溶血磷脂酸对移植肾血栓形成的预警作用

目的探讨在肾移植患者中监测血浆溶血磷脂酸(LPA)含量来判断体内凝血状态,评价血浆LPA水平对肾移植血栓性疾病早期诊断和积极预防的临床价值。方法入选患者150例,其中规律血透尿毒症患者50例(尿毒症组),肾移植患者(术后2周内)50例(肾移植组),50例健康者(对照组)。分别测定3组术后1～2周血浆中LPA水平,肾移植组术后2周内每日检测凝血功能常规、移植肾彩色多普勒及能量图(CDFI),计算部分凝血活酶时间(APTT)/凝血酶原时间(PT)值,记录移植肾主动脉、段动脉血流速度(VS)及阻力指数(RI)。结果术后1～2周,通过B超检查,肾移植组有血栓形成患者2例(血栓形成组),无血栓形成48例(无血栓形成组)。血栓形成组术后2周LPA浓度明显高于无血栓形成组(<0.01)。术后1周,无血栓形成组与尿毒症组及对照组LPA浓度差异均有统计学意义(均<0.01)。肾移植术后2周,血栓形成组与无血栓形成组肾主动脉及段动脉VS与RI差异均有统计学意义(均>0.05)。结论血浆中LPA作为体内凝血及血栓形成过程早期释放的标志物,对肾移植后移植肾血栓形成的诊断及指导合理应用抗血小板及抗凝药物有一定应用价值,可作为移植肾血栓形成的预警指标。     

Central drive and ventilatory failure in late-onset Pompe disease: At the gates of a new phenotype

Subjects with late-onset Pompe disease (LOPD) typically present as slowly progressive proximal muscle weakness. Respiratory muscle weakness and diaphragmatic paralysis are common features, and may be the initial manifestation of the disease. There is often a poor correlation between the severity of limb and respiratory muscle weakness. Early clinical observations about disproportionate hypercapnia to the respiratory muscular weakness in late-onset Pompe disease were recognized and will be discussed with special reference to blunted respiratory drive, and the connections between early clinical observations, respiratory functional studies and anatomical findings. According to new evidence about blunted respiratory drive in Pompe disease, it is necessary to rethink what is meant by “asymptomatic Pompe disease” and propose a new phenotype with its therapeutic implications. The conceptual model of the mechanisms leading to respiratory failure in this disease could be considered according to these new findings. It may broaden the diagnostic spectrum of the adult forms and warrants a closer interaction between neurologists and pulmonologists. The recognition of this new phenotype of predominant central alveolar hypoventilation in Pompe disease will improve the understanding of the underlying mechanisms of ventilatory failure and could lead to improved future therapeutic strategies.     

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目的了解福建省北部地区政和县儿童牙弓宽度,为研究当地儿童牙弓宽度生长发育的规律和特点提供依据。方法2003年6月至2005年6月选取福建省建瓯市政和县3～9岁儿童321名,采用电子数显游标卡尺及分规对其上下颌模型的牙弓宽度进行测量,并对数据进行统计学分析。结果牙弓宽度在多数年龄组、分段中存在显著性别差异。除下颌第一恒磨牙间牙弓宽度之外,各段牙弓宽度>7～9岁组均显著大于>5～7岁组。而各段牙弓宽度>5～7岁组与3～5岁组相比,除上颌乳尖牙间牙弓宽度>5～7岁组显著大于3～5岁组,其余各段牙弓宽度差异均无统计学意义。结论>7～9岁是牙弓宽度显著增长的年龄段,其原因可能与恒切牙的萌出有关。     

鞍区Rathke囊肿的MRI诊断价值

目的探讨鞍区Rathke囊肿的MRI表现及其诊断价值。方法回顾性分析5例经手术病理证实的鞍区Rathke囊肿的MRI资料。结果 5例囊肿均由鞍内向鞍上延伸,呈哑铃型,边界清楚,囊壁菲薄。囊液T1WI低信号T2WI高信号3例,T1WIT2WI囊液均为高信号2例,囊壁见线样增强1例。结论典型鞍区Rathke囊肿的MRI表现具有一定的特征性,术前正确诊断有可能,但需密切结合临床,并与垂体瘤、颅咽管瘤鉴别。     

Etomidate use in severe sepsis and septic shock patients does not contribute to mortality

