右美托咪定对大鼠脑创伤后炎症反应及认知功能的影响

目的 观察右美托咪定对大鼠脑创伤后炎症反应及认知功能的影响。方法 将20只成年雄性SD大鼠随机分为实验对照（CON）组和右美托咪定（DEX）组,各10只。应用可控皮层撞击法制备大鼠颅脑外伤模型。DEX组大鼠清醒后即可腹腔注射右美托咪定100 μg/kg,对照组不予处理,两组大鼠分别在创伤后6 h、24 h、72 h采用ELISA法对其血清TNF-α、IL-6及IL-1β水平进行检测,并进行新物体识别测试。结果 两组血清TNF-α、IL-6、IL-1β水平在脑创伤6 h、24 h、72 h比较,差异有统计学意义（P＜0.05）,两组TNF-α、IL-6水平在24 h下降,并于72 h再次升高,且CON组高于DEX组,差异有统计学意义（P＜0.05）;两组IL-1β水平在24 h、72 h时升高,且CON组高于DEX组,差异有统计学意义（P＜0.05）;各个时间点两组大鼠新物体识别测试结果比较,差异无统计学意义（P＞0.05）。结论 右美托咪定可减轻大鼠脑创伤后炎症反应,是否影响恢复期认知功能还需进一步观察。     

右美托咪定介导miR-526b-3p/MMP2通路影响人宫颈癌细胞株HeLa侵袭、迁移

目的 探讨右美托咪定（Dex）介导微小核糖核酸-526b-3p(miR-526b-3p)/基质金属蛋白酶2(MMP2通路影响人宫颈癌细胞株HeLa侵袭、迁移的作用。方法 采用不同浓度（0、10、20、40μmol/L）的Dex处理人宫颈癌细胞株HeLa并记为空白组、Dex低、中、高剂量组。Transwell小室实验检测细胞侵袭、迁移能力;实时定量聚合酶链反应（RT-qPCR）检测miR-526b-3p表达及MMP2信使核糖核酸（mRNA）表达。利用脂质体转染法分别将miR-526b-3p抑制物（anti-miR-526b-3p）及阴性对照（anti-miR-NC）、MMP2过表达载体（pcDNA-MMP2）及阴性对照（pcDNA-NC）转染至人宫颈癌细胞株HeLa,Transwell小室实验检测细胞侵袭、迁移能力;蛋白质免疫印迹法（WB）检测MMP2、MMP9、迁移侵袭增强因子1(MIEN1)蛋白表达;双荧光素酶报告实验验证miR-526b-3p靶向调控MMP2。结果 与空白组比,Dex低、中、高剂量组人宫颈癌细胞株HeLa侵袭和迁移细胞数目减少;与Dex+anti-miR-NC组比,...     

右美托咪定经鼻使用在麻醉中的研究进展

右美托咪定为美托咪定的活性右旋异构体,是一种高效、高选择性的α2肾上腺素能受体激动剂,具有良好的镇静、镇痛和抗交感作用.同时对呼吸无抑制,可作为围手术期麻醉合并用药.右美托咪定经鼻给药是临床常用的方式之一,鼻腔黏膜毛细血管丰富,吸收药物迅速.与静脉给药相比,经鼻给药无创简便、刺激性小,起效缓慢平稳、易于被患者接受,因而...     

右美托咪定与咪达唑仑治疗脓毒症的临床疗效对比

目的对比右美托咪定与咪达唑仑治疗脓毒症的临床疗效。方法选择2018年7月至2019年7月本院收治的142名脓毒症患者作为研究对象,根据治疗方式的不同分为右美托咪定组(R组,72例)和咪达唑仑组(M组,70例)。R组患者采用静脉输注右美托咪定治疗,M组患者采用静脉输注咪达唑仑治疗。比较两组患者用药前后各项心功能指标、用药后炎性因子水平、RASS评分和不良反应。结果用药24h后R组患者SBP、DBP、HR水平均降低,E/A水平升高,且R组患者SBP、DBP、HR水平降低幅度比M组更明显,E/A水平升高幅度比M组更明显(P0.05);M组、R组患者随着治疗时间的延长RASS评分逐渐降低、CRP、TNF-α和IL-6水平逐渐降低(P0.05),且R组患者在用药t_2、t_3、t_4时CRP、TNF-α和IL-6水平显著低于M组,差异具有统计学意义(P0.05);两组患者均未出现严重不良反应。结论静脉持续输注右美托咪定可有效改善脓毒症患者的心脏舒张功能,减少躁动发生,降低患者血液中炎性因子水平。     

