胰管结石的临床诊断与治疗

目的探讨胰管结石的诊断、分型及治疗方法选择。方法回顾性分析2010年1月至2019年12月间上海健康医学院附属周浦医院收治的32例胰管结石临床资料,总结不同类型胰管结石的处理方法。结果32例患者术前均通过超声、CT及磁共振胰胆管造影(MRCP)等明确诊断。其中超声诊断正确率81.3%(26/32),CT诊断正确率86.2%(25/29),MRCP诊断正确率90.4%(19/21),内镜逆行胰胆管造影(ERCP)诊断正确率100%(8/8)。根据结石的位置及术中探查将胰管结石分为3型:I型17例,结石位于主胰管;Ⅱ型11例,结石位于主胰管和分支胰管;Ⅲ型4例,结石位于分支胰管。依据不同类型采用不同的治疗方式。全组围术期无死亡病例。术后共有并发症11例(34.3%),术后残石率为9.3%(3/32)。32例均获得随访,随访时间6~60个月不等,术后腹痛、脂肪泻等症状消失或明显减轻。2例合并胰腺癌者于术后12~35个月后因胰腺癌复发转移死亡。结论胰管结石处理复杂,影像学检查是确诊胰管结石的主要方法。胰管结石分型对其个体化治疗方法选择具有重要意义。外科手术是治疗胰管结石常用的重要手段。     

355例药品不良反应分析

目的：了解医院药品不良反应（ADR）发生特点及引起不良反应的相关因素。方法：采取回顾式调查方式,对医院355例ADR病例进行统计、分析。结果：发生ADR的患者中,女性居多,老年人居多;以静脉方式给药引起的ADR居多;ADR的临床表现以皮疹居多。结论：医师、护士、药师三方协作,能够及时监测临床发生的ADR,可以减少ADR的发生。     

网塞加平片行无张力疝修补术276例治疗体会

目的探讨网塞加平片无张力疝修补术在腹股沟疝中的临床应用。方法回顾性分析我院2009年1月至2013年5月276例腹股沟疝无张力修补临床资料,全部采用网塞加平片无张力修补术。结果 276例全部治愈,4⁷ d出院。结论网塞加平片行无张力修补术治疗腹股沟疝疗效良好,操作简易、创伤小、恢复快、无显著并发症。     

169例药品不良反应报告特点分析

目的：分析某院药品不良反应（ADR）的特点与规律,以提高临床安全用药水平.方法：对我院2011年1月~2012年11月上报至国家ADR监测中心的169例ADR报告进行分析,研究ADR与患者性别、年龄及所用药情况的关系.结果：在169例ADR报告中,女∶男为2.13：1;在不同年龄段中,≥60岁者构成比最高,占22.5%;在给药方式上,静脉给药构成比最高,占71.6%;在药物种类上,抗菌药居首位,占67.5%;在累计系统/器官方面,以皮肤损害构成比最高,占35.5%.结论：减少不必要静脉用药,合理使用抗菌药,能降低ADR的发生风险,减少药源性损害的发生,促进安全用药,有助于提高医疗质量.     

TREK-1激动剂亚麻酸对星形胶质细胞谷氨酸诱导电流和摄取谷氨酸的影响

目的观察双孔钾通道TREK-1激动剂亚麻酸对星形胶质细胞谷氨酸诱导电流和摄取谷氨酸的影响。方法应用大鼠海马脑片膜片钳技术研究TREK-1激动剂亚麻酸对星形胶质细胞谷氨酸诱导电流的影响;原代培养大鼠皮层星形胶质细胞,采用免疫荧光双标法检测TREK-1在星形胶质细胞的表达,采用谷氨酸浓度检测法观察TREK-1激动剂亚麻酸对星形胶质细胞摄取谷氨酸的影响。结果 TREK-1在星形胶质细胞上表达丰富,谷氨酸可诱导星形胶质细胞产生内向电流,与对照组相比,给予TREK-1激动剂亚麻酸干预后星形胶质细胞谷氨酸诱导电流显著增加(P0.05),并显著增强原代培养的星形胶质细胞摄取谷氨酸能力(P0.05)。结论 TREK-1在星形胶质细胞上表达,TREK-1激动剂亚麻酸显著增加星形胶质细胞谷氨酸诱导电流,增强原代培养的星形胶质细胞摄取谷氨酸能力,提示TREK-1活性改变与星形胶质细胞平衡缓冲功能密切相关。     

超声评价慢性阻塞性肺疾病患者膈肌运动异常

目的 探讨超声评价慢性阻塞性肺疾病（COPD）患者膈肌运动异常的价值。方法 收集64例COPD急性加重期患者,根据2017GOLD指南综合评估将其分为C组（n=34）和D组（n=30）,以超声测量膈肌厚度、膈肌运动幅度及对合角,计算膈肌增厚分数及膈肌移动度。结果 C组膈肌增厚分数和收缩速度均明显大于D组（P均<0.05）,而2组膈肌移动度和对合角差异无统计学意义（P均>0.05）。膈肌增厚分数与第1秒用力呼气量/用力肺活量（FEV1/FVC）呈正相关（r=0.26,P=0.04）,膈肌移动度（r=0.35,P<0.01）、膈肌收缩速度（r=0.43,P<0.01）均与FVC呈正相关。DTF对鉴别诊断C、D组COPD性能相对较好（AUC为0.78）,DTF=30.22%,其诊断敏感度70.60%,特异度83.30%。结论 超声可评价COPD患者膈肌功能障碍,指导稳定期康复治疗。     

