冷盐水灌注导管消融持续性房性心动过速一例

本文报道普通射频温控导管消融未成功时，及时更换使用冷盐水灌注导管而消融成功，尤其是射频功率很低时，难以取得远期效果。本文价值在于提醒医师思维广泛，及时改变思路、方法，以取得成功。[编者按]     

Clinical and polysomnographic features of patients with multiple system atrophy in Southwest China

Purpose

The association between clinical features and polysomnographic variables of Chinese patients with multiple-system atrophy (MSA) remains largely unknown.

Methods

This study assessed 30 patients with MSA from Southwest China using the Unified Multiple-System Atrophy Rating Scale (UMSARS). Each patient also underwent video-polysomnography. Twenty age and gender matched healthy volunteers were performed video-polysomnography as control group.

Results

Of the 30 patients, 23 (76.7 %) were classified as having MSA-C and seven (23.3 %) were diagnosed with MSA-P. The mean age of the patients at disease onset was 53.2?±?8.5 years, and the mean duration of their disease was 3.6?±?2.8 years. Twenty-one patients complained of sleep disorders. The mean scores of UMSARS-I, UMSARS-II, and UMSARS-IV of patients with MSA-P were significantly higher than those of patients with MSA-C. Polysomnography revealed that 29 patients had sleep architecture alteration. A longer duration of stage N1 sleep, a shorter REM sleep, as well as decreased sleep efficiency and total sleep time (TST) were detected. Twenty-one patients had obstructive sleep apnea. Patients with MSA-C demonstrated longer sleep onset latencies compared with patients with MSA-P. TST was negatively correlated with MSA duration, whereas sleep latency was positively correlated with MSA duration. Moreover, TST, and mean SaO₂ were negatively correlated with motor disability.

Conclusions

Various sleep disorders are common in Chinese MSA patients. Sleep architecture and sleep-associated breathing disorders are predominant polysomnographic findings. Sleep quantity was reduced with disease progression.     

Peritonitis due to Burkholderia gladioli

We report a case of continuous ambulatory peritoneal dialysis (CAPD)–related peritonitis. Burkholderia gladioli, as a plant pathogen, were cultured from peritoneal effluent. Peritonitis healed after intraperitoneal cefazolin and gentamicin. This case indicated that CAPD effluent may be contaminated by B. gladioli, causing CAPD-related peritonitis. On the other hand, it can be successfully treated with intraperitoneal antimicrobials without removal of the Tenckhoff catheter.     

Interferon regulatory factor 8 functions as a tumor suppressor in renal cell carcinoma and its promoter methylation is associated with patient poor prognosis

Interferon regulatory factor 8 (IRF8), as a central element of IFN-γ-signaling, plays a critical role in tumor suppression. However, its expression and underlying molecular mechanism remain elusive in renal cell carcinoma (RCC). Here, we examined IRF8 expression and methylation in RCC cell lines and primary tumors, and further assessed its tumor suppressive functions. We found that IRF8 was widely expressed in human normal tissues including kidney, but frequently downregulated by promoter methylation in RCC cell lines. IRF8 methylation was detected in 25% of primary tumors, but not in adjacent non-malignant renal tissues, and associated with higher tumor nuclear grade of RCC. Ectopic expression of IRF8 inhibited colony formation and migration abilities of RCC cells, through inducing cell cycle G2/M arrest and apoptosis. IFN-γ could induce IRF8 expression in RCC cells, together with increased cleaved-PARP. We further found that IRF8 inhibited expression of oncogenes YAP1 and Survivin, as well as upregulated expression of tumor suppressor genes CASP1, p21 and PTEN. Collectively, our data demonstrate that IRF8 as a functional tumor suppressor is frequently methylated in RCC, and IRF8-mediated interferon signaling is involved in RCC pathogenesis.     

