陈祖皋以子午流注论治内伤咳嗽医案 3 则

陈祖皋先生,系原浙江省绍兴市人民医院中医科医生,乃绍兴当代名医,师承于绍兴当代名医潘文藻,是绍派伤寒医家何廉臣的再传弟子。从事中医内科临床工作五十余载,组方灵活,源出经典,学验俱丰,造诣甚深,重于实践,师古不泥,遣药组方不拘一格,圆机活法,随证而治,疗效显著。     

油茶皂甙对实验动物造血机能的影响

目的：研究油茶皂甙对豚鼠和罗非鱼造血功能的影响。方法：比较油茶皂甙（1mg/kg）处理前和处理后豚鼠红细胞和血红蛋白量计数变化。罗非鱼分对照组和油茶皂甙处理组，分别在清水和含1ppm油茶皂甙水饲养6天后，再同时置入清水中净养，观察其存活20％的最高温度。结果：豚鼠用药前后红细胞计数和血红蛋白含量改变轻微，无明显统计学差异（P＞0．05），对照组和油茶皂甙处理组罗非鱼在清水中饲养的耐受最高温度为41．5℃，但在含油茶皂甙水中能耐受的最主温度为36℃。结论：油茶皂甙可短暂，轻微地降低红细胞和血红蛋白，但并不影响造血功能。     

Agreement between different frequencies of measurements in ambulatory blood pressure monitoring.

The purpose of this study was to determine the degree of agreement among different frequencies of blood pressure measurements (FoM) in 24-hour ambulatory blood pressure monitoring (ABPM) in their ability to obtain useful clinical information. ABPM records were obtained with a Del Mar IV Avionics device from 49 hospitalised preeclamptic women with a FoM of 7 per hour (high-FoM). With these records, we simulated two sets of data as if measurements had been recorded at a rate of 1 measurement per hour (low-FoM) and of 2 per hour (medium-FoM). Diastolic blood pressure > 89 mmHg defined hypertension and > 109 mmHg, severe hypertension The median and 25th and 75th centiles for the differences in hypertensive rate detected (expressed as percentage points) between lowFoM vs. high-FoM was 0.00 (- 3.4-3.00) and between medium-FoM vs. high-FoM,- 1.04 (- 3.7-1.5). The agreement in the detection of severely affected patients was 85% (CI 95%: 74-96) between low-FoM and high-FoM and 87% (CI 95%: 77-98), between medium-FoM and high-FoM. Average blood pressure was similar in the three FoMs studied at day-time and night-time. We did not find any strong argument to perform ABPM at a high-FoM. Lower FoM are more comfortable for the patient and could reduce equipment deterioration, while providing equivalent information to that supplied by high-FoM.     

CD8 expression alters the fine specificity of an alloreactive MHC class I-specific T hybridoma.

The influence of CD8 on the fine specificity of MHC class I-restricted T cell allorecognition was evaluated by comparing the reactivity of CD8- and CD8-transfected forms of an allospecific, H-2Kb-restricted T hybridoma. The CD8- T hybridoma responded to cells expressing H-2Kb, H-2Kbm6, and the individual H-2Kb----bm10 back mutations 165V----M, 173K----E, and 174N----L. Under the same conditions the CD8- T hybridoma responded poorly or not at all to cells expressing H-2Kbm10, H-2Kbm8, the individual H-2Kb----bm10 back mutants 163T----A and 167W----S, and the individual H-2Kb----bm8 back mutations 22Y----F and 24E----S. In contrast, T hybridoma cells expressing high levels of CD8 reacted strongly with antigen presenting cells (APC) expressing H-2Kb and H-2Kbm6 molecules, as well as APC expressing H-2Kbm10 (weakly), H-2Kbm8, and all five individual H-2Kb----bm10 and the two H-2Kb----bm8 back mutants 22Y----F and 24E----S. The mutations which distinguish the T cell recognition of both H-2Kbm10 and H-2Kbm8 from H-2Kb are predicted to control the interaction of these class I molecules with antigenic peptides in the binding site, implying an important role for peptide antigen in T cell allorecognition. Nonetheless, CD8 expression by the H-2Kb-restricted T cells conferred novel or enhanced alloreactivity with cells expressing H-2Kbm10, H-2Kbm8, and each of the individual H-2Kb----bm10 and H-2Kb----bm8 back mutants. These findings reflect an important role for CD8 in influencing the fine specificity of MHC class I recognition by T cells and may indicate a limited structural role for peptide antigen in defining the ligand recognized by these alloreactive T cells.     

Effects of 1,3-di-o-tolylguanidine (DTG), a sigma ligand, on local cerebral glucose utilization in rat brain.

