大蒜素对脑局灶缺血大鼠血小板活化功能及其结构的影响

目的：观察大蒜素对脑局灶缺血大鼠血小板活化功能或轻药物诱导的血小板活化功能及其结构的影响。方法：（1）将SD大鼠随机分为（空白组、大蒜素大剂量组和小剂量组）3组，于末次给予试药1．5h后颈总动脉插管取血，加入诱导剂二磷酸腺苷（ADP）或胶原，测定血小板最大聚集率；（2）采用化学刺激（FeCl3)诱导血栓闭塞法制备大鼠急性大脑中动脉血栓模型，随机分为（假手术组、模型组、大蒜素大剂量组和小剂量组）4组，给药方法同实验（1），颈总动脉插管取血后分离血浆，测定血浆血栓烷B2（TXB2）、6－酮－前列腺素F1α(6-keto-PGF1α）含量；（3）加入ADP孵育激活性，离心得到血小板沉淀块，透射电镜下观察血小板的超微结构。结果：与空白组或模型组相比，大蒜素大剂量组（10mg/kg)、小剂量组（5mg/kg)均可显著抑制药物诱导的血小板聚集（P＜0．01），且大剂量组显著优于小剂量组（P＜0．05）；均可明显降低模型大鼠血浆TXB2的含量，降低TXB2／6－keto-PGF1α比值，大剂量组还显著升高血浆中6－keto-PGF1α水平（P＜0．05，P＜0．01）；可明显抑制血小板活化过程中超微结构的改变，且有一定的量效关系。结论：大蒜素可能通过抑制血小板聚集，抑制血小板活化时大量释放的活性肽TXA2、促进恢复TXA2／PGI2平衡，抑制血小板激活释放过程中超微结构的改变，从而对脑梗塞起治疗作用。     

Ethical aspects of withdrawing/withholding renal replacement therapies on patients in acute renal failure in an intensive care unit

The majority of patients being treated for acute renal failure in intensive care units have multiple medical problems. Accordingly, the withdrawal of renal replacement therapies should be considered as part of a general decision about whether to initiate or continue with treatment per se. Several guidelines on withdrawing and withholding therapy have been produced and some common themes emerge: concerns to avoid euthanasia, potential for benefit, patient consent (shared decision‐making), team consensus/decision‐making, and the provision of appropriate palliative care and resource implications. Each of these is considered in turn, although the word limit for this paper does not permit detailed exposition.     

急性脑血管病肿瘤坏死因子-α的临床研究

目的：探讨肿瘤坏死因子-α（TNF-α）在急性脑血管病（ACVD）中的作用及其变化的临床意义。方法：选取95例ACVD患者，并设性别及年龄相匹配的血清对照组（20例）及脑脊液对照组（10例）。应用酶联免疫吸附法（ELISA）于发病后第1、3、7、14d测定血清和脑脊液中TNF-α。结果：①三种脑血管病患者血清TNF-α动态变化存在差异，脑出血和脑梗死组的峰值单间为发病后第3d，而蛛网膜下腔出血（SAH）组为第1d。②脑梗死患者血清TNF-α水平与梗死面积、神经功能缺损程度及病情恶化与否相关。③SAH组于发病后第1d、3d、7d脑脊液TNF-α值高于血清，14d时降至对照组水平并与血清无差异。结论：①脑梗死患者血清TNF-α的动态观察，可为临床预测梗死灶大小、神经功能缺损程度及病情恶化与否提供依据。②发病早期的脑梗死患者若CT未能显示病灶时，血清TNF-α的明显升高有助于临床诊断和治疗。③SAH患者脑脊液中TNF-α水平明显高于血清，进一步提示脑内神经组织可产生TNF-α。脑脊液中TNF-α的持续明显升高可能与SAH后脑血管痉挛有关。④TNF-α参与了ACVD的炎性反应过程，早期抑制TNF产生及抗炎性反应的治疗可能具有潜在的临床价值。     

冠状动脉造影正常的急性心肌梗死患者的临床特点

目的：探讨冠状动脉造影（CAG）正常的急性心肌梗死（AMI）患者的发生机制及临床特点。方法：分析2000年6月至2001年10月86例AMI患者的CAG结果及冠心病相关危险因素。结果：86例中CAG正常者8例，年龄（39＋11．4）（25－52）岁；多无心绞痛史、高血压史、糖尿病史、血脂异常史及家族史；以情绪波动、精神压抑、大量吸烟、饮酒史者居多。结论：冠状动脉痉挛、血栓自溶或溶栓治疗后血栓消失是其主要发生机制；冠状动脉正常的AMI患者其貌似正常，实属高危人群，应高度重视。     

