托尼萘酸治疗老年戊型肝炎

目的：观察托尼萘酸治疗老年戊型肝炎的安全性及临床疗效。方法：56例老年戊型肝炎病人分为治疗组和对照组，2组病人均给予常规护肝、支持、对症治疗。治疗组36例，男性28例，女性8例：年龄（67&;#177;s11）a。加用托尼萘酸，2片，po，tid。对照组20例，男性16例，女性4例：年龄（66＋12）a，仅给予基础治疗。治疗后4，8wk时比较2组病人的临床指标改变。     

维生素A可减少HIV的传播但对新生儿有不同影响

据Medscape．com 4月7日报道（原载J Infect Dis2006；193，860-871），给予产后HIV（＋）的女性和其新生儿单—大剂量的维生素A虽不能减少病毒的母婴传播（MTCT），但能改善6周大HIV（＋）的婴儿的存活率。但是，对于母乳喂养的HIV（-）的新生儿来说，无论母体还是婴儿体内有大量的维生素A都可能使死亡率增加。     

吃虾 食之有道

虾营养极为丰富，含蛋白质是鱼、蛋、奶的几倍到几十倍；还含有丰富的钾、碘、镁、磷等矿物质及维生素A、氨茶碱等成分，且其肉质和鱼一样松软、易消化，不失为食用的营养佳品，对健康极有裨益；对身体虚弱从及病后需要调养的人也是极好的食物。[编者按]     

MMP-2、TIMP-2与碱烧伤后角膜新生血管形成的实验研究

目的:探讨基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-2组织型抑制剂(TIMP-2)在碱烧伤大鼠角膜新生血管(CNV)形成中的表达和意义。方法:采用碱烧伤大鼠角膜建立CNV模型,摘除角膜作病理切片,多形核白细胞(PMN)记数;免疫组化法检测MMP-2、TIMP-2的表达。结果:烧伤后1d角膜缘PMN开始增多,到CNV7d组PMN增加最明显,此后逐渐减少;免疫组化显示:MMP-2在CNV中阳性表达逐渐增加,于7d表达最明显,此后随炎性细胞的减少而减弱,21d后几乎无表达;TIMP-2则于早期变化不明显,7d表达开始升高,14d达高峰。结论:烧伤后CNV形成早期,MMP-2活性增高,继而TIMP-2表达增加,使MMP-2活性受抑,基底膜降解受阻,新生血管延伸停滞;CNV形成中,MMP-2的表达增加,并与角膜的炎性反应程度一致,PMN浸润可能是CNV形成的关键因素。     

超声电丛刺治疗后急性脑梗死患者神经功能缺损及实验室相关指标的变化

目的:观察超声电丛刺头穴丛刺法治疗急性脑梗死的效果,以及治疗前后体感诱发电位指标及血液生化指标变化。方法:①选择2003-01/2005-06在沈阳脑科医院神经内科住院的急性脑梗死患者261例,男160例,女101例。均为首次患病,且对治疗方案知情同意。将上述患者随机分为2组:丛刺治疗组131例,对照组130例。②丛刺治疗组:采用超声电丛刺治疗仪于头部电丛刺顶区(运动区),以100～200Hz疏密波电针通过6～8h,1次/d,1个疗程30次。对照组:均予以常规脑血管病药物同等治疗。丛刺治疗组和对照组均干预30d。两组疗效判定标准:治疗后神经功能缺损评分减少91%～100%为基本恢复,减少46%～90%为显著进步,减少18%～45%为进步。③采用酶联免疫法测定血浆α-颗粒膜蛋白水平;应用放射免疫法测定血浆血栓素A2水平;采用酶联免疫吸附法双抗体夹心法测定血浆D-二聚体水平;采用免疫透射比浊方法测定脂蛋白(a)水平。应用神经电生理检测仪检测体感诱发电位。④计数和计量资料差异比较采用χ2检验和t检验。结果:急性脑梗死患者261例均进入结果分析。①丛刺治疗组131例中:基本恢复31例,显著进步80例,进步15例,总有效率为96%(126/131);对照组130例:基本恢复14例,显著进步68例,进步12例,总有效率为72%(96/130);丛刺治疗组总有效率明显高于对照组(P<0.01)。②丛刺治疗组治疗后血浆α-颗粒膜蛋白、血栓素A2、D-二聚体和脂蛋白(a)含量较治疗前明显降低(P<0.01)。③丛刺治疗组治疗后体感诱发电位的波潜伏期与传导时间较治疗前明显缩短(P<0.01)。结论:超声电丛刺治疗急性脑梗死效果显著,可显著改善急性脑梗死患者体感诱发电位指标及血液生化指标。     

