安心颗粒联合血栓抽吸对急诊冠脉介入术后心肌灌注影响的研究

目的 在接受急诊冠脉介入术（PCI）的急性ST段抬高型心肌梗死患者中,评价术前使用安心颗粒联合血栓抽吸术对心肌灌注的影响。方法 160例接受急诊冠脉介入术的急性ST段抬高型心肌梗死患者被随机分为安心颗粒组（术前顿服安心颗粒8.8 g,术后安心颗粒4.4 g/次,每日2次）和对照组。所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀。术后观察心肌呈色分级（MBG）、心电图ST段回落百分比、肌钙蛋白(cTnI)和肌酸激酶同工酶(CK-MB)峰值、左室射血分数(LVEF)、主要不良心脏事件(MACE)。结果 安心颗粒组术后的MBG分级较高(P<0.05),达到MBG 3级的患者比例较多(P<0.05),术后ST段回落百分比>70%的患者数较对照组多(P<0.05),cTnI(P<0.01)和CKMB(P<0.05)峰值时间提前。术后第30天,安心颗粒组患者的左室射血分数明显高于对照组(P<0.01)。第(30±1)天时,2组患者主要不良心脏事件发生人数无显著性差别(P>0.05)。结论 急诊冠脉介入术前使用安心颗粒,联合血栓抽吸术,能改善心肌灌注和泵功能,但对短期内主要不良心脏事件无影响。      

Bloodletting Puncture at Hand Twelve Jing-Well Points Relieves Brain Edema after Severe Traumatic Brain Injury in Rats via Inhibiting MAPK Signaling Pathway

Objective:To investigate whether blood-brain barrier(BBB)served a key role in the edema-relief effect of bloodletting puncture at hand twelve Jing-well points(HTWP)in traumatic brain injury(TBI)and the potential molecular signaling pathways.Methods:Adult male Sprague-Dawley rats were assigned to the shamoperated(sham),TBI,and bloodletting puncture(bloodletting)groups(n=24 per group)using a randomized number table.The TBI model rats were induced by cortical contusion and then bloodletting puncture were performed at HTWP twice a day for 2 days.The neurological function and cerebral edema were evaluated by modified neurological severity score(mNSS),cerebral water content,magnetic resonance imaging and hematoxylin and eosin staining.Cerebral blood flow was measured by laser speckles.The protein levels of aquaporin 4(AQP4),matrix metalloproteinases 9(MMP9)and mitogen-activated protein kinase pathway(MAPK)signaling were detected by immunofluorescence staining and Western blot.Results:Compared with TBI group,bloodletting puncture improved neurological function at 24 and 48 h,alleviated cerebral edema at 48 h,and reduced the permeability of BBB induced by TBI(all P<0.05).The AQP4 and MMP9 which would disrupt the integrity of BBB were downregulated by bloodletting puncture(P<0.05 or P<0.01).In addition,the extracellular signal-regulated kinase(ERK)and p38 signaling pathways were inhibited by bloodletting puncture(P<0.05).Conclusions:Bloodletting puncture at HTWP might play a significant role in protecting BBB through regulating the expressions of MMP9 and AQP4 as well as corresponding regulatory upstream ERK and p38 signaling pathways.Therefore,bloodletting puncture at HTWP may be a promising therapeutic strategy for TBI-induced cerebral edema.     

如何学好药理学

药理学是研究药物与机体相互作用、作用机制及规律的科学,是连接基础医学与临床医学、医学与药学的一门重要课程.许多学生在初次学习药理学时,认为药理学不好学,内容复杂、抽象,药物种类较多,抓不住重点,难以记忆,不知道怎样学习药理学,现就这些问题谈谈学习药理学的方法.     

昆虫抗冻蛋白及其在医学领域中的应用

抗冻蛋白(antifreeze protein,AFP)是一类结构多样的蛋白质,具有热滞效应(thermal hysteresis,TH,降低冰点而不改变熔点)和重结晶抑制效应(recrystalization inhabition,RI).通过非共价吸附抑制机制吸附到冰核表面,限制冰晶生长和抑制冰晶重结晶,从而保护有机体免受结冰引起的伤害.由于抗冻蛋白具有阻止冰晶生长而不破坏细胞的特点,因而利用抗冻蛋白在低温中长期保存各种细胞、组织和器官,特别在器官移植中可能具有很好的应用前景.     

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection （DSWI） following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males （73.7%） and 5 females （26.3%）, aged 55±13 （18-78） years. According to the Pairolero classification of infected median sternotomies, 3 （15.8%） patients were type II, and the other 16 （84.2%） were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients （78.9%）, bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients （21.0%） needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients （10.5%） presented with subcutaneous infection, and 3 patients （15.8%） had hematoma. They recovered following local debridement and medication. 17 patients （89.5%） were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.     

植皮区域局限性皮肤松弛症1例

病人,女,81岁.40年前在工作时双上肢不慎被火烧伤,当年在大连化工厂医院烧伤科给予取自体腹部皮肤行前臂植皮术,术后植皮区域皮肤成活修复良好.4年前无明显诱因双侧前臂植皮区域肤色逐渐变深,无意中发现皮肤明显松弛,无不适感.近3个月自觉植皮区域疼痛不适,局部无红肿等,轻微牵拉皮肤时疼痛明显.自发病起4年皮损未见扩大.患者既往体健,否认家族有类似病患者.     

