肺内源性和肺外源性呼吸衰竭机械通气的临床对比研究

目的探讨肺内源性和肺外源性呼吸衰竭机械通气时的肺保护性策略。方法通过25例呼吸衰竭中12例肺内源性和13例肺外源性机械通气临床资料的回顾性分析,对比研究两组呼吸力学差异时对通气模式选择、参数设置和调节的影响,以及肺保护的实施方法。结果在两组APACHE-Ⅱ评分、平均年龄和Vt设置无差异的条件(P>005)下,肺内源性组PEEP/CPAP、PSV、f的需设值均明显高于肺外源性组(P<001)。肺内源性组Pplat、PIP、Raw的监测结果大于肺外源性组,而Crs小于肺外源性组(P<001)。肺内源性组417%和肺外源性组154%因MOF而死亡(APACHE-Ⅱ评分均>20分),组间比较有显著差异(P<001)。结论肺内源性和肺外源性呼吸衰竭机械通气时,实施肺保护的方法不同。前者应首选压力预置通气模式,后者可首选容量预置通气模式。以设置中、小Vt为原则,按个体化的通气需求而设置f和加用恰当的PSV、CPAP/PEEP对减少VILI、病死率可能有益。     

New wound protection for rabbits

Rabbits are the experimental animals of choice in many studies including flaps, wounds, and topical trials for new pharmacological agents. Because the topical drugs and other materials used for dressing are irritating to the animal, they tend to remove dressings, bandages, drapes, insensate flaps, and also topical drugs by scratching, licking, and biting if they are within the reach of the animal. In this study, we report an easy to prepare, user-friendly, comfortable, and cheap dressing protector called a dressing shield to prevent these problems.     

白塞病并发动脉瘤12例的外科治疗体会

目的总结白塞病并发动脉瘤的外科手术和腔内治疗经验。方法对1977年6月至2006年3月收治的12例白塞病患者并发21个动脉瘤进行回顾性分析。腹主动脉瘤3个,升主动脉瘤1个,髂动脉瘤4个,髂动脉吻合口假性动脉瘤1个,股总动脉瘤3个,股浅动脉瘤2个,腘动脉瘤2个,椎动脉瘤1个,锁骨下动脉瘤2个。颈动脉瘤1个和肠系膜上动脉瘤1个。21个动脉瘤中,行外科手术14个,包括动脉瘤切除、人工血管或自体大隐静脉移植术12个,动脉瘤切除、病变动脉结扎术2个;行支架型人工血管腔内修复术6个;1个升主动脉瘤因患者全身情况差,行保守治疗。结果围手术期死亡患者2例,其中1例行外科手术,1例行腔内修复术。术后吻合口假性动脉瘤1例（1个）,其他部位新动脉瘤形成7个,下肢血管移植物闭塞2例,但患肢无明显缺血坏死。6例患者随访3-293个月,随访中位时间28个月,1例死于肺癌。结论白塞病动脉瘤一旦发生,需积极处理。术前、术后积极免疫抑制治疗可降低外科手术和腔内修复术后并发症发生。因术后有吻合口和其他部位假性动脉瘤复发及血管移植物闭塞可能,需长期随访、及时处理。     

阿片肽与缺血性脑损伤

阿片肽及其受体系统在缺血性脑损伤的病理生理发展过程中具有非常重要的作用。其在缺血性脑损伤中的作用尚存争议，本文综述了阿片肽及其受体系统在缺血性脑损伤中的作用及其可能机制，有助于探索阿片肽在围术期的合理应用，为缺血性脑损伤防治研究提供新方向。     

丙丁酚对载脂蛋白E~(-/-)小鼠主动脉粥样硬化病变及病变处凝集素样氧化型低密度脂蛋白受体1表达的影响

目的观察丙丁酚对载脂蛋白E-/-小鼠主动脉粥样硬化斑块形成及主动脉凝集素样氧化型低密度脂蛋白受体1表达的影响,以探讨丙丁酚调节血脂以外的可能的抗动脉粥样硬化作用机制。方法将21只4周龄的雄性载脂蛋白E-/-小鼠随机分成基础饮食对照组、高脂饮食对照组和高脂饮食加丙丁酚组     

大肠癌患者血清MMP-9与VEGF水平的变化及意义

目的本文检测血管内皮生长因子(VEGF)和基质金属蛋白酶(MMP-9)在大肠癌患者血清中的水平,探讨其与大肠癌恶性程度、浸润、转移的关系。方法用ELISA法对48例大肠癌患者及40例正常对照者血清VEGF和MMP-9进行检测。结果大肠癌患者血清VEGF、MMP-9的水平分别为(665.8±232.8)ng/L;(532.7±208.9)ug/L。显著高于对照组(391.6±135.2)ng/L;(317.8±132.2)ug/L(P<0.01)。并与组织分化程度、Duke’s分期有关。低分化者及C、D期患者较中、高度分化及A、B期高(P<0.01)。结论大肠癌患者血清VEGF和MMP-9水平增高,与肿瘤的组织分化程度、转移、分期有关,提示VEGF、MMP-9对大肠癌恶性程度的判断有一定的价值。     

