正常颅内压状态下人脑桥静脉的影像学研究

目的 在体观察磁共振图像上脑桥静脉的形态学特征,建立生理状态下该段血管直径的正常值参考范围,评价脑内中小静脉磁共振血管成像的有效性和临床应用价值.方法 利用磁共振静脉血管成像技术的二维时间飞跃法(2D-TOF)对50例无颅内疾患成人的脑桥静脉扫描成像,以最大强度投影法对获得的原始图像进行后处理,Syngo fastview影像处理系统对人脑桥静脉影像测量分析,统计学分析得出直径的95%可信区间,建立该段血管生理情况下直径的正常值参考范围.结果 性与女性的桥静脉直径分别为(3.58±0.39)、(3.29±0.37)mm、95%可信区间分别为(3.48±0.39)、(3.22±0.26)mm.额叶桥静脉直径最小,其余各叶桥静脉直径差异无统计学意义,男性桥静脉直径大于女性.结论 脑桥静脉可通过2D-TOF血管扫描成像获得很好的显示,此段静脉在影像学上具有显著的形态学特征,如血管排列方式、血管走行、脑桥静脉壶腹的形成、汇入静脉窦前段的信号减弱甚至消失等.可把计算所得的95%可信区间认为是脑桥静脉直径的正常值范围,建立脑静脉系统的最后通路-脑桥静脉的直径正常值范围.人,脑桥静脉;磁共振成像;时间飞跃法;最大强度投影     

Inhibition and subsequent enhancement of platelet responsiveness by prostacyclin in the rabbit. Relationship to platelet adenosine 3'',5''-cyclic monophosphate.

Methods were developed for measuring changes in platelet sensitivity to a release-inducing stimulus and in platelet cyclic AMP in fresh whole blood samples from rabbits. These techniques permitted detection of the effects of exogenous and endogenous prostacyclin on circulating platelets. In these methods, rabbit platelets were labeled in vitro by incubation with [14C]serotonin and [3H]adenine and then transfused into other rabbits. Release of platelet [14C]serotonin by a standard dose of synthetic platelet-activating factor (40 pmol/ml) and the platelet cyclic [3H]AMP levels were then measured in citrated blood from the conscious animals within 2 min of arterial puncture. Bolus intravenous injections of prostacyclin (1-10 nmol/kg) caused concentration-dependent increases in platelet cyclic AMP after 2 min, which decreased approximately 75% by 5 min, and disappeared after 30 min. Significant inhibition of the platelet release reaction was detected 2 min but not 5 min after injection of 10 nmol of prostacyclin per kilogram. With lower doses, significant enhancement of the release of [14C]serotonin was observed after 5 min. Similar changes in platelet responsiveness and cyclic [3H]AMP were observed after release of endogenous prostacyclin by intravenous injection of angiotensin II (5 nmol/kg); inhibition of the release of [14C]serotonin after 2 min was followed by potentiation after 5 min, though platelet cyclic [3H]AMP remained above control values. In these experiments, the time course of the changes in platelet cyclic [3H]AMP correlated closely with values for blood prostacyclin obtained previously (Haslam, R.J., and M.D. McClenaghan, 1981, Nature [Lond.]., 292:364-366). Prostacyclin also had a biphasic effect on the release of [14C]serotonin when added to citrated blood in vitro, though both the increase in sensitivity to platelet-activating factor and the return of platelet cyclic [3H]AMP towards control values took place more slowly. At all times, addition of platelet-activating factor decreased platelet cyclic [3H]AMP towards but not below the control level observed in the absence of prostacyclin. Our results indicate that although transient increases in platelet cyclic AMP cause an immediate decrease in platelet responsiveness in vivo or in vitro, a period of enhanced platelet sensitivity follows as platelet cyclic AMP falls.     

