经皮封堵器治疗卵圆孔未闭的卒中二级预防——呼吁完成随机临床试验

目前,尚不明确预防原因不明、合并卯圆孔未闭（patent foramen ovale,PFO）患者的卒中或短暂性脑缺血再次发作的最佳措施。众多观察性研究发现,PFO与原因不明的卒中虽密切相关,但在大多数发病的患者中,两者间并未明确因果关系。治疗措施包括：抗血小板聚集或维生素K拮抗剂的药物治疗、经皮封堵术及外科手术修补。     

中国病毒性乙型肝炎的研究

我国是病毒性乙型肝炎(HB)高发病国家,人群感染HBV约有6.5亿,而HBsAg慢性携带者则为1.2亿,每年死于HB及相关性疾病者在16万人以上,HB已成为我国危害最大的社会公共卫生问题。现就目前我国HB研究的状况,提出一些思考,希望能对HB的研究有所助益。 1 病毒性乙型肝炎的分类我国现行的病毒性肝炎分类方案(以下称分类方案)与国际上基本一致,将其分为急性、慢性和肝炎肝硬变三大类,又根据HB不同的临床体征及组织病理学表现,而分成若干亚型。     

Generation of natural killer cells from Thy 1.1+ bone marrow precursor cells in the rat

We have recently described a long-term bone marrow culture (LTBMC) system in the rat for the generation of natural killer (NK) cells from bone marrow (BM) precursors in the presence of interleukin-2 (IL-2). We found that the LTBMC-conditioned medium was essential to render the NK precursor cells responsive to IL-2. In this report, we isolated by flow cytometric cell sorting Thy 1.1+ BM cells, which have been shown to contain pluripotent stem cells and early precursor cells of various hematopoietic lineages. These Thy 1.1+ immature BM precursors did not generate any detectable NK activity when cultured for 7 days with IL-2 alone. However, when the cells were cultured with IL-2 in the presence of LTBMC-conditioned medium, NK cells were generated as demonstrated by cytolytic activity against NK-sensitive tumor targets, large granular lymphocyte (LGL) morphology, and the acquisition of NK cell-associated phenotype (72% of the cells were 3.2.3+/OX41-/CD5-). This study demonstrates the existence of an IL-2 unresponsive Thy 1.1+ NK precursor in the BM of the rat, that can differentiate to a mature NK cell in the presence of LTBMC-conditioned medium and IL-2.     

热塑矫形支具治疗青少年特发性脊柱侧凸：疗效及材料和宿主反应随访

目的:回顾性分析支具矫正的青少年特发性脊柱侧凸适应证及临床效果。方法:对2003-01/2005-12在解放军第211医院骨科收治的106例未做过治疗的生长发育期青少年特发性脊柱侧凸患者,给予热塑矫形支具治疗。男21例,女85例;年龄8～19岁,平均(13.1±3.6)岁。单胸凸49例,双胸凸8例,胸和腰双凸37例,胸腰段或腰凸12例。原发Cobb角20°～42°,平均(±6.4)°。Risser征0度51例,Ⅰ度33例,Ⅱ度19例,Ⅲ度3例。支点29.5弯曲位时的矫正率≥50%的柔软性侧凸57例,<50%的僵硬性侧凸49例。每3～6个月复查1次,摄站立位全脊柱正侧位X射线片。结果:①全部病例随访24～72个月,平均36个月,79例(74.5%)治疗有效(原发性侧凸Cobb角增加≤5°,或是胸腰双主弯中继发侧凸超过原发侧凸≤5°),27例(25.5%)出现脊柱侧凸进展,治疗无效。②柔软性侧凸57例,支具矫正有效是48例;僵硬性侧凸49例,有效是37例,柔软性侧凸的矫正效果优于僵硬性侧凸。③脊柱侧凸Cobb角在20°°者63例,有效是54例,～2930～40°者43例,有效是25例,Cobb角20°°组的矫正效果优于Cobb角30°°组。③未出现特殊的材料和宿主的明显～29～40不良反应和负性事件,但腰、髋部骨密度明显下降。结论:①热塑矫形支具矫正青少年特发性脊柱侧凸能够取得良好疗效。②骨骼正处于生长发育期者,侧凸柔软性好者,Cobb角较小者,矫正效果好。③支点弯曲位时的矫正率可以预测支具矫正效果。④随访中发现应用支具后患者腰、髋部骨密度明显下降。     

