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。      

创伤刺激、肾上腺素和地塞米松对小鼠应激能力的影响

目的 比较创伤刺激和使用肾上腺素、地塞米松或两药合用对小鼠应激能力的影响.方法 分别采用剪尾法及游泳法结合血糖水平测定观察小鼠应激状态的变化;进一步在给予地塞米松、不同浓度肾上腺素及两药合用条件下,测定血糖水平和游泳力竭时间,观察药物对小鼠应激能力的影响.结果 剪尾组血糖水平与生理盐水对照组间比较,差异无统计学意义(P>0.05);给予一定剂量肾上腺素的小鼠,其血糖水平明显高于创伤刺激组和对照组小鼠,差异有统计学意义(P<0.05);在各种药物使用的比较中,较高浓度肾上腺素组游泳力竭时间明显短于地塞米松组和对照组,差异有统计学意义(P<0.05);较高浓度肾上腺素组、两药合用组游泳后血糖水平均明显高于地塞米松组和对照组,差异有统计学意义(P<0.05);低浓度肾上腺素组游泳后血糖水平也明显高于对照组,差异有统计学意义(P<0.05).结论 与对照组相比,剪尾创伤并不足以引起显著的以血糖升高为特点的应激反应;给予肾上腺素及肾上腺素与地塞米松合用虽均显著升高血糖水平但会降低小鼠的运动应激能力.     

Anti-obesity effect and UHPLC-QTOF-MS/MS based metabolite profiling of Solanum nigrum leaf extract

Objective:To evaluate the antioxidant potential and pancreatic lipase inhibitory action of optimized hydroethanolic extracts of Solanum nigrum.Methods:Optimized extraction for maximum recovery of metabolites was performed using a combination of freeze-drying and ultrasonication followed by determination of antioxidant and antiobesity properties.The ultra-high performance liquid chromatography equipped with mass spectrometry was used to analyze metabolite profiling of Solanum nigrum.Computational studies were performed using molecular docking and electrostatic potential analysis for individual compounds.The hypolipidemic potential of the most potent extract was assessed in the obese mice fed on fat rich diet.Results:The 80%hydroethanolic extract exhibited the highest extract yield,total phenolic contents,total flavonoid contents along with the strongest 2,2-diphenyl-1-picrylhydrazyl scavenging activity,total antioxidant power,and pancreatic lipase inhibitory properties.The 80%hydroethanolic extract not only regulated the lipid profile of obese mice but also restricted the weight gain in the liver,kidney,and heart.The 80%hydroethanolic extract also reduced alanine transaminase and aspartate transaminase concentrations in serum.The effects of plant extract at 300 mg/kg body weight were quite comparable with the standard drug orlistat.Conclusions:Solanum nigrum is proved as an excellent and potent source of secondary metabolites that might be responsible for obesity mitigation.     

高铁蛋白血症与早期糖脂代谢异常的关系

目的 探讨高铁蛋白血症与血糖、血脂代谢紊乱的关系.方法 收集杭州市第一人民医院"健康"体检者382例,根据铁蛋白水平,以310μg/L为限分为高铁蛋白组(A组)与低铁蛋白组(B组),分别测定血脂谱,空腹血糖(FBG)、尿酸(UA)、血红蛋白(Hb)、红细胞计数(RBC)、红细胞压积(HCT)、平均红细胞血红蛋白浓度(MCHC),超声检查脂肪肝,对两组间的数据进行统计学分析.结果 两组间TG、LDL、HDL、ApoAl、ApoB、FBG、UA、Hb、RBC、HCT、MCHC有显著差异,铁蛋白与TG、TC、LDL、ApoB、Hb、RBC、HCT呈正相关,与HDL、ApoA1呈负相关,A组脂肪肝的发生率较B组明显升高.结论 铁蛋白可能是早期糖脂代谢异常的标志物之一.     

解剖学课程资源的开发

课程资源是指供给课程活动、满足课程活动需要的一切,包括构成课程目标、内容的来源和保障课程活动进行的教学设备和材料[1].随着医学的迅猛发展,医学知识不断更新,解剖学作为医学专业的主干课程,开发、整合解剖学课程资源,使其具有前瞻性、有效性、实用性,并进一步优化学生的知识结构,成为解剖学教学研究的新课题.对此,我们进行了探索与实践.     

