急性冠脉综合征中妊娠相关蛋白-A与斑块不稳定性

目的探讨妊娠相关蛋白-A(PAPP-A)在急性冠脉综合征(ACS)中的变化及其与斑块不稳定性的关系。方法26例冠脉正常者作为对照组,稳定性心绞痛(SA)组22例,ACS组40例,包括不稳定性心绞痛(UA)20例、急性心肌梗死(AMI)20例。定量检测外周血PAPP-A、C-反应蛋白(CRP)、肌酸激酶MB同工酶(CK-MB)。对所有冠脉造影显示狭窄≥30%的病变进行影像学分析。结果ACS中PAPP-A含量(13·19±4·04)mIU/L明显高于SA(5·47±3·00)mIU/L(P<0·01)及对照组(5·09±2·19)mIU/L(P<0·01);并且与CRP(r=0·62P<0·01)、复杂性狭窄的数量(r=0·45P<0·05)有显著的正相关。结论PAPP-A在ACS患者外周血中明显升高,可能与斑块的不稳定性有关,对ACS的危险度分层可能具有一定的价值。     

山莨菪碱和无创面罩正压通气治疗急性呼吸窘迫综合征的临床观察

目的比较山莨菪碱联合无创正压面罩通气（654-2＋NIPPV）和传统机械通气（CMV）治疗急性呼吸窘迫综合征（ARDS）的临床效果，评估山莨菪碱联合无创正压通气在ARDS治疗中的作用。方法将各种原因所致ARDS患者42例随机分为654-2＋NIPPV组（21例）和CMV组（21例），在给予病因治疗同时分别实施654-2＋NIPPV和CMV。观察分析两组患者在治疗过程中动脉血气变化、并发症的发生率及治疗效果。结果654-2＋NIPPV组有8例（38．1％）治疗失败转为气管插管实行CMV，其中6例（28．6％）死亡。CMV组死亡7例（33．3％），两组病死率无显著差异（P〉0.05）。两组治疗有效的患者在分别接受654-2＋NIPPV和CMV治疗后1h和6h动脉血气有相似的显著改善。654-2＋NIPPV组患者机械通气时间和住院时间短于CMV组（P〈0.05）。654-2＋NIPPV组的并发症发生率低于CMV组（P〈0.05）。结论在经过选择的ARDS患者中，应用654-2＋NIPPV治疗的临床效果与CMV相似。实施654-2＋NIPPV可缩短机械通气和住院时间，减少并发症。654-2＋NIPPV可作为经过选择的ARDS患者首选的通气支持治疗手段。     

SARS胸部影像表现与评价(附75例分析)

目的：回顾分析75例严重急性呼吸综合症(SARS)病例，探讨该病影像学表现及其与临床治疗有关的问题。方法：全部75例患者均行胸片检查，一般隔日行影像追踪复查。结果：胸部X线表现为肺实质渗出病灶为主，肺内网状改变及肺门片块影较少。影像表现与临床病程有一定关系。结论：胸部影像表现以肺实质渗出病灶较常见。胸片检查是进行本病诊断和评估病程及疗效的重要方法。     

Effects of Carbamazepine on Murine Humoral and Cellular Immune Responses

Summary: Oral administration of carbamazepine (CBZ)(15, 10, or 5 mg/kg) to mice significantly decreased both humoral and cellular immune responses evaluated by enumeration of direct and indirect plaque-forming spleen cells (PFC) and delayed–type hypersensitivity reaction (DTH) against sheep red blood cells (SRBC) as compared with those observed in normal control animals. Moreover, spleen T cells obtained from CBZ–treated donor mice were capable of decreasing both PFC and DTH responses of normal spleen cells transferred into lethally irradiated recipient animals. The immunodepressor effect of CBZ was observed even though administration of CBZ induced augmentation of spleen cellularity.     

A New Method for Estimating Dermal Absorption from Chemical Exposure. 3. Compared with Steady-State Methods for Prediction and Data Analysis

Purpose. This paper compares unsteady-state and steady-state methods for estimating dermal absorption or analyzing dermal absorption data. The unsteady-state method accounts for the larger absorption rates during short exposure times as well as the hydrophilic barrier which the viable epidermis presents to lipophilic chemicals. Methods. Example calculations for dermal absorption from aqueous solutions are presented for five environmentally relevant chemicals with molecular weights between 50 and 410 and log₁₀K_ow between 0.91 and 6.8: chloromethane, chloroform, chlordane, 2,3,7,8-TCDD, and dibenz(a,h)anthracene. Also, the new method is used to evaluate experimental procedures and data analyses of in vivo and in vitro permeation measurements. Results. In the five example cases, we show that the steady-state approach significantly underestimated the dermal absorption. Also, calculating permeability values from cumulative absorption data measured for exposure periods less than 18 times the stratum corneum lag time will overestimate the actual permeability. Conclusions. In general, steady-state predictions of dermal absorption will underestimate dermal absorption predictions which consider unsteady-state conditions. Permeability values calculated from data sets which include unsteady-state data will be incorrect. Strategies for analyzing in vitro diffusion cell experiments and confirming steady state are described.     

