中效人胰岛素联合瑞格列奈治疗磺脲类降糖药继发性失效临床观察

目的观察中效人胰岛素与瑞格列奈联合应用治疗磺脲类降糖药继发性失效的疗效。方法将磺脲类降糖药继发性失效(SFS)36例病例随机分成两组,分别接受睡前小剂量中效人胰岛素加瑞格列奈(A组,20例)和单纯瑞格列奈(B组,16例)治疗,比较两组各生化指标。结果①治疗前空腹血糖(FPG)、餐后2小时血糖(2hPG)、C肽(C-P)、糖化血红蛋白(HbA1c)水平两组间无统计学差异;②治疗3个月后两组自身的FPG、2hPG、C-P、HbA1c水平均较治疗前明显改善,P值分别为0.01、0.05、0.05、0.01;③治疗3个月后FPG、2hPG、C-P、HbA1c水平A组均低于B组,P值分别<0.01、0.05、0.05、0.01。结论中效人胰岛素联合瑞格列奈和单用瑞格列奈治疗磺脲类降糖药继发性失效均有疗效,胰岛素和瑞格列奈联用优于单用瑞格列奈。     

Expression of human T-cell lymphotropic virus type-1 gene products in the short-term cultured skin tissues of an adult T-cell leukemia/lymphoma patient with cutaneous manifestations.

Adult T-cell leukemia/lymphoma (ATLL) is recognized as a disease etiologically associated with human T lymphotropic virus type-1 (HTLV-1) infection, but, neither viral replication nor specific virus antigen expression have been detected on ATLL cells distributed in organs, including skin. To examine the latent expression of HTLV-1 in the cutaneous lesions of ATLL patients, we cultured the lesional skin tissues in vitro and applied immunofluorescence staining with mouse monoclonal antibodies Lt-4, GIN-14, and F10, which react with p40tax, p19 and gp21, respectively. We recognized HTLV-1 specific antigens on clustered ATLL cells only in the deeper dermis of the skin after 24 hrs cultivation of the lesional skin tissue from an ATLL patient in RPMI-1640 medium supplemented with 20% fetal calf serum. In the electron microscope, we observed HTLV-1 like particles, 80-140 nm in diameter with envelope and core structures, in the same tissue specimen. These findings suggest that HTLV-1 gene products may be expressed in the skin lesions of ATLL patients and involved in the pathogenesis of skin eruptions in cutaneous type ATLLs. To our knowledge, this is the first report that envisages the potency of intracutaneous HTLV-1 expression in vivo.     

脑卒中与继发性癫癎

目的:探讨首发脑卒中患者继发性癫癎的发病率、发病时间与脑卒中病变部位的关系。方法:回顾性分析经我院近3年来治疗的659例首发脑卒中住院患者的临床资料。结果:首发脑卒中患者继发癫癎发生率为8.19%(54/659)。癫癎发作与卒中病变部位有关,累及皮层或邻近皮层者易继发癫癎(53.33%,24/45)。54例继发癫癎中68.52%为早发性癫癎(起病后2周内),余31.48%为晚发性癫癎(起病2周以后)。以脑出血继发早发性癫癎为主(81.25%,13/16);脑梗死则易发生晚发性癫癎(60.00%,12/20)。结论:分析首发卒中后癫癎的发病特点有助于指导临床治疗。     

A SLAP lesion associated with calcific tendinitis of the long head of the biceps brachii at its origin

Calcific tendinitis is a common condition with characteristic clinical and radiological findings. Although we do not know which condition initiated the pathologic cascade, we present a rare case of calcific tendinitis of the long head of the biceps brachii at its origin, associated with a SLAP lesion. The calcium deposit was removed and the SLAP lesion was repaired with a suture anchor arthroscopically.     

良性淋巴上皮病、淋巴上皮癌、MALT淋巴瘤的关系

良性淋巴上皮病(benign lymphoepithelial lesion)、淋巴上皮癌(lymphoepithelial carcinoma)、黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤(MALT淋巴瘤)(extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT lymphoma)是3种性质不同但又存在某些关联的病变,本文对3种病变的病因、组织病理学表现及三者之间的关系进行了介绍,并结合叶为民等论文中的一些内容进行了简要探讨。     

外伤性白内障术后二期人工晶状体植入术

目的 探讨外伤性白内障术后二期植入后房型人工晶状体的时机和手术方式。方法 对34例(34只眼)外伤性白内障术后无晶状体眼根据不同情况采用直接睫状沟植入法或缝线固定法进行二期植入后房型人工晶状体，观察两组患者的术后反应和治疗效果。结果 直接睫状沟植入法14只眼(41．2％)，缝线固定法20只眼(58．8％)，31只眼(91．2％)视力达到0．1以上，21只眼(61．76％)视力达0．3以上，28只眼(82．4％)术后矫正视力等于或高于术前最佳矫正视力。结论 选取合适的时机和方式二期植入人工晶状体，有助于减少术后并发症，提高视功能的恢复。     

Noonan syndrome associated with central giant cell granuloma

We report a case of Noonan syndrome associated with central giant cell granuloma. The patient was a 101/2-year-old boy with the chief complaint of proptosis of the right eye. He also had various malformations such as short stature, webbed neck, pectus excavatum, cubitus valgus, pulmonary valve stenosis and patent foramen ovale, a characteristic face appearance and cryptorchidism and so on. Chromosome analysis showed a 46, XY karyotype. A computed tomographic scan and magnetic resonance imaging showed a mass originated from the lateral wall of the right maxillary sinus. The patient underwent Caldwell-Luc operation. Histological examination of the mass showed the characteristics of central giant cell granuloma. This case report describes a patient with the features of the recently described Noonan-like/multiple giant cell lesion syndrome.     

