Calciphylaxis precipitated by ultraviolet light in a patient with end-stage renal disease secondary to systemic lupus erythematosus.

Calciphylaxis is a rare and severe calcification syndrome described mainly in patients with end-stage renal disease (ESRD) undergoing dialysis or with a renal transplant. This life-threatening condition is characterized by the abrupt onset of painful ischemic skin ulcers and necrosis. Secondary local and systemic infection may supervene and, without timely and appropriate interventions, calciphylaxis may be fatal. A precipitant or challenging agent is believed to be necessary to initiate the process. We describe a case of a woman with ESRD receiving continuous ambulatory peritoneal dialysis who developed calciphylaxis in the setting of severe hyperparathyroidism after receiving UV photoradiation therapy. We suggest that the UV light served as the challenging agent in the precipitation of this devastating condition.     

医疗机构医药"分开核算、分别管理"实施之我见

继新的《医院财务制度》、《医院会计制度》提出对医疗机构实行医药“分开核算、分别管理”的政策之后,国务院办公厅转发的国务院体改办等八部门共同制定的《关于城镇医药卫生体制改革的指导意见》以下简称《指导意见》),再次强调了医疗机构实行医药“分开核算、分别管理’的现实性和紧迫性,并赋予了医药“分开核算、分别管理”新的含义和内容。那么,怎样认识和理解《指导意见》中关于医疗机构实行医药“分开核算、分别管理”的意义和内涵?笔者认为,应从以下几个方面理解和把握。     

藏成药萨热十三味鹏鸟丸中木香、珍珠的薄层鉴别

采用薄层色谱法对藏成药萨热十三味鹏鸟丸中的木香,珍珠进行鉴别,方法易行,结果明显。     

针刺治疗神经性耳聋临床研究

针刺百会,完骨,听宫,外关治疗神经性耳聋,采用纯音听阈式,听性脑干反应（ＡＢＲ０测听两个指标,对６０例（８２耳）患者进行针刺效应与听力不同损伤程度关系的临床研究。结果表明针刺能明显降低纯音听阈测试的听阈均值,听力轻度及中度损失疗效优于重度损失,说明针刺效应与听力损失程度密切相关。『     

Phase I study of chimeric human/murine anti-ganglioside G(D2) monoclonal antibody (ch14.18) with granulocyte-macrophage colony-stimulating factor in children with neuroblastoma immediately after hematopoietic stem-cell transplantation: a Children's Cancer Group Study.

PURPOSE: Ganglioside G(D2) is strongly expressed on the surface of human neuroblastoma cells. It has been shown that the chimeric human/murine anti-G(D2) monoclonal antibody (ch14.18) can induce lysis of neuroblastoma cells by antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. The purposes of the study were (1) to determine the maximum-tolerated dose (MTD) of ch14.18 in combination with standard dose granulocyte-macrophage colony-stimulating factor (GM-CSF) for patients with neuroblastoma who recently completed hematopoietic stem-cell transplantation (HSCT), and (2) to determine the toxicities of ch14.18 with GM-CSF in this setting. PATIENTS AND METHODS: Patients became eligible when the total absolute phagocyte count (APC) was greater than 1, 000/microL after HSCT. ch14.18 was infused intravenously over 5 hours daily for 4 consecutive days. Patients received GM-CSF 250 microg/m(2)/d starting at least 3 days before ch14.18 and continued for 3 days after the completion of ch14.18. The ch14.18 dose levels were 20, 30, 40, and 50 mg/m(2)/d. In the absence of progressive disease, patients were allowed to receive up to six 4-day courses of ch14.18 therapy with GM-CSF. Nineteen patients with neuroblastoma were treated. RESULTS: A total of 79 courses were administered. No toxic deaths occurred. The main toxicities were severe neuropathic pain, fever, nausea/vomiting, urticaria, hypotension, mild to moderate capillary leak syndrome, and neurotoxicity. Three dose-limiting toxicities were observed among six patients at 50 mg/m(2)/d: intractable neuropathic pain, grade 3 recurrent urticaria, and grade 4 vomiting. Human antichimeric antibody developed in 28% of patients. CONCLUSION: ch14.18 can be administered with GM-CSF after HSCT in patients with neuroblastoma with manageable toxicities. The MTD is 40 mg/m(2)/d for 4 days when given in this schedule with GM-CSF.     

军用固体运动饮料对热区部队热适应能力的影响

目的:观察军用固体运动饮料增强热区部队热适应能力的作用。方法:检测不同环境温度、不同训练强度的部队指战员服用饮料前后心肌酶谱、肝肾功能、电解质及营养素等的变化。结果:(1)军用固体运动饮料不同程度地降低心肌酶的活性。热区部队约20％～50％指战员心肌酶谱高于正常,服用饮料后降至5％～20％左右。与未服饮料的对照组和服用饮料前比较,CK(肌酸激酶)、AST(天冬氨酸转氨酶)、LDH(乳酸脱氢同功酶)、ALT(丙氨酸转氨酶)的均值均有明显降低(P<0.05～0.01)。(2)能部分改善肝肾功能。与对照组及服用前比较,服用饮料者的肝脏酶谱ALT、r—GT、ALP(碱性磷酶)均处于较低水平(P<0.05～0.01)。(3)钠和氯的丢失与高强度训练有关,与服用饮料无关,钾和钙无明显变化。(4)有轻度降低胆固醇和甘油三酯的作用,对照组及实验组的血糖均较集中训练前降低,而总蛋白、脂蛋白等无明显改变。(5)能提高训练成绩,减轻疲劳程度。结论:饮料具有改善心、肝、肾功能,减轻热损伤,抗疲劳的作用。     

