重症脑出血微创术后下呼吸道感染病原学分析

目的:重症脑出血微创术后气管切开病人痰培养病原菌分布与耐药情况分析,其院内感染发生的原因、探讨防治对策。方法:应用痰培养检出的病原菌及耐药性分析。结果:重症脑出血微创术后气管切开病人下呼吸道感染41例,其中G-杆菌26例占63.4%,G 球菌15例占36.6%,其中金葡菌11例,药敏仍以敏感菌株为主,但耐药菌株有增多趋势。结论:重症脑出血微创术后气管切开病人下呼吸道感染以G-杆菌为主,G 球菌以金葡菌为主,仍以敏感菌珠为主,耐药有增多趋势。万古霉素对G 球菌,氨曲南对G-杆菌敏感性较敏感,故在培养结果未出来之前经验用药是非常重要的。     

骨桥蛋白在人脑动静脉畸形的表达及意义

目的研究骨桥蛋白(OPN)在脑动静脉畸形(CAVM)的血管组织及其在放射、栓塞治疗后血管病理变化中的表达。方法采用免疫组化方法检测42例CAVM病理标本及对照组10例内减压手术所获脑组织血管中OPN的表达。结果26例无术前治疗史的畸形血管组织中22例有OPN的表达,主要见于CAVM的静脉部分,在粥样硬化样病变的动脉处也有表达。对照组脑组织的血管中未见OPN的表达;有伽玛刀治疗史的5例中,2例在早、中期放射反应的动脉中可见OPN的明显表达;在经历栓塞治疗的11例中,7例在新生内膜组织或异物巨细胞中有强阳性表达。结论人CAVM血管组织中多有OPN的表达,这可能是其适应于适应血流动力学状态而具有的血管重塑的表现,并可能在放射及栓塞治疗后的血管重塑中发挥重要作用。     

Characterization of an immunologic polymorphism (D79H) in the heavy chain of factor V.

BACKGROUND: During the study of a family with hereditary factor (F)V deficiency (FV Amersfoort, 1102 A > T in exon 7) we identified an individual with 5% FV heavy chain antigen (FV(HC)) and 50% FV light chain antigen (FV(LC)). Further testing revealed that apart from the FV Amersfoort allele a second variant FV allele was segregating in this family, which encodes for a FV molecule with a reduced affinity for mAb V-23 used in the FV heavy chain ELISA (ELISA(HC)). OBJECTIVE: Identification and characterization of the molecular basis responsible for the reduced affinity of the variant FV for mAb V-23. METHODS: Family members of the proband were screened for mutations in the exons coding for the heavy chain of FV, after which the recombinant variant FV could be generated and characterized. Next, the cases and controls of the Leiden Thrombophilia Study (LETS) were genotyped for carriership of the variant FV. RESULTS: In the variant FV allele a polymorphism in exon 3 (409G > C) was identified, which predicts the replacement of aspartic acid 79 by histidin (D79H). Introduction of this mutation in recombinant FV confirmed that it reduces the affinity for binding to mAb V-23. The substitution has no effect on FV(a) stability and Xa-cofactor activity. In Caucasians the frequency of the FV-79H allele is approximately 5%. Analysis of the LETS revealed that the FV-79H allele is not associated with FV levels (FV(LC)), activated protein C sensitivity (using an activated partial thromboplastin time-based test) or risk of venous thrombosis (OR 1.07, CI 95: 0.7-1.7). CONCLUSION: The D79H substitution in FV should be considered as a neutral polymorphism. The monoclonal antibody V-23, which has a strongly reduced affinity for FV-79H, is not suitable for application in diagnostic tests.     

磁场治疗白兔脑出血的安全性及疗效的实验研究

目的　探讨磁场治疗对实验性脑出血的治疗作用和安全性。方法　实验一 :5 0只大耳白兔被钩破大脑中动脉以建立脑出血模型。用CT扫描和解剖的方法观察脑出血的情况。实验二 :45只大耳白兔随机分为 0 .4T组、0 .8T组和对照组 ,每组 15只。每只白兔均采用实验一的方法建成脑出血模型。磁疗前CT扫描观察出血情况 ,磁疗后CT扫描观察血肿吸收情况。结果　实验一 :5 0只大耳白兔大脑中动脉钩破术后均出现对侧后下肢无力 ,肌张力降低 ,回缩反射减弱或消失。CT和解剖证实有脑出血。实验二 :45只大耳白兔均成功建成脑出血模型。磁疗前CT扫描 3组之间脑出血差异无显著性意义 (P >0 .0 5 ) ;磁疗后CT扫描 2磁疗组之间血肿吸收差异无显著性意义 (P >0 .0 5 ) ,与对照组比较血肿吸收差异有显著性意义 (P <0 .0 1)。结论　用钩破兔大脑中动脉的方法可建立脑出血动物模型。磁场治疗可促进实验性白兔脑出血的血肿吸收 ,且不产生继发性脑出血     

