Release of Proinflammatory Cytokines During Pediatric Cardiopulmonary Bypass: Heparin-Bonded Versus Nonbonded Oxygenators

Background. Heparin bonding of the cardiopulmonary bypass (CPB) circuit may be associated with a reduced inflammatory response and improved clinical outcome. The relative contribution of a heparin-bonded oxygenator (ie, >80% of circuit surface area) to these effects was assessed in a group of pediatric patients.

Methods. Twenty-one pediatric patients undergoing CPB operations were assigned randomly to receive either a heparin-bonded oxygenator (group H, n = 11) or a nonbonded oxygenator (group C, n = 10) in otherwise nonbonded circuits. The two groups were similar in pathology, age, weight, CPB time, and cross-clamp time. Plasma levels of the cytokines tumor necrosis factor-, interleukin-6, and interleukin-8, as well as terminal complement complex, neutrophils, and elastase, were analyzed before, during, and after CPB.

Results. Significant levels of tumor necrosis factor- were not detected in either group. Plasma levels of all other markers increased during and after CPB compared with baseline. Plasma levels of interleukin-6 peaked in both groups 2 hours after the administration of protamine but remained significantly higher in group C 24 hours after operation. Plasma concentrations of interleukin-8 peaked at similar levels in both groups 30 minutes after protamine administration and returned to baseline thereafter. Levels of terminal complement complex and elastase peaked in both groups 30 minutes after protamine administration. Plasma levels of terminal complement complex were significantly higher at the end of CPB and after protamine administration in group C. Elastase levels were significantly higher 2 and 24 hours after CPB in group C. The ventilation time of patients in group H was significantly lower than that of patients in group C: 10 (range, 3 to 24) versus 22 (range, 7 to 24) hours, respectively (p < 0.01).

Conclusions. The present study confirms the proinflammatory nature of pediatric operations and demonstrates a lessened systemic inflammatory response with the use of heparin-bonded oxygenators. This is achieved without bonding of the entire circuit, which could have significant cost-benefit implications by negating the need for custom-built heparin-bonded circuitry.     

甲氟哌酸体外抗菌活性及对耐药感染者的治疗

对天津市新近临床分离的414株细菌进行了甲氟哌酸(Pflx)和氟哌酸(Nflx)体外抗菌活性研究。结果显示Pflx对绝大多数肠杆菌和细菌、不动杆菌有良好抗菌活性,抑菌率>90％。对绿脓杆菌、MSSA及凝固酶阴性葡萄球菌有中度抗菌作用,抑菌率分别为85％、87.5％、87.5％。对MRSA和链球菌抗菌活性稍差,抑菌率在40％～68.42％之间。Nflx体外抗菌活性和Pflx相似。此外,18例药敏试验耐Pflx和Nflx细菌感染患者,经Pflx治疗,肺化脓症1例显效,余17例难治性尿路感染者1例痊愈、9例显效、5例进步、2例无效。     

490名师范学院大学生失眠状况调查

目的　了解师范学院大学生失眠情况及其分布特征。方法　对上饶师院 4 90名学生进行睡眠和失眠相关问题的问卷调查。结果　 38.0 %的被试报告有失眠现象。男生失眠率显著高于女生 ( χ2 =9.79,P <0 .0 1) ;三年级毕业班学生失眠率高于一年级和二年级学生 ( χ2 =9.86 ,P <0 .0 1) ;文理科学生失眠率差异无显著性。SCL - 90调查结果显示 ,失眠学生躯体化、强迫、人际关系敏感、抑郁、焦虑、恐怖6个因子分和阳性项目数显著高于非失眠者。结论　师范学院大学生失眠现象常见 ,失眠学生心理问题症状较多     