AMACR(P504S)、P63、34βE12联合检测在前列腺癌早期诊断中的应用

目的:探讨AMACR(P504S)、P63、34βE12联合检测在前列腺癌(PCa)早期诊断中的临床应用价值。方法:应用即用型组合式单克隆抗体和双酶标记的免疫组化MaxvisionTM一步法检测42例PCa、12例高级别前列腺上皮内瘤变(HGPIN)和30例良性前列腺增生(BPH)穿刺活检标本中AMACR、P63、34βE12的表达情况。比较Glea-son评分各组中AMACR阳性表达情况。结果:AMACR、P63、34βE12抗原在PCa和BPH穿刺标本中的表达差异均有极显著性(P<0.01),PCa组织中AMACR阳性表达率为100%,无P63和34βE12表达;BPH组织中均无AM-ACR表达,P63和34βE12均高表达。HGPIN中AMACR的阳性表达率(91.67%)与BPH差异有极显著性(P<0.01),与PCa差异无显著性(P>0.05);P63和34βE12阳性表达率HGPIN(100%)与PCa差异有极显著性(P<0.01),而与BPH差异无显著性(P>0.05)。AMACR表达强弱与PCa的Gleason评分无关(P>0.05)。结论:AMACR是PCa高度敏感和特异的标志物,P63和34βE12联合标记基底细胞的特异性高,3者联合检测能增加前列腺穿刺活检标本诊断的准确性,在PCa早期诊断中具有重要的临床应用价值。     

国产A482双盘封堵器经导管治疗室间隔缺损伴发膜部瘤的效果

2002年以来，Amplatzer膜部VSD封堵器、国产对称型双盘状和偏心型膜部VSD封堵器先后应用于临床，介入治疗已成为VSD的一种重要方法。我们自2002年7月开展VSD封堵术以来，已完成689例膜周型VSD伴发膜部瘤的封堵治疗。现对39例膜周部VSD伴发膜部瘤采用国产特制A482双盘非对称型封堵器经导管治疗的临床疗效进行评价。     

^1H-magnetic resonance spectroscopy screening for animals with acute cerebral infraction suitable forthrombolytic therapy

