甲状腺功能减退合并心包积液老年麻醉一例

患者,男,75岁,因右上腹剧烈疼痛入院,诊断为胆囊结石、胆囊炎、心包积液、左侧胸膜炎、前列腺肥大。两年前在本市某医院诊断为慢性结石性胆囊炎,因心包积液(原因不明)而放弃手术治疗。患者入院眼睑水肿,唇厚舌大,皮肤干燥,反应迟钝,听力减退,心音减弱,无杂音,脉搏较弱。BP80/40     

凝血栓蛋白1基因异常甲基化与大肠腺癌关联

目的 探讨凝血栓蛋白l（THBS1）基因启动子CpG岛异常甲基化与大肠腺癌及其临床病理特征的关联。方法 THBS1基因甲基化状态用甲基化特异性PCR检测。结果 大肠腺癌、癌旁组织中，THBSI基因启动子cpG岛甲基化率的差异有显著性（X^2=5．93，P=0．025）；老年患者肿瘤组织中THBS1基因甲基化率明显商于非老年患者（X^2=5.68，P=0．017），直径≥3cm的肿瘤组织中THBSl基因甲基化率显著高于直径〈3cm的肿瘤（X^2=4．16，P=0．041），C期和D期肿瘤组织中THBS1基因甲基化率显著高于A期或B期肿瘤（X^2=8．04，u=2，P=0．018）。结论 THBS1基因甲基化与大肠腺癌的发生有关，肿瘤以老年、晚期和直径较大的肿瘤多见。     

空勤人员体检辅助检查规范化的几点建议

中国民航总局CCAR-67FS和AP-67FS-001部颁布以来，民航空勤人员的身体医学标准、体检程序、体检方法、体检手段等已经达到了一定程度的规范化，但是空勤人员体检的辅助检查尚未达到规范化管理水平。而空勤人员体检非常重要的一部分是辅助检查，特别是目前现代检查仪器精密度高，检查结果准确，     

加贝酯预防内镜逆行胰胆管造影术后胰腺炎的随机对照试验的荟萃分析

内镜逆行胰胆管造影术（ERCP）是肝胆胰疾病的重要诊治手段之一，然而，ERCP可引起急性胰腺炎（AP）并致死。有报道内镜逆行胰胆管造影术后胰腺炎（PEP）的发生率在1％～40％，而术后高淀粉酶血症发生率可高达70％。其中约10％PEP可发展为重症胰腺炎，危及患者生命。目前认为蛋白酶活性在AP发病过程中起关键作用，抑制蛋白酶活性可对AP起治疗作用。Cavallini等报道在ERCP术前用蛋白酶抑制剂加贝酯进行预防性治疗可降低PEP的发生，而其他一些研究认为该药仅有边缘效应。因此，有必要用荟萃分析方法对已有研究结果进行系统定量的综合分析，以提高研究结论的可信性。     

肝细胞生长因子与肝再生增强因子重组表达质粒对大鼠肝纤维化的影响

Objective To evaluate the therapeutic effects of recombinant expression plasmid containing hepatocyte growth factor (HGF) and augmenter of liver regeneration (ALR) on rats with hepatic fibrosis. Methods Ninety Sprague-Dawley rats, which had been established into hepatic fibrosis models, were equally divided into 6 groups: blank group, pcDNA3.1 therapy group,pcDNA3.1-HGF therapy group, pcDNA3. 1-ALR therapy group, pcDNA3.1-HGF and pcDNA3. 1-ALR combined therapy group, and pcDNA3. 1-HGF-ALR therapy group. Zero point one μmol of blank or plasmid was injected into model rats in each group by tail vein once a day for 3 days. Model rats in blank group didn't receive any treatment. Additional 10 rats were chosen as control group, which were not given any interference during the experiment. All rats were sacrificed 4 days after end of treatment. Liver tissues were reserved for observing pathologic changes after HE staining and detecting proliferating cell nuclear antigen (PCNA) and c-jun by immunohistochemistry. Measurement data were compared by single-factor analysis of variance. Comparison between groups was done by SNK test. Enumeration data were analyzed by Fisher's exact test. Results In blank group and pcDNA3.1 therapy group, hyperplasia of fibrous connective tissue was very obvious, false lobules were formed. There was no significant difference between these two groups (x2 =0. 317,P= 1. 000).In the 4 remaining groups, hepatic fibrosis all achieved different degree of amelioration, and the therapeutic effect of pcDNA3.1-HGF-ALR was optimal. In control group, the expressions of PCNA and c-jun in liver tissues were low, with absorbance value of 8.6±1.9 and 3.2 ± 1.2, respectively. In blank group and pcDNA3. 1 therapy group, the expressions of PCNA and c-jun were obviously increased, with absorbance value of 24. 1±3.0, 24.5±4.3 and 23.8±3.1, 24.9±4.2, respectively,which were significant different from control group (all P＜0.01). In the 4 remaining groups, the expressions of PCNA were all obviously increased, and expressions of c-jun were all obviously decreased. The maximum change scope was observed in pcDNA3. 1-HGF-ALR therapy group.Conclusions The recombinant expression plasmid pcDNA3. 1-HGF-ALR can effectively ameliorate experimental hepatic fibrosis of rats. The anti-fibrosis effects are achieved probably by up-regulating PCNA expression and down-regulating c-jun expression.     

