人工全膝关节置换术后深部感染的治疗

目的探讨人工全膝关节置换术后深部感染的治疗方法和临床效果。方法1994～2003年对9例人工全膝关节置换术后深部感染患者分别采用抗生素治疗;关节镜下清创、灌洗;切开清创、灌洗;清创后一期假体再置换;清创后二期假体再置换等不同治疗方法。对以上治疗方法采用自身前后对照的方法进行回顾性分析,HSS膝评分标准评估临床治疗效果。结果3例抗生素治疗,2例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例关节镜下清创、灌洗治疗,1例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例清创后一期假体再置换治愈;2例清创后二期假体再置换治愈。9例均获随访,平均随访51.2个月,均无感染复发。HSS膝评分由38分(21～52分)增加至74分(53～85分),膝关节平均活动度由45°(20°～108°)增加至80°(60°～105°)。结论每一种治疗方法都有其适应证和优缺点,应根据具体病情选择合理治疗方法。关节镜下清创损伤小,可最大程度恢复关节功能,但其彻底性不如切开清创,二期假体再置换临床治疗效果可靠。     

Effects of low‐frequency pulsed electromagnetic fields on plateau frostbite healing in rats

Plateau frostbite (PF) treatments have remained a clinical challenge because this condition injures tissues in deep layers and affected tissues exhibit unique pathological characteristics. For instance, low‐frequency pulsed electromagnetic field (PEMF) can affect tissue restoration and penetrate tissues. Therefore, the effect of PEMF on PF healing should be investigated. This study aimed to evaluate the effects of low‐frequency PEMF on PF healing systematically. Ninety‐six Sprague‐Dawley rats were randomly and equally divided into three groups: normal control, partial thickness plateau frostbite (PTPF), and PTPF with low‐frequency PEMF exposure (PTPF + PEMF). PTPF wounds were induced in the dorsum of the rats. The PTPF + PEMF group was exposed to low‐frequency PEMF daily. During PF healing, wound microcirculation in each group was monitored through contrast ultrasonography. Wound appearance, histological observation, and wound tensile strength were also evaluated. Results showed that the rate of the microcirculation restoration of the PTPF + PEMF group was nearly 25% faster than that of the PTPF group, and wound appearance suggested that the healing of the PTPF group was slower than that of the PTPF + PEMF group. Histological observation revealed that PEMF accelerated the growth of different deep tissues, as confirmed by tensile strength examination. Low‐frequency PEMF could penetrate PF tissues, promote their restoration, and provide a beneficial effect on PF healing. Therefore, this technique may be a potential alternative to treat PF.     

Association of psychological and physiological measures of stress in health‐care professionals during an 8‐week mindfulness meditation program: mindfulness in practice

Work stress, burnout, and diminished empathy are prevalent issues for health‐care professionals. Mindfulness meditation (MM) is one commonly used strategy to manage stress. Measuring salivary cortisol allows for the assessment of serum cortisol level, a known stress level indicator. This study evaluated the association of subject‐reported stress symptoms and salivary cortisol in health‐care professionals, in an 8‐week MM program, with data collected prospectively at baseline and 8 weeks after program completion. Questionnaires [Profile of Mood States—Short Form (POMS‐SF), Maslach Burnout Inventory (MBI), and Interpersonal Reactivity Index (IRI)] measured mood, burnout and empathy. A paired t‐test between groups for pre/post‐salivary cortisol yielded no significant change. The POMS‐SF was most sensitive to change (mean increase 12.4; p = 0.020). Emotional exhaustion, measured in the MBI, was also affected by MM (mean decrease 4.54; p = 0.001). Changes in empathy may not have been captured due to either absence of effect of MM on empathy, subject number or scale sensitivity. Baseline and 8‐week correlations between salivary cortisol and survey results, and correlations between changes in these measures, were weak and not statistically significant. Nevertheless, psychometric results present a strong case for additional clinical trials of MM to reduce stress for health‐care professionals. Copyright © 2005 John Wiley & Sons, Ltd.     

5alpha-dihydrotestosterone inhibits 1alpha,25-dihydroxyvitamin D3-induced expression of CYP24 in human prostate cancer cells

BACKGROUND: A cross-talk between 1alpha,25-dihydroxyvitamin D(3) [1alpha,25-(OH)(2)D(3)] and 5alpha-dihydrotestosterone (DHT) in the growth inhibition has been demonstrated, but the mechanism is unknown. METHODS: The expression of 25-hydroxyvitamin D(3) 24-hydroxylase (24-hydroxylase) was measured using a real-time quantitative RT-PCR assay and the catabolism of 1alpha,25-(OH)(2)D(3) was measured using a radioreceptor assay. RESULTS: Real-time RT-PCR showed that DHT at 1-100 nM significantly inhibited 1alpha,25-(OH)(2)D(3)-induced expression of 24-hydroxylase in LNCaP cells. Furthermore, the catabolism of 1alpha,25-(OH)(2)D(3) was decreased by 10 nM DHT. An androgen receptor (AR) antagonist, Casodex antagonized the DHT effect, whereas an AR agonist (due to the mutant AR in LNCaP cells) hydroxyflutamide did not. CONCLUSIONS: We demonstrated, for the first time, that DHT reduces the ability of 1alpha,25-(OH)(2)D(3) to induce 24-hydroxylase expression. Our results not only support the earlier finding of a cross-talk between androgen and vitamin D in human prostate cancer cells but also provide a possible mechanism how androgen and vitamin D signaling pathways may interact.     

