溶酶体保护蛋白/组织蛋白酶A基因敲除小鼠听力和耳形态学初步研究

目的研究溶酶体保护蛋白/组织蛋白酶A(protective protein/cathepsin A,PPCA)基因敲除小鼠听功能和耳形态学改变,探讨半乳糖唾液酸沉积症听力损害的病理生理机制。方法应用听性脑干反应(ABR)测试和颞骨连续切片,观察1月和2月龄的PPCA基因敲除纯合子(PPCA-/-)小鼠ABR反应阈和光镜下外耳、中耳及内耳形态改变,并以野生型(PPCA / )小鼠作对照。结果1月龄PPCA-/-小鼠ABR反应阈和耳形态无明显改变;2月龄时,短声和短音8、163、2 kHz反应阈较PPCA / 提高40~45 dB SPL,中耳黏膜增厚、听骨细胞囊泡化、变形和关节腔融合,血管纹增厚、螺旋神经节细胞、螺旋缘纤维细胞、前庭膜、基底膜及沿前庭阶外淋巴隙的间皮细胞囊泡化,但Corti器毛细胞及支持细胞正常。结论溶酶体保护蛋白/组织蛋白酶A缺乏可导致听力损害、中耳及耳蜗形态改变、中耳炎、听骨改变以及耳蜗螺旋神经节、血管纹、螺旋缘、前庭膜和基底膜等细胞的溶酶体储积,可能分别是传导性聋和感觉神经性聋的形成机制。     

Local Inflammation in Rat Dorsal Root Ganglion Alters Excitability and Ion Currents in Small-diameter Sensory Neurons

Background: Chronic pain conditions may result from peripheral nerve injury, chronic peripheral inflammation, or sensory ganglia inflammation. However, inflammatory processes may also contribute to peripheral nerve injury responses. To isolate the contribution of local inflammation of sensory ganglia to chronic pain states, the authors previously developed a rat model in which long-lasting pain is induced by inflaming sensory ganglia without injuring the neurons. This results in prolonged mechanical pain, local increases in proinflammatory cytokines, increased neuronal hyperexcitability, and abnormal spontaneous activity.

Methods: The authors used whole cell patch clamp in acutely isolated small-diameter neurons to determine how localized inflammation (3-5 days) of L4 and L5 ganglia altered voltage-gated K+ and Na+ currents.

Results: Tetrodotoxin-sensitive Na+ currents increased twofold to threefold in neurons from inflamed ganglia. Tetrodotoxin-resistant Na+ currents increased more than twofold, but only in cells that bound isolectin B4. These increases occurred without shifts in voltage dependence of activation and inactivation. Similar results are seen in models of peripheral inflammation, except for the large magnitudes. Unlike most pain models, localized inflammation increased rather than decreased voltage-gated K+ currents, due to increased amplitudes of the sustained (delayed rectifier) and fast-inactivating transient components. The overall effect in current clamp experiments was an increase in excitability as indicated by decreased rheobase and lower action potential threshold.     

铜绿假单胞菌对头孢菌素类抗生素耐药机制的初步研究

目的：研究成都市医院临床分离的铜绿假单胞菌对头孢菌素类抗生素耐药的情况与机制.方法：琼脂二倍稀释法测定各类药物对铜绿假单胞菌的MIC值;水解Nitrocefin法定性初筛β-内酰胺酶;K-B纸片法初筛ESBLs;三维试验检测高产AmpC酶的铜绿假单胞菌.结果：从成都市医院分离的62株铜绿假单胞菌对亚胺培南、美洛培南、头孢吡肟、头孢他啶、头孢哌酮、头孢噻肟、头孢曲松的耐药率分别为45.16%、29.03%、27.42%、30.64%、58.06%、58.06%、67.64%.有24株产β-内酰胺酶,其中初筛有3株产ESBLs,其中有3株高产AmpC酶.结论：产生β-内酰胺酶是这62株从成都医院分离的铜绿假单胞菌对头孢菌素类抗生素耐药的主要机制之一.     

PPH加黏膜柱状缝合、直肠周围高位注射治疗完全性直肠脱垂(附15例报告)

目的：探讨PPH加黏膜柱状缝合、直肠周围高位注射治疗完全性直肠脱垂的手术效果。方法：对15例完全性直肠脱垂（Ⅰ～Ⅱ度）患者，采用PPH加黏膜柱状缝合、直肠周围高位注射治疗。结果：治愈15例，无复发。结论：该术式操作简单，近期疗效好，远期效果有待进一步观察。     

腹腔镜胆囊切除术前超声内镜检查胆总管必要性的探讨

目的 探讨腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）术前超声内镜（endoscopic ultrasonography,EUS）检查胆总管的临床价值。方法 对25例术前经腹超声检查诊断胆囊结石,胆总管内径〉0.7 cm可疑胆总管梗阻的患者进行EUS检查,并与手术结果或内镜十二指肠乳头切开术（endoscopic sphincterotomy,EST）取石结果进行比较。结果 EUS对于胆总管病变诊断的敏感性、准确性和阴性预测值[100%（17/17）、92%（23/25）、100%（6/6）]均优于经腹超声[35%（6/17）、56%（14/25）、42%（8/19）]（P=0.000,0.008,0.020）。结论EUS对胆总管病变诊断优于经腹超声检查,可作为术前常规检查,特别是当胆总管内径〉1.0 cm时,EUS应作为术前必检项目。     

排粪造影对便秘成因的影像诊断

目的：通过回顾性比较分析用排粪造影法探讨便秘成因及临床应用价值。方法：分析排粪造影者276例资料和图像。结果：在便秘患者中总体阳性率为57．1％，其中功能出口性梗阻者占总体阳性中95．2％，而器质性出口梗阻为4．8％，女性患者以直肠前突多见，男性患者以直肠黏膜脱垂多见。结论：排粪造影对下消化道便秘成因的检查具有较高的诊断价值，为临床治疗提供客观依据，指导临床治疗原则。     

52例针灸结合刺络放血治疗骨性膝关节炎临床观察及护理

[目的]观察针灸结合刺络放血法治疗骨性膝关节炎的临床疗效和护理效果.[方法]对52例骨性膝关节炎病人采用针灸结合刺络放血治疗,并给予活动与功能锻炼指导,将治疗前和治疗20 d后病人疼痛程度、晨僵、肿胀、日常步行活动能力以及疼痛缓解时间进行分级评分比较.[结果]治疗前后各项指标的差异均有统计学意义(P＜0.01).[结论]针灸配合刺络放血法结合活动指导及功能锻炼治疗骨性膝关节炎,能够快速缓解病人关节疼痛、肿胀、晨僵,改善步行能力,从而提高生活质量.