胸部弥漫性彗星尾征与腹部脏器早期损伤的实验研究

目的建立油酸型动物模型,研究急性呼吸窘迫综合征(ARDS)胸部弥漫性彗星尾征与腹部脏器早期损伤的相关性。方法健康日本大耳白兔21只,雌性,将实验动物分为实验组(11只)与对照组(10只),制模前留取全部实验动物的肺、肝、肾声像图,随即处死对照组实验兔。实验组制备油酸型胸部弥漫性彗星尾征动物模型,制模成功的标准为胸部声像图表现为至少一个肺区出现不同程度的弥漫性彗星尾征。制模成功后留取肺、肝、肾脏超声声像图,处死实验兔。解剖2组实验兔,取出肺、肝、肾、脾脏,制备组织切片。观察、记录2组实验兔各脏器的大体观及镜下组织学改变。根据胸部声像图表现记录超声评分:短小彗星尾征为1分,孤立彗星尾征2分,轻度弥漫性彗星尾征3分,中度弥漫性彗星尾征4分,瀑布征(重度弥漫性彗星尾征)5分。采用两独立样本非参数检验中的曼-惠特尼秩和检验,检验肝脏病理损伤阳性实验兔与阴性实验兔的肺超声评分是否存在显著差异;采用Pearson相关性检验,对肝脏病理损伤阳性组的损伤面积百分比与超声评分进行相关性分析。根据脏器镜下病理损伤面积百分比评估脏器的损伤程度,比较胸部弥漫性彗星尾征与腹部脏器损伤的相关性。结果实验组胸部弥漫性彗星尾征制模的成功率为100%,肝、肾声像图表现实验前后未见明显改变。实验组肺脏阳性病理改变的发生率为100%(11只/11只),大体病理表现为肺脏形态饱满,表面暗红色出血区;镜下病理表现为肺水肿(11只/11只,100%)、肺出血(9只/11只,81.8%)。实验组肝脏阳性病理改变的发生率为45.5%(5只/11只),大体病理改变为形态饱满,表面呈红褐色、质韧;镜下病理表现为肝细胞水肿(5只/11只,45.5%)。实验组肾脏阳性病理改变的发生率为18.2%(2只/11只),大体病理未见明显异常,镜下病理可见肾小管上皮细胞水肿(2只/11只,18.2%)。肝脏损伤阳性实验兔的肺超声得分明显高于无肝脏损伤者,差异有统计学意义(Z=-2.529,P=0.011)。肝脏损伤阳性实验兔的肺超声得分与肝脏损伤面积呈正相关(r=0.893,P=0.041),肺超声得分越高,肝脏损伤程度越重。同期脾脏未见明显特异性改变。结论胸部弥漫性彗星尾征的出现早于肝脏、肾脏声像图改变;腹部脏器的组织学改变以肝脏最为敏感,其次为肾脏,胸部弥漫性彗星尾征的范围和程度可提示肝脏和肾脏早期损伤。     

酒精性肝病大鼠创伤弧菌脓毒症各脏器的超微结构观察

目的观察酒精性肝病大鼠创伤弧菌脓毒症重要脏器的超微结构变化,探讨研究创伤弧菌的致病性。方法采用酒精灌胃联合自由饮酒法制做大鼠酒精性肝病模型,取成模大鼠12只,分成2组,实验组6×108cfu/mL浓度创伤弧菌右下肢皮下注射感染肝病大鼠;对照组等量生理盐水右下肢皮下注射。48 h后颈动脉取血液及患肢病变组织进行细菌培养,留取肝脏、心脏、肺脏、肾脏、脾脏、右下肢肌肉、大脑等脏器组织0.1 cm×0.1 cm×0.1 cm置电镜固定液,超薄切片观察超微结构。结果实验组大鼠12 h后,皮温升高,右下肢明显肿胀、皮肤发紫,精神萎靡,活动减少,呼吸急促,均在48 h内濒临死亡,血液及患肢病变组织培养出创伤弧菌,电镜下见心肌、肺、肝、肾等组织的部分实质细胞内和间质中有创伤弧菌生长,肝脏、心脏、肺脏、肾脏、脾脏、右下肢肌肉、大脑存在不同程度超微结构改变,部分血管内皮细胞损伤及基膜断裂溶解,线粒体、内质网等细胞器损伤明显,其中以下肢骨骼肌、肺、肝脏的超微结构改变尤为明显,脾脏的改变相对较轻。结论创伤弧菌感染酒精性肝病大鼠后导致多个脏器的实质细胞及间质超微结构损伤,致使多器官功能障碍甚或衰竭,是导致机体快速死亡的重要原因。     

