呼气末正压对机械通气患者中心静脉压及髂总静脉压的影响

目的 观察不同呼气末正压(PEEP)水平对机械通气患者中心静脉压(CVP)和髂总静脉压(CIVP)及两者相关关系的影响.方法 将2007年2-8月收住重症加强治疗病房(ICU),无心肺疾患、循环稳定、无腹胀、无凝血功能异常,需机械通气的20例成年患者列为观察对象,采用自身对照,随机加用0、5和10 cm HzO(1 am H2O=0.098 kPa)PEEP,评估在此条件下,CVP、CIVP和两者压力阶差变化及其与机械通气压力变化间的相关关系.结果 CVP及CIVP随PEEP增加而增高,差异有统计学意义(P0.05);CVP及CIVP与机械通气各压力值变化呈正相关,但CVP及CIVP仅与平均气道压(Pmean)及PEEP有统计学意义(CVP与PEEP r=0.751,CIVP与PEEP r=0.685,CVP与Pmean r=0.634,CIVP与Pmena r=0.603,P均相似文献   

Splenectomy and/or bone marrow transplantation in the management of the Wiskott-Aldrich syndrome: long-term follow-up of 62 cases

This study describes the effects of two major treatment options, splenectomy and/or bone marrow transplantation, on the natural history of the Wiskott-Aldrich (WAS) syndrome. The records of 62 patients with the WAS evaluated at the National Institutes of Health Clinical Center from 1966 to 1992 were reviewed. Nineteen patients were treated with bone marrow transplantation (BMT) and the results were largely dependent on the source of the graft. Twelve of 12 patients receiving HLA-matched sibling marrow achieved satisfactory immunologic and hematologic reconstitution. By contrast, only 2 of 7 patients receiving haploidentical, parental, or matched unrelated marrow survived more than 1 year after BMT. Thirty-nine patients who lacked suitable bone marrow donors early in their course underwent splenectomy for management of their thrombocytopenia; most received prophylactic antibiotics to minimize the risk of sepsis. Nearly all these patients achieved normal platelet counts and the rate of serious bleeding was reduced nearly sevenfold. Median survival in the untransplanted splenectomy group was 25 years, compared with less than 5 years in unsplenectomized patients. We conclude that HLA-matched sibling donor BMT is the treatment of choice for patients with WAS and that splenectomy and daily prophylactic antibiotics provide a significant survival advantage to those boys without a matched sibling donor. Splenectomy should probably be used in preference to unmatched BMT until results with alternative donor BMT significantly improve or gene therapy becomes available.     

NMP 22与流式细胞术在膀胱癌诊断中的价值

目的：分析比较检测尿核基质蛋白22（NMP22）、流式细胞术（FCM）、 尿脱落细胞学检查3种无创方法诊断膀胱移行细胞癌（BTCC）的临床价值。方法：将85例同期住院病人分成BTCC组、泌尿系良性疾病组、泌尿系非尿路上皮恶性肿瘤组,分别应用酶联免疫吸附试验（ELISA）、FCM测定各组病人自排尿中NMP22和DNA含量,并同时行尿脱落细胞学检查。结论：BTCC组、泌尿系良性疾病组、泌尿系非路上皮恶性肿瘤组尿NMP22含量的中位数分别为16．1U／ml、7．2U／ml、4．5U／ml。BTCC组尿NMP22的含量与其他两组含量差别具有显著性意义（P＜0．05）。NMP22、FCM、尿脱落细胞诊断BTCC的敏感性分别为61．1％、69．4％、18．3％,特异性分别为67．4％、59．2％、100％。结论：尿NMP22测定,FCMDNA分析术检测BTCC具有比脱落细胞学更高的敏感性,可作为BTCC的辅助诊断手段。     

Molecular disorders in transitional vs. peripheral zone prostate adenocarcinoma.

