切实把握临床医学与ICD-10的关系

要使疾病相关分组系统在我国尽快推广使用就要提高ICD-10编码的准确率,编码人员必须加强临床医学知识的学习,结合ICD-10的编码原则,通过认真阅读病历再进行编码,临床医师也应了解ICD-10的分类轴心和规则,书写好病历.     

Reciprocal regulation of the nitric oxide synthase/arginase balance in mouse bone marrow-derived macrophages by TH 1 and TH 2 cytokines

Activation with lipopolysaccharide induces macrophages to produce the enzymes arginase and nitric oxide (NO) synthase. Both enzymes use as a substrate the amino acid L-arginine, which can be either hydrolyzed by arginase to urea and ornithine or oxidized by NO synthase to NO and citrulline. NO is important in the bactericidal and cytotoxic activities of macrophages. An equivalent functional role of arginase and its products is not known. We tested the induction of arginase in bone marrow-derived macrophages by endogenous mediators that are known to induce NO synthase, such as interferon-γ (IFN-γ), or suppress the induction of this enzyme, such as interleukin (IL)-4, IL-10, and prostaglandin E₂ (PGE₂). We find that PGE₂ and the TH2 cytokines IL-4 and IL-10 are potent inducers of arginase. In contrast, the TH 1 cytokine IFN-γ does not induce arginase. Simultaneous application of both types of mediators leads to reduced induction of both arginase and NO synthase. Exposure of macrophage cultures to inducers of NO synthase exhausts their ability to respond subsequently to inducers of arginase. Conversely, exposure of the cells to inducers of arginase exhausts their ability to respond subsequently to inducers of NO synthase. The results are consistent with a competition of both enzymes for their substrate, L-arginine, with a reciprocal inhibition in the induction of both enzymes, or a combination of both phenomena. The enzymes NO synthase and arginase appear to define two alternate functional states of macrophages, induced by TH 1 and TH 2 cytokines, respectively.     

An efficient procedure for the regioselective synthesis of 10-methoxy-11-hydroxyaporphine from (R,S)-10,11-dihydroxyaporphine

A regioselective preparation of 10-methoxy-11-hydroxyaporphine (“Apocodeine,1b”) from (R,S)-10, 11-dihydroxyaporphine(apomorphine,1a) is described. The isopropylidene ketal ring of 10,11-(isopropylidenyldioxy) aporphine (2) obtained by the isopropylidenation of apomorphine, was regioselectively opened by the ten equivalent of trimethylaluminum to give 10-hydroxy-11-t-butyloxyaporphine (3). The free 10-hydroxyl position of 3 was methylated with methyl p-toluenesulfonate/NaH, and afforded 10-methoxy-11-t-butyloxyaporphine (4) in high yield. Selective debutylation gave the desired 10-methoxy-11-hydroxyaporphine (“apocodeine”,1b) in good yield.     

高效液相色谱法测定辅酶Q_(10)含量的研究

应用色谱技术，建立了辅酶Q_10(CoQ_10)含量测定的高效液相色谱方法.并从多个影响保留时间的因素中选出三个水平、三个因子进行正交设计，从而确定了CoQ10。含量测定的最佳条件。本法选用碳十八硅烷为固定相，检测波长为275um，经过多批COQ10。测定，其回收率大于99．6％，RSD小于0．07％，方法简便快速、灵敏度高、特异性强，适用于该药品的含量分析检测。     

人IL-10基因重组复制缺陷型腺病毒DNA的构建

目的 构建人IL-10基因的重组腺病毒并进行体外表达和检测。方法从质粒pcDNA3IL-10的CMV启动子下游完整切下IL-10 cDNA的片段,将其定向插入Gateway载体,在克隆酶的作用下将阳性克隆质粒转入目的腺病毒载体。PacI酶线性化IL-10腺病毒DNA后阳离子质脂体转染293A细胞,获得人IL-10的复制缺陷型重组腺病毒。体外感染人胰腺癌细胞株Bxpc-3和大鼠胰腺细胞株AR-42J;Western blot检测人IL-10的表达。结果 成功地构建人IL-10重组腺病毒,病毒滴度达2×109PFU/mL。体外感染的细胞株均检测到IL-10的表达。结论 构建复制缺陷型重组腺病毒能够介导IL-10的基因表达,为细胞因子的抗炎冶疗奠定实验基础。     

