重症脑出血患者不同时期采用经皮胃镜下空肠造瘘术对腹泻发生率的影响

_{目的：比较不同时期采用经皮胃镜下空肠造瘘术进行肠内营养的重症脑出血患者腹泻发生率。方法：回顾性分析63例采用经皮胃镜下空肠造瘘术进行肠内营养的重症脑出血患者,按经皮胃镜下空肠造瘘术距离患者发病时间分组,早期组(3天以内)32例,晚期组(3天以后)31例,比较两组患者腹泻发生率。 结果：早期组患者腹泻发生率为12.5%,晚期组患者腹泻发生率为35.5%,早期组患者腹泻发生率明显低于晚期组患者(P值<0.05)。 结论：重症脑出血患者早期采用经皮胃镜下空肠造瘘术肠内营养可降低腹泻发生率。}     

抗多房棘球绦虫原头节单克隆抗体的制备

&#718;&#805;,Verdana,Arial'; mso-hansi-font-family: '&#718;&#805;,Verdana,Arial'; mso-bidi-font-family: 宋体">目的 制备抗泡球蚴组织单克隆抗体,并鉴定其特异性。 方法 运用泡球蚴组织粗抗原免疫小鼠制备免疫脾细胞,运用淋巴细胞杂交瘤技术将其与小鼠骨髓细胞SP2/0融合。采用ELISA和免疫组化方法筛选抗泡球蚴原头节单克隆抗体的杂交瘤细胞株。检测所获细胞株的染色体数目,采用ELISA和免疫组化法鉴定所获抗体的特异性。 结果 获得了一株能稳定分泌的抗泡球蚴原头节单克隆抗体的杂交瘤细胞株6G2A7F7。染色体数目为98条,为明显的融合细胞核型。所分泌的抗体McAb P325能与泡球蚴中的生发层和原头节特异结合,特别对原头节上的小钩和吸盘表现出很强的结合反应。但与棘球蚴（人源）和水泡带绦虫幼虫（细颈囊尾蚴）组织无特异性结合反应。 结论 制备的杂交瘤细胞能稳定分泌McAb P325,为泡球蚴的细胞分类、免疫组化和抗原研究提供工具和基础。     

Protective effect of Weikang decoction and partial ingredients on model rat with gastric mucosa ulcer

