内镜下金属钛夹在食管贲门粘膜撕裂综合征中的应用

目的 探讨经内镜下金属钛夹在食管贲门粘膜撕裂综合征中的应用价值。方法 2013年10月-2015年10月急诊胃镜确诊的34例食管贲门粘膜撕裂综合征,内科保守治疗效果欠佳的患者,经内镜金属钛夹止血治疗,观察临床效果、并发症、再出血情况。结果 34例患者均达到内镜下即时止血的目的,即时止血成功率100%。全组无穿孔等严重并发症,术后均未再出血。术后4-8周复查胃镜,钛夹均已脱落。结论 经内镜金属钛夹治疗食管贲门粘膜撕裂综合征安全、有效。     

氨甲环酸对减少单髁置换术后出血量的效果评价

目的研究微创单髁置换术后经引流管局部注射氨甲环酸对单髁置换术后出血量的影响。方法前瞻性研究2013年1月~2013年7月采用MI-UKA治疗膝关节内侧间室骨性关节炎的患者100例,随机分为夹管4小时组(n=50)与氨甲环酸+夹管4小时组(n=50)。分别比较两组患者术前、术后血红蛋白(Hb)浓度、红细胞压积(Hct)、术后48小时引流量、并发症与膝关节功能康复情况。结果两组间一般临床资料无统计学差异。术后经引流管局部注射氨甲环酸+早期夹闭4小时组的总引流量显著低于仅早期夹管4小时组,而术后Hb、Hct值显著高于仅早期夹管4小时组,且有统计学意义(0.05)。夹管4小时组在各时间点(术后24、36和48小时),其引流量明显多于局部注射氨甲环酸+早期夹闭4小时组,有统计学差异(0.05),且术后48小时Hb明显减少(0.05),术后48小时Hct值有明显差异(0.05)。经引流管局部注射氨甲环酸+早期夹闭4小时组与早期夹管4小时组比较,术后2天和7天的VAS评分无统计学差异(0.05)。术后2周,两组间VAS评分均无明显差异(0.05)。术后相关并发症及膝关节功能评分等方面两组间无统计学差异(0.05)。结论术后经引流管局部注射氨甲环酸能够显著减少MI-UKA术后的失血量,且不增加相关的术后并发症,功能恢复满意。     

种植体-杆卡式附着体固位的覆盖全口义齿

目的：总结和评价种植体一杆卡式附着体在覆盖全口义齿中的应用经验和效果。方法：将种植体与杆式附着体结合,以粘膜支持式、混合支持式和种植体支持式３种设计形式,为４６例患者制作种植式全口覆盖义齿,并检查义齿的固位力和稳定性;同时采用修复体测力仪对其中１５例患者义齿的固位效果进行定量评价。结果：３种设计均可达到良好的固位效果,其中混合支持式和种植体支持式的稳定、支持效果更好;应用２￣３只尼龙卡可分别为覆盖     

Four serine proteinases expressed in Manduca sexta haemocytes

Several putative serine proteinases were detected in Manduca sexta larval plasma by labelling with radio-active diisopropyl fluorophosphate. To begin to identify and characterize such enzymes, a polymerase chain reaction was carried out using haemocyte cDNA as template and primers designed to amplify conserved sequences from serine proteinases. Four serine proteinase cDNA fragments were cloned. These were used as probes to screen an M. sexta larval haemocyte cDNA library to obtain full-length clones encoding haemocyte proteinases 1–4 (HP1, HP2, HP3 and HP4). HP1 and HP2 contain an aminoterminal ‘clip’ domain similar to those found in horse-shoe crab clotting enzyme and clotting factor B and also in the Drosophila melanogaster proteinases snake and easter. HP3 and HP4 are most similar to proteinases from mammalian leucocytes. HP1 and HP2 are both present in plasma. HP1 is expressed in haemocytes (granular cells and oenocytoids) and not in fat body. HP2 is expressed in fat body and in granular haemocytes, plasmatocytes and oenocytoids. After injection of larvae with bacteria, the level of HP2 mRNA decreased in haemocytes and increased in fat body.     

暂时阻断夹对局部血管壁损伤的电镜研究

目的探导暂时阻断夹夹闭颈内动脉、大脑中动脉不同时限对局部血管壁损伤的情况。方法将SD大鼠64只随机分为颈内动脉和大脑中动脉两组,每组又随机分为四个亚组。手术暴露颈内动脉或大脑中动脉后,用动脉暂时阻断夹夹闭颈内动脉或大脑中动脉,分别阻断0．5h,lh,2h,2．5h后,再灌流至24h,然后处死动物。取夹闭段动脉,用电镜观察血管壁超微结构改变。结果夹闭30min组,偶见内皮细胞浆内出现空泡,细微处可见平滑肌细胞粗面内质网扩张;夹闭60min组可见平滑肌细胞线粒体轻度肿胀,肌层稍变厚,其间偶见有新分泌形成的胶原蛋白或／和弹性蛋白,内皮细胞浆内出现散在空泡,有少许疏松的细胞间质;夹闭120min组见肌层增厚明显,平滑肌线粒体肿胀,中膜平滑肌伸出较长的突起。穿越附近的平滑肌细胞及内弹力层而达内皮下层,其细胞突起周围则见有较多新分泌形成的胶原蛋白或／和弹性蛋白;部分可见内皮细胞层与内弹力膜层分离;夹闭150min组内皮细胞核出现固缩,部分内皮细胞层脱落。结论夹闭60min是血管壁能耐受的最大极限,如进一步延长夹闭时间,可引起局部血管壁的损伤和管腔的狭窄,以及内皮细胞的脱落形成栓子,造成不可逆的脑缺血损害。     

