The effect of Ulinastatin on autophagy and apoptosis in the acute paraquat poisoning rats lung cellular北大核心CSCD

Objective: To investigate the effects of ulinastatin on autophagy and apoptosis of lung cells in rats with acute paraquat poisoning. Methods: A total of 150 Wistar rats were randomly (random number) divided into three groups. The rats in control group had stomach lavaged once with 1 mL of normal saline followed by intraperitoneal injection of 1 mL normal saline twice a day. PQ poisoning model was produced by stomach lavaged once with 1 mL of 40 mg/kg PQ solution followed by intraperitoneal injection of 1 mL normal saline once a day. In PQ + ulinastatin (PU) group, UTI in dose of 12 000 U/kg was intraperitoneally injected in rats twice a day. The lung tissue was obtained on the 7th day after modeling, and the histopathological changes were observed under microscope after hematoxylin and eosin (HE) staining. The positive expressions of autophagy-related LC3 protein LC3 and Bcl-2 pretein in lung tissue were observed after immunohistochemistry staining, and the levels of LC3, Bax, Bcl-2 proteins were determined by Western blot. Results HE staining Results showed: it was observed from the PQ poisoning group that the abnormal cellular structure, enlargement in the pulmonary alveoli, leaking a lot of inflammatory cells, increased thickness of the alveoli wall and bleeding in the local area of lung tissue. Compared with the PQ poisoning group, the above changes in ulinastatin groups were relieved. Western blot Results showed; compared with the control group, the protein expressions of LC3-A/B were significantly increased in PQ poisoning group [LC3-A/B expression (A scale):0.22 ±0.05 vs. 0.14±0.03, F = 22.48, P < 0.01]. compared with PQ group, the expression of LC3 A/B obviously increased in the group of PU [LC3-A/B expression (A scale): 0.36 ± 0.08 vs. 0.22 ± 0.05, F = 22.78, P < 0.01]. compared with Con group, the expression of Bcl-2/Bax obviously decreased in the group of PQ [Bcl-2/Bax expression (A scale), 0.11 ± 0.04 vs. 0.83 ± 0.09, F = 154.43, P < 0.01]. Compared with PQ poisoning group, the protein expressions of Bcl-2/Bax were obviously increased in PU groups [Bcl-2/Bax expression (A scale): (0.63 ± 018) vs. (0.11 ± 0.04), F = 154.43, P < 0.01]. Immunohistochemistry result; compared with Con group, the expression of LC3 and Bcl-2 obviously decreased in the group of PQ [LC3 expression (A scale); (78.34±10.71) vs. (117.58 ±15.26), F =31.63, P < 0.01) (Bcl-2 expression (A scale): (62.54 ± 9.74) vs. (130.52 ± 9.86, F = 118.44, P < 0.01). Compared with PQ poisoning group, the protein expressions of LC3 and Bcl-2 were obviously increased in PU groups [LC3expression (A scale): (162.58 ±25.76) vs. (78.34 ± 10.71), F = 31.63, P < 0.01]; [Bcl-2 expression (A scale): (145.56 ±10.26) as. (62.54 ±9.74), F = 118.44, P < 0.01]. Conclusions: The endoplasmic reticulum stress - autophagy is activated in the lung cells of rats with acute PQ poisoning. UTI can adjust endoplasmic reticulum stress, increased the expression of Bcl-2 and enhance the proportion of Bcl-2/Bax to protect the lungs of rats from acute PQ poisoning.     

