严重会阴部挫裂伤治疗方案探讨

目的探讨会阴部严重挫裂伤治疗的合理方案，提高治疗质量。方法通过回顾我院收治的18例会阴部严重挫裂伤病例的治疗过程，总结与分析了这类损伤不宜Ⅰ期修复的原因和结肠造瘘术在治疗中的作用。结果本组18例会阴部严重挫裂伤，均在早期清创缝合修复，后因感染，同时并发不同程度、不同范围的皮肤坏死而造成缺损和伤口裂开。均需再次清创、皮瓣转移和植皮予以修复。在此过程中，采用结肠造瘘术来控制创面感染和预防创面继发感染，收到了良好效果。结论严重会阴部挫裂伤创面的早期治疗，特别是污染重、挫伤重、损伤范围大的，均不宜Ⅰ期修复。早期行结肠造瘘术对预防和控制会阴部创面感染能起到重要的作用。     

流式细胞术检测细胞毒方法的建立

目的：建立一种用流式细胞仪测定细胞介导细胞毒活性的方法。方法：用羧基荧光素二醋酸盐琥珀酰亚胺酯(CFSE)标记靶细胞，再用碘化丙碇(PI)标记DNA筛选细胞膜已破坏的靶细胞。效靶比为100：1—6．25：1，共孵育时间为1-6小时，流式细胞仪收集1000个靶细胞并测定被杀细胞的百分率。结果：CFSE是合适的标记靶细胞的荧光染料，18小时后也能很好地区分效靶细胞；靶细胞的自然死亡率低于5％；杀伤百分率随着效靶比和共孵育时间的增加而增加。最佳效靶比为50：1—25：1，共孵育时间为2—4小时。结论：CFSE／PI双荧光染料标记的流式细胞分析检测细胞毒具有多个优点：避免放射性试剂的应用，敏感性增强，单细胞水平的分析。     

Estrogen receptor-associated expression of keratinocyte growth factor and its possible role in the inhibition of apoptosis in human breast cancer

Although estrogen is known to play a crucial role in the pathogenesis of breast cancer, the molecular mechanisms underlying the action of estrogen remain elusive. In the present study, we focused on keratinocyte growth factor (KGF) and its receptor (KGFR) in the pathogenesis of breast cancer, as a growth factor mediating estrogen action, since significant roles of KGF were demonstrated in various steroid hormone-dependent tissues. First, using paraffin-embedded specimens from 42 breast cancer patients, we examined expression patterns of KGF and KGFR by both immunohistochemistry using newly generated antibodies and nonradioactive in situ hybridization with T-T dimerized synthetic oligonucleotide probes. We next compared the results with the expression of estrogen receptor (ER) alpha and beta, proliferative activity and apoptotic frequency (TUNEL staining). Also, the similar approaches were taken to analyze the expression and role of KGF in ER-positive (MCF7, ZR-75-1) and ER-negative (SK-BR-3, MDA-MB-231) human breast cancer cell lines in vitro. In the surgical specimens, KGF was expressed in cancer cells as well as stromal cells in 19/42 cases (45%), while KGFR was found in cancer cells in 24/42 cases (57%). The distribution of protein and mRNA in the analysis of both KGF and KGFR expression generally coincided. Moreover, KGF expression was closely associated with the expression of ER alpha, and the coexpression of KGF and KGFR significantly correlated with lower TUNEL index, but not with proliferative activity. In accordance with the in vivo findings, KGF expression was detected only in ER alpha-positive MCF7 and ZR-75-1 cells in vitro. And more importantly, we found the inhibitory effect of KGF upon the induction of apoptosis by anticancer drugs in MCF7 cells. Collectively, our results indicate that ER alpha may be involved in KGF expression, and that KGF may play antiapoptotic roles, rather than mitogenic, in human breast cancer.     

Early rehabilitation program in postmastectomy patients: a prospective clinical trial

The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.     

Gain-of-function polymorphism in mouse and human Ltk: implications for the pathogenesis of systemic lupus erythematosus

Systemic lupus erythematosus (SLE), a complex multigenic disease, is a typical antibody-mediated autoimmune disease characterized by production of autoantibodies against a variety of autoantigens and immune complex-type tissue inflammation, most prominently in the kidney. Evidence suggests that genetic factors predisposing to aberrant proliferation/maturation of self-reactive B cells initiate and propagate the disease. In SLE-prone New Zealand Black (NZB) mice and their F1 cross with New Zealand White (NZW) mice, B cell abnormalities can be ascribed mainly to self-reactive CD5+ B1 cells. Our genome-wide scans to search for susceptibility genes for aberrant activation of B1 cells in these mice showed evidence that the gene, Ltk, encoding leukocyte tyrosine kinase (LTK), is a possible candidate. LTK is a receptor-type protein tyrosine kinase, belonging to the insulin receptor superfamily, and is mainly expressed in B lymphocyte precursors and neuronal tissues. Sequence and functional analyses of the gene revealed that NZB has a gain-of-function polymorphism in the LTK kinase domain near YXXM, a binding motif of the p85 subunit of phosphatidylinositol 3-kinase (PI3K). SLE patients also had this type of Ltk polymorphism with a significantly higher frequency compared with the healthy controls. Our findings suggest that these polymorphic LTKs cause up-regulation of the PI3K pathway and possibly form one genetic component of susceptibility to abnormal proliferation of self-reactive B cells in SLE.     