两种局麻药术后镇痛效果及副作用比较

目的：观察比较0．2％罗哌卡因和0．15％布比卡因两种同麻药在硬膜外自控镇痛(PCEA)中的镇痛效果及副作用。方法：选用0．2％罗哌卡因和0．15％布比卡因两种同麻药用于PCEA中．对其效果进行对比分析。结果：0．2％罗哌卡因、0．15％布比卡因分别与0．1mg芬太尼联合用于PCEA中，镇痛效果确切．毒副作用轻微，并发症少。结论：将0．2％罗哌卡因替代0．15％布比卡因与0．1mg芬太尼合用后．病人术后行走能力的早期恢复可得到改善。     

Regulation of PTC phenotype and function by TGF-β1: implications for transdifferentiation

Introduction There is now increasing evidence that proximal tubular cells (PTCs) contribute to renal interstitial fibrosis by alteration of matrix turnover and by the generation of pro‐fibrotic cytokines such as TGF‐β1. Recent studies suggest that, through a process of transdifferentiation, the PTCs are one source of the interstitial myofibroblasts that directly drive the fibrotic process. The aim of this work was to examine the role and mechanism by which TGF‐β1 may regulate PTC phenotype and function. Methods Experiments were performed using both primary‐cultures of PTC and the human PTC cell line HK2. All experiments were performed on growth‐arrested cells in the absence of serum. Results TGF‐β1 altered cell phenotype, assessed by light microscopy, with cells appearing elongated and spindle‐shaped. This was associated with loss of cell–cell contact and rearrangement of the actin cytoskeleton, increased formation of stress fibres and focal adhesions. Disruption of the actin cytoskeleton with cytochalasin‐D prevented phenotypic alterations following addition of TGF‐β1. Transient transfection with Smad‐2/‐4 or Smad‐3/‐4 expression vectors did not alter cell phenotype. Previously, we have demonstrated β‐catenin translocation to PTC nuclei and its association with Smad proteins following addition of TGF‐β1, suggesting the possibility that TGF‐β1 may modulate Wnt signalling. Wnt‐responsive Xtwn‐reporter construct was, however, silent in response to TGF‐β1. Similarly, a second Wnt‐/LEF‐1‐regulated element Toplflash, which does not contain Smad‐binding sites, was insensitive to TGF‐β1 signalling. In contrast, phenotypic changes in response to TGF‐β1 were abrogated by inhibitors of the RhoA downstream target ROCK, which also prevented loss of cell–cell contact and adherens junction disassembly. Removal of TGF‐β1 and addition of 1% FCS, however, reverted cell phenotype to a typical cobblestone epitheliod appearance, suggesting that TGF‐β1 did not result in terminal PTC transdifferentiation. Cells grown on tissue culture dishes coated with either type‐I or type‐III collagen also acquired an elongated fibroblastic phenotype; this effect was exaggerated by the addition of TGF‐β1. In contrast to the cells stimulated with TGF‐β1 alone, following stimulation by both TGF‐β1 and exposure to interstitial collagens, cell phenotype was stable in that it was not reversed upon removal of TGF‐β1 and addition of FCS. Addition of TGF‐β1 to cells grown on type‐IV collagen had no greater effect than TGF‐β1 alone. Addition of TGF‐β1 alone had little effect on the expression of α‐SMA. In contrast, cells grown on either type‐I or type‐III collagen, following addition of TGF‐β1, demonstrated marked increased expression of α‐SMA, which appeared to be incorporated into the cell cytoskeleton. Similarly, the combination of interstitial collagen (either type‐I or type‐III) and TGF‐β1 had synergistic effect on the relocation and down‐regulation of the epithelial markers E‐cadherin and cytokeratin. Finally, the results demonstrated synergistic effects of coating with interstitial collagen (either type‐I or type‐III), on cell ‘fibroblastic’ cell function as assessed by cell migration and by the synthesis of type‐III and type‐IV collagen. Conclusion The results of these in vitro experiments suggest that terminal transdifferentiation of proximal tubular epithelial cells is the result of a combination of the effects of the pro‐fibrotic cytokine TGF‐β1 and exposure of the cells to components of the interstitial extra‐cellular matrix to which the cells are not exposed in the absence of damage to the tubular basement membrane.     

