碳酸氢钠预防造影剂肾病——一项随机对照研究

背景：造影剂肾病仍是放射影像学检查的一种常见并发症。在动物急性缺血性肾衰竭模型中，预先使用碳酸氢钠比氯化钠的肾脏保护作用更佳。缺血和造影剂引发的急性肾衰竭均被认为是自由基损伤所致。但是，在人或动物至今尚无评价碳酸氢钠预防造影剂肾病有效性的研究。 目的：在使用放射性造影剂前后用碳酸氢钠或氯化钠进行预防性水化，比较二者的有效性。 设计、地点和病人：一项于2002年9月16日至2003年6月17日进行的前瞻性、单中心、随机试验。119例血清肌酐稳定在≥1．1mg／dL（t≥97．2μmol／L）水平的病人，在应用碘帕醇（370mg碘／mL）造影前后，随机接受了氯化钠静脉滴注（n=59）或碳酸氢钠静脉滴注（n=60），剂量均为154mEq／L。在造影前及造影后第1、2天进行了血清肌酐检测。 干预：病人接受154mEq／L的氯化钠或碳酸氢钠，造影前以每小时3mL／kg的速度静脉滴注1小时，造影后以每小时1mL／kg的速度滴注上述药物6小时。 主要观察指标：造影剂肾病，其定义为在造影后2天内血清肌酐升高tμ25％。 结果：两组病人在年龄、性别、糖尿病发生、种族以及造影剂用量方面无显著差异。碳酸氢钠治疗组病人基线血清肌酐水平稍高于氯化钠治疗组，但亦无显著差异（氯化钠组均值[sD]为1．71[0．42]mg／dL[151．2{37．1}μmol／L]，碳酸氢钠组为1．89[0．69]mg／dL[167．1{61．0}μmol／L]；P=0．09）。氯化钠组8例（13．6％），发生造影剂肾病一级终点，而碳酸氢钠组仅1例（1．7％）（均值差别，11．9％；95％可信区间[CI]，2．6％～21．2％；P=0．02）。随后，又对191例符合研究纳入标准的病人给予了碳酸氢钠治疗并进行随访登记，结果有3例出现了造影剂肾病（1．6％；95％CI，0％～3．4％）。 结论：对于造影剂引发的肾衰竭，在造影前采用碳酸氢钠进行水化治疗比采用氯化钠水化治疗更为有效。     

有机锗对豚鼠实验性过敏反应的影响

我们采用了经典的豚鼠过敏性休克试验模型,对Ge-132的抗过敏作用进行了初步研究。动物随机分为四组。各组动物均于实验第一天和第二天经腹腔注射10％鸡蛋清各一次,分别为0.1ml/只和0.2ml/只。在末次注射后18天,给心脏注射20％鸡蛋清0.5ml/只,各鼠出现抓鼻、耸毛、咳嗽、打喷嚏、呼吸困难等过敏反应症状。     

美国肝病研究学会慢性乙型肝炎实践指南

这篇指南已获得美国肝病研究学会（AASLD）认可，并代表学会的观点。 0引言 指南目的在于帮助内科医生和其他医务工作者对感染乙型肝炎病毒（HBV）病人的识别、诊断和处理。这些推荐建议为乙型肝炎病人的治疗提供了数据支持。资料来源于：①截至2006年2月Medline关于本主题所有发表的文献和2003～2005年间会议上发表的摘要；[第一段]     

甲型H1N1流感确诊病例出院标准(试行)

甲型H1N1流感确诊病例同时满足下列条件时,可以出院: 1.体温正常,流感样症状消失≥3 d,无并发症,临床情况稳定;     

Ketamine Improves the Management of Exaggerated Postoperative Pain Observed in Perioperative Fentanyl-treated Rats

Background: Although opioids are unsurpassed analgesics, experimental and clinical studies suggest that opioids activate N-methyl-d-aspartate pronociceptive systems leading to pain hypersensitivity and short-term tolerance. Because it is difficult in humans to differentiate pain from hyperalgesia during the postoperative period, the authors performed experimental studies with fentanyl using the rat incisional pain model for evaluating relations between hyperalgesia and short-term tolerance. Because N-methyl-d-aspartate receptor antagonists oppose both pain hypersensitivity and tolerance induced by opioids, the authors examined the capability of ketamine for improving exaggerated postoperative pain management.

