化学发光免疫法检测粒细胞抗体IgG的研究

作者以ＡＢＥＩ－ＣｏＣｌ＿２－Ｈ＿２Ｏ＿２作为化学发光指示系统，用固相竞争法检测５８例白细胞减少症患者、４１例无白细胞减少症患者及３２例正常人等的粒细胞抗体ＩｇＧ。判断标准采用正常人血清化学发光强度指数法。实验结果表明，白细胞减少症患者血清中粒细胞抗体阳性率明显高于无白细胞减少症患者（Ｐ＜０．００５）。本法敏感性为４３．１％，特异性为９０．２％，准确性为６２．６％，是一种灵敏而准确的方法，能将粒细胞包被试管在室温下较长时间保存，以供临床监测粒细胞抗体，大大缩短检测时间。     

Three years' experience with levonorgestrel-releasing intrauterine device and Norplant-2 implants: a randomized comparative study

A randomized comparative study of levonorgestrel-releasing intrauterine device (LNG-IUD) and Norplant^R-2 implants was carried out in 200 women for 36 months. Three thousand one hundred woman-months of use were observed with each device. Only one pregnancy occurred in users of LNG-IUD at the 12th month of use. The change in bleeding pattern was the most frequent reason for discontinuation. The discontinuation rate for irregular bleeding with Norplant-2 was 17.3 and 26.8 at 24 and 36 months, respectively, as compared to 3.3 with LNG-IUD at both 24 and 36 months. The differences were statistically significant. Removal for amenorrhea and pain only occurred in acceptors of LNG-IUD. About 20–40% of women using Norplant-2 had prolonged bleeding through 36 months. The percentage of amenorrhea in LNG-IUD was the highest (29.3%) at the end of two years of use. More than 97% of subjects reported satisfaction with the methods used by themselves.

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Resumen Un estudio aleatorizado en el que se comparan los dispositivos intrauterinos que descargan levonorgestrel (LNG-IUD) con los implantes Norplant-2 se realizó en 200 mujeres durante 36 meses. Se observó un período de utilización correspondiente a tres mil cien meses-mujer con cada uno de los dispositivos. Hubo un solo embarazo, en el decimosegundo mes, entre las usuarias de LNG-IUD. La alteración del flujo menstrual fue la razón invocada con mayor frecuencia para el abandono del método. Los porcentajes de abandono por la irregularidad de la menstruación en el caso de los Norplant-2 fue de 17,3 y 26,8 a los 24 y 36 meses, respectivamente, en comparación con 3,3 con los LNG-IUD a los 24 y 36 meses. Estas diferencias son estadísticamente significativas. El retiro por amenorrea y dolores sólo ocurrió entre las mujeres que tenían los LNG-IUD. Los Norplant-2 ocasionaron sangrado prolongado durante los 36 meses estudiados en alrededor del 20 al 40% de las mujeres. El porcentaje de amenorrea con los LNG-IUD llegó al nivel máximo (29,3%) al cabo de dos años de uso. Más del 97% de las mujeres se mostraron satisfechas con los métodos que utilizaban.

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Resumé Une étude randomisée comparant les dispositifs intra-utûrins libérant du lévonorgestrel (LNG-IUD) aux implants Norplant-2 a été effectuée sur 200 femmes pendant 36 mois. On a ainsi observé une période d'utilisation correspondant à trois mille cent mois/femme avec chacun des dispositifs. Une seule grossesse s'est produite, au douzième mois, parmi les utilisatrices de LNG-IUD. L'altération du flux menstruel a été la raison le plus souvent invoquée pour l'abandon de la méthode. Les pourcentages d'abandon du fait de l'irrégularité de la menstruation dans le cas des implants se sont élevés à 17,3 et 26,8 après respectivement 24 et 36 mois, alors qu'ils n'atteignaient que 3,3 pour les LNG-IUD, tant à 24 qu'à 36 mois. Ces différences sont statistiquement significatives. Le retrait à la suite d'aménorrhée et de douleurs n'a été constaté que chez des femmes portant les LNG-IUD. Le Norplant-2 a occasionné des saignements prolongés pendant les 36 mois étudiés chez environ 20 à 40% des femmes. Dans le cas des LNG-IUD, le taux d'aménorrhée était le plus élevé (29,3%) au terme de deux années d'utilisation. Plus de 97% des patientes se sont dites satisfaites de la méthode qu'elles appliquaient.

     

广东汉族人群HLA-Cw多态性及单体型分析

目的检测广东汉族人群HLA．Cw及HLA-A、B、DRB1基因频率，分析该人群HLA-Cw等位基因多态性及其单体型特点。方法骨髓移植供者185例，抗凝血提取DNA，半量全自动PCR-RSSO分型检测HLA-A、B、Cw、DRB1基因型。结果在分辨水平检出Cw等位基因11个，其中分布频率较高的依次为：Cw*03(0．2580)、Cw*07(0．1887)、Cw*01(0．1732)、Cw*08(0．1070)。统计分析呈现显著连锁不平衡的HLA-Cw．A单体型7个，HLA-Cw-B单体型20个，HLA—Cw．DRB1单体型10个。结论广东汉族群体HLA-Cw基因具有较为丰富的多态性，其与HLA-A、B、DRB1间连锁不平衡单体型具有地区性遗传特征。     

Anti-leukemia effect of perillyl alcohol in Bcr/Abl-transformed cells indirectly inhibits signaling through Mek in a Ras- and Raf-independent fashion.

