Hypoxic hepatitis in children after cardiac surgery

<正>To the Editor: Hypoxic hepatitis(HH), also known as ischemic hepatitis or shock liver, is a liver injury characterized by necrosis of centrilobular hepatocytes with a rapid increase in serum aminotransferase levels. The incidence rate of HH among patients in the intensive care unit(ICU) was found to be 0.9%-11.9% [1]. Occurrence of HH appears to have a significant impact on the clinical outcome.     

Hypertension in developing nations in sub-Saharan Africa

There is a rapid development of the 'second wave epidemic' of cardiovascular disease that is now flowing through developing countries and the former socialist republics. It is now evident from WHO data that coronary heart disease and cerebrovascular disease are increasing so rapidly that they will rank No. 1 and No. 5 respectively as causes of global burden by the year 2020. In spite of the current low prevalence of hypertensive subjects in some countries, the total number of hypertensive subjects in the developing world is high, and a cost-analysis of possible antihypertensive drug treatment indicates that developing countries cannot afford the same treatment as developed countries. Control of hypertension in the USA is only 20% (blood pressure <140/90 mm Hg). In Africa only 5-10% have a blood pressure control of hypertension of <140/90 mm Hg. There are varying responses to antihypertensive therapy in black hypertensive patients. Black patients respond well to thiazide diuretics, calcium channel blockers vasodilators like alpha-blockers, hydralazine, reserpine and poorly to beta-blockers, angiotensin-converting enzyme inhibitors and All receptor antagonists unless they are combined with a diuretic. A comprehensive cardiovascular disease (CVD) programme in Africa is necessary. There are social, economic, cultural factors which impair control of hypertension in developing countries. Hypertension control is ideally suited to the initial component on an integrated CVD control programme which has to be implemented. Primary prevention, through a population-based lifestyle linked programme, as well as cost-effective methods of detection and management are synergistically linked. The existing health care infrastructure needs to be orientated to meet the emerging challenge of CVD, while empowering the community through health education.     

正常和链脲佐菌素诱导糖尿病模型大鼠体外破骨细胞样细胞的培养方法

目的:建立成年正常大鼠和链脲佐菌素诱导的糖尿病大鼠骨髓体外破骨细胞样细胞培养的方法。方法:实验于2003-05/2004-03在河北医科大学第三医院中心实验室完成。①雌性Wistar大鼠,2.5～3.0个月龄,用链脲佐菌素溶液,按60mg/kg单剂量进行腹腔注射,注射48h后检测血糖,血糖≥16.7mmol/L视为诱导糖尿病模型成功。随机选择链脲佐菌素诱导的糖尿病大鼠及成年正常大鼠各1只,麻醉下处死,无菌条件下取股骨,收集骨髓。②用α-MEM冲洗骨髓细胞,并稀释骨髓细胞至1.5×109L-1的浓度,将细胞悬液置于24孔培养板内,培养液为无酚红α-MEM,其中含体积分数为0.1的胎牛血清、30μg/L细胞核因子κB受体活化因子配基、10μg/L巨噬细胞集落刺激因子。培养板置于体积分数为0.05的CO2和37℃培养箱内培养,用倒置相差显微镜观察破骨细胞样细胞形态变化。③细胞培养7d后,进行细胞固定和抗酒石酸酸性磷酸酶染色,抗酒石酸酸性磷酸酶染色阳性且细胞核≥3个的细胞认定为破骨细胞样细胞。④在倒置显微镜下,计数破骨细胞样细胞数。结果:①倒置显微镜下动态观察细胞,发现细胞的形态逐渐由圆形变为椭圆形、长梭形和不规则形状。在培养的第3天始,单核细胞融合为多核细胞,破骨细胞样细胞形成。在第5,6天破骨细胞样细胞形成明显增多。②破骨细胞样细胞酶学检查,可见有大量多核且抗酒石酸酸性磷酸酶染色阳性的细胞。③破骨细胞样细胞计数:实验获得的破骨细胞样细胞的数量能够满足细胞计数的需要,与成年正常大鼠相比,链脲佐菌素诱导的糖尿病大鼠破骨细胞样细胞数量增加(92.50±10.87,107.00±13.72个/孔)。结论:正常成年大鼠和链脲佐菌素诱导的糖尿病大鼠骨髓体外破骨细胞样细胞的培养方法建立,分离培养的破骨细胞样细胞有多核、抗酒石酸酸性磷酸酶阳性的特性。     