The 2-deoxy-D-[1-14C]glucose ([14C]DG) method was used to examine the effects of the relatively selective sigma ligand 1,3-di-o-tolylguanidine (DTG) on cerebral metabolism in freely moving rats. Each animal received an i.p. injection of DTG (0.2, 1, or 5 mg/kg) or normal saline 20 min prior to the infusion of [14C]DG. DTG induced dose-dependent changes in local cerebral glucose utilization (LCGU) in several motor and limbic structures. Most structures showed increases in LCGU, with a maximum effect at 1 mg/kg. The most profound increases in LCGU were observed in brain regions that are rich in sigma receptors. These included cerebellar and related nuclei (interpositus, lateral and medial cerebellar n., vestibular n., olivary n.), ambiguus n., superior colliculus (superior layers), hippocampus (CA2, CA3, DG), n. basalis of Meynert interpeduncular n., and the substantia nigra pars compacta and pars reticulata. No significant decreases in glucose utilization were observed at any dose. Although the areas affected by DTG are similar to those previously reported for other sigma ligands, future studies employing a range of doses for additional selective sigma ligands must be carried out in order to confirm whether these changes in LCGU were sigma-mediated.     

乳腺浸润性小叶癌超声特征与腋窝淋巴结转移的相关性研究

[目的]本研究旨在探讨乳腺浸润性小叶癌(Invasive lobular carcinoma,ILC)患者腋窝淋巴结转移(axillary lymph node metastasis, ALNM)的超声特征及其他参数影响因素。[方法]收集病理已证实为ILC且术前行超声检查的病例91例,根据有无腋窝淋巴结转移分为ALNM组和无ALNM组,采用回顾性研究,收集患者的超声图像特征、术前CA153以及免疫指标等。[结果] 91例ILC患者中,45例发生ALNM,46例未发生ALNM。单因素x_²分析显示,病灶>23.5mm、纵横比≧1、周边高回声晕等超声特征,以及术前CA153>6.5U/ml与ALNM有关(P<0.05)。多因素logistic回归分析显示,周边高回声晕和术前CA153>6.5U/ml是影响ILC患者ALNM的独立危险因素(P<0.05)。[结论]周边高回声晕和术前CA153>6.5U/ml是影响ILC患者发生ALNM的独立危险因素,可作为临床实践参考指标。     

CIK细胞临床应用技术规范探讨

 细胞因子诱导的杀伤细胞（cytokin induced killer cells，CIK细胞）因具有体外增殖倍数高、抗瘤谱广、杀瘤活性强、副作用极小等特点而受到关注。研究表明，CIK细胞对肿瘤细胞的杀伤作用是LAK细胞的100倍[1]。CIK细胞过继性免疫治疗是肿瘤治疗中的一项新技术，目前已逐步在临床上应用，因此，制订科学、严格的技术规范对该技术的正确使用及推广意义重大。但迄今国内还没有关于CIK细胞培养和临床应用的统一技术规范。无锡旺庄医院生物治疗中心参考国家食品药品监督管理局1999年制订的《新生物制品审批办法》和美国FDA 1998年制订的《人体细胞治疗和基因治疗指导原则》，结合数年的CIK细胞临床应用经验，制订出我们的CIK细胞临床应用技术规范，现介绍如下，供同行切磋和讨论，以期促成全国性统一技术规范的早日制定。     

Variable MHC class I engagement by Ly49 natural killer cell receptors demonstrated by the crystal structure of Ly49C bound to H-2K(b)

The Ly49 family of natural killer (NK) receptors regulates NK cell function by sensing major histocompatibility complex (MHC) class I. Ly49 receptors show complex patterns of MHC class I cross-reactivity and, in certain cases, peptide selectivity. To investigate whether specificity differences result from topological differences in MHC class I engagement, we determined the structure of the peptide-selective receptor Ly49C in complex with H-2K(b). The Ly49C homodimer binds two MHC class I molecules in symmetrical way, a mode distinct from that of Ly49A, which binds MHC class I asymmetrically. Ly49C does not directly contact the MHC-bound peptide. In addition, MHC crosslinking by Ly49C was demonstrated in solution. We propose a dynamic model for Ly49-MHC class I interactions involving conformational changes in the receptor, whereby variations in Ly49 dimerization mediate different MHC-binding modes.     

采用永磁悬浮的永久性左心室辅助装置

研制出一台采用永磁轴承的左心室辅助装置（LVAD）。该装置包括一个定子和一个转子，采用径向驱动方式；转子包括驱动磁钢和叶轮，电机定子线圈和泵壳组成定子。装置设计采用了一种特殊结构的永磁轴承。转子的位置测量表明，转子稳定悬浮的前提条件是必须有较高的转速（大于3250r／min）且流量大于1L/min。用猪血为介质所做的液动力测试表明，当转速达到3500r／min～4000r／min时，血泵输出流量达到4L/min～6L/min，输出压力达到100mmHg。该装置重200g，最大处直径为40mm。