全营养素混合液(TNA)在肠外营养的应用

脂肪乳剂、葡萄糖、氨基酸、电解质、维生素及微量元素按一定程序混合配成10种全营养素混合液。在4℃14天贮存期内,10种混合液的pH和渗透压变化不大,不同混合液在不同时期的脂粒平均直径变化为0.3135±0.1012μm～0.4813±0.1893μm,94.93％脂粒的直径<0.6μm,无直径>6μm的脂粒,细菌培养阴性。74例共输全营养素混合液1,796次,无不良临床反应和异常实验室检查结果;用1周以上者大都显示氮平衡改善,用2周以上者血清转铁蛋白和白蛋白浓度可有不同程度升高。     

Acute Cellular Rejection with CD20-Positive Lymphoid Clusters in Kidney Transplant Patients Following Lymphocyte Depletion

Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup.     

提壶揭盖法治疗前列腺增生症82例

笔者自1995年以来，宗提壶揭盖法，用补中益气汤加减治疗前列腺增生82例疗效满意，报告如下。     

前列腺素E1对大鼠肝移植肾功能的保护作用

目的探讨术中应用前列腺素E1（prostaglandin E1，PGE1）对大鼠肝移植肾功能的保护作用。方法大鼠原位肝移植术中经颈内静脉灌注PGE1为治疗组，生理盐水和空白为对照组，观察术后1周存活率、1h的尿量，测定血浆肌酐、尿素氮和肾组织中丙二醛（malondjaldehyde，MDA）、谷胱甘肽（glutathione，GSH）含量，肾组织病理检查。结果PGE1治疗组术后1h尿量较对照组明显增加，肌酐和尿素氮水平均较对照组降低，PGE1治疗组肾组织中GSH含量显著高于两对照组，MDA含量低于两对照组。病理检查PGE1治疗组肾脏组织形态学损伤明显减轻。结论术中应用PGE1能显著改善大鼠肝移植后的肾功能，其机制可能与对抗氧自由基损伤作用有关。     

Expression of CD68 CD45RO CD20 and proliferating cell nuclear antigen in nasal polyps]

OBJECTIVE: To study the cellular expression of CD45RO, CD20, CD68 and proliferating cell nuclear antigen (PCNA) in nasal polyps. METHODS: Nasal polyp tissues from 50 patients were evaluated for cellular expression of CD45RO, CD20, CD68 and PCNA using immunohistochemistry SP by counting the average number in 5 chosen high-power fields, Histopathological observations were combined with HE. Analyses were performed on SPSS10.0. RESULTS: CD68+ cells were expressed more in nasal polyps dominated by eosinophils than by neutrophils(P < 0.05). There was no difference between CD45RO and CD20, but both of them had negative correlation(P = 0.05). Significant correlation was found between CD68+ cells and eosinophils or PCNA positive cells on epithelium. PCNA positive cells on epithelium had significant correlation on fibroblast (P < 0.05). CONCLUSION: Inflammatory cell infiltration (eosinophilia CD45RO, CD20, CD68) and cell proliferating in epithelium cells, glandular cell and fibroblast are strongly correlated with formation of nasal polyps. The nasal polyps are not only characteristic of eosinophilia but also by lymphocytes dominated by CD45RO and CD68 positive cells. CD68 may be stem cell of nasal polyp.     

Association of the GNAS1 gene variant with hypertension is dependent on alcohol consumption.

