rhGM—CSF对小鼠口腔粘膜损伤的防治作用

目的：观察rhGM-CSF对TMX致实验性小鼠口腔粘膜损伤的疗效。方法：按随机分组原则将501只昆明种小白鼠分成8组，分别在相应时间给予不同药物（MTX，CF或rhGM-CSF）的处理因素，于第1－10天光镜下观察小鼠口腔粘膜的病理改变和积分情况。结果：IDMTX致口腔粘膜损伤病变率（45％－63％）和积分率（19．4％－56％）较其它组高，且死亡率很低（小于5％）；IDMTX＋GM0（或GM2）组的口腔粘膜损伤病变率（30．53％和30．99％）和积分率（19．47％和17．25％）比IDMTX组（55．56％和36．31％）明显减少，且溃疡严重程度较轻，二者相差显著（P＜0．01）。结论：IDMTX致小鼠口腔粘膜损伤模型可以用于粘膜损伤的研究；rhGM-CSF可以减少MTX致小鼠口腔粘膜损伤，并促进粘膜损伤恢复。     

Serum transforming growth factor-β1 level reflects disease status in patients with esophageal carcinoma after radiotherapy

AIM: To evaluate the relationship between changes in serum transforming growth factor β1 (TGFβ1) level and curative effect of radiotherapy (RT) in patients with esophageal carcinoma.METHODS: Ninety patients with histologically confirmed esophageal carcinoma were enrolled. Serum samples for TGFβ1 analysis were obtained before and at the end of RT. An enzyme-linked immunosorbent assay was used to measure serum TGFβ1 level. Multivariate analysis was performed to investigate the relationship between disease status and changes in serum TGFβ1 level.RESULTS: Serum TGFβ1 level in patients with esophageal carcinoma before RT was significantly higher than that in healthy controls (P ＜ 0.001). At the end of RT, serum TGFβ1 level was decreased in 67.82% (59/87) of the patients. The overall survival rate at 1,3 and 5 years was 48.28% (42/87), 19.54% (17/87)and 12.64% (11/87), respectively. Main causes of death were local failure and regional lymph node metastasis.In patients whose serum TGFβ1 level decreased after RT,the survival rate at 1, 3 and 5 years was 61.02% (36/59),28.81% (17/59) and 18.64% (11/59), respectively. The survival rate at 1 year was 17.86% (5/28) in patients whose serum TGFβ1 level increased after RT, and all died within 18 mo (P ＜ 0.01).CONCLUSION: Serum TGFβ1 level may be a useful marker for monitoring disease status after RT in patients with esophageal carcinoma.     

肩关节周围炎的循证针灸治疗

目的:从循证医学的角度,向临床医生介绍肩关节周围炎的循证针灸治疗方案的确立方法.方法:以一位具体的肩关节周围炎患者为例,介绍如何提出临床问题,怎样检索相关文献,如何对所检索的文献进行评价,如何结合本病例的具体情况和医生的个人经验,运用所检索的证据拟定治疗方案.结果:采用按照循证医学方法确立的肩关节周围炎的针灸治疗方案治疗15次后,患者生活质量明显好转.结论:通过临床提出问题、寻找证据、分析证据、循证决策、循证实践过程,不但患者可达到满意疗效,主管医生也提高了理论水平和临床能力.     

经颅彩色双功超声在脑血管疾病中的临床应用和进展

经颅彩色双功超声是一种新型、无创的超声诊断仪,高空间分辨率显示颅内血管和脑实质的结构,笔者查阅了近年来相关文献,主要综述经颅彩色多普勒血流显像在颅脑血管疾病中的诊断价值,同时讨论二维经颅超声的应用及新的实验性显像技术。     

减少硬胶囊药料的吸附“沾盘”新工艺探讨

硬胶囊剂系指将一定量的药材提取物,药材提取物加药材细粉或辅料制成的均匀粉末或颗粒,充填于空心胶囊中制成,或将药材细粉直接充填于空心胶囊中制成.通常由中药复方制成胶囊剂,其药料最后常制成18～22目颗粒再充填于胶囊中,制成颗粒是为了增加药料的流动性,并减少充填时的粉末飞扬.我们在制备本院协定处方制剂“消渴安胶囊”、“仙灵胶囊”、“愈胃胶囊”及“脑立通胶囊”等时,发现整粒后的药料如果烘干后立即充填胶囊,以及粉性成分较多的药料如果按常规工艺制粒、整粒,烘干后进行充填胶囊,均会出现药料吸附性较强,充填中出现“沾盘”现象,对上述两种情形我们进行了多次工艺摸索,最终较好地解决了上述药料吸附问题,现介绍如下.     