AIM, To investigate the protective mechanisms of Weikang (WK) decoction on gastric mucosae. METHODS: Ninety rats were randomly divided into nine groups of 10 each, namely group, model group, group with large WK dosage, group with medium WK dosage, group with small WK dosage, group with herbs of jianpiyiqi (strengthening the spleen and replenishing qi), group with herbs of yangxuehuoxue (invigorating the circulation of and nourishing the blood), group with herbs of qingrejiedu (clearing away the heat-evils and toxic materials), group with colloidal bismuth pectin (CBP) capsules. According to the method adopted by Yang Xuesong, except normal control group, chronic gastric ulcer was induced with 100% acetic acid. On the sixth day after moldmaking, WK decoction was administered, respectively at doses of 20, 10 and 5 g/kg to rats of the WK groups, or the group swith herbs of jianpiyiqi, yangxuehuoxue and qingrejiedu, 10 mL/kg was separately administered to each group every day. For the group with CBP capsules, medicine was dissolved with water and doses 15 times of human therapeutic dose were administered (10 mL/kg solution containing 0.35% CBP). Rats of other groups were fed with physiological saline (10 mL/kg every day) .Administration lasted for 16 d. Rats were killed on d 22 after mold making to observe changes of gastric mucosa. The mucus thickness of gastric mucosa surface was measured. Levels of epidermal growth factor (EGF) in gastric juice, nitric oxide (NO) in gastric tissue, endothelin (ET) in plasma, superoxide dismutase (SOD) in plasma, malondialdehyde (MDA) in plasma and prostaglandin I2 (PGI2) were examined. RESULTS: Compared with control group, ulceration was found in gastric mucosa of model group rats. The mucus thickness of gastric mucosa surface, the levels of EGF, NO, 6-K-PGF1α and SOD decreased significantly in the model group (EGF: 0.818&#177;0.18 vs 2.168&#177;0.375, NO: 0.213&#177;0.049 vs0.601&#177;0.081, 6-K-PGF1α: 59.7&#177;6.3 vs 96.6&#177;8.30, SOD: 128.6&#177;15.0 vs 196.6&#177;35.3, P&lt;0.01), the levels of ET (179.96&#177;37.40 vs 46.64&#177;21.20, P&lt;0.01) and MDA (48.2&#177;4.5 vs 15.7&#177;4.8, P&lt;0.01) increased. Compared with model group, the thickness of regenerative mucosa increased, glandular arrangement was in order, and cystic dilative glands decreased, while the mucus thickness of gastric mucosa surface increased (20 g/kg WK: 51.3&#177;2.9 vs 23.2&#177;8.4, 10 g/kg WK: 43.3&#177;2.9 vs 23.2&#177;8.4, 5 g/kg WK：36.1&#177;7.2 vs 23.2&#177;8.4, jianpiyiqi: 35.4&#177;5.6 vs 23.2&#177;8.4, yangxuehuoxue: 33.1&#177;8.9 vs 23.2&#177;8.4, qingrejiedu: 31.0&#177;8.0 vs 23.2&#177;8.4 and CBP: 38.2&#177;3.5 vs 23.2&#177;8.4, P&lt;0.05-0.01). The levels of EGF (20 g/kg WK: 1.364&#177;0.12 vs 0.818&#177;0.18, 10 g/kg WK: 1.359&#177;0.24 vs 0.818&#177;0.18, 5 g/kg WK: 1.245&#177;0.31 vs 0.818&#177;0.18, jianpiyiqi： 1.025&#177;0.45 vs 0.818&#177;0.18, yangxuehuoxue: 1.03&#177;0.29 vs 0.818&#177;0.18, qingrejiedu: 1.02&#177;0.47 vs 0.818&#177;0.18 and CBP:1.237&#177;0.20 vs 0.818&#177;0.18, P&lt;0.05-0.01), NO (20 g/kg WK: 0.480&#177;0.026 vs 0.213&#177;0.049, 10 g/kg WK: 0.390&#177;0.055 vs 0.213&#177;0.049, 5 g/kg WK: 0.394&#177;0.026 vs 0.213&#177;0.049, jianpiyiqi: 0.393&#177;0.123 vs 0.213&#177;0.049, yangxuehuoxue: 0.463&#177;0.077 vs 0.213&#177;0.049, qingrejiedu: 0.382&#177;0.082 vs 0.213&#177;0.049 and CBP： 0.395&#177;0.053 vs 0.213&#177;0.049, P&lt;0.05-0.01), 6-K-PGF1α (20 g/kg WK: 86.8&#177;7.6 vs 59.7&#177;6.3, 10 g/kg WK: 77.9&#177;7.0 vs 59.7&#177;6.3, 5 g/kg WK:70.0&#177;5.4 vs 59.7&#177;6.3, jianpiyiqi: 73.5&#177;12.2 vs 59.7&#177;6.3, yangxuehuoxue: 65.1&#177;5.3 vs 59.7&#177;6.3, qingrejiedu: 76.9&#177;14.6 vs 59.7&#177;6.3, and CBP: 93.7&#177;10.7 vs 59.7&#177;6.3, P&lt;0.05-0.01) and SOD (20 g/kg WK: 186.4&#177;19.9 vs 128.6&#177;15.0, 10 g/kg WK: 168.2&#177;21.7 vs 128.6+15.0, 5 g/kg WK: 155.6&#177;21.6 vs 128.6&#177;15.0, jianpiyiqi: 168.0&#177;85.3 vs 128.6&#177;15.0, yangxuehuoxue: 165.0&#177;34.0 vs 128.6&#177;15.0, qingrejiedu: 168.2&#177;24.9 vs 128.6&#177;15.0, and CBP: 156.3&#177;18.1 vs 128.6&#177;15.0, P&lt;0.05-0.01) significantly increased. The levels of ET (20 g/kg WK: 81.30&#177;17.20 vs 179.96&#177;37.40, 10 g/kg WK: 83.40&#177;25.90 vs 179.96&#177;37.40, 5 g/kg WK: 93.87&#177;20.70 vs 179.96&#177;37.40, jianpiyiqi: 130.67&#177;43.66 vs 179.96&#177;37.40, yangxuehuoxue: 115.88&#177;34.09 vs 179.96&#177;37.40, qingrejiedu: 108.22&#177;36.97 vs 179.96+37.40,and CBP: 91.96&#177;19.0 vs 179.96&#177;37.40, P&lt;0.01) and MDA (20 g/kg WK: 21.6&#177;7.4 vs 48.2&#177;4.5, 10 g/kg WK: 32.2&#177;7.3 vs 48.2&#177;4.5, 5 g/kg WK: 34.2&#177;6.2 vs 48.2+4.5, jianpiyiqi: 34.9&#177;13.8 vs 48.2&#177;4.5, yangxuehuoxue: 35.5&#177;16.7 vs 48.2&#177;4.5, qingrejiedu: 42.2&#177;17.6 vs 48.2&#177;4.5, and CBP: 30.1&#177;6.1 vs 48.2&#177;4.5, P&lt;0.05-0.01) obviously decreased. The 20 g/kg WK group was better than 10 g/kg (the mucus thickness: 51.3&#177;2.9 vs 43.3&#177;2.9, NO: 0.480&#177;0.026 vs 0.390&#177;0.055, SOD: 186.4&#177;19.9 vs 168.2&#177;21.7, P&lt;0.01) and 5 g/kg (the mucus thickness: 51.3&#177;2.9 vs 36.1&#177;7.2, NO: 0.480&#177;0.026 vs 0.394&#177;0.026, SOD: 186.4&#177;19.9 vs 155.6&#177;21.6, P&lt;0.01) groups and CBP group (the mucus thickness: 51.3&#177;2.9 vs 38.2&#177;3.5, NO: 0.480&#177;0.026 vs 0.395&#177;0.053, SOD: 186.4&#177;19.9 vs 156.3&#177;18.1, P&lt;0.01) in the mucus thickness, NO and SOD levels and better than 10 g/kg (86.8&#177;7.6 vs 77.9&#177;7.0, P&lt;0.05) and 5 g/kg (86.8&#177;7.6 vs 70.0&#177;5.4, P&lt;0.05) groups in 6-K-PGF1α level, 10 g/kg WK group was better than 5 g/kg WK (the mucus thickness: 43.3&#177;2.9 vs 36.1&#177;7.2, P&lt;0.01, SOD: 168.2&#177;21.7 vs 155.6&#177;21.6, P&lt;0.05) and CBP groups (the mucus thickness: 43.3&#177;2.9 vs 38.2&#177;3.5, P&lt;0.01, SOD: 168.2&#177;21.7 vs 156.3&#177;18.1, P&lt;0.05) in the mucus thickness and SOD level. In compound group, jianpiyiqi group, yangxuehuoxue group, qingrejiedu group, the level of ET was decreased, NO contents were increased in gastric tissue of ulcers in rats. CONCLUSION: WK decoction and separated recipes have significantly protective effect on ethanol-induced gastric mucosal injury. They can increase the content of EGF in gastric juice, PGI2 SOD in plasma and NO in gastric tissues, thicken the mucus on the gastric mucosa, and decrease the impairing factor MDA, ET in plasma.     

