Emodin attenuates acute lung injury in Cecal-ligation and puncture rats

Acute lung injury (ALI) is a major cause of sepsis-induced acute respiratory failure. Emodin has been considered to play a protective role for acute lung edema in cecal ligation and puncture (CLP)-induced sepsis model. In this study we aimed to investigate whether emodin could improve CLP-induced lung sepsis via regulating aquaporin (AQP) and tight junction (TJ), inflammatory factors, and pulmonary apoptosis. The results showed that sepsis-induced pulmonary pathological changes were significantly improved after emodin treatment. Emodin was found to upregulate AQP and TJ expression in the CLP model. Meanwhile, inflammatory cytokine release and pulmonary apoptosis was remarkably reduced after emodin treatment in lung sepsis. Our data demonstrated that emodin could suppresse inflammation, restore pulmonary epithelial barrier and reduce mortality in CLP-induced ALI, suggesting the potential therapeutic application of emodin in sepsis.     

经肺动脉与支气管动脉血管造影的CTA观察原发肺癌的血供

目的用支气管动脉(BA)和肺动脉(PA)造影CTA观察肺癌血供情况。方法前瞻性观察6例支气管肺癌患者,分别行体循环动脉和肺动脉数字减影血管造影(DSA)后,留置BA导管与PA导管行CTBA与CTPA,观察BA与PA对肺癌的血供。结果CTPA上,无体动脉与左心强化的图像上肿瘤未见强化,有体动脉或左心强化的图像上见肿瘤边缘强化,CT强化值为10.0~45.6 Hu。CTBA上肿瘤部分明显强化,CT强化值为150.3~320.7 Hu,可见杂乱无章的肿瘤血管影,3例见纵隔淋巴结强化。结论本组病例观察表明原发性肺癌由BA为主的多发体循环动脉供血,未发现PA参与供血。     

异常灌注评分法评价肺血栓栓塞症患者治疗效果的价值

目的 分析异常灌注评分法对肺血栓栓塞症（PTE）疗效的评估价值。方法 选择明确诊断为急性PTE的患者46例，在治疗前及治疗后14d行肺灌注显像，2位核医学科医师分别对肺灌注显像图进行定性分析，随后采用异常灌注评分法和Parker创建的肺段评分法进行肺灌注显像结果判读，比较两者在判读结果方面的一致性及其相关性，并比较2种方法所示的治疗后灌注改善率。结果 2位医师对左肺灌注结果判读的一致性为100％（Kappa值为1．0），对右肺灌注结果判读的一致性为91．3％（Kappa值为0．69）。治疗前后2种灌注评分结果均有较高度的一致性（Kappa值分别为0．657和0．665，P均〈0．001）。在治疗前和治疗后通过2种评分方法所计算的联合评分均呈显著正相关（r值分别为0．770和0．771，P均〈0．001）。肺灌注改善率在2种评分方法之间无显著差异（P=0．128）。结论 异常灌注评分法判读简单，是评价PTE治疗效果的较好方法。     

Ross手术的临床应用现状

Ross手术自1967年应用于临床以来，已被用于各种原因引起的主动脉瓣狭窄、左心室流出道梗阻和二尖瓣病变。Ross手术经历了诸如根部置换、圆筒形包埋技术、瓣环缩小技术、Ross—Konno手术和自体肺动脉瓣二尖瓣置换术（Ross—Kabbani手术或RossⅡ手术）。由于自体肺动脉瓣有不需抗凝、大小适宜、能存活、生长和长期耐久的特性，并具有良好的血流动力学表现和对细菌性心内膜炎有抵抗力的优点，尤其适用于妊娠期妇女、儿童和青少年。现就Ross手术的外科技术、手术指征、选择标准、外科处理主动脉瓣狭窄、左心室流出道梗阻和二尖瓣病变的临床应用进展和效果进行综述。     

急性肺栓塞时心肌血流灌注的变化

目的观察急性肺栓塞（APE）后冠状动脉血流量及心脏肌钙蛋白T（cTnT）与肌红蛋白（Mb）含量变化，探讨心肌血流灌注在急性肺栓塞继发心肌损伤机制中的作用。方法通过介入方法经导管注入自体血栓选择性栓塞肺动脉，建立不同栓塞面积的急性肺栓塞动物模型。监测栓前、栓后5、30min，1、2h冠状动脉血流量变化及栓后4h血清cTnT与Mb含量。结果急性肺栓塞后血清cTnT与Mb含量升高。急性肺栓塞导致冠状动脉血流量显著下降，肺血管栓塞后15～30min降至最低值，30min后趋于平稳。右冠血流量下降程度与肺栓塞面积有显著相关性。结论冠状动脉血流量减少及血清心肌结构蛋白含量升高为急性肺栓塞继发心肌缺血改变提供了直接证据。急性心肌缺血严重影响急性肺栓塞的预后。     

Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy.

