稀土元素镧、铈对铁皮石斛组培苗生长影响的研究

目的 探讨添加稀土元素镧、铈对铁皮石斛组培苗以及移栽后铁皮石斛苗的生长的影响,寻找能显著促进铁皮石斛生长发育的稀土元素,以获得品质优良的铁皮石斛苗.方法 以铁皮石斛小苗为外植体,通过添加不同浓度硝酸镧、硝酸铈的培养基上进行培养,并对其性状特征、生理活性、移栽后生长状况等进行统计比较研究.结果 通过90 d的培养后,添加稀土元素组别的铁皮石斛的鲜质量、根数、株高、叶绿素含量均高于空白组,分蘖数低于空白组,而且随着硝酸镧和硝酸铈浓度的增高,铁皮石斛组培苗的鲜质量、株高、根数、叶绿素含量基本呈递增的趋势,分蘖数呈递减的趋势,硝酸铈浓度为40 mg/L时,其鲜质量、根数、株高最大,分蘖数最少;铁皮石斛移栽培养30 d后,稀土元素组比空白组中的存活率和抽芽率高,硝酸铈为40 mg/L时其生长情况最佳;一定浓度的稀土元素La 、Ce能增强铁皮石斛组培苗的T-SOD酶、CAT酶活性和根系活力,添加10.0～40.0 mg/L La3+,SOD酶活性和CAT酶活性均呈现先增后降的趋势;添加10.0～40.0 mg/L Ce3+,SOD酶活性逐渐增强,但CAT酶活性在Ce3+10～ 30.0 mg/L时逐渐增强,40.0 mg/L时又稍下降;添加10.0～40.0 mg/L La3+,根系活力呈先增后降的趋势,10～ 30.0mg/L时根系活力逐渐上升,40.0 mg/L时略有下降;添加10.0～40.0 mg/L Ce3+,根系活力逐渐上升,40.0mg/L时最高.结论 稀土元素镧、铈对铁皮石斛组培苗的生长及T-SOD酶、CAT酶活性和根系活力均有较显著的影响,本文结果为铁皮石斛组培苗的壮苗以及品质的提高提供了依据.     

胫骨平台骨折术后早期并发症的处理与分析

目的:探讨胫骨平台骨折术后早期并发症原因和对策.方法:回顾分析2003年12月至2013年12月行切开复位钢板和部分植骨内固定术后出现早期并发症的38例胫骨平台患者,男35例,女3例;年龄37~69岁,平均42.3岁.骨折按Schatzker分型:Ⅱ型3例,Ⅲ型2例,Ⅳ型2例,Ⅴ型19例,Ⅵ型12例.伤后至手术时间9 h~9 d,伤后3 d内手术26例.钢板固定15例,钢板加同种异体骨固定23例.皮肤坏死15例,感染6例,骨筋膜室综合征3例,腓总神经损伤2例,腓浅神经损伤3例,腘动脉损伤2例,骨折复位不良7例.结果:14例伤口Ⅰ期愈合,24例伤口延期愈合.住院时间7~67 d,平均25.6 d.38例均获随访,时间12~36个月,平均16.4个月.骨折愈合时间3~9个月,平均6.9个月.末次随访采用Merchant标准评定下肢功能:优19例,良12例,可5例,差2例.结论:胫骨平台骨折术后早期并发症与骨折严重程度密切相关,与术前准备不足、合并症的治疗、手术时机选择和手术技术有关;术后密切观察,早期发现及时处理减少损害.     

