周围动脉疾病介入治疗致血管迷走神经反射的探讨

目的 探讨周围动脉疾病(PAD)介入治疗发生血管迷走神经反射(VVR)的情况.方法 回顾我院PAD介入治疗528例患者临床资料,对12例发生VVR患者资料进行分析.结果 12例VVR患者均为混合型,发生在术中2例,术后10例.治疗后症状均缓解,未发生不良后果.结论 PAD介入治疗中应重视VVR,一旦发生应及时发现、处理,一般预后良好.     

Clinical diagnosis of trauma from occlusion and its relation with severity of periodontitis

The purpose of the present study was to determine the reliability of several selected signs of trauma from occlusion and their relations with severity of periodontitis. 32 moderate to advanced chronic periodontitis patients participated in the study. All teeth present were evaluated for various abnormal occlusal contacts, signs of trauma from occlusion, and the severity of periodontitis. Standardized periapical radiographs were also taken for each tooth. The results demonstrated that: (1) no significant difference occurred in probing pocket depth (PD), clinical attachment loss (AL), or percentage of alveolar bone height (BH) between teeth with and without various abnormal occlusal contacts, i.e., premature contacts in centric relation occlusion, non-working contacts in lateral excursions, premature contacts of anterior teeth or posterior protrusive tooth contacts; (2) teeth with either significant mobility, functional mobility, or radiographically widened periodontal ligament space (PDLS) had deeper PD, more AL and lower BH than teeth without these signs, while teeth with pronounced wear or radiographically thickened lamina dura had less AL than teeth without these findings; (3) 2 combined indices, i.e., the trauma from occlusion index (TOI) and the adaptability index (AI), were proposed for the identification of occlusal trauma and the response of periodontium to excessive biting forces in heavy function, respectively; TOI-positive teeth exhibit deeper PD, more AL and less osseous support than TOI-negative teeth; however, AI-positive teeth had less AL and more osseous support than AI-negative teeth; (4) with identical attachment level, TOI-positive teeth had less osseous support than TOI-negative teeth while the magnitude of difference became greater with an increase of attachment loss.     

大鼠延髓腹外侧区在可乐定心血管效应中的作用

目的：探讨大鼠延髓腹外侧区（VLM）在介导可乐定心血管效应中的作用。方法：氨基甲酸乙酯麻醉SD大鼠，应用微量注射和细胞外记录等方法观察尾端延髓腹外侧区（CVLM）和头端延髓腹外侧区（RVLM）内局部给予可乐定导致的心血管活动变化。结果：单侧CVLM微量注射可乐定（5nmol/100nl,n=10)不仅能明显升主动脉血压（AP）和增加心率（HR）（P＜0．01），而且能增加同侧RVLM压力敏感性神经元（n=80)的放电频率（P＜0．01），而单侧RVLM微量注射可乐定（5nmol/100nl,n=9)，明显降低AP和HR（P＜0．01）。结论：RVLM和CVLM在介导可乐定的心血管效应中具有不同的作用。     

化疗栓塞与化疗灌注在中晚期膀胱癌治疗中的对照研究

目的采用生存分析的方法对照研究化疗栓塞与化疗灌注在中、晚期膀胱癌中的治疗作用。资料与方法69例中、晚期膀胱癌患者分为两组,一组行双侧髂内动脉化疗灌注术,另一组行双侧髂内动脉化疗栓塞术。应用Cox比例风险模型对各个因素与术后膀胱癌的生存时间进行回归分析,筛选出主要的影响因素;应用Kaplan-Meier生存曲线分析两种治疗方法与生存时间的关系,并进行Log-Rank检验。结果69例手术均成功,双侧髂内动脉化疗栓塞术组生存时间为5~52个月,平均(26.52±3.29)个月;双侧髂内动脉化疗灌注术组生存时间为4~36个月,平均(13.41±1.69)个月。中晚期膀胱癌的死亡率与介入治疗的两种方法的相关性差异有统计学意义(P<0.05),其风险度为3.220,回归系数为1.169,证明双侧髂内动脉化疗栓塞术对于提高患者的生存时间具有更重要的意义。接受双侧髂内动脉化疗栓塞术的患者,生存时间明显高于接受双侧髂内动脉化疗灌注术的患者。结论应用化疗栓塞治疗较单纯化疗灌注治疗可明显提高患者的生存时间。     

Mechanical emergency recanalization of the left main coronary artery

Acute occlusion of the left main coronary artery is normally fatal. According to the literature, only a few cases have been treated by intracoronary thrombolysis; the prolonged period of ischemia, however, resulted in severe left ventricular dysfunction and numerous complications. Therefore, effort should be directed to recanalize the left main coronary artery within the shortest possible interval. We followed this approach in a case of acute occlusion of a subtotal stenosis of the left main coronary artery which could be mechanically reopened and dilated within a few minutes. The intervention resulted in immediate reversal of profound cardiogenic shock and complete restoration of normal left ventricular function. At hospital discharge, the patient was asymptomatic with a negative bicycle stress test. Immediate mechanical recanalization and angioplasty appear to be a feasible approach in life-threatening coronary occlusion.     