大鼠黑质多巴胺能神经元衰老性变化的多项参数测量

目的:探讨大鼠中脑黑质多巴胺能神经元的衰老性变化规律,为进一步揭示黑质病变的病因提供客观依据。方法:实验于2005-07/2006-07在贵阳医学院解剖学教研室完成。选择健康SD大鼠32只,雌雄各半,按随机数字表法分为幼年组(1～2个月龄)、青年组(4～5个月龄)、中年组(11～12个月龄)、老年组(≥24个月龄)4组,每组8只。取中脑组织常规石蜡包埋,行中脑黑质连续冠状切片,焦油紫染色、酪氨酸羟化酶免疫组织化学染色,图像分析仪测量酪氨酸羟化酶免疫阳性产物的吸光度值和酪氨酸羟化酶免疫反应阳性神经元的胞面积、体密度、数密度、圆球度。结果:32只大鼠均进入结果分析。①中脑黑质焦油紫染色形态学观察:幼年组与青年组大鼠黑质神经元胞体大,细胞排列密集,形状规则,细胞成椭圆形或锥体形,胞浆丰富,每个细胞有清晰的胞核,核仁清楚可见,尼氏体粗大而染色深,中年组和老年组大鼠神经元胞浆染色较淡,尼氏体较分散,细胞散在,数量少,可见软化灶形成。幼年组、青年组、中年组、老年组计数单位面积焦油紫染色细胞数分别为(48.00±9.10),(65.00±8.73),(20.00±4.10),(13.25±1.83)个/40倍视野,各组间比较差异有显著性意义(F=3.79,P<0.05)。②中脑黑质酪氨酸羟化酶免疫反应阳性神经元:光镜下,酪氨酸羟化酶免疫反应阳性神经元成群分布,胞浆内阳性产物以幼年组和青年组为显著,中年组和老年组胞浆内酪氨酸羟化酶阳性反应颗粒明显减少,部分神经元丧失大多角形或锥体形形状,胞体变大,排列不规则,数量减少。幼年组、青年组、中年组、老年组胞浆内酪氨酸羟化酶免疫反应阳性产物吸光度值分别为0.1993±0.0711,0.2428±0.1729,0.1978±0.0687,0.1671±0.1018,各组间比较差异有显著性意义(F=1.87,P<0.05)。中年组、老年组酪氨酸羟化酶免疫反应阳性神经元体密度、数密度低于青年组,差异有显著性意义[体密度分别为(2.57±0.02),(2.36±0.01),(3.22±0.01)×10-2μm-3,t=0.66,1.78,P<0.05;数密度分别为(0.91±0.04),(0.59±0.03),(1.20±0.09)×10-5μm-3,t=7.02,2.25,P<0.05]。幼年组平均截面积低于青年组,差异有显著性意义[分别为(27.30±5.56),(30.40±1.08)×101μm2,t=1.47,P<0.05]。幼年组、中年组、老年组平均体积低于青年组,差异有显著性意义[分别为(9.67±0.40),(5.85±0.42),(5.20±0.33),(11.53±0.90)×102μm3,t=1.60,2.93,0.18,P<0.05]。老年组神经元圆球度低于幼年组、青年组、中年组,差异有显著性意义(分别为0.74±0.18,0.91±0.01,0.92±0.05,0.90±0.03,t=0.68,0.99,1.02,P<0.05,0.001)。结论:黑质多巴胺能神经元随年龄增长而出现衰老性变化,可能是黑质病变的原因之一。     