TNF-α和低氧对胰腺癌细胞表达VEGF-A、C的调节

目的:探讨细胞活素肿瘤坏死因子-α(TNF-α)、SNAP(S-Nitroso-Nacetyl-penicillamine)对胰腺癌细胞产生血管内皮生长因子A、C(VEGF-A、C)的调节.方法:用Northern杂交和Western杂交法分析6种人胰腺癌细胞株中VEGF-A、C基因和蛋白的表达;以TNF-α或SNAP刺激其中两个细胞株后用逆转录-聚合酶链式反应技术(RT-PCR)分析其VEGF-A、C基因的表达.结果:Northern杂交法显示这6种胰腺癌细胞株均有4.1kb VEGF-A基因和2.4kb VEGF-C基因的表达;Western杂交法显示它们均有分子量为43kD的VEGF-A蛋白质和分子量为55kD的VEGF-C蛋白质的表达.RT-PCR分析法显示:TNF-α使细胞株COLO-357产生VEGF-A、VEGF-C mRNA分别减少约1～2.5倍、1～2倍,使细胞株CAPAN-1产生VEGF-A、VEGF-C mRNA分别减少约1倍、1.6～2.5倍;而SNAP刺激细胞株COLO-357产生VEGF-A mRNA增加约5倍,刺激细胞株CAPAN-1产生VEGF-A mRNA增加约4倍,但对这两种细胞株产生VEGF-C mRNA均无明显刺激作用.结论:细胞活素TNF-α和低氧通过调节血管内皮生长因子A、C的表达而影响胰腺癌细胞的生物学特性,抑制癌细胞的增殖,促进其凋亡、死亡或进展、恶化.     

Use of Fmoc-N-(2-hydroxy-4-methoxybenzyl) amino acids in peptide synthesis

The use of N, O-bisFmoc-N-(2-hydroxy-4-methoxybenzyl) amino acid derivatives in the synthesis of peptides with difficult sequences has already been described. With these amino acid derivatives the reversible protecting group 2-hydroxy-4-methoxybenzyl (Hmb) for the backbone amide bonds of peptide chains is introduced, and thus the aggregation due to hydrogen-bond interchain association is inhibited. This paper describes the synthesis and use of Fmoc-N-(2-hydroxy-4-methoxybenzyl)amino acid derivatives as an alternative means of introducing Hmb backbone protection. These new monoFmoc derivatives were obtained in higher yield than the bisFmoc derivatives. Coupling yields to the amino peptide resin were the same as those obtained with bisFmoc derivatives, under the TBTU/HOBt/DIEA conditions. We also compared different syntheses of a difficult peptide with the Fmoc approach [triple coupling, capping, use of chaotropic agents, backbone protection using monoFmoc (Hmb)Ala] and with optimized Boc chemistry. Both the backbone protection and optimized Boc chemistry approaches gave the desired product in excellent yield and purity. © Munksgaard 1997.     

The 2,4-dinitrophenyl group for protection of hydroxyl function of tyrosine during solid-phase peptide synthesis

The facile thiolytic cleavage of the O-2,4-dinitrophenyl (Dnp) tyrosine bond was applied to the solid-phase synthesis of the 22-amino acid residue peptide H-Asp-Ala-Val-Tyr -Thr-Gly-Leu-Asn-Thr-Arg-Asn-Gln-Glu-Thr-Tyr -Glu-Thr-Leu-Lys-His-Glu-Lys-OH, corresponding to positions 62-83 in the chain of the type 1 receptor for Fc_ε, domains expressed on the rat mucosal-type mast cells (line RBL-2H3). A method for the spectrophotometric determination of insoluble O-Dnp as well as of unprotected phenolic moieties of tyrosine was developed. It is based on monitoring S-Dnp-2-mercaptoethanol, produced upon O-Dnp thiolysis by 2-mercaptoethanol. © Munksgaard 1995. Dedicated to the memory of Dr. Susumu Funakoshi, a dear friend and a leader in peptide chemistry.     

The Future Detection and Prevention of Institutional Abuse: Giving Children a Chance to Participate in Research

The involvement of children in research studies is historically fraught with difficulties. Experiments on children without their consent or knowledge have been carried out in the past and thus the need for stringent ethical control is undoubtedly necessary. However this paper argues that the need to protect children from unethical research has somehow become entwined in the web of secrecy that surrounds the very nature of child abuse. In the name of 'protection' are children in danger of not having their voice heard?

In the foreword to 'Listening to Children' (Alderson, 1995) Roger Singleton writes, 'much research is carried out on and about children, but seldom with children. Children themselves are often strangely silent'. This paper draws on recent literature on the institutional abuse of young people in residential care and the lack of voice that those abused in residential care have traditionally had, suggesting that their silence is not 'strange' but perhaps contrived.

This paper does not repeat the work of Alderson (1995) and make suggestions as to how research with children may best be carried out, but seeks to address the issues in relation to research with children who are in institutions.