定制旋转铰链型人工膝关节置换治疗膝部骨肿瘤19例

背景：早期的固定铰链式关节由于存在较高的假体翻修率,已逐渐被旋转铰链式人工关节所替代。定制型人工膝关节还可以更好的匹配患者的解剖形态,实现机械和解剖的多样性个体化。 目的：评估定制旋转铰链型人工膝关节置换治疗膝部良恶性骨肿瘤的临床效果。 方法：应用旋转铰链型人工膝关节置换治疗膝部骨肿瘤患者19例,男13例,女6例,年龄19~51岁;其中良性骨肿瘤6例,恶性骨肿瘤13例,股骨下端肿瘤15例,胫骨上端肿瘤4例。 采用Enneking功能评定标准评估术后功能,复查X射线片评估假体情况与肿瘤复发。 结果与结论：手术时间 2.5~5.3(3.64±0.89)h,术中出血量300~800(452.63±135.88)mL。19例均获随访,随访时间3~64 (30.45±21.44)个月, 仅1例局部复发,无肺部转移。膝关节活动范围伸0°,屈曲95°~140°(124.47±12.89)°,Enneking功能评分为(20.95±3.69)分,优良率为89%。结果说明定制旋转铰链型人工膝关节置换是一种有效的治疗膝部良恶性骨肿瘤的保肢方法。     

氯吡格雷联合阿托伐他汀治疗缺血性心脑血管疾病的系统评价

目的:系统评价氯吡格雷与阿托伐他汀联合应用对缺血性心脑血管疾病的影响。方法:以"clopidogrel"、"atorvastatin"、"ClinicalTrial"、"氯吡格雷"、"阿托伐他汀"、"临床试验"为检索词,分别在EMBase、PubMed、Cochrane图书馆和中国期刊网数据库(CNKI)4个中英文数据库中进行检索,用ReviewManager5.0软件进行数据分析。结果:共有5项研究被纳入,以氯吡格雷为对照的相关临床研究有4篇(n=5874),以阿托伐他汀为对照的相关临床研究有3篇(n=6790)。结果显示,(1)氯吡格雷与阿托伐他汀联合应用时,心肌梗死、脑卒中和缺血性死亡综合事件的发生率比单独使用氯吡格雷低39%(合并RR=0.61,95%C(I0.51～0.74))。(2)氯吡格雷与阿托伐他汀联合应用时,综合终点事件发生率比单独使用阿托伐他汀低19%(合并RR=0.81,95%CI为(0.71～0.93))。结论:在临床上,氯吡格雷与阿托伐他汀的联合应用存在协同效应,比单独应用氯吡格雷或阿托伐他汀对缺血事件的预防作用更强。     

慢病毒载体介导siRNA沉默Id-1通过ERK1/2信号通路抑制裸鼠人肝癌移植瘤生长

目的 构建慢病毒表达载体介导siRNA沉默Id-1,观察其对人肝癌HepG2细胞裸鼠皮下移植瘤生长的抑制作用及其对ERK1/2信号通路的影响。 方法 构建合成特异性针对Id-1基因的siRNA慢病毒载体,转染肝癌HepG2细胞系,经半定量RT-PCR鉴定筛选沉默效果最佳的细胞系,于倒置荧光显微镜(×400)下观察转染前后细胞的形态学变化。取细胞浓度为5×10⁶ mL^-1的干扰效率最佳的稳定转染细胞系、稳定转染空载体病毒细胞系及正常HepG2细胞系悬液各0.2 mL,分别注射到转染实验组、阴性对照组及空白对照组的裸鼠右腋皮下,每周测量肿瘤体积及裸鼠体质量,绘制肿瘤生长曲线,28 d后处死裸鼠,制作肿瘤组织标本,行常规病理检查,采用半定量RT-PCR及Western-blot方法检测肿瘤组织Id-1,ERK1/2的mRNA和蛋白的表达水平及p-ERK1/2的蛋白表达水平。 结果 倒置荧光显微镜显示,转染前后细胞形态学变化不明显。经半定量RT-PCR筛选出Id-1基因的siRNA慢病毒载体的最佳细胞系为sh31,与稳定转染空载体病毒细胞系相比,目的基因Id-1的表达降低了80%以上,与未干扰的HepG2细胞相比降低了60%; 转染细胞皮下接种后,转染组最终瘤体大小明显小于阴性对照组和空白对照组(P<0.05)。半定量RT-PCR显示,转染组肿瘤组织的Id-1及ERK1/2 mRNA分别为(0.389±0.058)及(0.475±0.079),均明显低于阴性对照组[(0.845±0.113),(0.977±0.082)]和空白对照组[(0.917±0.083),(0.978±0.056)](均为P<0.05)。Western-blot检测显示,转染组的Id-1及p-ERK1/2蛋白均明显低于阴性对照组和空白对照组(P<0.05)。 结论 Id-1基因特异性siRNA的慢病毒表达载体通过靶向抑制Id-1的表达,明显抑制人肝癌细胞HepG2裸鼠皮下移植瘤的生长,推测Id-1可能通过调节ERK1/2 MAPK信号通路参与肝癌的发生发展。     