OBJECTIVE: To prospectively determine the sonographic findings of nodular hyperplasia of the thyroid, to compare these with reported findings associated with malignancy, and to assess interobserver reliability. METHODS: Seventy thyroid nodules were scanned, and then biopsies of the nodules were performed under sonographic guidance with fine-needle cytologic analysis; in all cases images were reviewed by 2 experienced radiologists without knowledge of clinical outcome. Findings reported associated with malignancy were specifically assessed. Interobserver agreement between the expert and secondary readers for each finding was calculated by the kappa or weighted kappa statistic and the Fisher exact test of independence. RESULTS: There were 68 benign and 2 malignant nodules in a population of 63 female and 7 male patients. The mean benign nodule size was 2.9 cm; 60% were solid; 54% were hypoechoic; 59% were microlobulated or macrolobulated; 47% had central vascularity; 24% contained calcifications; and 82% were elliptical in shape. There was very good interobserver reliability for the presence of calcium (kappa = 0.91) and good agreement for the presence and location of vascularity (kappa = 0.75) and the amount of cystic components (kappa = 0.62; all P < .01). CONCLUSIONS: Sixty-nine percent of benign nodules had at least 1 finding reported previously as associated with malignancy. The interobserver reliability of the sonographic findings was good to very good for 3 of the 5 findings assessed.     

83例6个月以下婴儿室间隔缺损的外科治疗

目的 总结外科手术治疗小婴儿期室间隔缺损(VSD)的临床经验.方法 对2000-2005年83例＜6月龄VSD患儿,年龄12 d至6(4.3±1.2)个月,体重3～6.5(5.1±0.8)kg.膜周部VSD 74例,干下型VSD 8例,膜周部并肌部VSD1例.术前中、重度肺动脉高压69例(83.1%).所有患儿均在浅低温体外循环下手术.结果 全组手术死亡4例,手术病死率为4.8%.术后主要并发症为肺动脉高压危象、肺部感染和心律失常.结论 随着麻醉、体外循环、手术技术和围术期监护处理措施的进步,在小婴儿期施行VSD的外科手术已成为安全的治疗方式.术后对肺高压的处理是手术成功的关键.     

正常婴儿肺动脉血流特征及解剖学原理分析

目的 应用超声多普勒技术测量正常婴儿肺动脉主干及左右肺动脉血流速度,并初步探讨其可能的机理.方法 使用GE Vivid7超声诊断仪检查60例正常新生儿,分别检测1周、1个月、6个月及1年时主动脉内径AOD;肺动脉主干内径MPA及血流速度Pv,左、右肺动脉内径LPA、RPA及血流速度LPv、RPv,并计算LPA RPA/AO.结果 1周时左、右肺动脉速度高于肺动脉主干速度,且以右肺动脉明显,1周后左、右肺动脉血流速度逐渐减慢,1年后均基本低于肺动脉主干内血流速度,肺动脉主干血流速度及LPA RPA/AO比例在1周、1个月、6个月及1年组差异无统计学意义.结论 正常新生儿左、右肺动脉血流速度较高,随生长、发育肺动脉血流速度逐渐降低直至正常.     

腹膜透析对尿毒症患者肺功能的影响

目的　了解尿毒症患者腹膜透析治疗前后的肺功能变化。方法　分别测定 5 0例尿毒症患者及2 0例正常人的用力肺活量 (FVC)、最大通气量 (MBC)、1秒钟用力呼气容积 (FEV1 )、最大呼气流量 (PEF)、最大呼气中段流量 (MMEF)、2 5 %肺活量最大呼气流量 (·V2 5)和肺一氧化碳弥散量 (DL co)等参数 ,其中 30例尿毒症患者在透析治疗 2月后进行了上述参数的复查。结果　尿毒症患者的肺通气量和气道功能指标 FVC、MBC、FEV1 、PEF、MMEF、·V2 5以及肺弥散功能指标 DL co均明显低于正常人 ;透析治疗后 ,尿毒症患者的气道功能指标 FEV1 、PEF、MMEF和 ·V2 5明显改善 (P<0 .0 5 ) ,但肺通气量指标 FVC、 MBC和肺弥散功能指标 DL co无明显改善 (P>0 .0 5 )。结论　尿毒症患者存在肺通气功能及弥散功能的降低 ,伴气道阻塞 ;透析治疗能显著改善气道阻塞 ,但对肺弥散功能及肺通气量无明显改善 ,此现象往往反映患者已有继发性肺纤维化的存在