对症喝汤好处多

夏季多喝汤不仅能调节口味,补充体液,增强食欲,而且能防病抗病,对健康有益. 日常人们常喝的汤有荤、素两大类.荤汤有鸡汤、肉汤、骨头汤、鱼汤、蛋花汤等,素汤有海带汤、豆腐汤、紫菜汤、番茄汤、冬瓜汤和米汤等.无论是荤汤还是素汤,都应根据各人的喜好与口味来选料烹制,加之"对症喝汤",就可达到抗衰治病、清热解毒的"汤疗"效果.     

维生素B1和维生素B12肌注致过敏性休克1例报告

1 临床资料 患者,男,23岁,因左下肢疼痛20 d来医院就诊.询问病史:患者2 d前在上级医院诊断为坐骨神经痛.既往健康,无药物过敏史.门诊当日给予维生素B1 100 mg,维生素B12 250靏肌注,用药约5 min时患者感到头晕、胸闷、呼吸困难、寒战,面色苍白,脉搏105次·min-1,血压80/50 mmHg,考虑为药物所致过敏性休克,立即给予平卧,氧气吸入,肾上腺素1 mg肌注,地塞米松10 mg静注,5 min后患者恢复正常.     

第16届欧洲呼吸学会年会会议纪要

第16届欧洲呼吸学会年会(The European Respiratory Society 16th Annual Congress)于2006年9月1日～6日在德国慕尼黑市国际会议中心(ICM)召开,来自100多个国家和地区的16 888名代表参加了会议,大会共收到论文5277篇,接收论文4221篇,其中来自中国(包括香港、澳门和台湾)84篇(图1).现将会议内容扼要介绍如下.     

抗精子抗体和抗子宫内膜抗体与不孕及流产的关系

目的　探讨抗精子抗体（ＡｓＡｂ）与抗子宫内膜抗体（ＥＭＡｂ）在不孕、流产中的作用及二者关系,进一步 揭示不孕、流产的病因。方法　采用酶联免疫吸附试验（ＥＬＩＳＡ）同时检测３４５例不孕、流产妇女血清中的ＡｓＡｂ与 ＥＭＡｂ,按ＡｓＡｂ检测结果分阳性组和阴性组,比较两组ＥＭＡｂ阳性率的差异。结果　原发不孕及自然流产妇女中, ＡｓＡｂ（－）组ＥＭＡｂ阳性率高达１６．６７％和１９．５１％,而ＡｓＡｂ（＋）组ＥＭＡｂ阳性率高达４３．６４％和４２．８６％,显著高于 ＡｓＡｂ（－）组（Ｐ＜０．０１,Ｐ＜０．０５）。继发不孕妇女中ＡｓＡｂ（－）组ＥＭＡｂ阳性率为１８．１８％,ＡｓＡｂ（＋）组ＥＭＡｂ阳性率 为３２．２％,二者无显著性差异（０．０１＞Ｐ＞０．０５）。结论原发不孕及自然流产妇女中因个体免疫反应差异使某些 人易对体内、外物质发生免疫反应而产生抗体,从而导致不孕或流产。     

气血与足月妊娠分娩关系的探讨

论述足月妊娠分娩的发动和维持依靠气的推动、温煦、气化、固摄功能和血的营养、濡润功能。顺利分娩既要气血充足，还要气顺血和。临床研究结果表明调补气血，是促进产程，预防难产的重要手段。实验研究结果阐明调补气血中药加强产力、促进产程主要是从改善产妇全身情况，提高机体抗应激、抗疲劳、耐缺氧能力，即所谓使产妇气血充足调和，充分发挥气血在分娩过程中的生理作用。     

水疗联合抚触对新生儿的生长发育、黄疸及睡眠的影响

目的探讨新生儿游泳联合抚触对新生儿的生长发育、黄疸及睡眠的影响。方法将经阴道顺产分娩的正常新生儿100例随机分为两组，观察组（水疗联合抚触组）50例，对照组（单纯沫浴组）50例。①测定两组10日、28日的体重、身长、上臂围；②观察记录胎便转黄时间，测定皿清胆红素；③记录24h睡眠时间。结果两组新生儿10日、28日体重、身长、上臂同增长有显著差异（P〈0．05），两组新生儿5日时，胎便转黄时间及黄疸指数比较均有显著性差异（P〈0．01），两组睡眠时间比较有统计学意义（P〈0．05），两组并发症比较无统计学意义（P〉0．05）。结论新生儿水疗联合抚触可促进新生儿的生长发育，能加速胎粪的早排出，减轻生理性黄疸程度，有效地降低新生儿高胆红素血症的发病率，提高睡眠质量。     

亚硝基脲类和亚硝基硫脲类的理化性质及致突变能力

本题选择N,N′-二甲基亚硝基脲(DMNU),N,N′-二乙基亚硝基脲(DENU),及其类似物N,N′-二甲基亚硝基硫脲(DMNTU)、N,N′-二乙基亚硝基硫脲(DENTU)为代表,测定了这些化合物的水解反应速度、脂溶性(HPLC的logk′值)、水解产物和致突变能力。证明了硫脲的脂溶性大于脲的脂溶性。DMNTU对TA100菌株的致突变能力最强,其它较弱。