The effect of preprocessing stored red blood cells on neonates undergoing corrective cardiac surgery

This study compared the effect of unprocessed and processed packed red blood cells (PRBCs) with the continuous autotransfusion system (CATS) during neonate heart surgery. Sixteen neonatal patients undergoing cardiac surgery were randomly divided into two groups: unprocessed PRBC (C group, n = 8); processed PRBC (P group, n = 8). The CATS was employed perioperatively. Series laboratory and clinical parameters, including levels of hematocrit, blood potassium, blood glucose, blood lactate, acid-base, and total priming volume of PRBC, were used to compare the effect between the two groups. Before CPB, the hematocrit of processed PRBCs in P group was significantly higher than those in C group (p < 0.01), and the concentrations of potassium, blood glucose, and lactate of processed PRBCs in P group were significantly lower than those in C group (p < 0.01). At the beginning and the end of CPB, the hematocrit levels in P group were all higher than those in C group (p < 0.05); lactate levels in P group were significantly lower than those in C group at the beginning of CPB (p < 0.01), and lower than that of C group at the end of CPB (p < 0.05). The total priming of PRBCs in P group was significantly less than that in C group (p < 0.01). Perioperative processing with CATS provided a high-quality RBC concentration, decreased the total priming of PRBCs, providing increased high-quality blood salvage during neonatal CPB procedure.     

Expression of cell surface antigens during the differentiation of osteoblast by human bone marrow-derived mesenchymal stem cells

OBJECTIVE: To explore the phenotypic changes of some cell surface antigens in the process that the bone marrow-derived mesenchymal stem cells (MSCs) differentiate into osteoblast lineage under certain conditions. METHODS: The mononuclear cells were isolated from human bone marrow and cultured in the medium in the presence (experimental group) or absence (control group 1) of dexamethasone, ascorbic acid and beta-glycerophosphate, or in the alpha-MEM only (control group 2). The expressions of CD45, CD34, CD117, CD90, and HLA-DR were examined by flow cytometry on culture day 7, 12, and 17. RESULTS: Human bone marrow MSCs can differentiate into mature cells with the characteristics of osteoblasts in vitro. The expression of CD45 was low in the experimental group and in the control groups on culture day 7, and became negative from day 12 in all groups. The expressions of CD34 and CD117 were negative at all time points. The expression of CD90 increased on day 12 in all groups, and was more obvious in the control groups. The expression of HLA-DR was gradually elevated along with the differentiation and maturation of osteoblasts in the experimental group, but dropped in the control groups in the later time points. CONCLUSIONS: MSCs can differentiate into mature osteoblasts after induction. The expression of cell surface antigens during differentiation has characteristic changes, which may be key markers in the early stage of osteoblasts differentiation.     

51例蕈样肉芽肿临床特征

目的分析蕈样肉芽肿患者的临床特征,提高对本病的认识,指导临床工作。方法回顾性分析1984～2006年我科住院治疗的51例蕈样肉芽肿及其亚型患者的临床资料,包括患者的确诊年龄、皮损特征、皮损组织病理表现、系统表现、误诊、治疗等情况。结果患者平均确诊年龄（44.24±2.05）岁。临床表现多数符合经典的红斑、斑块至肿瘤期的演变过程,亦有多种变异型和亚型的存在。68.6%的患者皮损全身泛发,70.6%的患者伴有瘙痒。组织病理显示68.6%出现嗜表皮现象,52.9%出现Pautriers微脓疡。T细胞受体基因重排的阳性率为81.3%,阳性率与疾病分期无关。64.7%的病例曾被误诊。早期患者经皮肤靶向治疗及生物学治疗可以完全缓解,晚期患者多数给予联合化疗。结论蕈样肉芽肿的临床病理表现多样,临床工作中应提高警惕,注意与其他良、恶性疾病进行鉴别。     

