患儿,女,1岁,65 cm,7 kg,因"发现骶尾部包块1年余"入院,初步诊断为"骶尾部包块,气道狭窄".胎龄22周时,超声检查发现骶尾部一包块(约2 cm×1 cm).37周顺产,出生时发现骶尾部有"鹌鹑蛋"大小包块.1月龄时曾就诊外院拟行手术,全麻诱导后可视喉镜发现声门下气道软骨呈"O"型闭合环,尝试插入ID 2. 5 mm普通气管导管失败,未行手术,后转入我院.1月龄时第1次入院,查体:双肺可闻及喘鸣和湿啰音,哭闹时可出现明显三凹征、口唇紫绀、喘憋和呼吸困难等症状,平静后可缓解.1月龄时胸部CT:主气管胸廓入口段管径稍窄,最窄径约2. 9 mm,上下范围约10 mm.经多学科会诊后建议暂缓手术.1岁时再次入院,自诉偶有轻微咳嗽,咳痰等症状,无活动性气促、呼吸困难等情况.查体:活动如常,心功能Ⅰ级;右中下肺少许干啰音及轻微哮鸣音,哭闹时未出现三凹征、口唇发绀、喘憋和呼吸困难等症状.1岁时胸部CT:双肺纹理增粗模糊、双肺透亮度减低;气道自胸廓入口至气道分叉上方管腔稍变窄,最窄径约4. 3 mm,矢状位测量狭窄累及长度约22. 1 mm,右肺中间干支气管入口局部管腔稍窄,最窄处管径约2. 4 mm;未见明显胸膜增厚与胸腔积液征象(图1).入院后行抗感染、雾化吸入等积极治疗1周后,患儿咳嗽咳痰症状有所改善,平静呼吸时听诊未闻及明显干湿啰音.术前诊断:骶尾部肿物.拟于全麻下行"骶尾部肿物切除术".

植物固醇具有降脂、抗炎、抗氧化等多种功能,在预防动脉粥样硬化和治疗心血管疾病上具有重大价值和意义.文章结合众多实验研究,综述植物固醇的功能、作用机制及其与心血管疾病之间关系的最新研究进展.

目的 观察多不饱和脂肪酸不同构成及其配比对ApoE-/-小鼠动脉粥样硬化(As)的预防作用,为合理使用脂肪酸预防As提供科学依据.方法 设置对照组、模型组、3组实验油组,按饱和脂肪酸(SFA)∶单不饱和脂肪酸(MUFA)∶多不饱和脂肪酸(PUFA)=0.25∶1∶1比例配制3种实验油定制饲料.设计实验油1和油2中ω-6/ω-3 PUFA比例为2.5∶1,实验油3中ω-6/ω-3 PUFA比例为10∶1.其中实验油1中ω-3 PUFA来源为α-亚麻酸(ALA),实验油2及实验油3中ω-3 PUFA来源为二十碳五烯酸(EPA)、二十二碳六烯酸(DHA)和α-亚麻酸(ALA).记录小鼠体质量变化,主动脉大体油红O染色及主动脉窦HE染色观察主动脉内膜斑块形成情况;肝脏油红O染色观察肝脏脂质蓄积情况;酶法检测肝脏甘油三酯(TG)和总胆固醇(TC)水平;酶法检测血清TG、TC、低密度脂蛋白胆固醇(LDLC)和高密度脂蛋白胆固醇(HDLC)水平.结果 与模型组比较,3组实验油均能减少主动脉As斑块形成(P＜0.05),降低肝脏TG、TC(P＜0.05),降低血清TG、TC、LDLC(P＜0.05),改善肝脏脂质蓄积.与实验油1组及实验油3组比较,实验油2组更能有效抑制主动脉As斑块形成(P＜0.05),显著降低肝脏TG、TC(P＜0.05),降低血清TG、TC、LDLC,升高血清HDLC(P＜0.05),改善肝脏脂质蓄积.结论 减少SFA摄入,增加MUFA和PUFA摄入具有抗动脉粥样硬化的作用,EPA、DHA和ALA共同作为ω-3 PUFA的供体比ALA单独提供ω-3 PUFA抗动脉粥样硬化效果更好,低比例ω-6/ω-3PUFA比高比例ω-6/ω-3PUFA抗动脉粥样硬化效果更好.

