剧烈呕吐致食管破裂1例

剧烈呕吐致食管破裂1例,以呕吐和腹痛为首发表现,累及消化系统及呼吸系统,CT示纵膈气肿,双侧胸腔积液,合并双肺基底段肺不张,左上腹大量气体影.胃镜检查提示距门齿40-45 cm处食管黏膜可见大量白色脓苔附着,脓苔中可见有气泡冒出,考虑为食管穿孔.治疗上以手术为主.     

细节管理决定临床护理工作的成与败

护理工作平凡而琐碎,日常工作中很多是由一个个看似不起眼的细节组成的,而护理质量的优劣恰恰就包含在这众多琐碎的、不起眼的工作细节当中;加强细节管理能使整体工作有质的改变,细节管理应该渗透在每一项工作中,因为优质的服务、品牌的打造就隐藏在细节当中。     

临床护理人员用药知识掌握的调查分析

目的 了解临床护理人员用药知识的掌握状况。方法 对某医院15个科室178名临床护理人员进行问卷调查。结果 临床护士主要对药物的作用机制(如血浆半衰期)了解较少。结论 建议将临床用药的相关知识纳入临床护士继续教育的内容。     

Morphine Preconditions Purkinje Cells against Cell Death under In Vitro Simulated Ischemia-Reperfusion Conditions

Background: Morphine pretreatment via activation of [delta]1-opioid receptors induces cardioprotection. In this study, the authors determined whether morphine preconditioning induces ischemic tolerance in neurons.

Methods: Cerebellar brain slices from adult Sprague-Dawley rats were incubated with morphine at 0.1-10 [mu]m in the presence or absence of various antagonists for 30 min. They were then kept in morphine- and antagonist-free buffer for 30 min before they were subjected to simulated ischemia (oxygen-glucose deprivation) for 20 min. After being recovered in oxygenated artificial cerebrospinal fluid for 5 h, they were fixed for morphologic examination to determine the percentage of undamaged Purkinje cells.

Results: The survival rate of Purkinje cells was significantly higher in slices preconditioned with morphine (>= 0.3 [mu]m) before the oxygen-glucose deprivation (57 +/- 4% at 0.3 [mu]m morphine) than that of the oxygen-glucose deprivation alone (39 +/- 3%, P < 0.05). This morphine preconditioning-induced neuroprotection was abolished by naloxone, a non-type-selective opioid receptor antagonist, by naltrindole, a selective [delta]-opioid receptor antagonist, or by 7-benzylidenenaltrexone, a selective [delta]1-opioid receptor antagonist. However, the effects were not blocked by the [mu]-, [kappa]-, or [delta]2-opioid receptor antagonists, [beta]-funaltrexamine, nor-binaltorphimine, or naltriben, respectively. Morphine preconditioning-induced neuroprotection was partially blocked by the selective mitochondrial adenosine triphosphate-sensitive potassium channel antagonist, 5-hydroxydecanoate, or the mitochondrial electron transport inhibitor, myxothiazol. None of the inhibitors used in this study alone affected the simulated ischemia-induced neuronal death.     

Isoflurane Preconditions Hippocampal Neurons against Oxygen-Glucose Deprivation: Role of Intracellular Ca2+ and Mitogen-activated Protein Kinase Signaling

Background: Isoflurane preconditions neurons to improve tolerance of subsequent ischemia in both intact animal models and in in vitro preparations. The mechanisms for this protection remain largely undefined. Because isoflurane increases intracellular Ca2+ concentrations and Ca2+ is involved in many processes related to preconditioning, the authors hypothesized that isoflurane preconditions neurons via Ca2+-dependent processes involving the Ca2+- binding protein calmodulin and the mitogen-activated protein kinase-ERK pathway.

Methods: The authors used a preconditioning model in which organotypic cultures of rat hippocampus were exposed to 0.5-1.5% isoflurane for a 2-h period 24 h before an ischemia-like injury of oxygen-glucose deprivation. Survival of CA1, CA3, and dentate neurons was assessed 48 later, along with interval measurements of intracellular Ca2+ concentration (fura-2 fluorescence microscopy in CA1 neurons), mitogen-activated protein kinase p42/44, and the survival associated proteins Akt and GSK-3[beta] (in situ immunostaining and Western blots).

Results: Preconditioning with 0.5-1.5% isoflurane decreased neuron death in CA1 and CA3 regions of hippocampal slice cultures after oxygen-glucose deprivation. The preconditioning period was associated with an increase in basal intracellular Ca2+ concentration of 7-15%, which involved Ca2+ release from inositol triphosphate-sensitive stores in the endoplasmic reticulum, and transient phosphorylation of mitogen-activated protein kinase p42/44 and the survival-associated proteins Akt and GSK-3[beta]. Preconditioning protection was eliminated by the mitogen-activated extracellular kinase inhibitor U0126, which prevented phosphorylation of p44 during preconditioning, and by calmidazolium, which antagonizes the effects of Ca2+-bound calmodulin.     

Parkinson''''s Disease and Smoking: An Integral Part of PD''''s Etiological Study

INTRODUCTION Parkinson抯 disease (PD), a debilitating neurodegenerative disorder, is featured with bradykinesia, resting, muscular rigidity, gait disturbances, and postural reflex impairment[1]. PD is rare before age of 50 years, but it increases dramatically with older ages, with peak onset occurring during the age of 70-85 years. In the United States, prevalence of PD in all age groups is approximately 150 per 100 000 and is roughly 30 per 100 000 at age of less than 50 years and 800 …     

老年脊髓亚急性联合变性的临床诊断经验(附56例分析)

近来在临床上屡屡见到一些老年亚急性联合变性（SCD）病人，长期得不到诊断或误诊，延误了治疗时机。为此我们将老年SCD诊断经验报告如下。     

影响肝癌肝移植预后的因素

本文综述了肝癌接受肝移植术的适应症，围手术期的处理，以及影响患者预后的主要因素。     

治痛风方

车前子30克（布包），加水500毫升，浸泡30分钟后煮沸，代茶频饮，每日1剂。可增加尿量，促进尿酸排泄。     

血脂康治疗脂肪肝的临床观察

目前肝组织学检验是诊断脂肪肝的金标准，但由于系创伤检查，推广应用受到限制。临床上多采用B超诊断，其优点是无创伤，重复性强。治疗可在调整膳食的基础上，采用中西医结合治疗，但疗效欠佳。我们在3年多临床工作中，应用血脂康治疗脂肪肝，取得满意效果，经B超动态观察，发现脂肪肝减轻或消失，总结报告如下。