小儿肺炎支原体感染肺外并发症278例

目的 探讨小儿肺炎支原体感染肺外脏器受累的发生情况及临床表现.方法 对我院2002年1月至2007年12月收治的肺炎支原体肺炎进行回顾性研究.结果 肺外脏器受累总发生率为31%,在肺外并发症中,发生率最高者为皮肤改变及泌尿系统改变,约20%,其次为心血管系统和消化系统改变约17%.结论 肺炎支原体感染引起肺外脏器受累发生率高,且呈多样性,应高度重视,早期诊断及治疗.     

致心律失常性心肌病受体心脏病理形态学及超微结构

目的:探讨致心律失常性心肌病(arrhythmogenic cardiomyopathy,ACM)的组织学和亚细胞学特点及其与临床的关系。方法:对38例因ACM行心脏移植术患者的临床、病理资料进行回顾性研究,分析其临床特征、心脏大体及组织学表现,并对其中7例进行透射电镜观察,寻找组织学表型、超微结构与临床心电表现间的关系。结果:本组ACM病例中右室型(57.9%)最常见,其次为双室型(31.6%),再次为左室型(10.5%)。右室型组织学改变以脂肪型为主,左室型组织学改变以纤维脂肪型为主(P0.05)。透射电镜显示本组病例均存在收缩不良、过度收缩、收缩不同步现象,85.7%(6/7)存在闰盘异常,71.4%(5/7)观察到幼稚的心肌细胞或幼稚的细胞器。单纯右室型者发病年龄较左室受累型者年轻(P=0.02);心律失常类型与解剖定位分型相关(P=0.01);室性心律失常发生率,双室型者(88.9%)右室型(42.3%)左室型(0%)。左室组织学改变与心脏重量增加相关(P0.01)。左室射血分数(left ventricular ejection fractions,LVEF)与解剖学定位分型及组织学分型均未显示出统计学意义(均P0.05)。结论:ACM的组织学及超微结构检查有助于本病的病因学诊断,亦为深入进行基因遗传学研究提供形态学依据。     

克雷伯杆菌肺炎老龄大鼠多器官损伤模型的建立

目的 建立细菌性老龄大鼠多器官损伤模型.方法 将大鼠随机分为老龄对照组、老龄模型组和青年对照组、青年模型组.采用气管插管法注入肺炎克雷伯杆菌引起肺部炎症,根据脏器有关生化指标变化、病理学改变及动物死亡率等情况评价该模型.结果 青年模型组和老龄模型组制模24 h后大鼠死亡率分别为33.3%(5/15)和60.0%(15/25).与同龄对照组比较,青年模型组和老龄模型组外周血白细胞计数和中性粒细胞比例明显增高(P均<0.01);肺、心、肝功能障碍发生率为60%～100%;肺动脉血氧分压(PaO2)明显下降,动脉血二氧化碳分压(PaCO2)显著上升(P<0.05或P<0.01);血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)明显增高(P<0.05或P<0.01);脏器组织学发生了明显的病理学改变.与青年模型组比较,老龄模型组肺PaO2明显下降、PaCO2显著上升;血清CK、CK-MB、LDH和ALT、AST明显增高(P<0.05或P<0.01);肺、心、小肠病理损伤评分显著增高(P均<0.05),肝、肾亦有增高趋势.结论 成功地制备了细菌性老龄大鼠多器官损伤模型,符合老年"肺启动"机制多器官功能障碍综合征(MODS)特征,该模型制备简便,成功率高.脏器损伤重、死亡率高为老龄大鼠多器官损伤的特点.     

不同复苏液对失血性休克大鼠肺组织超微结构的影响

目的 探讨不同复苏液对失血性休克大鼠肺组织超微结构的影响.方法 40只SD大鼠被随机分为对照组、休克组、林格组和羟乙基淀粉130/0.4(万汶)组,每组10只.按Lamson法快速放血使平均动脉压降至40 mm Hg(1 mm Hg=0.133 kPa)维持1 h制备失血性休克大鼠模型;制模后林格组给予乳酸林格液复苏,万汶组给予万汶加乳酸林格液复苏.复苏2 h后取血并处死大鼠取肺脏.观察组织病理学改变和电镜超微结构改变.结果 光镜下观察休克组大鼠肺泡壁破坏严重;林格组可见大鼠肺泡问质增宽,肺泡壁和血管壁有轻度水肿;万汶组大鼠肺泡结构接近正常.电镜下观察休克组大鼠肺组织超微结构呈明显损伤改变;林格组和万汶组大鼠肺组织超微结构损伤较轻,但林格组同时出现间质水肿现象;对照组大鼠肺组织超微结构正常.结论 大鼠发生失血性休克后,肺组织超微结构发生改变.单纯使用乳酸林格液治疗失血性休克可能会加重肺部损伤,但联合使用万汶能减少内皮细胞损伤,减轻炎性细胞浸润.     