动脉硬化性疾病是世界范围内造成死亡的重要原因,2017年,我国现患冠心病人群达1 100万,并且呈持续上升阶段,死亡率也在持续走高[1].已有日益增多的证据表明动脉粥样硬化(atherosclerosis,As)是由免疫介导的动脉壁的炎症性疾病,其中T细胞介导的免疫应答在As病变形成过程中起重要作用[2,3].调节性T细胞(T regulatory cells,Tregs)因其具有调节每个免疫细胞的功能,成为外周免疫耐受和稳态的基石,其涉及各种自身免疫,炎症,感染等疾病的发病机制[4].对于Tregs细胞靶向治疗疾病的观点,许多学者相继评估其在预防和治疗As性疾病中的地位.因此,我们在此简要介绍Tregs的产生和功能,并综述当前证据表明它们在As过程中的作用及其可能机制.

Hypertension is closely related to the formation of aortic dissection.Long-term effects of hypertension on the vessel wall can cause lesions of the aortic wall.Under the influence of various factors, the vascular structure is easy to be affected by hypertension, leading to tearing injury.This article mainly discuss the pathogenesis of aortic dissection by hypertension from three aspect:the hemodynamics, histopathology and inflammatory immunology.

Objective To investigate the adverse drug reactions (ADRs) induced by escitalopram and precautions. Methods Wanfang,CNKI,Pubmed databases were searched to retrieve information about escitalopram adverse reactions reported in the literature,focusing on analysis of adverse reactions in patients with age,sex,clinical manifestations,involved systems, etc. Results Totally,31 references were collected,and a total of 31 cases included in the review analysis.The adverse reaction rate was equivalent between the male and the female.The adverse reaction occurred a few hours to 6 months after medication,and it involved several organ systems,including the nervous system,circulatory system,endocrine system,alimentary system,urinary system,kinetic system,etc. Conclusion Escitalopram should be used according to the doctor's advice,and its amount should not be arbitrarily added.Regular monitoring of adverse reactions should be performed to ensure rational use of the drug.

OBJECTIVE:To investigate the clinical characteristics and gene polymorphism of oxcarbazepine (OXC)- induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). METHODS:Retrieved from CNKI,Wanfang,VIP, PubMed,EMBase,SpringerLink and other databases,case reports about OXC-induced severe ADR were summarized and ana-lyzed. RESULTS:Twelve literatures were collected,and 13 case reports about OXC-induced SJS/TEN were obtained. Male had more OXC-induced severe skin ADR than female. ADR mostly occurred during 1-14 d after medication. All patients were cured with treatment of glucocorticoid and antiallergy,without death case. Genotyping for 8 patients were performed and 6 of them showed the presence of HLA-B*1502 allele. While HLA-B alleles of 2 patients were HLA-B*1518/B*4001,which was the variation of HLA-B*1502. CONCLUSIONS:OXC-induced ADR should be monitored closely. Great importance should be attached to patient education and follow-up program. HLA-B*1502 gene detection should be performed to guide rational use of OXC and optimize clini-cal drug use plan.

目的：探讨奥卡西平( OXC)诱发中毒性表皮坏死松解症( TEN)及Stevens- Johnson综合征( SJS)易感基因检测的意义,特别是HLA-B?1502基因阴性的患者。方法分析由OXC诱发SJS/TEN患者的临床表现、实验室检查及基因学检测结果,同时对OXC诱发SJS/TEN与HLA-B?1502基因强相关的中国大陆、中国台湾及东南亚等地区所报道的OXC诱发SJS/TEN相关文献的基因检测结果进行复习并总结。结果该例患者在使用OXC(300 mg·次-1,2次· d-1)治疗20 d后出现皮疹,逐渐发展至颜面部、躯干及四肢出现大片表皮破溃、剥脱,黏膜破溃,尼氏征阳性,诊断为OXC诱发TEN。基因检测发现该患者为HLA-B?1502阴性。检索文献发现,在东南亚及中国等国家和地区,OXC引发SJS/TEN的相关报道仅有10例,其中6例患者为HLA-B?1502阳性,3例患者为HLA-B?1502阴性,其基因型为2例HLA-B?1518/ B?4001,1例HLA-B?1344。结论临床上可通过检测HLA-B?1502基因指导抗癫痫间药物的使用,同时也应该警惕即使是HLA-B?1502基因阴性者,仍存在其他易感基因而诱发严重皮肤不良反应的可能。

