间断性肝门阻断下肝细胞超微结构变化和应激基因的表达研究

目的　研究间断肝门阻断对肝细胞结构及应激基因变化的影响。方法　选择 33例和 14例 (分别作为实验组和对照组 ) ,采用半定量RT PCR方法和电子显微镜技术检测肝叶切除前后应激基因TNF α、IL 6、HSP70A和HSC70的表达状况及细胞超微结构的改变。结果　热休克基因家族HSP70A和HSC70在间断肝门血流阻断组阻断前后的mRNA表达分别为 1 5± 0 2 9,2 0 3± 0 5 3(u =0 92 ,Ρ <0 0 5 ) ;1 6 9± 0 47,1 86± 0 36 (u =1 0 ,Ρ <0 0 5 )。在对照组 ,HSP70A和HSC70切肝前后的表达值分别为 1 39± 0 2 2 ,0 92± 0 3(P >0 0 5 ) ;1 32± 0 19,1 2 8± 0 2 6 (P >0 0 5 )。TNF α和IL 6在两组中无明显差异。电子显微镜下发现阻断组肝细胞及肝窦内皮细胞的超微结构保持正常。结论　间断肝门血流阻断方法能诱导肝组织热休克基因家族高表达 ,这对保持肝细胞间的稳定和正常的超微结构非常重要。     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.     

Multiple miliary osteoma of the face

A case of multiple miliary osteomas of the face in a 68-year-old female with no personal history of acne or former inflammatory skin disorders is reported. The patient showed multiple painless, stone-like formations at several sites of the face. Histological, echographic and radiological investigations confirmed the presence of bone tissue in the dermal layer. Multiple miliary osteoma of the face is considered the rarest variant of primary osteoma.     

Correlation of serum HCV RNA and alanine aminotransferase levels in chronic hepatitis C patients during treatment with ribavirin

to evaluate the effect of ribavirin on serum hepatitis C virus (HCV) RNA and alanine aminotransferase (ALT) levels, 22 patients with chronic HCV infection were treated with oral ribavirin 1200 mg daily in three divided doses for 4 weeks. At the end of 4 weeks treatment, the serum ALT decreased in all but one patient and became normal in three individuals. The mean pretreatment serum ALT was reduced significantly from 193 ± 45 i.u./L to 95 ± 16 i.u./L after 4 weeks therapy (P= 0.009). However, 8 weeks after cessation of treatment, the serum ALT rose to a mean value of 154 ± 21 i.u./L. The mean pretreatment serum HCV RNA was not significantly decreased at the end of 4 weeks treatment (7.0 × 10⁵vs 4.1 × 10⁵ copies/mL, P > 0.05). However, serum HCV RNA levels were decreased in 12 and increased in 10 patients at the end of 4 weeks therapy. Eight weeks after cessation of therapy, the serum HCV RNA of 22 patients rose to a mean value of 4.9 ± 10⁵ copies/mL. Six patients who continued to have elevated serum ALT and positive HCV RNA after the initial 4 weeks treatment received oral ribavirin at the same dosage for an additional 24 weeks. The serum ALT again decreased in all six patients during therapy, but rose to pretreatment values by 8 weeks after cessation of the treatment. In addition, no significant changes were noted in the mean serum HCV RNA levels during and after 24 weeks of ribavirin therapy. Our results indicate that oral ribavirin only transiently lowered serum ALT values and did not efficiently suppress HCV synthesis in patients with chronic hepatitits C infection.     

Transjugular liver biopsy: Comparison with percutaneous liver biopsy

Abstract A transjugular liver biopsy was performed on 60 patients. Specimens were successfully obtained from 57 (95%) patients. Specimens obtained from cirrhotic patients were frequently small-sized/fragmented. The wedge hepatic venous pressure and hepatic venous pressure gradient were higher in patients with small-sized/fragmented specimens than those with non-fragmented specimens (16.3 ± 6.4 vs 12.3 ± 4.9 and 10.9 ± 6.2 vs 7.3 ± 3.4 mmHg, P <0.05, respectively). During the same period of time, percutaneous liver biopsies were consecutively performed on 277 patients. The liver specimens by transjugular method were generally smaller (0.63±0.58 vs 1.50±0.86 cm, P <0.001) and more fragmented (63% vs 16%, P <0.01) than those obtained by percutaneous method. Biopsy specimens obtained for diagnosis by the former method were inadequate from 6 (10%) patients and by the latter route were inadequate from 7 (2%) patients. Subcapsular haematoma in one patient was associated with the transjugular liver biopsy. Minor complications occurred in three patients: neck haematoma in two and paroxysmal supraventricular tachycardia during the procedure in one. In comparison, percutaneous liver biopsy was followed by minor complications in 20 patients and major complications in four patients. It is concluded that transjugular liver biopsy is a safe, valuable and alternative procedure to obtain liver specimens, especially in patients who were contraindicated for percutaneous liver biopsy.     

