氨溴索在兔人工气管置换术后抗炎作用的研究

目的探索氨溴索对新西兰兔气管移植后肺损伤的影响。方法 20只健康成年新西兰白兔随机分为两组,氨溴索治疗组和对照组,均进行PTFE替代物气管移植手术,术后第3日活杀后,检测肺湿/干比(W/D)和动脉血氧分压,光镜下观察肺组织结构变化。结果与对照组比较,氨溴索治疗组肺湿/干比显著减少(P0.05),且肺动脉氧分压显著升高(P0.05),肺组织学观察发现,肺水肿改变在对照组较氨溴索治疗组更加显著。结论氨溴索能够有效减轻PTFE气管移植兔的术后急性肺损伤。     

The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT)

Purpose:

Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors’ initial experience with image-guided SBRT in treating primary and metastatic RCC.

Materials and methods:

The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with 23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus, rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target volume margins.

Results:

Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There were no significant treatment-related side effects.

Conclusion:

Image-guided SBRT provides excellent symptom palliation and local control without any significant toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.     

双辅助切口白内障超声乳化术对角膜屈光的影响

[目的]评价小切口白内障超声乳化吸除术中,双辅助切口对角膜屈光的影响.[方法]20例38眼,行白内障超声乳化吸除、折叠式人工晶体植入术,在角巩膜缘3、9点位透明角膜两处行辅助切口.应用TOPCON 角膜曲率仪,于术前和术后1周、1个月、3个月对角膜进行检测,比较分析角膜屈光的变化.[结果]术后角膜曲率同术前值比较,差异均无显著性(P＞0.05) .术后1周角膜散光与术后3个月的数值比较,差异有显著性(P＜0.05),术前和术后1个月角膜散光与术后3个月的数值比较,差异均无显著性(P＞0.05).[结论] 双辅助切口的超声乳化白内障吸除术,对角膜曲率影响非常小;术后出现的角膜散光,可于术后1个月内显著减少;1个月后,角膜散光情况已基本稳定.     

'Subclinical MS': follow-up of four cases

Background and purpose: Subclinical multiple sclerosis (S‐MS) can be defined as the discovery of characteristic lesions at magnetic resonance (MR) or at autopsy, in the absence of clinical evidence consistent with MS. To describe four cases of S‐MS cases followed‐up with clinical and MR examinations. Methods: The four patients were initially evaluated because of accidental MRI findings suggestive of MS that fulfilled the Barkhof criteria. At the moment of MR examination, patients were asymptomatic or complained of unspecific symptoms. The objective examinations as well as the clinical history were negative. An extensive diagnostic work‐up excluded alternative diagnoses. Results: Case 1: 40‐year woman undergoing MR examination due to trivial cervical trauma. The cerebrospinal fluid (CSF) analysis showed an IgG Index of 3.32 and presence of oligoclonal bands (OCB). New MR enhancing lesions were detected in the brain and cervical cord after 2 and 5 years. The patient remained clinically asymptomatic. Neuropsychological assessment (NPS) performed after 5 years revealed moderate deficits of attention/concentration and executive functions. Case 2: 35‐ year man, undergoing MR due to recent‐onset headache. CSF analysis showed an IgG Index of 1.54 and presence of OCB. At baseline, NPS assessment revealed moderate deficit on complex attention tasks. New MR enhancing lesions were detected in the brain after 1 and 3 years. Four years after the first MR, the patient presented double vision with internuclear ophthalmoplegia. He fulfilled Polman’s criteria for MS and he started interferon beta therapy. He remained stable at a 8‐year follow‐up. Case 3: 32‐year man, undergoing MR due to brief loss of consciousness following neck hyperextension. CSF analysis showed absence of OCB and normal IgG Index. At baseline, NPS assessment revealed mild deficits of attention and executive functions. Over a 5‐year follow‐up the subject remained asymptomatic and MR was unchanged. Case 4: 40‐year woman, sister of an MS patient. MR was required during a period of marked tiredness taking into account the family history. The patient did not present any relevant symptoms and MRI remained unchanged over a 6‐year follow‐up. NPS evaluation performed after 7 years showed moderate impairment of memory, attention and executive functions. Conclusion: With the increased use of MR, S‐MS cases can be identified more often. In our series, despite the absence of any typical symptoms, an NPS assessment detected cognitive impairments consistent with those reported in MS.     

高气压暴露对大鼠血浆内皮素-1含量、血清一氧化氮含量、一氧化氮合酶活性的影响

目的 探讨高气压暴露对大鼠血浆内皮素-1(endothelin-1,ET-1)含量、血清一氧化氮(nitric oxide,NO)含量、一氧化氮合酶(nitric oxide synthase,NOS)活性的影响.方法 40只SD大鼠随机分为5组.A组为对照组,B组0.7 MPa空气暴露后缓慢减压,C组0.7 MPa空气暴露后快速减压,D组0.147 MPa纯氧暴露后减压,E组0.250 MPa纯氧暴露后减压.各组暴露时间均为60 min.采用放射免疫方法测定血浆ET-1含量,硝酸还原酶法测定血清NO含量,比色法测定血清NOS活性.结果 与对照组相比,安全减压组和高压氧组的血浆ET-1含量明显升高(P<0.05),原因可能与高分压氧有关(PO2=0.147 MPa/0.250 MPa);快速减压组血清NO含量、NOS活性明显升高(P<0.05),与血浆ET-1含量升高的3个组相比,血清NO、NOS升高得更为显著(P<0.01).结论 NO与ET-1在机体对高气压暴露的反应中呈拮抗关系.高气压与高压氧暴露导致血浆ET-1的释放增加,但快速减压刺激血管内皮细胞产生更多的NO,这种机制可能是通过提高血浆中的NOS活性实现的,这个现象可能是血管内皮系统对血管内气泡产生的应激性反应之一.     

