von Willebrand factor binding to platelet glycoprotein Ib-IX-V stimulates the assembly of an α-actinin-based signaling complex

Summary. Background: Pathological shear stress induces platelet aggregation that is dependent on von Willebrand factor (VWF) binding to glycoprotein (Gp)Ib‐IX‐V and phosphatidylinositol 3‐kinase activation. We tested the hypothesis that pathological shear stress stimulates phosphatidylinositol 3,4,5‐trisphosphate (PIP₃) synthesis by directing the assembly of a molecular signaling complex that includes class IA phosphatidylinositol 3‐kinase (PI 3‐KIA). Methods: Platelets were subjected to 120 dynes cm^?2 shear stress in a cone‐plate viscometer. Resting and sheared platelets were lyzed, immunoprecipitations of PI 3‐KIA performed, or lipids extracted for PIP₃ measurements. α‐Actinin was incubated with phosphatidylinositol 4,5‐bisphosphate (PIP₂), immunoprecipitated, and used as a substrate for in vitro PI 3‐KIA activity. Results: Pathological shear stress induces biphasic PIP₃ production. In resting platelets, PI 3‐KIA associates with α‐actinin and PIP₂. After exposure to shear stress, α‐actinin and PIP₂ rapidly disassociate from PI 3‐KIA. PI 3‐KIA then gradually re‐associates with PIP₂ and α‐actinin, and this complex becomes linked to GpIbα through the cytoskeleton. PIP₃ production and the observed changes in the association between α‐actinin, PIP₂, and PI 3‐KIA are inhibited when VWF binding to GpIbα is blocked. In a cell‐free system, α‐actinin binds PIP₂ and when the α‐actinin–PIP₂ complex is added to platelet PI 3‐KIA, PIP₃ production is stimulated. Conclusions: These results suggest that pathological shear‐induced VWF binding to GpIb‐IX‐V stimulates PIP₃ production through the assembly of an α‐actinin‐based complex that colocalizes PI 3‐KIA with substrate PIP₂.     

不同麻醉方式对儿童腹腔镜疝囊高位结扎术应激反应的影响

目的探讨两种麻醉方法对儿童腹腔镜疝高位结扎术（lapamscopic hernia sac high ligation）应激反应的影响。方法ASAⅠ-Ⅱ级择期行腹股疝疝囊高位结扎术患儿60例，年龄6—12岁，随机分为硬膜外麻醉组（E组）和单纯气管内全麻组（G组）各30例。检测术中不同时点血浆皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）、促肾上腺皮质激素（ACTH）浓度并观察平均动脉压（MAP）和心率（HR）的变化。结果E组各时点Cor、NE、E、ACHT浓度无明显变化（P〉0．05），G组气腹后上述各指标较气腹前明显增高（P〈0．05）且显著高于E组同时点（P〈0．05）（见表2）；E组气腹后平均动脉压及心率变化无统计学意义（P〉0．05），而G组的则显著升高（P〈0．05）；两组患儿气腹10min后PaC02均显著增加（P〈0．05），停气腹后渐恢复至正常，血PH值则变化不明显。结论硬膜外麻醉复合基础麻醉相对于单纯气管内全麻更能有效抑制儿童腹股疝疝囊高位结扎术的应激反应。     

第一、二鳃弓综合征颜面不对称的整形外科矫治

目的探讨第一、二鳃弓综合征面部不对称畸形的整形外科矫治方法。方法根据第一、二鳃弓综合征患者临床及X线所示面部双侧不对称情况,采用健侧下颌骨外板去除、颧骨截骨降低;患侧下颌体、颧骨应用健侧下颌骨外板贴附植骨或高密度多孔聚乙烯(Medpor)假体置入等术式,配合颏部水平截骨颏成形术,以缩小面部双侧宽度的差异,矫治颜面不对称畸形。结果共矫治23例,经6个月至3年的术后随访观察,双侧面部宽度差异明显缩小,正面观面部不对称明显改善。结论第一、二鳃弓综合征面部骨骼发育畸形是三维方向的,双侧面骨宽度的差异,是造成正面观面部不对称的重要因素,根据受术者的具体情况,采用以上术式的组合,扩充患侧或同时缩窄健侧骨骼,进行面部骨性支架重建,可以取得良好的矫治效果。     

内皮素在阻塞性黄疸早期门静脉高压症中的作用

目的初步探讨阻塞性黄疸早期门静脉高压的机制。方法将大鼠分为胆管结扎组（B）与假手术组（A），分别于术后3、7、14d比较两组的游离门静脉压力（FPP）、血浆和肝组织内皮素（ET）浓度。结果胆总管结扎7d后门静脉压力显著高于对照组；胆总管结扎后各时段ET水平均显著高于对照组；门静脉压力与血浆ET、肝组织ET呈正相关。结论阻塞性黄疸早期即有门静脉压力的升高，它可能是体内ET水平升高致肝窦阻力增加的结果。     

肝门部胆管癌的治疗

目的探讨肝门部胆管癌的治疗方法。方法回顾性分析我院1996，2004年间52例肝门部胆管癌患者的临床病例资料。I型癌肿切除率最高，Ⅳ型癌肿切除率最低。结果本组52例肝门部胆管癌中，围手术期死亡2例，均死于肝肾功能衰竭，余50例中31例术后获得随访，失访19例，随访率为62％。结论疑似或诊断肝门部胆管癌应早期积极手术探查，争取行根治性切除术；肝门部胆管癌肿瘤切除疗效明显优于其他治疗方式。     

The common ultrasonographic features of pilomatricoma.

