Ryanodine受体与心力衰竭

Ryanodine受体2(RyR2)是位于心肌肌浆网上的一种钙释放通道,它通过调节心肌的兴奋收缩耦联过程在心力衰竭中发挥着重要的作用,针对RyR2已成为心力衰竭治疗的一个新的靶点。现主要介绍RyR2的结构、功能、调节因素、在心衰中的作用以及基于RyR2的心衰治疗。     

小儿卵黄囊瘤的超声检查

小儿卵黄囊系胚源性恶性肿瘤,好发于生殖腺、骶尾部及体后壁中线附近。本院超声诊断卵黄囊瘤30例,超声图像显示了肿瘤的部位及大小,为选择手术方案及评估化疗效果提供了图像依据。     

基于四肢同步检测踝臂指数的方法和临床研究

目的利用优选法在波形特征法和幅度系数法的基础上提出1种同步采集四肢脉搏波信号和袖套压力波信号无创检测踝臂指数的新方法。方法计算出相邻脉搏波的幅度差值和它们的相对比值,并利用优选法在一定范围内进行突变点的判断。结果该方法能够解决将收缩压以前的点和平均压附近的点误判为突变点的问题,大量的病例分析和临床测试证实了该算法的有效性和可靠性。结论踝臂指数是动脉硬化的一个简便可靠的预测因素,它与传统的动脉硬化危险因素如年龄、血压等有相关性。     

Cardiopulmonary resuscitation training in Washington state public high schools

To determine the best approaches for increasing cardiopulmonary resuscitation (CPR) training opportunities for public high school students, we conducted a statewide survey of all 310 public high schools in Washington State. The findings describe CPR student training currently provided by high schools, barriers to providing, and strategies to increase CPR training of high school students. The response rate was 89% (276 schools) from a combination of mail and telephone surveys; 35% (n=97) reported that they did not provide any CPR student training. Of the 132 schools that provided CPR student training, 23% trained less than 10% of their students, and 39% trained more than 90% of their students. The majority of public high schools, 70%, did not have any teacher trained to teach CPR or had only one teacher with such training. Yet 80% of schools felt that CPR training is best provided in school settings. Schools perceived the greatest benefit of CPR training as providing students with the skill to save a life (43%). The most frequently identified barriers were logistical: limited time to teach the curriculum (24%), lack of funds (16%), and instructor scheduling difficulties (17%). Less than 5% of respondents voiced any opposition to CPR training, and that opposition was for logistical reasons. To increase CPR training, the single best strategies suggested were: increase funding, provide time in the curriculum, have more certified instructors, and make CPR student training a requirement.     

早期康复训练对脑卒中患者偏瘫肢体功能恢复的影响

目的　观察早期康复训练对脑卒中患者偏瘫肢体运动功能恢复的影响。方法　将 60例急性脑卒中患者随机分为康复组 (3 0例 )及对照组 (3 0例 ) ,康复组患者采用神经促通技术治疗 6个月 ,而对照组患者则不给予任何规范、系统的康复治疗。分别于治疗前、治疗 1个月、治疗 3个月及治疗 6个月时 ,采用Fugl Meyer评分及Barthel指数积分评定 2组患者日常生活活动能力和偏瘫肢体运动功能的改变情况。结果　治疗前 ,2组患者Fugl Meyer评分及Barthel指数积分基本接近 ,差异无显著性意义 (均P >0 .0 5 ) ;经治疗 1个月、3个月及 6个月后 ,康复组患者上述时间点的Fugl Meyer评分及Barthel指数积分均明显优于对照组 ,差异均有极显著性意义 (均P <0 .0 1)。结论　早期给予系统、规范的康复治疗可以显著提高患者的瘫肢运动功能及日常生活活动能力。当患者处于恢复期 (患病 4～ 6个月内 )时 ,指导患者家属帮助其进行功能训练 ,同样也能获得较好的疗效 ,该时期的康复治疗及患者家属的作用均应予以足够重视。     