颞部-颌下联合进路切除咽旁颞下区巨大肿瘤(附2例报道)

[目的]探讨切除侵犯中颅窝的咽旁颞下区巨大肿瘤安全而彻底的手术进路.利用颞部切口可充分暴露中颅窝底和颞下窝以及颌下进路显露咽旁区解剖的特点,联合进路切除2例咽旁颞下区巨大肿瘤.2例侵犯中颅窝底的咽旁颞下区肿瘤顺利切除,患者术中组织损伤、出血量相对较少,术后无严重并发症.[结论]颞部-颌下联合进路适合于侵犯中颅窝底的咽旁颞下区肿瘤的手术切除.     

Protection of chickens against highly lethal H5N1 and H7N1 avian influenza viruses with a recombinant fowlpox virus co-expressing H5 haemagglutinin and N1 neuraminidase genes

Inactivated whole avian influenza virus (AIV) vaccine provides protection against homologous haemagglutinin (HA) subtype virus, but poor protection against a heterologous HA virus. Moreover, it induces chickens to produce antibodies to cross-reactive antigens, especially nucleoprotein, which is limits AIV serological surveillance. In this study, a recombinant fowlpox virus co-expressing HA (H5 subtype) and NA (N1 subtype) genes of AIV was evaluated for its ability to protect chickens against intramuscular challenge with a lethal dose of highly pathogenic (HP) AIV. Susceptible chickens were also vaccinated by wing-web puncture with the parent fowlpox vaccine virus. Following challenge 4 weeks later with HPAIV, all chickens vaccinated with recombinant virus were protected, while the chickens vaccinated with either the unaltered parent fowlpox vaccine virus or unvaccinated controls experienced 100% mortality following challenge. This protection was accompanied by the high levels of specific antibody to the respective components of the recombinant vaccine. The above results showed that rFPV-HA-NA could be a potential vaccine to replace current inactivated vaccines for preventing AI.     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。     

辨证治疗特发性水肿43例疗效观察

特发性水肿是一种原因不明的综合征.在祖国医学属水肿.郁证范畴.近几年笔者采用辨证论治治疗本病43例,取得满意疗效,现报告如下.     

脐血抗—HPCA—2和Tük3标记的CD34阳性细胞的流式细胞仪比较分析

在标记脐血造血祖细胞表面抗原（ＨＰＣＡ），ＣＤ３４中，比较抗－ＨＰＣＡ－２－ＦＩＴＣ和Ｔｋ３（纯抗体）标记的ＣＤ（３４＋）细胞在流式细胞仪分析中的荧光特征及两种单抗标记的ＣＤ（３４＋）细胞与体外培养的粒单细胞集落形成单位（ＣＦＵ－ＧＭ），红系爆发形成单位（ＢＦＵ－Ｅ），和混合集落形成单位（ＣＦＵ－Ｍｉｘ）的相关性。结果发现脐血有核细胞中，抗ＨＰＣＡ－２阳性细胞占１．０５±０．７２％（ｎ＝１３），Ｔｋ３阳性细胞占２．０６±１．２５％（ｎ＝８），差别显著（Ｐ＜０．０５）。每毫升脐血两种抗体标记的细胞分别为９６．５６±５６．６４和２３１．４０±１６３．９３（Ｐ＜０．０５）。尽管ＨＰＣＡ－２阳性细胞与Ｔｋ３阳性细胞数量呈显著正相关（ｒ＝０．８７５，Ｐ＜０．０１），前者与ＣＦＵ－ＧＭ，ＢＦＵＥ，ＣＦＵ－Ｍｉｘ及集落总数ＣＦＵｓ均呈正相关，而后者仅与ＣＦＵ－ＧＭ，ＣＦＵｓ相关。研究提示在检测造血祖细胞时，用抗－ＨＰＣＡ－２－ＦＩＴＣ代替Ｔｋ３可降低假阳性，获得较好的ＯＤ（３４＋）细胞与ＣＦＵ间的线性关系。