Methacholine and adenosine 5'-monophosphate challenges in children with post-infectious bronchiolitis obliterans.

Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, but is also frequently demonstrated by children and adults with chronic obstructive lung diseases. AHR is usually measured by bronchial challenges using direct or indirect stimuli. The aim of this study was to compare these two types of bronchial challenge in children with post-infectious bronchiolitis obliterans (BO). Methacholine and adenosine 5'-monophosphate (AMP) challenges were used as tools for the evaluation of AHR to direct and indirect stimuli, respectively, in children with post-infectious BO (n = 28). These results were compared with those of asthmatic (n = 30) and control children (n = 25). Altogether, twenty-two patients (78.6%) with post-infectious BO were hyperreactive to methacholine with a provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20) of <16 mg x mL(-1), but only six (21.4%) were hyperreactive to AMP with a PC20 of <200 mg x mL(-1). All patients with asthma responded positively to methacholine, and most (28, 93.3%) also responded positively to AMP. The majority of controls were insensitive to both challenges. Airway hyperresponsiveness to methacholine is a frequent, but by no means universal, finding in children with post-infectious bronchiolitis obliterans, but is usually not accompanied by airway hyperresponsiveness to adenosine 5'-monophosphate. This finding suggests that airway hyperresponsiveness in patients with post-infectious bronchiolitis obliterans has characteristics that differ from those of asthmatic subjects.     

动态增强MR灌注成像在脑胶质瘤诊断中的价值

目的　探讨动态增强T2 WMR灌注成像在脑胶质瘤术前分级预测及鉴别诊断中的价值。资料与方法　有病理或追踪结果的 4 8例脑病变患者 ,其中胶质瘤 2 5例 (高、低级别胶质瘤分别为 16例和 9例 ) ,非胶质瘤病变 2 3例。全部病例均行常规T1WI、T2 WI和EPI SE序列动态增强MR灌注成像。计算每个病灶的最大相对脑血容量 (rCBV)比值 (病灶最大rCBV/对侧正常脑白质rCBV)。分析胶质瘤的最大rCBV比值与其组织学级别的关系 ,并比较胶质瘤与非胶质瘤的灌注异常及常规MRI强化表现。结果　高级别胶质瘤 ( 16例 )的最大rCBV比值为4 .6 0± 1.98( 2 .5 5～ 9.2 2 ) ,低级别胶质瘤 ( 9例 )的最大rCBV比值为 1.86± 1.5 2 ( 0 .85～ 5 .72 ) ,经t检验 ,两组之间有显著统计学差异 (P <0 .0 1)。脑膜瘤、转移瘤、血管母细胞瘤、淋巴瘤均显示有局部高灌注 ,最大rCBV比值为5 .35± 2 .39( 3.15～ 12 .39) ,而有强化表现的脑梗死、脑炎性灶及放射性脑损伤表现为低、等灌注 ,最大rCBV比值为1.2 7± 0 .36 ( 0 .85～ 1.72 )。结论　MR灌注成像在胶质瘤的术前影像学分级预测上有重要价值 ,在脑胶质瘤的某些鉴别诊断上亦具有一定的参考价值     

Buccal mucosal graft for urethral reconstruction.

Urethral reconstruction with graft substances, such as skin and bladder mucosa, has been previously used when primary anastomosis cannot be achieved. However, stricture and meatal prolapse are associated with these grafts. We report the use of buccal mucosa for the reconstruction of urethral defects in 3 patients. One patient with failed operation for hypospadias received tube buccal mucosal graft for urethral replacement. Two patients with urethral necrosis and stricture received onlay buccal mucosal graft. All patients were disease-free during follow-up (range, 12 to 49 months; mean, 36 months). One patient had a pinhole fistula that was successfully managed with simple repair. This technique appears to be useful for urethral reconstruction when a local graft is not available, even in patients with complicated conditions.     

The CLDN5 locus may be involved in the vulnerability to schizophrenia.

