Anaesthesia for vascular surgery on extremities

Patients with lower limb ischaemia present a significant challenge to the anaesthetist because of their widespread vascular disease, which is often asymptomatic, but which leads to a mortality of 12% per year, even without surgery. Lower limb revascularization procedures can be performed with either general or regional anaesthesia, and the type of anaesthetic chosen has no impact on perioperative mortality and only a small effect on the outcome of the bypass procedure. Use of regional anaesthesia in these patients may be associated with a greater than usual risk of epidural haematoma because of the preoperative use of aspirin, clopidogrel and low molecular weight heparin, and the intraoperative use of intravenous heparin. Whatever the technique used, prolonged surgery in a patient with severe cardiovascular disease requires close monitoring, often including arterial and central venous catheters, with careful management of fluid balance, and cardiovascular and coagulation status. Anaesthesia for the acutely ischaemic lower limb is challenging because of inadequate time to evaluate and treat comorbidities and the physiological disturbances resulting from an ischaemic limb. Local anaesthesia with invasive monitoring by an anaesthetist is the preferred technique for embolectomy, but progression to revascularization may still require general anaesthesia. Vascular surgery of the upper limb may include first rib resection for thoracic outlet syndrome (a procedure potentially associated with significant blood loss) and thoracoscopic sympathectomy for hyperhidrosis of the upper limb, which requires appropriate airway management to facilitate lung collapse and insufflation of carbon dioxide into the pleural space.     

军医大学生心理健康现状分析

军医大学生作为未来战争的预备军，其身心健康水平对提高和保障军队平战时战斗力具有重要意义。本文分析了军医大学生的心理特点，指出了目前存在的六个方面的心理问题，以便进一步采取心理健康干预措施。     

肝细胞生长因子抑制慢性缺血性心脏病心肌纤维化及心肌细胞凋亡的实验研究

目的:研究肝细胞生长因子（HGF）抑制慢性缺血性心脏病心肌纤维化及心肌细胞凋亡的作用。方法: 采用磷酸钙/DNA-TPC方法构建携带HGF基因的重组腺病毒(Ad.HGF)。经18只小型猪的左胸冠状动脉回旋支放置Ameroid环建立慢性心肌缺血猪动物模型,并随机分为3组即盐水组、AdHGF组和缺陷型空病毒Ad5(AdNull)组,每组6只(n=6)。于缺血心肌处,分别注射4×109 pfu 200 μl AdHGF、4×109 pfu 200 μl AdNull及200 μl盐水。4周后做超声心动图检查各组的心脏功能,并行病理学心肌纤维化、心肌凋亡检测。结果: 心脏彩超检测显示,AdHGF组室壁增厚,运动增加,左室舒张末容积（LVEDV）、左室射血分数（LVEF）及短轴缩短率（FS）等明显改善(P<0.05)。AdHGF组心肌组织切片缺血坏死区纤维组织增生明显低于AdNull组(P<0.05)。AdHGF组心肌中Ⅲ型胶原蛋白的量明显低于AdNull组(P<0.05)。AdHGF组心肌细胞的凋亡率(%)明显低于对照组(P<0.05)。结论: HGF具有抑制慢性缺血性心脏病心肌纤维化及心肌细胞凋亡的作用,从而可抑制心室重构和改善心功能。     

Structural Properties of the Lipid A Component of the Lipopolysaccharide(Endotoxin)Isolated from Bacteriodes fragilis NCTC 9343

Various chemical and gas-liquid chromatographic analyses indicate that the lipid A,backbone of the lipopolysaccharide(LPS)isolated from B.fragilis NCTC 9343 is chemically con-stitutεd by a β1,6-interlinked D-glucosamine disaccharide.It is phosphorylated at its 1-positionby a glvcosidic-linkage while the ester-linked phosphate at 4'—position present generally in otherlipid A is depleted.The lipid A is lower fatty acylated in the amount of 5.2 fatty acids/lipid Amolecule(of which 0.73 forms 3-acyloxyacyl groups).The LPS containing such an incompletelipid A component has been shown endowina with a weaker endotoxicitv.     

