Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

胃癌腹腔冲洗液多巴脱羧酶mRNA的检测

目的：通过检测胃癌腹腔冲洗液中DDCmRNA的表达，探讨多巴胶羟酶（DDC）与胃癌腹膜转移的关系，并为胃癌腹膜转移预测和亚临床转移的筛检提供新的方法．方法：用RNA提取和RT-PCR方法检测92例胃癌腹腔冲洗液中DDCmRNA的表达，同时做腹腔冲洗细胞学（PLC）检查；10例良性疾病的腹腔冲洗液作为阴性对照，结果：92例胃癌腹腔冲洗液中有57例检测到DDCmRNA的表达（62．0％），其表达阳性率与胃癌腹膜转移的PS因素密切相关（P〈0．05）；且胃癌腹腔冲洗液中DDCmRNA的表达水平还与胃癌浸润深度、浆膜类型、PLC检查结果以及是否存在肉眼腹膜转移有关，浸润深度深、浆膜受侵程度重、PLC检查结果阳性及存在肉眼腹膜转移病灶者的DDCmRNA表达相对值明显升高（P〈0．05）；而10例良性疾病腹腔冲洗液均未检测到DDCmRNA的表达．结论：胃癌腹腔液中DDCmRNA的表达与胃癌腹膜转移密切相关，通过RT—PCR来检测DDCmRNA适用于胃癌腹膜转移的预测和亚临床转移的筛检。     

经乙状窦后入路显微手术治疗继发性三叉神经痛37例

目的探讨经乙状窦后入路显微手术治疗桥小脑角占位性病变引起的继发性三叉神经痛的疗效。方法回顾分析我院2000年10月～2006年7月37例继发性三叉神经痛的临床资料，其中胆脂瘤18例，脑膜瘤8例，听神经瘤6例，三叉神经鞘瘤5例，均经乙状窦后入路显微手术切除肿瘤。结果肿瘤全切23例，次全切除10例，部分切除4例。35例疼痛症状消失（32例立即消失，3例术后2个月消失），随访3个月～5年无复发；2例无效。发生暂时性面瘫6例，面部麻木6例，无颅内感染及脑脊液漏。结论经乙状窦后入路显微手术是治疗继发性三叉神经痛安全有效的方法。     

风疹易感人群婚前风疹疫苗接种预防先天性风疹综合征

目的探讨婚前风疹易感人群风疹疫苗接种在提高孕妇对风疹的免疫力,预防先天性风疹综合征中的作用.方法对10 913例婚前风疹病毒抗体IgG阴性者给予国产风疹减毒活疫苗注射.3个月随防671例,比较风疹疫苗接种前后该地区孕妇近期风疹感染的发病率.结果818例风疹病毒抗体IgG阴性者接种后抗体转阳率为99.8%.风疹疫苗接种前后3年孕妇近期风疹感染率分别为0.37%及0.08%,有明显下降,有非常显著差异(P＜0.001).结论应用国产风疹减毒活疫苗对婚前易感人群作预防接种可提高育龄妇女对风疹的免疫力,降低孕期风疹感染的发生率,是预防先天性风疹综合征及风疹致畸的有效、安全措施.     

芪月降脂片制剂处方的优化

[目的 ]优化芪月降脂片的制剂处方 .[方法 ]采用正交设计和多指标综合评分法对已筛选出的药剂辅料进行处方优化 .[结果 ]最佳制剂处方为糖粉 50 g ,辅料X 50g ,微晶纤维素 75g .[结论 ]该处方合理 ,成型性好     