聚合酶链反应检测肝病患者血液中纳米细菌的研究

目的 评价PCR检测慢性肝病和肝癌患者血液中纳米细菌(NB)的临床价值.方法 对68例慢性乙型肝炎(CHB)、54例慢性重型乙型肝炎(CSHB)、66例肝硬化(CL)、23例肝癌(HCC)患者采用免疫组化染色、透射电镜扫描和PCR技术,检测血液中的纳米细菌,并与40例健康人结果比较.结果 PCR检测纳米细菌阳性率分别为27.69%、50.00%、61.29%、52.38%和5.00%,慢性肝病和肝癌患者阳性率明显高于健康人(P＜0.005).慢性乙型肝炎阳性率低于其他肝病(P＜0.005).PCR测定结果与免疫组化染色比较,两法阳性率无明显差异(P＞0.05),PCR灵敏度为46.51%,特异性为73.95%,总有效率66.67%.结论 PCR对纳米细菌的检测具有重要的参考价值.慢性肝病和肝癌患者血液中纳米细菌感染率高于健康人.     

颈动脉内中膜增厚的危险因素及与相关炎症标记物水平的关系

目的:探讨颈动脉内中膜增厚的危险因素及与相关炎症标记物水平的关系。方法:入选105例均行彩色多普勒检测颈动脉内中膜厚度(IMT),根据结果分成IMT≥1.0mm组(A组);IMT<1.0mm组(B组)。分析两组各危险因素和炎症标记物水平的差异。结果:A组中年龄、收缩压、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白(HDL-C)、胆固醇(HDL-C)、血尿酸、脂蛋白a[Lp(a)]、超敏C反应蛋白、纤维蛋白原、高血压及血脂代谢紊乱病史较B组差异明显。Logistic多元回归分析发现,年龄和LDL-C是颈动脉内中膜增厚的独立危险因素,相对危险度为1.052(95%可信区间1~1.105)和4.682(95%可信区间2.302~9.524),而HDL-C则与颈动脉IMT呈负相关,属保护性因素。结论:在颈动脉内中膜增厚的发生发展中除了传统的危险因素外,炎症反应也起了非常重要的作用。     

Direct protective effect of interleukin-10 on articular chondrocytes in vitro

Objective To assess whether interleukin-10 (IL-10) is chondroprotective in vitro.Methods Chondrocytes were isolated from femoral cartilage of rats (7-10 days) by digesti on with collagenase Ⅱ.The first passage cells were grown in 24- well plates with DMEM, supplemented with 10% fetal bovine serum, for 2-4 days.The ce lls were then cultured in 0.1% fetal bovine serum DMEM medium, and given respec tively interleu kin-1 (IL-1) 100 μ/ml, IL-1 100 μ/ml+recombinant murine interleukin-10 ( rmIL-10) 20 ng/ml, rmIL-10 20 ng/ml, and cultured for 48 hours.Scanning el ectron morphology and immunohistochemical study of nitric oxide synthase 2 and matric metalloproteinase 3 mRNA in situ hybridization were performe d.Cell proliferation and morphology were observed under inverted microscope fr om the beginning of cell culture for three weeks.Results IL-1 stimulated granule production in the cytoplasma of chondrocytes, and the c ells died in the second and third weeks of culture.IL-10 antagonized IL-1, p rotected the cells from death and maintained chondrocyte proliferation.Scannin g electron morphology showed that IL-1 stimulated the formation of numerous mic rovilli on the cell surface, while thin and less numerous microvilli were found in cultures with IL-10.Immunohistochemical study and in situ hybridization sh owed that IL-10 inhibited NOS2 and MMP3 expression.Conclusion IL-10 not only inhibits the synthesis of inflammatory cytokines, but also direc tly protects chondrocytes by antagonizing IL-1.     

结核分枝杆菌异烟肝耐药基因突变的研究

目的：了解我国结核分枝杆菌耐异烟肼（INH）分离株katG基因突变情况,探讨快速检测结核分枝杆菌耐药基因型的分子药敏检测方法。方法：用PCR单链构象多态性（PCR－SSCP）和PCR直接测序法（PCR－DS）检测30株结核分枝杆菌临床分离株的katG基因。结果：以结核分枝杆菌H37Rv标准株对照观察所有INH敏感株的PCR－SSCP和PCR－DS图谱,均未发现异常;而在12株INH耐药株中,有4株无PCR－SSCP和PCR－DS图谱异常,占INH耐药株的33．4％;有5株在94位发生核苷酸错义突变,占INH耐药株41．7％,有3株在96位发生核苷酸同义突变,占INH耐药株的25％。结论：多数结核分枝杆菌对INH是由于其katC基因突变所致,可先用PCR－SSCP筛选突变株,再用PCR－DS方法测定其突变位点,达到快速检测结核分枝杆菌INH耐药基因型的目的。     

实验性顺铂诱导急性肾功能衰竭动物模型的研究

1目的　建立顺铂 (cisplatin,CP)诱导的急性肾功能衰竭 (acute renal failure,ARF )大鼠模型 ,探讨 ARF的发病机制。2方法　 SD大鼠静脉一次性注射 CP 6 mg/ kg,动态观察大鼠血清肌酐 (Scr)、尿素氮 (BUN)变化以及肾组织形态学改变。 3结果　对照组不同时间 Scr、BUN差异不明显 (P>0 .0 5 ) ,肾组织形态学正常。模型组 Scr、BUN第 4d较第 1d明显升高 (P<0 .0 5 )。肾组织形态学显示 ,肾脏髓质外侧带大部分肾小管坏死 ,细胞核固缩、溶解、消失 ,管腔扩张 ,有坏死脱落碎屑。 4结论　 CP诱导的大鼠 ARF模型为一较为理想的 ARF模型