黄芪甲甙对Balb/C小鼠CVB3病毒性心肌炎心肌细胞凋亡及Bcl-2/Bax基因和蛋白表达的影响

[目的]探讨黄芪甲甙对Balb/C小鼠CVB3病毒性心肌炎心肌细胞凋亡及Bcl-2/Bax基因与蛋白表达的影响.[方法]Balb/C小鼠50只随机分5组（每组10只）,A组空白对照组：腹腔无菌注射不含病毒的Eagle＇s培养基0.1 mL,30 min后,以生理盐水0.1 mL灌胃,共7 d;B组病毒性心肌炎对照组：小鼠每只腹腔注射0.1 mL内含50%组织感染率（TCID50） 为1×10^5的CVB3病毒Eagle＇s培养基,30 min后,以生理盐水0.1 mL灌胃,共7 d;黄芪甲甙低、中、高剂量干预组（分别为C、D、E组）,在腹腔注射0.1 mL内含TCID50 为1×10^5的CVB3病毒Eagle＇s培养基,30 min后,用黄芪甲甙[具体剂量分别为0.07、0.2、0.6 mg/（kg·d）]0.1 mL灌胃,共7 d.采用缺口末端标记法（TUNEL）检测心肌凋亡细胞,免疫组织化学检测Bcl-2、Bax蛋白的表达,反转录聚合酶链反应（RT-PCR）检测Bcl-2、Bax基因的表达,并利用图像分析系统测量平均光密度值进行半定量分析.[结果]与A组比较,B组心肌细胞凋亡发生率增高（0.57±0.16vs 0.06±0.02,P〈0.01）;抑制凋亡因子Bcl-2基因（0.52±0.12 vs 0.76±0.11,P〈0.01）及蛋白（6.08±1.15 vs 12.38±3.05, P 〈0.01）表达下降,而促进凋亡因子Bax基因（0.79±0.12 vs 0.61±0.14, P 〈0.01）及蛋白（6.21±1.52 vs 3.01±0.75, P 〈0.01）表达增强,Bcl-2/Bax mRNA比值降低（0.58±0.14vs0.87±0.12,P〈0.05）.与B组比较,E组CVB3病毒性心肌炎心肌细胞的凋亡指数（0.09±0.03vs 0.57±0.16,P〈0.05）降低,Bcl-2基因（0.74±0.12 vs 0.52±0.12,P〈0.05）及蛋白水平（11.82±2.96 vs 6.08±1.15, P 〈0.05）表达增强,Bax基因（0.63±0.13 vs 0.79±0.12,P〈0.05）及蛋白（3.15±0.72 vs 6.21±1.52,P〈0.05）水平表达下降.[结论]黄芪甲甙在Balb/C小鼠CVB3病毒性心肌炎中抗凋亡作用机制可能是促进抑制凋亡基因Bcl-2表达,而抑制促凋亡Bax基因表达.     

NG-硝基-L-精氨酸对脂多糖诱导大鼠肺损伤时肺表面活性物质和细胞凋亡的影响

目的 探讨NG-硝基-L-精氨酸(L-NA)对内毒素性肺损伤大鼠肺表面活性物质(PS)和细胞凋亡的影响.方法 雄性SD大鼠24只,按随机数字表法均分为对照组、模型组、L-NA治疗组.模型组、L-NA治疗组舌下静脉注射脂多糖(LPS)复制内毒素性肺损伤模型;对照组给予等量生理盐水.L-NA治疗组于注射LPS 3 h后给予L-NA 20 mg/kg;对照组和模型组给予等量生理盐水.6 h后处死动物,取肺组织,用原位杂交法测定肺组织表面活性物质相关蛋白A(SP-A)mRNA表达;用流式细胞术检测肺组织细胞凋亡率;用蛋白质免疫印迹法(Western blotting)检测天冬氨酸特异性半胱氨酸蛋白酶3(caspase-3)蛋白表达;用免疫组化法测定Bcl-2和Bax蛋白表达.结果 与对照组比较,模型组SP-A mRNA表达[吸光度(A)值]明显下降(0.071±0.017比0.113±0.021),细胞凋亡率[(25.04±4.57)%比(11.37±3.08)%]、caspase-3蛋白表达(A值:298.64±37.11比110.24±14.35)、Bax蛋白表达(A值:0.145±0.011比0.076±0.010)明显升高,Bcl-2蛋白表达(A值:0.064±0.011比0.073±0.009)和Bcl-2/Bax比值(0.447±0.086比0.976±0.157)明显下降(均P<0.01).与模型组比较,L-NA治疗组SP-A mRNA表达(A值:0.085±0.015)和Bcl-2蛋白表达(A值:0.070±0.087)明显增强(P<0.01和P<0.05),但细胞凋亡率[(20.67±1.35)%]、caspase-3蛋白表达(A值:268.75±42.56)、Bax蛋白表达(A值:0.142±0.012)和Bcl-2/Bax比值(0.498±0.069)均无明显变化(均P>0.05).结论 L-NA不通过抑制肺细胞凋亡来减轻内毒素性肺损伤的程度,对调节凋亡相关基因caspase-3和Bax也无明显影响;而是可通过增强PS表达减轻内毒素性肺损伤.     