小儿胰腺损伤诊治分析

目的探讨小儿胰腺损伤临床特点及诊治方法。方法我院自2004年8月～2011年12月共收治胰腺损伤患儿13例,其中Ⅰ度胰腺损伤3例,Ⅱ度7例,Ⅲ度2例,Ⅳ度1例;淀粉酶升高4例。13例患儿均经病史、腹部查体、淀粉酶检测、B超及CT明确诊断,4例经手术探查证实。结果 3例Ⅰ度及6例Ⅱ度经非手术治疗;1例Ⅱ度行腹腔广泛引流;1例Ⅲ度胰腺损伤因膜膜炎行剖探查术,术中见腹腔中等量积液,胰腺中部断裂,胰管未断裂,行断裂修补,局部引流;1例Ⅲ度因形成胰腺假性囊肿行胰腺囊肿-空肠Roux-Y吻合术;1例Ⅳ度行胰腺断裂近端缝合、远端胰腺空肠Roux-Y吻合术。所有患儿均临床治愈。结论小儿胰腺损伤因其症状往往较为隐匿,诊断较为困难,了解胰腺损伤的机制及高度警戒心理有利于胰腺损伤的早期诊断及恰当治疗。胰淀粉酶及脂肪酶升高在胰腺损伤诊断中并不可靠;螺旋CT增强扫描检查应作为胰腺损伤首选检查方法;轻度胰腺损伤多可非手术治愈,重型胰腺损伤合并腹膜炎表现需行剖腹探查并相应处理。     

PTEN在胃癌中的表达

目的检测FIEN基因在胃癌组织中的表达，并研究其临床病理意义。方法采用逆转录聚合酶链式反应（RT-PCR）法检测FFEN在40例胃癌中的表达。结果①PINM分期Ⅰ、Ⅱ期胃癌与对照组正常胃黏膜组织FFEN的表达有显著性差异（P〈0．01）；FTNM分期Ⅲ、Ⅳ期和Ⅰ、Ⅱ期胃癌FFEN的表达有非常显著性差异（P〈0．05）；②FIEN在高、中分化腺癌和低分化胃癌阳性率表达差异具有显著性（P〈0．05）。③FFEN在有淋巴结转移组和无淋巴结转移组检出阳性率差异具有显著性（P〈0．05）。结论FFEN的表达与胃癌临床病理特征和生物学行为存在密切关系，FFEN基因是胃癌细胞增生活跃的重要影响因素。     

The ProSeal Laryngeal Mask Airway is more effective than the LMA-Classic in pediatric anesthesia: a meta-analysis

Study ObjectiveTo determine, in pediatric patients, whether the ProSeal Laryngeal Mask Airway (PLMA) has advantages over the LMA-Classic (cLMA) in leak pressure, placement difficulty, incidence of adverse events, postoperative blood staining, laryngospasm, bronchospasm, and hoarseness.DesignMeta-analysis.SettingMetropolitan university medical center.MeasurementsMEDLINE (1966–2011), EMBASE (1980–2011), and the CENTRAL (1977–2011) databases was searched for randomized controlled trials (RCTs). The relative risk (RR), mean difference (MD), and corresponding 95% confidence intervals (CIs) were calculated using RevMan 5 statistical software for dichotomous and continuous outcomes, respectively.Main ResultsOf the 13 RCTs that met study inclusion criteria, 8 trials comprising 557 patients were analyzed. Leak pressure was higher in the PLMA (RR = 5.02, 95% CI = 3.64, 6.4). The difference in rate of successful placement on the first attempt did not differ between the two devices (RR = 1.00, 95% CI = 0.94, 1.06). The incidence of gastric insufflation was lower with the PLMA (RR = 0.20, 95% CI = 0.07, 0.61). The incidence of postoperative blood staining on the mask did not differ (RR = 1.08, 95% CI = 0.52, 2.21), nor was there any difference between the two devices in incidence of laryngospasm or bronchospasm (RR = 0.75, 95% CI = 0.18, 3.21), or hoarseness (RR = 3.00, 95% CI = 0.13, 70.83). There was no difference in laryngeal view between the PLMA and cLMA (RR = 1.06, 95% CI = 0.90, 1.26). The maximum tidal volume per kg was greater with the PLMA (MD = 4.16, 95% CI = 3.56, 4.76).ConclusionsThe PLMA (in sizes 1,1.5, 2, and 2.5) offers some advantages over the cLMA in pediatric anesthesia.     

髂内动脉在肾移植术后髂外动脉出血中的应用

目的:探讨肾移植术后感染性外动脉移植肾动脉吻合口出血的处理。方法:采用自体髂内动脉片或段修补、串接治疗髂外动脉吻合口大出血。结果:修复后的髂外动脉血流通畅,患侧下肢血供良好。结论:感染性移植肾动脉髂外动脉吻合口出血为肾移植术后严重并发症,单纯缝扎止血常难以奏效,与其他方法比较,自体髂内动脉片或段修补、串接修补缺损的髂外动脉操作简单,效果非常满意。