心率变异性与心肌梗塞范围关系的研究

报道７２例急性心肌梗塞患者的心率变异性（ＨＲＶ）值与心肌梗塞范围的关系，并与１２０例正常人的ＨＲＶ值进行对比，结果发现，心肌梗塞急性期ＨＲＶ值明显降低，与正常组对比有显著统计学意义，但ＨＲＶ值降低与心肌梗塞部位、范围无关，可能主要为心肌梗塞引起的应激反应所造成的体液及神经调节改变所致。     

Nodular hyperplasia surrounding fibrolamellar carcinoma

We report a case of acetaminophen-induced liver necrosis in a 14-year-old girl. At autopsy, a 9 cm subcapsular nodule was present in the right lobe of the liver which showed distinct zonation: a central greyish white area of fibrolamellar carcinoma with a peripheral fleshy, tan-coloured rim ranging from 1 to 2 cm in thickness. This peripheral zone consisted of nodular, hyperplastic parenchyma resembling the changes seen in focal nodular hyperplasia, and stood out from the adjacent necrotic parenchyma. The sparing of this zone from the deleterious effects of acetaminophen provides indirect evidence of a predominantly arterial rather than portal blood supply to this region. The arterial supply was most probably derived from the tumour vasculature and may explain the parenchymal hyperplasia sometimes reported adjacent to a fibrolamellar carcinoma. Awareness of this phenomenon is essential when evaluating a needle biopsy, as sampling of this region may lead to a false negative diagnosis.     

Pollen extracts reduce the hepatotoxicity of paracetamol in mice

Cernitins are preparations obtained from plant pollen which contain numerous compounds of potential biological significance. This work deals with the influence of cernitins upon acute paracetamol toxicity in mice. The survival rate and indices of hepatic injury: aminotransferase and alkaline phosphatase activities, bilirubin level in serum, glutathione and cytochrome P-450 content in liver, liver weight, histopathologic picture of the liver and presence of glycogen and lipids in stained liver sections, under different experimental protocols, were determined. It was found that cernitins are able to increase the survival rate of mice and reduce liver injury in acute paracetamol poisoning. Cernitins are more effective when administered after, rather than before, a dose of paracetamol. The possible mechanism through which cernitins may act is discussed.     

烧伤患者急性期反应物的变化及其临床意义

用环状免疫单扩散法观察了２７例烧伤患者伤后４６天以内血清急性期反应物前白蛋白、铜蓝蛋白、α＿１酸性糖蛋白、α＿１抗胰蛋白酶、转铁蛋白、Ｃ反应蛋白、纤维连接蛋白、补体成分Ｃ＿４、Ｃ＿（３ｃ）、触珠蛋白的变化趋势、试图探讨它们与病情发生、发展规律之间的关系。结果：Ｃ反应蛋白、α＿１酸性糖蛋白和α＿１抗胰蛋白酶在所有患者都升高，提示烧伤后组织损伤逐渐加重及伴发炎症、感染的存在；白蛋白、铜蓝蛋白、转铁蛋白和纤维连接蛋白在伤后均明显降低，提示伤后的分解代谢增加、贫血及网状内皮系统功能降低与之有关；触珠蛋白伤后明显降低且死亡组更明显，提示其作为具有过氧化物酶活性的保护作用降低是促进死亡的原因之一；伤后补体Ｃ＿４、Ｃ＿（３ｃ）在存活组升高而死亡组明显降低，因而可能被用于对患者病情和预后的判断。总之，观测急性期反应蛋白的变化规律，有助于及时发现患者病情的变化，以便临床及时采取相应措施。     

急非淋白血病完全缓解后巩固治疗的对照研究

目的探讨急非淋白血病完全缓解后巩固治疗与缓解期的关系。方法对３０例坚持与未坚持完全缓解后巩固化疗的急非淋患者（每组１５例）进行对照研究。比较两组患者的完全缓解期。结果两组患者入院时情况、治疗及达完全缓解时间经统计学处理无明显差异（Ｐ＞０．０５）；而坚持巩固化疗组平均持续完全缓解期（１９．８ｍｏ）明显长于对照组（８．４ｍｏ），统计学具有显著差异（Ｐ＜０．０１）。结论急非淋白血病达完全缓解后，坚持骨髓抑制性治疗对延长完全缓解期以达长期生存目的具有重要意义。