维奈克拉增强MDS 细胞系对地西他滨化疗敏感性机制的实验研究

目的 研究维奈克拉（venetoclax,VCX）对骨髓增生异常综合征(myelodysplastic syndromes, MDS) 细胞系地西他滨（decitabine,DAC）化疗敏感性的可能作用机制。方法 CCK-8 法检测不同浓度VCX 对MDS 细胞（SKM-1 和MUTZ-1 细胞系）增殖活力的影响;将MUTZ-1 细胞根据不同处理分为4 组:对照组、VCX 组、DAC 组和VCX+DAC组;Annexin V-FITC/PI 法检测各组细胞凋亡率;Western blotting 检测细胞中凋亡相关蛋白[ 细胞色素C（cytochromeC）,裂解型半胱天冬酶3（cleaved Caspase-3）表达水平],B 细胞白血病/ 淋巴瘤2(B cell leukemia/lymphoma-2,Bcl-2) 与Bcl-2 相关蛋白X（Bax）比值;JC-1 线粒体膜电位检测试剂盒检测各组SKM-1 和MUTZ-1 细胞的线粒体膜电位;H2DCF-DA 荧光探针法检测细胞中活性氧（reactive oxygen species,ROS）含量;Western blotting 检测细胞中自噬相关蛋白Beclin1,P62 和LC3- Ⅱ /LC3- Ⅰ比值。结果 随VCX 浓度升高,MUTZ-1 细胞增殖活性明显降低,且呈浓度依赖性（F=0.003,P=0.001）。与对照组（4.28%±1.66%）相比,VCX 组（13.75%±3.02%）,DAC 组（12.39%±4.16%）和VCX+DAC组（18.10%±3.50%）细胞凋亡率明显增高,差异有统计学意义（F=45.782,P<0.05）。与对照组（1.01±0.02,1.04±0.02,1.01±0.04） 相比,VCX 组（1.67±0.05,2.23±0.10,0.43±0.05）,DAC 组（1.62±0.08,1.85±0.06,0.49±0.07） 和VCX+DAC 组（3.24±0.10,3.81±0.19,0.13±0.01） 细胞中凋亡相关蛋白cytochrome C,cleavedCaspase-3 蛋白表达及Bcl-2/Bax 比值明显升高,差异均有统计学意义（F=116.384,282.069,248.035,均P<0.05）。与对照组（2.05±0.34,8.78±1.37）相比,VCX 组（8.72±1.26,14.02±1.45）,DAC 组（8.44±2.13,13.20±2.41）和VCX+DAC 组（15.66±2.90,26.45±1.53）细胞线粒体膜电位及ROS 含量明显升高,差异具有统计学意义（F=66.782,69.071,均P<0.05）。与对照组（1.05±0.04,1.02±0.08,1.01±0.07）相比,VCX组（1.62±0.15,2.60±0.19,0.56±0.15）,DAC 组（1.67±0.17,2.45±0.20,0.54±0.14）和VCX+DAC 组（3.72±0.21,3.58±0.27,0.13±0.09）自噬相关蛋白Beclin1,LC3- Ⅱ /LC3- Ⅰ表达明显升高,而P62 蛋白表达则明显降低,差异均有统计学意义（F=118.257,209.422,236.92,均P<0.05）。与DAC 组比较,VCX+DAC 组细胞凋亡率、cytochrome C,cleaved Caspase-3,Beclin1 蛋白表达水平,LC3- Ⅱ /LC3- Ⅰ比值和ROS 含量均明显降低（t=2.473,28.564,17.291,16.115,7.021,9.319）;线粒体膜电位、Bcl-2/Bax 比值和P62 蛋白表达均明显升高（t=4.621,9.244,4.278）,差异具有统计学意义（均P ＜ 0.05）。DAC 组和VCX 组细胞中上述检测指标差异均无统计学意义（均P ＞ 0.05）。结论 VCX 可能通过调节细胞凋亡、自噬和氧化应激来促进MDS 细胞对DAC 的化疗敏感性。     

