血栓弹力图评价全髋置换术围手术期应用利伐沙班后的凝血功能改变

目的研究血液凝固性在全髋关节置换术前、后的改变以及术后服用利伐沙班对其影响。方法随机选择2011年在我科行全髋关节置换术的患者66例。所有患者术后第1天开始口服利伐沙班,并分别于术前、术后第1天、术后第4天行血栓弹力图（thromboelastography,TEG）检查。比较各阶段TEG重要指标的差异。结果全髋关节置换术后TEG各指标中凝血反应时间（r）、血细胞凝集块形成时间（k）、凝血时间（r＋k）值短于术前,血细胞凝集块形成速率（α）、最大振幅（ma）、凝血指数（CI）值高于术前,差异有统计学意义;术后服用利伐沙班后TEG各指标中r、r＋k时间长于服药前,差异有统计学意义;k、α、ma、CI无显著变化,差异无统计学意义。结论全髋关节置换术可明显增加患者的血液凝固性,而增加血栓风险;术后短期口服利伐沙班可降低血液凝固性。     

老年冠心病合并糖尿病患者雷帕霉素洗脱支架置入术后5年随访研究

目的探讨老年冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入雷帕霉素洗脱支架（SES）治疗的远期疗效。 方法回顾性随机入选2003年1月至2007年12月住院期间老年冠心病合并糖尿病患者行PCI 100例,并入选同时期100例无糖尿病的冠心病患者行PCI为对照组。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果 两组支架术成功率均为100%。随访率100%,随访5年,糖尿病组与非糖尿病组术后并发症发生率（8.0%、7.0%）、卒中发生率（5%、3.0%）、心源性死亡率（0%、0%）差异无显著性（均为ρ〉0.05）。再次血运重建率（30.0%、14.0%）、非致死性心肌梗塞（6.0%、2.0%）心绞痛复发率（42%、20%）、全因死亡率（10%、2.0%）糖尿病组高于非糖尿病组;但心源性病死率均为0%。结论：老年患者选择性冠脉内置入药物洗脱支架安全,成功率高,远期疗效尚好,但糖尿病仍是远期不良预后的独立预测因素。     

Childhood Pityriasis Rosea

Abstract: Pityriasis rosea (PR) is an acute, self‐limiting papulosquamous disorder of unknown etiology. Published studies of childhood PR are scarce and most are reviews. The aim of this study was to determine the demographic and clinical features of childhood PR.     

内毒素耐受THP-1细胞中糖皮质激素受体-α在炎症反应中的作用

目的:应用脂多糖(Lipopolysaccharide,LPS)刺激人单核细胞白血病细胞系THP-1细胞,模拟体外脓毒症模型,了解单核细胞系统在产生内毒素耐受时,糖皮质激素受体-α(Glucocorticoid receptor-α,GR-α)在转录水平上的表达。方法:用无血清培养基培养人THP-1细胞,将细胞随机分为4组(A、B、C、D),分别用不同浓度LPS刺激THP-1细胞24 h后,再改变LPS浓度刺激上述各组细胞24 h,分别提取RNA和蛋白质,以逆转录聚合酶链反应(RT-PCR)检测GR-α的mRNA表达,用西部印迹法(Western Blotting)检测NF-κB蛋白质表达,以酶联免疫吸附试验(ELISA)检测培养液中肿瘤坏死因子-α(TNF-α),白细胞介素1β(IL-1β),白细胞介素10(IL-10)水平。结果:A、B、C、D组GR-αmRNA与-βactin比值,NF-κB蛋白与GAPDH比值差异有统计学意义(P<0.01),在受到LPS刺激时,GR-αmRNA与NF-κB蛋白的表达负相关(r=0.816,P<0.01)。结论:内毒素耐受的THP-1细胞GR-α表达上调,这可能在THP-1细胞的内毒素耐受时炎症反应的发生起到重要作用。     

A holiday break for adolescents provided by the Malcolm Sargent cancer fund for children

The paper describes a holiday for a group of adolescents with cancer (from the Young Oncology Unit at the Christie Hospital, Manchester, UK) at Malcolm Sargent House, Prestwick, Scotland. The aim was to provide an opportunity for young people with cancer to build and to develop therapeutic relationships away from the pressures of hospital, home and treatment. The nature and range of care given by the nurses and social worker who accompanied them is described and includes accounts of individual progress which are demonstrated by brief case studies.     