动态血压监测15种单药治疗原发性高血压的降压疗效

目的通过系统比较15种降压药单药治疗原发性高血压的降压疗效,为医师选择有效降压药物时提供依据。方法对370例原发性高血压患者应用动态血压监测对15种单药治疗8周的降压疗效进行系统比较。结果氯沙坦、缬沙坦、厄贝沙坦、奥美沙坦、苯那普利、依那普利、美托洛尔、贝凡洛尔、吲达帕胺、贝尼地平和氨氯地平均有效降低24h平均舒张压和收缩压,坎地沙坦能有效降低收缩压。但各单药间降压幅度无差异。而低剂量特拉唑嗪、多沙唑嗪仅能降低日间舒张压,托拉塞米降低24h平均血压的效果不明显。结论血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、β-阻滞剂和长效钙拮抗剂单药治疗能有效降压,而单用低剂量特拉唑嗪、多沙唑嗪和托拉塞米因短期作用有限,不建议作为单独药物治疗高血压,作为联合治疗可能更为适宜。     

Cookgas气管插管型喉罩用于预测困难气管插管的临床观察

目的比较经Cookgas气管插管型喉罩(CILA)纤维光导支气管镜(FOB)和视可尼喉镜(SOS)在预测困难气管插管时的临床效果。方法择期在全身麻醉下行整形外科手术的预测困难气管插管患者60例,随机分为FOB组(n=30)和SOS组(n=30)。麻醉诱导后,置入CILA,经CILA由FOB或SOS引导气管插管,记录CILA置入、气管插管次数和时间、CILA退出时间、气管插管成功率、FOB及SOS镜下声门的情况,并记录麻醉诱导前、后,气管插管过程中和气管插管后5min内的血压和心率变化。结果60例患者均成功置入CILA,FOB组28例首次气管插管成功,2例分别在第2和3次成功;SOS组18例1次插管成功,7例在第2次成功,5例颈部重度瘢痕患者插管失败,改用FOB引导完成插管。与FOB组比较,SOS组气管插管时间[(60.2±29.6)vs.(92.4±47.9)s]和喉罩退出时间[(104.6±39.9)vs.(130.0±51.9)s]显著延长(P<0.05)。气管插管对两组患者血液动力学的影响较轻。结论经CILA引导FOB和SOS均可安全有效地应用于预测困难气管插管患者,其中FOB引导气管插管的插管时间较短,成功率较高。     

抗凋亡蛋白Bcl-xL在巨核细胞分化和成熟过程中的作用

目的 研究抗凋亡蛋白Bcl-xL在巨核细胞分化和成熟过程中的作用。方法采用PDBu诱导K562细胞向巨核细胞分化,RNA干扰阻断Bcl-xL在K562细胞向巨核细胞诱导分化中的表达,RT-PCR和流式细胞仪技术检测其改变。采用免疫磁珠从正常骨髓中富集CD34＋细胞,在无血清培养下用TPO诱导其向巨核细胞分化,免疫组织化学和流式细胞仪技术观察分化过程中Bcl-xL的表达改变。结果 PDBu诱导K562细胞向巨核细胞分化24h后,CD61＋细胞百分比迅速增加,并且在72h内维持较高的阳性率;用siBcl-xL干扰后72h内,CD61＋细胞百分比只有轻度增加,同时RT-PCR检测显示24h后Bcl-xLmRNA表达显著减少,流式细胞检测显示Bcl-xL蛋白的表达也相应降低。正常骨髓中CD34＋细胞经TPO诱导后,在培养5—20d间Bcl-xL蛋白表达阴性的巨核细胞随着培养时间延长逐渐增多,免疫组织化学检测显示未成熟的巨核细胞Bcl-xL蛋白表达呈强阳性,而在成熟的巨核细胞中表达为阴性。结论抗凋亡蛋白Bcl-xL在巨核细胞分化过程中发挥重要作用,而在巨核细胞发育晚期Bcl-xL蛋白的表达下调可能是巨核细胞成熟的关键,并与成熟巨核细胞的特殊凋亡发生密切相关。     

下肢动脉硬化性闭塞症的规范化治疗探讨

下肢动脉硬化性闭塞症是血管外科的常见疾病,在我国的发病率逐年增加,已逐渐成为显著影响患者生活质量,甚至危及生命的疾病。本文就下肢动脉硬化闭塞症的外科治疗原则、适应证和不同病变部位治疗方法的选择进行了讨论,提出对于下肢动脉硬化闭塞症重症患者(Rutherford分级4~6级)应当采取积极的外科治疗;对于TASC分级为A、B级患者应当以腔内治疗为主;对于膝下动脉狭窄和糖尿病足患者应首选膝下动脉球囊扩张术。     

