尼莫通对神经细胞骨架成分微管相关蛋白2保护作用观察

观察钙通道阻滞剂尼莫通对神经细胞骨架成分微微相关蛋白的保护作用。方法健康Ｗｉｓｔａｒ大鼠随机分为缺血前，缺血２０分钟，缺血２０分钟再灌注１小时、６小时、１日、４日和７日７组，每组６只，制作 全脑缺血模型；治疗组于缺血前１５分钟及缺血后２０分钟腹腔注射１ｍｇ／ｋｇ尼莫通各１次。     

尼莫通和川芎嗪对脑缺血-再灌注时c-fos和bcl-2蛋白表达的影响

目的：为临床应用尼莫通和川芎嗪治疗缺血性脑血管病提供充分的理论依据。方法：对实验大鼠于脑缺血前应用尼莫通和川芎嗪进行药物干预,然后采用免疫组化法检测脑缺血 再灌注不同时间内ｃ ｆｏｓ 及ｂｃｌ ２蛋白表达的变化。结果：①与未用药组相比,尼莫通组和川芎嗪组大鼠脑缺血后的梗死体积显著减小,但两用药组之间相比无显著性差异;②尼莫通组和川芎嗪组脑缺血 再灌注时皮质和基底节区ｃ ｆｏｓ的表达明显下降;而ｂｃｌ ２ 的表达明显增高。结论：尼莫通和川芎嗪具有神经保护作用     

全脑缺血—再灌注大鼠大脑c—fos基因表达的实验研究

目的：研究大鼠全脑缺血再灌注时大脑细胞ｃｆｏｓ基因表达及药物对其的影响，为探讨脑缺血再灌注损伤的基因机制提供依据。方法：从不同缺血再灌注时点大鼠的大脑提取ＲＮＡ，与探针ｃｆｏｓｃＤＮＡ进行打点分子杂交，图像经分析测出各时点大脑ｃｆｏｓ基因ｍＲＮＡ的相对水平。结果：大脑ｃｆｏｓ基因表达从缺血２０分钟开始，再灌注２０分钟表达水平显著高于对照组（Ａ值：１０．１２８±１．４５４比２．１３２±０．６２３，Ｐ＜０．０１），再灌注４０分钟达高峰（Ａ值：１４．９０８±１．８６２），随后下降，再灌注９０分钟达到并维持正常水平，显示ｃｆｏｓ基因早期、快速、一过性高表达；用尼莫地平缺血前预处理能显著抑制缺血３０分钟再灌注４０分钟时大脑ｃｆｏｓ基因表达（Ａ值：２．３１２±０．９４１）。结论：ｃｆｏｓ基因极可能介导了Ｃａ２＋的信息，作为信使参与全脑缺血再灌注大脑病理损伤的基因机制     

胞浆游离钙和组织ATP,ADP,AMP在脑复苏中变化及药物的保护作用

目的：为了探讨胞浆游离钙、ＡＴＰ、ＡＤＰ、ＡＭＰ在脑缺血和再灌流损伤中的作用及相互关系以及药物的影响。方法：应用沙鼠建立脑缺血模型。缺血前１５分钟腹腔注射药物，分别阻断双侧颈动脉５０分钟，阻断颈动脉５０分钟再灌流１０分钟，再灌流６０分钟及１２０分钟。检测脑组织中ＡＴＰ、ＡＤＰ和ＡＭＰ的变化以及应用尼莫地平及东莨菪碱后的影响。结果：（１）胞浆游离钙在脑缺血５０分钟后大幅度升高，再灌流时再度升高，然后缓慢下降。（２）在缺血期ＡＴＰ迅速下降，再灌流期先上升，此后再度下降，而ＡＤＰ及ＡＭＰ在缺血及再灌流期积聚。（３）尼莫地平及东莨菪碱对减缓胞浆游离钙升高，减缓ＡＴＰ的耗竭均有作用。结论：对脑缺血和再灌流损伤有治疗意义。     

大鼠脑缺血再灌注区细胞间粘附分子1表达与白细胞浸润的实验研究

目的：观察大鼠脑缺血－再灌注后不同时间缺血区细胞间粘附分子－１（ＩＣＡＭ－１）的表达和中性粒细胞的浸润以及神经细胞的损伤情况。方法：４０只Ｗｉｓｔａｒ大鼠分为对照组、假手术组和缺血２小时再灌注２、４、１２、２４、４８、９６小时组,分别用免疫组织化学和组织切片方法检测大脑中动脉阻塞２小时再灌注不同时间点局部脑组织ＩＣＡＭ－１蛋白表达及中性粒细胞浸润情况。结果：大鼠脑缺血 灌液２小时局部脑组织ＩＣＡＭ     