A decade of G3P[8] and G9P[8] rotaviruses in Brazil: Epidemiology and evolutionary analyses

This study aims to estimate the frequency of group A rotaviruses (RVA) infection with genotypes G3P[8] and G9P[8] in children that suffered from diarrheal disease (DD) between 2001 and 2011 in different Brazilian regions. In addition, the genetic diversity of G3P[8] and G9P[8] RVA strains recovered from vaccinated and non-vaccinated children was assessed. Laboratory-based RVA surveillance included 15,115 cases of DD, and RVA was detected by enzyme immune-assay and/or polyacrylamide gel electrophoresis in 3357 (22%) samples. RVA was genotyped by the semi-nested RT-PCR and among RVA-positive samples, 100 (2.9%) were G3 (63 G3P[8], 32 G3P not typed [NT], and 5 G3P[6]) and 378 (16.2%) were G9 (318 G9P[8], 59 G9P[NT], and 1 G9P[6]). From the G3 and G9 positive samples, 16 and 12, respectively, were obtained from children aged 4–48 months vaccinated with the monovalent vaccine (Rotarix®, RV1). Phylogenetic analyses of the VP7 and VP8¹ encoding genes were performed for 26 G3P[8] and 48 G9P[8] strains. VP8¹ phylogenetic analysis revealed that all strains analyzed belonged to P[8] lineage III, whereas RV1 belongs to P[8]-I lineage. VP7 analysis revealed that all G3 and G9 strains belonged to G3-lineage III and G9-lineage III. The comparison of the VP7 and VP8¹ antigenic epitopes regions of Brazilian strains with RV1 strain revealed several amino acid changes. However, no particular differences among Brazilian strains detected before and after vaccine introduction were observed, or among strains detected from vaccinated and non-vaccinated children. Complete genome characterization of four G3P[8] and seven G9P[8] strains revealed a typical conserved human Wa-like genomic constellation. Changes in the genetic diversity of G3P[8] and G9P[8] RVA detected from 2001 to 2011 in Brazil seemed not be related to RV1 introduction in Brazil.     

正常子宫不同月经状态的扩散峰度成像研究

目的:研究正常女性不同年龄段和不同月经周期的子宫不同结构的扩散峰度成像(DKI)定量参数值的变化。方法:56例不同年龄段正常女性志愿者,按月经状态分组后进行盆腔MRI扫描,并测量子宫内膜、结合带及外肌层的平均扩散峰度(K)、平均扩散系数(D)。结果:育龄期组排卵期和分泌中期内膜与外肌层、结合带与外肌层间比较D值均有统计学差异(P<0.05)。围绝经期组排卵期和分泌中期子宫三层结构间K值、D值均无统计学差异(P>0.05)。绝经期组在内膜与结合带、结合带与外肌层间K值、D值均有统计学差异(P<0.05);育龄期组与围绝经期组在排卵期与分泌中期比较子宫同一结构间K值、D值均无统计学差异(P>0.05)。结论:不同年龄、不同结构区、不同月经周期会对子宫的DKI参数值产生影响。     

Src family kinases involved in CXCL12-induced loss of acute morphine analgesia

Functional interactions between the chemokine receptor CXCR4 and opioid receptors have been reported in the brain, leading to a decreased morphine analgesic activity. However the cellular mechanisms responsible for this loss of opioid analgesia are largely unknown. Here we examined whether Src family-kinases (SFK)-linked mechanisms induced by CXCR4 contributed to the loss of acute morphine analgesia and could represent a new physiological anti-opioid signaling pathway. In this way, we showed by immunohistochemistry and western blot that CXCL12 rapidly activated SFK phosphorylation in vitro in primary cultured lumbar rat dorsal root ganglia (DRG) but also in vivo in the DRG and the spinal cord. We showed that SFK activation occurred in a sub population of sensory neurons, in spinal microglia but also in spinal nerve terminals expressing mu-(MOR) and delta-opioid (DOR) receptor. In addition we described that CXCR4 is detected in MOR- and DOR-immunoreactive neurons in the DRG and spinal cord. In vivo, we demonstrated that an intrathecal administration of CXCL12 (1 μg) significantly attenuated the subcutaneous morphine (4 mg/kg) analgesia. Conversely, pretreatment with a potent CXCR4 antagonist (5 μg) significantly enhanced morphine analgesia. Similar effects were obtained after an intrathecal injection of a specific SFK inhibitor, PP2 (10 μg). Furthermore, PP2 abrogated CXCL12-induced decrease in morphine analgesia by suppressing SFK activation in the spinal cord. In conclusion, our data highlight that CXCL12-induced loss of acute morphine analgesia is linked to Src family kinases activation.