重T2WI和增强T1WI MRI联合评估泪囊鼻泪管的优势

目的探讨MRI重T2WI(h-T2WI)和增强T1WI(Ce-T1WI)组合序列对正常和阻塞的泪囊鼻泪管的显示能力。材料与方法在脂肪抑制的基础上,用hT2WI和Ce-T1WI序列,薄层连续扫描正常和有阻塞的泪囊鼻泪管,扫描方位是轴面(AP)和冠状面(CP),用静态和动态两种扫描方式。结果静态扫描正常泪囊鼻泪管23例46侧,其中24侧用h-T2WI+Ce-T1WI+AP+CP组合,6侧用hT 2 W I+C e-T 1 W I+A P组合,8侧用h-T 2 W I+A P+C P组合,8侧用C eT1WI+AP+CP组合。动态轴面扫描正常泪囊鼻泪管10例20侧,均用hT2WI+AP组合。静态扫描阻塞的泪囊鼻泪管9例10侧,均用h-T2WI+CeT1WI+AP+CP组合。正常和有阻塞的泪囊鼻泪管均能被良好显示。(1)正常的泪囊鼻泪管:静态扫描见泪囊鼻泪管的管腔狭小,鼻泪管更小,并且形态多样;动态扫描见部分节段的管腔可自主性增大或变小。横断面上泪囊呈长椭圆形(16侧)或裂隙状(30侧),移行部均呈半月形,鼻泪管呈短椭圆形(28侧)或类圆形(18侧)。用静态h-T2WI序列,轴面图像上94.7%(36/38侧)的泪囊鼻泪管呈现了3层信号结构,冠状面图上31.2%(10/32侧)呈现了3层信号结构;这3层信号结构分别代表了管腔内容物、管壁内1/4和管壁外3/4;管腔内的泪液、泪膜和空气分别呈最高信号、高信号和最低信号;管壁内1/4呈低信号,管壁外3/4呈高信号。在Ce-T1WI序列上,管壁可以被明显强化。(2)有阻塞的泪囊鼻泪管:梗阻部位和病变的范围均被精确显示,其中管腔狭窄1侧,闭塞9侧;梗阻点以上管腔积液(脓)扩张,管壁变薄;梗阻点管腔消失或明显狭小,在h-T2WI上丧失3层信号结构。结论 h-T2WI结合Ce-T1WI序列的MRI,可以清晰的显示正常生理状态下的泪囊鼻泪管的管腔、管壁的层次和行经;也能够精确显示有梗阻的泪囊鼻泪管的梗阻部位、病灶范围,区分有血供和无血供的组织结构。动态h-T2WI发现正常管腔的大小有自主性变化。     

Partial trisomy 4q resulting from a familial 4/3 translocation

A case of trisomy 4q resulting from a balanced paternal translocation is described. Phenotypic similarity of cases with similar break points included hypoplastic nasal alae, short philtrum and pursed lips, and prominent ears. The birth of the proband was preceded by unexplained infertility, oligospermia in the father, and increased fetal wastage. Each of these features is an appropriate indication for cytogenetic analysis. If such an analysis had been done, the unbalanced translocation state in a liveborn, handicapped child could have been anticipated.     

A system of electronic records developed by a children's hospice

This paper describes the development, implementation and dissemination of an electronic data collection system for children's hospices in the UK. In 1999, CHASE Hospice Care for Children (CHASE) began providing support for life-limited children and their families in their own homes across south-west London, Surrey and West Sussex. CHASE community team is multidisciplinary and original members of the team had to create all of the necessary administrative systems for collecting and storing information about referrals and care provided to children and their families. The community team had the foresight to record activity statistics from day one of the service. The team worked together to identify information routinely collected that could usefully be stored on a computer database and a simple solution was created for this purpose using Microsoft Access version 2. CHASE was in a privileged position because the commitment to use information technology came from people providing care to children and their families.     

护士服务态度在医院效益中的作用

目的 确定护士服务态度在医院效益中的作用,以便更好地提高护理服务质量.方法 采用问卷调查法,根据冈谷惠子的"护患关系信任度量表"及自行设计问卷,对162名住院患者进行调查,并对结果进行分析.结果 患者对护士服务态度的需求高于真实体验;患者对医生的服务态度认可高于对护士服务态度;患者对护士服务态度满意度低于对护理技术的满意度.结论 护士服务态度在医院效益中起保健因素作用.     