CTLA-4 +49A>G polymorphism is associated with the risk but not with the progression of colorectal cancer in Chinese

Purpose  

Colorectal cancer (CRC) is one of the most common malignancies in the world and a multipathway disease. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) is a potent immunoregulatory molecule that suppresses antitumor response by down-regulating T-cell activation. The most studied +49A>G polymorphism of CTLA-4 gene has been associated with several autoimmune or cancer diseases. Our aim was to investigate the association between this genetic variant and the risk as well as progression of colorectal cancer in Chinese.     

新药开发中药物的盐型选择

成盐是改善弱酸性及弱碱性药物的溶解度和提高药物生物利用度的重要手段.因此,为药物筛选合适的反离子是药品研发过程的关键步骤.本文探讨了筛选反离子时需考虑的因素和成盐对药物的溶解度和溶出速率的影响.     

银屑病发病机制研究进展

银屑病（psoriasis）是多种免疫细胞共同参与的慢性复发性炎症性皮肤病,它具有明显的鳞屑性红斑和不同程度的自觉症状,严重影响患者的生活质量。该病的发病机制探讨多集中在遗传、感染、免疫等方面。目前,越来越多的研究证明了IL-23和CD4阳性辅助性T淋巴细胞17（CD4＋Thelper17,Thl7）在银屑病病理机制中起到了关键作用。本文就银屑病发病机制的进展作一综述。     

两种不同类型左心耳封堵器的动物实验研究

目的评价单盘圆柱型及双盘分体型两种不同左心耳封堵器进行动物左心耳封堵的可行性及安全性。方法 14只健康实验犬使用单盘圆柱型或双盘分体型左心耳封堵器经股静脉途径进行左心耳封堵,术中左房造影评价封堵后效果;对非预期死亡的实验犬立即进行大体标本检查分析死因,存活的实验犬分别于术后第45天、80天、110天、15月处死,对封堵器表面组织行HE染色及DAPI、CD31免疫荧光评价内皮化程度。结果 6只实验犬使用单盘圆柱型封堵器进行左心耳封堵,5条实验犬于术后30 min-8 h死亡,1条实验犬存活至15月后处死;大体心脏解剖发现4条实验犬封堵器表面均存在大量血栓,存活的1条实验犬封堵器表面约1/5未见新生组织覆盖;8只实验犬使用双盘分体型封堵器进行左心耳封堵,7例实验犬完全封堵;术后110 d新生组织完全覆盖封堵器表面,HE及免疫荧光染色呈现完整内膜形成,并可见新生血管。结论单盘圆柱型封堵器植入左心耳后急性血栓发生率及即时死亡率高;双盘分体型左心耳封堵器用于封堵左心耳,器械相关并发症低,左心耳封堵术后4月覆盖盘完全完整内膜化。     

基于图像几何变换映射的色盲矫正方法

为了提高色盲患者分辨色彩的能力,提出了基于图像几何变换映射的色盲矫正方法。首先根据图像中颜色面两侧的颜色比例对颜色空间各个平面进行相应的几何变换,进而划分不同的颜色映射区域,通过颜色变换,生成色盲患者较易分辨颜色的图像。实验表明,该方法可以改善色盲患者对原本难以区分的颜色的分辨能力,同时计算速度快,有望满足实时处理的需要,性能上优于已有的方法。     

军医大学本科毕业生住院医师规范化培训初探

军医大学培养的五年制临床医学专业本科毕业生分配到基层部队后,从事全科医师工作,但却未经全面、系统、规范的毕业后培训,难以胜任岗位任职需要。探索基层医师住院医师规范化培训制度,系统规范地培训分配到基层的医学生,有利于推动部队卫生事业的健康发展,是提高基层部队卫勤保障能力的重要举措。