Short-term stability of HIV provirus levels in the peripheral blood of HIV-infected individuals

Changes in viral load have been reported to reflect disease progression or response to therapy; however, the stability of HIV DNA levels in HIV infected individuals has not been extensively studied. Cellular HIV DNA levels in infected individuals were evaluated over a short time period to determine degree of variability as well as any correlation with other measurements of virus load or immune status. Peripheral blood mononuclear cells (PBMC) were obtained several times over 1 month from 32 asymptomatic or symptomatic non-AIDS, HIV-infected individuals currently on AZT therapy. PCR amplification of the HIV gag region was performed with DNA from PBMC lysates and the PCR amplified products quantitated by liquid phase hybridization. HIV DNA levels in the majority of the patients were relatively stable, with 26 of 32 persons having less than threefold change. Changes over the study period were both positive and negative, and the median change in HIV DNA levels was 68.6%. These changes were found to positively correlate with fluctuations in plasma p24 levels. In contrast, no correlations were found with other measurements of immune system activity, including changes in CD4 number, CD4 percent, and p, -microglobulin when compared with provirus changes. This study shows that levels of HIV DNA can be relatively stable over short periods in most non-AIDS, HIV-infected persons. © Wiley-Liss, Inc.     

GROWTH PATTERNS OF CARDIAC STRUCTURES AND CHANGES IN SYSTOLIC TIME INTERVALS IN THE NEWBORN AND INFANT: A Longitudinal Echocardiographic Study

Abstract. Oberhänsli, I., Brandon, G., Lacourt, G. and Friedli, B. (Department of Pediatrics and Genetics, University Hospital, Geneva, Switzerland). Growth patterns of cardiac structures and changes in systolic time intervals in the newborn and infant. Acta Paediatr Scand, 69: 239, 1980.—A longitudinal study was undertaken in 21 newborns to determine cardiac growth pattern by echocardiography over the course of the first year of life. Most cardiac structures increased in size as a linear function of age and weight; however, the right ventricular end-diastolic diameter remained unchanged so that the RV/LV ratio decreased as a parabolic function of age. Left and right ventricular systolic time intervals (RVSTI, LVSTI) after birth were also studied. The ratio of left ventricular preejection period (LVPEP) to left ventricular ejection time (LVET) decreased markedly immediately after birth and subsequently remained at a constant mean value (0.30 ± 0.04) for the rest of the study period. Right ventricular systolic time interval ratios (RVPEP/RVET) decreased rapidly and significantly during the first days of life (from a mean value of 0.39 ± 0.08 in the first 24 hours to 0.28 ± 0.05 on the 6th day of life). Constant values of 0.24 ± 0.03 were found from the 3rd month of life onwards. The decrease in RVPEP/RVET in the first days of life followed a parabolic function reflecting the physiological decrease of pulmonary vascular resistance after birth.     

