高位胸段硬膜外阻滞治疗顽固性心绞痛及其对循环内皮细胞的影响

目的观察高位胸段硬膜外阻滞(TEA)对顽固性心绞痛(FAP)的治疗效果及循环内皮细胞(CEC)数量。方法20例FAP患者接受TEA治疗,观察疗效和心电图变化,并于TEA治疗前及治疗结束时检测血浆CEC的变化。结果TEA治疗后心绞痛缓解率100％,心电图ST段压低导联数和ST压低值显著减少(P<0．05),CEC显著减少(P<0．01)。结论TEA治疗FAP疗效满意,并可能通过保护血管内皮细胞起作用。     

The value of local registry data for describing cervical cancer management and outcomes over three decades in Australia

Registry data on invasive cervical cancers (n = 1,274) from four major hospitals (1984‐2012) were analysed to determine their value for informing local service delivery in Australia. The methodology comprised disease‐specific survival analyses using Kaplan‐Meier product‐limit estimates and Cox proportional hazards models and treatment analyses using logistic regression. Five‐ and 10‐year survivals were 72% and 68%, respectively, equating with relative survival estimates for Australia and the USA. Most common treatments were surgery and radiotherapy. Systemic therapies increased in recent years, generally with radiotherapy, but were less common for residents from less accessible areas. Surgery was more common for younger women and early‐stage disease, and radiotherapy for older women and regional and more advanced disease. The proportion of glandular cancers increased in‐step with national trends. Little evidence of variation in risk‐adjusted survival presented over time or by Local Health District. The study illustrates the value of local registry data for describing local treatment and outcomes. They show the lower use of systemic therapies among residents of less accessible areas which warrants further investigation. Risk‐adjusted treatment and outcomes did not vary by socio‐economic status, suggesting equity in service delivery. These data are important for local evaluation and were not available from other sources.     

高血压脑出血血肿周围组织血-脑屏障变化的动态观察

目的动态观察高血压脑出血血肿周围组织血-脑屏障的变化.方法对6例高血压脑出血患者实施立体定向血肿碎吸术,术中取血肿周围少许脑组织进行超微病理观察.结果血-脑屏障的损伤与出血时间的长短呈正比.脑出血后24h,可见星形胶质细胞肿胀,部分细胞崩解、坏死.毛细血管周围细胞足突肿胀,血-脑屏障损坏.72h,部分星形胶质细胞高度肿胀,细胞器溶解.毛细血管内皮细胞胞核增大,胞质突入管腔,内皮细胞间紧密连接消失.4～7d,星形细胞高度肿胀,胞质内充满水肿液,细胞器消失,细胞变性.毛细血管星形细胞足突明显肿胀,血管周围可见微小出血灶.结论血-脑屏障的变化与患者的预后有密切关系.     

抗肿瘤药物的研究Ⅲ. 数种锑胺羧螯合物对实验肿瘤的作用

1.锑胺羧螯合物是一种新型的抗肿瘤药物,应用Sb-26(EDTA-SbNa)、Sb-57(PDTA-SbNa)、Sb-66(HEDT-Sb)和Sb-71(ATA-Sb)分别为15—20、30—50、25—30和20—40毫克/公斤剂量时,均能显著地抑制小白鼠Ehrlich 腹水瘤的生长,平均延长生存时间4—22天,延长率36—147%.上述剂量对大白鼠Guerin 氏癌也有抑制作用,抑制率为58—70%.后3个药物,还能使小白鼠梭形细胞肉瘤腹水型的生存时间延长5—16天,延长率50—160%,其中以Sb-71的疗效最著.Sb-26、Sb-57、Sb-71、Sb-66对肉瘤180和AK 肉瘤及前3者对Ehrlich 固体瘤和淋巴白血病固体型的实验结果,除Sb-71对肉瘤180有抑制作用外,其他均无疗效.2.4 类锑化合物:3个(月弟)酸化合物(Sb-8,Sb-11和Sb-42)及1个酒石酸锑(Sb-15),与螯合的间苯二酚锑(Sb-64)和8羟基喹啉锑(Sb-85)各1个,对Ehrlich 腹水瘤的实验结果,均无明显疗效.3.小白鼠的急性半数致死量,Sb-57和Sb-71分别为131和62毫克/公斤,亚急性半数致死量分别为75和58毫克/公斤.     

RSS椎弓根钉内固定结合植骨融合治疗腰椎间盘突出症的有效性探究

目的：探讨RSS椎弓根钉内固定结合植骨融合治疗腰椎间盘突出症伴腰椎不稳的临床效果。方法将本院2011年9月~2013年9月收治的44例腰椎间盘突出症伴腰椎不稳患者按不同手术治疗方案随机分为对照组21例和观察组23例,对照组采用髓核摘除＋经后路关节突单纯植骨融合手术治疗,观察组采用RSS椎弓根钉内固定＋植骨融合手术治疗,比较两组的围术期情况、JOA评分、植骨融合情况。结果两组的手术耗时、术中出血量及住院时间比较差异无统计学意义（P〉0.05）。两组术后6个月的JOA评分均明显高于术前（P〈0.05）;观察组术后6个月的JOA评分高于对照组（P〈0.05）。两组植骨融合成功率比较差异有统计学意义（P〈0.05）。结论RSS椎弓根钉内固定结合植骨融合治疗腰椎间盘突出症伴腰椎不稳具有植骨融合率高、远期恢复效果显著等优点,值得临床推广应用。     