心肌梗死后不同时间移植骨髓间充质干细胞对心脏功能修复的作用

目的:观察心肌梗死后不同时间点移植骨髓间充质干细胞对梗死心肌修复的影响,寻找细胞治疗的有效移植时间窗。方法:实验于2006-04/10在郑州大学基础医学院完成。①实验动物:清洁级6周龄雄性SD大鼠81只,1只用于获取骨髓间充质干细胞,剩余80只随机数字表法分为细胞移植组、培养液对照组,再按心肌梗死后1d及1,2,3周进行移植的时间各分为4个亚组,10只/组。②实验方法:获取、培养大鼠骨髓间充质干细胞,培养至第3代接近70%融合时,加入5-溴脱氧尿嘧啶体外标记,调整细胞密度为4×1010L-1备用。两组大鼠均结扎左冠状动脉前降支建立心肌梗死模型。细胞移植组各亚组按对应时间点在心肌梗死中央及四周移植骨髓间充质干细胞悬液50μL/点(2×106个),培养液对照组各亚组于相同部位移植L-DMEM培养液,50μL/点。③实验评估:移植前和移植3周后检测心功能;苏木精-伊红、免疫组织化学染色观察心肌梗死区组织及细胞变化。结果:共79只大鼠进入结果分析。①骨髓间充质干细胞的生长特点:刚分离的细胞为圆形。5d后有集落形成,细胞呈梭形、纺锤形或多角形,胞核较大。传代后细胞体积较原代细胞增大,生长速度加快。②心肌梗死后不同时间移植骨髓间充质干细胞的心功能比较:与移植前比较,移植3周后细胞移植组各亚组左室射血分数、短轴缩短率均有所改善(P<0.05),以心肌梗死后2周细胞移植组最为明显(P<0.01);培养液对照组各亚组左室射血分数、短轴缩短率均下降(P<0.05)。③梗死心肌组织学观察:细胞移植组心肌梗死区及周边可见核蓝色深染的细胞,排列整齐,梗死区瘢痕化减轻。④骨髓间充质干细胞在心肌组织中的分化:细胞移植组梗死心肌内可见大量BrdU标记阳性的骨髓间充质干细胞,胞核呈棕黄色,对心肌特异性肌钙蛋白T呈阳性表达。结论:心肌梗死后早期移植骨髓间充质干细胞能够改善心功能,以2周内进行细胞移植的效果较佳。     

Post-traumatic stress disorder among recently diagnosed patients with HIV/AIDS in South Africa

This study examined the prevalence of and factors associated with post-traumatic stress disorder in recently diagnosed HIV/AIDS patients in South Africa. One hundred and forty-nine (44 male, 105 female) recently diagnosed HIV/AIDS patients (mean duration since diagnosis = 5.8 months, SD = 4.1) were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviours were assessed. Twenty-two patients (14.8%) met criteria for PTSD. Current psychiatric conditions more likely to be associated with PTSD included major depressive disorder (29% in PTSD patients versus 7% in non-PTSD patients, p = 0.004), suicidality (54% versus 11%, p = 0.001) and social anxiety disorder (40% versus 13%, p = 0.04). Further patients with PTSD reported significantly more work impairment and demonstrated a trend towards higher usage of alcohol as a means of coping. Discriminant function analysis indicated that female gender and a history of sexual violation in the past year were significantly associated with a diagnosis of PTSD. Patients whose PTSD was a direct result of an HIV/AIDS diagnosis (8/22) did not differ from other patients with PTSD on demographic or clinical features. In the South African context, PTSD is not an uncommon disorder in patients with HIV/AIDS. In some cases, PTSD is secondary to the diagnosis of HIV/AIDS but in most cases it is seen after other traumas, with sexual violation and intimate partner violence in women being particularly important.     

Hypertension in black South Africans

Hypertension is a major disease in the black populations of sub-Saharan Africa and the USA. The prevalence of hypertension varies from 1-30% in the adult population. Differences in blood pressure (BP) between black and white patients have been documented. In this review genetic, endocrine and environmental characteristics, renal physiology and cardiac function are reviewed. Racial differences in renal physiology and socio-economic status seem to account for BP differences. Black hypertensive patients in sub-Saharan Africa are prone to cerebral haemorrhage, malignant hypertension, leading to uraemia and congestive heart failure, whereas coronary artery disease is relatively uncommon. Responses to antihypertensive drugs like the beta-blockers and the angiotensin-converting enzyme (ACE) inhibitors are poor unless these agents are combined with a thiazide diuretic. Black hypertensive patients respond best to diuretics, vasodilators or calcium channel blockers. A profiled approach to the treatment of hypertension in black patients is suggested.