Liver transplantation for chronic hepatitis B with lamivudine-resistant YMDD mutant using add-on adefovir dipivoxil plus lamivudine.

Lamivudine treatment in patients with chronic hepatitis B virus (HBV) infection may improve clinical state and suppress viral replication before liver transplantation. Emergence of lamivudine-resistant YMDD mutant is common. We report the results of liver transplantation in 16 patients with pretransplantation YMDD mutants after receiving lamivudine treatment for a median of 738 days (range, 400-1799 days). Adefovir dipivoxil (10 mg daily) was added on to lamivudine for a median of 20 days (range, 8-271 days) before (n = 11) or at (n = 5) liver transplantation, and the combination was continued indefinitely thereafter. Eight patients received additional intravenous hepatitis B immune globulin (HBIG) for a median of 24 months. Fifteen patients with known pre-adefovir HBV DNA levels had a median titer of 14,200 x 10(3) copies/mL (2 x 10(3) to 4,690,000 x 10(3) copies/mL), and 14 had HBV DNA >10(5) copies/mL. All but 1 patient remained positive for HBV DNA (by quantitative polymerase chain reaction [qPCR]) at the time of liver transplantation, and the titer was greater than10(5) copies/mL in 8 patients. The median follow-up after liver transplantation was 21.1 (range, 4.4-68.9) months. One patient (6%) died of an unrelated cause 12.2 months after transplantation, and 15 patients (94%) were alive with the original graft. All patients cleared HBV DNA and had no detectable HBV DNA by qPCR at the latest follow-up. Fourteen patients had cleared hepatitis B surface antigen (HBsAg), but 2 patients who received only adefovir dipivoxil and lamivudine without HBIG remained HBsAg positive after 7.7 and 9.5 months. Serum HBV DNA, however, was negative, and there was no biochemical or histological evidence of recurrence. Adefovir dipivoxil was well tolerated with no significant renal toxicity. In conclusion, a combination of add-on adefovir dipivoxil plus lamivudine therapy provides effective prophylaxis in patients with pretransplantation YMDD mutant that may be actively replicating. The cost effectiveness of additional passive immunoprophylaxis remains to be defined.     

Stereotaxic Interstitial Laser Therapy of Early-Stage Breast Cancer

Abstract: Coagulation leading to fibrosis of mammo-graphically detected breast cancers by interstitial laser therapy was tested as an alternative to surgical removal. Availability of computerized stereotaxic digital imaging allows the precise placement of laser and thermal needles into the target tumor and its controlled ablation by heat. The methodology of interstitial laser therapy (ILT), evolution of the subsequently removed tumors, and their histologic appearance are outlined.
Eight patients with mammographically well-defined tumors were selected. Definitive diagnosis and receptor evaluation were made on core biopsies. Under local anesthesia, stereotaxically guided diode laser energy at 5–10 w was delivered via a 400 xm fiber in a 19-gauge needle placed into the center of the tumor until the peripheral temperature exceeded 60°C. Patients experienced transient pain and pyrexia. Subsequent to ILT, seven invasive carcinomas were excised while one case of multiple papillomas was kept under surveillance. Histologic study revealed central necrosis but some peripheral residual tumor in the first five cases. In the last two, central necrosis surrounded by concentrically arranged, recognizable but severely injured, focally "windswept" and "ghostlike" tumor and granulation tissue were noted. The multiple papillomas showed radiologic shrinkage at 5 months and extensive fibrosis on needle biopsy.
ILT is an attractive new method of treating small, well-defined breast tumors and offers a potentially significant alternative to surgical removal; further exploration is warranted.     

舰船员慢性荨麻疹与马拉色菌相关性研究

OBJECTIVE: To investigate the association of Malassezia furfur with chronic urticaria in the crew members of ships. METHODS: A comparative mycological study of 126 crew members of ships with chronic urticaria and 45 normal control subjects was carried out. The 82 urticaria patients identified as positive for Malassezia furfur were divided into groups A and B to receive treatment with antihistaminics (group A) and antihistaminics combined with 2% ketoconazole shampoo(group A). RESULTS: The carrier rates of Malassezia furfur were significantly higher in urticaria patients than in the normal control subjects (P<0.01), but in view of the case ratios of the final cure or improvement, no significant difference was observed between the two groups by the end of the treatment courses (P>0.05). But 6 to 8 weeks from the end of the treatment course, better therapeutic effect was noted in group B (P<0.01), with higher rate of negative Malassezia furfur findings (P<0.01). CONCLUSION: Malassezia furfur may play an important role in the prevalence of chronic urticaria among the crew members, and anti-fungal treatment may produce better long-term therapeutic effect.     

