The value of serial determination of MEGX and hyaluronic acid early after orthotopic liver transplantation

Abstract. Post-transplant assessment of early graft function has become an essential part of monitoring, especially when deciding on retransplantation. If primary non-function is indicated, retransplantation is inevitable; early graft dysfunction may be related to subsequent complications. In a prospective study in 84 patients after orthotopic liver transplantation (OLT) we measured aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), bilirubin (BIL), prothrombin time, MEGX formation, hyaluronic acid (HA) and soluble interleukin-2 receptor (sIL-2R) concentrations during the first 2 postoperative weeks; graft outcome was followed over 4 months. The aim of this study was to determine whether graft survival could be predicted by such variables early after OLT. Compared with patients with stable graft function (n= 25), patients with post-transplant icteric cholestasis (n= 30) exhibited no difference in graft survival, despite a decrease in MEGX formation to a nadir median of 12 μgL^-1 on day 10. Patients with rejection (n= 8) and septicaemia (n= 6) showed a marked decrease in MEGX values and an increase in HA and sIL-2R concentrations between postoperative days 3 and 7. Patients with primary non-function (PNF; n= 5) were characterized by strongly reduced MEGX formation (median 4 μgL) and increased HA values (median 2300 μgL^-1) on day 3 after OLT. A total of 24/84 grafts were lost within 120 days. In a survival analysis using the Cox proportional hazards regression, HA and MEGX values on day 1 were the only independent variables entering the model that showed an adequate prognostic sensitivity. At cut-off points of 22 μgL^-1 (MEGX) and 730 μgL^-1 (HA) the combined use of these parameters in a parallel approach yielded a sensitivity of 58% with a corresponding specificity of 95% for 120-day graft survival. These findings suggest that the inclusion of MEGX and HA in postoperative monitoring of OLT patients may be helpful in the early prediction of graft survival.     

国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较

目的：了解中国不同地区间中老年人群膝关节骨性关节炎患病危险因素。方法：调查时间为2005—07／08。①从中国六大行政区（西北，华北，华东。中南，东北，西南）选出六城市（西安，石家庄，上海。广州，哈尔滨市，成都），用分层多阶段整群抽样方法，抽取6218名40岁及以上具有正式户口常住男女人群进行膝关节骨性关节炎的流行病学问卷调查（包括一般情况、现病史、既往史、体格检查、X射线片检查情况和疾病诊断6个方面，共计94个问题141个变量指标），并对其中4808名有症状者进行X射线平片膝正侧位投照。②膝关节骨性关节炎诊断标准为临床症状阳性加X射线Kellgren ＆ Lawrence分级二级及以上者。③计算患病率，并采用Epilnf06．0和SPSS 10．0软件对其中83个变量进行多因素非条件Logistfc回归分析，表示疾病与暴露因素之间联系强度的指标用比值比（OR），若OR〉1，说明疾病发生危险性增加，与暴露因素呈正关联；若OR〈1，说明疾病发生危险性减少，与暴露因素呈负关联。 结果：①六城市膝关节骨性关节炎总患病率为15．6％，其中西安7．7％，石家庄11．2％，上海9．8％。广州30．5％，哈尔滨16．9％，成都17．5％，各城市患病率比较差异显著（P〈0．01）。②Logistic回归分析膝关节骨性关节炎在大部分城市有共同的危险因素如年龄大（OR=1．032—1．181），使用蹲坑排便年限长（OR=1．021-1．077），体质量高（OR=1．048—1．073），和开始饮酒年龄大（OR=1．008～1．028）；而从事专职体育运动（OR=1．651，西安），骨质疏松病史（OR=3．311，石家庄），吸烟（OR=2．654，石家庄），类风湿关节炎病史（OR=4．964，上海），文化程度高（OR=2．593，上海），女性（OR=2．510，广州），姐妹骨关节炎史（OR=13．251，哈尔滨），母亲骨关节炎史（OR=5．683，成都）等危险因素分别在不同地区出现． 结论：年龄大、使用蹲坑排便年限长、体质量高和开始饮酒年龄大是中国六地区膝关节骨性关节炎患病的共同危险因素，同时，不同地区主要危险因素又有一定差异。     

Nail incorporation kinetics of terbinafine in onychomycosis patients

Patients with toe-nail onychomycosis were treated with terbinafine (250 mg daily, n= 20) for either 6 or 12 weeks in a randomized double-blind study. Plasma and distal nail clippings were taken before initiation of therapy and 1, 6, 12, 18, 24, 36 and 48 weeks thereafter. Analytical data of terbinafine extracted from nail clippings or plasma were obtained by high-performance liquid chromatography (HPLC). Nail extracts and isolated HPLC terbinafine peaks were analysed using a combined gas chromatography - mass spectroscopy system (GC-MS) for unequivocal identification of the drug. Terbinafine could be detected in the distal nail in the majority of the patients within 1 week of starling therapy. Maximum terbinafine levels of 0·52 and 1·01 μg;g were measured after 18 weeks in the 6- and 12-week treatment groups, respectively. While plasma levels decreased rapidly after termination of therapy terbinaiine was detected in the nails as long as 36 weeks (6 weeks treatment) and 36 weeks (12 weeks treatment) after termination of therapy at a range of 0·–0·19 μg/g. The drug concentrations measured at all time points are well above the minimum inhibitory concentration (MIC) tor dermatophytes and other fungi, These data suggest that the drug readies the nail plate rapidly and persists there for several months after cessation of active treatment.     