目的:从原发性高血压(HPN)与慢性心力衰竭(CCF)的双视角,利用Cochrane方法系统评价缬沙坦与卡托普利的疗效,为临床药物选择提供循证证据.方法:计算机检索PubMed、EMbase、Web of Science、Cochrane Library、 CBM、CNKI、维普和万方等数据库,检索时限均为从建库至2013年6月.由2名评价者按照纳入与排除标准以及Cochrane协作网推荐的方法独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 4.2软件进行Meta分析.结果:HPN有效性部分纳入13个研究,1 222例患者,CCF有效性部分纳入9个研究,852例患者.与卡托普利比较,缬沙坦治疗HPN和CCF的效果总体上优于卡托普利.在治疗HPN方面,缬沙坦降低收缩压效果优于卡托普利[WMD=-1.88(95％CI,-3.84 ～0.08),P=0.05];在治疗CCF方面,缬沙坦提高左心室射血分数(LVEF)效果优于卡托普利[WMD=-3.15 (95％ CI,0.79 ～5.52),P＜0.01].安全性部分纳入17个研究,合并分析结果显示缬沙坦治疗HPN和CCF的不良反应发生率低于卡托普利[OR =0.23(95％ CI,0.16 ～0.32),P＜0.01].结论:基于现有临床循证医学证据,缬沙坦治疗原发性高血压与慢性心力衰竭的有效性和安全性均优于卡托普利,是临床治疗高血压及慢性心力衰竭较好的用药选择.

目的:综合评价坎地沙坦治疗原发性高血压和慢性心力衰竭的有效性和安全性,为临床药物选择提供循证证据.方法:计算机全面检索Cochrane library、Embase、Medline、Pubmed、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数字化期刊全文库(各数据库检索时间均从创建至2013年6月)坎地沙坦治疗原发性高血压和慢性心力衰竭的随机对照试验,研究者按照纳入与排除标准独立筛选试验、提取资料、方法学质量评价、统计分组,并用RevMan 5.0软件进行统计分析.结果:(1)治疗原发性高血压的有效性:纳入文献115篇,分为九组.坎地沙坦组3个疗效指标均优于安慰剂,部分疗效指标优于氯沙坦、氨氯地平、依那普利、卡托普利、贝那普利,联合用药组疗效优于单药组;(2)治疗慢性心力衰竭的有效性:纳入文献72篇,分为8组.坎地沙坦单药治疗组与对照组比较,无显著性差异,但与卡维地洛、美托洛尔、贝那普利等药物联合治疗时,疗效显著优于单药组.(3)安全性:纳入85篇文献的不良反应发生率为4.73％,发生率及分布与药品说明书报道一致.结论:坎地沙坦是一种安全有效的治疗原发性高血压和慢性心力衰竭的药物,且联合其他抗心衰药的疗效更为显著.

目的:通过Cochrane系统评价方法对厄贝沙坦与依那普利治疗原发性高血压的有效性、安全性和经济性进行评价,为临床药物选择提供循证证据.方法:计算机检索Cochrane library、Embase、Medline、PubMed、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数字化期刊全文库(各数据库检索时间均从创建至2013年6月)厄贝沙坦与依那普利治疗原发性高血压的随机对照试验,由2名研究者按照纳入与排除标准独立筛选试验、提取资料、评价方法学质量,并用RevMan5.0软件进行统计分析.结果:①有效性部分纳入27个研究,对研究进行合并分析,厄贝沙坦治疗原发性高血压的总有效率高于依那普利[OR=1.54(95％ CI,1.23 ～ 1.92),P＜0.01];厄贝沙坦降低收缩压效果优于依那普利[MD=-3.08(95％CI,-5.91～-0.25),P＜0.05];厄贝沙坦降低舒张压效果优于依那普利[MD=-2.76(95％ CI,-5.06 ～0.46),P＜0.05].②安全性部分纳入26个研究,合并分析结果显示厄贝沙坦治疗原发性高血压的不良反应发生率低于依那普利[OR=0.33(95％ CI,0.26 ～0.43),P＜0.01].③经济性部分纳入2篇成本-效果分析文献,对其进行综述发现厄贝沙坦的经济性优于依那普利.结论:基于现有临床证据,厄贝沙坦治疗原发性高血压的有效性、安全性、经济性均优于依那普利,是临床治疗原发性高血压较好的用药选择.