带血管自体腓骨移植修复胫骨良性骨肿瘤致骨缺损

目的:观察带血管自体腓骨移植修复胫骨中上段良性骨肿瘤致骨缺损的临床应用结果。方法:选择2001-10/2006-12在南京医科大学附属南京第一医院骨科应用带血管腓骨移植修复因良性肿瘤所致胫骨长段骨缺损患者12例,患者均知情同意。肿瘤清除后,采用健侧带血管腓骨皮瓣移植重建患侧胫骨,切取健侧腓骨长度为8￣23cm,平均长度13cm。术后定期随访,根据Enneking评分结果、移植腓骨转归的影像学评价结果和腓骨供区的随访结果进行效果评定,Enneking系统评分根据患者肢体疼痛、功能活动、自我感受、旋转活动度、精细操作、工作能力等6个方面对患肢进行评分,满分30分,26￣30分评为优,21￣25分评为良,16￣20分评为中,11￣15分评为差。结果:全部12例患者均获随访,随访时间6个月￣3年,其中6￣12个月3例,17￣26个月7例,27￣36个月2例,平均19个月。Enneking评分26￣30分7例,20￣25分4例,15￣20分1例。11例关节功能良好,可完成正常生活功能,仅1例因靠近膝关节至关节功能受限,经康复治疗后改善。X射线片均呈现理想的替代形态,无胫骨下端的成角畸形,腓骨均有不同程度的增粗,仅1例胫骨内侧平台塌陷约3.5mm,另11例无明显塌陷。12例患者无供区踝关节外翻畸形及腓总神经支配区感觉异常,腓骨长、短肌肌力四五级,踝关节活动不受限。结论:带血管腓骨移植用于修复胫骨良性骨肿瘤致骨缺损是可行的,但仍需要积累更多的病例数及更长期的随访以观察远期效果。     

应用等离子刀生物学特征完成内窥镜下跖筋膜松解术

目的:观察等离子刀在内窥镜下跖筋膜松解中的应用效果及优势。方法:选取2002-01/2005-02南京医科大学附属南京第一医院骨科收治的12例患者,跖筋膜炎7例,先天性高弓仰趾足畸形3例,马蹄内翻足2例。分别在跟骨内外侧建立两个入路,引入关节镜和等离子刀。等离子刀由内向外切开跖筋膜,直到显示跖筋膜下的疏松结缔组织或可见到拇展肌、趾短屈肌等的肌纤维。对于高弓足和马蹄内翻足,在切开处的远端用Saber等离子刀再作数个横行切开,并且用蓝钳切除掉部分跖筋膜组织,也可以用等离子刀进行汽化消融。对于跖筋膜炎,只切开跖筋膜内侧的2/3。在高弓足和马蹄内翻足的病例,同时施行截骨矫形、跟腱延长或肌腱转移等其他手术。记录手术时间并观察足跟局部反应和畸形矫正效果。结果:12例患者均成功完成手术进入结果分析。①手术时间5￣20min。②术后足底肿胀较轻,渗出少,未见皮肤的坏死和感染。③术后随访≥14个月。7例跖筋膜炎的病例,有4例疼痛完全缓解,或仅在走高低不平的路时有不适感;3例疼痛较术前有好转,但仍然有隐痛的感觉,不过能接受,不需要服用止痛药。3例高弓足的病例,术后高弓畸形明显改善,足底和趾背胼胝、疼痛消失,能穿皮鞋行走,其中有1例主诉足趾背伸肌力减弱。马蹄内翻足的病例,术后对外形的矫正都很满意。结论:等离子刀用于内窥镜下跖筋膜松解具有明显的优点:①等离子刀具有止血的作用,术后基本没有什么渗血。②创伤小,损伤反应轻,康复快。③操作简便,手术时间短。④安全性高。     

Effect of RANTES on the infection of monocyte-derived primary macrophages by human immunodeficiency virus type 1 and type 2