乐胃煎对大鼠胃粘膜上皮异型增生细胞凋亡及调控基因的影响*

目的研究乐胃煎对大鼠胃粘膜上皮异型增生细胞凋亡及调控基因(Bcl-2、Fas、ICE)蛋白表达的影响,探讨乐胃煎治疗胃粘膜癌前病变的作用机制.方法用N-甲基-N-硝基-N-亚硝基胍(MNNG)建立大鼠胃粘膜异型增生模型,对大鼠胃粘膜用TUNEL法检测细胞凋亡,免疫组织化学法检测Bcl-2、Fas蛋白表达水平.结果治疗组癌前病变发生率与造模组和对照组比较,均有显著性差异(P＜0.05).Bc1-2蛋白表达率及过量表达率,治疗组与造模组比较,均有显著性差异(P＜0.05);治疗组与造模组比较,Fas蛋白表达率亦有显著性差异(P＜0.05),过表达率无显著性差异(P＞0.05).结论乐胃煎治疗可抑制大鼠胃粘膜Bcl-2基因蛋白的表达,促进Fas基因蛋白的表达,从而使胃粘膜上皮细胞发生正常凋亡,逆转或阻止胃癌的发生.     

询检法确定血吸虫病化疗对象的探讨

自世行贷款血吸虫病控制项目实施以来,根据项目的总策略,在血吸虫病高度流行区(人群感染率≥15%的地区)采用全民化疗并对经常接触疫水的高危人群每年治疗两次的方法减少和控制人、畜血吸虫病感染。但在项目实施过程中,如何确定高危人群以及怎样保证人群化疗覆盖率达到90%左右,尚存在一定的难度,为努力实现项目的目标,笔者在朱湖农场(血吸虫病人群感染率1687%～1762%)开展了询检法确定高危人群化疗与全民化疗的覆盖率及防治效果的比较和分析,现将结果报告如下:1　材料与方法11　询检法化疗对象在当地主要感染季节,从事捕鱼、放牧、割草、插秧…     

肝硬化患者血浆一氧化氮与GMP-140水平的变化

目的：观察肝硬化患者血浆一氧化氮（ＮＯ）与可溶性α－颗粒膜蛋白（ＧＭＰ－１４０）水平的变化。方法：分别采用硝酸还原酶法和酶联免疫分析法,测定２９例肝硬化（无腹水）、２３例肝硬化（有腹水）患者和３０例健康人的血浆ＮＯ２＾－／ＮＯ３＾－水平及ＧＭＰ－１４０含量。结果：肝硬化患者有腹水组和无腹水组较健康对照组血浆ＮＯ２＾－／ＮＯ３＾－水平均有显著性增高（Ｐ〈０．０１）;肝硬化有腹水组较健康对照组ＧＭＰ－１４０含量显著性增高（Ｐ〈０．０１）,无腹水且亦增高但无显著性意义。结论：提示ＮＯ和粘附分子可能参与肝硬化的发生发展过程。     

The function of apoptosis and protein expression of bcl-2, p53 and C-myc inthe development of gastric cancer

AIM To understand the rule and possible function of apoptosis and protein expression of bcl-2, p53 and C-myc in chronic gastritis, gastric ulcer, non-classic proliferation of gastric mucosa and gastric cancer.METHODS Apoptosis was detected by using in situ terminal labelling (TUNEL). The protein expression ofbcl-2, p53 and C-myc was detected by immunohistochemical method.RESULTS The indexes of apoptosis in chronic active gastritis, gastric ulcer, mild and severe non-classicproliferation of gastric mucosa, early and progressive gastric cancer were 16.8%±12.3%, 24.1%±20.0%,19.3%±16.4%, 15.7%±15.2%, 10.1%±9.1% and 6.3%±6.0%, respectively. The index of progressivegastric cancer was lower than that of early gastric cancer and non-classic proliferation of gastric mucosa(P<0.05). The positive rate of bcl-2 protein was 9.4%, 27.6%, 52.9%, 75.0%, 83.3% and 46.7%,respectively. The positive rate of bcl-2 of early gastric cancer was higher than that of progressive gastriccancer. The positive rates of p53 protein of severe non-classic proliferation, early and progressive gastriccancer were 25.0%, 33.3% and 63.3%, respectively. The positive rate of p53 of progressive gastric cancerwas higher than that of early gastric cancer and non-classic proliferation (P<0.05). In Lauren types, theindex of apoptosis, protein expression rates of bcl-2, p53 and C-myc of intestinal type were 8.3%±7.2%,38.9%, 77.7% and 56.6%, while that of diffuse type were 5.1%±4.9%, 58.3%, 50.0% and 8.3%,respectively. All markers had statistical difference between two types (P<0.05).CONCLUSION Apoptosis was inhibited stepwise in the development of non-classic proliferation of gastricmucosa to early gastric cancer and then to progressive gastric cancer. The high expression of bcl-2, p53 andC-myc was related to the development of gastric cancer, bcl-2 might play an important role in early gastriccancer while p53 and C-myc act mostly in middle and late stage gastric cancer. The Lauren typing of gastriccancer is closely related to the index of apoptosis and expression of bcl-2, p53 and C-myc.