Loss of heterozygosity (LOH) and microsatellite instability (MSI) have been shown to be mechanisms for tumor-suppressor gene inactivation in human oncogenesis. In our study, we examined LOH and MSI using 16 polymorphic markers of DNA for chromosomes 1, 3, 7, 8, 10 and 11. Microdissected tumor samples were isolated from 32 patients, representing 11 foci of incidentally discovered prostate cancer of the transitional zone (TZ), 12 prostate cancer of the peripheral zone (PZ) and 10 of high-grade PIN. We found loss of heterozygosity in the TZ group in 91% of informative cases (10/11) with al least 1 marker compared to 58% of cases (7/12) in PZ group and 70% of cases (7/10) in the HGPIN group. Chromosome 7 showed the highest rate of allelic loss in all 3 categories, with loss of 43% of loci in PIN, 37% in TZ tumors and 31% in PZ tumors. At chromosome 11, LOH was detected in 26% of loci in the TZ group, in 7% of loci in the PZ group and in 13% of loci in the PIN group. On chromosome 8, the PZ and HGPIN group showed allelic loss in 22% and 21% of loci, respectively, compared to 10% detected in the TZ group. The TZ group showed a significant higher rate of allelic instability compared to that observed in tumor samples from the peripheral zone: 73% of cases (8/11) showed genetic alterations (RER+ phenotype) in at least 4 loci analyzed compared to 8% and 10% in the PZ and HGPIN groups, respectively (p = 0.0006). These data suggest that transitional zone carcinoma and peripheral zone carcinoma display distinct and specific genetic alterations in different chromosomes. This diversity may help explain biologic and clinical differences between carcinomas arising in these distinct zones of the prostate. Also our results strongly suggest that the RER+ mutator phenotype could be linked to early development of transitional zone prostate carcinoma.     

活体肝移植术前64层螺旋CT肝体积评估的实验研究

目的：利用64层螺旋CT测量家兔肝脏体积,并模拟供肝切取及灌注的过程探讨CT肝体积测量的准确度,分析CT测量值与实际肝体积数值差异的原因和体积与重量的关系。方法：选取健康家兔30只,随机分为实验组、对照组,采用64层螺旋CT行兔肝三期增强扫描,在后处理工作站上分别测量门静脉期、肝静脉期1mm、3mm兔肝全肝体积;实验组模拟供肝切除及灌注过程后取出肝脏,对照组结扎血管后取出肝脏,利用排水法、称重法测量两组实际肝体积及重量,用统计软件SPSS 13.0分析数据。结果：实验组、对照组不同层厚、时相CT测量体积与实际肝体积之间差异分别为20.2%±0.5%、6.29%±0.43%,实验组、对照组肝脏密度分别为（1.000±0.011）g/ml、（1.003±0.007）g/ml。供肝切取和灌注是造成肝脏实际体积与CT测量体积差异的主要原因（F=420.380,P<0.05）。两组不同层厚不同时相CT测量体积与实际体积呈正相关（r值均>0.975,P<0.001）,不同层厚、不同时相CT测量体积的差异无统计学意义（P>0.05,P>0.05）,两独立样本t检验表明两组肝脏密度无明显差异（t=-1.076,P=0.294>0.05）。结论：CT测量肝体积与实际肝体积呈正相关,供肝切取和灌注是造成两者之间差异的主要原因。64层螺旋CT评估肝脏体积有较好的准确度及可重复性。     

The complete genome sequence of the Arabidopsis and tomato pathogen Pseudomonas syringae pv. tomato DC3000

We report the complete genome sequence of the model bacterial pathogen Pseudomonas syringae pathovar tomato DC3000 (DC3000), which is pathogenic on tomato and Arabidopsis thaliana. The DC3000 genome (6.5 megabases) contains a circular chromosome and two plasmids, which collectively encode 5,763 ORFs. We identified 298 established and putative virulence genes, including several clusters of genes encoding 31 confirmed and 19 predicted type III secretion system effector proteins. Many of the virulence genes were members of paralogous families and also were proximal to mobile elements, which collectively comprise 7% of the DC3000 genome. The bacterium possesses a large repertoire of transporters for the acquisition of nutrients, particularly sugars, as well as genes implicated in attachment to plant surfaces. Over 12% of the genes are dedicated to regulation, which may reflect the need for rapid adaptation to the diverse environments encountered during epiphytic growth and pathogenesis. Comparative analyses confirmed a high degree of similarity with two sequenced pseudomonads, Pseudomonas putida and Pseudomonas aeruginosa, yet revealed 1,159 genes unique to DC3000, of which 811 lack a known function.     

Imaging of adrenal tumors using FDG PET: comparison of benign and malignant lesions.

OBJECTIVE: The aim of this study was to differentiate benign from malignant adrenal tumors using positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with unilateral adrenal masses originally detected by CT or MR imaging. CONCLUSION: PET imaging with FDG can metabolically characterize adrenal masses. Abnormally increased FDG uptake in adrenal malignancies allows one to differentiate these abnormalities from benign lesions. Whole-body PET can also reveal extraadrenal tumor sites in patients with malignant tumors, using a single imaging technique for accurate disease staging.