沙土鼠短暂性脑缺血后海马CA1区细胞凋亡及亚低温的影响

目的：研究沙土鼠短暂性脑缺血后海马ＣＡ１区细胞凋亡及亚低温的治疗作用。方法：阻断沙土鼠双侧颈总动脉２０分钟造成前脑缺血模型。实验动物被随机分为假手术组、缺血－再灌注组、亚低温治疗组。海马ＣＡ１区的迟发性神经元死亡（ＤＮＤ）过程通过序列光镜观察进行研究,原位末端标记（ＴＵＮＥＬ）法用来检测死凶的ＤＮＡ片断。结果：短暂性脑缺血后,海马ＣＡ１区锥体神经元于再灌注后２～７日死亡。死亡锥体神经元的序列光镜观察没有发现早期的凋亡样改变,ＤＮＡ 断化也发生在ＤＮＤ出现之后。亚低温处理动物再灌注后２～７日,海马ＣＡ１区缺血性神经元死亡较常温处理动物显著减轻,再灌注后３～７日,海马ＣＡ１区ＤＮＡ片断化也显著减少。结论：缺血后的亚低温治疗产生了神经保护作用,而抑制神经元ＤＮＡ片断化的出现可能是其保护机制之一。     

川芎嗪注射液对脑缺血-再灌注损伤家兔血清白细胞介素-8的影响

目的：观察川芎嗪注射液（ＴＭＲＩ）对脑缺血－再灌注损伤（ＣＩＲＩ）家兔血清白细胞介素－８（ＩＬ－８）的合成和释放的影响,并探讨其脑保护机制。方法：制备家兔ＣＩＲＩ模型,随机分为假手术对照组、缺血－再灌注组和ＴＭＲＩ组,分别在缺血前、缺血３０分钟、再灌注３０、６０、１２０分钟取静脉血,测定血清ＩＬ－８浓度,实验结束取脑皮质ＨＥ染色,光镜观察脑组织病理学改变。结果：缺血－再灌注组在脑缺血－再灌注时间不同时间点血清ＩＬ－８水平随脑缺血－再灌注时间延长呈进行性升高,分别为缺血前的１．３８、１．６２、１．９３和２．２９倍,明显高于假手术组,光镜下白细胞大量浸润、神经元明显损伤;ＴＭＲＩ组不同时间点血清ＩＬ－８浓度显著低于缺血－再灌注组,光镜下白细胞浸润、神经元损伤程度较缺血－再灌注组明显减轻,而与假手术组比较均无显著性差     

尼莫通对急性脑缺血保护作用临床及实验研究

目的：探讨尼莫通对脑缺血再灌流保护作用机制。方法：采用家兔四动脉闭塞脑缺血灌流动物模型，检测脑缺血再灌流前后血清丙二醛（ＭＤＡ）、超氧化物歧化酶（ＳＯＤ）变化及脑组织Ｈ２Ｏ、Ｎａ＾＋、Ｋ＾＋、Ｃａ＾＋＋含量；同时进行了５５例脑梗塞患分组对照。结果：再灌流后尼莫通组怀其它组相比ＭＤＡ下降、ＳＯＤ升高均显。结论：尼莫通通过阻止Ｃａ＾＋＋内流抑制脂质过氧化损伤，对脑缺血具有保护作用。     

P选择素单克隆抗体对大鼠肝缺血—再灌注损伤的治疗作用研究

目的：探讨Ｐ选择素单克隆抗体（单抗）对大鼠肝缺血再灌注损伤的保护作用。方法：在肝缺血再灌注大鼠模型上观察了细胞间粘附分子１和Ｐ选择素的变化，并用Ｐ选择素单抗对其进行阻断治疗。结果：缺血再灌注大鼠肝细胞发生水肿及空泡变性，血清天冬氨酸转氨酶和丙氨酸转氨酶水平升高；但再灌注前５分钟经静脉注射Ｐ选择素单抗，则肝组织与正常组相近，肝细胞未见空泡变性，血清酶水平明显减低；酶联免疫吸附试验发现，再灌注后血清ＩＣＡＭ１和血浆Ｐ选择素水平显著升高，经Ｐ选择素单抗处理的大鼠血ＩＣＡＭ１和Ｐ选择素明显下降。结论：ＩＣＡＭ１和Ｐ选择素与缺血再灌注损伤密切相关，Ｐ选择素单抗对肝缺血再灌注损伤具有保护作用。     