OBJECTIVES: The purpose of this series was to describe typical ultrasonographic features of 20 cases of pilomatricoma and to improve its diagnostic rate with the use of an ultrasonographic approach. METHODS: For 20 pilomatricomas in 19 patients with preoperative ultrasonography from 1995 to 2004, we reviewed age, sex, symptoms, duration, referring clinician, and tumor sites. The ultrasonographic findings were retrospectively analyzed for tumor location, shape, size, margin, echo texture, echogenicity, presence, amount, and shape of calcification, presence of a hypoechoic rim, and Doppler flow pattern. RESULTS: The mean age of the 19 patients was 6.9 years (range, 1-21 years), and the female-male ratio was 1.1:1. Patients had a painful palpable mass in 10 cases (50%). Nine lesions occurred in the neck, 5 in the cheek, 2 in the preauricular region, and 4 in the extremity. All tumors were located in the subcutaneous layer. The mean size of the tumors was 13.4 mm. Fourteen pilomatricomas (70%) appeared as well-defined oval masses. Tumors were heterogeneously hyperechoic in 80% of cases. All tumors had internal echogenic foci. A hypoechoic rim was seen in 17 cases (85%). Doppler flow signals were observed in the peripheral region in 14 cases (70%). A correct preoperative diagnosis was made in 33% on the basis of clinical findings and in 76% by ultrasonography. CONCLUSIONS: Diagnosis of pilomatricoma should be considered when a well-defined mass with inner echogenic foci and a peripheral hypoechoic rim or a completely echogenic mass with strong posterior acoustic shadowing in the subcutaneous layer of the head, neck, or extremity is found on ultrasonography.     

埋藏式可调节缝线在二切口青光眼白内障联合手术中的应用

目的：观察应用可调节缝线的二切口青光眼白内障联合手术的临床效果。方法：回顾性分析行青光眼白内障联合手术的患者84人（92眼）,二切口组38人（42眼）,在二切口联合手术基础上加可调节缝线;单切口组46人（50眼）。比较两组患者术后视力和眼压,浅前房、高眼压等并发症的发生,术后6个月的手术成功率及滤过泡形态。结果：手术前后两组患者之间视力比较差异无统计学意义;两组患者术前及术后1d眼压比较无统计学意义,但术后3d,术后1周,术后1月及术后6月两组患者的眼压比较均具有统计学意义;术后6个月手术成功率,观察组高于对照组,但差异无统计学意义（P〉0.05）;术后6个月的滤过泡形态,两组之间差异无统计学意义。结论：应用埋藏式可调节缝线的二切口青光眼白内障联合手术可有效控制患者眼压,提高联合手术远期成功率。     

《癌变·畸变·突变》杂志1992──1995年16期文献计量分析

运用文献计量分分析法对本刊１９９２－１９９５年１６期所刊文章作了分析。结果：致突变的文章较多；每篇文章作者平均３．９４人，大多集中在高等院校及科研机构，地区分布较广，高产作家尚少；平均引文８．２２篇，引文以中、英文期刊为主；文献半衰期为中文４．１６年，英文６．９３年；有８种核心期刊；自引率较高。与创刊后的前１２期（１９８９－１９９２）相比：一次性文献比重明显增加，致畸文章比重增加，高产作家相对增多，英文引文增加，英文半衰期缩短近二年半，提示刊物水平有提高趋势。     

青霉烷砜对氨苄青霉素的增效作用

观察加用青霉烷砜后氨苄青霉素对痢疾杆菌的体外杀菌效果。结果表明,加用青霉烷砜后对69株痢疾杆菌的杀菌效果,从单纯氨苄青霉素的杀菌率59.4％(41/69)提高到98.6％(68/69),有显著增效作用(P<0.005)。各株痢疾杆菌对国产和墨西哥产氨苄青霉素的敏感性无差异。证明青霉烷砜对氨苄青霉素有增效作用,对原耐氨苄青霉素痢疾杆菌的杀菌率达96.4％(27/28)。对耐药痢疾杆菌治疗药物的选择提供了有益的参考。     

手部烧伤后重度虎口挛缩虎口重建术

自１９８９年２月～１９９５年３月，对２３例手部烧伤后重度虎口挛缩行瘢痕切除及虎口开大后，选用带旋髂浅血管蒂的腹股沟皮瓣移植重建虎口，术后均取得了满意效果。虎口挛缩的程度为０°～２５°。虎口开大后达８０°～９０°。虎口区瘢痕切除后皮肤缺损最小８ｃｍ×５ｃｍ，最大１２ｃｍ×６ｃｍ，平均１０ｃｍ×５ｃｍ。皮瓣切取面积最小１４ｃｍ×７ｃｍ，最大１８ｃｍ×８ｃｍ，平均１６ｃｍ×７ｃｍ。术后皮瓣断蒂时间为２～３周，２３例皮瓣均完全成活。对重度虎口挛缩应用带旋髂浅血管蒂的腹股沟皮瓣移植重建虎口是一种简单易行、成功率高的方法。因其具有供区部位隐蔽，皮肤质量好，不损伤肢体重要血管及可早期断蒂等优点，极易被患者接受。