The present study was designed to detect three single nucleotide polymorphisms (SNPs) located on 22q11 that was thought as being of particularly importance for genetic research into schizophrenia. We recruited a total of 176 Chinese family trios of Han descent, consisting of mothers, fathers and affected offspring with schizophrenia for the genetic analysis. The transmission disequilibrium test (TDT) showed that of three SNPs, rs10314 in the 3'-untranslated region of the CLDN5 locus was associated with schizophrenia (chi(2) = 4.75, P = 0.029). The other two SNPs, rs1548359 present in the CDC45L locus centromeric of rs10314 and rs739371 in the 5'-flanking region of the CLDN5 locus, did not show such an association. The global chi-square (chi(2)) test showed that the 3-SNP haplotype system was not associated with schizophrenia although the 1-df test for individual haplotypes showed that the rs1548359(C)-rs10314(G)-rs739371(C) haplotype was excessively non-transmitted (chi(2) = 5.32, P = 0.02). Because the claudin proteins are a major component for barrier-forming tight junctions that could play a crucial role in response to changing natural, physiological and pathological conditions, the CLDN5 association with schizophrenia may be an important clue leading to look into a meeting point of genetic and environmental factors.     

肺隔离症的影像诊断和介入治疗

目的探讨肺隔离症的影像学表现及介入治疗的应用价值. 资料与方法对5例肺隔离症患者的X线平片、CT、MRI表现进行分析,并对隔离的肺组织的供血动脉进行栓塞. 结果 X线平片主要表现为囊状或团状高密度影及支气管扩张样改变,CT、MRI可发现部分异常供血动脉,血管造影均能发现供血动脉,经异常供血动脉采用不锈钢圈栓塞后临床症状逐渐减轻、消失,随访6个月～1年,症状未再复发. 结论在影像诊断方面,X线平片难以确诊,CT、MRI可部分确诊,而DSA检查是肺隔离症诊断的金标准.经异常供血动脉栓塞治疗肺隔离症安全,患者痛苦小,并发症少,是一种有效的治疗方法.     

青年性前部视网膜劈裂锯齿缘断离及视网膜脱离

目的：探讨青年性前部视网膜劈裂锯齿缘断离及视网膜脱离的临床特点、治疗及其预后。方法：对青年性前部视网膜劈裂锯齿缘断离合并视网膜脱离患者10例20只眼进行常规检眼镜眼底及Goldmann三面镜联合巩膜压陷检查，根据不同情况进行激光光凝，或巩膜冷凝外加压手术治疗，并随访1～5年。结果：共lO例，年龄17～32岁，8例为双眼患病，病变位于颞下，双侧对称。11眼同时患有前部视网膜劈裂、锯齿缘断离及视网膜脱离，3眼患有前部视网膜劈裂及锯齿缘断离，1眼仅有前部视网膜劈裂，3眼仅有锯齿缘断离其中2眼合并视网膜脱离。13眼合并视网膜脱离者采用巩膜冷凝外加压术，全部一次治愈，5眼行激光封闭锯齿缘断离及劈裂区。随访期间未见视网膜脱离，视力均有不同程度提高。结论：青年性前部视网膜劈裂锯齿缘断离及视网膜脱离有典型的临床特点，尽早发现、适宜治疗，预后良好。     

Potential interference of agents on radioiodide thyroid uptake in the euthyroid rat.

The objective of this research was to investigate the merits of controlled studies with euthyroid rats as a means of determining the influence of dose and time after administration of agents that may interfere with radioiodide uptake in the thyroid. METHODS: Potassium iodide (KI), propylthiouracil (PTU), diatrizoate meglumine, and iohexol were selected to represent interfering agents. Two dose levels per agent were investigated. Doses used were 1 and 2 mg/kg of body weight for KI, 3.5 and 7 mg/kg of body weight for PTU, 1 mL/kg (282 mg I/kg) and 2 mL/kg (564 mg I/kg) of body weight for diatrizoate meglumine, and 1 mL/kg (300 mg I/kg) and 2 mL/kg (600 mg I/kg) of body weight for iohexol. The 24-h radioiodide thyroid uptake was determined after (131)I was given at 1, 8, 15, and 22 d after administration of interfering agents. RESULTS: The percentage radioiodide uptake value for the thyroid decreased significantly compared with controls for all agents and both doses on day 1 but returned to control levels by day 22 for all agents and both doses The time to return to normal varied between agents and doses. CONCLUSION: We conclude that the interfering agent, the dose given, and the length of time after administration influence the potential for an agent to affect radioiodide uptake in the thyroid. Further studies with the rat, preferably hyperthyroid, would be beneficial in generating data to reduce confusing contradictory information on the length and severity of interference of agents in radioiodide thyroid studies.     

