Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism

To evaluate the response of circulating intact parathyroid hormone (iPTH) on myocardial hypertrophy in hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), echocardiographic and neurohormonal assessments were performed over a 15-week period in 15 HD patients with SHPT before and after calcitriol treatment and 10 HD control patients with SHPT not receiving calcitriol therapy. We prospectively studied a group of 15 patients with significantly elevated iPTH levels (iPTH >450 pg/mL) receiving calcitriol (2 microg after dialysis twice weekly). Clinical assessment, medication status, and biochemical and hematological measurements were performed once a month. Throughout the study, calcium carbonate levels were modified to maintain serum phosphate levels at less than 6 mg/dL, but body weight, antihypertensive medication, and ultrafiltration dose remained constant. In patients treated with calcitriol, an adequate reduction of iPTH levels was found (1,112 +/- 694 v 741 +/- 644 pg/mL; P < 0.05) without changes in values of serum ionized calcium (iCa++), phosphate, or hematocrit. Blood pressure (BP), cardiac output (CO), and total peripheral resistance (TPR) did not significantly change. After 15 weeks of treatment with calcitriol, M-mode echocardiograms showed pronounced reductions in interventricular wall thickness (13.9 +/- 3.6 v 12.8 +/- 3.10 mm; P = 0.01), left ventricular posterior wall thickness (12.5 +/- 2.4 v 11.3 +/- 1.8 mm; P < 0.05), and left ventricle mass index (LVMi; 178 +/- 73 v 155 +/- 61 g/m2; P < 0.01). However, in control patients, these changes were not found after the treatment period. In addition, sequential measurements of neurohormonal mediator levels in patients receiving calcitriol showed that plasma renin (18.5 +/- 12.7 v 12.3 +/- 11.0 pg/mL; P = 0.007), angiotensin II (AT II; 79.7 +/- 48.6 v 47.2 +/- 45.7 pg/mL; P = 0.001), and atrial natriuretic peptide (ANP; 16.6 +/- 9.7 v 12.2 +/- 4.4 pg/mL; P = 0.03) levels significantly decreased, whereas antidiuretic hormone (ADH), epinephrine, and norepinephrine levels did not change significantly. The percent change in LVMi associated with calcitriol therapy had a strong correlation with the percent change in iPTH (r = 0.52; P < 0.05) and AT II (r = 0.47; P < 0.05) levels. We conclude that the partial correction of SHPT with intravenous calcitriol causes a regression in myocardial hypertrophy without biochemical or hemodynamic changes, such as heart rate, BP, and TPR. The changes in plasma levels of iPTH and, secondarily, plasma levels of neurohormones (especially AT II) after calcitriol therapy may have a key role in attenuating ventricular hypertrophy in SHPT.     

自体骨髓干细胞移植治疗神经系统损伤和变性疾病42例报告

目的:观察42例神经系统损伤和变性疾病患者经自体骨髓干细胞移植后,其神经系统症状与体征的改善。方法:①选取2005-06/2006-09解放军第四六三医院神经外科收治的神经系统损伤和变性疾病患者42例,对本试验均签署知情同意书。其中各种原因所致脊髓损伤30例,脑血管意外引起的偏瘫4例,老年痴呆2例,小脑疾患引起的共济失调2例,运动神经元变性疾病4例。患者入院后常规检查身体各项指标以评估是否适合行干细胞移植术。②术前患者均于皮下注射粒细胞集落刺激因子进行骨髓干细胞动员,5～12μg/(kg.d),连续4～5d。动员结束后患者在局麻状态下,于髂后上棘采集自体骨髓血约200mL,去除红细胞,密度梯度离心,分离出单个核细胞,再将收获的单个核细胞制成1.5mL细胞悬液(约1×108个细胞)备用。③通过手术或立体定向的方法将干细胞直接移植在神经损伤或变性部位,然后再根据病情经腰穿或静脉途径进行细胞移植,每次给予干细胞量按(2～3)×102个/kg计算,1次/周,共4周。④自体骨髓干细胞移植治疗过程中,为促进干细胞的生长和分化,根据患者病情及个人身体状况给予物理疗法、作业疗法等相应的康复功能锻炼,同时配以针灸、高压氧及药物营养神经和改善微循环治疗。结果:42例神经系统损伤和变性疾病患者均进入结果分析。自体骨髓干细胞移植治疗后1～3个月,17例脊髓损伤患者肢体症状明显改善,尤其是脑损伤后遗症引起的脊髓损伤其肢体症状改善更为显著;2例脑出血和1例脑血栓引起偏瘫的患者其肢体症状改善效果均较好;遗传性共济失调的2例患者疗效均不明显;1例老年痴呆患者其老年痴呆症状得到明显改善,并能在搀扶下行走,与旁人进行正常的交流;运动神经元变性病中1例患者肌萎缩性侧索硬化症改善效果较好,肌张力正常,颤抖减轻及至消失,多发性硬化中2例患者症状减轻。结论:干细胞移植配合功能锻炼等辅助手段对神经系统损伤和变性疾病的治疗效果肯定,有一定的临床应用价值。     