短暂前脑缺血再灌注鼠海马区迟发性神经元死亡与凋亡的关系

目的系统研究短暂前脑缺血再灌注后，海马迟发性神经元死亡与细胞凋亡的关系。方法蒙古沙土鼠，前脑缺血５分钟，在再灌注的１小时、１天、３天、５天取海马，分别行末端脱氧核苷酸转移酶介导的ｄ－ＵＴＰ生物素缺口末端标记（ＴＵＮＥＬ）染色光镜观察、透射电镜观察及流式细胞仪检测。结果缺血再灌注组均出现了ＴＵＮＥＬ阳性细胞，以再灌注３天组最为显著，再灌注３天组电镜下可见凋亡小体，再灌注１小时、１天、３天、５天与对照组的凋亡细胞百分比分别为１９２０％、２５８８％、４３１８％、２６７３％和１８１４％。再灌注３天组凋亡细胞与对照组有显著差异，其余各组与对照组均无显著差异。结论沙土鼠短暂前脑缺血再灌注损伤后，海马区神经元发生了迟发性死亡，主要表现为细胞凋亡。     

医生与护士社会地位的调查研究

目的 调查医生、护士对医护社会地位的认知情况及形成医护社会地位差异的影响因素.方法 采用自编的医生护士社会地位问卷对280名医生、290名护士进行调查.结果通过经济待遇、社会权益、职业声望三方面的调查,医生、护士均认为医生的社会地位高于护士的社会地位.医护社会地位差异的影响因素有医生所在医院、对专业技术的要求、工作成就感、工作稳定性;专业化程度、工作压力.结论深入研究医护社会地位问题及其形成的影响因素,有助于我们从对策上研究提高护士社会地位的方法,创建和谐的医护关系促进护理队伍的可持续发展.     

成都市新都区餐饮具消毒效果监测

为了解餐饮具消毒现状,采用纸片检验法对新都区饮食单位餐饮具消毒效果进行了监测。结果,抽检餐饮单位297户,餐饮具样本1914份,总合格率为73.51％;抽检全部合格的单位占43.43％,全部不合格的单位占8.08％。结果显示,新都区餐饮业消毒效果和卫生状况整体水平较低,其中以中餐业和中等规模餐饮店卫生状况最差。因此,必须加强管理,加大监督监测力度,全面落实消毒和卫生管理制度,改进餐饮业卫生质量。     

糖尿病患者对糖尿病眼部并发症的认知与需求调查

目的 调查糖尿病患者对眼部并发症的知识、态度、行为及其需求.方法采用自设问卷,对58例有眼病及51例无眼病的门诊糖尿患者进行调查.结果 50%以上的患者对糖尿病眼病的危险因素认识不足;80%以上认为糖尿病患者需要定期进行眼科检查;无眼病组患者中,82.4%出现过一种或几种眼部症状,且近10%经常出现症状,但52.4%的患者不做任何处理;80%以上的患者希望获得糖尿病眼病的相关知识.其现有知识和希望获得途径均为眼科医生、媒体、内科医生、其他糖尿病患者等,从护上获得知识的比例非常低.结论多数糖尿病患者对糖尿病眼病的危险因素认识不足,未形成良好的定期眼科检查的保健行为,今后需加强内科医生、护士在糖尿病眼病健康宣教中的作用.     

逆转录病毒介导Fcy::Fur融合基因联合5-FC治疗胶质瘤的体内试验研究

目的构建含融合自杀基因Fcy::Fur重组逆转录病毒,用自杀基因治疗系统Fcy::Fur/5-氟胞嘧啶(5-FC)对裸鼠胶质瘤进行体内抑瘤作用的实验研究。方法扩增Fcy::Fur基因并构建Fcy::Fur基因重组逆转录病毒载体;载体转染包装细胞获得高滴度病毒并转染鼠胶质瘤细胞C6,筛选并鉴定阳性转基因克隆;构建裸鼠荷胶质瘤动物模型,腹腔注射5-FC,观察裸鼠肿瘤重量变化及电镜、流式细胞仪(FCM)检测肿瘤的凋亡。结果PCR法扩增出全长Fcy::Fur基因,经测序证实序列正确;构建了PLXSN-Fcy::Fur逆转录病毒载体,载体转染包装细胞PT67,获得滴度为3.5×106CFU/mL的逆转录病毒;转染C6获转基因阳性克隆C6-Fcy::Fur,检测C6-Fcy::Fur有Fcy::Fur基因的mRNA表达;裸鼠前肢背部接种转基因细胞,成瘤后腹腔注射5-FC,转基因肿瘤的生长较对照组明显抑制。FCM法检测到凋亡峰,电镜观察到转基因肿瘤细胞有凋亡小体。结论AdE1CMVCD与5-FC联合在体内对胶质瘤有明显的抑制作用,为临床胶质瘤基因治疗提供了可靠的理论及应用依据。     

