胸部开放伤后海水浸泡对实验犬前炎症细胞因子的影响

目的：探讨海水浸泡胸部开放伤对实验犬血浆前炎症细胞因子肿瘤坏死因子－α（TNF－α）和白细胞介素－1β（IL－1β）水平变化的影响。方法：方法：实验动物致伤后随机分为对照组（n=10)、海水浸泡组（n=10)和生理盐水浸泡组（n=5）。对照组为单纯胸外伤,海水浸泡组和生理盐水浸泡组的动物于致伤后分别置入人工配制的海水或生理盐水中,于伤前及浸泡后15、30、45min及1、2、3和4h取务测定TNF－α和IL－1β变,货时监测血流动力学、呼吸系统和动脉血气变化。对照组除不浸泡海水外处理同海水浸泡组。结果：海水浸泡组的血TNF－α和IL－1β伤后明显升高并且高峰出现时间明显提前。急性肺损伤明显重于对照组和生理盐水浸泡组。结论：胸外伤后海水浸泡能启动了全身前炎症细胞因子TNF－α和IL－1β的过度表达,并且这种变经可能在急性肺损伤的发病机理中起重要作用。     

胸部开放伤后海水浸泡对实验犬血浆渗透压及电解质平衡的影响

探讨胸部开谚伤后海水浸泡对实验犬血浆渗透压和电解质平衡的影响。方法：实验动物致伤后随机分对照组（ｎ＝１０）、海水浸泡组（ｎ＝１０）和生理盐水或生理盐水中,于致伤前及入水１５、３０、４５分钟及１、２、３和４小时取血测定血浆渗透压、血钠、血钾、血氯,同时监测血流动力学变化。结果：海水浸泡组动物有严重的电解质紊乱和血液高渗状态,表现为高渗综合征、高钠血症和高氯血症,而对照组和生理盐水浸泡组致伤前后无明显     

胸部开放伤后海水浸泡对实验犬肾脏病理形态学的影响

目的：探讨胸部开放伤后海水浸泡对实验犬肾脏病理形态学的影响。方法：实验动物致伤后随机分为对照组（n＝5）；单纯胸伤组（n=10，致伤后直接观察4小时）；海水浸泡组（n=10，致伤后立即放入人工配制的海水浸泡4小时）。采用光镜和电镜对肾组织进行病理形态学检查，并于致伤前及伤后（浸泡后）15、30、45分钟以及1、2、3和4小时采取血标本，采用酶联免疫吸附（ELISA）法测定血浆肿瘤坏死因子－α（TNF-α）和白介素－1β（IL-1β）水平。结果：光镜检查表现为部分肾小球毛细血管丛体积缩小，腔内空虚、塌陷，部分扩张充血，体积增大，电镜下可见足细胞内线粒体肿胀，内质网扩张，足突变形、融合；肾小管上皮浊肿，部分有透明变性及空泡变性，部分有斑片状坏死，并可见远曲小管上皮消失，管腔内有蛋白管型，肾间质血管充血，海水浸泡组伤后血浆TNF－α和IL－1β表达明显升高，且高峰出现时间明显提前。结论：胸部开放伤后海水浸泡可导致伤后早期肾细胞的病理形态学改变。     

胸部开放伤后海水浸泡对实验犬肝功能及形态学的影响

目的：探讨胸部开放伤后海水浸泡对实验犬肝功能及其病理形态学的影响。方法：实验动物伤后随机分为对照组（n=10)和海水浸泡组(n=10)。对照组为单纯胸外伤,海水浸泡组的动物于致伤后置入人工配制的海水中。致伤前及入水15、30、45分钟以及1、2、3和4小时取血测定总胆红素、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）和碱性磷酸酶（AKP）,同时对肝组织进行光镜及透射电镜检查。结果：海水浸泡组血液总胆红素、ALT、AST和LDH明显升高并且出现时间早,肝脏有明显的病理形态学改变,而对照组肝功能改变轻微且出现时间晚。结论：海水浸泡可导致实验犬的肝功能损伤和肝细胞病理形态学变化。     

犬烧冲复合伤后海水浸泡对酸碱平衡的影响

目的：建立犬烧冲复合伤后海水浸泡的实验模型，探讨烧冲复合伤海水浸泡对犬酸碱平衡的影响，为海水浸泡早期救治提供理论依据。方法：20条健康成年杂种犬按随机数字表法随机分为两组。对照组：致伤后直接观察(n=10)；浸泡组：致伤后置入21℃海水中浸泡4h(n=10)，于伤前，浸泡后即刻(相当于对照组伤后4h)，浸泡后3h(相当于对照组伤后7h)，浸泡后6h(相当于对照组伤后10h)，浸泡后16h(相当于对照组伤后20h)，浸泡后24h(相当于对照组伤后28h)测定血气、酸碱平衡以及血流动力学指标。结果：浸泡组出海后PaO2、BE、HCO3^-、pH和PaCO2与对照组相比均明显下降，且BE、pH、HCO3^-和PaCO2呈进行性下降；而PaO2随时间延长呈恢复趋势。对照组致伤前后无明显变化。结论：海水浸泡可导致犬严重的低碳酸血症和代谢性酸中毒，对体液内环境的失衡有重要影响。     

内毒素致家兔急性肺损伤时肺和肺外脏器的病理组织学变…

目的：了解内毒素血症时各脏器受损的病理组织学变化及东莨菪碱和前列腺素Ｅ１的保护作用。方法：大耳白兔５０只，随机分为５组：Ａ组为对照组；Ｂ组为内毒素致伤组（７００μｇ／ｋｇ）；Ｃ组、Ｄ组分别为内毒素致伤后东莨菪碱和前列腺素Ｅ１治疗组，Ｅ组为东莨菪碱和前列腺素Ｅ１联合治疗组。实验前及实验后０．５、２、４和６小时分别测血压和呼吸频率；实验后６．５小时放血处死动物，测肺气细血管通透指数，同时取肺、心、脑、     

