痛风急性发作诱因分析及护理对策

目的探讨痛风急性发作的诱因,为护理干预提供依据.方法对68例痛风住院病例进行诱因回顾性分析,并针对诱因给予护理干预及病情追踪2年.结果高嘌呤饮食和/或饮酒占60.29%,精神紧张、过度疲劳占8.84%,天气变化、受凉占10.29%,使用影响尿酸排泄药物占5.88%,手术、外伤占5.88%,无诱因占8.82%.通过护理干预,发现68例病人平均年发作次数从5.73次降至2.23次.结论痛风急性发作大部分是有诱因的;有效的护理干预对减少诱因发生,进而控制痛风急性发作起到重要的作用.     

缺血后处理激活自噬保护皮瓣机制研究

目的:缺血后处理皮瓣在临床上已经运用,开始相关研究探究缺血后处理对皮瓣保护机制。方法:健康成年新西兰大白兔,分为3组。A组为给予缺血后处理;B组为再灌注前5mi n给予自噬阻滞剂3-甲基腺嘌呤10μl+缺血后处理。C组,直接应用微血管夹阻断腹壁浅血管持续缺。6h后再灌。各组分别进行自噬指标Becl i n1、LC3免疫组化和皮瓣存活率检测。结果:新西兰大白兔完全存活。B、C组相比较,自噬Becl i n1、LC3免疫组化染色阳性细胞面积变化未见统计学差别(P>0.005)。实验组皮瓣存活面积比较,B与C相比较,无统计学意义(P>0.005),但是A与B、C相比较,上述指标两两之间都有统计学意义差别(P<0.005)。结论:缺血后处理对皮瓣再灌注损伤有保护作用,该作用可能和自噬激活有关。     

直肠充盈对直肠壁CT影像组学特征的影响

目的:探讨直肠充盈对直肠壁CT影像组学特征的影响。方法:收集95例宫颈癌后装治疗定位CT扫描图像,患者在直肠填充苦参凝胶前后分别进行CT扫描,手动勾画直肠壁,计算提取7类共计851个特征,包括形态、统计、灰度相关矩阵、灰度游程矩阵、灰度共生矩阵、灰度区域矩阵及邻域灰度差分矩阵特征,采用一致性相关系数评估特征稳定性,威尔科克森符号秩检验分析直肠充盈对直肠壁CT影像组学特征的影响。结果:直肠充盈前后较稳定（一致性相关系数值小于0.8）的特征占总数的13%（113/851）,有显著性差异（P<0.05）的特征占总数的92%（782/851）。结论:直肠充盈对直肠壁CT影像组学特征影响较大,应予以关注。     

Ex vivo relaxation effect of Cuscuta chinensis extract on rabbit corpus cavernosum

The effect of Cuscuta chinensis extract on the rabbit penile corpus cavernosum (PCC) was evaluated in the present study. Penises obtained from healthy male New Zealand white rabbits (2.5–3.0 kg) were precontracted with phenylephrine (Phe, 10 µmol l⁻¹) and then treated with various concentrations of Cuscuta chinensis extract (1, 2, 3, 4 and 5 mg ml⁻¹). The change in penile tension was recorded, and cyclic nucleotides in the PCC were measured by radioimmunoassay (RIA). The interaction between Cuscuta chinensis and sildenafil was also evaluated. The result indicated that the PCC relaxation induced by Cuscuta chinensis extract was concentration-dependent. Pre-treatment with an nitric oxide synthase (NOS) inhibitor (Nω nitro-L-arginine-methyl ester, L-NAME), a guanylyl cyclase inhibitor (1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, ODQ), or a protein kinase A inhibitor (KT 5720) did not completely inhibit the relaxation. Incubation of penile cavernous tissue with the Cuscuta chinensis extract significantly increased cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) in the PCC. Moreover, the Cuscuta chinensis extract significantly enhanced sildenafil-induced PCC relaxation. In conclusion, the Cuscuta chinensis extract exerts a relaxing effect on penile cavernous tissue in part by activating the NO-cGMP pathway, and it may improve erectile dysfunction (ED), which does not completely respond to sildenafil citrate.     

A matched-pair comparison between bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy

The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer (PCa) underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1∶2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients (age ≤65 years) and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates 1 year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.     

Estimating amoxicillin influx/efflux in chinchilla middle ear fluid and simultaneous measurement of antibacterial effect

Understanding the transport process and the factors that control the influx/efflux of antibiotics between plasma and middle ear fluid is essential in optimizing the antimicrobial efficacy in the treatment of acute otitis media. In this study, an experimental chinchilla model with the application of a microdialysis technique was utilized to evaluate amoxicillin middle ear distribution kinetics. Amoxicillin solutions at various doses were instilled into the middle ear with a simultaneous intravenous bolus dose. Unbound amoxicillin levels were monitored by microdialysis in both ears. Serial phlebotomy provided samples for the measurement of unbound amoxicillin concentration in plasma ultrafiltrates. In infected chinchillas, discrete middle ear fluid samples were plated and cultured to characterize Streptococcus pneumoniae growth-kill kinetics. Noncompartmental analysis was used to estimate distributional and elimination clearances assuming linear pharmacokinetics. A nonlinear Michaelis-Menten equation was also used to determine the efflux clearance (from middle ear fluid to plasma) in a mammillary compartment model. No difference was observed in amoxicillin pharmacokinetics between control and infected chinchillas. Influx clearance was (4.6 +/- 2.4) x 10(-3) ml/min-kg and significantly lower than the efflux clearance estimated as (19.2 +/- 9.7) x 10(-3) ml/min-kg (P < 0.002). Nonlinear kinetics was observed in the locally dosed ear. The microdialysis procedure did not interfere with the bacterial growth-kill profile, thereby enabling pharmacokinetic and pharmacodynamic evaluation concurrently. In conclusion, the results suggested that the distribution equilibrium of amoxicillin in the middle ear favors efflux to plasma over influx. An active transport mechanism across middle ear mucosal epithelium may be involved in amoxicillin distribution.     