右美托咪定对老年人直肠癌根治术后认知功能的影响

目的观察老年人直肠癌根治术中应用右美托咪啶（DEX）对术后认知功能的影响。方法将60例择期行直肠癌根治术的老年患者按数字表法随机分为2组：DEX组（n=30）和对照组（n=30）。均采用静脉麻醉,将DEX 2 ml（200μg）加入48ml生理盐水中,配成4mg／L的溶液。DEX组在气管插管成功后10min内泵入0．5μg／ks的DEX溶液,继续以0．5μg·kg^-1·h^-1持续泵入至手术结束前30min;对照组在气管插管成功后的10min内泵入0．125ml／kg生理盐水,继以0．125ml·kg^-1·h^-1持续泵入至关腹前。记录2组术前（T0）、术毕（T1）、拔管后5min（T2）、拔管后30min（T3）的收缩压（SBP）、舒张压（DBP）、心率（HR）,并记录停全麻药至自主呼吸恢复的时间、至拔管的时间,术前24h、术后24h采用简易精神状态量表（MMSE）评价两组患者认知功能。结果与T0比较,DEX组T1～T3的SBP及HR降低,而对照组T1-T3的SBP升高,差异均有统计学意义（P值均〈0．05）;与对照组比较,DEX组T1-T3的SBP及HR减低,差异均有统计学意义（P值均〈0．01）。DEX组发生术后认知功能障碍（POCD）2例（6．7％）,对照组9例（30．0％）,两组POCD发生率差异有统计学意义（χ^2=5．46,P〈0．01）。结论DEX能改善老年直肠癌根治术患者的术后认知功能,且使血流动力学更稳定。     

探究右美托咪定对异丙酚麻醉新生大鼠脑损伤的作用

目的 从丝裂原活化蛋白激酶(MAPK)/细胞外调节蛋白激酶(ERK)信号通路,探究右美托咪定抗异丙酚麻醉所致新生大鼠脑损伤的作用机制。方法 异丙酚麻醉诱导建立新生大鼠脑损伤模型,分为正常对照组、异丙酚组、右美托咪定+异丙酚组、MAPK抑制剂+异丙酚组、右美托咪定+抑制剂+异丙酚组,每组20只。Westernblot法检测MAPK/ERK、PI3K/AKT通路相关蛋白及神经突触素(synapsinI)、生长相关蛋白-43(GAP-43)、神经生长营养因子(BDNF)、突触后致密区蛋白95(PSD95)表达水平。结果 右美托咪定可改善异丙酚反复麻醉的新生大鼠海马组织神经元损伤、凋亡,升高ATP酶活性,降低Ca²⁺水平,促进MAPK/ERK和PI3K/AKT通路活化及与神经生长及发育相关蛋白表达,并改善新生大鼠成年后神经元减少及学习记忆能力降低现象(P<0.05)。MAPK抑制剂干预,可加重异丙酚麻醉的新生大鼠神经元损伤凋亡,并逆转右美托咪定的上述作用(P<0.05)。结论 右美托咪定可通过激活MAPK/ERK活化,来发挥神经保护效应,减轻异丙酚麻醉诱发的神...     

右美托咪定对脓毒血症大鼠血脑屏障的影响

目的探讨右美托咪定(dexmedetomidine,DEX)对内毒素血症大鼠模型血脑屏障及认知功能的影响。方法健康SD雄性大鼠24只,随机分为4组(n=6):空白对照组(C组)、脂多糖组(LPS组)、右美托咪定组(DEX组)和右美托咪定+脂多糖组(DEX+LPS组)。采用尾静脉注射LPS方法制备内毒素血症模型。各组大鼠进行Morris水迷宫实验,记录大鼠逃避潜伏期、穿越平台次数、在平台所在象限时间。处死大鼠,取海马组织,采用免疫组化法和Western blot检测各组大鼠海马组织血脑屏障(BBB)结构蛋白Occludin和ZO-1蛋白表达,采用ELISA方法检测各组大鼠海马组织炎症因子TNF-α、IL-1β和IL-6。结果 LPS组大鼠认知功能受损严重,海马组织Occludin和ZO-1蛋白的表达水平降低,炎症因子TNF-α、 IL-1β和IL-6含量显著升高;DEX+LPS组大鼠认知功能受损程度较LPS组轻,海马组织Occludin蛋白和ZO-1的蛋白表达升高,炎症因子TNF-α、IL-1β和IL-6含量显著降低。结论右美托咪定改善内毒素血症大鼠的认知功能,与上调Occludin以及ZO-1蛋白表达水平相关。     