Bcl-2/Bax在百草枯中毒鼠肺组织中的表达及三七总皂苷的保护作用

目的 探讨急性百草枯(PQ)中毒鼠肺组织病理损伤变化和肺组织中抗凋亡基因(Bcl-2)、促凋亡基因(Bax)的表达及三七总皂苷(PNS)的保护作用.方法 150只SD雄性鼠分为正常对照组(C组,30只)、百草枯中毒组(PQ组,60只)及三七总皂苷保护组(PNS组,60只).PQ组和PNS组一次性灌胃PQ 25 mg/kg染毒,C组予等体积生理盐水灌胃.其中PNS组于染毒前15 min以PNS 50 mg/kg阴茎静脉注射保护,以后每日1次给药直至处死前;PQ组、C组分别在同时间点予与等体积生理盐水.观察各组大鼠在中毒后6 h、12 h、1 d、3 d、5 d、7 d肺组织病理改变,采用反转录-聚合酶链反应(RT-PCR)方法测定鼠肺组织Bcl-2和Bax mRNA的表达.结果 PNS组Bcl-2 mRNA的表达在6 h、12 h及1 d各亚组高于相应点PQ组,差异有统计学意义(P<0.05);PQ组Bax mRNA的表达在6 h、12 h、1 d及3 d各亚组高于相应点PNS组,差异有统计学意义(P<0.05);PQ组Bcl-2/Bax比例为促凋亡的Bax基因占优势;PNS组Bcl-2/Bax比例亦为促凋亡的Bax基因占优势,但这种优势不如PQ组明显.PQ组肺病理损伤评分在6 h、12 h、1 d及3 d各亚组均高于PNS相应组,差异有统计学意义(P<0.05),C组Bcl-2、Bax mRNA几乎不表达,肺组织病理大致正常,与PQ组及PNS组相比差异有统计学意义(P<0.00).结论 Bcl-2/Bax基因不均衡表达参与PQ中毒所致肺损伤,PNS对百草枯中毒所致肺损伤有保护作用.     