Genomic determination of CR1 CD35 density polymorphism on erythrocytes of patients with gallbladder carcinoma

AIM: To study the changes of quantitative expression, adhering activity and genomic density polymorphism of complement types in erythrocytes (CR1) of patients with gallbladder carcinoma and the related clinical significance.METHODS: Polymerase chain reaction (PCR), HindⅢ restrdion enzyme digestion, quantitative assay of CR1 and adhering activity assay of CR1 in erythrocytes were used.RESULIFS: The number and adhering actvity of CR1 in patients with gallbladder carcinoma (0.738&#177;0.23, 45.9&#177;5.7) were significantly lower than those in chronic cholecystitis and cholecystolithiasis (1.078&#177;0.21, 55.1&#177;5.9) and healthy controls (1.252&#177;0.31, 64.2&#177;7.4) (P&lt;0.01). The number and adhering activity of CR1 in patients with chronic cholecystitis and cholecystolithiasis (1.078&#177;0.21, 55.1&#177;5.9) were significantly lower than those in healthy controls (1.252&#177;0.31, 64.2&#177;7.4) (P&lt;0.05). There was a positive correlation between quantitative expression and adhering activity of CR1 (r = 0.79, P&lt;0.01).Compared with those on preoperative day (0.738&#177;0.23,45.4&#177;4.9), the number and adhering activity of CR1 in patients with gallbladder carcinoma decreased greatly on the third postoperative day (0.310&#177;0.25, 31.8&#177;5.1) (P&lt;0.01), and on the first postoperative week (0.480&#177;0.25, 38.9&#177;5.2) (P&lt;0.01), but they were increased slightly than those on the preoperative day (P&gt;0.05). The number and adhering activity of CR1 recovered in the second postoperative week (0.740&#177;0.24, 46.8&#177;5.9) (P&lt;0.01) and increased greatly in the third postoperative week (0.858&#177;0.35, 52.7&#177;5.8) (P&lt;0.01) in comparison with those on the preoperative day and in the first postoperative week. The number and adhering activity of CR1 of gallbladder carcinoma patients with infiltrating, adjacent lymphogenous and distant organ metastases were significantly lower than those of gallbladder carcinoma patients without them (P&lt;0.01). No difference was observed between the patients with gallbladder carcinoma and healthy individuals in the spot mutation rate of CR1 density gene (%2 = 0.521, P&gt;0.05).The distribution of expression was 67.8% in high expression genomic type, 24.8% in moderate expression genomic type,and 7.4% in low expression genomic type. The number and adhering activity of CR1 high expression genomic type gallbladder carcinomas (0.749&#177;0.22, 42.1&#177;6.2) were significantly lower than those of healthy individuals(1.240&#177;0.29, 63.9&#177;7.2), and were also significantly lower than those of healthy individuals (0.921&#177;0.23, 54.8&#177;7.1), but no difference was observed between the number and adhering activity of CR1 lower expression genomic type gallbladder carcinomas (0.582&#177;0.18, 44.3*_5.5) and those of healthy individuals (0.610&#177;0.20, 45.8&#177;5.7) (P&gt;0.05).CONCLUSION: Defective expression of CR1 in gallbladder carcinoma is mostly acquired through central peripheral mechanisms. The changes in CR1 quantitative expression and adhering activity are consanguineously related to the development and metastasis in gallbladder carcinoma.     

我国伊蚊族蚊类记录的校订及新分类系统的建议（双翅目∶蚊科）

本文根据国外蚊虫分类经验,对我国伊蚊族蚊类以往记录171种的分类地位作了校订,其中160种可归入我国伊蚊族新分类系统的29个属中,另外11种地位未定,暂按旧分类地位列名表供查考。我国伊蚊族新分类系统包括伊蚊属Aedes、阿蚊属Armigeres、艾蚊属Ayurakitia、博蚊属Bothaella*、布蚊属Bruceharrisonius*、环喙蚊属Christophersiomyia*、科蚊属Collessius*、丹蚊属Danielsia*、唐蚊属Downsiomyia*、箭阳蚊属Edwardsaedes*、纷蚊属Finlaya*、弗蚊属Fredwardsius*、贾蚊属Gilesius*、领蚊属Heizmannia、喜蚊属Himalaius*、霍金蚊属Hopkinsius*、呼蚊属Hulecoeteomyia*、连蚊属Jihlienius*、奈蚊属Kenknightia*、陆蚊属Luius*、霉蚊属Mucidus*、新黑蚊属Neomelaniconion*、骚扰蚊属Ochlerotatus、花蚊属Phagomyia*、盾蚊属Scutomyia*、覆蚊属Stegomyia*、田中蚊属Tanakaius*、尤蚊属Udaya和奇阳蚊属Verrallina等29属,其中22属（*）为我国新记录。此外,还对《中国动物志,昆虫纲第8卷,双翅目：蚊科上卷》记载的4种伊蚊作了重要订正。安图伊蚊Ae. （Edw.） antuensis应是平坝箭阳蚊Ed. pingpaensis的同物异名。滇西伊蚊Ae. （Sin.） occidentayunnanus、黄背伊蚊Ae. （Och.） flavidorsalis和亚同伊蚊Ae. （Fin.） subsimilis分别订正为滇西领蚊Hz. （Mat.） occidentayunnana、白色骚扰蚊Oc. albineus和亚同尤蚊Ud. subsimilis。     

Expression of gamma-aminobutyric acid A receptor subunits α1，β1，γ2 mRNA in rats with hepatic encephalopathy

