甲基强的松龙预防牵张性脊髓损伤的实验研究

为探索甲基强的松龙（ＭＰ）对牵张性脊髓损伤的防治作用，选用日本大耳白兔４８只，随机分为对照组（Ａ、Ｂ）、实验组（Ｃ、Ｄ）。实验组于伤前３０分钟一次静脉缓慢推注ＭＰ３０ｍｇ／ｋｇ；伤后１５分钟开始，每１小时静脉滴注ＭＰ５．４ｍｇ／ｋｇ，持续５小时。对照组用生理盐水治疗。采用皮质体感诱发电位（ＳＣＥＰ）监护、组织形态学、脊髓组织生化测定、运动功能评定等方法评价。结果表明，Ｃ组、Ｄ组较Ａ组、Ｂ组ＳＣＥＰＰ１波波幅恢复快速、稳定；伤后８小时及１４天运动功能评定其障碍率低于Ａ组、Ｂ组（Ｐ＜０．０５）；脊髓前角灰质神经元体积密度及１００μｍ白质范围内有髓神经纤维数高于Ａ组、Ｂ组（Ｐ＜０．０５）；丙二醛含量低于Ａ组、Ｂ组，过氧化物歧化酶含量高于Ａ组、Ｂ组（Ｐ＜０．０５）；神经元及神经纤维变性、坏死，灰质出血范围及脊髓微血管痉挛程度明显轻于Ａ组、Ｂ组。认为，在脊柱畸形矫正术前应用大剂量ＭＰ，具有预防牵张性脊髓损伤的作用；伤后及时给予ＭＰ，可减轻脊髓继发性损伤     

血清心肌肌球蛋白轻链Ⅰ测定在烧伤后心肌损伤诊断中的应用

采用３０％Ⅲ度烧伤大鼠模型，动态检测了伤前及烧伤后血清心肌肌球蛋白轻链Ⅰ（ＣＭＬＣ１）含量及心肌酶谱（ＣＫ，ＡＳＴ和ＬＤＨ）变化，以进行烧伤后心肌损伤的评价。结果表明ＣＭＬＣ１在烧伤后１小时即明显增高，以后持续增高，伤后１２小时比对照值升高约２０倍，至伤后２４，４８小时仍保持高水平，伤后７２小时开始轻度下降。心肌酶谱则于伤后３小时开始显著升高，至伤后２４，４８小时已表现出明显下降的趋势，伤后７２小时已接近对照水平。提示：ＣＭＬＣ１迅速大幅度增高表明严重烧伤早期心肌即发生明显损伤，ＣＭＬＣ１与心肌酶谱比较具有出现早、高敏感、高特异等特点，是评价烧伤后心肌损伤的一个可靠指标。     

异丙酚防止体外循环复温期脑氧供需失衡

目的：观察ＣＰＢ复温期使用异丙酚对颈静脉血氧饱和度（ＳｊＯ２）的影响。方法：２２例瓣膜置换术病人随机分为两组。异丙酚组１２例（１组），复温开始时至ＣＰＢ结束１５分钟以异丙酚４～６ｍｇ．ｋｇ＾－１．ｈ＾－１持续静脉泵入：对照组１０例（Ⅱ组），不同异丙酚。观察两组病人ＣＰＢ前、ＣＰＢ后５分钟、低温稳定期、复温国对鼻咽温（ＮＰＴ）３４℃及ＣＰＢ后５分钟及１５分钟时ＳｊＯ２变化。结果：异丙酚组复温至ＮＰＴ     

大鼠脊髓损伤后兴奋性氨基酸的变化及其对血流量的影响

采用Ａｌｌｅｎ＇ｓ打击法复制大鼠脊髓损伤（ＳＣＩ）模型，氨基酸微量检测技术和氢清除法分别测定伤段脊髓组织２４ｈ内兴奋性氨基酸（ＥＡＡ）即谷氨酸（Ｇｌｕ）、天冬氨酸（Ａｓｐ）含量和脊髓灰质血流量（ＳＣＢＦ）的变化，并观察脊髓蛛网膜下腔注射ＥＡＡ受体激动剂Ｎ－甲基－Ｄ－天冬氨酸（ＮＭＤＡ）对ＳＣＢＦ的影响，探讨ＥＡＡ在ＳＣＩ中的作用。结果发现：ＳＣＢＦ在伤后１０ｍｉｎ即有明显下降，２ｈ较１ｈ略有回升，４～８ｈ又进一步下降，第二次下降与第一次下降相差显著。伤后脊髓蛛网膜下腔注射ＮＭＤＡ明显加剧ＳＣＩ后脊髓缺血。Ｇｌｕ、Ａｓｐ伤后１０ｍｉｎ均明显升高，１～２４ｈＡｓｐ较对照组明显降低，８ｈ较２ｈ略有回升；Ｇｌｕ在伤后１０ｍｉｎ有所下降，但仍高于对照组，４ｈ、８ｈ较２ｈ略增加。ＥＡＡ变化与ＳＣＢＦ呈显著负相关。结果提示ＳＣＩ后ＥＡＡ的过度释放是ＳＣＩ后继发损伤的重要因素。     

异丙酚和哌氟合剂辅助连硬外阻滞下行胆囊切除术血浆内皮素？…

目的：观察异丙酚和哌氟合剂作为硬膜外辅助用药的临床效果及其对术中血浆内皮素（ＥＴ）和一氧化氮（ＮＯ）水平的影响。方法：２１例择期胆囊切除病人随机分为两组。麻醉完善后，Ⅰ组用微泵输注异丙酚２ｍｇ．ｋｇ＾－１．ｈ＾－１；Ⅱ组给于哌替啶５０ｍｇ静注。于麻醉前、麻醉后、牵拉胆囊及术终抽静脉血测定ＮＯ和ＥＴ的含量。结果：麻醉后两组病人ＢＰ、ＥＴ值均明显下降，ＮＯ值升高；牵拉胆囊及术终抽静脉血测定ＮＯ和ＥＴ的     

