铁道车祸危险因素与行车安全经济效益的探讨

作者以1380名机车乘务员为研究对象,测查其生理心理指标,探讨发生车祸的危险因素,分析34年车祸流行的规律,并对行车安全的社会经济效盖进行了估算。研究结果显示,社会安定是减少车祸、保证行车安全的重要因素。通过多因素分析,揭示车祸的危险因素是低文化程度、过度疲劳、睡眠不足、视运动反应迟钝和弱神经类型,其间存在交互作用。实践表明,推行安全行车千日活动,可获巨大社会经济效益(1∶7)。     

Discriminant analysis in diagnosing carcinoma of the pancreas and of the papilla of Vater

The clinical and biochemical presentation of carcinoma of the pancreas (PC) and of the papilla of Vater (CPV) are very similar, and, consequently, detailed investigations are required to correctly distinguish between them. The aim of the present study was to select the clinical and biochemical variables that would most efficiently discriminate the precise site of tumor origin. The study group consisted of 72 patients with PC and 22 patients with CPV consecutively hospitalized in our department. The following clinical parameters were considered: age, asthenia, anorexia, vomiting, weight loss, pain, fever, pruritis, and constipation; the biochemical parameters considered were total, direct, and indirect bilirubin, glucose, alkaline phosphatase, gamma glutamy transferase, transaminase, total protein, amylase, and occult blood in stools. The results indicated that in the initial phase of PC the most frequent clinical parameters were weight loss (P<0.0001), anorexia (P<0.02), constipation (P<0.001), and pruritus (P<0.01). In contrast, in CPV, fever (P<0.003) was most frequent in the same phase. There was a statistically significant difference in occult blood in stools (P<0.0001), total (P<0.03) and direct bilirubin (P<0.02), alkaline phosphatase (P<0.05), and transaminase (P<0.002) values in the two groups. On discriminant analysis, weight loss, constipation, pruritus, nausea, anorexia, and fever were the variables which best discriminated between the two types of tumors. In fact, the presence of weight loss, anorexia, asthenia, constipation, and pruritus correctly classified 87.5% of the patients with PC, while the presence of fever and nausea correctly classified 72.7% of the patients with CPV.     

高血压病患者血清瘦素含量与胰岛素抵抗水平的相关性研究

目的：探讨高血压病患者血清瘦素水平与胰岛素抵抗的关系。方法：测定217例高血压病患者(男92例，女125例)的空腹血清瘦素含量、空腹血糖、胰岛素、收缩压、舒张压和体质量指数(BMI)，稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)。分析瘦素与其他各项参数的相关性。结果：以HOMA—IR的25％位点，作为判断胰岛素抵抗的切割点，把高血压病患者分为胰岛素抵抗组(IR)和胰岛素敏感组(IS)，血清瘦素浓度IR组显著高于IS组(P＜0．05)。血清瘦素浓度与HOMA—IR呈显著正相关(男性r＝0．407，P＜0．01；女性r＝0．254，P＜0．01)；校正年龄和BMI后，男性组两者仍呈显著正相关(r＝0．219，P＜0．05)，女性组两者无相关；逐步回归分析显示，男性组HOMA—IR为血清瘦素浓度的独立预测因素。结论：男性高血压病患者血清瘦素浓度与胰岛素抵抗直接相关，女性则无直接相关性。性别差异的机制有待进一步探讨。     

Porins and lipopolysaccharide stimulate platelet activating factor synthesis by human mesangial cells.

