人工耳蜗植入术后儿童二字调个案研究

目的探讨人工耳蜗术后儿童二字调训练的有效方法.方法对1名6岁人工耳蜗植入儿童进行二字调言语训练,采用实验语音学的方法提取其基频(F0)数据,分析其二字组合调形,结合听感监控其训练疗效.结果训练3个月后,被试二字组合的调形,尤其是含有阳平、上声的二字组合调形得到了较大改善;二字组合中时长的稳定性也得到了提高.结论合理的二字调训练方法及呼吸训练、放松训练对二字调言语障碍聋童有较好的疗效.     

The relaxing effect of perivascular tissue on porcine retinal arterioles in vitro is mimicked by N‐methyl‐D‐aspartate and is blocked by prostaglandin synthesis inhibition

Purpose: Retinal hyperperfusion resulting from disturbances in the regulation of arteriolar tone is involved in the pathophysiology of a variety of retinal diseases. The mechanisms underlying this regulation of tone involve cellular components in both the vascular wall and the perivascular tissue. However, previous in vitro studies of the influence of perivascular retinal tissue on retinal tone regulation have been hampered by the release of an endogenous relaxing factor that renders the arteriole insensitive to vasoconstrictors. The purpose of the present study was to test whether N‐methyl‐D‐aspartate (NMDA) and γ‐amino butyric acid (GABA) receptors, and a cyclooxygenase (COX) product influence this effect of perivascular retinal tissue in vitro. Methods: Porcine retinal arterioles were mounted in a wire myograph for isometric force measurements. The contractile effect of the prostaglandin analogue U46619 was studied on vessels with preserved perivascular retinal tissue and after this tissue had been removed. The influence of the perivascular tissue was studied after addition of NMDA (a specific agonist for a subtype of the glutamate receptor), DL‐amino‐5‐phosphonovaleric acid (DL‐APV, an antagonist at the same receptor), the natural inhibitory transmitter GABA, and picrotoxin (an antagonist at ionotropic GABA receptors). These experiments were made in the absence and presence of the COX inhibitor, ibuprofen. Results: U46619 caused a concentration‐dependent contraction of isolated retinal arterioles. This vasoconstriction was significantly smaller in the presence of perivascular tissue. The NMDA‐receptor antagonist, DL‐APV, reduced this attenuating influence of the perivascular tissue on the response to U46619, and the response could be modified by NMDA and GABA, but not by picrotoxin. However, ibuprofen totally blocked the attenuating influence of the perivascular tissue on the response to U46619. Conclusions: The inhibition of vascular contractility induced by perivascular retinal tissue in vitro involves NMDA‐receptors and an effect of GABA‐mimetic substance on retinal tissue. The generation of these effects involves a COX product.     

外周T细胞淋巴瘤合并纯红细胞再生障碍性贫血一例

患者男,63岁.因发热3个月,颈部及腹股沟肿块2个月为主诉入院.2007年5月11日,患者于外院行右颈肿块活检术,术后病理示:淋巴组织不典型增生.免疫组化:CD3(+)、CD45Ro(+)、CD20(+)、CD79α(+)、Bcl-2(+)、Ki67(+)、CD68(+)、CD21(+).活检组织经PCR检测T淋巴细胞受体基因重排:TCRα基因重排JVⅠ阴性、JVⅡ阴性;TCRβ基因重排D1J2阴性、D2J2阳性,诊断为外周T细胞淋巴瘤(PTCL).6月11日外院血常规检查示:白细胞(WBC)2.9×109/L,血红蛋白(Hb)41 g/L,血小板(BPC)180×109/L,给予多次输注红细胞悬液治疗.     

血浆置换联合免疫抑制剂治疗干细胞移植后移植物抗宿主病和纯红细胞再生障碍性贫血疗效分析

目的探讨血浆置换治疗干细胞移植后移植物抗宿主病(GVHD)和纯红细胞再生障碍性贫血(PRCA)的疗效.方法对2002年9月至2006年1月在广西医科大学第一附属医院行干细胞移植后并发难治性GVHD和PRCA的10例患者应用血浆置换联合免疫抑制剂治疗.预处理方案急性髓细胞白血病和慢性粒细胞白血病患者采用BU/CY方案;急性淋巴细胞白血病患者采用TBI/CY方案.回输单个核细胞中位数为8.1×10S/kg,CD34 细胞中位数为9.2×106/kg.应用环孢菌素A、霉酚酸酯和短程甲氨喋呤预防GVHD.采用美国Baxter CS-3000 plus血细胞分离机行血浆置换治疗.每次置换新鲜冰冻血浆2 500～3 000ml.每例患者置换2～4次.结果10例患者均获得造血重建,经短串联重复序列DNA位点分析,10例患者移植后血细胞的DNA与供者血细胞DNA完全一致.7例GVHD患者血浆置换后白细胞介素2受体、白细胞介素6、8、肿瘤坏死因子α等细胞因子水平明显低于血浆置换前(P均＜0.05),其中6例临床症状减轻,中位随访时间39个月(11～50个月),均无疾病进展而生存;1例患者移植后14个月死于慢性GVHD.4例PRCA患者经治疗后红细胞恢复,血红蛋白在100g/L以上,血型均转为供者血型.结论血浆置换联合免疫抑制剂是治疗干细胞移植后GVHD和PRCA的有效方法.     

