Mini-plasminogen: a mechanism for leukocyte modulation of plasminogen activation by urokinase

Urokinase activation of blood fibrinolysis involves polymorphonuclear leukocytes. To determine if a leukocyte proteinase can modulate plasminogen activation, plasminogen was digested with leukocyte elastase. A major product was a small, approximately 34,000 dalton fragment (mini-plasminogen), without lysine-binding function, but with fibrin-binding activity. After urokinase activation, the resulting mini- plasmin had amidolytic activity for a tripeptide plasmin substrate and fibrinolytic activity. By 125I-fibrin assay, activities of mini-plasmin and plasmin (12 nmole/liter) were 38 and 20 ng fibrin lysed/min, respectively. Lysis times of fibrin clots containing urokinase, and mini-plasminogen or plasminogen (800 nmole/liter), were 282 and 290 sec, respectively. Mini-plasmin and plasmin were inhibited similarly by epsilon-aminocaproic acid and normal plasma, but differed in responses to gel filtration fractions of plasma containing alpha 2-antiplasmin and alpha 2-macroglobulin, the primary and secondary plasmin inhibitors. With purified inhibitors, mini-plasmin required higher concentrations of, or longer preincubation with, alpha 2-antiplasmin, and lower concentrations of, or shorter preincubation with, alpha 2- macroglobulin, to produce inhibition equivalent to that observed with plasmin. Leukocyte elastase digests plasminogen to generate a mini- plasminogen which, when activated by urokinase, has a novel pattern of response to the major plasmin inhibitors in plasma.     

二氧化碳气腹对肿瘤细胞生长和播散影响的研究

目的　研究静脉使用 5 %NaHCO3 纠正CO2 气腹造成的酸中毒能否改善其对肿瘤细胞的促生长和播散作用。方法　观察静脉推注 5 %NaHCO3 的CO2 气腹组、CO2 气腹组及对照组带瘤Wister大鼠的肿瘤生长及穿刺点转移情况。结果　静脉推注 5 %NaHCO3 的CO2 气腹组、CO2 气腹组及对照组肿瘤的重量、体积和腹水体积有差异 ,但无统计学意义。穿刺点转移率无明显差异。结论　CO2 气腹影响肿瘤细胞生长和播散的机制复杂 ,不能完全以CO2 引起机体酸中毒解释。未找到通过静脉推注 5 %NaHCO3 可改善CO2 气腹对肿瘤细胞生长影响的基础理论依据。     

低频率抗Mur抗体引起溶血性输血反应的调查研究

目的研究抗Mur抗体血型血清学特征，调查其在输血医学中临床意义。方法对2例患者的血清，与已知血型的试剂红细胞和4个已知Mur抗原，在盐水介质、低离子间接抗球蛋白介质，分析鉴定出其抗体的特异性。结果这2例患者与已知血型的试剂红细胞在多种反应介质中的反应结果显示患者血清中含有抗Mur抗体，患者血清与4个已知Mur抗原的反应证实该例抗体只与Mur抗原反应。结论该例同种抗体为特异性抗Mur抗体，在临床会引起溶血性输血反应。在东方人群中Mihenberger血型抗体常规筛选鉴定值得探讨。     

Long-Term Results of Hybrid Therapy in Patients with Atrial Fibrillation Who Develop Atrial Flutter During Flecainide Infusion

The flecainide infusion test has been proposed to screen candidates for hybrid pharmacological and ablation therapy. We report the long-term follow-up of 154 consecutive patients with paroxysmal or persistent atrial fibrillation (AF) who developed atrial flutter (AFL) during flecainide infusion (IC AFL), treated with inferior vena cava-tricuspid annulus isthmus catheter ablation and oral flecainide (hybrid therapy). Over a mean of 54.1 ± 13.1 months 82 patients (53%) remained free of AF and AFL. Flecainide was discontinued because of adverse effects in 6 patients (4%). A history of persistent AF, and the documentation of ≥1 spontaneous AFL episode before the flecainide test were independent predictors of successful hybrid therapy. In patients with paroxysmal AF without documented spontaneous AFL, the long-term efficacy of hybrid therapy was 38.5% (P = 0.03). The flecainide infusion test reliably detects candidates for hybrid therapy. The efficacy of this therapy is maintained over the long-term with a high patient compliance.     