医源性结肠穿孔原因分析及处理措施

目的探讨结肠镜检查及治疗时发生肠穿孔的原因及对其早期诊断和治疗的方法。 方法回顾性分析2013年1月至2017年12月经宁夏人民医院总院和分院行结肠镜检查或治疗的25 426例患者的临床资料,记录发生肠穿孔患者的年龄、性别、临床诊断、穿孔部位、穿孔原因及穿孔后的治疗方法。 结果共有6例发生肠穿孔,其中,5例为即刻穿孔、1例为迟发性穿孔。6例患者中,3例为结肠息肉钳除术患者,内镜下用钛夹封闭穿孔,经保守治疗后出院;另外2例结肠肿瘤溃疡、1例溃疡性结肠炎患者经外科治疗后好转出院。 结论结肠穿孔是结肠镜诊疗时并不常见的并发症;术前应充分了解患者的临床资料,严格掌握适应证及禁忌证,操作时动作轻柔,可最大程度地减少或避免此类并发症的发生。     

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration

AIM:To compare closure methods,closure times and medical costs between two groups of patients who had post-endoscopic resection(ER) artificial ulcer floor closures.METHODS:Nineteen patients with duodenal adenoma,early duodenal cancer,and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital,an affiliated hospital of Kagawa University,were included in the study.We retrospectively compared two groups of patients who received postER artificial ulcer floor closure:the conventional clip group vs the over-the-scope clip(OTSC) group.Delayed bleeding,procedure time of closure,delayed perforation,total number of conventional clips and OTSCs and medical costs were analyzed.RESULTS:Although we observed delayed bleeding in three patients in the conventional clip group,we observed no delayed bleeding in the OTSC group(P = 0.049).We did not observe perforation in either group.The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min,respectively(P = 0.0001).The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group,respectively,with significant difference(P = 0.039).As for medical costs,the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850(P = 0.005).If the post-ER ulcer is under 20 mm in diameter,a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs.CONCLUSION:If the post-ER ulcer is over 20 mm,the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs.     

小蓟醇提物对肾性高血压大鼠血浆Intermedin的干预影响

目的 探讨小蓟醇提物对两肾一夹(2 - kidney1 - clip,2K1C)高血压大鼠血浆Intermedin (IMD)变化的影响.方法采用2K1C复制肾性高血压大鼠模型;免疫组化法检测心脏、肾脏和腹主动脉IMD的水平;放射免疫学方法检测血浆中IMD和血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)的含量;采用硝酸还原酶法测定血清中一氧化氮(nitric oxide,NO)含量,Griess化学比色法测定血清中一氧化氮合酶(nitric oxide sythase,NOS)活性.结果 与正常组比模型组大鼠心脏、肾脏和腹主动脉IMD的水平及血浆中IMD和AngⅡ的含量升高,血清中NO和NOS的含量降低;与模型组相比,小蓟组大鼠心脏、肾脏和腹主动脉IMD的蛋白增加,血浆中IMD的含量、血清中NO和NOS的含量均升高,血浆中AngⅡ的含量降低,差异均有显著性.结论 小蓟对肾性高血压有降压作用,该作用可能是通过调节IMD及其NO/NOS通路实现的.     

Inflammatory cytokines in paraventricular nucleus modulate sympathetic activity and cardiac sympathetic afferent reflex in rats

Aims: G protein‐coupled receptors such as the AT_1aR are frequently subject to desensitization, extensively studied in cell culture but to small extent in hypertensive models. Recently, angiotensin II (ANG II)‐induced desensitization was shown to last 10 min in isolated afferent arterioles (AAs), suggesting impact on ANG II vasoactivity. In the present study, we explored ANG II desensitization and effects of adenosine (Ado) in AAs from two‐kidney, one‐clip (2K1C) hypertensive rats. Our main hypothesis was that Ado affects ANG II contractility differently in 2K1C, because of persistently elevated levels of ANG II. Methods: Afferent arterioles were isolated with the agarose‐infusion/enzyme‐treatment technique from normotensive and 2K1C hypertensive rats, and stimulated with ANG II (10^?7 m ) at baseline and re‐stimulated after 20 or 40 min, with or without Ado (2.5 × 10^?5 m ) in the vessel bath. Results: Afferent arterioles from normotensive rats re‐stimulated with ANG II after 20 min displayed a blunted contraction (Δ12.8 ± 4.3%, P < 0.05), which disappeared when AAs were stimulated after 40 min (Δ2.7 ± 2.3%, NS), indicating that desensitization lasted for 30 ± 10 min. Ado augmented ANG II contractions after 20 min, but not after 40 min, suggesting that only de‐sensitized vessels were affected. Similar experiments in AAs from the clipped and non‐clipped kidneys revealed no desensitization when re‐stimulated with ANG II after 20 and 40 min, and contractions were unaffected by Ado. Conclusions: Reduced duration of desensitization in AAs from 2K1C may cause vessels to be sensitized longer and increase vasoconstriction. The present study demonstrates that Ado does not augment ANG II‐induced contractions in AAs from 2K1C as in normotensive rats, possibly because of a reduced period of desensitization.