Relationships between the severity of cirrhosis and haemodynamic values in patients with cirrhosis

Abstract The relationship between the severity of cirrhosis and systemic and hepatic haemodynamic values was evaluated in 193 patients with cirrhosis, most of whom were diagnosed with post-necrotic cirrhosis. It was found that the hepatic venous pressure gradient and cardiac output in Pugh's A patients (13.6 ± 4.8 mmHg and 6.2 ± 1.6 L/min, mean ± s.d.) were significantly lower than in both Pugh's B (16.8 ± 4.3 mmHg and 7.3 ± 2.1 L/min) and Pugh's C (18.8 ± 5.5 mmHg and 7.4 ± 2.3 L/min) patients ( P < 0.01), respectively. In contrast, the systemic vascular resistance in Pugh's A patients (1232 ± 369 dyn/s per cm⁵) was significantly higher than in both Pugh's B (1016 ± 345 dyn/s per cm⁵) and Pugh's C (935 ± 234 dyn/s per cm⁵) patients ( P < 0.01), respectively. Additionally, not only was there a positive correlation found between Pugh's score and cardiac output and hepatic venous pressure gradient, but a negative correlation was found between Pugh's score and systemic vascular resistance. It was also confirmed that the degree of portal hypertension and the hyperdynamic circulation were more severe in patients with ascites than in those without ascites. However, there were no statistically significant differences in hepatic venous pressure gradient among patients with F1, F2 and F3 esophageal varices (15.7 ± 4.0, 17.0 ± 4.8 and 18.0 ± 4.8 mmHg, respectively). It is concluded that in those patients with cirrhosis, the severity of cirrhosis is closely related to the degree of the hyperkinetic circulatory state and portal hypertension.     

Microcystic meningiomas—an unusual morphological variant of meningiomas

Evidence for tumour suppressor genes (anti-oncogenes, hemerogenes, flatogenes) has been obtained from the behaviour of familial childhood tumours in man, tumours in Drosophila caused by recessive mutations, experiments on fusing tumour cells to normal cells in tissue culture and revertants of oncogene-transformed cells. They may comprise more than one class of genes, one of which is likely to consist of genes responsible for normal differentiation. In large long-lived animals like man, which have a large potential somatic mutational load, mutant genes are associated with autosomal dominant behaviour in families. The susceptible individuals inherit heterozygosity of the tumour gene but the emergence of a tumour appears to follow a second somatic mutational event which results in homozygosity or hemizygosity. Hence, in tumour cells the mutations behave in a recessive manner. Success in isolating the normal genes may provide new tools for antenatal diagnosis of carriers and open up the possibility of developing new gene therapy.     

Emergency Cardiac Pacing for Severe Bradycardia

ALTAMURA, G., ET AL.: Emergency Cardiac Pacing for Severe Bradycardia. Our study included the treatment of transcutaneous cardiac pacing (TCP) in 32 patients: (A) 19 patients were treated in the emergency area for complete symptomatic AV block before endocavitary pacing; (B) five patients were in asystole following DC shock or out-of-hospital cardiac arrest; and (C) eight patients were affected by bifascicular block undergoing emergency surgery and were treated in order to prevent complete AV block. Two transcutaneous stimulators were used. PaceAid-CRC model 50/52 with 20-msec pulse width; the electrodes were positioned on the V, ECG position and on the back. Results: in all but two patients, it was possible to obtain stable cardiac capture; in one patient arrived in hospital in asystole after prolonged cardiac arrest and in the other one was affected by complete AV block, TCP was ineffective. In groups A and B, TCP was maintained for a mean time of 15 minutes; in group C, TCP was tested in all patients, but performed in only one patient during surgery. Mean threshold was 81 mA. Stimulation was well tolerated in all but five patients. TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by medical staff. In our opinion, it should be considered as the first choice emergency treatment of severe symptomatic bradycardia. In asystole, beneficial effects can be obtained only if TCP is performed early enough after the onset of arrhythmia.     

Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients

Schärer LO, Hartweg V, Valerius G, Graf M, Hoern M, Biedermann C,Walser S, Boensch A, Dittmann S, Forsthoff A, Hummel B, Grunze H, Walden J. Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients. Bipolar Disord 2002: 4(Suppl. 1): 107–108. © Blackwell Munksgaard, 2002     

Prolonged Atrium Electromechanical Interval Is Associated with Stroke in Patients with Atrial Fibrillation After Catheter Ablation

Electromechanical Interval and Strokes After Ablations of AF . Introduction: Atrial fibrillation (AF) is associated with increased risk of embolic stroke. Catheter ablation of AF provides an effective therapy for patients with symptomatic and drug‐refractory AF. The aim of this study was to evaluate whether the atrial electromechanical interval is useful in identifying patients at risk of stroke after successful catheter ablation. Methods and Results: A total of 279 AF patients who received catheter ablation and showed no evidence of recurrences were enrolled. Electromechanical interval (PA–PDI) was determined as the time interval from the initiation of P wave deflection to the peak of mitral inflow A wave on pulse wave Doppler imaging. The PA–PDI interval was measured for each patient after the 3‐month blanking period of catheter ablation. The clinical endpoint was the occurrence of ischemic stroke. During the follow‐up of 46.5 ± 17.2 months, 6 patients suffered from ischemic strokes. Patients with strokes had higher CHA₂DS₂–VASc scores and longer PA–PDI intervals (138.7 ± 12.4 ms vs 161.2 ± 7.7 ms, P value < 0.001) compared to those without strokes. At a cutoff point of 150 ms identified by ROC curve, the positive and negative predictive values of the PA–PDI interval to predict stroke were 86.7% and 100%, respectively. The PA–PDI interval improved the predictive performance of the CHA₂DS₂–VASc score, and the area under the ROC curve increased from 0.75 to 0.85. Conclusions: Our results suggest that the PA–PDI interval is a useful tool to identify patients with high risk of stroke after successful catheter ablation of AF. (J Cardiovasc Electrophysiol, Vol. 24, pp. 375‐380, April 2013)