树脂吸附抢救急性摇头丸中毒的疗效观察

目的:探讨树脂吸附剂治疗急性摇头丸中毒的疗效。方法:将36例急性摇头丸中毒患者随机分为常规治疗组(常规组)和常规治疗基础上加树脂吸附治疗组(树脂组),观察比较治疗后3、6、12h两组的疗效、副作用和并发症。结果:治疗组的疗效明显优于对照组(H=3.9,P<0.05),尤其是6h时疗效更佳(H=10.4,P<0.01);2组均未发现明显的副作用和并发症。结论:树脂吸附能迅速清除血液中的有毒物质,可有效治疗急性摇头丸中毒。     

聚磷酸钙纤维和左旋聚乳酸软骨支架复合自体骨髓间充质干细胞构建组织工程化人工关节软骨

目的应用组织工程学技术，体外初步构建组织工程化人工关节软骨。方法制备三维多孔软骨支架材料CPP／PLLA，体外诱导兔MSCs向软骨细胞表型分化，免疫组织化学染色检测软骨特异性Ⅱ型胶原表达，将诱导细胞与软骨支架材料CPP／PLLA复合，体外培养构建人工关节软骨，1周后终止培养，扫描电镜观察组织工程化人工软骨的微观结构；同时将构建人工软骨移植于兔大腿皮下，3周后处死动物，甲苯胺蓝染色观察。结果扫描电镜观察可见该复合材料CPP／PLLA为高孔隙率的网状、连通、微孔结构，微孔分布均匀，孔径大小为300～400Ⅳn之间；兔MSCs经体外软骨表型定向诱导后，Ⅱ型胶原免疫组化染色阳性。诱导后的MSCs可在支架材料内良好贴附生长，细胞被分泌的胶原基质包裹；从体内获取的培养物组织切片观察可见大量的软骨细胞生成，甲苯胺蓝染色阳性。结论经软骨起源诱导后的MSCs与CPP／PLLA复合培养可以构建自体软骨移植的替代物，为应用软骨组织工程方法修复关节软骨缺损和功能重建提供一种新材料，具有较大的潜在应用价值。     

危重患者经外周静脉置入中心静脉导管的临床研究——前瞻性随机对照研究

目的 比较经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)与经锁骨下静脉中心静脉置管在危重患者中的临床应用.方法 通过前瞻性随机对照研究方法,将80例ICU危重患者分为PICC组(40例)和锁骨下静脉组(40例),观察两组穿刺成功率、穿刺时间、穿刺不良反应发生率等.结果 PICC组较锁骨下静脉组一次穿刺成功率高(92.5%vs 75.0%,χ2=4.501,P=0.034),穿刺时间短[(15.7±5.3)min vs(23.9±6.3)min,t=-6.263,P=0.000],总不良反应发生率低(10.0%vs 27.5%,χ2=4.021,P=0.045).结论 PICC穿刺简便易行,危险性小,在危重患者中PICC置管优于锁骨下静脉置管.     

^1H-magnetic resonance spectroscopy screening for animals with acute cerebral infraction suitable forthrombolytic therapy