快速输注低张液体在治疗胸外伤后海水浸泡致高渗血症中的作用

目的：探讨快速输液在海水浸泡性胸外伤致高渗血症治疗中的作用。方法：实验犬致伤后随机分为对照组（10只）和治疗组（10只）。对照组用于胸外伤后置入人工配制的海水中,观察期间不予任何治疗;治疗组于浸入海水25分钟后捞出进行紧急救治（包括关闭伤口、胸腔闭式引流以及于4小时内快速输入低张液体,输液量为总补液量的1／2）。于不同时间点取血测定血浆渗透压、血钠、血钾、血氯和动脉血气。结果：对照组和治疗组均于浸泡海水后出现严重高渗血症、高钠血症和高氯血症。对照组在实验期间的死亡率为90％,平均生存时间为45分钟。而治疗组经胸腔闭式引流和快速输入低张液体后,平均血浆渗透压于24小时回落到伤前基础水平,全组平均存活时间为40．0小时（治疗组中5只犬存活时间＜24小时,死亡前平均血浆渗透压为377mmol/L,平均存活时间为14．7小时;而存活时间超过24小时的5只犬平均血浆渗透压为309mmol/L,平均存活时间为67．2 小时）。结论：胸外伤后海水浸泡对机体的血浆渗透压和电解质平衡有严重影响,是实验犬致死的重要原因之一。早期快速输入低张液体对降低血浆渗透压、改善生存时间有重大意义。     

创伤低血容量性休克时血浆β内啡肽含量的变化及纳络酮的治疗作用

创伤引起的低血容量性休克是创伤致死的主要原因之一。本研究通过动态测定创伤致低血容量性休克时血浆β内啡肽（βＥＰ）的含量变化及观察纳络酮逆转休克时低血压的疗效,明确纳络酮在早期抗休克过程中的作用及意义,报告如下。１　资料与方法１．１　动物实验：１．１．１　实验动物：雄性中国大白兔２０只,由浙江医科大学实验动物中心提供。随机分成纳络酮治疗组（ＮＡＬ组,１０只）和生理盐水对照组（ＮＳ组,１０只）,２组动物平均体重比较,有可比性。１．１．２　实验方法：按文献〔１〕方法复制创伤致低血容量性休克动物模型。先…     

创伤鼠血β—内啡肽,皮质醇变化与当归补血汤的免疫保护作用

目的：研究当归补血汤对创伤应激后小鼠的免疫调节作用，探讨其对应激素释放的影响。方法：随机将昆明种小鼠分为治疗组、对照组、正常组，治疗及对照组落体撞击法造成双有闭合性骨折。伤后、小时对照组７放血后取脾行免疫功能检测。治疗及对粗每日二次胃灌入中药或生理盐 分别于伤后第１、２、５日早８：３０取血放免法测定血β－内肽（β－ＥＴ）、皮质醇（Ｃｏｒ）含量，三组均于第５日放血后取脾测淋巴细胞对ＰＨＡ的增殖反应。     

对海水浸泡复合伤伤情的简易评估方法

背景：建立海水浸泡复合伤伤情快速评定方法的实验动物模型，以利于其愈后恢复。 目的：探讨建立海水浸泡复合伤简易伤情评定方案的方法。 设计：分组对照实验。 单位：解放军第一一三医院骨二科，第三军医大学大坪医院野战外科研究所。 材料：健康成年杂交犬32只，体质量12-15kg，雌雄不限。 方法：本实验部分于200l-10／2002—06由第三军医大学大坪医院野战外科研究所第五、六研究室在我国特定海域完成。犬随机分为烧冲复合伤组与弹烧复合伤组，每组又分浸泡组10只与对照组6只。烧冲复合伤组：制造烧伤和轻度冲击伤模型，对照组致伤后直接置于25℃室内，浸泡组立即用固定架将犬浸泡模拟海水中。弹烧复合伤组：制造烧伤和轻中度弹片伤模型，致伤后对照组和浸泡组处理方法同前。观察各组在伤后28h内各项生理指标的变化，找出与死亡发生有关的指标，分析其相关性，建立伤情评分表，内容包括体温、心率、平均动脉压、氯离子浓度、动脉氧分压及致伤因素各项，分为0-5分，总分分值越高死亡率越高。主要观察指标：①各组犬死亡数分析。②伤情评分。③评分表评定伤情的验证。 结果：32只犬均进入结果分析。①犬死亡数分析及各项指标与死亡发生的关系：犬共死亡12只，10-20h是死亡发生高峰期，无论浸泡是否发生；体温、心率、平均动脉压、动脉氧分压、氯离子浓度等5指标与死亡发生有显著影响（P〈0．05）。②各组犬伤情评分、预测死亡率与实际死亡率比较：烧冲对照组各项分别为（5．89&;#177;3．25）分，0，17％；弹烧对照组分别为（6．78&;#177;2．02）分，25％，33％；烧冲浸泡组分别为（9．50&;#177;4．20）分，50％，30％；弹烧浸泡组评分别为（11．13&;#177;3．57）分，50％。60％。 结论：①建立的评分表易于获得常用生理指标以快速评定伤情，且有无合并海水浸泡均可进行评定，适用面较广。②评定的准确性经验证可以接受。③但此表是基于动物实验数据建立，与真正的伤员伤情评分表仍有差距。     

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.