右美托咪啶预先给药和后处理对大鼠肾缺血再灌注损伤的影响

目的 评价右美托咪啶预先给药和后处理对大鼠肾缺血再灌注损伤的影响.方法 健康雄性Wistar大鼠32只,体重220～300 g,3～4月龄,采用随机数字表法,将大鼠随机分为4组(n=8):假手术组(S组)、缺血再灌注组(I/R组)、右美托咪啶预先给药组(Pre组)和右美托咪啶后处理组(Post组).肾缺血60min,再灌注48 h制备肾缺血再灌注损伤模型.Pre组和Post组分别于缺血前30 min和再灌注开始时腹腔注射右美托咪啶50μg/kg.于再灌注即刻、24、48 h(T1-3)时分别测定血清肌酐和血尿素的浓度.再灌注结束时取肾组织,光镜下观察病理学改变,并行急性肾小管坏死评分,采用TUNEL法测定细胞凋亡,计算细胞凋亡指数.结果 与S组比较,其余3组T2,3时血清肌酐和血尿素的浓度升高,急性肾小管坏死评分和细胞凋亡指数升高(P＜0.05).与I/R组比较,Pre组和Post组T2,3时血清肌酐和血尿素浓度降低,急性肾小管坏死评分和细胞凋亡指数降低(P＜0.05).结论 右美托咪啶预先给药和后处理均可减轻肾缺血再灌注损伤,其机制与抗细胞凋亡作用有关.     

细胞间粘附分子—1表达水平对心肌再灌注损伤的影响及N—乙 …

探讨细胞间粘附分子表达与中性粒细胞浸润与心肌血再灌注损伤的关系并观察Ｎ－乙酰半胱氨酸对ＩＲＩ的保护效果。方法大鼠１１６只,分设：（１）缺血再灌注（ＩＲ）组;（２）ＩＲ＋ＮＡＣ组;（３）假手术对照组,并分庙再灌注１、３、６、１２、２４ｈ时相点。取缺血心肌用原位杂交和免疫组织检测ＩＣＡＭ－１ｍＲＮＡ及其蛋白表达水平,用酶法测定ＰＭＮｓ浸润数,ＴＴＣ染色法测心肌梗死范围,结果心肌再灌注时,ＩＣＡＭ－１表     

Increased levels of serum interferon-gamma in pulmonary sarcoidosis and relationship with response to corticosteroid therapy

The aim of this study was to evaluate serum levels of the lymphokine interferon-gamma (IFNg) in patients with chronic pulmonary sarcoidosis, and to investigate its value as a predictive marker of clinical response to corticosteroid therapy. Twenty-five patients and 28 age-matched control subjects were studied. All the patients had parenchymal shadows (Stage II or Stage III) and none had clinical evidence of extrathoracic disease. Before therapy, serum IFNg levels were significantly higher in the patient group (p less than 0.001), and 20 (80%) had values above the normal range. After oral treatment with corticosteroids for a median 13 months (range, 3 to 49 months) the levels decreased significantly (p less than 0.01). However, the falls were less pronounced in patients who had a better outcome in terms of achieving complete radiographic resolution and in those who improved in forced vital capacity by greater than or equal to 10%. The prognostic value of the pretreatment serum IFNg was explored, and a significant relationship was found between higher pretreatment levels and lower grades or radiographic abnormality assessed 3 yr after commencement of treatment (p less than 0.01). In addition, the patients who had cleared completely while receiving steroids and remained in remission had significantly higher pretreatment serum IFNg levels than did those with incomplete resolution of parenchymal shadows or radiographic relapses (p less than 0.05). We conclude that elevated levels of circulating IFNg are detectable in most untreated patients with Stage II/III pulmonary sarcoidosis and that patients with the highest levels appear to have a better chance of achieving complete resolution with corticosteroid therapy.     

The growth fraction of human myeloma cells

Greater reductions of tumor load in patients with multiple myeloma may result from therapeutic strategies that are based on a better knowledge of growth kinetics. We have previously shown that the labeling index of myeloma cells remains unchanged when tumor mass is reduced and that the cells of relapsing patients have differnt biologic properties than the cells present before melphalan-prednisone therapy. This study investigated the growth fraction (GF) of myeloma cells at various disease stages using continuous i.v. infusions of tritiated thymidine. We studied 17 patients on 22 occasions (4 untreated, 2 unresponsive, 6 in remission, and 10 in relapse). All untreated an unresponsive patients and 5 of 6 patients in remission had a GF of less than 4%. GF was defined in these studies as the maximum percentage of labeled plasma cells exposed continuously to tritiated thymidine. Relapsing patients, with the most rapid tumor doubling times, had GF ranging from 14% to 83%. The plasma cell transit time through the proliferative compartment for all of the relapsing patients ranged from 6.6 to 11.9 days and the calculated intrinsic cell loss ranged from 50% to 86%. These findings support our model for the growth kinetics of multiple myeloma that assumes that the entire tumor mass issues from a small proportion of proliferating cells and that the growth kinetics of myeloma cells in relapsing patterns differ from those in untreated and unresponsive patients. Therapeutic trials with cycle-active agents need further investigation in selected relapsing patients who are likely to have a high growth fraction.