BACKGROUND: As a non-invasive technique which can provide comprehensive biological information, 1H-magnetic resonance spectroscopy (1H-MRS) may provide valuable reference data for irreversible recovery or reversible changes in ischemic tissue after stroke. OBJECTIVE: To monitor and evaluate the effect of the urokinase thrombolytic therapy after experimental acute cerebral ischemia by 1H-MRS technology and investigate its adaptability. DESIGN: Randomly controlled animal study. SETTINGS: Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science. MATERIALS: Eleven healthy adult Sprague-Dawley (SD) rats, weighing 260–300 g and of both genders, were supplied by Experimental Animal Center of Tongji Medical Collage, Huazhong University of Science and Technology [SCXK (e) 2004-007]. 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. METHODS: The experiment was carried out in Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science from August 2003 to December 2005. ① The rats were randomly divided into 30-minute self-thrombo-embolism group (n =6) and 60-minute self-thrombo-embolism group (n =5). Six rats in 30-minute self-thrombo-embolism group were occluded with clot embolus for 30 minutes and 5 rats in 60-minute self-thrombo-embolism group were occluded for 60 minutes. 10 000 U/kg urokinase was dissolved in 2 mL saline and the operation lasted for 5 minutes. ② 1H-MRS was performed before thrombolysis and at 3 hours and 24 hours after successful embolization. The metabolic changes of N-acetyl-L-aspartic acid (NAA)/phosphocreatine (PCr) + creatine (Cr), choline phosphate (Cho)/PCr+Cr and lactic acid (Lac)/PCr+Cr in the region of interests were analyzed. ③ The T2W image was conducted 24 hours after the thrombolytic therapy with TR=500 ms and TE=25 ms. ④ The subjects were sacrificed immediately after 1H-MRS and the brain tissues were cut into pieces and stained with HE method; in addition, pathological changes were observed under optic microscope. MAIN OUTCOME MEASURES: ① Metabolic changes of NAA/PCr+Cr, Cho/PCr+Cr and Lac/PCr+Cr in the region of interests; ② T2W image at 24 hours after the thrombolysis; ③ pathological observation of brain tissue. RESULTS: Eleven rats were all involved in the final analysis. ① Metabolic changes in the region of interests : In 30-minute self-thrombo-embolism group, the Lac peak emerged immediately after the embolism, but the ischemic zone decreased 3 hours after the thrombolytic therapy (0.252±0.01, 0.603±0.01, P < 0.01). Lac/(PCr+Cr) ratio was 0.290±0.01 at 24 hours after thrombolysis, which was higher than that at 3 hours after thrombolysis (P < 0.01). The NAA/ (PCr+Cr) ratio decreased significantly at 3 hours after the thrombolysis as compared with that before thrombolysis (0.922±0.16, 1.196±0.01, P < 0.05). In 60-minute self-thrombo-embolism group, the Lac/(PCr+Cr) ratio was higher at 3 hours after thrombolysis than that before thrombolysis (0.846±0.12, 0.601±0.11, P < 0.05) and the NAA/(PCr+Cr) decreased at 3 hours after the embolism. Fluctuation of NAA/ (PCr+Cr) ranged from 0.68 to 0.75 before thrombolysis and from 0.71 to 0.75 at 3 hours after thrombolysis. ② T2W image: T2W image showed that 2 subjects in 30-minute self-thrombo-embolism group whose Lac/NAA was higher than 0.7 suffered from intracranial hemorrhage. This meant that the subjects with Lac/NAA > 0.7 were more likely to suffer from intracranial hemorrhage. ③ Histological and morphological examinations: Optic microscope demonstrated that interspace surrounding nerve cells was widened at ischemic center; neurons were swelling; nucleus was stained lightly; pyknosis and mesenchymal edema were mainly observed in lateral cortex of brow and vertex and in lateral part of corpus striatum. CONCLUSION: ①Compound parameters in ischemic area before thrombolysis should be regarded as an important predicting marker for thrombolytic therapy, effect evaluation and termination. ② 1H-MRS combining with other imaging technique is a detecting way for screening cases who are suitable for thrombolytic therapy.     

42例重症心脏瓣膜病瓣膜置换术的麻醉

目的 总结42例重症心脏瓣膜病围手术期的麻醉处理经验。方法 采用芬太尼30ug／kg、咪唑安定0．2～0．3mg／kg、维库溴胺0．2～0．25mg／kg静滴，异氟醚吸入麻醉，术后适量应用血管活性药物改善循环并适当延长术后拔管时间。结果与麻醉诱导前相比，诱导期血流动力学无明显改变(P>0．05)，诱导后、插管时、插管后各组间血流动力学无明显变化(组间P>0．05)。术后死亡4例，死于急性肾功能衰竭1例，顽固性低心排1例，多器官功能衰竭l例，顽固性心衰1例。死因均与术前病史较长，全身其它脏器功能受损严重和术中主动脉阻断时间较长有关。术后平均呼吸支持时间(25．6±6．8)h。结论 中等剂量芬太尼为主的静吸复合麻醉适用于重症心脏瓣膜病患者，术后适量应用血管活性药物及延长呼吸支持时间有利于患者的恢复。