HOW TO EVALUATE CLINICAL PARAMETERS AT A GLANCE

Schiøtz, P.O., Beck, B. and Pedersen, M. (Paediatric Department TG, Rigshospitalet, Copenhagen, Denmark). How to evaluate clinical parameters at a glance. Acta Paediatr Scand 1982; suppl 301: 121-124. — A brief introduction is given to the practical approach in cystic fibrosis patient care, which is used at the Danish Cystic Fibrosis centre employing Dr. Flensborg's flowsheets.     

应用28通道近红外光谱分析恢复过程中老年期抑郁症患者前额叶的激活特征

目的：认知功能障碍是老年期抑郁症的可逆性症状，试验以认知功能研究为突破口，采用28通道的近红外光谱技术分析处于恢复过程中的老年期抑郁症患者在执行词语流畅性测验时前额叶的激活特点，探讨老年期抑郁症的发病机制。 方法：①分组：患者组为2006～03／12首都医科大学附属北京安定医院收治的12例处于恢复过程中的老年期抑郁症患者，入组时符合DSM-4有关重度和中度抑郁发作或复发的标准诊断，首次发病年龄≥60岁，均服用SSRIs类抗抑郁药物治疗。对照组为12例性别、年龄和教育程度与患者组相匹配的健康志愿者。所有受试者排除脑器质性病变：②试验方法：所有受试者接受近红外光谱测查，在28通道的CW5（TechEnInc．American）NIRS系统上完成。通过近红外光谱系统监测被试者在执行词语流畅性测验任务过程中，前额叶氧合血红蛋白和脱氧血红蛋白浓度的变化，从而反映前额叶认知任务相关的激活效应。采用组块设计的词语流畅性测验作为认知激活任务，任务范式包括词语重复任务和词语流畅性任务两种试验。 结果：24例受试者均进入结果分析。①在健康老年人和处于恢复过程中的老年期抑郁症患者，词语流畅性测验能够激活双侧前额叶．未发现半球单侧化激活效应。②处于恢复过程中的老年期抑郁症患者在词语流畅性测验任务过程中，左侧前额叶激活效应较对照组减弱。③尽管在健康老年人和处于恢复过程中的老年期抑郁症患者，近红外光谱显示了不同的激活模式，但词语流畅性测验的成绩不存在显著性的组间差异（P〉0．05）。 结论：处于恢复过程中的老年期抑郁症患者存在词语流畅性测验相关的功能性左侧前额叶功能减退，微血管功能失调和多巴胺系统异常也许在老年期抑郁症的病理生理学机制中起重要作用。     

新型长循环紫杉醇脂质体的制备及其细胞毒性

目的:制备一种新型的长循环紫杉醇脂质体,评价其质量,并考察对胃癌细胞(BGC823)的抑制作用。方法:实验于2006-05/11在凯里学院化学系实验室和黔东南州疾病预防控制中心理化科检验室进行。①包封率测定:采用超声薄膜法制备紫杉醇脂质体,用RP-HPLC测定紫杉醇脂质体的药物包封率。②稳定性测定:将紫杉醇脂质体分散在pH为6.5的磷酸缓冲液里,存放在4℃冰箱中30d,观察其包裹量的变化。③对胃癌细胞(BGC823)的抑制作用:MTT法考察在5,10,15,20mg/L4个不同药物浓度下,紫杉醇脂质体对处在对数生长期的BGC823细胞增殖的影响,并用紫杉醇游离药物作为对照。结果:①经RP-HPLC检测,这种长循环紫杉醇脂质体的药物包封率高达97.6%。②紫杉醇脂质体存放在4℃冰箱中,在长达1个月时间内不见絮凝状沉淀,在保存3,8,15,22,30d后,药物在脂质体颗粒中的包裹量分别为97.3%,96.2%,95.6%,94.9%和94.2%,在30d时间里紫杉醇脂质体在缓冲液中的药物泄漏仅有6%。③体外细胞毒性实验表明,5,10,15,20mg/L的紫杉醇注射液对BGC823细胞的抑制率分别为35.24%,48.37%,57.49%,74.84%,而相同药物浓度下的紫杉醇脂质体对BGC823细胞的抑制率为33.46%,44.15%,51.94%,68.64%。结论:①实验置备的紫杉醇脂质体实现了药物的高包封率,而且非常稳定。②紫杉醇药物浓度相同条件下,紫杉醇脂质体对BGC823细胞的抑制率低于游离的紫杉醇药物,说明脂质体对紫杉醇起到了一个很好的缓释作用。     

Short report: long-term management of peptic ulcer disease with ranitidine in Germany

One hundred and twenty-five patients with duodenal ulcer disease were given continuous ranitidine therapy after initial acute healing. Cumulative remission rates indicated that 95 % of patients were ulcer-free after 1 year, 89% at 2 years, 81% at 3 years, 70% at 4 years and 60% at 5 and 6 years. Nine patients had a second recurrence after healing of the first. No patient developed an ulcer complication. These results support the view that long-term continuous ranitidine therapy prevents ulcer recurrence and complications.     

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is a rare neoplasm that accounts for approximately 0.1–0.2% of all esophageal tumors. Many cases are advanced at the time of diagnosis, and survival time is very short. The literature lists only four long‐term (> 5 years) survivors after optimal surgical excision. We present the case of a geriatric woman with a malignant melanoma of the esophagus that showed no pigment on gross inspection.