咪唑安定对氯胺酮诱导的c-fos基因在大鼠后扣带回皮质区表达的影响

目的 观察咪唑安定对氯胺酮诱导的c-fos基因在大鼠后扣带回皮质区表达的影响，探讨咪唑安定预防或减轻氯胺酮所致精神症状及神经损害的机制。方法 雄性Wistar大鼠30只，随机分为生理盐水5ml组、咪唑安定15mg／kg组、氯胺酮100mg／kg组、咪唑安定15mg／kg加氯胺酮100mg／kg组、氯胺酮100mg／kg加咪唑安定15mg／kg组。咪唑安定与氯胺酮两药间隔15min给药，所用药物均由腹腔注射。各组动物于用药后2h开胸经心脏灌流脑固定，用免疫组织化学方法检测后扣带回皮质区c-fos蛋白的表达，用彩色病理图像分析系统测定c-fos阳性细胞的百分率和阳性细胞的密度。结果氯胺酮可明显诱导c-fos蛋白在大鼠后扣带回皮质区的表达；咪唑安定自身不能诱导c-fos的表达；咪唑安定预处理可显著抑制氯胺酮诱导的c-fos在这一区域的表达；先用氯胺酮后给予咪唑安定仅能部分抑制c-fos的表达。结论 咪唑安定预处理可抑制氯胺酮诱导的c-fos基因在大鼠后扣带回皮质区的表达，这可能是其预防或减轻氯胺酮所致精神症状和神经损害的机制之一。     

异丙酚及地西泮对氯胺酮引起的大鼠大脑皮质c-fos基因表达及神经元损害的影响

目的 观察异丙酚和地西泮对氯胺酮诱导的大鼠大脑皮质Glu(谷氨酸)释放和c-fos基因表达的影响,探讨异丙酚抑制氯胺酮中枢神经系统副作用的基因机制。方法 将28只Wistar大鼠随机分为生理盐水3 ml-生理盐水1 ml组,生理盐水3 ml-氯胺酮 100 mg/kg组,异丙酚100 mg/kg-氯胺酮100 mg/kg组,地西泮10 mg/kg-氯胺酮:100 mg/kg组。于用药后30 min,检测c-fos mRNA水平。另取大鼠,用药注射后2 h取大脑皮质检测Glu含量、组织含水量和Fos蛋白阳性细胞率。结果 氯胺酮注射后30 min引起大脑皮质c-fos mRNA表达增高,2 h时大脑皮质Glu、水含量和Fos阳性细胞率与生理盐水组相比增加(P<0.01)。异丙酚和地西泮预处理抑制了c-fos基因表达以及组织谷氨酸、水含量的增加,且抑制程度不同。结论 c-fos基因参与了异丙酚和地西泮抑制氯胺酮引起的精神症状和神经元损害的基因机制;异丙酚抑制作用强于地西泮。     

氯胺酮诱导的热休克蛋白70在大鼠脑组织中不同区域的表达

目的 研究氯胺酮诱导的热休克蛋白70(HSP70)在大鼠脑组织中不同区域的表达.方法 SD大鼠20只,随机均分为氯胺酮组(K组)和生理盐水组(N组),分别在腹腔注射氯胺酮80mg/kg和生理盐水3ml.24h后取鼠脑,应用HSP70单克隆抗体免疫组化染色检测胼胝体压部后皮质、海马、大鼠后扣带回和枕叶皮质中HSP70的表达,并用MIAS-2000图文分析系统分析上述区域HSP70阳性细胞百分率、阳性细胞密度(个/mm2)和阳性产物灰度值.结果 氯胺酮可诱导大鼠大脑特定区域表达HSP70;大脑各区域HSP70表达不同.结论 氯胺酮诱导HSP70在大脑特定区域的表达,提示可能产生神经细胞损害;氯胺酮对大脑特定区域产生损害.     

氟哌啶醇对氯胺酮诱导的热休克蛋白70在大鼠海马中表达的影响

目的 研究氟哌啶醇对于氯胺酮诱导的热休克蛋白70（HSP70）在大鼠海马中表达的影响,探讨氟哌啶醇能否预防或治疗氯胺酮导致的脑损害。方法 选择48只大鼠,随机分为8组,分别在腹腔注射氯胺酮80．0mg/kg前后给予不同剂量氟哌啶醇（1．0,5．0,10．0mg/kg),24h后取鼠脑,应用HSP70单克隆抗体免疫组化染色检测大鼠海马中HSP70的表达,并用MIAS－2000图文分析系统分析大鼠海马HSP70阳性细胞百分率、阳性细胞密度和灰度值。结果 单独应用氯胺酮可在大鼠海马表达HSP70;预先给予氟哌啶醇能抑制氯胺酮诱导的HSP70表达,且随着剂量的增加,其抑制作用增强;在使用氯胺酮后给予氟哌啶醇,不能减少HSP70的表达。结论 氯胺酮可诱导HSP70在海马的表达,提示海马的神经元可能受到损害;氟哌啶醇可以预防氯胺酮所致的神经元损害,但对已造成的神经元损害无治疗作用。     