大鼠腰髓背角星形胶质细胞及神经元对一侧胫、腓骨骨折的反应及其相互关系

目的 研究大鼠脊髓内星形胶质细胞及神经元对一侧胫、腓骨骨折的反应及相互关系。方法 应用细胞免疫组织化学方法，观察脊髓内胶质原纤维酸性蛋白(GFAP)、Fos蛋白双标记以及蛋白激酶C(PKC)在左侧胫、腓骨骨折后不同时程的表达变化。结果 1．左侧胫、腓骨骨折后，GFAP阳性反应产物主要分布于同侧腰髓背角的星形胶质细胞胞浆，Fos阳性产物在其胞核也有表达，且以浅层为主，神经元的胞核也有Fos阳性产物；2．Fos—LI神经元与GFAP／Fos-LI星形胶质细胞的分布基本一致，两者关系密切；3．GFAP／Fos—LI星形胶质细胞表达高峰期在骨折后45min，而Fos—LI神经元的表达高峰期在骨折后90min；PKC—LI星形胶质细胞出现及达到高峰的时间比PKC—LI神经元要早。结论 腰髓背角的星形胶质细胞参与了下肢骨折伤害性刺激的应激反应及调节过程，而且Fos—LI、PKC-LI的表达早于神经元，可能主动地影响神经元的活动。     

PCR-RFLP based molecular typing of enteroviruses isolated from patients with aseptic meningitis in Korea

Summary.  We have evaluated PCR–RFLP as a practical method for rapid typing of enteroviruses causing aseptic meningitis in Korea. Through blind examination of 80 clinical isolates from patients with aseptic meningitis, we have compared the results of conventional serotyping with PCR–RFLP based genotyping, which was developed for this study. Among the 80 case isolates, which had been previously typed by routine neutralization test, only 42 cases (52.5%) were matched with typing by PCR–RFLP. The result clearly demonstrated that the enterovirus serotype does not coincide with the genotype. Therefore, the classification of enteroviruses by genotyping with PCR–RFLP, although rapid and simple, may be complicated by regional or seasonal differences. However, the PCR–RFLP method developed in this study is applicable to the epidemiological study of enteroviruses when regional or seasonal differences exist, and is useful in identifying the source of an infection. Received August 6, 2001; accepted April 15, 2002 Published online July 10, 2002     

饮酒对小鼠睾丸生精小管一氧化氮合酶、增殖细胞核抗原表达及细胞凋亡影响的研究

目的　探讨酒精对小鼠睾丸的组织结构、内皮型一氧化氮合酶 (eNOS)、增殖细胞核抗原 (PCNA)及细胞凋亡的影响。　方法　用 5 %、10 %及 15 % 3种不同浓度的酒精作用于 2 2d龄小鼠 ,取睾丸做石蜡切片、HE染色 ;用免疫组织化学方法检测睾丸eNOS、细胞增殖的变化 ;TUNEL法检测细胞凋亡的变化 ,并进行统计学分析。　结果　随着酒精浓度的增大 ,睾丸组织结构发生明显改变 ,生精小管的直径逐渐减小 ,eNOS阳性细胞面积密度逐渐增大 ,单位面积内PCNA阳性细胞和凋亡细胞数目增加 ,高浓度酒精组与其他组差异极显著 (P <0 0 1)。　结论　酒精可使生精小管的直径变小 ,eNOS及PCNA表达增强 ,凋亡细胞增加并随酒精浓度的增大而变化加重。这可能是过量饮酒导致生精细胞减少 ,生殖能力降低的重要因素。     

Graves′病患者IL-6、TNF-α、IFN-γ水平治疗前后的变化及其临床意义

对Graves′病患者, 用放射免疫分析法(RIA)测定了IL-6和TNF-α, 用双抗体夹心ELISA法测定了IFN-γ.Graves′病患者的IL-6、TNF-α、IFN-γ水平均高于对照者.治疗后, IL-6水平降至正常, 而TNF-α、IFN-γ水平仍高于对照者.提示: IL-6水平与病情变化相平行, 而TNF-α、IFN-γ水平仍较高.     

西洋参茎叶皂甙对 CPHD病人外周淋巴细胞增强与调节作用

目的 :为了开发西洋参在临床医学方面的应用 ,提高CPHD病人的各项免疫指标。方法 :选择 4 0例CPHD病人 ,分成用药组 2 0例 ,对照组 (非用药组 ) 2 0例 ,通过流式细胞术检测病人外周血中T淋巴细胞亚群中各亚群所占的比例来反映机体的细胞免疫状态。结果 :通过两组临床研究观察 ,用药组疗效优于对照组 (P <0 0 5 )。西洋参茎叶皂甙可直接作用于淋巴细胞分化成熟过程 ,具有增强和调节CPHD病人机体免疫功能的作用。结论 :合理应用西洋参茎叶茎叶皂甙对改善CPHD病人免疫功能低下和紊乱状态 ,具有重要临床意义。