Methods: During halothane anesthesia, a hind paw plantar incision was performed in rats receiving four fentanyl subcutaneous injections (100 [mu]g/kg per injection, every 15 min). In some groups, three subcutaneous ketamine injections (10 mg/kg per injection, every 5 h) were performed in saline- or fentanyl-treated rats. One day after surgery, the analgesic effect of morphine (2 mg/kg subcutaneous) was tested. Analgesia, mechanical hyperalgesia, tactile allodynia, and pain score were assessed for several days using the paw pressure vocalization test, the von Frey application test, and the postural disequilibrium test.

Results: Fentanyl induced analgesia but also produced exaggerated postoperative pain as indicated by the enhancement of hyperalgesia, allodynia, and weight-bearing decrease after hind paw plantar incision. Ketamine pretreatment prevented such a fentanyl-induced enhancement of postoperative pain and improved its management by morphine.     

Mirizzi综合征的诊疗体会

1984年Mifizzi首先提出Mifizzi综合征后，国内外陆续有报道。笔者收集和分析我院近5年来对21例Mifizzi综合征的诊治体会报道如下。     

核转录因子κB与前列腺癌

核转录因子κB(nuclearfactorofkappaB ,NF κB)是一种多极性核转录因子 ,参与调控多种与免疫反应、凋亡、炎症、肿瘤形成和转移有关的基因表达。近年来 ,NF κB在肿瘤发生、耐药、转移中的作用及其机制逐渐成为医学研究的热点。本文主要综述了NF κB的结构、生物学功能及其抗凋亡诱发肿瘤的机制 ,NF κB调控的前列腺癌相关基因的表达和调控 ,NF κB参与前列腺癌浸润与转移的机制及其在前列腺癌基因治疗中的可能策略等。     

招飞初检中使用B超探测肝脾下界的价值

目的 探讨招飞初检中使用B超探测肝脾下界的实用价值。方法 在招飞初检中常规使用B超仪检查肝脾下界,代替医生触诊,统计初检、全面体检中漏诊和检查出入的人数,比较B超法与触诊法的优劣。结果 B超检测1618人,淘汰129人,防止了肝脾检查漏诊。结论 在招飞初检中使用B超代替触诊检查肝脾下界准确可靠,方便易行,宜于推广。     

Apopotic gene Bax expression in carotid plaque

The expression of BAX in carotid atherosclcrosis and its regulation is far from defined. Objectives To investigate BAX expression in stable/fibrous and instable/vulnerable carotid plaque and its clinical significance. Methods 25 cases of carotid plaque specimens obtained from endarterectomy were divided into two groups, stable/fibrous 14 cases, vulnerable/instable 11 cases; aortic artery and its branches from hepatic transplantation donors 6 case as control. The expression of proapoptotic BAX was detected by immunohistochemistry (IHC), in situ hybridization(ISH) and in situ TdT dUTP nick end labeling (TUNEL). Results 5 eases of BAX ( ) were detected by ICH and ISH, 4 case of TUNEL ( ) were detected by TUNEL in stable/fibrous carotid plaque, while 10 cases were BAX ( )by IHC(P<0.05) , 11 case by ISH and 9 case by TUNEL were detected in instable/vulnerable carotid plaque (P<0.01), respectively. The intensity of BAX ( ) cells by IHC and ISH was 8.63±2.62 and 10.32±3.12 in fibrous plaques, whereas 122±21.64 and 152±23.35 in vulnerable plaques, respectively. No expression of BAX was found in controlled group. Conclusion The higher expression of Bax in vulnerable carotid plaque may be one mechanisms in molecular pathogenesis of carotid atherosclerosis which affect plaque stability and be the cause of higher incidence of stroke than fibrous carotid plaques, the regulation of BAX expression in different stage of atherosclerosis may provide targets in gene therapy for carotid atherosclerosis.     

β2-ADRENERGIC RECEPTOR GENE POLYMORPHISM IN CHINESE NORTHERN ASTHMATICS

THEβ2-adrenergicreceptor(β2-AR)ishighlyexpre-ssedonairwaysmoothmusclecellsinlung,anddefectsinβ2-ARsignalpathwaywereinvolvedinthepathogenesisofasthma.1 Humanβ2-ARgeneisanintr-onlessgenewithacodingblockconsistingof1239nucleo-tidesonchromosome5q31-32,genome-widesearchforas-thmasusceptibilitylocishowedthatmarkersonthisregionhavebeenlinkedtoasthma-associatedphenotypesinvariousethnicpopulations.2 Reihsausetal3 firstdescribedninecod-ingregionpolymorphisms,particularly,thethreecommonaminoacidsu…