百草枯中毒致大鼠肺组织损伤时氨溴索对肺组织Bcl-2/Bax的表达及细胞凋亡的影响

目的 探讨在百草枯(PQ)中毒所致大鼠急性肺损伤时氨溴索(AM)对肺组织Bcl-2/Bax的表达及细胞凋亡的影响.方法 44只大鼠随机分为4组:正常对照组(C组)6只、AM对照组(AM组)6只、急性肺损伤组(PQ组)16只和急性肺损伤+AM治疗组(PQ+AM组)16只.取肺组织苏木精-伊红(HE)染色来评价肺组织损伤情况;检测血清中肿瘤坏死因子α(TNF-α)水平;蛋白质印迹方法检测肺组织p38丝裂酶原激活蛋白激酶(MAPK)表达;肺组织Bcl-2、Bax免疫组化分析;TUNEL检测肺组织细胞凋亡.结果 C组和AM组大鼠的肺组织结构基本完整,PQ组肺组织损伤程度加重,PQ+AM组肺组织损伤程度较PQ组减轻.PQ组血清TNF-α水平、p38 MAPK和Bax蛋白表达、肺组织细胞凋亡均较C组和AM组显著增加(P＜0.05),PQ+AM组较PQ组均有降低(P＜0.05),而抗凋亡基因Bcl-2在AM干预后较PQ组升高(P＜0.05).结论 百草枯中毒导致了大鼠急性肺损伤,经氨溴索治疗后,通过调节p38 MAPK、Bcl-2和Bax蛋白的表达从而使肺组织细胞凋亡减少,从而有效地减轻了百草枯中毒所致的大鼠急性肺损伤.     

百草枯中毒大鼠肾组织Livin蛋白与Caspase-3的表达及干预

目的 观察急性百草枯(Paraquat,PQ)中毒大鼠肾组织Livin蛋白及Caspase-3的表达及乌司他丁(Ulilnastatin,UTI)的干预作用.方法 将54只SD大鼠随机分为对照组(A组)、PQ组(B组)和UTI组(C组),每组各18只.B,C组以生理盐水稀释PQ 80 mg/kg一次性灌胃;C组灌胃后以UTI 105 U/kg腹腔注射,每天1次;A组等量生理盐水一次性灌胃.于不同处理后24,48,72 h分别用免疫印迹法(Westem-bolt)和免疫组化法测定不同时间点肾组织中Livin蛋白及Caspase-3表达的情况,同时观察大鼠肾组织病理变化.结果 A组肾组织结构清晰;B组肾组织结构清晰度明显下降,染毒24 h可见充血、水肿及空泡变性等病理变化,且随时间延长而加重,重者可见核固缩,细胞结构消失,肾小球、髓质部亦可受累;C组病理变化较B组明显减轻.A组Caspase-3蛋白多不表达;B组染毒24h在皮质部肾小管上皮细胞的胞膜及胞浆中Caspase-3蛋白呈阳性表达;C组亦出现表达,但表达水平较PQ组降低,各组比较差异均有统计学意义(P＜0.01).与A组比较,各时间点B组和C组肾组织Livin蛋白的表达明显增强,尤以C组为甚,差异有统计学意义(P＜0.01).结论 PQ中毒肾损伤主要表现为上皮细胞变性、浊肿、部分坏死.Caspase-3参与了PQ中毒肾损伤的发病过程.UTI对PQ中毒大鼠肾组织有保护作用,可能是通过促进Livin表达、抑制Caspase-3表达起作用,但其调节途径尚需进一步探讨.     

百草枯中毒大鼠肺组织热休克蛋白70表达及乌司他丁干预研究

目的 观察热休克蛋白70(HSP70)在百草枯(Paraquat PQ)中毒大鼠肺组织中表达及乌司他丁干预对其影响.方法 72只Spragne-Dawley(SD)大鼠随机(随机数字法)分为3组:空白对照组(A组)、染毒组(B组)和乌司他丁组(C组),每组各24只.B组和C组PQ灌胃(80 mg/kg)染毒建立急性中毒模型.C组于PQ灌胃后30 min腹腔注射给UTI(10万U·kg-1·d-1).观察染毒后12,24,48,72 h各组肺组织HSP70的表达、湿/干重比(W/D)和病理改变.HSP70采用逆转录聚合酶链反应(RT-PCR)测定.计量资料以均数±标准差((x)±s)表示,组间单因素方差分析,结果以P＜0.05为差异有统计学意义.结果 与A组相比,各时间点B组和C组肺组织HSP70的表达明显增强,尤以C组为甚,差异有统计学意义.B组和C组肺组织病理检查可见PQ中毒后肺泡壁充血、炎性细胞浸润,并有局灶性出血.但C组病理改变较轻.结论 乌司他丁增强HSP70的表达,从而减轻PQ中毒大鼠急性肺损伤.     

