子宫内膜异位症和流产及不孕患者血清12种自身抗体的分析

检测69例健康孕妇和225例子宫内膜异位症(EMT)、流产和不孕患者血清中 EMAb、ANA、A-dsDNA、A-Sm、A-RNP、A-TG、A-TM、RF、AphA、InAb、CaMAb、ANCA 等12种自身抗体,健康孕妇 EMAb 阳性率为1.4%,其他抗体的总阳性率为4.3%;EMT(n=66)、流产(n=87)和不孕(n=72)组患者 EMAb 阳性率分别为72.7%、37.9%和38.9%,其余11种自身抗体的总阳性率分别为51.5%、24.1%和19.4%,均显著高于健康孕妇(P<0.01)。结果提示:EMT 患者体内存在高水平自身免疫反应,某些自身抗体的增加,可能影响正常生育。     

α_1—抗胰蛋白酶异质体的测量新方法及其临床意义的探讨

本文对a_1-抗胰蛋白酶异质体的检测方法(小扁豆凝集素亲合交叉免疫电泳法)进行改进。改进后的方法操作流程短、成本低、结果清晰、操作简便、不需预测a_1-抗胰蛋白酶总浓度,适合于临床广泛应用。本文用该法对原发性肝癌、转移性肝癌,其它器官癌肿、肝硬化及正常人血清中的a_1-抗胰蛋白酶异质体进行分析,发现小扁豆凝集素结合型a_1-抗胰蛋白酶百分比(LCA-R-AAT％)原发性肝癌组明显高于其它各组,以LCA-R-AAT(％)>25％为阳性标准,则原发性肝癌诊断的敏感性、特异性、准确性分别为80.6％、86.2％和84.3％,与小扁豆凝集素结合型甲胎蛋白联合检测,可使原发性肝癌诊断的敏感性提高至100％(P<0.05),特异性和准确性分别为82.8％和89.9％(P均>0.05),表明LCA-R-AAT(％)的检测对原发性肝癌的诊断及鉴别诊断有一定的价值。     

The remedial effect of soluble interleukin-1 receptor type Ⅱ on endometriosis in the nude mouse model

Objective： Recent studies have shown that the local expression of soluble interleukin （IL） -1 receptor type Ⅱ （slL-1 R Ⅱ ） in endometrial tissue of women with endometriosis is decreased, and the depression of IL-1 R Ⅱ was more significant in infertile women than that in fertile women with endometriosis. In this research, we investigated the remedial effect of slL-1-R Ⅱ administration on endometriosis in the nude mouse model. Methods： Nineteen nude model mice with endometriosis were randomly divided into three groups： group A was treated by intraperitoneal administration with only slL-1 R Ⅱ for two weeks, group B was similarly treated with only IL- 1, and group C （control） was administered saline. After 2 weeks, the size of the ectopic endometrial lesions was calculated, and the expression of vascular endothelial growth factor （VEGF） and B-cell lymphoma leukemia-2 （Bcl- 2） were detected by immunohistochemistry. The IL-8 and VEGF levels in the peritoneal fluid （PF） and serum were also measured by enzyme-linked immunosorbent assay （ELISA）. Results： The mean size of ectopic endometrial lesion did not differ between the three groups （P 〉 0.05）. Compared with the control, the expression of VEGF and Bcl-2 was significantly lower in group A, and higher in group B. In the three groups, the levels of IL-8 in the PF and serum were highest in group A, and lowest in group B. Conclusion： slL-1 R Ⅱ may suppresse hyperplasia of ectopic endometriosis, perhaps by reducing the expression of certain cytokines, such as VEGF, IL-8, and Bcl-2, which could provide a new clinical strategy for the treatment of endometriosis.     

一种细菌金属β-内酰胺酶筛查方法的建立

目的　建立一种简便、易行的实验方法 ,检测细菌产生的金属酶。方法　根据协同试验原理 ,采用亚胺培南 (IP)与巯基乙酸 (MA)协同作用的方法检测金属酶 ,并与PCR方法检测金属酶基因进行比较。结果　 4 7株嗜麦芽窄食单胞菌全部产生了金属酶 ;14株黄杆菌中有 9株产生了酶 ;2 0株铜绿假单胞菌均没有产生金属酶。该检测结果与PCR法检测金属酶基因结果一致。结论　使用伊米配能与巯基乙酸协同作用的方法可以检测金属酶 ,该方法有较好的敏感性和特异性 ,并且操作简便 ,不需要特殊的仪器设备 ,适合用于临床微生物实验室筛查产金属酶的菌株。     

Highlights from the 8th World Congress on Peritoneal Surface Malignancies

The 8th World Congress on Peritoneal Surface Malignancies was held in Berlin,Germany from October 31,2012 to November 2,2012,in which more than 571 delegates from 56 countries attended.This conference covered a variety of topics on peritoneal carcinomatosis(PC) from gastric, colorectal,and ovarian cancers,as well as pseudomyxoma peritonei,malignant peritoneal mesothelioma,and abdominal sarcoma.PC experts across the world presented the most upto -date results of their basic and translational studies as well as clinical trials.In particular,the following research interests were highlighted. Professor Paul H.Sugarbaker from the Washington Hospital Cancer Center,Washington DC,USA,systemically     

Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies.