Long Duration of Erythrocyte Hypoplasia after Bone Marrow Transplantation

Bone marrow transplantation was performed on a 15 year old girl with chronic myelogenous leukemia. The bone marrow was obtained from her younger sister, who was human leukocyte antigen haplo-identical but major ABO incompatible. As a result, the condition of pure red cell aplasia (PRCA) persisted over a long period of time. In order to overcome major ABO incompatibility, erythrocytes were eliminated from the bone marrow graft before transplantation, and methotrexate and cyclosporine (CsA) were used to prevent graft-versus-host disease (GVHD). Administration of erythropoietin proved ineffective. B19 parvovirus infection could not be detected during that time. Agglutinin titers decreased to less than fourfold in parallel with the recovery of erythrocytes. Reports on similar PRCA have been limited to cases of transplantation with ABO incompatibility and cases where CsA was administered to prevent GVHD. This suggests that ABO incompatibility and CsA might be related to the development of PRCA.     

Pregnancy following induction of ovulation with pure FSH after suppression of endogenous gonadotropins with subcutaneous Buserelin

Summary Ovarian stimulation in patients with disorders of ovulation or an inadequate luteal phase using human menopausal gonadotropins (hMG) gives a low pregnancy rate with a high incidence of overstimulation and a premature LH surge. In order to overcome these problems, a new approach has been used, namely prior suppression of endogenous gonadotropins with a gonadotropin-releasing-hormone analog (LHRH) and subsequent ovarian stimulation with hMG. We present a case of ovarian stimulation with pure FSH during suppression of endogenous gonadotropins with the LHRH analog Buserelin. A clinical pregnancy was achieved in the first treatment cycle and led us to conclude that follicular development does not depend on LH stimulation. This could be of substantial interest in IVF programs.     

The baroreflex and beyond: control of sympathetic vasomotor tone by GABAergic neurons in the ventrolateral medulla

1. Barosensitive, bulbospinal neurons in the rostral ventrolateral medulla (RVLM), which provide the major tonic excitatory drive to sympathetic vasomotor neurons, are prominently inhibited by GABA. 2. A major source of the GABAergic inhibition to presympathetic RVLM neurons arises from an area immediately caudal to the RVLM, known as the caudal ventrolateral medulla (CVLM). 3. Arterial baroreceptor afferents projecting to the nucleus tractus solitarius (NTS) provide a major tonic excitatory input to GABAergic CVLM neurons. These CVLM cells are a critical component for baroreflex-mediated changes in presympathetic RVLM neuronal activity, sympathetic nerve activity (SNA) and arterial pressure (AP). 4. Some GABAergic CVLM neurons are tonically activated by inputs independent of arterial baroreceptors or the NTS, providing a GABAergic-mediated inhibition of the presympathetic RVLM neurons that is autonomous of baroreceptor inputs. 5. GABAergic CVLM neurons appear to play two distinct, yet important, roles in the regulation of sympathetic vasomotor tone and AP. They dampen immediate changes in AP via the baroreflex and tonically inhibit the activity of the presympathetic RVLM neurons by baroreceptor-independent mechanisms. This baroreceptor-independent, GABAergic inhibition of presympathetic RVLM neurons may play an important role in determining the long-term level of sympathetic vasomotor tone and AP.     

Vascular effects of a heme oxygenase inhibitor are enhanced in the absence of nitric oxide