AIM: To investigate the mRNA expression of gammaaminobutyric acid A (GABAA) receptor subunitsα1,β1,γ2 in different parts of the brain of rats with hepatic encephalopathy.METHODS: Twelve adult male Sprague-Dawley rats were randomly divided into two groups: (1) hepatic encephalopabhy model group (n = 6), which was induced by intraperitoneal injection of thioacetamide (TAA, 350 mg/kg) for three consecutive days; (2) control group (n = 6), in which the rats were treated with same dose of normal saline solution. After the freeze slice of cerebrum was made, in situ hybridization was used to detect the mRNA of GABAA receptor subunits α1,β1,, and γ2 in rat cerebral cortex,basal nuclei, substantia nigra and hippocampi. Image data were collected and analyzed quantitatively by QWin550CW model image signal gather and analysis system.RESULTS: In rats with hepatic encephalopathy, mRNA expression levels of GABAA receptor subunits α1,β1 increased significantly in basal nuclei, substantia nigra pars compacta, substantia nigra pars reticularis and hippocampi (144.7&#177;15.67/184.14&#177;4.41, 60.61&#177;33.66/113.07&#177;32.44,87.71&#177; 21.25/128.40&#177;18.85, 122.34&#177;5.56/161.60&#177;4.56,123.29&#177;5.21/140.65&#177;4.15, 123.40&#177;4.42/140.09&#177;4.52,124.76&#177;4.18/140.09&#177;4.12, 141.62&#177;15.09/182.80&#177;5.20,69.13&#177;30.74/134.21&#177;43.76, 87.87&#177;25.16/151.01&#177;19.49,122.14&#177;6.30/162.33&#177;3.92, 122.81&#177;5.09/137.19&#177;7.12,123.00&#177;4.63/138.11&#177;5.92, 125.75 &#177;2.43/138.81&#177;6.10,P&lt;0.01), but did not change in the cerebral cortex compared to the control group. Similar changes were found in the mRNA expression levels of GABAA receptor subunit γ2,which increased significantly in basal nuclei, substantia nigra pars compacta, substantia nigra pars reticularis (136.81&#177;26.41/167.97&#177;16.23, 51.00&#177;36.14/113.18&#177;36.52,86.35&#177;20.30/126.90&#177;19.74, P&lt;0.01), CA1 of hippocampal(162.15:1:9.05/178.62:1:6.45, P&lt;0.05), and no changes were found in the cerebral cortex and CA2, CA3, CA4 of hippocampi.CONCLUSION: In rats with hepatic encephalopathy,mRNA expression levels of GABAA receptor subunits α1,β1,γ2 increase significantly in basal nuclei, substantia nigra and hippocampi, suggesting that the changes of mRNA expression levels in GABAA receptor subunits may contribute to the pathogenesis of hepatic encephalopathy.     

Relationship between lymphocyte apoptosis and endotoxin translocation after thermal injury in rats

AIM：To investigate the relationship between lymphocyte papotosis in peripheral blood,spleen and mesenteric lymph nodes(MLN)and endotoxin translocation after thermal injury in rats.METHODS:In a wistar rat model infilicted with 30% TBSA Ⅲdegree scalding,serum LPS levels in portal vein and vena cava were quantified by tachypleus amebocyte lysate(TAL) technique.The analysis of peripheral bolld lymphocyte was employed in in situ Cell Death Detection Kit and evaluated by flow cytometry.Apoptotic lymphocytes in paraffinembedded spleen and MLN sections were examined by histologic analysis,in situ deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL)and peroxidase(POD) staining.The imagines were taken by Cooldccd camera system,and the count and optical density value (transmission light) of apoptotic lymphocytes were analyzed with software Spot and lmagine proplus 4.10a(IPP4.10a).RESULTS:In the Period of 3 to 48 postburn hours(PBHs) serum LPS level(&#215;10%3EU.L^-1)in portal vein(2.11&#177;0.02,5.66&#177;0.20,3.70&#177;0.22,2.56&#177;0.28,0.90&#177;0.11)was higher than that in vena cava(0.63&#177;0.01,.1.53&#177;0.18,0.83&#177;0.32,0.52&#177;0.12,0.23&#177;0.02,P&lt;0.01),but both increased sharply in postburn rats(P&lt;0.01)and reached a peak at 6 PBH.Analysius of apoptotic lymphocytes showed that the proportion(%) of postburn apoptotic cells was much higher than that in healthy rats(8.34&#177;1.53,8.13&#177;1.81,20.77&#177;3.94,23.90&#177;3.92,11.23&#177;1.35and 13.26&#177;2.09at3,6,12,24,48and 72 PBH,respectively,vs 3.99&#177;1.72,P&lt;0.01)especially after 6 PBH.The concentrations of lymphocytic apoptosis at 12 and 24 PBH were markedly higher than that at other time points.Meantime,few apoptotic lymphocytes were found in normal MLN,but increased postburn obviously(3&#177;1vs 546&#177;83,285&#177;39,149&#177;30,58&#177;10,36&#177;11and 33&#177;9in turn,P&lt;0.01),especially at 3 PBH,whereas apoptotic lymphocytes were concentrated in splenic cortex before the burn and decreased obviously during 72PBHs(499&#177;186vs12&#177;8,19&#177;15,12&#177;7,100&#177;15,123&#177;25and 226&#177;26in turn,P&lt;0.01) though a slight rise was found in the medulla after 24 PHB Optical density of apoptotic lymplhocytes was significantly reduced in spleen in the 24 PBHs and raised in MLN during 48 PBHs than that prior to the burn,respectively.CONCLUSION:Gut-origin LPS is a major cause of endotoxemia taken place early in rate following severe thermal injury and could induce extensive lymphocyts apoptosis in blood and MLN,which suggests an immunosuppression state could follow the initial injury and favores a septic state based on apoptotic mechanism.     

