Tocilizumab en el tratamiento del rechazo humoral crónico activo resistente a terapia estándar

IntroductionThere is no consensus on the most appropriate treatment for chronic active antibody-mediated rejection (cAMR). Recent studies suggest that treatment with tocilizumab (TCZ) may stabilize graft function, decrease the intensity of donor-specific HLA antibodies (DSAs) and reduce inflammation of microcirculation.Patients and methodsObservational study with renal allograft recipients diagnosed with cAMR (n = 5) who had not submitted a response to traditional treatment based on the combination of plasma replacements, immunoglobulins, and rituximab. Patients were told to be treated with TCZ as compassionate use in six doses per month (8 mg/kg/month). Renal function, proteinuria, and the intensity of DSAs were monitored during follow-up.ResultsFive patients, average age 60 ± 13 years, three male and two retrasplants (cPRA average 55%) with preformed DSAs. Treatment with TCZ was initiated within 47 ± 52 days of biopsy. In two cases treatment was discontinued after the first dose, by severe bicitopenia with cytomegalovirus viremia and by graft failure, respectively. In the three patients who completed treatment, no stability of renal function (serum creatinine from 1.73 ± 0.70 to 2.04 ± 0.52 mg/dL, e-FGR 4 6 ± 15 to 36 ± 16 mL/min), showed increased proteinuria (3.2 ± 4.0 to 6.9 ± 11.0 g/g) and the intensity of DSAs maintain stable. No changes were observed in the degree of inflammation of microcirculation (g + pt 4.2 ± 0.8 vs. 4.3 ± 1.0) or in the degree of transplant glomerulopathy (cg 1.2 ± 0.4 vs. 1.8 ± 1.0).ConclusionsTCZ therapy does not appear to be effective in modifying the natural history of chronic active antibody-mediated rejection, does not improve the degree of inflammation of microcirculation and does not reduces the intensity of DSAs.     

某设备所致脉冲X射线辐射场测量与防护评价

目的 了解某设备实验条件下不同位置脉冲X射线电离辐射水平，提出适当的防护建议。方法 采用热释光测量方法，分别在设备舱周围不同方向不同距离布放热释光剂量计，累积一定数量脉冲辐射后进行测量；采用电离室型X、γ剂量率仪（FJ-347A）实时测量工作状态下不同距离处电离辐射剂量率水平。依据《电离辐射防护与辐射源安全基本标准》（GB18871—2002）规定的职业照射人员和公众个人剂量限值提出不同工作位辐射防护建议。结果 热释光剂量计累计接收3 000个脉冲辐射，设备舱外壁0.01～8.98 mGy，顶部0.01～15.67 mGy，距外壁1～12 m之间0.01～2.18 mGy，工作位0 mGy。工作状态下，X射线剂量率仪测得距设备舱外侧壁1～20 m之间空气比释动能率范围0.26～16 mGy/h。结论 热释光剂量计、电离室型剂量率仪测量结果基本一致，说明两种方法均可用于脉冲X射线测量；工作状态下设备舱外近距离处辐射剂量率较高，可通过采取防护措施或者限制人员工作量以满足辐射防护要求。     

Predicting Renal Function Outcomes After Partial and Radical Nephrectomy

Background

Partial nephrectomy (PN) is generally favored for cT1 tumors over radical nephrectomy (RN) when technically feasible. However, it can be unclear whether the additional risks of PN are worth the magnitude of renal function benefit.

腹腔镜卵巢穿刺内凝治疗多囊卵巢不孕症的临床研究

目的探讨腹腔镜卵巢穿刺内凝对多囊卵巢不孕症的治疗价值。方法１５１例腹腔镜卵巢穿刺内凝术（实验组）和１５１例开腹卵巢楔切术（对照组）治疗多囊卵巢不孕症配对对比研究。结果实验组的手术时间３３．１±７．２ｍｉｎ，术中失血１５．６±４．７ｍｌ，总排卵率９２．０５％，总妊娠率４９．６７％，均优于对照组（Ｐ＜０．０１）；术后雄激素、ＬＨ／ＦＳＨ下降幅度小于对照组（Ｐ＜０．０１）。随时间推移，两组术后排卵巢、妊娠率均有下降倾向，而术后雄激素、ＬＨ／ＦＳＨ则有逐渐回升的倾向。结论腹腔镜卵巢穿刺内凝术对多囊卵巢不孕症有较好的治疗效果     

脑络康缓释胶囊的制备工艺和体外释放度的研究

以羟丙甲基纤维素作为主要的缓释辅料,采用正交设计方法优化处方研制成脑络康缓释胶囊.以人参皂苷的累积释放量作为考察指标,按照<药典>规定的缓释制剂的释放度进行优选.结果:最佳的处方工艺即羟丙甲基纤维素216 mg,乙基纤维素24 mg,混合稀释剂132 mg,释放曲线符合Higuchi动力学模型.     