Pharmacokinetics of biliary excretion of N-nitrosodimethylamine in rats fed diets containing levels of protein

Albino Wistar rats (Rattus norvegius) fed semi-purified diets containing 3.5%, 8%, 27%, and 64% casein, respectively, as the protein source, were poisoned with an intraperitoneal dose of 20mg N-nitrosodimethylamine (NDMA)/kg, following cannulation of the bile duct, in vitro, under urethane anaesthesia. Bile exudates was collected at designated time intervals and analysed for unchanged NDMA using thin layer chromatography and gas liquid chromatography methods. Rats on 64% high protein diet (HPD) were the highest excretors of NDMA, followed by rats on the 3.5% kwashiorkorigenic diet (KWD), 8% low protein diet (LPD) and 27% normal protein diet (NDP) as the least excretors, in that order. The corresponding values for culmulative excretions of NDMA were 4.38%, 2.74%, 2.96% and 4.11%, and for elimination rate contents they were 54.05Kh⁻¹, 23.01Kh⁻¹, 23.76Kh⁻¹ and 48.88Kh⁻¹, while the respective elimination half-life values were 0.013h, 0.031h, 0.029h and 0.014h. The toxicological and pharmacological implication of the pharmacokinetic findings are discussed.     

Increased trinucleotide repeat instability with advanced maternal age

Nucleotide repeat instability is associated with an increasing number of cancers and neurological disorders. The mechanisms that govern repeat instability in these biological disorders are not well understood. To examine genetic aspects of repeat instability we have introduced an expanded CAG trinucleotide repeat into transgenic mice. We have detected intergenerational CAG repeat instability in transgenic mice only when the transgene was maternally transmitted. These intergenerational instabilities increased in frequency and magnitude as the transgenic mother aged. Furthermore, triplet repeat variations were detected in unfertilized oocytes and were comparable with those in the offspring. These data show that maternal repeat instability in the transgenic mice occurs after meiotic DNA replication and prior to oocyte fertilization. Thus, these findings demonstrate that advanced maternal age is an important factor for instability of nucleotide repeats in mammalian DNA.      

Psychological health in patients with genital and oral erosive lichen planus

BACKGROUND: Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported. OBJECTIVES: As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed. RESULTS: Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group. DISCUSSION AND CONCLUSIONS: Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.     

Congenital chylothorax in siblings

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X-linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.     

Importance of nitric oxide in hepatic arterial blood flow and total hepatic blood volume regulation in pigs

The importance of nitric oxide in regulating basal arterial blood flow has been examined in several different vascular beds by intra-arterial infusion of inhibitors of nitric oxide synthesis, but not in the arterial vascular bed of the liver. In the present study, N^G-nitro-L -arginine (L -NNA), in a dose of 0.5 and 1.0 μmol mL^?1 of hepatic arterial blood flow, was infused for 5 min into the hepatic artery in seven pigs anaesthetized with pentobarbital sodium. The haemodynamic effects observed by the first infusion were not further enhanced by the second infusion. Hepatic arterial resistance increased by 143 ± 38% and hepatic arterial blood flow declined by 38 ± 10%. A systemic effect due to `spillover' was observed, as evidenced by an increase in mean aortic blood pressure of 24 ± 4 mmHg. However, no significant increase in arterial mesenteric resistance was observed and total liver blood flow remained unchanged. Hepatic arterial vasodilation in response to occlusion of the portal vein, the arterial buffer response, remained intact after inhibition of nitric oxide synthesis. Liver lobe thickness, measured by an ultrasonic technique,was not found to change with inhibition of arterial nitric oxide synthesis, excluding a significant direct effect of arterial nitric oxide on liver capacitance. In conclusion, nitric oxide is an important regulator of hepatic arterial resistance, but does not mediate the hepatic arterial buffer response and was not found to play any significant role in total hepatic capacitance regulation.