几种化合物对石棉诱发肺泡巨噬细胞产生一氧化氮的抑制作用

为了寻求一种适宜的石棉表面改性剂，利用体外细胞培养技术，通过测定培养液中亚硝酸根（ＮＯ－２）含量，观察了茫崖产温石棉对豚鼠肺泡巨噬细胞（ＡＭ）产生一氧化氮（ＮＯ）的诱导作用以及混合稀土、亚硒酸钠、柠檬酸铝对石棉诱发ＡＭ产生ＮＯ的影响。结果显示，温石棉纤维可使培养液中ＮＯ－２浓度升高，并呈明显的剂量反应关系；混合稀土、亚硒酸钠、柠檬酸铝均可抑制石棉诱发ＡＭ产生ＮＯ，而且随上述化合物浓度的升高，抑制作用增强。提示用混合稀土和亚硒酸钠拮抗石棉的致病作用有实际应用的可能。     

改良Richard钉在髋部骨折中的应用

髋部骨折是常见骨折之一，且逐年增多。多发生于老年人，并发症多，死亡率高。应用Ｒｉｃｈａｒｄ钉治疗是目前最佳方法之一。我们将Ｒｉｃｈａｒｄ钉进行了改进，一是增加了松质骨螺钉粗螺纹长度；二是根据不同类型的粗隆下骨折，增加了套筒钢板的长度。经５２例粗隆间骨折和２１例粗隆下骨折患者的临床应用，无死亡，无髋内翻及机械装置并发症的发生。术后病人无需外固定，可早期床上及下地活动。经随访８～３８个月，平均随访时间１５．６个月，骨折全部愈合。我们认为改良Ｒｉｃｈａｒｄ钉是治疗髋部粗隆间和粗隆下骨折更为理想的内固定装置。     

氧化胆固醇对动脉毒性作用的研究

将Wistar大鼠随机分成氧化胆固醇组(Och)、纯胆固醇组(Pch)和对照组,分别用氧化胆固醇混合物(250mg/kg bw/d)、纯胆固醇(250mg/kg bw/d)以及悬浮固醇用的明胶液体给大鼠灌胃,连续二天。于第二次灌胃后18小时,从大鼠尾静脉注射伊文思兰溶液,并于注射后2小时处死;取出主动脉用荧光显微分光光度术测定主动脉内膜的通透性。此外,另一部分动物在第二次灌胃后24小时处死,取出主动脉作扫描电镜的内膜观察。结果表明,Och大鼠主动脉内膜的通透性显著高于Pch组与对照组大鼠(P<0.01),而Pch组大鼠主动脉内膜的通透性和对照组无显著差异(P>0.05)。     

Histological comparison of implanted cadaveric and porcine dermal matrix grafts.

OBJECTIVES: Histological comparison of human-based (AlloDerm) and porcine-based (ENDURAGen) dermal matrices regarding tissue incorporation and neovascularization as potential soft tissue augmentation materials. STUDY DESIGN: In vivo, rat model. METHODS: Subcutaneous implantation of 1-mm thick, 1 cm x 1 cm pieces of AlloDerm, ENDURAGen, and meshed ENDURAGen was performed in 24 Sprague Dawley rats. Implant materials were harvested at 4 (n = 12) and 8 weeks (n = 12). Histological quantification of soft tissue ingrowth and microvascular density was performed following hematoxylin-eosin staining and CD34 immunohistochemistry, respectively. RESULTS: AlloDerm showed significantly greater soft tissue ingrowth and microvascular density compared with both ENDURAGen and meshed ENDURAGen at 4 and 8 weeks (P < 0.001). CONCLUSIONS: Although these results may differ in human host tissues, AlloDerm seems to be a more suitable dermal matrix implant than ENDURAGen for cases in which tissue incorporation and neovascularization are sought for the optimal outcome based on this animal model.     

交叉韧带重建手术中可吸收挤压螺钉的应用

目的探讨交叉韧带重建术中可吸收挤压螺钉的使用方法和疗效。方法总结53例交叉韧带重建病例使用可吸收挤压螺钉的情况，在术中、术后并发症、术后康复、膝关节功能状况等方面进行回顾性分析。结果三例出现韧带切割现象。两例股骨侧螺钉拧入后导引针无法拔出。一例挤压螺钉断裂。术后Lysholm评分平均92.4±4．1。结论交叉韧带重建术中使用可吸收挤压螺钉固定的方法固定牢固，术后恢复快，利于早期康复。     

中国三城市儿童步行者道路交通安全状况回顾性研究

目的了解北京、上海、广州三城市儿童步行安全状况及相关因素,为加强儿童道路交通伤害预防、干预提供科学依据。方法回顾性收集2000~2004年三城市交管部门14岁以下儿童步行者交通伤害发生资料。结果三城市5年间儿童步行者道路交通伤害发生率为14.93/10万,男女比例为1.79∶1,5~9岁为高发年龄,儿童步行者发生道路交通伤、亡的主要责任方为行人,受伤害儿童43.0%为轻伤,46.6%为重伤,10.4%为死亡。结论道路交通伤害严重威胁儿童安全与健康,儿童步行者发生道路交通伤害与多种因素有关,需社会各个部门参与预防。