Urban Trauma Transport of Assaulted Patients Using Nonmedical Personnel

Objective: To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome.
Methods: Retrospective data were assembled over a six–year period through the use of the state trauma registry for an urban county served by seven state–accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability. An unexpected death index (UDI), calculated as the difference between expected (TRISS method) and observed death rates, also was determined. Outcomes for patients transported by fire medics (FMs) vs nonmedical, police personnel (NPs) were compared.
Results: FMs transported 2,108 (44%) and NPs transported 1,356 (29%) of the injured assault victims. The FM–transported patients had a lower expected probability of survival than had the NP–trans–ported patients (p < 0.001). This also was true within the penetrating–injury subgroup (p < 0.001), but not the blunt–injury subgroup. The observed death rate was higher for all the FM–transported patients than it was for the NP–transported patients (15% vs 11%; p < 0.01). The UDIs were not different overall, although the NP–transported patients who had blunt trauma had a significantly lower UDI (p < 0.01).
Conclusions: NP transport of assaulted patients is generally associated with equivalent outcomes in comparison with FM transport in this urban environment. However, these data also provide evidence of an on–scene implicit triage with more severely injured patients generally transported by FMs.     

脊柱骨质增生症的康复治疗

应用离子导入法、超声波、脉冲中频电疗及牵引４种疗法，对４８例脊柱骨质增生患者进行同步、交叉综合治疗，平均治疗时间２５天。结果痊愈８例，显效２８例，好转１２例。作者尚对脊柱骨质增生病因及上述疗法的机理进行了讨论。     

Electrocardiographic ambulatory monitoring with a real-time analysis system

The analysis of records collected during long-term ambulatory electrocardiographic monitoring has traditionally involved the review of massive data, either manually or with the aid of interactive scanning computers. Many factors complicate this analysis, including the use of analog tape for storage of electrocardiographic waveforms, the need to analyze 100,000 waveforms from an average 24-hour study, and the need to deal with an interface that compresses 24 hours of data into as little as 6 minutes on a screen. Today, the computer incorporated in the monitor can scrutinize each cardiac cycle in real time. The system produces a statistical report based on every heart beat and also performs data reduction and storage of electrocardiograph samples. To assess real-time analysis we examined data collected from the Circadian CircaMed ambulatory electrocardiography system. We found that it could detect and quantify simple or complex ventricular ectopic beats, brady- or tachyarrhythmic events, and ST-segment deviation. One hundred fifty patients 21 to 85 years old with symptoms or clinical findings suggestive of ischemia, cardiac arrhythmia, or conductive defects were referred to our electrocardiography laboratory for ambulatory monitoring. The results demonstrate that this system can detect the full range of cardiac disease found with the traditional method. Of the 150 patients, ambulatory electrocardiographic tests were positive in 93 (62%). In addition, we developed a methodology for lead placement when using two bipolar leads, as is typical for ambulatory electrocardiography. We present a procedure for determining the optimum lead placement that is based on the patient’s history and a 12-lead electrocardiogram.     

患者中心疗法对2型糖尿病患者心理行为的影响

目的 探讨患者中心疗法对糖尿病患者心理状况及行为的影响.方法 将60例糖尿病患者随机分为对照组(30例)和干预组(30例),对干预组进行患者中心疗法干预,干预前后用症状自评量表(SCL-90)和糖尿病患者行为评估表对两组患者心理状况和行为状态进行评定.结果 干预前两组患者在SCL-90量表各因子上得分的差异无统计学意义(P>0.05),干预后两组比较,躯体化、强迫、人际关系敏感、敌对、恐怖、偏执、精神病性等因子均统计学意义(P<0.01);干预后两组患者在不良饮食习惯纠正、戒酒、复查时间的掌握及在血糖控制、坚持运动锻炼、戒烟方面的差异有统计学意义(P<0.01),按时服用降精药物或注射胰岛素无统计学意义(P>0.05).结论 患者中心疗法对提高糖尿病患者的心理健康水平,增加其健康行为有积极的作用.     

Microstream capnograpy technology: a new approach to an old problem

Significant technical limitations inherent in blackbody infrared technology used in conventional sidestream and mainstream capnography have hindered the acceptance and growth of capnography as a monitoring tool outside the operating room environment. We describe a new technology (Microstream) for CO₂ monitoring, based on molecular correlation spectroscopy, which results in a highly efficient and selective emission of a spectrum of discrete wavelengths exactly matching those for CO₂ absorption. The CO₂ specific emissions allow for an extremely small sample cell (15 µl), which in turn, permits the use of a very low sample flow rate (50 ml/min) without compromising waveform integrity or end-tidal CO₂ accuracy. Design and technology features of the CO₂ emission source, sample cell, and breath sampling circuits are described.     

Warning devices for prevention of dental injury during laryngoscopy. Preliminary report

The prototypes of two novel warning devices for protection against dental trauma during direct laryngoscopy are described. Either can be attached to a standard laryngoscope blade (e.g., Macintosh). The basic design is that of as witch that is closed by pressure on the maxillary incisors by the laryngoscope blade. This revised version was published online in July 2006 with corrections to the Cover Date.