内皮素及NO在严重烧伤早期胃肠粘膜缺血中的作用

目的　采用３０ ％ Ｔ Ｂ Ｓ Ａ 烧伤小型猪模型,系统观察内皮素及一氧化氮（ Ｅ Ｔ／ Ｎ Ｏ） 在胃肠缺血中的作用,并通过应用 Ｎ Ｏ 供体 Ｃ８７３７５４ 对胃肠缺血防治机制进行探讨。方法　小型猪１８只,随机分为对照组（ Ｃ 组） 、烧伤组（ Ｂ 组） 及 Ｎ Ｏ 供体组（ Ｎ 组） 。 Ｃ 组只手术不致伤,其余各组伤后按 Ｐａｒｋｌａｎｄ 公式进行复苏。 Ｎ 组在复苏同时给予 Ｃ８７３７５４（００１２５ ｍｇ·ｋｇ － １ ·ｍｉｎ － １） 。结果　烧伤后 Ｂ 组在肠道血流量下降的同时,门脉血及肠道组织中的 Ｅ Ｔ 含量迅速升高,于伤后１ｈ 达到峰值,伤后７２ｈ 未能恢复到伤前水平;而同时 Ｎ Ｏ 含量呈相反变化,二者呈显著负相关。 Ｎ 组能使肠道血流量在伤后２４ｈ 内恢复较快,同时发现能升高门脉血及肠道组织内 Ｎ Ｏ 含量。 Ｎ Ｏ Ｓｄ Ｎ Ａ Ｄ Ｐ Ｈ 染色也发现肠组织内密度明显较 Ｂ 组增加。结论　①胃肠道血流量下降与 Ｅ Ｔ／ Ｎ Ｏ 变化有关。② Ｎ Ｏ 供体能通过释放 Ｎ Ｏ,有效地改善胃肠组织血流灌注,对防治胃肠缺血有积极意义。     

安氟醚,七氟醚和异丙酚对胸肺静态顺应性的影响

２４例ＡＳＡⅠ￣Ⅱ级在全麻下行乳癌根治术的患，分为三组：安氟醚组（Ｅ）、七氟醚组（Ｓ）和异丙酚组（Ｐｒｏ）。Ｅ、Ｓ组分别以１．０ＭＡＣ的安氟醚和七氟醚维持麻醉。Ｐｒｏ组静点异丙酚４￣６ｍｇ·ｋｇ＾－１·ｈ＾－１维持麻醉。采用吸气末气道阻断法测定胸肺静顺应性（Ｃｒｓ）。用药３０分钟后Ｃｒｓ明显降低（Ｐ〈０．０１）；Ｐｒｏ组的Ｃｒｓ下降上于Ｅ和Ｓ组（Ｐ〈０．０５）。表明：麻醉药是影响Ｃｒｓ的重要因素     

异丙酚及氯胺酮对大鼠急性缺氧肺保护作用的比较

目的 比较异丙酚、氯胺酮对急性缺氧肺动脉压、肺组织中Ｃａ＾２＋含量及超微结构的影响。方法 Ｗｉｓｔａｒ大鼠２１只,随机分为三组：Ｐ组：静滴异丙酚８ｍｇ．ｋｇ＾－１．ｈ＾－１,１５ｍｉｎ后吸入气改为混合气（１０％Ｏ２＋９０％Ｎ２）,通气２０ｍｉｎ;Ｋ组：静滴氯胺酮８ｍｇ．ｋｇ＾－１．ｈ＾－１,其余同Ｐ组;Ｃ组：为持续静滴等量生理盐水,２１％氧气通气３５ｍｉｎ。实验结整时经颈动脉采集动脉血行血气分析,     

大鼠分级脊髓损伤对经颅电刺激运动诱发电位的影响

目的 了解不同程度脊髓损伤（ＳＣＩ）对运动诱发电位（ＭＥＰ）的影响以及ＭＥＰ对ＳＣＩ运动功能预后的价值。方法 采用改良Ａｌｌｅｎ′ｓ法,分别以３０ｇｃｆ、５０ｇｃｆ、８０ｇｃｆ和１００ｇｃｆ冲量打击４０只ＳＤ大鼠Ｔ８￣９脊髓,造成不同程度ＳＣＩ,于伤前及伤后１个月连续记录Ｌ１￣２脊髓硬膜外ＭＥＰ（ｓｃＭＥＰ）和双侧腓肠肌ＭＥＰ（ｍＭＥＰ）,并采用斜板试验和Ｔａｒｌｏｖ评分评估运动神经功能。结果（１     

血清心肌肌球蛋白轻链I测定在烧伤后心肌损伤诊断中的应用

采用３０％Ⅲ度烧伤大鼠模型，动态检测了伤前及烧伤后血清心肌肌球蛋白轻链Ｉ（ＣＭＬＣ１）含量及心肌酶谱（ＣＫ，ＡＳＴ和ＬＤＨ）变化，以进行烧伤后民肌损伤的评价。结果表明ＣＭＬＣ１在烧伤后１小时即明显增高，伤后１２小时比对照升高约２０倍，至伤后２４，４８仍保持高水平，伤后７２小时开始轻度下降。心肌酸疼     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.