The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based.

Although many studies in animals and volunteers have demonstrated that multiple-dose activated charcoal increases drug elimination significantly, this therapy has not yet been shown in a controlled study in poisoned patients to reduce morbidity and mortality. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered.

Based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. With all of these drugs there are data to confirm enhanced elimination, though no controlled studies have demonstrated clinical benefit.

Although volunteer studies have demonstrated that multiple-dose activated charcoal increases the elimination of amitriptyline, dextropropoxyphene, digitoxin, digoxin, disopyramide, nadolol, phenylbutazone, phenytoin, piroxicam, and sotalol, there are insufficient clinical data to support or exclude the use of this therapy.

The use of multiple-dose charcoal in salicylate poisoning is controversial. One animal study and 2 of 4 volunteer studies did not demonstrate increased salicylate clearance with multiple-dose charcoal therapy. Data in poisoned patients are insufficient presently to recommend the use of multiple-dose charcoal therapy for salicylate poisoning.

Multiple-dose activated charcoal did not increase the elimination of astemizole, chlorpropamide, doxepin, imipramine, meprobamate, methotrexate, phenyítoin, sodium valproate, tobramycin, and vancomycin in experimental and/or clinical studies.

Unless a patient has an intact or protected airway, the administration of multiple-dose activated charcoal is contraindicated. It should not be used in the presence of an intestinal obstruction. The need for concurrent administration of cathartics remains unproven and is not recommended. In particular, cathartics should not be administered to young children because of the propensity of laxatives to cause fluid and electrolyte imbalance.

In conclusion, based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.

This Position Statement was drafted by JA Vale, EP Krenzelok, and GD Barceloux.     

Position Paper: Gastric Lavage

Gastric lavage should not be employed routinely, if ever, in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. The results of clinical outcome studies in overdose patients are weighed heavily on the side of showing a lack of beneficial effect. Serious risks of the procedure include hypoxia, dysrhythmias, laryngospasm, perforation of the GI tract or pharynx, fluid and electrolyte abnormalities, and aspiration pneumonitis. Contraindications include loss of protective airway reflexes (unless the patient is first intubated tracheally), ingestion of a strong acid or alkali, ingestion of a hydrocarbon with a high aspiration potential, or risk of GI hemorrhage due to an underlying medical or surgical condition. A review of the 1997 Gastric Lavage Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.     

隐神经卡压征的临床解剖学研究

目的 :探讨隐神经卡压征的解剖学基础。方法 :利用 2 0具成人尸体和 1 5条游离下肢 ,解剖、观测了隐神经在股部穿收肌腱板裂孔和在膝部穿缝匠肌—股薄肌下端间隙处的形态参数 ,并定位。结果 :在股部的收肌腱板裂孔处 ,隐神经宽 (2 .7± 0 .4)mm ,厚(1 .2± 0 .3)mm(厚 /宽 :0 .46) ;裂孔宽 (5 .2± 0 .7)mm ,高 (1 4 .1± 2 .4)mm ,孔远大于穿行其内的隐神经。在膝部的缝匠肌—股薄肌腱间隙处 ,神经宽 (2 .2± 0 .3)mm ,厚 (0 .8± 0 .2 )mm(厚 /宽 :0 .37) ;膝部隐神经更扁薄 ,且当膝关节屈伸时 ,神经在缝匠肌—肌薄肌间隙中受挤压 ,并与两肌内面的腱组织产生摩擦。另为隐神经卡压征的定位提供了一些参数。结论 :就股部收肌腱板裂孔和膝部缝匠肌—股薄肌间隙而言 ;隐神经更易在膝部的肌间隙内受挤压和摩擦而损伤。     

卡维地洛治疗肾病患者难治性高血压的前瞻性多中心临床研究

目的评价卡维地洛治疗各种肾脏病患者中难治性高血压的安全性、降压疗效和其对心肾功能的影响。方法采用前瞻性、多中心、开放、自身对照试验,入选患者共2171例,观察期限为8周。结果与用药前相比,所有患者治疗4周后平均收缩压(SBP)和舒张压(DBP)均明显下降(P＜0．01)。卡维地洛治疗4周降压有效率达57．1%,显效率为11．5%;至用药8周时有效率达79．7%,显效率为26．7%。治疗后平均心率有所下降,由治疗前(79．3±10．2)次/min下降为4周时(75．9±7．6)次/min和8周时的(75．0±8．5)次/min(P＜0．05),但仍处于正常范同。血浆中去甲肾上腺素平均水平由治疗前38．7ng/L降至17．6ng/L(P＜0．05)。卡维地洛治疗后患者肝肾功能、心电图均无明显改变,不良反应轻微。结论卡维地洛治疗肾病患者难治性高血压安全有效。