蒺藜中水溶性多糖的研究——杂多糖H的纯化与结构初步确定

从蒺藜(Tribulus terristris L)茎和叶中提出醇溶皂甙后,再提取水溶性粗多糖,其单糖组成及其摩尔比为Ara.,Rha.,Xyl.,GalA.,Gal.,Glc.,Man.,6.0:2.1:1:3.6:3.4:7.7:2.9.粗多糖经分级与纯化得一均一级分H,其单糖组成及其摩尔比为Ara.,Rha,Xyl,GalA,Gal,Glc,1.6:2.4:0.1:3.5:1.3:1。H为酸性杂多糖,分子量约为10万。经果胶酶酶解、β-D-半乳糖苷酶酶解,高碘酸氧化、Smith降解、部分酸水解、甲基化、与GC及GC-MS分析等,表明H为α-D-GalA(1→4)与L-Rha(1→2)可能交替连接构成的主链,一些Rha.上带有分枝。     

The physician at wit's end; a bezoar

The case is described of a three-year-old Moroccan girl with iron deficiency anaemia and a bezoar resulting from trichotillomania and trichophagy leading to a slowly developed obstruction ileus. Causes, symptoms and treatment of the various forms of bezoar are discussed.     

多抗甲素体外对人淋巴细胞IL-2生成及反应性的影响

本文结果表明,多抗甲素(polyactin A,PA)在0.01～100μg/ml的浓度范围内能显著提高人淋巴细胞在PHA作用下分泌白细胞介素2(IL-2),表达IL-2受体以及对IL-2发生反应的能力,此作用呈剂量依赖性。PA在低浓度(0.01～0.1μg/ml)时,尚能拮抗正常人血清中IL-2抑制物的活性。上述结果提示PA能促进IL-2的生成和反应性,从而增强细胞免疫功能。     

多抗甲素抗肿瘤转移作用及其机理

多抗甲素(PAA)在100mg·kg^-1·d^-1剂量下,给药18d,显著抑制B₁₆-F₁₀黑色素瘤人工肺转移,肺转移结节数由137个下降到95个。同位素参入法测定PAA对正常及荷瘤小鼠脾细胞有促增殖作用,并使小鼠脾细胞对PHA刺激的反应性不因荷瘤而降低;PAA且能增强正常及荷瘤小鼠脾脏NK细胞活性,拮抗环磷酰胺对NK细胞活性的抑制作用;PAA体外能不同程度地抑制B₁₆-F₁₀黑色素瘤细胞DNA,RNA和蛋白质合成。放射免疫测定法表明PAA对小鼠血浆TXA₂/PGI₂比值影响较小。PAA抗肿瘤转移作用主要与促进荷瘤机体抗肿瘤免疫反应和直接抑制肿瘤细胞有关。     

高效液相色谱法测定尿中美芬妥英及代谢产物4'-羟基美芬妥英

A simple, sensitive and reproducible HPLC assay is described for the determination of mephenytoin and 4'-hydroxymephenytoin in human urine. Phenobarbital was used as an internal standard.The compounds were separated on a U-Bondapack RP-C₁₈ column using a mobile phase of and the UV detectou was set at 210 nm. Calibration curves in the range 0.05～1.00ug/ml for mephenytoin and 0.5～100.0ug/ml for 4'-hydroxymephenytoin were linear (r=0.9998and r=0.9992,respectivesy). The average recovery was 95.10±2。95%,and the relative standard devia- tion within day and day to day was less than 10%。The detection limit for mephenytoin was 25mg/ml and 4‘-hydroxymephenytoin was 50mg。ml。The method was used to study the metabolism of S-mephenytoin 4'-hydroxylatoin in 10healthy volunteers.The 12 h urinary metabolic ratio (MR)and hydroxylation index(HI)were calculated to express interindividual variation in metabolism. Two of them exhibited defective 4'-hydroxylation of S-mephenytoin as poor metabllizers (HI:1349.18 and 409.57;MR:105.29 and 8.25).In the remaining 8 subjects, the ranged from 1.68 to 6.71 and the MR ranged from 0.002 to 0.014,as extensive metabolizers of S-mephenytoin.     

高效液相色谱法测定乙吗噻嗪在人的血浆浓度及药代动力学

建立了反相高效液相色谱法测定人血浆中乙吗噻嗪浓度。色谱柱采用SpherisotbC18柱(25cm×4.6mm,5μm),流动相为甲醇—水—三乙胺(70:30:0.4,pH6.5),检测波长268nm。用乙腈沉淀蛋白后,吹干浓缩进样。血药浓度在20～4000ng/ml范围内呈线性关系,相关系数0.9994,血浆最低检测浓度3ng/ml。方法回收率90～103%,日内、日间RSD2.4～10.2%。应用该法研究了8名志愿者口服乙吗噻嗪片后的药代动力学,用一室模型拟合,消除相半衰期为1.75±0.45h。本法简便、回收率和灵敏度高、重复性好,适于临床药代动力学和药效学的研究。