0.05),其余时间点比较差异不显著;回避和高激惹分量表评分治疗后及随访时均显著低于治疗前(t=3.542,3.124,5.246,4.138,P<0.05),治疗后与随访时差异不显著。②症状自评量表总分两组间比较差异不显著,组内比较差异有显著性意义(F=41.21,P<0.01),量表总分的时间变化与分组之间无交互作用。两两比较结果发现,症状自评量表总分治疗后及随访时均显著低于治疗前(t=10.526,6.354,P<0.01),治疗后与随访时差异不显著。③贝克卓艹抑郁问卷、状态-特质焦虑问卷、汉密顿抑郁量表、汉密顿焦虑量表评分两组间均无差异;各量表组内比较差异有显著性意义(F=56.701,33.165,33.222,33.491,P<0.01),量表评分与分组之间有交互作用(F=9.615,7.110,4.380,3.953,P<0.05)。④结合治疗组有2名不再符合PTSD诊断,药物治疗组仍全部符合PTSD诊断,两组比较无显著差异(χ2=2.004,P>0.05)。结论:认知暴露疗法能够弥补药物治疗的效果短和无法进行认知重建的不足,减少创伤性应激障碍患者的复发,有助于PTSD患者的心理康复。     

A study on plucked hair as a substrate for direct immunofluorescence in pemphigus vulgaris

Background  It has recently been demonstrated in a study on 15 patients that plucked hair can be used as a substrate for direct immunofluorescence (DIF) in pemphigus.
Objective  Our aim was to assess the sensitivity of DIF on plucked hairs in pemphigus vulgaris (PV) patients with positive DIF of oral mucosa.
Methods  One hundred and ten new PV patients were enrolled in the study. They all showed the typical clinical and histological findings as well as positive DIF of the oral mucosa, diagnostic for PV. Approximately 30 hairs were obtained in the same way as for the trichogram. The hairs with their outer root sheaths (ORS) were processed for DIF in order to detect immunoglobulin G and C3.
Results  Immunodeposits favouring PV were demonstrated in the ORS of 100 cases showing a sensitivity of 91%.
Conclusion  Regarding the relatively high sensitivity of DIF on plucked hair in PV patients with positive oral mucosal DIF in our study, it seems that hair plucking is a suitable alternative to the more invasive techniques of skin or mucosal biopsy for obtaining specimens for DIF in PV.

Conflicts of interest

None declared     

Bilateral blepharochalasis

Blepharochalasis is a rare disorder characterized by recurrent painless periorbital oedema, which leads to atrophy of the periorbital skin. Pathomechanism of the disease is probably immunological with a nearly complete loss of elastic fibres. The authors describe a 17-year-old woman, who was followed for 7 years. IgA deposits were found in the periorbital tissues, which confirm the immunological background of the condition. Electron microscopy results show that not only elastic but also collagen fibres were affected.     

The 'transitional' mucosa adjacent to large bowel carcinoma—electron microscopic features and myofibroblast reaction

An electron microscopic study of the 'transitional' mucosa adjacent to 10 carcinomas of the colon showed impaired maturation of epithelial cells. The pericryptal fibroblast layer was absent, accounting for an increase in the length and distension of crypts. In the tunica propria a massive accumulation of myofibroblasts was noted and was indicative of an intensive fibre-producing activity. Review of the literature identifies various theories concerning the functions of myofibroblasts in respect of contraction, embryonal collagen-fibre formation and non-specific stromal reaction. Of these, the latter two are considered likely in relationship to transitional colonic mucosa.