胎儿严重肺动脉瓣狭窄或闭锁的产前超声心动图诊断评估、右心室发育评估及宫内介入治疗的结局随访

目的探讨胎儿室间隔完整型严重肺动脉狭窄(critical pulmonary stenosis with intact ventricular septum,CPS/IVS)或室间隔完整型肺动脉闭锁(pulmonary atresia with intact ventricular septum,PA/IVS)的产前超声心动图诊断、右心室发育评估及宫内介入治疗的结局随访。方法回顾性分析广东省人民医院2016年9月至2018年12月6例产前超声心动图诊断为PA/IVS或CPS/IVS(1例诊断PA/IVS,5例为CPS/IVS)行胎儿肺动脉瓣球囊成形术(fetal pulmonary valvuloplasty,FPV)胎儿的产前超声心动图诊断、右心室发育评估及结局随访资料。结果 6例胎儿诊断孕周为(26.48±2.15)周。6例胎儿术前三尖瓣环/二尖瓣环比值(tricuspid valve annulus/mitral valve annulus,TV/MV)分别为0.53、0.82、0.71、0.85、0.77、0.71,右心室纵径/左心室纵径比值(right ventricle length/left ventricle length,RV/LV)分别为0.42、0.63、0.52、0.61、0.75、0.61,三尖瓣流入时间/心动周期长度比值(tricuspid valve inflow duration/cardiac cycle length,TVID/CCL)比值分别为0.26、0.35、0.39、0.44、0.44、0.35,肺动脉瓣环/主动脉瓣环(pulmonary valve annulus/aortic annulus,PV/AV)比值分别为0.85、1.03、0.85、0.86、1.20、0.78。动态观察2周后,6例胎儿右心室各指标未见明显增长,于(29.45±1.19)周行FPV术,均取得技术性成功(100%),无宫内死亡,孕妇及胎儿无严重并发症。FPV术后,6例胎儿术后1～2周内TV/MV、RV/LV、TVID/CCL明显增长,术后2～6周增长趋于稳定,而PV/AV则在术后2～4周增长较明显。6例患儿分娩胎龄为(37.74±1.17)周,出生体质量(3.04±0.24)kg,于生后(15.33±7.31)d完成行一期手术,其中2例行外科手术,4例12的严重感染所致的多器官功能衰竭。存活的5例患儿血氧饱和度95%,无右心衰竭症状。结论产前可通过超声评估CPS/IVS、PA/IVS胎儿右心室发育状况,筛选宫内介入治疗适应证,适时进行FPV,可促进右心室小梁部及三尖瓣发育,争取患儿生后实现双心室循环。     

Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease(CHD) who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients' follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation(SpO_2), 6-minute walk test(6 MWT), superior vena cava pressure(SVCP), pulmonary arterial pressure(PAP), pulmonary capillary wedge pressure(PCWP), pulmonary vascular resistance(PVR), small pulmonary vascular resistance(s PVR) were measured. Pre-and post-total cavopulmonary connection(TCPC) SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic(ROC) curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery(75.42 ± 9.62% to 86.98 ± 7.63%, P 0.001) from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%(P 0.001). The △SpO_2 and 6-minute walk distance(6 MWD) in the 32 who underwent TCPC and ten of them did not reach statistical significance(17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure(s RPAP), mean right pulmonary artery pressure(m RPAP), mean left pulmonary artery pressure(m LPAP), PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure(s SVCP), mean superior vena cava pressure(m SVCP), and left pulmonary artery systolic pressure(s LPAP) were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg(P = 0.025),s RPAP ≤ 22 mm Hg(P = 0.0001, mRPAP ≤ 13 mm Hg(P =0.003), s LPAP ≤ 27 mm Hg(P =0.03), m LPAP ≤ 11 mm Hg(P = 0.01), PVR ≤ 4.3 Wood U/m~2(P 0.0001) and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg(P = 0.06) and s PVR ≤ 2.0 wood U/m~2(P = 0.0531). One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m~2 can help identify post Glenn-shunt patients indicated for TCPC.     