Comparing different domains of analysis for the characterisation of N-glycans on monoclonal antibodies

With the size of the biopharmaceutical market exponentially increasing,there is an aligned growth in the importance of data-rich analyses,not only to assess drug product safety but also to assist drug development driven by the deeper understanding of structure/function relationships.In monoclonal antibodies,many functions are regulated by N-glycans present in the constant region of the heavy chains and their mechanisms of action are not completely known.The importance of their function focuses analytical research efforts on the development of robust,accurate and fast methods to support drug development and quality control.Released N-glycan analysis is considered as the gold standard for glycosylation characterisation;however,it is not the only method for quantitative analysis of glycoform heterogeneity.In this study,ten different analytical workflows for N-glycan analysis were compared using four monoclonal antibodies.While observing good comparability between the quantitative results generated,it was possible to appreciate the advantages and disadvantages of each technique and to summarise all the observations to guide the choice of the most appropriate analytical workflow according to application and the desired depth of data generated.     

治疗肺癌巧用"原子弹"

二战时期,美国科学家率先研制成功原子弹,它是一种利用核裂变原理制成的核武器,在爆炸的同时会放出强烈的核辐射,危害生物组织。1945年美国向日本的广岛、长崎各投放了一枚原子弹,其杀伤     

葫芦里卖的什么药?——"哑谜医疗"的前世今生

在中国古代,老百姓对于医生的言行心生疑虑,有一个经典的发问: "不知他葫芦里卖的什么药?"以表达对医生、医学的不安与不满."不过,这种疑虑似乎还只是表现在药物属性上,真药还是假药?贵药或贱药?价格是否诚实?是否贱药贵卖?……如今这种知情诉求可是大大拓展了,不仅关心药物的疗效与毒副作用,还要关心诊断、预后、护理细节、康复举措,还有费用标准与合理性.     

院前急救程序

院前急救是急诊医疗体系的重要组成部分,院前急救处理正确与否直接关系到患者的生死存亡.有效的现场急救,要求医务人员须严格按预定的急救规范进行,这不仅有利于提高急救质量,对解决医疗纠纷、保险等也有重大意义.本栏目倡导尽量使用最新的药物、器械诊治;各操作程序方案的设置力求符合最新理论,并注重可操作性、科学性和实用性.     

女医生擅离职守救灾对焉 院领导照章处以辞退错否

事件回放 娄继英原是重庆某医院住院部的助理医师,汶川地震发生后,她主动请缨到灾区去服务,但未获医院批准.5月19日,娄继英毅然与其他志愿者奔赴灾区做医护志愿者.然而,当她回到重庆后,却被医院告知,由于她连续旷工3日,医院为严肃劳动纪律,决定对其按自动离职处理.     

Congenital rudimentary medial meniscus--report of a case of development arrest of medial meniscus

We present an unusual case, where the medial meniscus does not coincide with the embryological development of the formation of a discoid cartilage. A fairly, careful perusal of English literature since 1945 to date makes us feel that the following case merits recording. The meniscus had a normal anterior horn attached to the intercondylar area, in front of the anterior cruciate ligament. Medially, it was attached to the capsule and the condylar surface of the medial tibial plateau. The posterior horn was rounded, smooth, and floating free of any attachments. It was approximately 2 cms in length, semilunar in shape, and extended posteriorly up to the anterior margin of the medial collateral ligament. The rest of the medial tibial plateau had no other protective covering.     

Isolated medial rectus palsy

To the editor:Eye movement disorder caused by cerebral stem infarction was common in clinical practice.1 However,isolated medial rectus palsy due to a tiny infarction lesion was rarely seen. An 80-year-old man with a 10-year history of hypertension and diabetes,presented to the hospital for a sudden onset of diplopia.Neurological examination of cranial nerves revealed left medial rectus palsy when gazing to the right side (Figure 1A).     

Isolated medial rectus palsy

To the editor： Eye movement disorder caused by cerebral stem infarction was common m clinical practice. However, isolatedmedial rectus palsy due to a tiny infarction lesion was rarely seen.
An 80-year-old man with a 10-year history of hypertension and diabetes, presented to the hospital for a sudden onset of diplopia. Neurological examination of cranial nerves revealed left medial rectus palsy when gazing to the right side （Figure 1A）. Other saccadic eye movements, the direct and indirect pupillary light reflex, eyelid activity were normal.     

