兰索拉唑口服治疗消化性溃疡急性大出血

目的：观察兰索拉唑口服治疗消化性溃疡急性大出血的疗效。方法：３０例消化性溃疡急性大出血病人（男性２４例，女性６例，年龄４８±ｓ１６ａ）予兰索拉唑３０ｍｇ，ｐｏ，ｑｄ×（１０～１４ｄ），并酌情输液、输血。结果：兰索拉唑３０例（１００％）止血成功，住院天数为１４．１±２．１ｄ；输血量为０。未见药物不良反应。结论：兰索拉唑口服对消化性溃疡急性大出血有良好疗效。     

吻合血管的腓骨瓣移植一期重建双侧下颌骨

目的探讨下颌骨巨大肿瘤截骨切除后应用游离腓骨复合组织瓣一期重建双侧下颌骨方法和疗效。方法2000年7月至2002年10月,分别对波及双侧下颌骨的4例巨大成釉细胞瘤、2例牙龈癌施行截骨切除,手术造成跨中线的双侧下颌骨巨大缺损。根据下颌骨缺损的特点,以腓动静脉为血管蒂切取腓骨肌(皮)瓣,经截骨塑形后,用微形钛板将移植骨与双侧下颌骨残端坚固内固定,腓动、静脉与颈部小血管吻合,形成血管化腓骨复合组织瓣一期重建双侧下颌骨。结果6例移植腓骨复合组织瓣全部成活。随访6个月-2年,面下部外形恢复良好,移植腓骨与上颌骨相对位置正常,接受活动义齿修复后咬合关系和咀嚼功能均较满意。结论腓骨复合组织瓣节段性的骨膜供血和骨髓滋养动脉的双重供血特点十分适合塑造成下颌骨的弓状形态,是修复下颌骨巨大肿瘤导致的跨中线双侧下颌骨巨大缺损的理想材料。     

Thrombin induces expression of cytokine-induced SH2 protein (CIS) in rat brain astrocytes: involvement of phospholipase A2, cyclooxygenase, and lipoxygenase

Previously we have reported that thrombin induces inflammatory mediators in brain glial cells (Ryu et al. 2000. J Biol Chem 275:29955). In the present study, we found that thrombin induced a negative regulator of a cytokine signaling molecule, cytokine-induced SH2 protein (CIS), in rat brain astrocytes. In response to thrombin, CIS expression was increased at both the mRNA and protein levels. Although STAT5 is known to regulate CIS expression, thrombin did not activate STAT5, and inhibitors of JAK2 (AG490) and JAK3 (WHI-P97 and WHI-P154) had little effect on thrombin-induced CIS expression. In contrast, cytosolic phospholipase A(2) (cPLA(2)), cyclooxygenase (COX), and lipoxygenase (LO) play a role in CIS expression, since inhibitors of cPLA(2), cyclooxygenase (COX), and LO significantly reduced CIS expression. Reactive oxygen species (ROS) scavengers (N-acetyl-cysteine [NAC] and trolox) reduced thrombin-induced CIS expression, and inhibitors of COX and LO reduced ROS produced by thrombin. Furthermore, prostaglandin E(2) (PGE(2)) and leukotriene B(4) (LTB(4)), products of COX and LO, respectively, potentiated thrombin-induced CIS expression, indicating that ROS, and PGE(2) and LTB(4) generated by COX and LO, mediate CIS expression. Since interferon-gamma (IFN-gamma)-induced GAS-luciferase activity and tyrosine phosphorylation of STAT1 and STAT3 were lower in CIS-transfected cells compared to control vector-transfected cells, CIS could have anti-inflammatory activity. These data suggest that thrombin-stimulation of ROS and prostaglandin and leukotriene production via the cPLA(2), COX and LO pathways results in CIS expression. More importantly, CIS expression may be a negative feedback mechanism that prevents prolonged inflammatory responses.     

Changes in thyrotropin receptor antibody after subtotal thyroidectomy in Graves' disease: comparison with the degree of lymphocytic infiltration in the thyroid

To evaluate changes in TSH receptor antibody after surgery in Graves' disease and its relationship with the degree of lymphocytic infiltration, serial serum levels of TSH receptor antibody were measured before and after the subtotal thyroidectomy in 50 patients with Graves' disease. In 22 (44%) out of 50 patients, thyrotropin binding inhibitor immunoglobulin (TBII) levels gradually decreased and disappeared completely within 12 months after surgery (TBII disappearing group). Twenty-eight (56%) patients showed persistent TBII activity and their levels were not changed until 12 months after surgery (TBII persistent group). The changes of thyroid stimulating antibody (TSab) levels were very similar to those of TBII in both groups. The thyroidal lymphocytic infiltration was more prominent in the TBII disappearing group. The degree of the decrease of TBII levels after surgery correlated with the grade of thyroidal lymphocytic infiltration. There was no significant difference of TSH receptor antibody (both TBII and TSab) levels between the thyroid and peripheral venous blood. These data suggest that the persistence or disappearance of TSH receptor antibody after surgery may reflect the difference between patients in whom the thyroid is the major site of TSH receptor antibody and those in whom additional sites of TSH receptor antibody synthesis exist.     