非永久型下腔静脉滤器预防肺栓塞的安全性和有效性

目的评价非永久型下腔静脉滤器预防下肢深静脉血栓(DVT)脱落导致肺栓塞(PE)的安全性和有效性。方法回顾性分析2003年9月~2006年6月在我院收治的12例使用非永久型滤器的DVT患者的临床资料。结果12例患者中,10例采用临时型滤器,2例采用可回收滤器,所有植入手术均获得成功,无严重并发症。10例临时滤器患者中,9例在术后4周成功取出滤器,1例出现滤器周围巨大血栓,继续给予抗凝治疗于术后12周取出。2例可回收滤器中,1例于术后2周成功取出;1例因捕捉巨大血栓,将滤器留置体内。12例患者中,滤器抓捕血栓6例(50%),其中2例(16.6%)血栓>2cm,1例(8.3%)>1cm,3例(25%)<1cm。10例患者在术前进行了PE影像学检查,其中5例有PE;8例患者在术后6个月行PE检查,其中4例有小面积PE,但较治疗前均已有显著改善。12例患者均进行了有效随访,随访时间3个月~2年,其中10例患者随访时间>6个月,1例患者在术后4个月因恶性肿瘤死亡,1例临时滤器在术后出现下腔静脉梗阻,5例PE患者均有缓解。结论非永久型滤器可有效预防PE发生,但在某些技术细节上还需进一步研究和改善。     

药物治疗对子宫内膜异位症患者在位内膜凋亡的影响

目的探讨药物治疗,包括左炔诺孕酮宫内节育系统（LNG-IUS）、口服甲羟孕酮（MPA）或注射促性腺激素释放激素类似物（GnRHa）对子宫内膜异位症患者在位内膜凋亡的的影响。方法采集中、重度子宫内膜异位症患者术前以及放置LNG-IUS、口服MPA或注射GnRHa后的在位内膜,以末端转移酶介导的缺口末端标记法（TUNEL）检测细胞凋亡率,透射电镜观察细胞形态,RT-PCR检测内膜中凋亡相关蛋白Bax、Fas和Fas-LmRNA的表达。结果放置LNG-IUS后,在位内膜腺体细胞凋亡率由（24.4±35.0）%升高至（51.0±37.8）%（P=0.027）,间质细胞凋亡率由（35.3±30.2）%升高至（76.4±11.2）%（P=0.008）。电镜下的凋亡状况,按程度由强至弱依次为：注射Gn-RHa、放置LNG-IUS、口服MPA。子宫内膜异位症患者在位内膜中Fas-LmRNA的表达率显著高于正常对照（P〈0.05）,但药物治疗前后3种凋亡相关蛋白mRNA的表达差异均无显著性。结论药物治疗可促进在位内膜凋亡,其诱导内膜细胞凋亡的作用由强至弱依次为：注射GnRHa、放置LNG-IUS、口服MPA。     

正电子发射断层显像中子宫和卵巢生理性摄取的特点

目的了解正电子发射断层显像(PET)中女性子宫和卵巢生理性摄取的特点和规律。方法对247例女性受试者共进行了288次PET检查,其中恶性肿瘤164例,良性病变44例,正常39例,均无盆腔病变。分析比较子宫和卵巢摄取18F-脱氧葡萄糖(FDG)的高低与所处月经周期时段的关系。结果月经规律患者116例,共行131次PET检查,其高、中度子宫内膜摄取多出现在月经早期或中期,呈倒置椎形,尖端指向膀胱后方;一侧或双侧卵巢摄取常在月经中期出现,多呈卵圆形,位于膀胱后上方两侧;月经来潮后期和增殖早期无明显子宫或卵巢摄取的可能性最大,分别为86%和80%。17例(19次PET)月经明显不规律、112例(136次PET)停经和2例尚未开始来月经者均无子宫、卵巢高摄取。结论子宫和卵巢对18F-FDG的生理性摄取随月经周期而变化,正确认识可避免误诊,通过选择检查时机可减少其影响。