The effect of β chemokines on human immunodeficiency virus type I (HIV-1) infection of primary macrophages is controversial, and their effect on HIV-2 infection of these cells has not yet been documented. We examined the effect of synthetic and recombinant regulated-on-activation, normal T cell-expressed and -secreted (RANTES) on HIV-1 and HIV-2 infection of primary monocyte-derived-macrophages (MDM) that were obtained as the adherent cells of 5-day cultures of blood mononuclear cells (PBMC), followed by 2-day culture without peripheral blood mononuclear cells (PBMCs) nor added cytokines. These MDM expressed CD4, CCR5 and CXCR4, the major coreceptors for HIV macrophage- and T cell-tropic isolates, respectively. Infection of MDM from different donors with HIV-1 or HIV-2 macrophagetropic strains was reproducibly inhibited by RANTES. This inhibition depended on RANTES continuous presence in culture during and after infection. Treatment of MDM with RANTES just before or during, but not after, exposure to virus did not protect MDM from infection. When RANTES was added after MDM had been infected, and was continuously maintained in culture thereafter, no inhibition occurred and limited enhancement of infection could be observed. These data indicate that RANTES inhibits HIV-1 as well as HIV-2 infection of MDM, likely at a post-binding step, and support the role of CCR5 as the major coreceptor for HIV-1 and HIV-2 entry into primary macrophages.     

Effects of thoracic epidural anesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial

Introduction

Severe acute pancreatitis is still a potentially life threatening disease with high mortality. The aim of this study was to evaluate the therapeutic effect of thoracic epidural anaesthesia (TEA) on survival, microcirculation, tissue oxygenation and histopathologic damage in an experimental animal model of severe acute pancreatitis in a prospective animal study.

Methods

In this study, 34 pigs were randomly assigned into 2 treatment groups. After severe acute pancreatitis was induced by intraductal injection of glycodesoxycholic acid in Group 1 (n = 17) bupivacaine (0.5%; bolus injection 2 ml, continuous infusion 4 ml/h) was applied via TEA. In Group 2 (n = 17) no TEA was applied. During a period of 6 hours after induction, tissue oxygen tension (tpO₂) in the pancreas and pancreatic microcirculation was assessed. Thereafter animals were observed for 7 days followed by sacrification and histopathologic examination.

Results

Survival rate after 7 days was 82% in Group 1 (TEA) versus 29% in Group 2: (Control) (P <0.05). Group 1 (TEA) also showed a significantly superior microcirculation (1,608 ± 374 AU versus 1,121 ± 510 AU; P <0.05) and tissue oxygenation (215 ± 64 mmHg versus 138 ± 90 mmHG; P <0.05) as compared to Group 2 (Control). Consecutively, tissue damage in Group 1 was reduced in the histopathologic scoring (5.5 (3 to 8) versus 8 (5.5 to 10); P <0.05).

Conclusions

TEA led to improved survival, enhanced microcirculatory perfusion and tissue oxygenation and resulted in less histopathologic tissue-damage in an experimental animal model of severe acute pancreatitis.     

A Home-Based Exercise Program to Improve Function,Fatigue, and Sleep Quality in Patients With Stage IV Lung and Colorectal Cancer: A Randomized Controlled Trial

ContextExercise benefits patients with cancer, but studies of home-based approaches, particularly among those with Stage IV disease, remain small and exploratory.ObjectivesTo conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures.MethodsSixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week; training and step-count goals were advanced during bimonthly telephone calls. The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form. Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities (Ambulatory Post Acute Care Daily Activities Short Form), quality of life (Functional Assessment of Cancer Therapy-General), and fatigue (Functional Assessment of Cancer Therapy-Fatigue).ResultsThree participants dropped out and seven died (five in the intervention and two in the control group, P = 0.28). At Week 8, the intervention group reported improved mobility (P = 0.01), fatigue (P = 0.02), and sleep quality (P = 0.05) compared with the usual care group, but did not differ on the other measures.ConclusionA home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer.