解毒通络方治疗克罗恩病肛瘘临床疗效

目的:观察基于吴门医派络病理论自拟解毒通络方治疗克罗恩病肛瘘临床疗效。方法:31例克罗恩病肛瘘患者随机分为治疗组16例和对照组15例,两组均采用保留括约肌引流挂线术,术后治疗组采用解毒通络方坐浴,对照组采用高锰酸钾溶液坐浴,观察两组术后疼痛和拆线时间,3个月瘘管治愈率、PDAI评分和1年治愈率。结果:治疗组术后第3、7天疼痛、拆线时间和PDAI评分均优于对照组(P0.05)。治疗组术后3个月和1年治愈率分别为87.5%、81.2%,均高于对照组(P0.05)。结论:解毒通络方治疗克罗恩病肛瘘疗效显著,可缩短拆线时间,快速缓解疼痛,加速康复,值得临床推广。     

重组沙门菌表达结核分枝杆菌ESAT-6及其特异性免疫应答分析

目的 分析重组沙门菌表达的结核分枝杆菌(Mycobacterium tuberculosis,Mtb)分泌性蛋白ESAT-6诱导的特异性免疫应答.方法 将ESAT-6蛋白编码基因导入原核表达载体pYA3333中,构建重组质粒pYA33-esat.通过电穿孔法转化减毒鼠伤寒沙门菌X4550,获得重组菌X4550(33-esat).以每只105CFU剂量的重组菌滴鼻免疫C57BL/6小鼠,间隔18 d,在第2次免疫后10 d取免疫小鼠脾脏、肺脏、肠系膜淋巴结(mesenteric lymph node,MLN)及派伊尔淋巴集结(Peyer's patch,PP)细胞,以ESAT-6多肽作为刺激原,检测特异性的IFN-γ分泌细胞和IL-4分泌细胞.同时,运用CFSE方法榆测了体内抗原特异性CTL效应.结果 经沙门菌表达并运送的Mtb抗原ESAT-6能诱导特异性的免疫应答.在肺脏及PP细胞巾,检测到较高水平的IFN-γ和IL-4分泌细胞,免疫应答以Th1型为主.而在脾脏和MLN中,免疫应答呈现Th1/Th2混合应答.此外,体内CTL试验表明,重组菌能够诱导抗原特异的CTL效应,且特异性杀伤率为69.9%.结论 以滴鼻方式接种重组沙门菌,不仅能够诱导ESAT-6蛋白特异性的细胞免疫应答,还能激发特异的CTL效应,为结核病的防控提供了新的认识.     

病理性瘢痕谷胱甘肽和辅酶Ⅱ含量测定及其意义

目的 了解病理性瘢痕中氧化还原状态的变化.方法 对正常皮肤、增生性瘢痕、瘢痕疙瘩组织中的氧化型与还原型谷胱甘肽(GSSG、GSH)、氧化型与还原型辅酶Ⅱ(NADP+、NADPH)含量进行测定,计算还原型与氧化型的比值,分析氧化还原状态的变化.结果 增生性瘢痕组和瘢痕疙瘩组组织中GSSG、GSH、NADP+、NADPH的含量均高于正常皮肤组(P<0.05),增生性瘢痕组和瘢痕疙瘩组之间各项指标差异均无统计学意义(P>0.05),各组GSH/GSSG比值、NADPH/NADP+比值差异均无统计学意义(P>0.05).结论 组织微环境内氧化能力的提高,可能是病理性瘢痕发生机制中的一个重要环节;病理性瘢痕组织中,很有可能发生了氧化还原系统的代偿性再平衡.     

重组沙门菌表达结核分枝杆菌ESAT-6及其特异性免疫应答分析

Objective To determine the immune responses induced by recombinant Salmonella ty-phimurium expressing the secreting antigen ESAT-6 of Mycobacterium tuberculosis. Methods ESAT-6 cod-ing gene was cloned and identified by PCR and sequencing. Prokaryotic expression plasmid pYA33-esat car-rying the ESAT-6 coding sequence was constructed firstly and electro-transformed into an attenuated strain X4550 of Salmonella typhimurium, the recombinant bacteria was named as X4550(33-esat). C57BL/6 mice were immunized intranasally (I. N) with 108 CFU recombinant bacteria at day 0 and 18. Cells from spleen, lung, mesenteric lymph node (MLN) and Peyer's patch (PP) were collected from mice after second immu-nization, and the specific IFN-γ-secreting cells and IL-4-secreting cells were detected by ELISPOT assay u-sing ESAT-6 peptide as stimulus. Furthermore, CTL effects were in vivo evaluated by CFSE assay. Results The results showed that cellular immune responses specific for ESAT-6 could be detected by ELISPOT assay. In lung and PP cells, immune responses against ESAT-6 were biased toward Th1 type, the frequency of IFN-γ-secreting cells was much higher than that of IL-4-secreting cells. In splenocytes and MLN cells, the anti-gen specific immune responses acted as Thl and Th2 balance, the frequency of IFN-γ-secreting cells was close to that of IL-4-secreting cells. CFSE assay indicated that recombinant bacteria could induce the high level of CTL effects specific for ESAT-6 peptide. Conclusion These results suggested that recombinant Sal-monella typhimurium X4550(33-esat) not only can induce cellular immune responses, but also can elicit specific CTL responses after I. N immunization. It also provided the useful information for the control of infec-tious disease of tuberculosis.     