氟乙酰胺中毒致死的病理形态学研究

目的 研究氟乙酰胺中毒致死人体组织学与超微结构的形态学改变，为临床治疗与法医鉴定提供形态学依据。方法 取5例氟乙酰胺中毒致死的人体心、脑、肺、肝、肠、脾、肠淋巴组织。采用HE切片法与投射电子显微镜观察组织形态学与超微结构的改变。结果 显示各脏器出现不同程度的变性、灶性坏死及水肿出血等改变。结论 出现不同程度的变性、灶性坏死及水肿变化，提示临床治疗中应对细胞采取保护性治疗措施；出现类似改变提示法医工作者应警惕中氟乙酰胺中毒可能并加以排除。     

铁皮枫斗颗粒对放射损伤小鼠存活情况及肺病理组织学改变的影响

目的 研究铁皮枫斗颗粒(DCWD)对放射损伤小鼠存活情况和肺病理组织学改变的影响.方法 BALB/c小鼠125只,随机分为正常对照组、单纯照射组及DCWD大、中、小剂量组.采用直线加速器6MV X射线8.0Gy或5.0Gy全身单次均匀照射,照前连续灌胃10d,每天一次,照后继续给药至小鼠死亡或活杀.观察受8.0Gy照射小鼠的存活情况,及受5.0Gy照射小鼠肺HE染色病理组织学改变.结果 受8.0Gy照射小鼠平均存活时间均在10d之内,较正常对照组明显缩短(P＜0.01),DCWD组较单纯照射组延长3～4d(P＜0.01);5.0Gy照射后小鼠出现肺脏的急性放射性损伤,表现为血循环障碍、细胞变性及代偿性反应等病理改变,DCWD组病变程度较轻、恢复较快.但无明显的最效关系.结论 DCWD能明显延长受照小鼠平均存活时间,提高其存活率,减轻受照射小鼠肺脏的病理改变程度,对放射损伤具有一定的保护作用.     

水下冲击波的物理参数特征和冲击伤的形态学变化

目的:探讨水下冲击伤的病理形态学改变。方法:成年杂种犬61只,山羊8只,用200,500和1000gTNT水下爆炸致水下冲击伤,PCB水下爆炸压力传感器测定冲击波物理参数,观察伤后6h动物的存活情况和冲击伤病理形态学改变。结果:水下冲击波物理参数的特征表现为高的峰值压力,正向持续时间较短,冲量较大。61只犬中,死亡23只,死亡率为37.7%(23/61),8只山羊中,死亡2只。形态学观察发现肺损伤发生率最高,其次为胃肠道损伤,少数动物可发生肝脾等实质脏器损伤,而膀胱和胆囊等含液脏器则很少发生损伤。肺损伤主要表现为不同程度的肺出血,重者常伴有肺水肿,甚至发生血性肺大泡和肺撕裂。胃肠道损伤主要表现为不同程度的浆膜下出血,部分动物可见浆膜下血肿和浆肌层撕裂,甚至发生胃肠道穿孔。肝脾等实质脏器可见包膜下出血、血肿,严重者发生肝脾破裂。形态学改变与冲击波物理参数明显有关,冲量越大,发生率越高,伤情也越重。结论:水下冲击伤具有伤情重和死亡率高的特点,早期救治中应加强急性呼吸窘迫、胃肠道穿孔和实质脏器引起的内出血的处理。     

小儿沛炎支原体感染肺外并发症278例

目的探讨小儿肺炎支原体感染肺外脏器受累的发生情况及临床表现。方法对我院2002年1月至2007年12月收治的肺炎支原体肺炎进行回顾性研究。结果肺外脏器受累总发生率为31％，在肺外并发症中，发生率最高者为皮肤改变及泌尿系统改变，约20％，其次为心血管系统和消化系统改变约17％。结论肺炎支原体感染引起肺外脏器受累发生率高，且呈多样性，应高度重视，早期诊断及治疗     

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.