不同温度液体静脉输入对剖宫产术中穿刺局部疼痛的影响

目的观察不同温度的液体静脉输入对剖宫产术中穿刺局部疼痛的影响。方法按随机数字表将240例择期剖宫产产妇分为A、B、C组,每组80例。在剖宫产手术中输入不同温度的液体:A组输入38.5℃液体,B组输入37.5℃液体,C组输入未经加热液体。运用视觉模拟法观察、记录静脉输液穿刺部位疼痛情况。结果无痛率A组高于B组、B组高于C组,经比较x2=20.138,P=0.000。结论在剖宫产术中,静脉输入38.5℃加热液体,能有效缓解输液肢体局部疼痛。     

止血带联合子宫下段横和“U”字缝合术在凶险型前置胎盘剖宫产术中的应用

【目的】探讨止血带联合子宫下段横向“U”字缝合术在凶险型前置胎盘（PPP）剖宫产术中止血的效果及临床应用价值。【方法】将本院因PPP行剖宫产术的患者共53例,按单双号分为两组,观察组27例患者采用止血带环扎联合子宫下段横向“U”字缝合术止血,对照组26例患者常规手术方式,比较两组手术时间、术中出血量、子宫切除率及感染病率。【结果】观察组患者术中出血量少于对照组患者,差异具有统计学意义（ P ＜0．05）。观察组患者子宫切除率少于对照组患者,差异具有统计学意义（ P ＜0．05）。【结论】PPP剖宫产术中止血带环扎联合子宫下段横U字缝合术,能明显减少出血,降低子宫切成率,值得临床推广。     

剖宫产腰麻后低血压防治措施的研究进展

单次腰麻现在已经成为目前世界范围内剖宫产麻醉最常用的技术。由于产妇孕期生理发生了一系列的改变,导致低血压是腰麻剖宫产术最常见的并发症。严重的、持续的低血压会导致产妇恶心呕吐、胸闷、呼吸困难甚至心脏骤停,还可以引起胎儿缺血缺氧甚至胎儿窘迫。因此,如何防治腰麻后低血压在剖宫产手术中显得尤为重要,这也是近年来产科麻醉研究的一个热点。     

Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE)

Background:

Factors related to early stimulation of the immune system (breastfeeding, proxies for exposure to infectious agents, normal delivery, and exposure to animals in early life) have been suggested to decrease the risk of childhood acute lymphoblastic leukaemia (ALL).

Methods:

The national registry-based case–control study, ESTELLE, was carried out in France in 2010–2011. Population controls were frequency matched with cases on age and gender. The participation rates were 93% for cases and 86% for controls. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, gender, and potential confounders.

Results:

In all, 617 ALL and 1225 controls aged ⩾1 year were included. Inverse associations between ALL and early common infections (OR=0.8, 95% confidence interval (CI): 0.6, 1.0), non-first born (⩾3 vs 1; OR=0.7, 95% CI: 0.5, 1.0), attendance of a day-care centre before age 1 year (OR=0.7, 95% CI: 0.5, 1.0), breastfeeding (OR=0.8, 95% CI: 0.7, 1.0), and regular contact with pets (OR=0.8, 95% CI: 0.7, 1.0) in infancy were observed.

Conclusions:

The results support the hypothesis that conditions promoting the maturation of the immune system in infancy have a protective role with respect to ALL.     

Nickel chloride (NiCl2)-caused inflammatory responses via activation of NF-κB pathway and reduction of anti-inflammatory mediator expression in the kidney

Nickel (Ni) or Ni compounds target a number of organs and produce multiple toxic effects. Kidney is the major organ for Ni accumulation and excretion. There are no investigations on the Ni- or Ni compounds-induced renal inflammatory responses in human beings and animals at present. Therefore, we determined NiCl₂-caused alteration of inflammatory mediators, and functional damage in the broiler''s kidney by the methods of biochemistry, immunohistochemistry and quantitative real-time polymerase chain reaction (qRT-PCR). Dietary NiCl₂ in excess of 300 mg/kg caused the renal inflammatory responses that characterized by increasing mRNA expression levels of the pro-inflammatory mediators including tumor necrosis factor-α (TNF-α), cyclooxygenase-2 (COX-2), interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-18 (IL-18) via the activation of nucleic factor κB (NF-κB), and decreasing mRNA expression levels of the anti-inflammatory mediators including interleukin-2 (IL-2), interleukin-4 (IL-4) and interleukin-13 (IL-13). Concurrently, NiCl₂ caused degeneration, necrosis and apoptosis of the tubular cells, which was consistent with the alteration of renal function parameters including elevated alkaline phosphatase (AKP) activity, and reduced activities of sodium-potassium adenosine triphosphatase (Na⁺/K⁺-ATPase), calcium adenosine triphosphatase (Ca²⁺-ATPase), lactic dehydrogenase (LDH), succinate dehydrogenase (SDH) and acid phosphatase (ACP) in the kidney. The above-mentioned results present that the activation of NF-κB pathway and reduction of anti-inflammatory mediator expression are main mechanisms of NiCl2-caused renal inflammatory responses and that the renal function is decreased or impaired after NiCl2-treated.     