经皮激光心肌血运重建术治疗心绞痛的临床疗效观察

【目的】观察经皮激光打孔心肌血运重建术治疗顽固性心绞痛的临床疗效。【方法】应用经皮激光 (HO :YAGlaser)心内膜心肌打孔治疗 2 7例顽固性心绞痛患者 ,以加拿大心绞痛标准分级和Naughton运动试验ST段下移至 1mm所需时间作为激光心肌血运重建术疗效的临床观察指标。【结果】每例打孔 5～ 15个 ,平均 (8± 4)个。打孔前和打孔后 1月、3月、6月按加拿大心绞痛标准分级 ,分别为 (3 5± 0 5 )、(2 2± 0 8)、(2 0± 0 6 )、(2 1± 0 5 )级 ;Naughton运动试验ST段下移至1mm所需时间则分别为 (36 0± 16 0 )s、(4 0 6± 2 6 0 )s、(4 2 0± 2 90 )s、(4 5 0± 312 )s。【结论】经皮激光打孔心肌血运重建术能降低患者心绞痛的严重程度 ,对不能常规施行经皮冠状动脉腔内成形术 (PTCA)或冠状动脉旁路搭桥术 (CABG)的严重冠心病心绞痛的患者 ,经皮激光心肌血运重建术是一种有效治疗方法。     

尿激酶对脑梗死特异性烯醇化酶的影响及其临床意义

目的：探讨尿激酶与急性脑梗死（ACI）患者特异性烯醇化酶（NSE）的关系。方法：该实验采用酶联免疫吸附法（EusA）测定脑梗死常规治疗组、尿激酶治疗组血清NSE水平。结果：尿激酶组NSE值显著低于ACI常规治疗组。结论：尿激酶能降低血清酶活性，使已形成的纤维蛋白水解，从而缩小梗死灶体积，改善脑缺血、缺氧，从而起到保护脑细胞的作用。     

青年急性冠脉综合征冠脉造特点及随访

目的:探讨青年急性冠状动脉综合征(ACS)冠状动脉(冠状)造影特点及其与远期心脏事件的关系。方法:比较青年ACS与老年ACS患者冠脉病变程度、范围,并进行心脏事件随访。结果:78例青年ACS患者有冠脉病变74例(94.9％),单支病变46例(58.9％);171例老年ACS患者有冠脉病变166例(97.1％),单支病变41例(23.9％)。平均随访9个月,青年ACS患者发生心脏事件者10例(12.8％),其中心绞痛再入院6例(7.7％);老年ACS患者发生心脏事件者47例(27.5％),其中心绞痛再入院30例(17.5％),两组比较差异有显著性(P<0.05)。结论:ACS患者冠状动脉粥样硬化青年时期之前已经发生,ACS预后与冠脉病变程度和年龄呈正相关。     

老年脑梗死患者急性期血小板活化功能定量检测

目的 :探讨老年脑梗死患者外周血中血小板膜糖蛋白变化的临床意义。　方法 :应用流式细胞术检测了 6 8例急性期老年脑梗死患者外周血血小板活化分子标记物CD4 1、CD6 2p和CD6 3的含量水平 ,与 4 2例正常老年人对照 ;并对脑梗死组病灶大小、梗死部位、病情分级等与血小板活化分子表达的变化进行分析 ,应用统计学进行处理。　结果 :急性期脑梗死患者血小板粘附分子CD4 1、CD6 2 p和CD6 3的表达水平显著高于正常对照组 (P <0 .0 1) ,且与梗死灶大小及病情分级密切相关 ,与梗死部位无关。　结论 :老年脑梗死患者急性期外周血血小板活化功能明显增强 ,为早期应用抗血小板聚集药物的治疗提供了实验依据     

Epidemiology of acute diarrhea in children living in Sicily

A longitudinal survey (February 1984 - January 1985) on the incidence of acute diarrhea episodes in a sample of 8,164 children (aged 0–12 years) living in southeastern Sicily was carried out by means of weekly telephone interviews with doctors practising in the territory. The incidence rate was 0.479 (0.472–0.485 95% C.I.) per child per year and the frequency of episodes was significantly higher (p < 0.001) in children aged 0–4 years (0.86). Diarrhea was more frequent in industrial areas than in rural ones, and almost half (45.1%) of the total episodes had a mild course. No death from diarrhea occurred and admission to hospital was reported for 8.4% of all cases.Corresponding author.     

ASSOCIATION OF PLASMA HOMOCYSTEINE LEVEL AND N^5,N^10—METHYLENETETRAHYDROFOLATE REDUCTASE GENE POLYMORPHISM WITH CEREBRAL INFARCTION

OBJECTIVE: To investigate the relationship of plasma homocysteine (Hcy) level to stroke and genetic factor to elevated plasma Hcy level. METHODS: The plasma Hcy level was measured by capillary electrophoresis-ultraviolet detection and the gene polymorphism of N5,N10-methylenetetrahydrofolate reductase (MTHFR) was studied with PCR-RFLP assay in 43 patients with cortical cerebral infarction and 42 healthy control. RESULTS: The plasma Hcy level of the patients (19.3 +/- 6.0 micromol/L) was markedly higher than that of the controls (13.7 +/- 5.4 micromol/L) (t = 4.16, P < 0.001). There are 3 genotypes, C/C, C/T and T/T, about base-variation of MTHFR gene at locus 677. The plasma Hcy level of the subjects with T/T genotype was higher than that of subjects with other genotypes. However, the frequencies of each genotype and allele were not significantly different between the patients and the controls. CONCLUSIONS: The elevated plasma Hcy level is a risk factor for atherothrombotic cerebral infarction, and is related to the C-->T mutation at locus 677 of MTHFR gene.