乳腺癌中E-cadherin和BCA-225蛋白表达与预后的相关性研究

目的探讨乳腺癌组织中E-cadherin和BCA-225蛋白表达及其与临床病理因素和预后的关系。方法应用SP免疫组化方法检测70例原发性乳腺癌组织和10例良性乳腺病变中E-cadherin和BCA-225蛋白的表达。结果乳腺癌组织中E-cadherin的高表达率显著低于良性乳腺疾病,其表达与肿瘤大小、临床TNM分期、组织学分级、淋巴结转移状态密切相关（P〈0.05）,而与雌孕激素受体状态及癌基因Her-2无关。BCA-225的高表达率显著高于良性乳腺疾病（P〈0.01）,其表达与组织学分级及癌基因Her-2密切相关（P〈0.05）,而与肿瘤大小、临床TNM分期、淋巴结转移、及雌孕激素受体状态无关。E-cadherin与BCA-225两者表达无相关性。Kaplan-Meier生存曲线分析显示E-cadherin高表达患者的生存状况较对应情况好,且差异有统计学意义（P〈0.05）。多因素Cox回归分析表明,E-cadherin蛋白为乳腺癌有效的独立的预后指标,其风险系数exp为-1.795954,（P〈0.05）。结论乳腺癌E-cadherin表达缺失或减少,与肿瘤的发生发展、增殖、侵袭转移及预后密切相关,可作为评价乳腺癌患者独立的预后指标。乳腺癌BCA-225表达上调与肿瘤的分化程度相关,但作为乳腺癌患者独立的预后评价指标还尚待进一步深入探讨。     

阿魏酸钠治疗不稳定型心绞痛临床观察

不稳定型心绞痛（unstable angina,UA）是临床常见的急性冠状动脉综合征,易发展为急性心肌梗死。阿魏酸钠（sodium ferulate）用于辅助治疗UA,临床报道甚少。为此,笔者于2005年3月至2006年9月间应用阿魏酸钠联合常规疗法治疗UA,取得较好疗效。现报道如下。     

临床医学科学数据分类的探讨

临床医学科学数据分类是一个系统的研究课题,是临床医学科学数据中心建设的基本数据类标准之一,它既具有网络信息分类组织的系统性,又具有临床医学科学数据组织的专业性。文章通过对网络信息资源组织的理解,探讨临床医学科学数据的分类技术方法。     

2型糖尿病患者指骨骨密度的比较研究

目的 观察2型糖尿病（T2DM）患者指骨骨密度（BMD）改变并与正常人群比较。方法 采用Metriscan骨密度仪检测指骨BMD。结果 （1）指骨BMD与腰椎（L2-4）和股骨颈BMD呈正相关（r=0．737，0．715，P〈0．05）；（2）正常女性峰值骨量为31～40岁；（3）糖尿病组指骨BMD与正常组间差异有显著性意义，绝经后T2DM妇女指骨BMD与正常组、T2DM组绝经前的妇女及男性间差异有显著性意义。结论 指骨BMD与腰椎及股骨颈BMD有明显相关性。2型糖尿病患者骨量丢失的规律与正常人相近，而LDM患者指骨BMD明显低于正常人。     

氩激光治疗中心性浆液性视网膜脉络膜病变56例临床

目的:观察氩激光治疗中心性浆液性脉络膜视网膜病变的疗效.方法:根据视网膜血管荧光造影确诊,确定渗漏点的位置,采用氩激光直接封闭渗漏点.结果:56例(56眼),光凝一次治愈49眼,两次激光治愈7眼.其中1wk治愈7眼,2wk治愈14眼,3wk治愈12眼,4wk治愈10眼.＞4wk～2mo以上治愈13眼.6眼复发,再次激光治疗治愈.结论:氩激光治疗中心性浆液性视网膜病变病程明显缩短,视力提高,无并发症的发生.     

门诊糖尿病患者的健康教育

糖尿病是一种由于胰岛素分泌绝对或相对不足，以及靶组织细胞对胰岛素敏感性降低所引起的代谢紊乱，是一种终身性疾病。随着人们生活水平的提高，生活节奏的加快，糖尿病的发病率逐年增加，严重的危害着人们的健康。患者对疾病的态度及其对治疗经过的认识对糖尿病的控制有很大的影响。如果血糖长期控制不良，可引起多种并发症，导致残疾和过早死亡。对患者实施有效地健康教育，有利于控制糖尿病患者的病情发展，提高患者的生活质量。我院2002年7月和河北石家庄糖尿病医院联合对前来我院就诊的糖尿病患者实施健康教育。