A highly efficient and consistent method for harvesting large volumes of high-titre lentiviral vectors

Lentiviral vectors pseudotyped with vesicular stomatitis virus glycoprotein (VSV-G) are emerging as the vectors of choice for in vitro and in vivo gene therapy studies. However, the current method for harvesting lentivectors relies upon ultracentrifugation at 50,000 g for 2 h. At this ultra-high speed, rotors currently in use generally have small volume capacity. Therefore, preparations of large volumes of high-titre vectors are time-consuming and laborious to perform. In the present study, viral vector supernatant harvests from vector-producing cells (VPCs) were pre-treated with various amounts of poly-L-lysine (PLL) and concentrated by low speed centrifugation. Optimal conditions were established when 0.005% of PLL (w/v) was added to vector supernatant harvests, followed by incubation for 30 min and centrifugation at 10,000 g for 2 h at 4 degrees C. Direct comparison with ultracentrifugation demonstrated that the new method consistently produced larger volumes (6 ml) of high-titre viral vector at 1 x 10(8) transduction unit (TU)/ml (from about 3,000 ml of supernatant) in one round of concentration. Electron microscopic analysis showed that PLL/viral vector formed complexes, which probably facilitated easy precipitation at low-speed concentration (10,000 g), a speed which does not usually precipitate viral particles efficiently. Transfection of several cell lines in vitro and transduction in vivo in the liver with the lentivector/PLL complexes demonstrated efficient gene transfer without any significant signs of toxicity. These results suggest that the new method provides a convenient means for harvesting large volumes of high-titre lentivectors, facilitate gene therapy experiments in large animal or human gene therapy trials, in which large amounts of lentiviral vectors are a prerequisite.     

辛伐他汀对新生鼠脑缺氧缺血后细胞间黏附分子1的影响

目的:观察缺血缺氧性脑损伤时皮质和海马区细胞间黏附分子1mRNA的表达,以及辛伐他汀的干预作用,并以胞二磷胆碱作标准对照。方法:实验于2003-04/2004-02在东南大学临床医学院实验室进行。选用144只7日龄SD大鼠,随机分为4组,每组又分为0,12,24,48,72h和7d6个时间点,每个时间点6只。①假手术组:手术游离左侧颈总动脉但不结扎,不干预。②生理盐水组:结扎左侧颈总动脉建立缺氧缺血性脑损伤模型后,于即刻及之后的每天同一时刻腹腔注射生理盐水10mL/kg。③胞二磷胆碱组:同前造模,于相同时间点给予胞二磷胆碱稀释液(胞二磷胆碱15mL+生理盐水85mL)10mL/kg。④辛伐他汀组:造模同前,于相同时间点给予辛伐他汀20mg/kg。各组均于相应时间点取脑皮质和海马,观察脑外观,反转录-聚合酶链反应检测细胞间黏附分子1mRNA表达,以细胞间黏附分子1/β-actin吸光度表示。结果:144只动物进入结果分析。①左侧脑皮质细胞间黏附分子1mRNA表达:假手术组各时间点无差异(P>0.05),其他3组于缺氧缺血后12h时始显著升高,24h达高峰,然后开始回落,但胞二磷胆碱组、辛伐他汀组于12,24,48和72h时显著低于生理盐水组,7d时,辛伐他汀组已接近假手术组水平(P>0.05),且72h时,辛伐他汀组显著低于胞二磷胆碱组(P<0.05)。②脑左侧海马细胞间黏附分子1mRNA表达:与脑皮质类似,生理盐水组、胞二磷胆碱组和辛伐他汀组在缺氧缺血后12h始升高,24h达高峰,然后开始下降,但胞二磷胆碱组、辛伐他汀组于12,24,48和72h时显著低于生理盐水组,7d时,辛伐他汀组已接近假手术组水平(P>0.05),生理盐水组和胞二磷胆碱组表达量接近(P>0.05),仍然显著高于假手术组(P<0.01)。③脑外观:12h开始,生理盐水组结扎侧大脑半球出现水肿、苍白、液化坏死、萎缩的全过程,胞二磷胆碱组程度明显减轻,辛伐他汀组仅出现轻微水肿。结论:细胞间黏附分子1在缺氧缺血脑损伤后12h的表达显著升高,24h达高峰,然后持续下降,7d时虽明显下降,但仍高于正常水平,胞二磷胆碱和辛伐他汀均能有效地抑制其表达,对缺氧缺血脑损伤起到保护作用,但辛伐他汀的作用更强更快。     

术后持续镇痛患者拔除尿管时机的探讨

目的探讨术后拔除尿管的适宜时间。方法98例腹部手术患者随机分为实验组(n=50)与对照组(n=48)。实验组于术后第3d拔除镇痛泵后5h拔除尿管,对照组于术后第3d拔除镇痛泵后1h拔除尿管。结果实验组有1例发生尿潴留,对照组则有10例发生尿潴留。两组患者排尿成功率的差异有统计学意义(P<0.05)。结论患者在术后第3d拔除镇痛泵后5h拔除尿管,可有效防止尿潴留的发生。