三维CT脑血管造影在脑动脉瘤诊断中注意点

目的探讨三维CT脑血管造影(3D-CTA)在诊断脑动脉瘤时的注意事项。方法回顾总结3D-CTA检查的106例蛛网膜下腔出血(SAH)病例,其中14例初次3D-CTA显示动脉瘤不清或发现颅内非动脉瘤样血管异常者,对其进行DSA脑血管造影检查。结果初次3D-CTA检查正确诊断脑动脉瘤92例,其中16例为多发脑动脉瘤,共检出115个。余14例因诊断不明确进而实施DSA脑血管造影检查,其中确诊动脉瘤合并烟雾病2例、严重脑血管痉挛致动脉瘤显示不清2例、脑动静脉畸形1例(此5例与3D-CTA所见一致);在3D-CTA扫查范围外发现脑动脉瘤2例。对上述阳性诊断的99例进行手术,并得到证实。另7例在3D-CTA和DSA检查未发现引起SAH的原因病灶,给予保守治疗。结论在脑动脉瘤诊断中,3D-CTA具有较好的精确性。在判断动脉瘤与颅骨位置关系、操作的便捷性和经济性等方面明显优于DSA。在应用3D-CTA对脑动脉瘤进行诊断时,有必要根据患者和设备的具体情况进行个性化设计,方能减少漏诊、误诊。     

Von Willebrand factor, platelets and endothelial cell interactions

Summary.  The adhesive protein von Willebrand factor (VWF) contributes to platelet function by mediating the initiation and progression of thrombus formation at sites of vascular injury. In recent years there has been considerable progress in explaining the biological properties of VWF, including the structural and functional characteristics of specific domains. The mechanism of interaction between the VWF A1 domain and glycoprotein Ibα has been elucidated in detail, bringing us closer to understanding how this adhesive bond can oppose the fluid dynamic effects of rapidly flowing blood contributing to platelet adhesion and activation. Moreover, novel findings have been obtained on the link between regulation of VWF multimer size and microvascular thrombosis. This progress in basic research has provided critical information to define with greater precision the role of VWF in vascular biology and pathology, including its possible involvement in the onset of atherosclerosis and its acute thrombotic complications.     

脑梗死OCSP分型和预后

目的了解脑梗死患者OCSP临床分型的构成及不同亚型与预后及复发的关系。方法采用回顾性队列研究,登记2002年1月~2005年6月第四军医大学西京医院神经内科确诊的617例脑梗死患者,按照OCSP标准分型并进行随访,分析各亚型与预后及复发的关系。结果OCSP各亚型构成比分变为:TACI占7.3%,PACI23.3%,POCI6.0%,LACI63.4%,分型与预后明显相关,TACI的预后最差,POCI和LACI预后相对较好,PACI次之,卒中复发与分型无明显相关。结论OCSP分型作为一种脑梗死临床分型方法,可以为脑梗死的预后判断提供参考依据。     

Is endoscopic one‐piece mucosal resection essential for early gastric cancer?

Background: Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However, the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods: We investigated 1101 EGCs that had been resected by EMR at the National Cancer Center Hospital (NCCH), Tokyo, Japan, according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results: The recurrence rate of non‐evaluable resection was higher than that of evaluable resection (P < 0.0001). Eighty‐three lesions among 772 lesions in the JGCA group were non‐evaluable. Thirty‐seven leisons among 329 lesions in the NCCH group were non‐evaluable. There was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.8329). However, the rate of curative resection was lower in the NCCH group than in the JGCA group (P = 0.0009). In piecemeal resection, there was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.0527). In one‐piece resection, the rate of non‐evaluable resection was lower in the NCCH group than the JGCA group (P = 0.0137). Conclusion: Based on our series of cases, we propose one‐piece resection as a gold standard for EMR because it enables accurate histological evaluation, even in the EMR, according to the expanded indication.     

Decreased Risk of Renal Allograft Thrombosis Associated With Interleukin-2 Receptor Antagonists: A Report of the NAPRTCS

Graft thrombosis is the most common cause of first year graft failure in pediatric renal transplantation. The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database was analyzed for cases of graft failure due to thrombosis among patients transplanted from 1998 to 2004. The impact of interleukin-2 (IL-2) receptor antagonists as induction therapy was determined. There were a total of 51 graft failures due to thrombosis among the 2750 reported renal transplants (1.85%) (95% CI (1.39%, 2.41%)). This represents the most common cause of graft loss during the first year post-transplant accounting for 35% of first year losses and 18% of all graft losses. The incidence of thrombosis among patients who received IL-2 receptor antibodies was 1.07% (12/1126) compared to 2.40% (39/1624) among patients who did not (OR 0.44, 95% CI 0.23, 0.84, p = 0.014). Use of IL-2 receptor blockade was the only significant prognostic factor in a multivariate model with previously identified risk factors. Analysis of NAPRTCS data found that the use of IL-2 receptor antibodies as induction therapy is associated with a significantly decreased risk of graft failure due to thrombosis. This provocative finding requires further investigation to determine whether thrombotic failure can be decreased by this therapeutic strategy.