有剖宫产史孕妇再次妊娠分娩方式的探讨

目的：探讨剖宫产术后再次妊娠分娩的最佳方式。方法：回顾分析上海交通大学医学院附属瑞金医院2004年1月—2012年9月剖宫产术后再次妊娠的286例孕妇的分娩方式,其中剖宫产234例,阴道试产52例,并随机抽取同期首次行剖宫产术300例孕妇为对照组。结果：286例孕妇中258例（90.2%）再次行剖宫产术,28例阴道分娩,试产成功率53.9%。阴道分娩组无大出血发生,再次剖宫产组发生10例（3.88%）,对照组发生2例（0.67%）,差异有统计学意义（P〈0.05）。再次剖宫产组术中出血量（325.4±12.5）mL,高于对照组（225.6±26.8）mL及阴道分娩组（148.4±15.7）mL,差异有统计学意义（P〈0.05）。再次剖宫产组平均手术时间（59.2±20.5）min,高于对照组（30.9±14.6）min;腹腔粘连146例（56.59%）,高于对照组0例,差异均有统计学意义（P〈0.05和0.01）。再次剖宫产组住院时间（7.2±0.9）d,与对照组（6.8±1.2）d和阴道分娩组（3.5±1.8）d比较,差异有统计学意义（P〈0.05）。结论：瘢痕子宫再次妊娠不是剖宫产的绝对指征。有剖宫产史孕妇再次妊娠后,若无剖宫产指征,应增加阴道试产机会;而提高剖宫产手术水平,是降低剖宫产史孕妇再次剖宫产并发症的关键。     

Successful endoscopic ultrasound-guided overstenting biliary drainage through a pre-existing proximal migrated metal biliary stent

Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques.     

International Headache Society classification: interobserver reliability in the diagnosis of primary headaches

We assessed interobserver reliability of the International Headache Society (IBIS) classification for diagnosis of primary headaches. The study was performed on 103 patients consecutively seen at two Headache Centres. Each patient was given a structured interview recorded on videotape. Four experienced clinicians then reviewed the interviews separately and made a diagnosis of headache according to IHS criteria at the one- and two-digit levels. At both the one- and the two-digit level the agreement was substantial (Kappa = 0.74 and 0.65, respectively). The analysis of reliability for each of nine items necessary for diagnosis showed an agreement ranging from substantial (Kappa = 0.69) to almost perfect (Kappa = 0.89). Our results indicate that the IHS classification has a good reliability for the diagnosis of primary headaches at the one- and two-digit levels.     

不同处理方法对经尿道前列腺电切术患者寒战反应的预防效果分析

目的比较不同的处理方法对减少经尿道前列腺电切术中患者寒战的效果。方法收集320例择期行经尿道前列腺电切术患者，随机分成Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组各80例，全部采用蛛网膜下隙阻滞硬膜外联合麻醉，经尿道行前列腺电切术，对4组患者分别采用不同的预防和护理方法，观察4组患者寒战发生情况。结果寒战的发生率Ⅰ组和Ⅲ组较Ⅳ组显著降低，差异有统计学意义。结论物理升温及曲马多静脉注射可降低经尿道前列腺电切术中患者寒战的发生率。     

双清平化方对代谢综合征大鼠骨骼肌自噬通路蛋白表达的影响

目的 观察双清平化方对代谢综合征大鼠Lee''s指数、血糖、血脂及骨骼肌哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)、自噬效应蛋白1(Beclin1)、微管相关蛋白1轻链3(microtubule-associated protein1 light chain 3,LC3)蛋白表达的影响,探讨其改善糖脂代谢的作用机制。方法 大鼠给予高脂饲料加10%果糖水溶液喂养,并联合应用N-硝基-L-精氨酸甲酯(N-nitro-L-arginine methyl ester,L-NAME)及链脲佐菌素(streptozotocin,STZ)诱导代谢综合征模型。代谢综合征大鼠给予双清平化方或二甲双胍干预8周,实验前后定期测量大鼠体质量、体长、腹围、血压、糖耐量、糖化血红蛋白(glycated hemoglobin,GHb)、胰岛素(insulin,INS)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C),计算葡萄糖曲线下面积(OGTT-AUC)和胰岛素抵抗指数(HOMA-IR);采用苏木素-伊红(HE)染色观察骨骼肌组织病理形态学变化;采用Masson染色观察骨骼肌纤维形态变化;采用免疫组化法检测骨骼肌组织中LC3蛋白表达;采用Western blotting检测骨骼肌组织中mTOR、Beclin1和LC3蛋白表达。结果 与对照组比较,模型组大鼠空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h postprandial glucose,PG2h)、OGTT-AUC、HOMA-IR、INS、GHb、TC、TG及LDL-C水平均显著升高(P<0.01),HDL-C水平显著降低(P<0.01);骨骼肌组织中mTOR蛋白表达显著上调(P<0.01),Beclin1、LC3蛋白表达显著下调(P<0.01)。与模型组比较,双清平化方组FBG、PG2h、OGTT-AUC、HOMA-IR、INS、GHb、TC、TG及LDL-C水平均显著降低(P<0.05、0.01),HDL-C水平显著升高(P<0.01);骨骼肌组织中mTOR蛋白表达水平显著上调(P<0.01),Beclin1和LC3蛋白表达显著下调(P<0.01)。结论 双清平化方可以改善代谢综合征大鼠胰岛素抵抗,改善糖脂代谢水平,抑制骨骼肌病理变化,其作用机制可能与调节骨骼肌自噬,激活骨骼肌组织自噬通路中mTOR、Beclin1、LC3蛋白表达有关。