肥厚性心肌病患者合并心房颤动的危险因素分析

目的 探讨肥厚性心肌病合并心房颤动患者的危险因素。方法 纳入2015-01至2018-03间在我院住院的肥厚性心肌病的患者69例（HCM组）及肥厚性心肌病合并房颤患者23例（HCM-AF组）,统计患者临床资料及相关检查结果。以Logistic回归分析肥厚性心肌病患者发生房颤的危险因素。结果 单因素分析结果显示,HCM组与HCM-AF组在NYHA分级（2.33&amp;#177;0.69比3.00&amp;#177;0.85）、病程[1.0（1.0,2.0）年比5.5（1.1,17.5）年]、淋巴细胞计数（1.92&amp;#177;0.73比1.59&amp;#177;0.40）、NLR（2.27&amp;#177;1.20比3.37&amp;#177;2.32）、N末端B型利钠肽原[696.50（243.75,1788.00）pg/mL比1746.50（602.25,7719.75）pg/mL]、总胆固醇（4.28&amp;#177;0.96mmol/L比3.54&amp;#177;0.77mmol/L）、甘油三酯（1.98&amp;#177;1.68mmol/L比1.15&amp;#177;0.53mmol/L）、低密度脂蛋白胆固醇（2.34&amp;#177;0.76mmol/L比1.84&amp;#177;0.65mmol/L）、左心房内经（38.48&amp;#177;6.65mm比46.21&amp;#177;11.03mm）、左室射血分数（57.95&amp;#177;6.70比53.86&amp;#177;7.71）的差异均有统计学意义（P&amp;lt;0.05）。多因素Logistic回归分析发现,NYHA分级（OR=5.15, 95% CI 1.03~25.70,P&amp;lt;0.05）、病程（OR=1.20, 95% CI 1.04~1.39,P&amp;lt;0.05）、NLR（OR=2.03, 95% CI 1.10~3.76,P&amp;lt;0.05）、左心房内经（OR=1.10, 95% CI 1.02~1.19,P&amp;lt;0.05）是肥厚性心肌病患者发生房颤的独立危险因素。结论 NYHA分级差、病程长、NLR高和左心房内经增大是肥厚性心肌病患者发生房颤的独立危险因素。     

依托咪酯与环泊酚在全麻诱导期对老年高血压患者心室-动脉耦合的影响

［摘要］　目的　分析依托咪酯与环泊酚在全麻诱导期对老年高血压患者心室-动脉耦合（VAC）的影响。方法　招募2023年5月至11月于广州市红十字会医院行全身麻醉手术治疗的57例老年高血压患者,采用随机数字表法将其分为依托咪酯组（E组,28例）和环泊酚组（C组,29例）。记录两组麻醉诱导前（T₀）、诱导1 min后（T₁）、2 min后（T₂）、气管插管前（T₃）和插管完成1 min后（T₄）的平均动脉压（MAP）、心率（HR）、左心室每搏输出量（LVSV）、有效动脉弹性（E_a）、左心室收缩末期弹性（E_es）、E_a与E_es的比值（E_a/E_es）,以及术后拔管时间、麻醉后恢复室（PACU）停留时间、不良反应发生情况、阿托品和去氧肾上腺素使用情况、E_a/E_es>1.0的人数占比。结果　与T₀时比较,E组E_a/E_es在T₁～T₃时上升,MAP、HR、LVSV在T₁～T₃时下降,HR在T₄时上升,E_a在T₁、T₂时上升,E_es在T₂～T₄时下降;C组E_a/E_es在T₁～T₄时上升,MAP、HR、LVSV及E_es在T₁～T₄时下降,E_a在T₁～T₃时上升,在T₄时下降,差异有统计学意义（P<0.05）。E组HR和LVSV在T₁～T₄时高于C组,E_a/E_es在T₁～T₄时低于C组,MAP在T₃、T₄时高于C组,E_es在T₁、T₃、T₄时高于C组,E_a在T₂时低于C组,差异有统计学意义（P<0.05）。两组术后拔管时间、PACU停留时间、不良反应发生率、阿托品和去氧肾上腺素使用情况以及E_a/E_es>1.0的人数占比比较差异无统计学意义（P>0.05）。结论　依托咪酯和环泊酚在老年高血压患者的麻醉诱导中具有较好的安全性,但依托咪酯能更好地维持VAC。     

前列腺六次跨膜蛋白2基因变异与维吾尔族人群代谢指标及肿瘤坏死因子的关系

 目的 探讨前列腺六次跨膜蛋白2(STAMP2)基因功能区变异与新疆维吾尔族人群代谢指标及TNFα的关系。方法 采用以流行病学调查为基础的病例研究,选取维吾尔族个体894例,以TNFα水平分组:高水平组(TNFα≥7.95 μg/L)313例,中水平组(TNFα>5.34~<7.95 μg/L)268例,低水平组(TNFα≤5.34 μg/L)313例。首先在小样本代谢综合征患者中测序筛查STAMP2基因的变异位点,采用TaqMan-PCR方法在大样本人群中进行基因型鉴定及关联研究。结果 在STAMP2基因功能区选取3个代表性变异位点(rs8122、rs1981529和rs34741656),rs8122和 rs1981529的基因型及等位基因分布在不同TNFα水平3组间差异有统计学意义(P<0.05),rs34741656的基因型及等位基因分布在3组间差异无统计学意义(P>0.05)。方差分析发现rs1981529多态AA基因型与AG基因型间的TNFα水平差异有统计学意义[(2.77±0.33) μg/L比(2.83±0.31) μg/L,P<0.05], STAMP2不同基因型间的TC、HDL-C、LDL-C、TG水平差异无统计学意义(P>0.05)。结论STAMP2基因变异与新疆维吾尔族人群TNFα相关。         

