高血压脑出血血肿周围组织血-脑屏障变化的动态观察

目的动态观察高血压脑出血血肿周围组织血-脑屏障的变化.方法对6例高血压脑出血患者实施立体定向血肿碎吸术,术中取血肿周围少许脑组织进行超微病理观察.结果血-脑屏障的损伤与出血时间的长短呈正比.脑出血后24h,可见星形胶质细胞肿胀,部分细胞崩解、坏死.毛细血管周围细胞足突肿胀,血-脑屏障损坏.72h,部分星形胶质细胞高度肿胀,细胞器溶解.毛细血管内皮细胞胞核增大,胞质突入管腔,内皮细胞间紧密连接消失.4～7d,星形细胞高度肿胀,胞质内充满水肿液,细胞器消失,细胞变性.毛细血管星形细胞足突明显肿胀,血管周围可见微小出血灶.结论血-脑屏障的变化与患者的预后有密切关系.     

广州管圆线虫病的临床预后

目的 :探讨 1997年 10～ 11月间 ,温州市区暴发的广州管圆线虫病的临床预后。方法 :入选病例符合如下条件 :(1)于 1997年 9月中旬～ 11月中旬期间急性起病 ;(2 )头痛和 (或 )游移性躯干四肢皮肤抚摸痛 ;(3)周围血液或脑脊液中嗜酸性粒细胞增高和 (或 )广州管圆线虫虫体抗原抗体阳性 (EL ISA法 ) ;(4)病前一个月内有食用未熟的淡水螺肉或贝虾史 ;(5 )排除其它蠕虫移行症。采用统一设计的随访调查表 ,由专人对符合上述标准的 35例 ,通过电话和(或 )面访 ,进行为期 1.5年的随访。结果 :全组无死亡 ,无复发 ,无严重残疾或并发症 ,遗留症状轻微 ,以局限性的主观或客观根性感觉障碍为主。主观症状多于客观体征。早期神经根痛严重者 ,后遗根性感觉异常较多。结论 :该组病例远期预后良好 ,病程自限。病性较重者多数可遗留轻微局限性感觉异常或感觉减退 ,可能与广州管圆线虫蚴对脊髓后根神经髓鞘直接或间接损害以及虫体死亡后致局部肉芽肿形成有关     

A high resolution CEPH crossover mapping panel and integrated map of chromosome 11

High resolution (0.1 cM) CEPH crossover mapping panels were constructed for chromosome 11. These panels will facilitate a transition from top- down physical and genetic mapping strategies to integrated breakpoint mapping strategies. Novel methods, which differ from other methods in overcoming the limitations of incomplete heterozygosity and variable marker density, were developed for creating the panels and integrated maps. This made it possible to identify and sublocalize the majority of crossovers in 61 families. The panels were used to map 139 microsatellite markers. A semi-integrated map and a fully-integrated map were constructed by combining these data with data from CEPH 7.1 and then integrating data from the radiation hybrid (RH) map. Genetic lengths estimated from the mapping panels were similar to the estimates obtained when all recombinant and non-recombinant offspring were included (189.4 cM in females and 126.1 cM in males), indicating that genetic distances are stable at this high marker density. The maps have a cM density of 0.62. The distance between ordered markers is 1.39-2.92 cM depending on the criterion for order and the extent of map integration. The 2D maps provide the resolution and flexibility needed to enhance current applications such as positional cloning and mapping complex disorders; while the mapping panels will greatly improve the resolution, reliability and efficiency of future genetic mapping.      

IL-21在ITP中的表达及大剂量地塞米松对其调控的研究

目的:探究免疫性血小板减少症(immunologic thrombocytopenia,ITP)与IL-21表达异常的相关性,同时探究大剂量地塞米松(high-dose dexamethasone,HD-DXM)冲击治疗ITP的疗效是否与IL-21有关。方法:抽取26例初诊ITP患者及24例健康人的外周血10 ml,密度梯度离心法获得血清及单个核细胞,分别采用流式细胞术和实时荧光定量PCR法检测单个核细胞IL-21的表达,采用酶联免疫吸附实验(ELISA)检测ITP治疗前后及正常对照者血浆中IL-21,IFN-γ和IL-4的水平。结果:流式细胞术测定发现,ITP患者单个核细胞表面分子IL-21表达明显高于健康对照(13.07%vs 8.2%);ITP患者IL-21 mRNA(9.524±0.97)与健康对照组(3.701±0.60)存在显著统计学差异,经HD-DEX治疗后IL-21 mRNA的比率值(5.87±1.21)较治疗前显著降低(P0.01);ITP患者血清中IL-21和IFN-γ水平与健康对照组和HD-DEX治疗组相比均具有显著的统计学差异(P0.01);而IL-4在治疗后含量却上调,与治疗前相比有统计学意义。结论:IL-21的表达异常参与了ITP发病过程,地塞米松对ITP的疗效与下调IL-21表达有关。     