右美托咪定对上肢手术止血带反应的影响

目的 观察右美托咪定对臂丛神经阻滞下上肢手术止血带反应的影响.方法 择期上肢手术患者80例,年龄25 ～ 65岁,体质量55～ 75 kg,身高155～ 175 cm,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为右美托咪定组(D组,n=40)和对照组(C组,n=40).D组于神经阻滞前10min静脉注射右美托咪定负荷剂量1 μg/kg,继之以0.5μg·kg-1·h-1的速率持续输注至手术结束.C组给予等量生理盐水.行超声引导下肌间沟臂丛神经阻滞,定位成功后两组均注射0.5％盐酸罗哌卡因30ml.记录两组止血带反应例数、止血带反应发生时间、止血带反应程度、术中辅助用药情况;记录患者入室时(To)、阻滞后5 min(T1)、10 min(T2)、15 min(T3)、30 min (T4)、60 min(T5)心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2);记录不良反应发生情况.结果 D组止血带反应例数、止血带反应程度、术中辅助芬太尼用药剂量均低于C组[止血带反应例数:8/40比14/40,止血带反应程度:2.4±0.8比60.2±20.4,辅助芬太尼用药剂量:(4.2±1.2)μg比(130.3±38.6) 1μg,均P＜0.05],止血带反应发生时间迟于C组[(52.2±12.5)min比(30.2±11.8)min,P＜0.05)].To时C组与D组两组HR、MAP、SpO2差异无统计学意义;T1～T5时D组HR较C组减慢(均P＜0.05);T1～T3时两组MAP差异无统计学意义;T4、T5时点D组MAP明显低于C组(P＜0.05);两组术中SpO2差异无统计学意义.D组术中有4例发生心动过缓,两组均未发生低血压、局部麻醉药中毒等不良反应.结论 上肢神经阻滞前10 min静脉注射右美托咪定1 μg/kg,继之以0.5 μg·kg-1·h-1的速率持续输注至手术结束,可明显减少止血带反应例数、减轻止血带反应程度、推迟止血带反应发生时间.     

右美托咪定对低氧诱发人支气管上皮细胞氧化应激损伤的影响

目的观察并探讨α2肾上腺素能受体激动剂右美托咪定(dexmedetomidine,DEX)对化学性低氧模拟剂氯化钴(cobalt chloride,CoCl_2)诱发人支气管上皮细胞(BEAS-2B)氧化应激损伤的影响。方法以人支气管上皮细胞株BEAS-2B为研究对象,将其随机分为4个实验组:正常对照组、CoCl_2组、0.01μmol/LDEX+Co Cl2组、0.1μmol/LDEX+CoCl_2组。MTT比色法检测细胞的存活率;DCFH-DA染色流式细胞仪检测细胞内活性氧自由基水平(reactive oxygen species,ROS);试剂盒测定细胞上清液中丙二醛(malonaldehyde,MDA)释放量;Western Blot检测细胞内血红素加氧酶-1(HO-1)和超氧化物歧化酶(SOD)的蛋白表达。结果与正常对照组相比,BEAS-2B细胞经低氧处理后,细胞存活率降低,ROS含量升高,MDA释放增多。经DEX+CoCl_2联合处理后,能明显抑制低氧导致的BEAS-2B细胞氧化损伤,呈现剂量依赖性;并且细胞内HO-1和SOD的蛋白表达水平明显高于CoCl_2组。结论右美托咪定能保护BEAS-2B细胞对抗化学性低氧诱发的氧化应激损伤,可能与上调细胞内HO-1和SOD等氧化酶的表达,抑制ROS水平相关。     

右美托咪定对骨科老年患者术后谵妄的影响

目的观察右美托咪定对骨科老年患者术后谵妄发生率的影响。方法选择全麻下行择期骨科手术老年患者100例,随机分为右美托咪定组（D组）和对照组（c组）。D组在气管插管后采用注射泵以0．5μg／（kg·h）速率持续静脉注射,c组以相同方法静脉注射0．9％氯化钠溶液。两组均术毕前20min内停止注射。记录术中七氟醚和芬太尼用量、术后VAS评分、术后Ramsay镇静评分、术后谵妄的发生率。结果两组患者芬太尼和七氟醚用量、VAS评分、Ramsay镇静评分、舒适度评分、术后谵妄的发生率差异有统计学意义（P〈0．05）。与C组对比,D组患者术后谵妄的发生率降低,芬太尼和七氟醚用量减少,Ramsay镇静评分和舒适度评分更优,VAS评分降低（P〈0．05）。结论右美托咪定能减少骨科老年患者术后谵妄的发生率,其机理可能与其提供良好的镇静、镇痛和减少麻醉药物用量有关。     