Baroreflex improvement in shr after ace inhibition involves angiotensin-(1-7)

ACE inhibitors are extensively used in the treatment of hypertension mainly because of their efficiency in reducing blood pressure levels and decreasing vascular and cardiac hypertrophy. In addition, ACE inhibitors improve baroreceptor reflex control. Chronic inhibition of ACE produces (in addition to decreased angiotensin II levels) a severe increase in angiotensin-(1-7) [Ang-(1-7)] levels in several species. We have previously shown that Ang-(1-7) produces a facilitation of the baroreflex control of heart rate. In this study, we evaluated the participation of endogenous Ang-(1-7) in the improvement of baroreflex sensitivity in spontaneously hypertensive rats after central infusion of ramiprilat, an ACE inhibitor. Reflex changes in heart rate were elicited, in conscious rats, by bolus injections of phenylephrine (baroreflex bradycardia) before and after intracerebroventricular infusion of (1) saline (8 microL/h), 4 hours (n=5); (2) ramiprilat (14 microg/h), 4 hours (n=6); (3) ramiprilat for 2 hours, followed by ramiprilat combined with A-779 (4 microg/h), a selective Ang-(1-7) antagonist, for an additional 2 hours (n=6); and (4) A-779 for 2 hours, followed by A-779 combined with ramiprilat for an additional 2 hours (n=5). Intracerebroventricular infusion of ramiprilat produced an important increase ( approximately 40%) in baroreflex sensitivity (evaluated as the ratio between changes in heart rate and changes in mean arterial pressure) that was completely reversed by A-779. Furthermore, intracerebroventricular infusion of A-779 prevented the improvement of the baroreflex sensitivity produced by ramiprilat. Intracerebroventricular infusion of saline or A-779 alone did not significantly alter the baroreflex sensitivity. These results suggest that endogenous Ang-(1-7) is involved in the improvement of baroreflex sensitivity observed in spontaneously hypertensive rats during central ACE inhibition.     

Effect of atrial natriuretic factor on renal prostaglandin E2 release in the anaesthetized dog

Experiments were undertaken in two groups of barbiturate anaesthetized dogs to examine whether atrial natriuretic factor (ANF) exerts an effect on renal release of prostaglandin E₂ (PGE₂). In the first group, intravenous infusion of ANF (50 ng min^-1kg^-1body wt) reduced basal PGE₂ release from 4.4 ± 0.8 pmol min^-1to 1.8 ± 0.7 pmol min^-1. In the second group, intrarenal infusion of an α-adrenoceptor agonist, phenylephrine (2.5–6.75 μg min^-1), raised PGE₂ release from 2.7 ± 0.5 pmol min^-1to 7.5 ± 1.3 pmol min^-1. During continuous α₁-adrenergic stimulation, intravenous infusion of ANF (100 ng min^-1kg^-1body wt) reduced PGE₂ release to 3.5 ± 1.0 pmol min^-1. These results demonstrate that ANF reduces basal and α₁-adrenergic stimulated renal PGE₂ release.     

Anti‐infliximab antibody status and its relation to clinical response in psoriatic patients: A pilot study

Although the mechanisms underlying the loss of response to infliximab are not completely understood, the formation of antibodies to infliximab (ATI) are thought to play a role. The aim of this study was to investigate the presence of ATI in psoriatic patients and to evaluate its relationship to the clinical response. Fifteen patients with psoriasis were treated with infliximab (5 mg/kg) every 8 weeks after an initial three‐dose induction treatment. An enzyme linked immunosorbent assay kit was used for analyzing the presence of ATI in sera. Effectiveness assessments included the change in Psoriasis Area and Severity Index (PASI) compared with study entry. Five (33.3%) patients developed ATI. While 5.9 ± 3.2 infliximab infusions achieved a fall in the PASI score from a mean of 20.4 ± 8.3 to 5.3 ± 2.4 in ATI‐negative patients, these values changed from 23.3 ± 11 to 10 ± 4.9 after 9 ± 5.2 infusions in ATI‐positive patients. Our results suggested that ATI measured in psoriatic patients are of clinical importance. Therefore, monitoring for the induction of ATI and rescue strategies should be developed to avoid or to maintain a delay in ATI development.     

Salbutamol for hyperkalaemia in children

Hyperkalaemia is a potentially fatal disorder that demands direct treatment. The efficacy of traditional medical treatment is unpredictable, limited, of short duration or carries the risk of serious adverse events. The administration of salbutamol for hyperkalaemia in children is described in several clinical trials and case reports.

Conclusion: Salbutamol, inhaled or infused, is safe and efficacious and results in a predictable and long-lasting reduction in serum potassium. Salbutamol merits a place as the preferred medication for hyperkalaemia in children without arrhythmias. If follow-up with haemodialysis is required, the administration of salbutamol gives time to make the necessary preparations.