乌司他丁对硫化氢急性中毒大鼠肺组织氧化应激损伤的干预作用及机制研究

目的 观察硫化氢(hydrogen sulfide,H2S)急性中毒大鼠肺组织血红素氧合酶-1(heme oxygenase 1,HO-1)、醌氧化还原酶-1(NAD(P)H:quinine oxidoreductase 1,NQO-1)和核转录因子红系相关因子-2(nuclear factor E2-related factor 2,Nrf2)的动态变化及乌司他丁(ulinastatin,UTI对其的影响.方法 将清洁级SD大鼠96只随机(随机数字法)分为健康对照组(NS组,n=8),UTI对照组(UTI组,n=8),H2S染毒模型组(H2S组,n=40,采用在染毒柜内暴露吸入体积分数200×10-6的H2S1h,构建H2S急性染毒模型)和UTI干预组(H2S+UTI组,n=40,建立模型后立即腹腔注射UTI 10万U/kg).后两组大鼠于染毒后2、6、12、24、48 h时点麻醉后活杀,留取肺标本.观察大鼠行为学变化,ELISA法测定肺组织中HO-1和NQO-1活力的动态变化;RT-PCR法检测肺组织HO-1、NQO-1和Nrf2 mRNA表达,Western blot法检测Nrf2蛋白表达.观察肺组织病理学改变并行肺损伤评分.结果 与NS组比较,H2S组在染毒后2、6、12h时点HO-1活力和mRNA表达均明显升高(P＜0.01),其中2h呈高峰;与同时间点H2S组比较,H2S+ UTI组染毒后6、12、24、48 h时点HO-1活力和mRNA表达显著升高(P＜0.01).与 、NS组比较,H2S组在染毒后2、6、12、24 h时点NQO-1活力和mRNA表达均明显升高(P＜0.01)其中2h呈高峰;与同时间点H2S组比较,H2S+UTI组染毒后6、12、24、48 h时点NQO-1活力和mRNA表达显著升高(P＜0.01).与NS组比较,H2S组在染毒后2、6、12 h时点Nrf2mRNA和蛋白表达均明显升高(P＜0.01或P＜0.05),其中2h呈高峰;与同时间点H2S组比较,H2S+UTI组染毒后6、12、24、48 h时点Nrf2 mRNA和蛋白表达显著升高(P＜0.01).光镜下,H2S组在染毒后24 h大鼠肺组织损害明显;H2S+UTI组大鼠肺损伤较H2S组有所减轻.在染毒后12、24、48 h时点H2S+UTI组的肺损伤评分明显低于H2S组(P＜0.01).结论 HO-1、NQO-1和Nrf2参与了H2S中毒急性肺损伤的病理生理学过程;UTI干预治疗能显著提高HO-1、NQO-1及Nrf2的活力及表达,减轻H2S中毒急性肺损伤.     

低氧环境下肺腺癌A549细胞自噬及miR-155表达变化的研究

目的观察低氧环境下培养人肺腺癌A549细胞自噬及miR-155表达的变化,为探讨miR-155与自噬关系的研究奠定基础。方法分别在常氧（20%O2/5%CO2/75%N2）（常氧组）及低氧（1%O2/5%CO2/94%N2）（低氧组）环境下培养A549细胞,采用电镜检测自噬体变化,Western blot检测自噬标记蛋白LC3蛋白表达,分析LC3Ⅱ/LC3Ⅰ比值变化,Real-Time PCR检测miR-155表达变化。结果与常氧组相比,低氧组LC3Ⅱ/LC3Ⅰ增加（0.46±0.03）倍;低氧组miR-155表达上调,于24、48 h分别增加（1.45±0.23）倍及（2.10±0.32）倍。结论在低氧环境中,A549细胞中miR-155表达上调,保护性自噬增加。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.