Porins, a family of hydrophobic proteins located in the outer membrane of the cell wall of gram-negative bacteria and lipopolysaccharide (LPS), were shown to stimulate the synthesis of platelet activating factor (PAF), a phospholipid mediator of inflammation and endotoxic shock, by cultured human glomerular mesangial cells (MC). The synthesis of PAF induced by porins was rapid (peak at 20 min) and independent either from contamination by LPS or from generation of an endotoxin-induced cytokine such as tumor necrosis factor (TNF) since it was not prevented by cycloheximide, an inhibitor of protein synthesis or anti-TNF blocking antibodies. LPS also stimulated PAF synthesis by MC. However, the kinetic of PAF synthesis induced by LPS was biphasic with an early and transient peak at 10 minutes and a second and sustained peak at three to six hours. This second peak required an intact protein synthesis and was prevented by anti-TNF antibodies, suggesting the dependency on LPS-induced synthesis of TNF. Experiments with labeled precursors demonstrated that in MC, either after stimulation with porins or LPS, PAF was synthesized via the remodeling pathway that involves acetylation of 1-0-alkyl-sn-glyceryl-3-phosphorylcholine (2-lyso-PAF) generated from 1-0-alkyl-2-acyl-sn-glyceryl-3-phosphorylcholine by phospholipase A2 (PLA2) activity. Porins and LPS, indeed, induced PLA2-dependent mobilization of [14C]-arachidonic acid that was inhibited by p-bromodiphenacylbromide (PBDB). PBDB, an inhibitor of PLA2, also blocked PAF synthesis by preventing the mobilization of 2-lyso-PAF, the substrate for PAF-specific acetyltransferase.(ABSTRACT TRUNCATED AT 250 WORDS)     

白细胞介素-13功能研究进展

白细胞介素－13主要由活化的Th2(CD4^ )细胞分泌，诱导单核巨噬细胞分化及延长寿命；促进MHC－Ⅱ，CD23表达；抑制炎性和趋化因子产生；诱导B细胞增殖，活化，刺激IgM,IgG的产生和重链的转换；使血管细胞粘附分子－1表达；抑制人类免疫缺陷病毒（HIV）复制；间接诱导巨噬细胞和NK细胞参与抗肿瘤作用。在变态反应性疾病和哮喘中引起呼吸道高反应性，嗜酸粒细胞性炎症，粘液分泌过多，基膜纤维化等，其受体是与IL－4Rα形成功能复合体而发挥作用。IL－13信号转导途径除了JAK／STAT6以外，尚有IRS－1,Fes，磷酸激酶，BCL－6／SOCS等途径。     

Chronic peritoneal dialysis in paediatrics: Experience of a national registry

The results of the first 3 year' collaboration of the Italian Registry of Paediatric Chronic Peritoneal Dialysis (CPD) (1986–1988) are presented. This Registry acquired data on the majority of the paediatric patients treated with CPD in Italy, thus providing a national picture in a field where few nationwide surveys are available. Patients of less than 15 years of age at the start of dialysis were enrolled and clinical data collected until the age of 19 years. The number of nephrological paediatric centres participating in the Registry increased from 7 in 1986 to 11 in 1988. The total number of patients on CPD was 70 and the percentage of dialysed children treated with CPD ranged from 40.2% to 43.6%. Data on 89 peritoneal catheters were collected: during 1417 dialysis-months 70 catheter-related complications were observed (1:20.8 dialysis-months); actuarial catheter survival was 92.7% at 6 months, 84.8% at 1 year and 68.8% at 2 years. The incidence of peritonitis changed from 1 episode every 10.9 patient-months in 1986 to 1 every 19.8 in 1988. Abdominal hernias were the other main clinical complication observed. The survival of patients was 92.5% at 3 years, while the technique survival at the same time was 84%.     

Spontaneous angina caused by spasm of the left coronary artery]

A 42 year old woman presented with a one year history of retrosternal chest pain and back pain on effort and at rest sometimes accompanied by minor syncopal attacks. Transient atrioventricular block was documented during one such episode associated with hypotension. Coronary angiography showed spontaneous spasm of the left main coronary artery with clinical symptoms but no electrocardiographic changes. The spasm was relieved by injection of SIN-1. The similarity between the previous clinical symptoms and those observed at coronary angiography was in favour of the diagnosis of spasm of the left main coronary artery without atherosclerotic coronary disease. Treatment with calcium atherosclerotic coronary disease. Treatment with calcium blockers and platelet antiaggregants led to total regression of her symptoms with a follow-up of 5 months.