高位胸段硬膜外阻滞治疗顽固性心绞痛及其对循环内皮细胞的影响

目的观察高位胸段硬膜外阻滞(TEA)对顽固性心绞痛(FAP)的治疗效果及循环内皮细胞(CEC)数量。方法20例FAP患者接受TEA治疗,观察疗效和心电图变化,并于TEA治疗前及治疗结束时检测血浆CEC的变化。结果TEA治疗后心绞痛缓解率100％,心电图ST段压低导联数和ST压低值显著减少(P<0．05),CEC显著减少(P<0．01)。结论TEA治疗FAP疗效满意,并可能通过保护血管内皮细胞起作用。     

冠心病合并糖尿病患者可降解涂层雷帕霉素洗脱支架置入术后5年随访研究

目的探讨冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入EXCEL可降解涂层雷帕霉素洗脱支架（SES）治疗的远期疗效。方法回顾性随机入选2007年1月至2007年12月住院期间冠心病合并糖尿病患者行PCI162例,并入选同时期150例无糖尿病的冠心病患者行PCI为对照组。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果两组支架术成功率均为100％。随访率100％,随访5年,糖尿病组与非糖尿病组术后并发症发生率（8．8％、7．0％）、卒中发生率（3．9％、3．0％）、心源性死亡率（0．0％、0．0％）差异无统计学意义（均为P〉0．05）。再次血运重建率（30．4％、14．0％）、心绞痛复发率（42,1％、30．0％）、全因死亡率（9．8％、2．0％）糖尿病组高于非糖尿病组;但心源性病死率均为0．0％。结论选择性冠脉内置入药物洗脱支架安全,成功率高,远期疗效尚好,但糖尿病仍是远期不良预后的独立预测因素。     

Profound decrease of in vivo formation of thromboxane during oestrogen therapy

Oestrogen has been proposed to influence platelet activity and formation of the vasoactive eicosanoids thromboxane and prostacyclin. Previous studies have been based on ex vivo techniques with well-known artifacts during blood sampling and ex vivo conditions. The present study is the first to assess in vivo formation through gas chromatographic/mass spectrometric analysis of the major urinary metabolites 2,3-dinor-thromboxane B₂ and 2,3-dinor-6-keto-PGF_1α. Ten consecutive male patients with prostatic carcinoma participating in a randomized study comparing the effects of parenteral oestrogen therapy ( n =5) with orchidectomy ( n =5) were included. Oestrogen was given as polyestradiol phosphate 240 mg i.m. every month. 2,3-dinor thromboxane B₂ and 2,3-dinor-6-keto-PGF_1α were analysed with the help of tetradeuterated internal carriers/standards. We found a consistent decrease of in vivo formation of thromboxane by ≈40% during parenteral oestrogen therapy ( P =0.008) and a doubling after surgical castration. The ratio of prostacyclin to thromboxane increased by ≈50% ( P =0.023) during oestrogen therapy. In conclusion, oestrogen induced a marked decrease of in vivo formation of thromboxane and a marked increase in the ratio of prostacyclin to thromboxane formation in all patients. According to current knowledge this should be beneficial for the cardiovascular system. Furthermore, thromboxane formation increased after surgical castration. The latter fact should direct attention to the influence of androgens on thromboxane synthesis. Our findings discloses a marked sex-hormone sensitivity of the thromboxane-forming system.     

The prevalence of psychiatric morbidity on a coronary care ward

Numerous studies have documented the high prevalence of psychological and emotional disorders in patients seen in general medical settings. However, despite the emphasis placed on holistic approaches to nursing care in all professional models of nursing practice, much of this distress is still missed by nursing staff. The Hospital Anxiety and Depression (HAD) scale is an easy-to-use self-administered screening instrument purportedly designed to detect psychological distress amongst hospitalized patients with physical illnesses. On using the HAD scale on patients admitted to a coronary care ward of a district general hospital, 44% were found to be suffering high levels of anxiety or depression. This figure is consistent with the results of similar studies in other cardiac wards and out-patient clinics. In most cases, the levels of distress found were not sufficiently severe to warrant seeking specialist psychiatric support. Instead, there is much that the general nurse can do to alleviate the understandable fears and worries of patients being treated for cardiac disease. However, to respond appropriately, nursing staff must be able to identify psychological distress in patients. The HAD scale, if it can be validated in cardiac in-patient settings, provides an instrument which could easily become part of the routine assessment of patients' nursing needs.