浅低温心脏不停跳心内直视手术119例报告

1993年7月30日至1998年4月20日在浅低温心脏跳动中行心内直视手术119例，其中房间隔缺损40例、室间隔缺损47例、动脉导管未闭1例、肺动脉狭窄6例，法乐四联症1例、完全性心内膜垫缺损4例，右室双腔心2例、左房粘液瘤1例、二尖瓣置换8例、二尖瓣置换+三尖瓣成形4例、三尖瓣置换1例、法乐三联症4例，包括2例室间隔缺损+重度肺高压，7例重症瓣膜病。结果：死亡1例，气栓致肢体偏瘫2例，术后合并Ⅱ度房室传导阻滞1例，轻度瓣周漏1例，其余病人无气栓、低心排、严重心律失常等并发症。作者认为这种体外循环手术方法避免了低温和主动脉阻断造成的心肌缺血、缺氧性损害和再灌注损伤，对心肌保护有利。缺点是操作相对困难，修补有时不够确切；有形成气栓危险，左、右心吸引多，引起血液机械性破坏增加，指出这种手术不宜用于术前诊断不够明确，一些复杂先心畸形的病人。     

三叶因子1表达与胃黏膜损伤及胃癌的关系

目的　测定三叶因子 1(TFF1)在正常及病理条件下胃黏膜中的表达情况 ,探讨TFF1在胃黏膜损伤修复及胃癌抑制中的作用及意义。方法　应用免疫组化方法测定正常及不同病理条件下胃黏膜中TFF1的表达情况 ,通过图像分析软件分析阳性信号平均吸光度值以了解其表达情况。结果　胃炎、胃溃疡及十二指肠球部溃疡患者TFF1表达明显高于正常胃黏膜 (0 .5 1± 0 .0 5 ,0 .5 1± 0 .0 6 ,0 .5 0± 0 .0 6比 0 .4 4± 0 .0 6 ;P值均 <0 .0 1)。胃腺癌患者癌旁组织表达 (0 .5 1± 0 .0 7)明显高于正常胃黏膜 ,而腺癌组织的表达强度则与癌组织的分化程度呈正比 ,分化程度愈低 ,表达愈弱 ,低分化腺癌无阳性表达 ,中、高分化腺癌表达 (0 .4 1± 0 .0 7)略低于正常黏膜 ,但差异无显著性 (P >0 .0 5 )。结论　TFF1表达随黏膜损伤程度的加重而表达增强 ,提示其在胃黏膜保护及促进上皮重建机制中具有一定的作用。TFF1在癌旁组织中表达增强提示其可能与肿瘤抑制及分化机制有关 ,而在癌组织中表达减弱可能与其分泌减少有关。     

腺苷心肌保护作用研究进展

腺苷对缺血再灌注心肌有保护作用 ,近年来对其保护作用的机制研究较多 ,主要集中于受体机制 ,认为腺苷通过与其受体A1 、A2 a、A2 b、A3 结合发挥作用 ,抑制白细胞与内皮细胞相互作用 ,减轻儿茶酚胺的心脏毒性 ,减轻细胞内钙超载 ,激活三磷腺苷敏感性钾通道产生预处理作用。临床上腺苷可用于终止室上性心动过速 ,心肌缺血的药物预处理 ,以及作为体外循环心脏停搏液的辅剂等。腺苷的应用为心肌保护提供了一种新的手段 ,但是腺苷的临床应用还存在不少问题 ,心肌保护作用的具体机制还不十分明了 ,仍需要进一步深入研究。     

人端粒保护蛋白在胃癌中的异常表达及其临床意义

目的 探讨人端粒保护蛋白（human protection of telomeres，hPOT1）在胃癌中的异常表达及其临床意义。方法 用SP免疫组化方法检测hPOT1在57例胃癌标本中的表达，同时以10例正常胃黏膜标本做对照。结果 57例胃癌标本的表达全阳性，阳性率100％，显著高于正常胃黏膜hPOT1的表达（40％）。浸润至或超过浆膜层的胃癌hPOT1表达强度显著高于未达浆膜层者，Ⅲ／Ⅳ期胃癌明显高于Ⅰ/Ⅱ期胃癌，低分化胃癌高于高分化胃癌（P〈0．05）。结论 hPOT1在胃癌组织中表达异常增高，提示hPOT1与胃癌的发生、发展有密切的关系，检测hPOT1的表达可能会有助于胃癌的早期诊断和预后。     

