大鼠岛叶皮质与迷走神经背核的直接通路──光镜和电镜研究

将ＷＧＡ－ＨＲＰ及＾３Ｈ－亮氨酸分别注大鼠－侧岛叶皮质，光镜下可见顺行物ＨＲＰ标记终支及＾３Ｈ－亮氨酸标记颗粒密集分布在两侧孤束核（Ｓｏｌ）及迷走神经核（ＤＭＶ）的周边部，以对称为主。在ＤＭＶ内也发现有标记的终支。将大鼠双侧岛叶毁损并用（ＣＢ－ＨＲＰ从其胃壁逆行追踪，电镜下在ＤＭＶ内及其与Ｓｏｌ的交界区可见溃变的终扣呈电子致密型溃变，溃变终扣可与标记细胞及标记树突形成突触联系。以上结果表明，岛叶皮     

Oral administration of l-carnitine improves the clinical outcome of fertility in patients with IVF treatment

Age-dependent decline of mitochondrial function has been proposed to be a main cause of decline of embryo quality. Then, l-carnitine plays important roles in reducing the membranous toxicity of free-fatty acids by forming acyl-carnitine and promoting β-oxidation, preventing cell damage. Recent research revealed that l-carnitine played important roles in vitro in oocyte growth, oocyte maturation and embryo development. However, such beneficial effects of l-carnitine in vivo have yet to be verified. The effect of oral l-carnitine supplementation on embryo quality and implantation potential was examined. A total of 214 patients were included in this study. They all previously received in vitro fertilization-embryo transfer (IVF-ET) and failed to conceive. Then they were administered l-carnitine for 82 days on average and underwent IVF-ET again. There were no significant differences in the total number of retrieved oocytes, and their maturation and fertilization rates between before and after l-carnitine administration. The quality of embryos on Days 3 and 5 after insemination was improved following l-carnitine administration (p?l-carnitine administration compared with previous cycles. Healthy neonates were born after IVF-ET following l-carnitine administration. Our data suggested that oral administration of l-carnitine to fertility patients improved the developmental competence of their oocytes after insemination.     

Venous thromboembolism in pregnancy

Venous thromboembolism remains a common cause of direct maternal deaths in high-income settings such as the United Kingdom. Pregnancy alone increases the risk of deep vein thrombosis and pulmonary embolus at least five-fold, and many women develop or have additional risk factors for venous thrombosis during pregnancy and the puerperium, the latter representing the period of highest risk. Early and repeated risk stratification and adequate thromboprophylaxis, usually with low molecular weight heparin, is the key to preventing venous thromboembolism (VTE). Women with a past history of VTE, and those affected by thrombophilia, require multidisciplinary care involving an obstetric haematologist. Women suspected of having acute thromboembolism should be commenced on empirical treatment promptly prior to diagnostic confirmation. Pulmonary embolism should be considered as a differential diagnosis in maternal collapse.     

剖宫产瘢痕妊娠的介入治疗

血管性介入治疗已成为剖宫产瘢痕妊娠（CSP）治疗的重要手段,除了作为CSP发生大出血时的急救措施外,其在联合清宫术、宫腔镜等的综合方案中体现了重要价值,具有快速有效止血、杀胚、降低出血风险、提高后续手术成功率等优势。但介入治疗为侵入性操作,有并发症风险,临床应用时应把握指征。现有研究表明,病灶血供丰富是选择预防性介入治疗的重要参考依据。目前,介入术后进行外科操作的时机尚存在争议,大部分学者选择在24～72h内施行清除病灶手术。因此,亟待进行大样本、多中心、前瞻性、随机的临床研究,以更全面、客观地指导介入治疗在CSP诊治中的合理应用。     

剖宫产瘢痕妊娠期待治疗的利与弊

剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）是指受精卵着床于前次剖宫产子宫切口瘢痕处的一种特殊类型的异位妊娠。具有限时性,早孕期为异位妊娠,中晚孕则发展为宫内中孕,胎盘植入或凶险性前置胎盘,并发症发生率高,有大出血、子宫破裂甚至子宫切除的风险。处理原则：应该早诊断、早终止、早清除。终止的方法尚无标准。目前为药物治疗,手术治疗或子宫动脉栓塞或者两者的联合。药物等保守治疗具有一定的局限性,失败率高,耗时长等特点不建议首选。     

盐酸纳洛酮治疗急性乙醇中毒35例临床分析

目的：评价纳洛酮在治疗急性乙醇中毒中的临床效果。方法：对35例急性乙醇中毒患者采用纳洛酮肌肉注射或静脉注射0．4～0．8mg,每隔30min静脉注射1次,反复使用至临床症状消失。结果：全部患者1d内治愈。结论：盐酸纳洛酮治疗乙醇中毒具有催醒快,疗程短,副作用小等优点,对伴有昏迷者效果更好。     

Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study

Background The impact of diet on cow's milk allergy (CMA) duration and whether exposure to residual amounts of cow's milk protein influences the onset of tolerance are unknown. Objective To prospectively assess the dietary factors influencing disease duration in a randomized cohort. Methods We randomly switched the formula of symptomatic patients from the Milan Cow's Milk Allergy Cohort to one of three treatment groups according to the quarterly rotation of rice hydrolysate formula, extensively hydrolysed cow's milk formula and soy‐based formula. In this intention‐to‐treat, randomized analysis, a hazard ratio (HR) estimation model was used to analyse dietary impact on disease duration. Results Seventy‐two children aged a mean of 14.1±8.6 months at diagnosis were followed up for a median of 26 months. Fifty‐one reached tolerance at a mean of 34.1±15.2 months. The mean duration of disease was 40.2±4.8 months with milk hydrolysate, 24.3±3.6 months with rice and 24.3±2.6 months with soy. Dietary choice independently predicted shorter duration of disease [adjusted HRs 3.09 (P=0.007) for rice, 2.54 (P=0.02) for soy, both against milk hydrolysate]. In 50 children not co‐sensitized to soy, diet choice impacted the duration of disease more strongly [adjusted HRs 8.02 (P=0.006) for rice, 6.53 (P=0.015) for soy, both against milk hydrolysate]. Discussion Patients not exposed to cow's milk protein residue achieve cow's milk tolerance earlier than patients who follow an extensively hydrolysed cow's milk diet. This may be due to residual antigenicity in hydrolysed milks. As the effect of dietary intervention is stronger in patients not sensitized to soy, we infer that when atopic disease has progressed to multiple sensitizations, the elimination of allergenic exposure may not be sufficient to reduce the duration of CMA. Cite this as: L. Terracciano, G. R. Bouygue, T. Sarratud, F. Veglia, A. Martelli and A. Fiocchi, Clinical & Experimental Allergy, 2010 (40) 637–642.