氯胺酮—咪唑安定对感染性休克大鼠血清肿瘤坏死因子—α及心肌热休克蛋白70表达的影响

目的 探讨氯胺酮-咪唑安定对感染性休克大鼠的心肌保护作用及可能的使用机制。方法 选择健康成年SD大鼠112只，随机分为对照组（NS组和E组）和实验组（EM组、EK组及EKM组）。NS组为正常对照组，E组给予内毒素（LPS）20mg/kg，ip；EK组、EKM组及EM组同E组，但给LPS前分别给予KTM80mg/kg,ip,KTM80mg/kg M0.5mg/kg ip,M0.5mg/kg ip，1小时后追加半剂。在LPS处理2小时后及E组大鼠临终时测血清肿瘤坏死因子-α（TNF-α）及心肌热休克蛋白70（HSP70）的表达，并观察各组大鼠存活时间。结果 E组TNF-α显著高于NS组、EK和EKM组，E组HSP70表达强于NS组，但弱于EK及EKM组，E组与EM组，EK与EKM组的TNF-α、HSP70表达无明显差异。结论 氯胺酮可降低感染性休克时血清TNF-α，减轻其心肌损害。其机制可能为增强心肌HSP70的表达。咪唑安定-氯胺酮复合应用不影响氯胺酮保护感染心肌的作用。     

丙泊酚对脑缺血-再灌注后海马组织热休克蛋白70和c-fos基因表达的影响

目的观察丙泊酚对脑缺血一再灌注后海马组织热休克蛋白70(HSP70)与c-fos基因表达的影响。方法雄性Wistar大鼠40只,随机分为假手术组、缺血一再灌注对照组和缺血一再灌注丙泊酚处理组,后者按丙泊酚用量又分为50、100和150mg／kg三个亚组。采用大鼠全脑缺血一再灌注损伤模型。全脑缺血10min再灌注60min时,断头取脑,采用免疫组织化学和半定量RT-PCR方法,对脑内HSP70与c-fos蛋白及其mRNA在海马组织的表达水平进行检测。结果缺血一再灌注后皮层、海马、纹状体及边缘区等脑区均有大量的HSP70和c-fos阳性蛋白表达,海马组织HSP70及c-fos基因mRNA的表达水平明显增高,其中以缺血一再灌注对照组表达最为显著;假手术组仅有少量阳性蛋白的表达,海马组织mRNA的表达水平极低;麻醉相关剂量的丙泊酚可显著抑制HSP70与c-fos蛋白在各脑区的表达,尤以海马CA1区最为显著,亦可明显下调HSP70和c-fos mRNA在海马组织的表达水平。结论缺血一再灌注损伤可明显诱导HSP70与c-fos基因的表达,丙泊酚的脑保护作用可能与其下调HSP70与c-fos基因的异常表达有关。     

氯胺酮-咪唑安定对感染性休克大鼠心肌环磷酸腺苷及热休克蛋白70表达的影响

目的：探讨氯胺酮-咪唑安定在感染性休克中的心肌保护作用及作用机制。方法：选择健康成年SD大鼠104只，随机分为对照组(NS组、E组)和试验组(EM组、EK组、EKM组)。NS组为正常对照组，E组给予LPS20mg／kg ip，EK组、EKM组、EM组同级处理前分别给KTM80mg／kg ip、KTM80mg／kg M0．5mg／kgip、M0．5mg／kg ip，1h后追加半剂。临终时取各组大鼠心肌放免法测cAMP水平及免疫组化方法测HSP70的表达，并观察各组大鼠存活时间。同时监测EK、EKM组KTM血药浓度。结果：E组cAMP水平显著低于NS组及EK、EKM组，E组HSP70表达强于NS组，EK、EKM组HSP70表达强于E组，E，EM组、EK、EKM组cAMP、HSP70表达无明显差异。结论：氯胺酮可升高感染性休克时心肌cAMP水平，保护感染心肌，其机制可能为增强心肌HSP70的表达。咪唑安定-氯胺酮复合应用不影响氯胺酮保护感染心肌作用。     