Use of etomidate in severe sepsis and septic shock has been challenged in recent literature due to its link to adrenal insufficiency and suspected increased mortality. We hypothesized that etomidate does not contribute to mortality in this patient population. A retrospective chart review of 230 intubated, severe sepsis/septic shock patients at two university tertiary care referral centers was conducted for patients receiving treatment between 12/2001 and 10/2009. The primary endpoint was in-hospital mortality. Additional investigated variables included the use of corticosteroids, hospital and intensive care unit (ICU) length of stay, mechanical ventilation days and patient demographics. One hundred seventy-three patients received etomidate and fifty-seven patients received either no medication or an alternative drug. Use of etomidate in this patient cohort did not worsen mortality. Mortality in the etomidate group was 43.9% (76/173). Mortality in the non-etomidate cohort was 45.6% (26/57) (p = 0.48). APACHE II scores were 22 ± 7.2 and 23 ± 7.1 for the etomidate group and the non-etomidate group, respectively, (p = 0.36). There was no significant difference in mortality between etomidate and non-etomidate cohorts in this study. This large retrospective multi-center study further supports the safety of etomidate use in severe sepsis and septic shock.     

藏羚羊和藏系绵羊左心室收缩功能的比较研究

目的:探讨藏羚羊适应高原低氧环境的左心功能特点。方法:捕捉海拔4 300 m藏羚羊9只、藏系绵羊10只运至格尔木(海拔2 800 m)实验基地。测定二者的心脏/体重比(HW/BW)、右心室/(左心室+室间隔)重量比[RV/(LV+IVS)];应用心导管技术测定心率(HR)、收缩压(SBP)、舒张压(DBP)、左室等容收缩期心室内压力上升最大速率和左室等容舒张期心室内压力下降最大速率(±dp/dt)。以格尔木市的氧浓度(21.1%)为基线,分别给予更低浓度氧14.6%、12.5%(分别相当于海拔5 300 m、6 300 m)的低氧吸入15 min后重复测定以上指标。应用透射电镜观察心肌超微结构。结果:藏羚羊HW/BW显著高于藏系绵羊(P0.01),基础状态下藏羚羊SBP低于藏系绵羊(P0.05),+dp/dt与藏系绵羊比无显著差异,吸入14.6%和12.5%的低氧气体后藏羚羊+dp/dt分别升高至145.1%和148.1%,而藏系绵羊分别降低至68.4%和70.5%(P0.05);电镜下观察藏羚羊心肌超微结构与藏系绵羊比较,其心肌细胞线粒体较为丰富。结论:藏羚羊心脏对高海拔低氧环境的适应,是通过增加心脏器官的重量及心肌细胞线粒体的含量来实现,其心肌收缩功能的适应性特征为:在静息状态下以较低的左心室心肌收缩力来降低氧耗量以此适应高原低氧环境,而以海拔更高的较低氧浓度为应激条件下,左心室心肌收缩力明显升高。提示:藏羚羊作为高原适应性动物,经过漫长的自然选择其心脏对高原低氧环境的适应不同于藏系绵羊。     

EGFR、p53在db/db自发性糖尿病小鼠颌下腺的表达

目的 观察表皮生长因子受体（EGFR）、p53在糖尿病小鼠颌下腺中的表达。方法 选取3、4、6、8、10月龄db／db糖尿病小鼠及相应月龄的db／＋m正常小鼠颌下腺。应用HE染色及免疫组织化学方法染色后进行图像分析，统计EGFR、p53在颌下腺组织内表达的细胞阳性率。结果 随着糖尿病的发展，颌下腺组织出现腺叶萎缩及实质细胞排列不整齐，堆集呈簇。纤维及血管增多；EGFR、p53在对 照组及糖尿病组颌下腺中均有表达。其细胞阳性率随月龄增大均呈增高趋势。且糖尿病组显著高于对照组。结论 ①db／db糖尿病可导致颌下腺组织萎缩及实质细胞形态学改变。②EGFR、p53表达增多。说明糖尿病时EGFR作为多效应受体，可能被激活从而诱导了颌下腺的细胞凋亡；p53表达的上升。提示随着糖尿病发展，颌下腺实质细胞有凋亡趋势。     

Cancer: A reproductive strategy of "ultra-selfish" genes?

A hypothesis is presented in which the process of "malignant transformation" which ultimately results in the rapidly dividing tumor(s)(cells) causing "cancer", is regarded as an evolved reproductive strategy of "ultra-selfish" (proto-)(onco-)genes, already present in the genome, or introduced by a virus.