改良翼点入路显微手术治疗鞍区肿瘤

目的探讨经改良翼点入路显微手术治疗鞍区肿瘤的方法。方法回顾性总结近4年来我院神经外科采用改良翼点入路显微手术治疗的326例鞍区肿瘤病例，其中，垂体腺瘤158例，颅咽管瘤89例，鞍区脑膜瘤79例。术前准备主要是进行糖激素的替代疗法和癫痫的预防。手术采用改良翼点入路，显微镜下解剖脑底诸池，经鞍区的5个手术间隙切除肿瘤。术后处理主要包括严密观察病人的意识、尿量和血清电解质，及时防治尿崩症、电解质紊乱等并发症，预防癫痫和糖皮质激素的替代疗法。结果采用改良翼点入路开颅，面神经额支的保留率达到92％，眶上神经的保留率达到96％，颞肌萎缩发生率为0％；全部肿瘤的全／次全切除率达到95％，垂体柄的保留率达到62％；术后并发症主要为尿崩症和电介质紊乱，发生率虽然高达61％，但是经过术后的严密观察和处理，97％的病人在术后1个月内得到恢复。结论改良翼点入路对面神经额支、眶上神经和颞肌的损伤机会减少。采用改良翼点入路，应用显微解剖技术，结合积极有效的防治并发症的措施，可以提高鞍区肿瘤的全切除率，减少术后并发症的发生，值得在临床中推广应用。     

正常人与肺癌患者胸膜间皮细胞扫描电镜观察

应用扫描镜超微病理技术，分析对比了肺癌患者胸膜间皮细胞与正常人胸膜间皮细胞间超微形态的异同。结果显示：正常成人胸膜脏层间皮细胞轮廓清楚，间皮细胞表面布满高低不一的微嵴及微绒毛。肺癌患者间皮细胞肿胀，细胞表面微嵴消失且出现大量细胞孔，浆膜游离面有大量渗液。依据扫描电镜所见，作者提出肺表面间皮细胞改变是肺癌导致胸水形成的形态学基础。     

重组沙门菌表达结核分枝杆菌ESAT-6及其特异性免疫应答分析

Objective To determine the immune responses induced by recombinant Salmonella ty-phimurium expressing the secreting antigen ESAT-6 of Mycobacterium tuberculosis. Methods ESAT-6 cod-ing gene was cloned and identified by PCR and sequencing. Prokaryotic expression plasmid pYA33-esat car-rying the ESAT-6 coding sequence was constructed firstly and electro-transformed into an attenuated strain X4550 of Salmonella typhimurium, the recombinant bacteria was named as X4550(33-esat). C57BL/6 mice were immunized intranasally (I. N) with 108 CFU recombinant bacteria at day 0 and 18. Cells from spleen, lung, mesenteric lymph node (MLN) and Peyer's patch (PP) were collected from mice after second immu-nization, and the specific IFN-γ-secreting cells and IL-4-secreting cells were detected by ELISPOT assay u-sing ESAT-6 peptide as stimulus. Furthermore, CTL effects were in vivo evaluated by CFSE assay. Results The results showed that cellular immune responses specific for ESAT-6 could be detected by ELISPOT assay. In lung and PP cells, immune responses against ESAT-6 were biased toward Th1 type, the frequency of IFN-γ-secreting cells was much higher than that of IL-4-secreting cells. In splenocytes and MLN cells, the anti-gen specific immune responses acted as Thl and Th2 balance, the frequency of IFN-γ-secreting cells was close to that of IL-4-secreting cells. CFSE assay indicated that recombinant bacteria could induce the high level of CTL effects specific for ESAT-6 peptide. Conclusion These results suggested that recombinant Sal-monella typhimurium X4550(33-esat) not only can induce cellular immune responses, but also can elicit specific CTL responses after I. N immunization. It also provided the useful information for the control of infec-tious disease of tuberculosis.     

腹部损伤并颅脑伤病人在诊治中应注意的问题

在多发性创伤中,腹部损伤合并颅脑伤并非少见,病情不但复杂,而且死亡率甚高,在诊断和治疗上有其特殊性,应当引起重视。本文收集了我院自1976～1992年间所收治的腹部损伤并颅脑伤病人52例,现结合本组病人就其诊治中应注意的一些问题加以讨论。1 临床资料1.1 一般资料 本组52例.男34例,女18例;年龄最大72岁,最小12岁,平均30.5岁。全部病例均存在有颅脑和腹部双重损伤,详细情况见表1、表2。