The beta-adrenoceptor (beta-AR)-stimulatory guanine nucleotide-binding (Gs) protein system has been shown to play important roles in the cardiovascular system. The gene encoding the alpha-subunit of Gs proteins (GNAS1) is a candidate genetic determinant for hypertension. Because alcohol consumption is known to affect blood pressure partly through the beta-AR-Gs protein system, we examined the possible interaction between GNAS1 T393C polymorphism and drinking status in the association with hypertension in the present study. As a result, a non-significant but reasonable trend supporting the presence of an interaction was shown (p = 0.076). In line with this trend, the T393C polymorphism significantly interacted with drinking status in the association with systolic blood pressure (p = 0.028). Moreover, supporting the presence of an interaction, T allele carriers consistently had a higher probability of hypertension, higher systolic blood pressure, and higher diastolic blood pressure than CC homozygotes in non-drinkers and light drinkers. In contrast, CC homozygotes consistently had a higher probability of hypertension, higher systolic blood pressure, and higher diastolic blood pressure than T allele carriers in moderate to heavy drinkers. The present study also showed a significant interaction between the T393C polymorphism and drinking status in the association with pulse pressure (p = 0.026), reflected by a significant association between the T393C polymorphism and pulse pressure in moderate to heavy drinkers (p = 0.026). These findings may be helpful in conducting further molecular and biological studies on the relationship among the effects of alcohol, the beta-AR-Gs protein system, and hypertension.     

The epidemiology and surveillance of blood lead in Taiwan (R.O.C.): A report on the PRESS-BLL project

 To monitor the lead hazards in industries and to investigate the prevalence of elevated blood lead levels (BLLs) in lead-exposed workers, a lead surveillance system (PRESS-BLLs) has been established and operated in Taiwan, Republic of China, since July 1993. A cohort of lead-exposed workers who received a periodic annual health examination at 55 accredited hospital laboratories was constructed. A total of 9807 separate BLL measurements were reported to the system in 1994. The mean BLL was 15.8 μg/dl in male workers and 11.6 μg/dl in female workers. The mean BLL of lead-exposed workers was significantly (P<0.05, z-test) higher than that of the general Taiwanese population (8.6 μg/dl for males and 6.7 μg/dl for females). In addition, the BLLs of 983 (10.0%) workers exceeded the regulatory action level (40 μg/dl for males; 30 μg/dl for females). The workplaces and homes of 57% of the workers with elevated BLLs were thoroughly investigated to determine the sources of lead contamination. These actions identified the causes of elevated BLLs and set up strategies to reduce workers’ lead exposure. The establishment of this occupational lead surveillance system represents a method for monitoring of lead hazards from occupational and environmental settings to prevent lead poisoning. The information acquired from the system can help in the setting up of a priority of prevention and the development of control measures. It is also useful for further monitoring of changes in the BLLs of the lead-exposed-worker cohort. The Health Department of Taiwan can use this information to evaluate the effectiveness of current industrial hygiene practice. Subjects with elevated BLLs have been medically treated and placed on long-term follow-up for sequelae. Received: 2 September 1996/Accepted: 29 November 1996     

大鼠脊髓缺血再灌流时脊髓神经元对躯体和内脏传入刺激的反应

５０只大鼠用乌拉坦麻醉，箭毒制动。通过阻断腹主动脉血流以模拟腰段脊髓的局部缺血和再灌流损伤，玻璃微电极记录Ｌ２节段脊髓单位放电（ＳＣＵＤｓ），观察缺血再灌流时脊髓神经元对腓神经刺激（ＰＮＶ），内脏大神经刺激（ＶＬＮＶ）及两者同时刺激（ＳＶ）的反应。结果在缺血前所记录的１３３个自发放电单位中，对３种刺激均产生兴奋（Ｅ）、抑制（Ｉ）及无反应（ＮＲ）３种形式的反应，表明大鼠Ｌ２节段脊髓存在躯体、内脏和躯体内脏反应性神经元，并有会聚和阻塞现象。在脊髓缺血再灌流时，神经元对ＰＮＶ、ＶＬＮＶ、ＳＶ也产生Ｅ、Ｉ、ＮＲ３种形式的反应，提示脊髓缺血再灌流时神经元对躯体和内脏传入刺激的反应形式不受影响；但缺血时ＳＣＵＤｓ对ＰＮＶ、ＶＬＮＶ产生反应的单位数减少，这表明脊髓缺血损伤时神经元对躯体和内脏传入刺激的反应性减弱，随着缺血损伤加重，脊髓神经元对躯体内脏信号的整合功能下降