HYPERTHYROIDISM, DIABETES MELLITUS AND THE CONGENITAL RUBELLA SYNDROME

Abstract. Floret, D., Rosenberg, D., Hage, G. N. and Monnet, P. (Clinique Médicate Infantile B, Hopital E. Herriot, Lyon, France). Hyperthyroidism, diabetes mellitus and congenital rubella syndrome. Acta Paediatr Scand, 69: 259, 1980.—A male patient born to a mother who developed rubella during the tenth week of gestation presented a typical congenital rubella syndrome with mental retardation, neuro-sensory deafness, hypoplasia of the dental enamel and chorioretinitis. Hyperthyroidism occurred at the age of 3 10/12 years and was treated successfully with propylthiouracil for 4 years. The course was complicated by premature craniosynostosis and a craniectomy was performed at the age of 7 years. Overt diabetes mellitus developed at 17 years and was well controlled by insulin therapy. Histocompatibility (HLA) antigens were A2, B8, B40. Diabetes mellitus and thyroid disorders have previously been reported after congenital rubella, and recently after congenital cytomegalovirus infection. Our patient had both endocrinopathies. It is possible that HLA B8 antigens might be responsible for increased susceptibility to rubella infection.     

TREATMENT OF GIRLS WITH EXCESSIVE HEIGHT PREDICTION: Follow-up of Forty Girls Treated with Intramuscular Estradiol and Progesterone

Abstract. Andersen, H., Brock Jacobsen, B., Kastrup, K. W., Krabbe, S., Peitersen, B., Petersen, K. E., Thamdrup, E. and Wichmann, R. (Endocrine Clinic, Children's Hospital Fuglebakken, University of Copenhagen). Treatment of girls with excessive height prediction. Follow-up of 40 girls treated with intramuscular estradiol and progesterone. Acta Pædiatr Scand, 69:293, 1980.—In a follow-up study of 40 tall girls treated with intramuscular estradiol and progesterone, the final height, bone age maturation, side effects and acceptance of treatment were evaluated. The mean duration of treatment was 18 months. During treatment, mean height increase was 6.5 cm (height velocity 3.7 cm/year), which is nearly 50 % reduction of normal growth rate. The mean increase in bone age was 2.7 years (bone age velocity 1.8 years/year), which approximates twice the normal maturation rate. The mean reduction in final height was 5.0 cm as evaluated by the method of Bayley-Pinneau (BP), 2.9 cm by the method of Tanner et al. (TW) and 3.0 cm by the method of Roche et al. (RWT). The reduction was greatest when treatment was started before menarche, according to all three prediction methods. When treatment was started after menarche the calculated height reduction was greatest according to the BP method. There was good agreement between the three prediction methods in girls with a bone age below 12 years before treatment. In girls with a bone age above 12 years the height reduction by the BP method was much greater than when measured by the other methods. Side effects evaluated at follow-up were minimal and first menstruation occurred within 3 months (mean) after cessation of treatment. The number of pregnancies was estimated to be normal for age. All but three accepted the treatment. It is concluded that this type of treatment must be restricted to girls with severe psychological problems due to excessive height prognosis and selection for treatment must be based on an individualized evaluation.     

THE ROLE OF NUTRITIONAL STATUS, AIRWAY OBSTRUCTION, HYPOXIA, AND ABNORMALITIES IN SERUM LIPID COMPOSITION IN LIMITING EXERCISE TOLERANCE IN CHILDREN WITH CYSTIC FIBROSIS