腹腔镜结直肠癌手术中不同通气策略对患者机械功及炎症因子水平的影响

［摘要］　目的　观察腹腔镜结直肠癌手术中不同通气策略对患者机械功（mechanical power，MP）及炎症因子水平的影响。方法　选择2021年5月至2021年11月在广州市红十字会医院接受腹腔镜下结直肠癌手术的患者60例，采用随机数字表法将其分为常规通气组（V组）和肺保护通气组（P组），每组30例。V组：潮气量（VT）=9 ml/kg，呼吸末正压（PEEP）=0 cmH₂O。P组：VT=7 ml/kg，PEEP=5 cmH₂O。于气管插管后5 min（T₁）、建立气腹后10 min（T₂）、60 min（T₃）和气腹消失后10 min（T₄）时间点，记录气道峰压（P_peak）、气道平台压（P_plat）、肺动态顺应性（Cdyn）并计算MP。于T₁、T₂、T₃、进入麻醉后监测治疗室（PACU）时采集动脉血行血气分析，记录血气酸碱度（pH值）、二氧化碳分压（PaCO₂）、氧分压（PaO₂）并计算氧合指数（OI）和肺泡-动脉氧分压差（P_A-aO₂）。于T₁、T₃和术毕测定血清中肺Clara细胞分泌蛋白（CC-16）、白细胞介素-6（IL-6）和中性粒细胞弹性蛋白酶（NE）水平。结果　两组MP在T₂～T₄时间点呈升高趋势，血清CC-16、IL-6和NE水平在T₃和术毕均较T₁时间点显著升高（P<0.05）。在T₂、T₃时间点，P组MP水平低于V组，差异有统计学意义（P<0.05）。在术毕即刻，P组血清CC-16、IL-6水平均显著低于V组（P<0.05）。气腹期间总MP大小与血清CC-16、IL-6和NE变化水平呈正相关（P<0.05）。结论　肺保护性通气策略的保护机制可能与较低的MP有关。     

Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

AIM: Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis. The aim of the study was to evaluate changes in rnicroperfusion of the pancreas, liver, kidney, stomach,colon, skeletal muscle, and to investigate the influence of heparin on the organ rnicrocirculation in caerulein-induced experimental acute pancreatitis.METHODS: Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein (Cn) (15 μg/kg). The organ microcirculation was measured by laser Doppler flowrnetry. Serum interleukin 6 and hernatocrit levels were analysed.RESULTS: Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs. Heparin administration (2&#215;2.5 mg/kg) improved the rnicrocirculation in pancreas (36.9&#177;4% vs75.9&#177;10%), liver (56.6&#177;6% vs 75.2&#177;16%), kidney (45.1&#177;6% vs79.3&#177;5%), stomach (65.2&#177;8% vs78.1&#177;19%), colon (69.8&#177;6% vs 102.5&#177;19%),and skeletal muscle (59.2&#177;6% vs 77.9&#177;13%). Heparin treatment lowered IL-6 (359.0&#177;66 U/mL vs 288.5&#177;58 U/mL) and hematocrit level (53&#177;4% vs 46&#177;3%).CONCLUSION: Hepadn administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.     

征解39结果公示

1.正确答案窦性心律及VDD起搏,伴间歇性心房感知不良2.答案情况本期收到答案42份,答案正确者21份,正确率50%。1~3名:邸成业(天津泰达国际心血管病医院);王湘娟(河南省濮阳市油田医院);李兴杰(山东省济宁市第一人民医院)4~21名:徐立文;崔勇;蒋勇;高英;赵笑春;李红;王志鹏;刘学;屈琼;孔记华;杨仕富;李世敬;刘斌;郭飞;李小平;张晓晓;胡慧娟;杜中平;肖玲;赵涛;杨丽敏     

第一批卫生部心血管疾病介入诊疗培训基地名单（二）

第一批卫生部心律失常介入诊疗（导管消融和植入器械）培训基地名单：北京协和医院;北京协和医学院阜外心血管病医院;北京大学第一医院;北京大学人民医院;首都医科大学附属安贞医院;首都医科大学附属朝阳医院;天津医科大学总医院;天津医科大学第二医院;天津市胸科医院;河北省人民医院;山西医科大学第一医院;内蒙古自治区医院;中国医科大学第一附属医院;     