氯胺酮-咪唑安定对感染性休克大鼠心肌HSP70表达的影响

目的 探讨氯胺酮（KTM）-咪唑安定（M）在感染性休克中的心肌保护作用及可能的作用机制。方法 选择健康成年SD大鼠112只,随机分入对照组（NS组、E组）和试验组（EM组、EK组、EKM组）。NS组为正常对照组,E组给予LPS 20mg/kg ip,EK组、EKM组、EM组在同E组处理前分别给予KTM 80mg/kg ip,KTM 80mg/kg M 0.5mg/kg ip,M 0.5mg/kg ip,1h后追加半剂。在LPS处理2h后及E组大鼠临终时取心肌用免疫组化方法测HSP70的表达,并观察各组大鼠存活时间。结果 E组HSP70表达强于NS组,EK、EKM组HSP70 表达强于E组,存活率也高于E组,且随时间延长HSP 70表达呈增强趋势;E组、EM组和HSP 70表达及存活率无明显差异。结论 氯胺酮可增强感染性休克时大鼠心肌HSP 70的表达,可能是氨胺酮保护感染心肌的机制之一;咪唑安定-氯胺酮复合应用不影响氨胺酮保护感染心肌的作用。     

异丙酚或氯胺酮对内毒素性急性肺损伤大鼠肺小动脉BMP-2表达的影响

目的评价异丙酚或氯胺酮对内毒素（LPS）性急性肺损伤大鼠肺小动脉骨形态构建蛋白-2（BMP-2）表达的影响。方法雌性Wistar大鼠60只，体重220—260g，6—7周龄。随机分为6组，每组10只。对照组（C组）：1．5h内经股静脉输注生理盐水5ml；LPS组（L组）：1h内输注生理盐水3ml，然后30min内输注内毒素1mg／kg（溶于2ml生理盐水中）；异丙酚20mg／kg＋LPS组（P1组）、异丙酚50mg／kg＋LPS组（P2组）、氯胺酮20mg／kg＋LPS组（K1组）、氯胺酮50mg／kg＋LPS组（K组）1h内经股静脉分别输注不同剂量的药物，然后30min内输注LPS1mg／kg（溶于2ml生理盐水中）。输注完毕后72b断头处死大鼠。RT-PCR法测定肺小动脉BMP-2mRNA、BaxmRNA表达。免疫组织化学法、Western blot测定肺小动脉BMP-2、Bax、Bcl-2表达。显微成像分析系统测量肺小动脉中膜厚度。结果各组肺小动脉BMP-2、Bax、Bcl-2均有表达。与C组比较，其余组BMP-2、Bax蛋白水平和mRNA表达降低，Bcl-2水平升高（P〈0．05或0．01）。与L组比较，异丙酚或氯胺酮使BMP-2、Bax蛋白水平及mRNA表达升高，Bcl-2水平降低（P〈0．05）。各组肺小动脉中膜厚度较C组增加（P〈0．05）；异丙酚或氯胺酮减轻了肺小动脉中膜的增厚（P〈0．05）。结论异丙酚或氯胺酮可以抑制大鼠LPS致急性肺损伤肺血管的重建，其机制可能与BMP-2、Bax基因表达上调，Bcl-2基因表达下调有关。     

不同剂量异丙酚麻醉对新生大鼠远期认知功能的影响

目的 探讨不同剂量异丙酚麻醉对新生大鼠远期认知功能的影响.方法 雄性SD大鼠100只,出生后7d,体重9～18g,采用随机数字表法,将大鼠随机分为5组(n =20)∶对照组(C组)、异丙酚25 mg/kg组(P1组)、异丙酚50 mg/kg组(P2组)、异丙酚100 mg/kg组(P3组)和异丙酚200 mg/kg组(P4组).P1组和P2组分别腹腔注射异丙酚25和50 mg/kg;P3组和P4组首次注射异丙酚50 mg/kg,翻正反射恢复时,再追加异丙酚50 mg/kg,直至给完总量.每组取5只大鼠,于苏醒后即刻抽取动脉血样进行血气分析.苏醒后放回笼内继续饲养直至9周龄,采用Morris水迷宫实验测定认知功能,处死后,取海马组织,分别采用Western blot法和RT-PCR法测定神经生长因子(NGF)和Caspase-9蛋白及其mRNA的表达;电镜下观察海马神经元超微结构.结果 5组大鼠血气分析指标差异无统计学意义(P＞0.05).与C组比较,P1组逃避潜伏期和穿越原平台次数差异无统计学意义(P＞0.05),P2组～P4组逃避潜伏期延长,穿越原平台次数减少,P1组～P4组海马NGF蛋白及其mRNA表达下调,Caspase-9蛋白及其mRNA表达上调(P＜0.05);P1组～P4组逃避潜伏期逐渐延长,NGF蛋白及其mRNA表达逐渐下调,Caspase-9蛋白及其mRNA表达逐渐上调,P2组～P4组穿越原平台次数少于P1组(P＜0.05),但P2组～P4组间差异无统计学意义(P＞0.05);P2组～P4组海马神经元出现核固缩、染色质边集、核碎裂、凋亡小体.结论 异丙酚麻醉可损害新生大鼠的远期认知功能,且该作用与剂量有关;其机制可能与抑制NGF表达,增强Caspase-9活性有关.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.