Objective:To investigate the effect of X-ray on proliferation of cultured astrocytes(AS) and the action mechanism.Methods: The 80% confluent cultured AS were irradiated by different doses of X-ray,and effects of irradiation on cell cycle and apoptosis were analyzed by flow cytometry.The 80% confluent cultured AS were synchronized by serum deprivation for 48 h,then the cultured AS were randomly divided into 2 groups: control group(10% FBS) and irradiation group(10% FBS+irradiation).Western bolt was used to detect the expression of PCNA,p53 and cyclin E.Results:X-ray irradiation could reduce the percentage of cells in S phase in a dose-dependent manner,but not increase the apoptosis rate of AS.After the culture was serum-starved for 24 h,almost confluent AS remained at G0 phase.As a response to FBS,the percent of S phase cells and the expression levels of PCNA and cyclin E were increased in control group;In irradiation group,the percent of S phase cells was decreased dose-dependently.The expression of PCNA and cyclin E was also inhibited significantly,and the expression of p53 increased significantly in irradiation group as compared with control group.Conclusion: X-ray can effectively inhibit proliferation of AS by regulating cell cycle of AS.

Objective To observe the effect of excessive astrocytic proliferation on focal microcirculation in hippocampus and ischemia boundary zone after middle cerebral artery occlusion(MCAO).Methods Rats were randomly divided into the sham-operated group,ischemia group and roscovitine group.Cerebral ischemia was induced by occluding the middle cerebral artery for 1h in the ischemia and roscovitine-treated groups.0.2% DMSO was infused into the lateral ventricle by ALZET micro-osmotic pump in the ischemia group.The roscovitine-treated group was given cell cycle inhibitor roscovitine.No drug intervention was given in the sham-operated group.Vascular marker FITC-dextran was injected into femoral vein 7d after ischemia.Immunofluorescent stain was used to show astrocytes.Three-dimensional laser scanning confocal imaging was performed to show the relationship between astrocytes and microcirculation.Result GFAP-positive cells were increased in the ipsilateral hippocampus and ischemic boundary zone,with local microvascular perfusion decreased significantly.Inhibition of glial cell proliferation by roscovitine infusion significantly increased local microvascular perfusion.Conclusion Prolifrative astrocytes are closely related to microcirculation in hippocampus and boundary zone after ischemia.

目的 探讨骨髓间充质干细胞(MSCs)移植对脊髓损伤大鼠神经功能恢复的影响极其可能机制.方法 采集SD大鼠骨髓,分离出MSCs,并培养、纯化,取传至第6代的MSCs,移植前1 d以5溴2脱氧尿嘧啶核苷(Brdu)标记,然后用显微注射器将其缓慢注射到脊髓损伤大鼠模型(成年SD大鼠)的受损脊髓中心,以不进行移植的脊髓损伤大鼠模型(损伤组)和假手术组为对照.术后进行运动功能评分以判断神经功能恢复情况,并切取移植区域脊髓组织,应用荧光免疫化学染色检测脊髓损伤灶边周的神经元凋亡情况(TUNEI.与NeuN双标记)以及移植的MSCs的分布和向神经元分化情况(Brdu与NeuN双标记),应用逆转录聚合酶链反应检测损伤灶区域脑源性神经营养因子(BDNF)mRNA的表达.结果 移植后第3天开始,损伤组和移植组大鼠的BBB运动功能评分明显上升,第14天后进入平台期,但移植组各时间点的.BBB运动功能评分均明显高于损伤组(P<0.05).移植后3 d,在移植组的脊髓组织中可见Brdu标记阳性细胞,少部分Brdu标记阳性细胞同时表达神经元特异性标志物NeuN;移植后第3、7天,损伤组和移植组脊髓组织中的凋亡神经元均显著多于假手术组(P<0.01),凋亡的神经元多存在于损伤周边区,但移植组的凋亡神经元显著少于损伤组(P<0.01);移植后第3、7天,假手术组未检测到BDNF mRNA的表达,损伤组和移植组均可检测到BDNF mRNA的表达,移植组的表达量分别较损伤组高28.6%和39.2%(P<0.05).结论 移植的骨髓MSCs可促进脊髓损伤大鼠神经功能的恢复,其机制除MSCs直接分化为神经元进行修复外,还可能与其改善脊髓损伤区的微环境、上调BDNF、mRNA表达、减少神经细胞凋亡有关.

