001 醛固酮抑制剂限制前壁心肌梗死后心肌胶原合成与左室肥大

心肌梗死(MI)后心肌的修复常与心肌胶原合成有关.既往发现,心肌纤维化多由血管紧张素Ⅱ和醛固酮共同介导,而MI后的心肌修复是否亦与之有关目前尚未清楚.本文旨在就MI后血管紧张素转换酶抑制剂(ACEI)伍用醛固酮抑制剂,能否减缓梗死后心肌胶原合成,以及与之相关的持续左室扩张肥厚等进行了对照分析. 对象与方法 46例初发前壁Q波型MI患者,男34例,女12例,年龄60±11岁,均于发病即期接受了溶栓和ACEI治疗.随后分为随机双盲服用烯睾丙酸钾(口服醛固酮抑制剂,50mg/d)组24例(1组),和安慰剂对照组22例(2组).并分别于治疗前,以及治疗后3、6、12个月,动态随访监测血浆氨基前肽Ⅲ前胶原(PⅢNP)水平,和超声心动图所示左室体积重量,分别用于评估两组心肌胶原合成率,及左室扩张肥厚程度,最后比较结果. 结果两组启用ACEI时间、疗程长短、药物剂量及药物种类均无明显差异.随访期间两组共有5例(1组2例,2组3例,P＝NS)因药物毒副反应而被迫停用ACEI,诸如干咳、低血压、血肌酐升高等.1组均能良好耐受烯睾丙酸钾.高钾血症仅见于5例(1组3例,2组2例,P＝NS).随访期间,2例死亡,4例因急发左心衰而住院,均为2组者;复发再梗死3例,1组2例,2组1例(P＝NS).两组出院前血浆PⅢNP水平并无差异,但均明显高于正常水平(P＜0.0001);然用药3、6、12个月后,两组血浆PⅢNP水平皆持续降低.尤以1组各期水平降低较2组更著.治疗6、12个月后,超声心动图所示左室容积重量1组均明显低于2组,但左室射血分数两组无异. 讨论以上结果表明,至少在前壁Q波型MI患者,烯睾丙酸钾伍用ACEI长程治疗,能有效减缓MI后心肌胶原合成,既而明显减轻MI后的持续左室扩张与肥厚. (袁志敏摘杜静平校)     

Persistent macrocytosis assessed by erythrocyte subpopulation analysis following erythrocyte regeneration in cats

Serial erythrocyte volume distribution curves were used to characterize changes in erythrocyte subpopulations following the induction of Heinz body hemolytic anemia in cats. Macrocytes produced in response to hemolysis were observed after loss of reticulum. After recovery from hemolysis, a gradual reduction in mean cell size resulted from a combination of macrocyte remodeling and production of normocytic cells. The mean apparent prehemolysis half-survival time for chromium-51- labeled erythrocytes was 13.7 days. There were two components to the posthemolysis survival curve. An initial accelerated loss of label was due to either destruction of posthemolysis macrocytes or loss of cell contents associated with remodeling. The second survival curve component reflected an increased mean apparent half-survival time of 20.2 days. After correction for isotope elution, the latter component reflected cohort-like labeling of relatively young erythrocytes having normal survival for the duration of the experiment. At the beginning for this latter component, 42% of the erythrocytes were macrocytic (mean of 3.3 x 10(6) macrocytes/microliter). Since the number of macrocytes gradually declined during the period of normal survival, it was concluded that these cells entered the normocytic size range. Recognition of persistent macrocytosis is important in the concept of the regenerative response and should be considered in the interpretation of erythrocyte volume distribution curves.     