Outcome of fetuses with abnormal biophysical profile

Sonographic observation of fetal behavior as a possible indicator for the state of fetal health was quantified with a modified biophysical profile (BPP). The observation time was extended to 40 min, as the fetal rest-activity cycle implies that inactivity may last that long. Gestational age ranged 27-43 weeks. Cardiotocography (CTG) was performed subsequent to an abnormal BPP (ultrasound score 0-4). Reactivity, indicating favorable fetal outcome, was more common in near-term fetuses, suggesting that BPP should be interpreted in relation to gestational age. Therefore, fetuses with an abnormal BPP (n = 29) were each matched and compared with 2 fetuses of same gestational age but normal BPP (ultrasound score 6-8; n = 58). The perinatal mortality and morbidity were significantly higher in infants with abnormal score than in infants with normal score (p less than 0.01). BPP by third trimester sonography helps to diagnose acutely endangered fetuses, and an abnormal fetal movement pattern should lead to further evaluation, i.e. CTG. While BPP scoring, as compared to CTG, is less favorable as a primary surveillance technique and not superior for identifying the hypoxic fetus, additional information is obtained with BPP by diagnosing the growth-retarded and/or malformed fetus.     

血清胶原代谢指标在评价高血压左室重构中的作用

目的 探讨高血压患者血清胶原代谢指标的变化及临床意义。方法 按WHO（1999年）高血压诊断标准选择原发性高血压患者94例，其中左室肥厚组（EH-LVH）4l例、非左室肥厚组（EH-NLVH）53例；对照组32例。用放射免疫分析法测定血清Ⅰ型前胶原羧基端肽（PICP）、Ⅲ型前胶原（PCⅢ）、透明质酸（HA）、层粘连蛋白（LN）水平，同时应用超声背向散射积分（IBS）技术测定左室图像平均强度（AⅡ2、AⅡ2）、左室质量指数（LVMI），对上述各指标进行相关性分析。结果 EH-LVH组PⅠCP、PCⅢ、LN、HA水平高于EH-NLVH组和对照组；EH-NLVH组上述指标水平亦高于对照组。3组左室IBS参数AⅡ1、AⅡ2间差异均有显著性。PⅠCP、PCⅢ、LN均与AⅡ1、AⅡ2和LVMI呈正相关。结论 PⅠCP、PCⅢ、LN和HA可反映高血压患者胶原代谢异常，并对评价左室重构有一定作用。     

New oligoethylene ester derivatives of 5-iodo-2'-deoxyuridine as dermal prodrugs: synthesis, physicochemical properties, and skin permeation studies.

Five new oligoethylene ester derivatives (9-13) of 5-iodo-2'-deoxyuridine (IDU) were synthesized and assayed to determine their lipophilicity by both experimental lipophilicity indices (log K') and calculated partition coefficients (CLOGP). In vitro experiments were carried out to evaluate the chemical and enzymatic stability and fluxes through excised human skin of these new IDU derivatives. Esters 9-13 showed increased lipophilicity compared with the parent drug (IDU), had good stability in phosphate buffer (pH 7.4), and were readily hydrolyzed by porcine esterase. No correlation between lipophilicity and skin permeation fluxes of synthesized esters 9-13 was observed. Results from in vitro percutaneous absorption studies showed that, among all esters synthesized, only esters 9 and 10 significantly increased the cumulative amount of IDU that penetrated through excised human skin compared with the parent drug (IDU).     

Administration of live attenuated varicella vaccine to children with cancer before starting chemotherapy

From July 1985 to February 1987, of 46 consecutive children with cancer (26 male, 20 female; median age, 4 years) with no prior history of chickenpox, the initial 30 patients were randomized either to receive or not to receive live attenuated varicella vaccine (LAVV) before chemotherapy was started and the remaining 16 patients were all immunized without randomization. Before immunization, Varicella zoster (VZ) antibodies were detected by immunofluorescence and ELISA in 11 (34%) of 32 vaccinated children and two (14%) of 14 controls, indicating previous infection. A booster effect was evident in 70% of them and no side effects were noted. Ten (28%) of 32 vaccinees were excluded from the analysis because of early death due to cancer (1–4 weeks). Seroconversion was demonstrated in ten (77%) of 13 vaccinees, with high antibody titres. Only three of them lost their antibodies 2 years after immunization, as disclosed by serological follow-up. Eight out of 13 vaccinees had household contacts with VZ and none became infected. Zoster immunoglobulin (ZIG) was never given. Among controls, seven out of 14 were exposed to VZ and four (57%) became infected. Mild side effects were observed in four (12.5%) out of 32 vaccinees (three with papulovesicular rash, 6—30 lesions, and one with a 3-day intermittent fever). Local reactions, zoster and spreading of vaccinal virus did not occur. LAVV proved to be safe and effective when administered before starting chemotherapy to children with cancer and no history of varicella.