PURPOSE: Perillyl alcohol (POH) displays preventive and therapeutic activity against a wide variety of tumor models, and it has been suggested that this might be associated with the ability of POH to interfere with Ras prenylation. POH also selectively induces G(1) arrest and apoptosis in Bcr/Abl-transformed hematopoietic cells. Because signaling through Ras is necessary for Bcr/Abl transformation, we examined whether POH induces its anti-leukemia effect by inhibiting Ras signaling. EXPERIMENTAL DESIGN: The ability of POH to inhibit posttranslational farnesylation and signaling from Ras as well as signaling through the Raf-Mek-Erk cascade was examined in Bcr/Abl-transformed and mock-transformed cells and related to the anti-leukemia effect of POH. RESULTS: POH does not affect Ras prenylation or Ras activity, but it blocks signaling downstream of Ras by reversing the state of activation of the Erk kinase, Mek. POH affects Mek activity only when it is added to intact cells. Treatment of either cell lysates or of purified Mek with POH has no effect on Mek activity. Inhibition of the Mek-Erk pathway seems to be related to the POH anti-leukemia effect for the following reasons: (a) the concentration of POH needed to block the Erk pathway, as well the kinetics with which POH inhibits this signaling cascade, both correlate with the anti-leukemia effect of POH; (b) both U0126 (a specific Mek inhibitor) and POH induce similar anti-leukemia effects; and (c) mock-transformed hematopoietic cells are simultaneously resistant to POH anti-leukemia effects and inhibition of the Mek-Erk pathway. CONCLUSION: Blocking Mek is sufficient to induce growth arrest and apoptosis in Bcr/Abl-transformed cells; therefore, POH represents a novel small molecule inhibitor of Mek that might be effective for treating Bcr/Abl leukemias.     

不同类型高危儿早期干预的临床研究

目的 探索早期干预对窒息、高胆、早产三类高危儿智力发育改善的效果，寻找更合适的早期干预措施。方法 将三类高危儿分为干预组及对照组，同时随机选取正常对照组进行随访。干预组采用鲍秀兰教授“0～3岁”早期干预方案训练，各组均在6个月、1岁时分别采用婴幼儿智能发育量表(CDCC)进行智力发育测评，结果用MDI、PDI表示。结果 (1)6个月龄时MDI各干预组与对照组间有显著性差异，窒息组、早产组与正常组间亦有显著性差异；高胆组与正常组间无差异；PDI窒息组中干预组与对照组之间有显著差异(P＜0．01)，高胆组、早产组均无差异(P＞0．05)。(2)1岁时MDI和PDI结果一致，干预组与对照组间比较窒息组、高胆组有显著差异，早产组无差异；窒息组、高胆组干预组与正常组比较无差异，对照组和早产组与正常组比较均有显著差异(P＜0．01)。(3)所有干预组测评分值均高于对照组，6个月与1岁之间比较有显著差异，各观察组间比较有显著性差异(P＜0．01)。结论 三类高危儿早期干预效果差异较大，干预组均较对照组分值高，早期干预有改善智力发育的作用；三类高危儿中，窒息组、高胆组效果最好，均达到或超过正常水平。所有未干预组均不及正常水平；早期干预对足月高危儿效果显著，对早产儿欠佳，远期效果尚需进一步随访观察。     

移植肾破裂的处理

目的　提高移植肾破裂的防治水平。方法　 6例移植肾破裂 ,手术前 2例 ,手术后 4例。 2例术前供肾破裂 ,采用切开移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。 1例术后移植肾破裂早期 ,出血少 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物。 3例术后移植肾破裂出血量估计超过 10 0 0ml者 ,采用手术延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。结果　 ( 1)手术前 2例手术后 4例 ,采用切开或者延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾并配合“硝普钠”降压的方法处理 ,均未再破裂出血 ,移植肾功能恢复良好。 ( 2 ) 1例术后移植肾破裂早期的患者 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物 ,非手术治疗成功。结论　 ( 1)采用手术切开或延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾可以有效治疗移植肾破裂。 ( 2 )移植肾破裂出血少的情况下 ,可以在密切观察下非手术治疗     

Childhood fractures are associated with decreased bone mass gain during puberty: an early marker of persistent bone fragility?