OC11Hyperimmunoglobulin E syndrome presenting with oral premalignant papillomas

Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency characterized by the clinical triad of recurrent staphylococcal abscesses, recurrent cyst-forming pneumonia and an elevated serum IgE level. A 10-year-old female with HIES presenting with widespread oral premalignant papillomas, which are an uncommon co-existing manifestation, and labial herpes simplex virus infection is reported. The patient experienced recurrent furuncles, pneumonia, tuberculosis, otitis media and sinusitis attacks since she was 6 months-old. She had been diagnosed with HIES at the age of 6 when the papillomatous lesions first occurred in oral cavity. Family history was not remarkable. Intraoral examination revealed diffuse multiple papillomas covering the tongue, lips, buccal, labial and palatinal mucosa and gingiva extending to the crowns of teeth. The lips were enlarged to the double of normal size due to numerous papilloma formations and the outline could hardly be traced. These lesions caused nutritional, aesthetic, psycological problems besides loss of appetite. Histopathological examination of the lesions revealed papillary proliferations of squamous epithelium which was confirmed to be positive for human papilloma virus DNA by molecular based test (Inno lipa HPV genotyping test) which is based on reverse hybridization principle and PCR. Typing of HPV was found to be as HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42–45, 51–53, 56, 58, 59, 66, 68, 70 and 74, forming a high/intermediate risk group for malignancy. For the management of widespread papillomas, diode laser was applied. After therapy, significant clinical improvement, reduction in oral discomfort and improvement in appetite was observed. Since infection with HPV is a significant independent factor for oral squamous cell carcinoma, the patient remains under regular review.     

Interventions for replacing missing teeth: treatment of perimplantitis

Background : One of the key factors for the long‐term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. Objectives : To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. Search strategy : We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomized controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 15 March 2006. Selection criteria : All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants. Data collection and analysis : Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random‐effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Main results : Seven eligible trials were identified, but two were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening. Follow up ranged from 3 months to 2 years. No meta‐analysis was conducted due to different interventions tested and outcomes used. No side effects occurred in any of the trials. The only significant statistically differences were observed in a 4‐month follow‐up RCT evaluating the use of adjunctive local antibiotics to manual debridement in patients having lost at least 50% of the supporting bone around the implants. There were improved probing attachment levels (PAL) mean differences of 0.61mm (95% CI 0.40 to 0.82), and reduced probing pockets depths (PPD) mean differences of 0.59mm (95% CI 0.39 to 0.79) in those patients receiving adjunctive local antibiotics. This trial was judged to be at high risk of bias. Authors' conclusions : There is no reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. However, the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6mm additional improvement for PAL and PPD over a 4‐month period in patients associated with severe forms of perimplantitis. In three trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve results similar to the more complex and expensive therapies. Smoothening of rough implant surfaces was not associated with statistically significant improvements of the clinical outcomes. However, sample sizes were small, therefore these conclusions have to be considered with great caution. More well‐designed RCTs are needed. Plain language summary : As with natural teeth, dental implants can be lost due to gum disease (perimplantitis). This review looked at which are the most effective treatments to arrest perimplantitis Five studies were included in the review and evaluated five different treatment modalities. In one small study of short duration (4 months) it was shown that the use of locally applied antibiotics in addition to the deep manual cleaning of the diseased implants decreased the depth of the pockets around the implants of an additional 0.6mm in patients affected by severe forms of perimplantitis. In conclusion, at present, there is no reliable evidence to determine which is the most effective way to treat perimplantitis. This is not to say that currently used interventions are not effective. The majority of trials testing more complex and expensive therapies did not show any statistically or clinically significant advantages over the deep mechanical cleaning around the affected implants.     

Screening tests for blood donors presumed to have transmitted the acquired immunodeficiency syndrome

We investigated 18 sets of blood donors from 12 to 50 months after they donated blood to recipients who subsequently developed the acquired immunodeficiency syndrome (AIDS). Within each donor set, only one donor was suspected of having transmitted the disease (ie, member of an AIDS risk group). The other donors (n = 189) were not risk group members and served as controls. A number of laboratory tests distinguished suspected from nonsuspected donors, including determination of T helper/T suppressor cell ratio, antibody to hepatitis B core antigen, and immune complexes, but none of these was as sensitive and specific as tests for antibody to the human retrovirus, HTLV-III/LAV.