Abstract. Coates, A. L., Boyce, P., Muller, D., Mearns, M. B. and Godfrey, S. (Department of Paediatrics, Hammersmith Hospital, Queen Elizabeth Hospital, and the Institute of Child Health, London, England). The role of nutritional status, airway obstruction, hypoxia, and abnormalities in serum lipid composition in limiting exercise tolerance in children with cystic fibrosis. Acta Paediatr Scand, 69:353, 1980.—Previous work has shown that impaired exercise tolerance in children with cystic fibrosis (C.F.) is related to the severity of airway obstruction without elucidating the possible roles of hypoxia or malnutrition. It has been suggested that poor nutrition leads to abnormalities in serum fatty acids composition, which may lead to tissue hypoxia. We investigated the roles of hypoxia, pulmonary mechanics, nutritional status, and serum fatty acid composition in limiting exercise tolerance in C.F. In 20 children with C.F., exercise tolerance, while breathing air and while breathing oxygen, was evaluated on a cycle ergometer and compared to pulmonary function tests, anthropometric data, serum lipid composition, and clinical condition. The mean percent work expected from height (W_max) was 75, and was unchanged by 0_z. W_max correlated significantly with the degree of respiratory impairment, the discrepancy between height and weight, and the clinical score but not serum fatty acid composition. Where measured, no child at any time had an elevated end tidal CO₂(P_etCO2). We conclude that nutritional status and airway obstruction are closely correlated with exercise tolerance in C.F. and that, unlike the case in adults with chronic obstructive pulmonary disease, exercise-limiting dyspnea occurs in the presence of a normal P_etCO2.     

VASOACTIVE INTESTINAL POLYPEPTIDE (VIP)-PRODUCING GANGLIONEUROMA IN A CHILD WITH CHRONIC DIARRHEA

Abstract. Hansen, L. P., Lund, H. T., Fahrenkrug, J. and Søegaard, H. (The Department of Paediatrics, Central Hospital, Randers, The Department of Clinical Chemistry, Bispebjerg Hospital, Copenhagen, and the Department of Pathology, Municipal Hospital, Árhus, Denmark). Vasoactive intestinal polypeptide (VIP)-producing ganglioneuroma in a child with chronic diarrhea. Acta Paediatr Scand, 69: 419, 1980. In a 2½-year-old girl with persistent watery diarrhea a retroperitoneal tumour and lymph node composed of benign ganglioneuroma cells were found. The histological picture was compatible with an original metastasizing neuroblastoma which has passed through a stage of late maturation. Electron microscopy of the ganglioneuroma showed cytological evidence of increased secretory activity. The tumour contained large amounts of vasoactive intestinal polypeptide (VIP) and preoperative plasma concentration of this peptide was increased. Postoperatively the VIP concentration was normalized, and the diarrhea ceased. Analysis of catecholamine metabolites in urine was normal. The findings suggest that the watery diarrhea was due to the benign VIP-producing neural crest tumour.     

RENAL CONTROL OF SODIUM and FLUID BALANCE IN NEWBORN INFANTS DURING INTRAVENOUS MAINTENANCE THERAPY

ABSTRACT: Aperia, A., Broberger, O., Thodenius, K. and Zetterström, R. (Department of Paediatrics, Karolinska Institutet, St Göran's Hospital for Children, Stockholm, Sweden). Renal control of sodium and fluid balance in newborn infants during intravenous maintenance therapy. Acta Paediatr Scand, 64:725, 1975.–Changes in accumulated fluid and sodium balance during intravenous maintenance fluid therapy has been studied in 38 newborn infants with different clinical disorders and gestational ages 28–42 weeks. The results from the infants born before 36 weeks of gestation (preterms) have been compared with the result from infants born after 36 weeks. Three different saline infusions 10, 20 and 40 mEq Na½/1000 ml 5.5% glucose have been given. The infusion rate has in preterm neonates been 3.3 ml/kg and hour and in the more full-term neonates been 3.6 ml/kg and hour. The study lasted for 5–8 hours. Urine was collected by spontaneous voidings in plastic bags. The balances were calculated as the difference between the amount given intravenously, and the amount excreted in the urine. In the more full-term neonates Nai balance became increasingly negative with the 10 mEq solution, just balanced with the 20 mEq solution and increasingly positive with the 40 mEq solution. A different response was found in the preterm neonates. The natriuresis was higher and the sodium balances were increasingly negative with both the 10 and 20 mEq solutions. With the 40 mEq solution the negative balance tended to level off. The fluid balances were fairly well maintained in all infants regardless of the sodium concentration in the infusate.