自体腱重建膝内侧副韧带手术探讨

目的:探讨重度膝内侧副韧带断裂修复重建的手术方法及临床疗效.方法:对33例严重膝内侧副韧带断裂患者采取手术重建、修复方法治疗.全部患者损伤程度为III度,即内侧副韧带浅层及深层全部断裂,部分患者合并半月板损伤、胫骨平台骨折.手术方法采用在解剖修复内侧副韧带基础上游离移植自体半腱肌腱(semitendinous tendon,ST)或骨-髌韧带-骨(bone-patella tendon-bone,BPTB)重建内侧副韧带浅层.结果:33例患者得到随访,随访时间为43.1(3～71)月.术后症状明显改善,膝关节无明显不稳及疼痛者27例;仍感觉有内侧不稳定者1例,外翻应力位X线照片检查,患膝内侧间隙增宽大于5 mm;膝关节仍感疼痛者5例,5例中膝关节屈伸功能未完全恢复者4例.术后Lysholm评分为81～91(87.42±3.78)分,与术前0～56(26.45±21.03)分相比较有统计学差异 (P＜0.01).结论:游离肌腱移植重建膝内侧副韧带效果佳.BPTB及ST均是可供选择的移植物.     

内侧型蝶骨嵴脑膜瘤显微手术治疗

目的 探讨内侧型蝶骨嵴脑膜瘤显微手术技巧.方法 回顾性分析23例内侧型蝶骨嵴脑膜瘤显微手术治疗的临床资料,讨论显微手术治疗内侧型蝶骨嵴脑膜瘤的手术要点.结果 23例患者均行显微外科手术切除肿瘤.肿瘤全切15例,次全切6例,部分切除2例.无手术死亡,疗效满意.结论 采用经翼点入路,利用显微手术可以明显提高肿瘤全切率.肿瘤是否全切,取决于肿瘤的部位、质地、脑水肿的程度.对无法全切的肿瘤,可考虑姑息手术结合术后放疗.     

内侧髌股韧带重建术的研究进展

髌骨脱位是骨科的一种常见疾病,青少年发病率最高,平均患病年龄为21.4岁。髌骨脱位的治疗方法众多,其中重建内侧髌股韧带(MPFL)治疗髌骨脱位为主流术式。本文通过回顾国内外相关文献,详细阐述了内侧髌股韧带重建术的生物力学、移植物选择,并对股骨止点定位及髌骨止点固定、术后并发症等进行了讨论,以期为临床工作者提供相关参考依据。针对不同的术后并发症,目前出现多种优化方案,合理的手术方案选择是良好手术满意率的前提。     

老年人蝶骨嵴内侧型脑膜瘤的显微手术

目的:分析探讨老年人用显微手术提高蝶骨嵴内侧型脑膜瘤的全切经验。方法:对18例老年人蝶骨嵴内侧型脑膜瘤患者的手术治疗进行回顾性分析。结果:手术全切13例(72.22%),次切3例(16.67%),部分切除2例(11.11%),无死亡病例。结论:根据内侧型脑膜瘤比邻显微结构,采用显微技术,利用肿瘤与脑血管之间的蛛网膜间隙界面,阻断基底部血运,完整切除肿瘤。大型肿瘤应保护周围血管、神经组织,分块切除。部分侵到下丘脑、海绵窦的肿瘤可考虑姑息性手术。     

前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效

  目的  探讨经前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效，为此类临床问题的解决提供参考。  方法  2018年1月—2019年12月蚌埠医学院第二附属医院收治陈旧性内踝骨折患者9例，均为扭伤所致，术前曾行时间不等的非手术治疗，病程为43~128(83.0±34.6)d。采用前内侧入路切开复位拉力螺钉固定并自体松质骨植骨治疗，3例伴三角韧带损伤者加用带线锚钉修复。术后观测骨折愈合时间、手术并发症，测量并比较术前及末次随访时内踝间隙宽度及踝-后足评分系统(AOFAS)评分评价其疗效。  结果  9例患者随访12~36(24.7±7.6)个月，术后3~5(3.8±0.7)个月骨折愈合，无血管神经损伤、踝关节不稳或创伤性关节炎。末次随访时，内踝间隙宽度由(4.4±0.9)mm缩小至(2.4±0.3)mm，AOFAS评分由(47.3±6.2)分升高至(93.4±9.3)分，与术前比较差异有统计学意义(均P < 0.01)。依据AOFAS评分，优6例，良2例，可1例，优良率为88.9%。  结论  前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折，骨折愈合率高，并发症少，足踝功能恢复良好。