Intestinal damage mediated by Kupffer cells in rats with endotoxemia

AIM：To determine the in vivo effects of phagocytic blockade of Kupffer cell(KC)on the release of proinflammatory cytokines in small intestinal lesion and on the integrity of intestinal tract by using gadolinium chloride(GdCl3)during early endotoxemia.METHODS:Wistar rats were divided into three groups:GropA,rats were injected with endotoxin(E.coliO111:B4,adose of 12mg&#183;kg^-1)only;GroupB,rats were pretreated intravenously with 25mg of GdCl3per kg24hare given endotoxin;and Group C,sham operation only.All animals were sacrificed 4h after endotoxin injecton.In portion of the rats of three groups.bile duct was cannulated,which the bile was collected externally.Morphological changes of ileum were observed under light microscopy and electronic microscopy.The KC were isolated rfrom rats by collagenase perfusion and inKC,expression of TNF-αand IL-6mRNA were determined by RT-PCRanalysis.Plasma and bile TNF-αandIL-6Levels were determined by enzyme-linked immunosorbent assay(EISA)&gt;RESULTS:In group A,there were neutrophil infiltration and superficial epitelial necrosis of the ilealvvilli,sloughing of mucosal epithelium.and disappear ance of somevilli.In groupB.the ileal mucosal damage was much reduced.which in groupC,no significant morphological changes were seen,GdCl3pretreatment decreased significantly the expression of TNF-αand IL-6mRNA ingroupB(4.32&#177;0.47and4.05&#177;0.43)when compared to groupA(9.46&#177;1.21and9.04&#177;1.09)(P&lt;0.05).There was no significant expression of TNF-αand IL-6mRNA in groupC(1.03&#177;0.14and10.4&#177;0.13).In rats of groupA,the levels of TNF-αand IL-6in bile and plasma were 207&#177;29ng&#183;L^-1,1032&#177;107ng&#183;L^-1,213&#177;33ng&#183;L^-1,and 1185&#177;127ng&#183;L^-1,respectively.In groupB,they were113&#177;18ng&#183;L^-1,repectively.In groupC,they were 67&#177;10ng&#183;L^-1,72&#177;13ng&#183;L^-1,109&#177;18ng&#183;L^-1,and 118&#177;22ng&#183;L^-1respectively.There were significant difference between the three group(P&lt;0.05).CONCLUSION:KC release cytokinesTNF-αand IL-6causing damage to the integrity of intestinal epithelium and play a crucial role in the initiation and progression of intestinal mucosal damage during early endotoxemia.     

慢性心力衰竭患者体重指数与运动耐量的相关性研究

  目的 探讨慢性收缩性心力衰竭（心衰）患者BMI与运动耐量的关系。方法 收集慢性收缩性心衰患者,计算BMI,心肺运动试验测定运动峰耗氧量（PVO₂）,公斤体重耗氧量（PKVO₂）,每搏耗氧量（VO₂/HR）和每分通气量/每分CO₂产生量（VE/VCO₂）。结果 273例慢性收缩性心衰患者中,消瘦者（BMI＜18.5 kg/m²）6例,体重正常者（BMI 18.5~<24.0 kg/m²）113例,超重者（BMI 24.0~<28.0 kg/m²）116例,肥胖者（BMI≥28 kg/m²）38例。肥胖组和超重组患者PVO₂显著高于消瘦组和正常体重组患者［（1077.2±30.9）、（1095.3±54.3）ml/min比（550.2±192.1）、（886.0±31.2）ml/min］,而PKVO₂和VE/VCO₂显著低于消瘦组和正常体重组［（14.6±2.2）、（16.5±0.5）ml·min^-1 ·kg^-1比（14.4±0.5）、（11.6±0.9）ml·min^-1·kg^-1 ,43.4±6.1、42.3±1.5比42.3±1.5、38.6±1.6,P<0.05］。在不同心功能状态下,单相关分析显示,BMI和PVO₂呈正相关（r=0.40, P<0.01）,与PKVO₂和VE/VCO₂分别呈负相关（r=-0.15、-0.25,P值均<0.01）。多元逐步回归分析显示,年龄、性别、BMI和LVEF是PKVO₂的独立影响因素,而年龄和BMI是VE/VCO₂的独立影响因素（P<0.05）。结论 慢性收缩性心衰患者BMI与运动耐量显著相关,且是运动耐量的独立危险因素。     

倾向性评分匹配法分析达格列净和沙库巴曲缬沙坦对心力衰竭预后的影响

目的 基于倾向性评分匹配法分析达格列净和沙库巴曲缬沙坦对心力衰竭患者预后的影响。方法 回顾性分析2018年6月至2021年12月山西医科大学第一医院收治的369例心力衰竭患者的临床资料,根据治疗方法不同将患者分为达格列净组和沙库巴曲缬沙坦组。倾向性评分匹配后比较2组患者的预后并分析其影响因素。采用SPSS 26.0和R Studio(4.1.2版本)进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验、χ²或Fisher精确概率法。采用Cox回归模型分析2组患者预后的影响因素并绘制Kaplan-Meier曲线。结果 倾向性评分匹配后每组70例,Kaplan-Meier曲线示2组患者出院后首次心力衰竭再住院情况差异无统计学意义(P=0.190)。Cox多因素分析显示,达格列净组纽约心脏病学会(NYHA)分级(HR=6.923,95%CI=1.032~46.426;P=0.046)、左室舒张末期内径(LVEDD)(HR=1.139,95%CI=1.004~1.293;P=0.044)、标准化Z值的N端-B型钠尿肽前体(NT-proBNP)(HR=1.825,95%CI=1.075~3.097;P=0.026)是影响心力衰竭患者预后的危险因素;饮酒(HR=0.086,95%CI=0.018~0.413;P=0.002)和HDL-C(HR=0.012,95%CI=0.000~0.642;P=0.029)是保护因素。沙库巴曲缬沙坦组吸烟(HR=14.376,95%CI=1.657~124.748;P=0.016)是影响心力衰竭患者预后的危险因素;饮酒(HR=0.082,95%CI=0.012~0.578;P=0.012)和血红蛋白(HR=0.953,95%CI=0.912~0.995;P=0.030)是保护因素。结论 倾向性评分匹配后,达格列净组NYHA分级、LVEDD、标准化Z值的NT-proBNP、HDL-C和饮酒是患者预后的影响因素;沙库巴曲缬沙坦组吸烟、Hb和饮酒是患者预后的影响因素。达格列净和沙库巴曲缬沙坦对患者预后的影响无显著差异。     