矿岩棉致肺纤维化病例的探讨

20世纪60年代以来，人们对石棉导致肺纤维化，诱发肺癌、间皮瘤及其他癌症的认识逐渐加深，石棉代用品的研制和应用亦日渐发展，如玻璃纤维、金属纤维、石化纤维、碳纤维以及矿岩棉等。矿岩棉是以玄武岩和矿渣为主要原料，按一定比例混合，经高温熔化并离心、拉丝而制成的人造无机纤维。由于其与石棉外观及理化特性相似，国内外学者已对矿岩棉纤维的影响进行了深入的动物学实验研究和流行病学调查，但对其所引起的尘肺病例却罕见报道。     

补充多种营养素对原发性高血压病的疗效观察

目的：探讨多种营养素对原发性高血压病的治疗作用。方法130例高血压患者将其随机分为治疗组及对照组各36例，观察治疗前后降压情况及副作用。治疗组日服多种维生索和矿物质，对照组按常规处理，疗程3个月。结果：治疗组高血压有效率98％，对照组的95％，两组差异无显著性（P〉0．05）.结论：口服多种营养素对治疗原发性高血压患者有着重要的治疗价值     

特殊部位硬膜下血肿的CT、MRI诊断

目的 分析大脑镰、小脑幕硬膜下血肿的CT、MRI表现，提高其诊断准确率。方法 回顾性分析总结60例大脑镰、小脑幕硬膜下血肿的CT和MRI资料。结果 60例中发生于单侧55例，双侧5例；大脑镰硬膜下血肿25例表现为条索状，10例呈小带状，发生于两侧4例，MRI表现为双轨征，小脑幕下血肿7例呈片状，5例呈扇形，MRI表现为片带状高信号影，小脑幕并大脑镰硬膜下血肿6例呈“Y”形，3例呈镰刀状。结论 通过60例大脑镰、小脑幕硬膜下血肿的CT、MRI表现的比较分析，得到了进一步的认识，有助于提高诊断符合率，MRI在定位诊断方面优于CT。     

丹参阻抑慢性肺源性心脏病肺血管内皮细胞损伤的效应与途径

目的:探讨丹参注射液治疗慢性肺源性心脏病(简称肺心病)时对肺血管内皮细胞损伤的保护作用,以及对血管内皮细胞分泌功能的影响。方法:选择1999-02/08吉林大学第四医院呼吸内科收治的慢性肺心病急性发作期患者44例。随机分为丹参组和对照组,各22例。对照组给予一般常规治疗,丹参组在一般常规治疗同时加用丹参注射液静脉滴注,50g/L葡萄糖注射液250mL中加丹参注射液20mL,1次/d,连用14d。两组治疗前后均采血测定静脉血循环内皮细胞、血浆内皮素-1。采用ABL-520型血液气体酸碱分析仪检测动脉血酸碱度、动脉血氧分压、动脉血二氧化碳分压。结果:纳入患者44例,均进入结果分析。①循环内皮细胞:丹参组治疗后较治疗前下降明显[(0.87±0.23),(1.27±0.26)×107L-1,t=7.99,P=0.000];对照组治疗后较治疗前下降不明显[(1.09±0.28),(1.19±0.26)×107L-1,t=2.00,P=0.059];治疗后丹参组与对照组比较下降明显(t=4.03,P=0.000)。②内皮素-1:丹参组治疗后较治疗前下降明显[(70±14),(105±26)ng/L,t=8.64,P=0.000];对照组治疗后较治疗前下降不明显[(88±23),(99±24)ng/L,t=2.00,P=0.059];治疗后丹参组与对照组比较下降明显(t=3.99,P=0.000)。③直线相关分析:循环内皮细胞与内皮素-1呈显著正相关(r=0.733,P<0.01);与动脉血氧分压呈显著负相关(r=-0.751,P<0.01);而与动脉血酸碱度、动脉血二氧化碳无明显相关性(r=-0.115,0.237,P>0.05)。结论:丹参对于慢性肺心病患者的肺血管内皮细胞具有保护作用,使其免受损伤和对抗内皮素-1,使内皮素-1合成减少,或同时使内皮素-1灭活增加,从而达到阻抑或减轻肺血管内皮细胞损伤而带来的一系列病理反应。     