EMS诱变广金钱草突变体库的构建

目的:利用甲基磺酸乙酯(EMS)溶液诱变处理广金钱草种子,对M_1和M_2代群体单株在茎、叶、分枝等表型变异进行观察记录,并鉴定和筛选突变体。方法:以广金钱草种子为材料,用不同EMS浓度的磷酸缓冲液(0%,0.5%,0.6%,0.7%,0.8%)分别处理广金钱草种子4、8、12 h,使其发生诱变,得到半致死剂量和处理时间,再用该半致死剂量和处理时间创建突变材料,观察并统计诱变后植株表型性状的变异。结果:EMS诱变广金钱草种子的半致死剂量浓度为0.6%,处理时间为4 h。初步鉴定了M_1代658个单株和M_2代1 131个单株的形态学性状,共获得759份发生一个到多个性状变异的突变株,主要包括叶、株高、分枝数、株型以及其他性状变异。结论:初步构建了EMS诱变广金钱草突变体库,得到了对种植生产有利的变异性状,为优良品种选育提供了基本材料。     

综合医院对突发事件应急救援工作的策略分析

目的评估某三级综合医院在突发事件应急救援所存在的风险水平,判断评价并明确归纳可能对健康造成损害的风险类型,对医院完善应急管理策略提供参考依据。方法用风险矩阵法评估某三级综合医院应急救援工作中存在的问题进行分析,根据相关标准对各种类型突发事件出现的可能性和造成的威胁进行评估。结果三级综合医院的应急救援工作中社会治安事件是对人群健康威胁程度最高的风险,其他依次为地震、火灾和道路交通事故等。结论医院应急救援工作要充分考虑到可能导致对人群健康造成威胁的风险隐患,医院应急管理部门在建立风险预案时要结合自身医疗资源、区域特点,确认有针对性、科学性,对高风险事件要重点解决,对次要风险采取积极应对策略,对低风险事件持续监测,做到全面有效控制。     

ITS2序列对牛樟等樟属植物鉴定评估及聚类分析研究

目的:应用ITS2序列及其二级结构对牛樟等樟属植物进行鉴定效率评估及聚类分析研究,以期发现与牛樟亲缘关系较近的物种。方法:比较DNA提取试剂盒和改良CTAB法对牛樟等样品总DNA的提取效果;应用Bio Edit v7.0.9.0与MEGA 6.0软件将以ITS2序列进行PCR扩增的目的序列与Gen Bank中同源性较高的同属序列构建系统进化树,并应用ITS2数据库网站预测其二级结构。结果:改良CTAB法提取的DNA纯度比试剂盒稍低,但浓度较高;针对本研究中16个樟属样品,ITS2对其鉴定成功率为62.5%;基于ITS2序列的种间亲缘关系中最接近牛樟的树种为细毛樟。结论:ITS2序列作为植物鉴定条形码之一,对樟属植物鉴别率略低,可见其通用性有待考证;在对于樟属植物的聚类分析研究中,ITS2序列可结合其二级结构构型,为樟属种间遗传关系和亲缘关系鉴定提供参考。     

实时超声引导鼻骨骨折闭合复位

目的 探讨实时超声引导鼻骨骨折闭合复位的临床价值。方法 将60例临床确诊的鼻骨骨折患者随机分为试验组和对照组,每组30例。对2组患者均在全麻下行鼻骨骨折闭合复位治疗,其中试验组为实时超声引导下行骨折闭合复位,对照组为传统视诊、触诊下骨折闭合复位。复位后,基于鼻部CT平扫图像采用3分法评价复位效果。对比分析2组间骨折二次复位率、患者住院时间及术后CT评分的差异。结果 试验组骨折二次复位率为0,对照组为13.33%（4/30）,2组间差异有统计学意义（χ²=4.286,P=0.038）。试验组患者中位住院时间为4天,对照组为5天,试验组较对照组明显缩短（Z=-5.024,P<0.001）。试验组术后CT评分为3分、2分及1分者分别为19例、11例和0,对照组分别为11例、16例和3例,试验组较对照组复位效果更优（χ²=6.059,P=0.048）。结论 实时超声引导鼻骨骨折闭合复位精准、可靠,可减少骨折二次复位风险并避免X线辐射,且可有效缩短患者住院时间,提高医患双方满意度。