放射性125I粒子植入治疗非小细胞肺癌近期疗效的多因素分析

  目的 探讨影响放射性¹²⁵I粒子植入治疗非小细胞肺癌（NSCLC）近期疗效的因素。方法 141例原发性NSCLC患者实施CT引导下放射性¹²⁵I粒子植入治疗,其中26例单纯粒子植入,115例粒子植入联合化疗。所有患者术后6个月行胸部CT检查,根据肿瘤大小变化进行疗效评估,并分析影响近期疗效的相关因素。结果 （1）粒子植入后完全缓解37例,部分缓解93例,有效率92.2%。（2）单因素分析显示：肿瘤分型（F=5.162,P=0.023）、覆盖100%肿瘤瘤体剂量（D₁₀₀）（F=100.713,P=0.000）、治疗模式（F=16.205,P=0.000）对局部疗效有影响。单因素logistic回归分析显示：D₁₀₀、治疗模式、肿瘤分型均为影响局部疗效的独立因素。（3）单因素分析显示：肿瘤分型（χ²=7.313,P=0.007）、D₁₀₀（χ²=71.6,P=0.000）、治疗模式（χ²=20.5, P=0.000）均为影响晚期NSCLC粒子植入治疗效果的重要因素。所有患者治疗期间均未发生相关严重并发症,且与近期疗效无明显相关（P>0.05）。结论 CT引导下放射性¹²⁵I粒子植入治疗NSCLC是一种安全、有效的治疗方法,D₁₀₀为影响近期疗效最主要的因素。     

浅快呼吸指数、中心静脉血氧饱和度及其变化率对机械通气患者拔管成功率预测价值的差异性研究

【】 目的 探讨浅快呼吸指数(RSBI)、中心静脉血氧饱和度(S_CVO₂)及中心静脉血氧饱和度变化率(ΔS_CVO₂)与机械通气患者拔管成功率的预测价值的差异。方法 采用前瞻性研究方法,选取ICU的机械通气患者70例次,按拔管结果分成2组,比较2组S_CVO₂、ΔS_CVO₂及RSBI。结果 2组患者性别、年龄差异无统计学意义(P>0.05)。2组SBT30min S_CVO₂、ΔS_CVO₂及RSBI差异有统计学意义(P＜0.05)。SBT30min S_CVO₂与拔管成功率正相关(r=0.283,P=0.025),ΔS_CVO₂与拔管成功率负相关(r=-0.425,P=0.001),RSBI与拔管成功率负相关(r=-0.282,P=0.025)。SBT30min S_CVO₂、ΔS_CVO₂和RSBI的ROC下面积分别为0.697、0.190、0.349。结论 SBT30min S_CVO₂、ΔS_CVO₂和RSBI对机械通气患者拔管成功率具有一定的预测价值,SBT30min S_CVO₂优于RSBI 、ΔS_CVO₂。     

Effects of estradiol on liver estrogen receptor-alpha and its mRNA expression in hepatic fibrosis in rats

AIM:Estradiol treatment regulates estrogen receptor (ER) level in normal rat liver.However,little information is available concerning the role of estrogen in regulating liver ER in hepatic fibrosis in rats.The present study was conducted to determine whether estradiol treatment in CCl4-induced liver fibrosis of female and ovariectomized rats altered liver ERα and its mRNA expression,and to investigate the possible mechanisms.METHODS:Seventy female rats were divided into seven groups with ten rats in each. The ovariectomy groups were initiated with ovariectomies and the sham operation groups were initiated with just sham operations.The CCl4 toxic fibrosis groups received 400mL/L CCI4 subcutaneously at a dose of 2 mL/kg twice weekly.Estrogen groups were treated subcutaneously with estradiol 1mg/kg, the normal control group and an ovariectomy group received injection of peanut oil vehicle twice weekly.At the end of 8 weeks,all the rats were killed to detect their serum and hepatic indicators,their hepatic collagen content, and liver ER and ER mRNA expression.RESULTS: Estradiol treatment in both ovariectomy and sham ovariectomy groups reduced liver levels of ALT (from 658&#177;220nkat/L to 311&#177;146nkat/L and 540&#177;252nkat/L to 314&#177;163nkat/L,P&lt;0.05) and AST (from 697&#177;240nkat/L to 321&#177;121nkat/L and 631&#177;268nkat/L to 302&#177;153nkat/L,P&lt;0.05),increased serum nitric oxide (NO) level (from 53.7&#177;17.1μmol/L to 93.3&#177;4.2μmol/L and 55.3&#177;3.1μmol/Lto 87.5&#177;23.6μmol/L, P&lt;0.05) and hepatic nitric oxide synthase (NOS) activity (from 1.73&#177;0.71KU/g to 2.49&#177;1.20KU/g and 1.65&#177;0.46KU/g to 2.68&#177;1.17KU/g, P&lt;0.05),diminished the accumulation of hepatic collagen,decreased centrolobular necrotic areas as well as the inflammatory reaction in rats subjected to CCl4. The positive signal of ER and ER mRNA distributed in parenchymal and non-parenchymal hepatic cells,especially near the hepatic centrolobular and periportal areas.Ovariectomy decreased ER level (from 10.2&#177;3.2 to 4.3&#177;1.3) and ER mRNA expression (from 12.8&#177;2.1 to 10.9&#177;1.3) significantly (P&lt;0.05). Hepatic ER and ER mRNA concentrations were elevated after treatment with estradiol in both ovariectomy (15.8&#177;2.4, 20.8&#177;3.1) and sham ovariectomy(18.7&#177;3.8, 23.1&#177;3.7) fibrotic groups (P&lt;O.05).CONCLUSION: The increase in hepatic ER and mRNA expression may be part of the molecular mechanisms underlying the suppressive effect of estradiol on liver fibrosis induced by CCI4 administration.