Factors related to renal haemodynamics in young type-1 diabetes mellitus patients

The influence of metabolic control (HbA_1c), noradrenaline (NA) and insulin-like growth factors (IGF-I and IGF-II) on renal function and size was investigated in 11 insulin-dependent diabetes mellitus patients aged 11–17 years. Renal function was evaluated in terms of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal size was determined as renal parenchymal volume (RPV) by ultrasonography. The patients' HbA_1c values ranged from 8.2% to 12.9% (normal range 5.5–8.5%) and their GFR and ERPF were higher than normal. Their IGF-II values were higher, and NA and IGF-I levels were lower than those of healthy controls. Inverse correlations between NA and GFR (r=–0.66) and NA and ERPF (r=–0.63) were found. No correlation was found between serum IGF-I and renal functional parameters. The IGF-II values correlated with GFR and HbA_1c (r=0.63,r=0.70 respectively). There were linear correlations between RPV and GFR, RPV and ERPF, HbA_1c and GFR, and ERPF and RPV. Decreased NA concentrations and increased IGF-II values appear to be factors contributing to renal hyperfunction in these patients.     

脂蛋白（a）对肾小球系膜细胞的作用

目的探讨脂蛋白（ａ）［Ｌｐ（ａ）］对肾小球系膜细胞（ＧＭＣ）的作用。方法将体外培养的系膜细胞，加脂蛋白（ａ）刺激后，测定细胞生长率和细胞上清中血小板活化因子（ＰＡＦ）、肿瘤坏死因子（ＴＮＦ）、乳酸脱氢酶（ＬＤＨ）及纤维连结蛋白（ＦＮ）水平，并以未经刺激者作对照。结果经脂蛋白（ａ）刺激４８小时，在终浓度５～２０ｍｇ／Ｌ时细胞生长率轻度增加，而在５０～４００ｍｇ／Ｌ时细胞生长率明显下降。刺激１８小时，细胞上清中ＰＡＦ的水平明显高于对照，且与脂蛋白（ａ）浓度呈明显正相关（ｒ＝０．９３７，Ｐ＜０．０１）；Ｌ９２９细胞的杀伤率有所增加，但未达５０％；ＬＤＨ的水平在脂蛋白（ａ）１００ｍｇ／Ｌ以下时有所增加；刺激１８、４８、７２小时后的细胞上清纤维连结蛋白均为阴性。结论脂蛋白（ａ）对系膜细胞体外增殖有低浓度轻度促进、高浓度抑制的双向作用，对细胞ＰＡＦ的产生具有浓度依赖的促进作用，并能增加细胞上清中ＬＤＨ及ＴＮＦ水平，因而可通过多种途径介导肾小球损伤。     

Influence of rate of administration of raclopride on akathisia and prolactin response

The D₂-dopamine receptor antagonist raclopride was administered to eight healthy male subjects, who had previously experienced akathisia following antipsychotic drugs. The influence of administration rate on onset, severity and duration of akathisia and on prolactin response was studied. Raclopride 3,5 or 9 mg or placebo (P) was administered as single IV infusions during 10 min (R10 min/3 mg), 1 h (R1h/5 mg) or 4 h (R4h/9 mg) according to a randomized double-blind design. Despite a 24-fold difference in administration rate a similar peak raclopride concentration of about 350 nmol/l was obtained after all three infusions. Three of the eight subjects experienced akathisia following R10 min/3 mg and R1h/5 mg, respectively. After R4h/9 mg seven subjects experienced akathisia of longer duration but not more severe than after the short infusions. The incidence and duration of akathisia seem to be mainly related to the plasma raclopride concentrations over time, whereas the rate of administration might be more important for the severity. A maximal prolactin response was induced which was not markedly affected by the rate of administration.     

32578例住院患者医院感染调查分析

目的　了解我院住院患者医院感染发病率。方法　对我院 2 0 0 2年 32 5 78例住院患者进行调查。结果　 5 48例发生医院感染 (1.6 8%) ,最高科室为 9.79%,以下呼吸道最常见 (37.79%)。检出病原菌 184株 ,以革兰阴性菌为主 (49.46 %) ,多为铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌。前者对常用抗菌药物耐药率均 >5 0 %,对亚胺培南的耐药率为 81.82 %。结论　加强重点易感区域的监测、细菌的耐药性监测和培训教育 ,以更有效的预防和控制医院感染。