食管癌高低发区人群食管粘膜组织病理学研究

目的探讨食管癌高、低发区人群食管粘膜上皮组织学改变，为癌前病变防治提供依据。方法高（林州市）、低发区（范县、清丰县）分别取无症状居民食管活检２２９人和１８７人，均分为４组，２５岁～３４岁、３５岁～４４岁、４５岁～５４岁及≥５５岁，常规石蜡ＨＥ制片，按标准诊断归类。结果高、低发区食管上皮萎缩、棘层肥厚、炎细胞浸润相应年龄组比较无显著差异，基底细胞增生高发区３５岁～４４岁、４５岁～５４岁组显著大于低发区相应组（Ｐ＝０．０３１２，Ｐ＝０．０２７３），非典型增生４５岁～５４岁、≥５５岁组高发区显著大于低发区相应组（Ｐ＝０．０１９６，Ｐ＝０．０２６３）。高、低发区总体人群比较除棘层肥厚、炎细胞浸润无差异外，余各病变间均有极显著差异（Ｐ＜０．０１）。结论食管上皮萎缩、基底细胞增生应作为较狭义的癌前病变对待，食管上皮棘层肥厚、炎细胞浸润似与食管癌变无关。     

Radiofrequency Current Ablation of Porcine Right Atrium: Increased Lesion Size with Bipolar Two Catheter Technique Compared to Unipolar Application In Vitro and In Vivo

Interruption of atrial flutter and fibrillation by RF catheter ablation may be favored by large, elongated lesions. We administered RF current in unipolar and bipolar mode in porcine right atrium. Bipolar ablation was performed between the tip electrodes of two serially coupled catheters. With 4-mm tip electrodes in vitro, lesion length increased from a mean (SD) of 7.9 (1.2) mm at 3 mm-interelectrode distance (IED) to 13.3 (3.3) mm at 9-mm IED, but decreased at 12-mm IED due to nonconfluent lesions (P < 0.0001), With 4 mm distal electrodes and 8 mm IED, bipolar lesions were 65% longer than corresponding unipolar ablations. Switching to bipolar mode increased the lesion length more than increasing electrode tip length to 6 mm in unipolar mode. Power and temperature controlled ablation created equally sized lesions. Twelve anesthetized pigs were randomized to unipolar or two catheter bipolar temperature controlled ablation of the right atrial free wall. Bipolar ablation created confluent lesions with endocardial length × width of 13.5 (5.8) × 7.3 (3.7) mm, unipolar ablation 6.4 (2.8) × 4.6 (1.4) mm (P < 0.001 when comparing length and P = 0.013 for lesion width). The atrial lesions in both groups were transmural and extended into hilar lung lesions with maximal depth of 3.0 (1.1) and 2.6 (1.0) mm, respectively (P = 0.44). Five bipolarly and four unipolarly ablated pigs developed right diaphragmal paresis. We conclude that bipolar ablation may be preferable in situations where large, elongated lesions are favorable. The two catheter technique is feasible in porcine right atrium. Both bipolar and unipolar ablation of the porcine right atrial free wall may frequently be complicated by injury to the phrenic nerve and adjacent lung tissue.     

Enhanced tyrosine phosphorylation of striatal NMDA receptor subunits: effect of dopaminergic denervation and l-DOPA administration

Sensitization of striatal N-methyl- -aspartate receptors (NMDAR) has been linked to events leading to the motor response changes associated with the administration of dopaminomimetics to parkinsonian animals and patients. To determine whether tyrosine phosphorylation of NMDAR subunits contributes to the apparent long-term enhancement in synaptic efficacy of these receptors, we examined the effect of unilateral nigrostriatal dopamine system ablation with 6-hydroxydopamine followed by twice-daily treatment with -DOPA on the phosphorylation state of rat striatal NR2A and NR2B subunits. Three weeks of intermittent -DOPA administration produced a shortening in the duration of the rotational response to dopaminergic challenge and other changes mimicking those occurring in patients with Parkinson's disease. Concurrently, tyrosine phosphorylation of NR2A and especially of NR2B subunits increased ipsilateral to the lesion (20±5% and 46±7% of intact striatum, respectively; p<0.01) without attendant changes in subunit protein levels. Selective blockade of NR2B subunits with ACEA 10-1244, but not of NR2A subunits with MDL 100,453, reversed the -DOPA-induced response alterations. The intrastriatal injection of a tyrosine kinase inhibitor, genistein, at a dose (2.0 μg) that normalized the response shortening, attenuated the NR2A and NR2B phosphorylation increase by about 12% and 24%, respectively (p<0.01). Taken together, these results suggest that augmented tyrosine phosphorylation of NR2B subunits, alone or in combination with the smaller rise in NR2A subunit phosphorylation, contributes to the apparent enhancement in striatal NMDAR sensitivity and thus to the plastic alterations in dopaminergic responses in -DOPA-treated parkinsonian rats.