Whether peak bone mass is low among children with fractures remains uncertain. In a cohort of 125 girls followed over 8.5 years, 42 subjects reported 58 fractures. Among those, BMC gain at multiple sites and vertebral bone size at pubertal maturity were significantly decreased. Hence, childhood fractures may be markers of low peak bone mass acquisition and persistent skeletal fragility. INTRODUCTION: Fractures in childhood may result from a deficit in bone mass accrual during rapid longitudinal growth. Whether low bone mass persists beyond this period however remains unknown. MATERIALS AND METHODS: BMC at the spine, radius, hip, and femur diaphysis was prospectively measured over 8.5 years in 125 girls using DXA. Differences in bone mass and size between girls with and without fractures were analyzed using nonparametric tests. The contribution of genetic factors was evaluated by mother-daughter correlations and that of calcium intake by Cox proportional hazard models. RESULTS: Fifty-eight fractures occurred in 42 among 125 girls (cumulative incidence, 46.4%), one-half of all fractures affecting the forearm and wrist. Girls with and without fractures had similar age, height, weight. and calcium intake at all time-points. Before and during early puberty, BMC and width of the radius diaphysis was lower in the fracture compared with no-fracture group (p < 0.05), whereas aBMD and BMAD were similar in the two groups. At pubertal maturity (Tanner's stage 5, mean age +/- SD, 16.4 +/- 0.5 years), BMC at the ultradistal radius (UD Rad.), femur trochanter, and lumbar spine (LS), and LS projected bone area were all significantly lower in girls with fractures. Throughout puberty, BMC gain at these sites was also decreased in the fracture group (LS, -8.0%, p = 0.015; UD Rad., -12.0%, p = 0.004; trochanter, -8.4%, p = 0.05 versus no fractures). BMC was highly correlated between prepuberty and pubertal maturity (R = 0.54-0.81) and between mature daughters and their mothers (R = 0.32-0.46). Calcium intake was not related to fracture risk. CONCLUSIONS: Girls with fractures have decreased bone mass gain in the axial and appendicular skeleton and reduced vertebral bone size when reaching pubertal maturity. Taken together with the evidence of tracking and heritability for BMC, these observations indicate that childhood fractures may be markers for low peak bone mass and persistent bone fragility.     

膀胱癌组织P-gp,GST-π和TOPO-Ⅱ表达评估灌注化疗

目的：探讨膀胱癌的多药耐药性(MDR)，指导灌注化疗用药。方法：采用免疫组化法检测44例膀胱癌病理标本中P-糖蛋白(P-gp)、谷胱肽S转移酶(GST-π)和拓扑异构酶(TOPO—Ⅱ)的表达，评估肿瘤耐药谱。结果：①P-gp检测显示，54．5％的病例对阿毒索、丝裂毒索、长春新碱等抗生索类和生物碱类抗癌药高耐药。②GST-π检测显示仅34．1％的病例对顺铂、环磷酰胺等高耐药，而反有56．8％的病例对该类药无耐药或低度耐药。③TOPO-Ⅱ检测显示对阿霉索、柔红毒索、VP16等TOPO-Ⅱ抑制剂类抗癌药，仅13．6％的病例高度耐药，29．5％中度耐药。56．8％低度耐药。结论：检测膀胱癌MDR，了解多药耐药谱，可指导灌注化疗用药。     

腰椎管狭窄症的手术减压与内固定选择(259例临床分析)

目的：探讨腰椎管狭窄症的手术减压指征、减压范围及内固定选择。方法：回顾性分析腰椎管狭窄症患者259例，平均年龄52．2岁，平均病程4年1个月。根据病情分别采用椎板间节段开窗潜行减压术139例，腰椎管内径扩大成形术63例，全椎板切除减压、椎间植骨融合内固定术57例。结果：221例获得平均4年2个月随访。三种手术方法优良率分别为91．53％、87．50％和85．45％；手术并发症发生率为13．69％、15．87％和20．11％。结论：对严重的腰椎管狭窄症若手术适应证和减压范围掌握恰当，不论采取何种手术方式的神经减压术，均可取得满意疗效。正确选择病例和熟练的外科技术是应用内固定器械的重要条件。     

前列腺癌去雄激素治疗不良反应的预防和处理

目的观察去雄激素治疗前列腺癌的不良反应,并探讨其预防和治疗。方法回顾性分析1998年7月-2006年1月112例去雄激素治疗晚期前列腺癌的临床资料。结果112例患者中,97例完成了不良反应的调查。随访3-36月,去雄激素治疗后潮热、性功能障碍、病理性骨折发生率分别为46％、75％、4％;患者潮热、精神疲乏、四肢乏力、纳差症状明显加重(P<0．05);性功能明显减退(P<0．05)。12例潮热症状严重者使用抗抑郁药博乐欣(25mg,tid)1-2周症状减轻。7例有骨转移性疼痛或严重骨质疏松患者,应用唑来膦酸4mg静脉滴注,每45d一次,骨痛症状缓解。结论去雄激素对前列腺癌患者生活质量有一定影响。博乐欣可减轻患者潮热症状,唑来膦酸可预防和治疗去雄激素相关的骨质疏松并发症。