Vanadium toxicity in the thymic development

The purpose of this study was to define the toxic effects of vanadium on thymic development in broilers fed on diets supplemented with 0, 5, 15, 30, 45 and 60 mg/kg of vanadium for 42 days. We examined the changes of relative weight, cell cycle phase, apoptotic cells, and protein expression of Bcl-2, Bax, and caspase-3 in the thymus by the methods of flow cytometry, TUNEL (terminal-deoxynucleotidyl transferase mediated nick end labeling) and immunohistochemistry. The results showed that dietary high vanadium (30mg/kg, 45mg/kg and 60mg/kg) caused the toxic effects on thymic development, which was characterized by decreasing relative weight, increasing G₀/G₁ phase (a prolonged nondividing state), reducing S phase (DNA replication) and proliferating index (PI), and increasing percentages of apoptotic thymocytes. Concurrently, the protein expression levels of Bax and caspase-3 were increased, and protein expression levels of Bcl-2 were decreased. The thymic development suppression caused by dietary high vanadium further leads to inhibitive effects on T lymphocyte maturity and activity, and cellular immune function. The above-mentioned results provide new evidences for further understanding the vanadium immunotoxicity. In contrast, dietary 5 mg/kg vanadium promoted the thymic development by increasing relative weight, decreasing G₀/G₁ phase, increasing S phase and PI, and reducing percentages of apoptotic thymocytes when compared to the control group and high vanadium groups.     

不同采集地土茯苓中(切面红色、白色)总糖及多糖含量分析与体外抗氧化作用

目的:分析测定26个不同采集地土茯苓中(切面红色、白色)总多糖及多糖的含量并探讨其体外抗氧化活性。方法:采用蒽酮-硫酸比色法,比较分析不同产地及不同切面颜色土茯苓中总糖及多糖含量;同时,以抗坏血酸为阳性对照,通过DPPH自由基(1,1-二苯基-2-苦肼基自由基)清除法来评价该药材中总糖与多糖的抗氧化能力。结果:切面红色土茯苓中总糖的质量分数为1.897 3%~11.680 9%,多糖为0.048 0%~1.863 4%;切面白色土茯苓中总糖的质量分数为7.957 5%~81.681 0%,多糖为0.413 2%~7.963 9%,两者含量差异较大;抗氧化结果表明,总糖及多糖均有清除自由基活性,其IC50依次为抗坏血酸(0.033 4 g·L-1)切面红色多糖(0.176 7 g·L-1)切面白色多糖(0.294 9 g·L-1)切面红色总糖(0.354 8 g·L-1)切面白色总糖(0.769 5 g·L-1)。结论:不同切面颜色及不同产地土茯苓药材中总糖及多糖的含量存在显著性差异,其多糖的含量高低与抗氧化作用的强弱不呈正相关。     

MRI对剖宫产瘢痕妊娠的诊断价值

目的探讨MRI诊断剖宫产后瘢痕妊娠(cesarean scar pregnancy,CSP)的价值。方法回顾性分析2008年1月至2011年9月间经MRI诊断为CSP的23例患者的MR图像特征及术后结果。结果 23例CSP患者全部行手术治疗,MRI正确诊断20例,准确率86.96%(20/23)。误诊3例(宫颈妊娠1例、滋养细胞疾病1例、不全流产1例)。典型MRI图像表现为孕囊型、混合包块型。结论 MRI是诊断CSP的有效手段,能较好地反映CSP病理学特点,为临床诊断和治疗提供重要影像学依据。     

Pathology for the HPB Surgeon

Optimal care of a patient implies a good professional understanding between all the medical personnel involved in that patient’s care. Similarly a basic understanding of the areas where surgery and pathology interact would go a long way, in clarifying the disease process in the patient. This review aims to cover a few topics in liver lesions, FNAC Vs core biopsy, IHC, Margin examination, and frozen sections, in order to improve the communication between these two specialities.