BACKGROUND: As a non-invasive technique which can provide comprehensive biological information, 1H-magnetic resonance spectroscopy (1H-MRS) may provide valuable reference data for irreversible recovery or reversible changes in ischemic tissue after stroke. OBJECTIVE: To monitor and evaluate the effect of the urokinase thrombolytic therapy after experimental acute cerebral ischemia by 1H-MRS technology and investigate its adaptability. DESIGN: Randomly controlled animal study. SETTINGS: Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science. MATERIALS: Eleven healthy adult Sprague-Dawley (SD) rats, weighing 260–300 g and of both genders, were supplied by Experimental Animal Center of Tongji Medical Collage, Huazhong University of Science and Technology [SCXK (e) 2004-007]. 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. METHODS: The experiment was carried out in Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science from August 2003 to December 2005. ① The rats were randomly divided into 30-minute self-thrombo-embolism group (n =6) and 60-minute self-thrombo-embolism group (n =5). Six rats in 30-minute self-thrombo-embolism group were occluded with clot embolus for 30 minutes and 5 rats in 60-minute self-thrombo-embolism group were occluded for 60 minutes. 10 000 U/kg urokinase was dissolved in 2 mL saline and the operation lasted for 5 minutes. ② 1H-MRS was performed before thrombolysis and at 3 hours and 24 hours after successful embolization. The metabolic changes of N-acetyl-L-aspartic acid (NAA)/phosphocreatine (PCr) + creatine (Cr), choline phosphate (Cho)/PCr+Cr and lactic acid (Lac)/PCr+Cr in the region of interests were analyzed. ③ The T2W image was conducted 24 hours after the thrombolytic therapy with TR=500 ms and TE=25 ms. ④ The subjects were sacrificed immediately after 1H-MRS and the brain tissues were cut into pieces and stained with HE method; in addition, pathological changes were observed under optic microscope. MAIN OUTCOME MEASURES: ① Metabolic changes of NAA/PCr+Cr, Cho/PCr+Cr and Lac/PCr+Cr in the region of interests; ② T2W image at 24 hours after the thrombolysis; ③ pathological observation of brain tissue. RESULTS: Eleven rats were all involved in the final analysis. ① Metabolic changes in the region of interests : In 30-minute self-thrombo-embolism group, the Lac peak emerged immediately after the embolism, but the ischemic zone decreased 3 hours after the thrombolytic therapy (0.252±0.01, 0.603±0.01, P < 0.01). Lac/(PCr+Cr) ratio was 0.290±0.01 at 24 hours after thrombolysis, which was higher than that at 3 hours after thrombolysis (P < 0.01). The NAA/ (PCr+Cr) ratio decreased significantly at 3 hours after the thrombolysis as compared with that before thrombolysis (0.922±0.16, 1.196±0.01, P < 0.05). In 60-minute self-thrombo-embolism group, the Lac/(PCr+Cr) ratio was higher at 3 hours after thrombolysis than that before thrombolysis (0.846±0.12, 0.601±0.11, P < 0.05) and the NAA/(PCr+Cr) decreased at 3 hours after the embolism. Fluctuation of NAA/ (PCr+Cr) ranged from 0.68 to 0.75 before thrombolysis and from 0.71 to 0.75 at 3 hours after thrombolysis. ② T2W image: T2W image showed that 2 subjects in 30-minute self-thrombo-embolism group whose Lac/NAA was higher than 0.7 suffered from intracranial hemorrhage. This meant that the subjects with Lac/NAA > 0.7 were more likely to suffer from intracranial hemorrhage. ③ Histological and morphological examinations: Optic microscope demonstrated that interspace surrounding nerve cells was widened at ischemic center; neurons were swelling; nucleus was stained lightly; pyknosis and mesenchymal edema were mainly observed in lateral cortex of brow and vertex and in lateral part of corpus striatum. CONCLUSION: ①Compound parameters in ischemic area before thrombolysis should be regarded as an important predicting marker for thrombolytic therapy, effect evaluation and termination. ② 1H-MRS combining with other imaging technique is a detecting way for screening cases who are suitable for thrombolytic therapy.     

64排螺旋CT冠状动脉造影与DSA的对照研究

目的:通过和冠脉造影对比,评价64排螺旋CT冠状动脉成像在冠状动脉狭窄中的临床应用价值。方法:28例患者同时行64排螺旋CT冠状动脉成像和有创性冠脉造影检查,依据AHA17段分段法,评价所有有效节段,并将两者进行对比。结果:冠脉造影显示阴性病例占7.1%(2例),单只病变占21.4%(6例),多支病变占71.4%(20例)。按节段分析,CT检出冠脉狭窄的敏感度,特异度,阳性预测值和阴性预测值分别为91.1%,94.6%,90.0和95.3%。结论:64排螺旋CT冠状动脉成像和传统的冠脉造影检查对检出正常冠脉节段以及狭窄节段具有很好的一致性。