嗜铬细胞瘤患者围手术期处理的改进

目的：探讨提高嗜铬细胞瘤患者围手术期安全性的措施。方法：对15例嗜铬细胞瘤患者、术前采用选择性α1受体阻滞剂多沙唑嗪控释片(可多华)控制高血压；11例患者采用3D DCEMRA进行肿瘤定位；术中均采用联合高容量血液稀释(AHH)和术中患者自体血回输纠正血容量。结果：除1例持续性高血压患者需联合钙离子拮抗剂和ACEI药物降压外．其余患者血压控制均为满意；根据3D DCEMRA定位选择手术径路者均顺利完成手术；AHH联合术中自体血回输使14例患者避免了异体输血。结论：本文围手术期处理改进．可多华可明显减少药物的不良反应；采用3D DCEMRA进行肿瘤定位，可增加手术安全性；AHH联合术中自体血回输可减少医疗成本和异体输血，以及由此而引起的并发症。     

Immunoregulatory effects of phospholipase A2 (PLA2) on the proliferation of human lymphocytes

Extracellular phospholipase A2 (PLA2) is a proinflammatory enzyme found especially in the inflammatory exudate to modulate blood flow to areas of antigen stimulation. In this study we found that PLA2 exerted a biphasic effect on the proliferation of phytohemagglutinin (PHA)-stimulated human mononuclear cells (PHA MNC). At low concentrations range from 0.001 to 1 U/ml, PLA2 enhanced the proliferation of PHA MNC (maximal increase was 37.0 +/- 5.67%). Conversely, at concentrations over 10 U/ml, PLA2 markedly suppressed the PHA-induced MNC proliferation (maximal decrease was 88.86 +/- 2.89%). PLA2 was non-toxic to lymphocytes after three days culture, unless the concentration was higher than 100 U/ml. The membrane polarization of PHA-stimulated lymphocytes was also increased by PLA2 at a low concentration. In addition, PLA2 displayed a similar effect on the proliferation of streptokinase-streptodornase (SK/SD) or allogeneic cell stimulated lymphocytes. The change of lymphocyte proliferation by PLA2, was parallel to the change of percentage of helper T cells. Furthermore--a CD4-rich population was proved more susceptible to PLA2 effect than a CD8-rich population. Para-bromophenacyl bromide (pBPB), an irreversible inhibitor of PLA2, abrogated the biphasic effect of PLA2 on PHA MNC proliferation. These results suggest that PLA2 plays a regulatory role on immune reactions by modulating the percentage of helper T cells.     

A cross-reactive idiotype in scleroderma

Autoantibodies to centromere proteins (anti-CENPs) and to topoisomerase-I are highly specific for scleroderma. Unlike most autoantibodies in other diseases, these autoantibodies are mutually exclusive. We have analysed the idiotypes (Ids) expressed by anti-CENP-B, antitopoisomerase-I, and IgGs from 20 scleroderma patients. Rabbit anti-Ids were prepared to antitopoisomerase-I from two scleroderma patients, and to anti-CENP-B from four patients. These six anti-Ids were used to study the purified autoantibodies from 20 scleroderma patients: four antitopoisomerase-I, 10 anti-CENP-B, and six purified IgG from scleroderma patients who were negative for both autoantibodies. In addition, we studied sera from 40 normal autoantibody-negative controls, and sera and purified immunoglobulins from 17 systemic lupus erythematosus (SLE) patients containing high titres of anti-double-stranded DNA, and/or autoantibodies to extractable nuclear antigens (ENA). Using direct binding, and competitive inhibition ELISAs and immunoblots, we identified an Id present in the heavy chains of all the affinity-purified antitopoisomerase-I, and anti-CENP-B. Interestingly, this Id was also present in the immunoglobulins of the scleroderma patients who had neither of the two autoantibodies. By contrast, cross-reactive Id-EM was not found in the sera or immunoglobulins from 17 SLE patients, or in the sera from 40 normal subjects. Several samples from two patients showed that this cross-reactive Id-EM was stable over time. The scleroderma disease-specific autoantibodies may be identified through a common structural feature at the variable region of the heavy chain: cross-reactive Id-EM.