黄芪、小柴胡冲剂联合辅酶Q10治疗病毒性心肌炎

目的观察黄芪、小柴胡冲剂联合辅酶Q10治疗病毒性心肌炎(VMC)的临床疗效.方法治疗组(30例)应用黄芪注射液、小柴胡冲剂和辅酶Q10;对照组(30例)用GIK极化液、辅酶Q10和维生素C,两组患者无禁忌证者均给予β-受体阻滞剂,钙拮抗剂和对症治疗.两组疗程均为3个月.结果治疗组临床症状和心律失常总有效率分别为73.3%和86.6%,高于对照组的43.3%和63.3%(p＜0.05).结论黄芪、小柴胡冲剂联合辅酶Q10对VMC有较好疗效,且无明显不良反应.     

Hyperthyroidism associated with papilloedema and pyramidal tract involvement

Summary In a patient with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes [MELAS] who had normal mitochondrial enzyme activity, high doses of coenzyme Q₁₀ (CoQ) were administered. Clinical improvement with decreased serum lactate and pyruvate levels was observed. Though the mechanism of action of CoQ is not known, a trial is worthwhile in patients with MELAS.     

重组人白细胞介素10的融合表达及鉴定

目的 研究重组人白细胞介素10(rhIL—10)载体在大肠杆菌B121(DE3)pLyse细胞中的表达，为进一步研究IL-l0在动脉粥样硬化中的作用机制奠定基础。方法 用构建成功的IL-l0—PCRT7/NT-TOPO质粒转化大肠杆菌BL21(DE3)pLyse细胞，并通过SDS-PAGE鉴定融合表达蛋白。结果 PCRT7/NT—TOPO质粒载体成功载入rhIL-l0基因；在异丙基硫代—β-D-半乳糖苷(IPTG)诱导下表达的蛋白质主要以包涵体形式存在。结论 在IPTG诱导下，重组的IL-l0—PCRT7/NT—TOPO质粒载体在大肠杆菌BL2l(DE3)pLyse细胞内成功表达。     

Phase II study of 10-ethyl-10-deaza-aminopterin (10-EdAM; CGP 30 694) for stage IIIB or IV non-small cell lung cancer

Summary Thirty-one patients with stage IIIB or IV non-small cell lung cancer (NSCLC) were treated with intravenous 10-EdAM on a weekly basis. The starting dose was 80 mg/m², with subsequent doses adjusted depending on evidence of toxicity. There were 20 men and 11 women with a median age of 58 years (range, 33–75). Response was evaluated in 30 patients, 5 with evaluable but not measurable tumors and 25 with measurable indicator lesions. There were no complete remissions; 3 patients achieved partial remission. Nine patients had a minor response, 6 showed no change, and 12 had progressive disease. Median survival for all 31 patients was 43 weeks (range, 12–65+). During the first 3-week period, the 10-EdAM dose was reduced or withheld in 19 patients (because of stomatitis in 12, SGPT elevation in 3, skin rash in 2, and granulocytopenia in 2), escalated in 11 patients, and unchanged in 1 patient. A mean of 34–88 mg/m²of 10-EdAM (median, 50) was given per week during the first 5-week period. Myelotoxicity was infrequent and there was no significant nephrotoxicity. Considering the modest side effects of this treatment and the conservative dose-modification schedule which mandated substantial dose reductions, we conclude that 10-EdAM is a promising antitumor agent for NSCLC.