咪达普利的药理学特性和临床治疗意义

咪达普利不仅具有良好的降压效果 ,而且不良反应小 ,患者依从性好 ,作为新的血管紧张素转化酶抑制剂体现出不同于其它同类药物及肾上腺素能受体结合剂制剂的优越性 ,在心血管疾病治疗中具有广泛的应用前景。     

温-冷-温灌注法在先天性心脏病矫治术中的心肌保护作用

目的探讨温血高钾心脏停搏液诱导心脏停跳、术中冷血维持及终末温血灌注即"温-冷-温"技术在先天性心脏病(先心病)矫治术中的心肌保护作用.方法选择先心病矫治术30例,随机分为二组,即温血高钾停搏液诱导心脏停跳+冷维持+终末温血灌注组(温血组)和单纯冷血高钾停搏液组(冷血组).通过对二组患者临床效果的观察,并于术前0.5h,术毕,术后3、24、72h和6d,分别从颈内静脉抽取血液测定肌酸激酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10).结果温血组的自动复跳率(100%)明显高于冷血组(61%);温血组术后机械通气时间及ICU停留时间明显短于冷血组.冷血组分别有2例出现一过性房室传导阻滞、室上性心动过速,4例发生低心输出量综合征,而温血组心脏复跳后无明显并发症.与冷血组比较,温血组在术毕,术后3、24、72h的血浆CK-MB、TnI水平明显降低,有统计学意义(P<0.01);温血组在术毕,术后3、24、72h的TNF-α、IL-6水平比冷血组明显降低,差异有统计学意义(P<0.01);而术后上述时间段的IL-10升高的幅度,温血组明显高于冷血组,差异有统计学意义(P<0.01).结论温-冷-温灌注技术更有利于先心病矫治术中患者的心肌保护.     

Renal angioplasty and stenting under protection: The way for the future?

The purpose of this study was to evaluate the feasibility and safety of renal artery angioplasty and stenting utilizing a distal protection device to reduce the risk of intraprocedural artery embolism and avoid deterioration of the renal function. Fifty-six hypertensive patients (32 men; mean age, 66 +/- 11.8 years; range, 22-87) with atherosclerotic renal artery stenosis (8 bilateral) underwent angioplasty and stenting with distal protection in 65 renal arteries (58 ostial lesions). Five patients had a solitary kidney, 18 a renal insufficiency. The lesion was crossed either with a GuardWire temporary occlusion balloon (n = 38), which was inflated to provide parenchyma protection or with a filter (EPI Filter; n = 26), or with Angioguard (n = 1), which allows a continuous flow. Generated debris was aspirated and analyzed. Blood pressure and serum creatinine levels were followed. Immediate technical success was 100%. All lesions except one were stented, either directly (43 ostial lesions) or after predilatation (22 ostial lesions). Visible debris were aspirated with the PercuSurge in all patients or removed with filters in 80% of the patients. Mean particle number and diameter were 98.1 +/- 60.0 per procedure (range, 13-208) and 201.0 +/- 76.0 microm (range, 38-6,206), respectively. Mean renal artery occlusion time was 6.55 +/- 2.46 min (range, 2.29-13.21) with the PercuSurge device. Mean time in situ (filters) was 4.25 +/- 1.12 min. Mean follow-up was 22.6 +/- 17.6 months (range, 1-47). Systolic and diastolic blood pressure declined from 169.0 +/- 15.2 and 104.0 +/- 13.0 mm Hg, respectively, to 149.7 +/- 12.4 and 92.7 +/- 6.7 mm Hg after the procedure. The mean creatinine level remains constant during the follow-up. At 6-month follow-up (45 patients), renal function did not deteriorate in any patient, whereas 8 patients with baseline renal insufficiency improved after the procedure. At 3 years (19 patients), renal function deteriorated only in 1 patient with renal insufficiency and in 1 patient treated for bilateral renal stenosis, one side without protection. These preliminary results suggest the feasibility and safety of distal protection during renal interventions to protect against atheroembolism and to avoid renal function deterioration. This technique's beneficial effects should be evaluated by randomized studies.     