10例骨巨细胞瘤光镜和电镜观察

本文对10例骨巨细胞瘤(GCT)进行了光镜和电镜观察,同时10例冷包埋石蜡切片用偶联法进行酸性磷酸酶(ACP)组织化学观察。LM和EM均显示GCT、由单个核细胞(MC)和多核巨细胞(MGC)组成。MC包括成纤维细胞(FB)、组织细胞(HC)、原始间叶细胞、中间型细胞、黄色瘤细胞。其中4例有肌纤维母细胞(MFB),3例少数细胞内有N-内分泌颗粒。并且见到原始间叶细胞过渡为不同分化的FB和HC。MGC由MC融合而成,以HC型为主,少数兼有HC和FB的特征。ACP染色证实MGC多为HC型,亦证实MC中有HC,HC随级别的增高而逐渐减少,而FB随之逐渐增多。我们认为GCT起源于原始间叶细胞,HC、FB和MFB为肿瘤性细胞,MGC为反应性细胞。     

An Unusual Form of Endoplasmic Reticulum in Mononuclear Cells of a Giant Cell Tumor of Bone

A peculiar configuration of endoplasmic reticulum (ER) was observed by electron microscopy in some mononuclear cells from a malignant giant cell tumor of bone that had been removed from a cervical vertebral body in a 54-year-old female. The unusual ER consisted of looped, smooth tubules, which originated from poorly developed rough ER present in the tumor cells. The tubular structures were approximately 23 ran in diameter and contained paracrystalline material. The curvilinear tubular ER closely resembles the vermiform tubular structures that have been observed mainly in histiocytes from different clinical forms of histiocytosis X.     

骨巨细胞瘤外科治疗的随访

目的探索骨巨细胞瘤术前X线表现、病理分级与预后的关系,寻求最有效的治疗方法。方法对资料完整的60例骨巨细胞瘤的X线、手术方法、病理结果进行回顾性分析。结果骨巨细胞瘤的X线分度在一定程度上反映病理分级及预后,以瘤段骨切除体外灭活再植术疗效最佳,但手术复杂。结论术前可根据骨巨细胞瘤的X线分度或结合病理活检结果选择合适的手术方法。     

Osteoclast Origin of Giant Cells in Giant Cell Tumors of Bone: Ultrastructural and Cytochemical Study of Six Cases

To clarify the histogenesis of giant cells appearing in giant cell tumors of bone (GCTB), an ultrastructural and cytochemical study of six cases was performed with both acid phosphatase (ACPase) and tartrate-resistant acid phosphatase (TRACPase) as marker enzymes. TRACPase is considered a specific marker for osteoclasts. ACPase was demonstrated in the macrophagelike stromal cells, the multinucleated giant cells, and the infiltrating macrophages. The enzyme reaction was localized in lysosomal dense bodies and Golgi areas. Intense TRACPase activity was demonstrated in the multinucleated giant cells, whereas a weak reaction was found in the macrophagelike stromal cells. The multinucleated giant cells and macrophagelike stromal cells resembled osteoclasts with regard to the subcellular localization of TRACPase. The present results suggest that the giant cells in GCTB are indeed derived from osteoclasts.     

Osteoclast Origin of Giant Cells in Giant Cell Tumors of Bone: Ultrastructural and Cytochemical Study of Six Cases

To clarify the histogenesis of giant cells appearing in giant cell tumors of bone (GCTB), an ultrastructural and cytochemical study of six cases was performed with both acid phosphatase (ACPase) and tartrate-resistant acid phosphatase (TRACPase) as marker enzymes. TRACPase is considered a specific marker for osteoclasts. ACPase was demonstrated in the macrophagelike stromal cells, the multinucleated giant cells, and the infiltrating macrophages. The enzyme reaction was localized in lysosomal dense bodies and Golgi areas. Intense TRACPase activity was demonstrated in the multinucleated giant cells, whereas a weak reaction was found in the macrophagelike stromal cells. The multinucleated giant cells and macrophagelike stromal cells resembled osteoclasts with regard to the subcellular localization of TRACPase. The present results suggest that the giant cells in GCTB are indeed derived from osteoclasts.     