螺旋CT在肺动脉栓塞诊断中的价值

目的:评价螺旋CT在诊断肺动脉栓塞中的作用。方法:16例肺动脉栓塞患者行螺旋CT肺动脉造影 (SCTA)检查,层厚3mm,扫描时间0.8s,对比剂注射速度3.5ml/s,总量100ml,扫描延迟时间15s。结果:16例 共644支,其中134支肺动脉及分支显示了栓塞,占20.8%。228支肺段肺动脉中,有56支显示肺动脉栓塞,占分 析肺动脉支的24.5%。204支亚段肺动脉中37支显示肺动脉栓塞,占分析肺动脉支15.4%。肺动脉栓塞的CT形 态:①直接征象为不同程度的肺动脉分支内充盈缺损。中心型充盈缺损17支,偏心型充盈缺损44支,附壁血栓型 34支,完全阻塞型39支。②间接征象胸膜下肺梗死灶,内乳动脉一侧增粗,肺纹理稀少,胸水,肺动脉高压。结论: 螺旋CT肺动脉造影是诊断肺动脉栓塞的快速、有效、无创伤的诊断方法。     

Arnold-Chiari畸形合并脊髓空洞症的外科治疗(附32例报告)

目的：探讨Chiari畸形合并脊髓空洞症的手术治疗方法。方法：分析我科收治的32例Chiari畸形合并脊髓空洞症患者进行手术治疗，以后颅窝减压、小脑扁桃体切除、脊髓空洞穿刺、松解四脑室正中孔蛛网膜粘连为主，达到解除后脑受压，解除粘连，恢复枕大孔区CSF循环通畅的目的。结果：随访24例患者中，临床症状完全消失18例，好转2例，术前有头痛、颈痈或肩臂病症状者均有显著减轻，3例自觉症状无变化，复查MRI显示21例空洞明显缩小。结论：后颅窝减压、松解四脑室正中孔蛛网膜粘连，恢复枕大孔区CSF循环通畅是手术治疗Chiari畸形合并脊髓空洞症的关键。     

聚合酶链反应检测铜绿假单胞菌感染性角膜溃疡的实验研究及临床应用

目的：探索聚合酶链反应（PCR）技术对铜绿假单胞菌感染性角膜溃疡快速诊断的可行性。优越性及其在临床应用中的价值。方法：建立PCR检测标准铜绿假单胞菌方法，对兔铜绿假单胞菌感染性角膜溃疡模型研究并应用于临床，并与细菌培养做比较。结果：铜绿假单胞菌扩增出一条长504bp的阳性条带，其他常见细菌，人和兔正常角膜组织均为阴性，动物模型PCR敏感性为93.8%。特异性为100.0%；细菌培养敏感性为68.7%。特异性为93.7%。临床标本PCR阳性率为66.7%；细菌培养阳性率为38.1%。结论：PCR技术对快速检测实验室和临床标本中的铜绿假单胞菌具有重要的应用价值。     

急性大血管闭塞性轻型卒中血管内治疗的疗效及安全性观察

目的 观察急性大血管闭塞性轻型卒中患者血管内治疗的疗效及安全性。
方法 回顾性分析2018年1月-2019年5月行血管内治疗的急性大血管闭塞性轻型卒中（NIHSS评分
≤5分）患者的临床资料。观察术后血管成功再通率（mTICI≥2b级）、围手术期并发症、90 d良好预后率
（mRS评分≤2分）等。
结果 共纳入13例患者，平均年龄58.7±14.5岁，男性11例（84.6%）。术后血管成功再通率100%；围
手术期并发症2例，假性动脉瘤1例、无症状性颅内出血1例；90 d良好预后率100%。
结论 急性大血管闭塞性轻型卒中行血管内治疗可能是安全、有效的。     

睾丸网腺癌(1例报告并文献复习)

目的了解睾丸网腺癌的发病和临床特点，提高其早期诊断和治疗水平。方法分析1例睾丸网腺癌患者的临床资料，并结合文献对睾丸网腺癌的临床病理特点、早期诊断和治疗进行讨论。结果术前诊断为左睾丸鞘膜积液、左睾丸肿瘤待排，遂行左高位睾丸切除术，术后病理检查诊断为睾丸网腺癌。免疫组化：AFP（-），PLAP（-），CK（＋），CD30（-），CK20（＋）。术后CT示肝内多发转移瘤、左肾和左肾上腺转移改变。结论睾丸网腺癌是原发于睾丸网纵膈的恶性肿瘤，极为罕见，其临床表现独特，基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术，放疗和化疗效果欠佳。该病预后差，文献报道5年生存率仅为13％。