BACKGROUND: Vascular endothelium and smooth muscle express heme oxygenase (HO) that metabolizes heme to biliverdin, iron and carbon monoxide (CO). Carbon monoxide promotes endothelium-independent vasodilation, but also inhibits nitric oxide formation. This study examines the hypothesis that an inhibitor of HO promotes endothelium-independent vasoconstriction, which is attenuated in the presence of unabated nitric oxide formation. METHODS: In vivo studies were conducted in anesthetized male Sprague-Dawley (SD) rats instrumented with flow probes and arterial catheters. In vitro experiments were performed on pressurized first-order gracilis muscle arterioles isolated from male SD rats superfused with oxygenated modified Krebs buffer. RESULTS: Vascular smooth muscle and endothelium showed positive HO-1 and HO-2 immunostaining. In anesthetized rats the HO inhibitor chromium mesoporphyrin (CrMP; 45 micromol/kg intraperitoneally) had minimal effect on hindlimb resistance. However, in animals pretreated with N(omega)-nitro-L-arginine methyl ester (L-NAME; 300 mg/kg intraperitoneally), CrMP substantially increased hindlimb resistance. In contrast, in rats infused with phenylephrine to increase blood pressure and vascular tone, CrMP had no effect on hindlimb resistance. In isolated arterioles denuded of endothelium, CrMP (15 micromol/L) caused a powerful vasoconstriction, which was abolished in the presence of a functional endothelium. In arterioles with intact endothelium pretreated with L-NAME (1 mmol/L), or with L-NAME and sodium nitroprusside (10 to 30 nmol/L), CrMP promoted a similarly powerful vasoconstriction as in vessels denuded of endothelium. CONCLUSIONS: These results suggest that smooth muscle-derived CO may contribute to endothelium-independent regulation of vascular tone by providing a vasodilatory influence. Furthermore, the dilatory effects of endogenous CO are offset by a unique interaction between the CO and nitric oxide systems.     

鼻咽癌3-D计划放射治疗后放射性中耳炎的临床分析

背景与目的:中耳咽鼓管损害高峰发生在放疗后半年,并且在很多病例可持续终身,至今为止临床上尚无有效的治疗方法,寻求放射治疗中中耳鼓室及咽鼓管更好的保护仍是放射治疗医师面临的责任,在精确放疗技术应用逐渐普遍的今天,肿瘤周围正常组织和器官的保护受到越来越多的重视,但到目前为止,有关中耳放射损伤的研究报道极少。我们采用回顾性分析的方法,通过比较鼓室腔及骨性段咽鼓管剂量分布与放疗后分泌性中耳炎的发生率,评价在鼻咽癌3-D计划放射治疗中中耳功能保护的可能性,同时了解放疗后时间、化疗、T分期等因素对结果的影响。方法:40例80耳有完整听力学检查材料的鼻咽癌3-D计划放射治疗的患者进入此项研究。所有病例放疗前后均经耳部检查,电测听及声阻抗测听,放疗后随访时间为6~24个月。电测听以500,1 000,2 000,4 000 Hz听阈平均值计算气骨导差,声阻抗根据鼓室图分为A、B、C 3型,A型为正常鼓室图,B型为中耳鼓室积液,C型为咽鼓管功能不良。结果:79耳符合声阻抗分析条件。放疗后62%耳与放疗前保持不变,13%耳得到改善,25%耳恶化。鼓室腔及骨性段咽鼓管剂量分布在恶化耳与其他各组耳之间比较差异有显著性。80耳电测听分析结果,放疗后无变化耳58%,改善耳12%,恶化耳30%。分析剂量因素对声阻抗结果的影响,恶化组的鼓室腔及骨性段咽鼓管平均受照剂量为(5379.81±706.01)cGy,不变组的平均受照剂量为(4735.72±812.30)cGy,改善组的平均剂量为(4652.86±809.78)cGy;分析剂量因素对电测听结果的影响,恶化组的中耳及骨性咽鼓管平均受量为(5229.38±778.11)cGy,不变组的平均受量为(4719.64±744.82)cGy,改善组的平均剂量为(4702.38±922.21)cGy。统计分析发现3组的剂量差异有显著性。T分期变化及1年内或1年后时间分组对听力测试结果的影响差异有显著性,而化疗对听力测试结果的影响不明显。结论:在鼻咽癌3-D放射治疗中,如将鼓室腔及骨性段咽鼓管剂量控制在4700 cGy以下,则可明显减少延迟性放射性中耳炎的发生率。对中耳鼓室腔及骨性段的保护随着肿瘤体积的增大可能性减少。放射性中耳功能损伤发病高峰在1年内,在放疗前具有正常听觉功能者,放疗1年后有更多的机会从放射损伤中恢复。     

论善

无私利他的正道德价值最高，是伦理行为的最高境界应该如何，是道德的最高原则，是善的最高原则，是至善；单纯利己的道德价值最低，是伦理行为最低境界的应该如何，是道德最低原则，是善的最低原则，是最低的善；为己利他是利他与利己的混合境界，其道德价值介于无私利他与单纯利己之间，是伦理行为基本境界的应该如何，是道德基本原则，是善的基本原则，是基本的善。利他主义否定为己利他和单纯利己，而把无私利他奉为评价行为是否道德的唯一准则；合理利己主义否定无私利他和单纯利己，而把为己利他奉为评价行为是否道德的唯一准则；个人主义否定无私利他或为己利他，而把单纯利己奉为评价行为是否道德的唯一准则。所以，利他主义与合理利己主义以及个人主义不过是分别夸大无私利他、为己利他、单纯利己三大善原则而堕入谬误的片面化真理而已。