Current treatment options for abnormal uterine bleeding: an evidence-based approach

Heavy menstrual bleeding is the predominant complaint in women with abnormal uterine bleeding. Treatment options are drug therapy, and first- and second-generation endometrial resection. Many women will subsequently have a hysterectomy. Uterine fibroids are the most common solid pelvic tumours in women, and although many fibroids seem to cause no symptoms, they can have serious adverse effects and impact on quality of life. As women postpone having children, gynaecologists will have to manage fibroids and polyps in a conservative manner. The past decade has witnessed the development of highly sophisticated diagnostic and therapeutic technology for women suffering from menorrhagia, fibroids and polyps, including minimally invasive uterine therapy. The tools currently at our disposal permit greater management flexibility, which must be tailored to the individual clinical situation. This chapter reviews the evidence-based approach and minimally invasive therapy.     

MMP-3在咬合创伤牙周组织中的表达

目的:探讨基质金属蛋白酶-3(MMP-3)在咬合创伤牙周组织的表达和意义。方法:通过在Wistar大鼠左侧上颌第一磨牙粘结高出咬合面的牙本质固位钉建立咬合创伤动物模型,应用免疫组织化学方法观察咬合创伤后24h、3、7、15和30d MMP-3在牙周组织的表达。结果:咬合创伤后,随着病变程度不断加重,MMP-3在牙周组织的表达逐渐增强,咬合创伤15d时MMP-3的表达达到最强,咬合创伤1个月时,MMP-3的表达有所下降。结论:MMP-3可能在咬合创伤牙周组织的破坏过程中起重要作用。     

A role of insular cortex in cardiovascular function

We sought to determine whether the insular cortex contributes to the regulation of arterial blood pressure (AP). Responses to electrical and chemical stimulation of the cortex were studied in the anesthetized, paralyzed, and artificially ventilated Sprague-Dawley rat. The insular cortex was initially defined, anatomically, by the distributions of retrogradely labeled perikarya following injections of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) into the nucleus tractus solitarii (NTS). Injections of WGA-HRP into the insular cortex anterogradely labeled terminals in cardiopulmonary and other divisions of the NTS and confirmed projections revealed by retrograde tracing experiments. Electrical stimulation of the insular cortex elicited elevations of AP (less than or equal to 50 mm Hg) and cardioacceleration (less than or equal to 40 bpm). The locations of the most active pressor sites corresponded closely to the locations of retrogradely labeled cells in layer V of granular and posterior agranular areas of the insular cortex (areas 14 and 13) and the extreme capsule. Maximal pressor responses were obtained at a stimulus intensity of three to five times threshold current of 20-30 microA. Responses elicited mostly with higher-threshold currents were also mapped in areas 2a and 5lb and the claustrum and within the corpus callosum. Unilateral injections into the insular pressor area of the excitatory amino acid monosodium glutamate (L-Glu; 0.05 nmol to 10 nmol) or the rigid structural analogue of L-Glu, kainic acid (KA) (0.4 nmol) (which specifically excite perikarya), caused topographically specific elevations in AP and tachycardia. During the course of the anatomical transport studies, new findings were obtained on the organization and characteristics of the cortical innervation of the NTS and the nucleus reticularis parvocellularis. Topographic relationships between the cortex and the NTS were organized in a more complex manner than previously thought. Cells projecting to caudal cardiopulmonary segments of the NTS were fewer and generally located ventrally and caudally and in a more restricted area than cells projecting rostrally or to the parvicellular reticular formation. Anterograde transport data revealed new presumptive terminal fields in dorsolateral, ventral, periventricular, and commissural regions of the NTS, including an area overlapping the terminal field of the aortic baroreceptor nerve. We conclude that neurons within an area of the insular cortex projecting to multiple brainstem autonomic nuclei, including a region of the NTS innervated by baroreceptor afferents, increase arterial blood pressure and heart rate.(ABSTRACT TRUNCATED AT 400 WORDS)