Objective To explore the effect of blocking spreading depression which was induced by focal cerebral ischemia on the delayed neuronal death in ipsilateral hippocampus. Methods A rat model of middle cerebral artery occlusion was made by the intraluminal occlusion technique, the spreading depression waves were recorded by electrophysiology, and the effect of blocking spreading depression induced by ischemia on delayed neuronal death in the hippocampus was observed by Nissl's staining and TUNEL labeling. Results With no inhibitor of spreading depression, delayed neuronal death was detected in 39% of the animals in hippocampal CA1 region 3 days after middle cerebral artery occlusion. With the inhibitor of spreading depression, delayed neuronal death appeared in only 10% of the animals. Conclusion Spreading depression might be related to delayed neuronal death in hippocampus after middle cerebral artery occlusion.

目的观察体外培养的星形胶质细胞(astrocyte, AS)对物理损伤的反应,探讨细胞周期调控对AS活化及增殖的影响.方法建立体外培养大鼠纯化的AS机械损伤模型,利用免疫细胞化学方法观察损伤区的细胞增殖细胞核抗原(PCNA)、5-溴脱氧尿苷(BrdU)的动态变化;以及周期素依赖的蛋白激酶(CDK)选择性抑制剂olomoucine干预后PCNA、BrdU表达的变化.结果物理损伤后24 h,损伤边缘区AS明显活化,细胞数目增加、胞体肥大,且交织成网状; PCNA表达增强, BrdU阳性细胞比率增加,大量AS进入增殖期.特异性细胞周期抑制剂olomoucine干预后,AS的 PCNA表达增强被抑制,胞体肥大程度减轻,BrdU阳性细胞比率减少.结论损伤刺激可促使胶质细胞细胞周期(cell cycle)启动、反应性增殖活化; olomoucine可以通过抑制CDK调控反应性AS的肥大、增殖.

目的观察细胞周期调控对大鼠全脑缺血再灌流后海马区迟发性神经元死亡(delayed neuronal death,DND)以及星形胶质细胞的活化、增殖的影响.方法建立大鼠短暂性全脑缺血再灌流模型,利用尼氏染色、TUNEL、免疫组织化学方法观察再灌流后细胞周期素依赖的蛋白激酶(cyclin depedent kinase, CDK)抑制剂Olomoucine对海马DND以及星形胶质细胞活化增殖的影响.结果全脑缺血再灌流后3d、7d、30d海马神经元明显脱失,部分CA1、CA2区神经元凋亡;星形胶质细胞数目增多,GFAP表达上调,应用Olomoucine后TUNEL阳性神经元数目明显减少,幸存神经元数目增加;星形胶质细胞数目无明显增多,GFAP表达明显下调.结论 CDK抑制剂Olomoucine可有效抑制大鼠全脑缺血后海马神经元DND以及星形胶质细胞活化增殖.

目的观察正常SD大鼠发育过程中海马细胞周期相关蛋白表达及分布特点,探讨其与脑老化的关系.方法采用免疫组织化学方法观察不同发育时期(1周,2月,4月,10月,15月)Cyclin D1、CDK4、P16、NeuN表达的规律.结果在各年龄组Cyclin D1、CDK4、P16、NeuN阳性细胞层的厚度随着增龄而逐渐变薄.各阳性细胞的排列逐渐由紧密变得松散,胞体逐渐增大,各阳性细胞逐渐伸出轴突进入分子层.P16随月龄的增长在海马各区染色增强,但P16阳性细胞数目减少.结论 Cyclin D1、CDK4、P16、NeuN在海马发育的各个时期均有表达,老龄大鼠海马内Cyclin D1、CDK4、P16表达的下调提示细胞增殖活性受限,这可能与脑老化有关.