急性肝衰竭大鼠肝组织SOCS表达及意义

目的 研究急性肝功能衰竭(acute liver failur,ALF)大鼠肝组织细胞因子信号转导抑制因子(SOCSs)基因表达的动态变化及意义.方法 腹腔注射D-胺基半乳糖(D-GalN)、脂多糖(LPS)建立急性肝衰竭大鼠模型,D GalN和LPS剂量分别为800 mg/kg和8μg/只,分别在注射D-GalN、LPS后2,6,12,24,48 h 5个时间点留取大鼠血及肝脏标本.观察大鼠肝功能及肝脏病理变化;逆转录聚合酶链反应法(RT-PCR)检测动物肝组织中SOCS-1和SOCS-3mRNA表达;ELISA法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平.结果 肝衰竭大鼠肝组织SOCS-1和SOCS-3mRNA表达均明显上调,在造模后2 h即明显高于对照组,分别于6,12 h达高峰值.血清TNF-α、IL-6产生均显著增多(P＜0.01),均于造模后6 h达峰值.结论 急性肝功能衰竭可诱导体内SCCSs表达上调.其改变与TNF-α、IL-6水平的改变密切相关,提示其可能参与急性肝功能衰竭时炎症反应平衡的调节过程.     

谷胱甘肽硫转移酶T1 基因多态、吸烟与大肠腺瘤的关联

目的探讨谷胱甘肽硫转移酶(GST)T1基因多态、吸烟与大肠腺瘤易感性的关联。方法用多重PCR法检测174例大肠腺瘤患者和101例健康人GSTT1基因多态性。结果管状腺瘤、绒毛状腺瘤及混合型腺瘤患者分别与健康人比较，GSTT1空白基因型频率的差异均无显著性；重度吸烟的管状腺瘤患者与健康对照比较，其差异有显著性(较正OR=2．67，95％CI=1．12—6．37，P=0．027)。结论GSTT1空白基因型与大肠腺瘤的危险性无关，重度吸烟且携带GSTT1空白基因型的个体患大肠腺瘤的危险性明显上升。     

大肠癌的致癌物及代谢的研究近况

环境因素是大肠癌发生机制的重要研究领域。本着重综述大肠癌致癌物的代谢酶及代谢特点，常见致癌物的代谢途径及其影响因素，以便更 全面地研究大肠癌的病因及预防大肠癌。     

瑞芬太尼用于硬膜外麻醉腹腔镜手术清醒镇静临床观察

目的观察瑞芬太尼(REM)用于硬膜外麻醉下腹腔镜胆囊切除手术清醒镇静的效果。方法随机选择腹腔镜胆囊切除手术25例，行椎管穿刺插管硬膜外麻醉，麻醉效果确切后，给予瑞芬太尼首剂量1—2μg／kg，继以14—18ml／hr(瑞芬太尼1mg用0．9％生理盐水稀释到50ml)微泵输注，胆囊切除后停用瑞芬太尼。选择首剂量后1分钟、气腹前瞬间、气腹达到预计压力时、牵拉暴露胆囊时、气腹下分离切除胆囊时、术毕时6个时刻点进行警觉／镇静评分(OAA／S)和痛觉视觉模拟评分(VAS)，同时监测血压(BP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(SPO2)、呼吸频率(RR)、呼气末二氧化碳(PETCO2)和记录停用瑞芬太尼后完全清醒时间及副作用等。结果首剂量后1分钟、气腹前瞬间、气腹达到预计压力时、牵拉暴露胆囊时4个时刻点OAA／S为Ⅴ—Ⅳ，气腹下分离切除胆囊时OAA／S为Ⅲ-Ⅳ，术毕时OAA／S为Ⅳ-Ⅴ。VAS6个时刻点均小于3分。首剂量后1分钟、气腹下牵拉暴鼹胆囊和分离切除胆囊时BP、HR波动大。RR减少明显，最少只有6次／分钟。其它监测指标无明显变化。结论瑞芬太尼在严密监测下14—18ml／h(0．002％)静脉输注，用于麻醉中清醒镇静是可行的，在硬膜外麻醉时使用要注意维持心血管功能的稳定和防止呼吸抑制导致缺氧。