旋毛虫肌蚴抗原诱导小鼠抗日本血吸虫保护性免疫的研究

目的：探讨旋毛虫幼虫抗原免疫小鼠对日本血吸虫攻击感染的交叉保护作用。方法：用４种不同的旋毛虫幼虫抗原制剂经颈部皮下多点免疫小鼠，然后用日本血吸虫尾蚴３０条或１００条攻击感染，攻击后４５ｄ剖杀小鼠，收集成虫、肝组织和粪便中的虫卵，并计数。结果：４种不同制剂均可诱导不同程度的保护性免疫效应，以旋毛虫幼虫匀浆上清可溶性抗原（ＴｓＳＡ）效果较好，减虫率为２１．３％，加用福氏佐剂时，其减虫率为２９．３％，肝组织和粪便中的虫卵减少率分别达４８％和５８．５％，平均每鼠肝组织和粪便中的虫卵ＥＰＧ减少率分别为４１．７％和４８．９％；当抗原剂量为１００００条旋毛虫并加用福氏佐剂时，其减虫率达３９．６％。结论：旋毛虫抗原免疫小鼠能诱导抗日本血吸虫攻击感染的免疫效应     

慢性肝病伴结核病时化疗方案的选择及肝损害的防治对策

目的探讨慢性肝病伴结核病时化疗方案的选择及肝损害的防治对策。方法170例慢性肝病伴结核病的患者在化疗前常规的作肝功能检河，并根据临床类型及其程度选择不同的化疗方案。对乙肝病毒复制指标阳性伴肝炎活动的患者进行抗病毒治疗。结果肝损害的发生率或恶化率慢性HBV携带者〈酒精性肝病、脂肪性肝病〈慢性肝炎轻度〈慢性肝炎中度〈慢性肝炎重度、肝硬化（P〈0．01）；抗病毒治疗的乙型肝炎肝损害的加重或恶化率低于非抗病毒治疗组（P〈0．05）；综合疗法与单纯化疗者肝损害好转与恶化的发生率和结核病的转归之间有明显的差异（P〈0．01）。结论对于慢性肝病伴结核病的患者，化疗前要做好肝功能状况的评估工作，并依据肝病的临床类型及其程度选择合适的化疗方案，对肝损明显及某些特殊群体要加强抗炎、护肝、免疫、增强等措施，伴HBV复制的活动性乙肝同时进行抗病毒治疗。     

Monoclonal antibodies against a 62 kDa proteinase of Trichomonas vaginalis decrease parasite cytoadherence to epithelial cells and confer protection in mice

Trichomonas vaginalis infects the epithelium of the genital tract. The mechanism by which it invades the tissue leading to the disease is not thoroughly understood. However, results of several studies seem to agree that parasite adhesion to epithelium cells is the initial step leading to infection in women. T. vaginalis is associated with high levels of proteolytic activity. The role of some of these proteinases in the development of infection has been demonstrated. The current study establishes the role of a 62 kDa excretion-secretion proteinase in parasite cytoadherence. Monoclonal antibodies (MAbs) against this enzyme were tested for their ability to inhibit this process. Three stable hybrid producers of IgG(1)class MAbs (4D8, 1A8, 3C11) against the 62 kDa proteinase were obtained. Two of them (4D8 and 1A8) showed parasite recognition by immunofluorescence. Parasite cytoadherence to a monolayer of HeLa cells was inhibited by the 4D8, 1A8 and 3C11 antibodies. MAb 4D8 administered 24 h before a challenge with T. vaginalis by the intraperitoneal route was able to protect the majority of mice. Nitric oxide levels in the serum of animals inoculated with MAb 4D8 and challenged with the parasite were significantly different from those recorded in mice treated with an unrelated MAb. These studies show that an appropriate antibody against 62 kDa proteinase can help the host resist a challenge by the intraperitoneal route with T. vaginalis.