长效纳曲酮缓释剂植入治疗阿片依赖渴求的线索诱发事件相关电位评价

目的:在前期成功研制出长效纳曲酮缓释剂植入剂型的基础上,应用线索诱发事件相关电位观察长效纳曲酮缓释剂植入治疗阿片依赖者心理渴求的神经心理学作用.方法:①对象和分组:阿片依赖综合征患者自湖北、湖南和广东等地,包括两个不同戒毒方式的组,即长效纳曲酮缓释剂治疗组和强制戒毒组,同时设计一个未戒毒的阿片依赖对照组和一个健康对照组.②方法:采用事件相关电位记录被试由图片的情绪内涵激发的脑内电活动,无需被试对所观察的图片作出外显反应,现场采集记录其观看药物相关情景线索图片和中性图片时产生的脑电事件相关电位波形.结果:①长效纳曲酮缓释剂治疗组各波形的潜伏期和波幅已接近健康对照组(P > 0.05);而强制戒毒组和阿片依赖对照组的P200潜伏期与健康对照组差异非常显著(P < 0.01);而且,与未治疗的阿片依赖对照组比较,强制戒毒组没有表现出显著的P200正常化的效应.②源定位分布表明,观察药物相关线索图片P200的源发生点健康对照组在中脑导水管周围灰质,长效纳曲酮缓释剂治疗组在扣带回后部,强制戒毒者在内侧前额叶皮质,阿片依赖对照组在大脑前额叶皮质.结论:①与强制戒毒比较,长效纳曲酮缓释剂植入能降低心理渴求,使患者的心理状况更好.②长效纳曲酮缓释剂治疗能有效改善阿片药物依赖者的神经系统功能,抑制其心理渴求的高级神经活动.     

Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma

We investigated whether serum thyroglobulin (Tg) measured at the time of remnant ablation (ablation-Tg) could be a prognostic indicator complementary to serum Tg levels at the time of the first diagnostic whole-body scan (WBS) after thyroid hormone withdrawal (control-Tg; approximately 6-12 months after ablation-Tg) and whether ablation-Tg could predict the persistence or recurrence of disease in low-risk patients with differentiated thyroid carcinoma. Patients with differentiated thyroid carcinoma (n = 268) treated with total or near-total thyroidectomy followed by immediate (131)I remnant ablation were studied. Patients with anti-Tg autoantibodies and those showing evidence of extracervical metastases were excluded. Two patients showing remnant uptake on follow-up diagnostic WBS received a second ablation. We found significant correlation between ablation-Tg and control-Tg levels; 114 of 143 patients (80%) with ablation-Tg greater than 2 microg/liter showed detectable (>/=1 microg/liter) control-Tg, and 70 of 125 (56%) patients with ablation-Tg 2 microg/liter or less showed undetectable (<1 microg/liter) control-Tg [odds ratio 5.1, 95% confidence interval (CI) 3.0-8.9, P < 0.001]. When the 268 patients were followed up for a mean period of 5.7 +/- 1.4 yr (range 2.8-8.3 yr), 35 (13%) had recurrences; 73 (27%) were classified as "Tg positive, no evidence of disease"; and 160 (60%) showed complete remission. Of 143 patients with ablation-Tg greater than 2 microg/liter, recurrence was observed in 33 cases (23%); "Tg positive, no evidence of disease," was observed in 52 cases (36%); and complete remission was observed in 58 cases (41%). Of 125 patients with ablation-Tg 2 microg/liter or less, two patients (2%) showed recurrence during the follow-up; 21 patients (17%) were regarded as "Tg positive, no evidence of disease"; and 102 patients (81%) showed complete remission. The positive predictive value for recurrence in patients having ablation-Tg greater than 2 microg/liter was found to be 23.1% (33 of 143 patients, 95% CI 16.4-30.8%). The negative predictive value for recurrence in patients having ablation-Tg 2 microg/liter or less was found to be 98.4% (123 of 125 patients, 95% CI 94.4-99.8%). These data indicate that serum Tg levels measured at the time of immediate postoperative (131)I remnant ablation correlated well with serum Tg levels at the time of the initial diagnostic WBS and had a complementary role for predicting persistence or recurrence of disease in the earliest postoperative period.