A Small Aneurysmal Bone Cyst Restricted to the Cortical Bone of the Femur Resembling So-called Subperiosteal Giant Cell Tumor or Subperiosteal Osteoclasia

We report a 16-year-old Japanese girl with a cystic lesion restricted to the cortical bone under the periosteum of the diaphysis of the left femur. Roentgenograms showed a long, oval translucent lesion in frontal view and an eccentric erosive lesion in lateral view. Computed tomography showed a distinct intracortical lesion. The lesion, which was excised en bloc , measured 3×2×2 cm. The outer layer of the cortical bone was eroded eccentrically. From the margin of the eroded bone, thin fragile bony tissue and preserved periosteum extended like the roof of a dome. Multicystic structures, filled with blood, were lined with fibrous granulation and occasional giant cells. Histologically, this lesion falls within the category of aneurysmal bone cyst. However this case is of a rare type, since the lesion was relatively small, and showed a very specific intracortical location, in marked contrast to typical aneurysmal bone cyst. Additionally, this lesion is similar to so-called subperiosteal giant cell tumor or subperiosteal osteoclasia described in the literature. Acta Pathol. Jpn. 39: 539∼544, 1989.     

癌基因C-erbB-2和H-ras在骨巨细胞瘤中的表达

目的　探讨 C- erb B- 2和 H- ras癌基因在骨巨细胞瘤 (GCT)的表达及与 GCT有关临床指标的关系。方法　应用 SP免疫组织化学方法检测 C- erb B- 2和 H- ras在 5 2例 GCT(GCT按 Jaffe分级 : 级 15例、 级 2 5例、 级 12例 )中的表达。结果　 11例 C- erb B- 2表达阳性 ,阳性率 2 1.2 % ,7例 H- ras表达呈阳性 ,阳性率 13.5 %。其阳性表达与病理分级均无显著性差异 (P >0 .0 5 )。 C- erb B- 2和 H- ras在复发和无复发的病例中 ,阳性表达率分别为 38.5 %、15 .4%和 2 3.1%、10 .3% ,两者同时阳性表达的有 2例。C- erb B- 2和 H- ras的阳性表达与 GCT复发无显著性差异。结论 C- erb B- 2和 H- ras在 GCT中的表达与病理分级和复发无关     

沉默lncRNA-H19对甲状腺癌细胞增殖、侵袭和细胞周期的影响

目的 探讨长链非编码RNA(lncRNA)-H19对甲状腺癌细胞增殖、 侵袭和细胞周期的影响.方法 检测lncRNA-H19在癌组织、 癌旁组织、 正常人甲状腺上皮细胞TEC及甲状腺癌细胞KAT18、FTC133、BCPAP、TPC-1中的表达;检测沉默lncRNA-H19对细胞增殖、 侵袭和细胞周期的影响.结果 ln...     

Intriguing Case: Atypical Tumor of the Mediastinum: Epithelioid Hemangioendothelioma Containing Metaplastic Bone and Osteoclastlike Giant Cells

A 66-year-old woman presented with a superior-anterior mediastinal mass that contained considerable calcification by computed tomography. Initial biopsy interpretation was inconclusive but suggested a giant cell sarcoma of soft parts because the tumor contained atypical epithelioid cells and osteoclastlike giant cells. After radiation and chemotherapy, the tumor was removed. It contained large epithelioid cells, pale chondroid areas, metaplastic bone, and osteoclastlike giant cells. Immunohistochemical and electron microscopic studies revealed the epithelioid cells to be factor VIII positive and to contain abundant intermediate filaments, micropinocytotic vesicles, Weibel-Palade bodies, basal lamina, and primitive cell-cell junctions. These epithelioid cells also stained for muscle-specific actin (HHF-35), yet were negative for desmin and cytokeratins (CAM 5.2 and AE1/3). The findings were most consistent with those reported to occur in epithelioid hemangioendothelioma.     

Intriguing Case: Atypical Tumor of the Mediastinum: Epithelioid Hemangioendothelioma Containing Metaplastic Bone and Osteoclastlike Giant Cells

A 66-year-old woman presented with a superior-anterior mediastinal mass that contained considerable calcification by computed tomography. Initial biopsy interpretation was inconclusive but suggested a giant cell sarcoma of soft parts because the tumor contained atypical epithelioid cells and osteoclastlike giant cells. After radiation and chemotherapy, the tumor was removed. It contained large epithelioid cells, pale chondroid areas, metaplastic bone, and osteoclastlike giant cells. Immunohistochemical and electron microscopic studies revealed the epithelioid cells to be factor VIII positive and to contain abundant intermediate filaments, micropinocytotic vesicles, Weibel-Palade bodies, basal lamina, and primitive cell-cell junctions. These epithelioid cells also stained for muscle-specific actin (HHF-35), yet were negative for desmin and cytokeratins (CAM 5.2 and AE1/3). The findings were most consistent with those reported to occur in epithelioid hemangioendothelioma.