烟雾吸入伤后内皮素─1水平的变化及意义

目的：观察大鼠烟雾吸入伤后血浆及支气管肺泡灌洗液（ＢＡＬＦ）中内皮素。１（ＥＴ－１）含量的动态变化，以探讨其与急性吸入性肺损伤发生发展的关系。方法：采用大鼠烟雾吸入伤模型，分别检测了正常对照及致伤２、６、１２和２４小时动物的动脉血气、肺水量、静态肺顺应性（Ｃｓｔ）、ＢＡＬＦ中总蛋白（ＴＰ和白蛋白（Ａｌｂ）、以及血浆和ＢＡＩＦ中ＥＴ－１量。结果：动物吸入伤后出现急性呼吸衰竭和严重肺水肿，Ｃｓｔ显著降低，ＢＡＩＦ中ＴＰ及Ａｌｂ进行性升高；血浆及ＢＡＬＦ中ＥＴ－１水平亦明显增加，且血浆ＥＴ－１的变化与Ｃｓｔ及ＢＡＬＦ中ＴＰ的改变相关显著。结论：ＥＴ－１在烟雾吸入伤后肺血管通透性增加和肺功能损害中可能有重要作用。     

烟雾吸入伤后肺表面活性物质蛋白A含量的动态变化及意义

目的探讨烟雾吸入伤后肺表面活性物质蛋白Ａ（ＳＰ－Ａ）含量的变化、可能机理及其与肺表面活性物质（ＰＳ）活性抑制和肺功能损害的关系。方法采用大鼠烟雾吸入伤模型，分别检测正常对照及致伤２ｈ、６ｈ、１２ｈ和２４ｈ动物的动脉血气，肺水量，静态肺顺应性（Ｃｓｔ），支气管肺泡灌洗液（ＢＡＬＦ）表面张力特性，ＢＡＬＦ中ＳＰ－Ａ、丙二醛（ＭＤＡ）、总蛋白（ＴＰ）含量及弹性蛋白酶（Ｅｌａ）活性。结果动物伤后出现急性呼吸衰竭和肺水肿，Ｃｓｔ显著降低；ＢＡＬＦ的最小表面张力（ＳＴｍｉｎ）升高，滞后环面积下降；ＢＡＬＦ中ＳＰ－Ａ、ＭＤＡ、ＴＰ含量及Ｅｌａ活性明显升高，但ＳＰＡ－Ａ的相对含量（％ＴＰ）降低，且与Ｅｌａ、Ｃｓｔ和ＳＴｍｉｎ的变化相关显著。结论烟雾吸入伤早期ＳＰ－Ａ相对含量减少，可能是导致肺表面活性物质活性抑制及肺功能障碍的主要原因之一。氧化及Ｅｌａ可能是引起ＳＰ－Ａ含量和（或）功能异常的重要因素。     

PDGF-AB对成纤维细胞增殖及DNA合成的影响

目的：探讨ＰＤＧＦ－ ＡＢ促进伤口愈合及其在瘢痕增生中的作用机理。方法：取体外培养的人正常皮肤及增生性瘢痕成纤维细胞（ｎｏｒｍａｌｓｋｉｎｆｉｂｒｏｂｌａｓｔ,ＮｓＦｂ,ｈｙｐｅｒｔｒｏｐｈｉｃ ｓｃａｒｆｉｂｒｏｂｌａｓｔ,ＨＴｓＦｂ） ,用ＭＴＴ和３Ｈ－ ＴｄＲ掺入法观察ＰＤＧＦ－ ＡＢ对两种细胞增殖及ＤＮＡ合成的影响。结果：ＰＤＧＦ－ ＡＢ对两种成纤维细胞增殖及ＤＮＡ合成均有明显刺激作用,且均呈剂量依赖性关系,但作用有差异。结论：ＰＤＧＦ－ ＡＢ可能通过刺激成纤维细胞增殖及ＤＮＡ合成促进伤口愈合,但同时在瘢痕增生性疾病中可能起重要促进作用。     

脑损伤早期神经细胞c－fos基因表达变化与脑水肿

采用免疫细胞化学方法（ＡＢＣ）研究大鼠脑损伤早期神经细胞ｃ－ｆｏｓ基因表达变化，探讨脑损伤时神经细胞ｃ－ｆｏｓ基因表达变化与脑水肿的关系。结果发现，脑损伤后仅０．５ｈ，脑损伤区周围神经细胞中ｃ－ｆｏｓ基因表达已明显，伤后３～６ｈ更为显著。同时伴有相应部位脑灰质及脑白质水含量增加。初步研究结果提示，脑损伤早期神经细胞ｃ－ｆｏｓ基因表达变化与脑水肿的发生有密切关系。     

前列腺癌中Fas、FasL、Bcl-2及Bax的表达及意义

采用免疫组化染色方法检测４０例前列腺癌、２２例前列腺增生症（ＢＰＨ）及１４例正常前列腺（ＮＰ）组织中Ｆａｓ、ＦａｓＬ、Ｂｃｌ－２及Ｂａｘ的表达。结果表明：①Ｆａｓ、ＦａｓＬ、Ｂａｘ表达于所有被检测的组织中；Ｂｃｌ－２表达于７５．０％Ｐｃａ组织、５４．５％ＢＰＨ组织、３５．７％ＮＰ组。Ｆａｓ在Ｐｃａ中表达强度最弱（Ｐ〈０．０５）。Ｐｃａ与ＢＰＨ及ＮＰ组织比较，Ｂｃｌ－２表达差异有显著性意义（Ｐ〈０．     

Iloprost对大鼠脑创伤后脑保护作用的实验研究

探讨前列环素衍生物Ｉｌｏｐｒｏｓｔ对大鼠脑创伤后脑的保护作用为脑外伤的临床提供实验依据。方法建立大鼠液压冲击致脑创伤型，分成对照组，创伤组及创伤治疗组，各组于伤后２小时、２４小时及４天检测伤区脑组织血栓素Ｂ２及６－酮－前列腺素Ｆ１α的含量，并行脑组织病理学检查。     

下腔静脉滤过器的临床应用(附20例报告)

目的 评价置入下腔静脉滤过器预防各种因素所致静血栓脱落引起肺动脉栓塞的效果和安全性。方法：２０例下肢深静脉、盆腔静脉及下腔静脉血栓患者经布销骨下静脉或股静脉置入钛质Ｂｉｒｄ’ｓ ｎｅｓｔ ｆｉｌｔｅｒ（ＢＮＦ）２例,Ｖｅｎａ Ｔｅｃｈ－ＬＧＭ Ｆｉｌｔｅｒ（ＶＴＦ）１８例;滤器置于肾静脉开水平上方３例、下方１７例;术后立即摄腹部平处及血管造影,观察滤器位置、形态及血流情况,并积极进行局部或全身溶栓     

力学刺激对肌成纤维细胞转归的影响

成纤维细胞 (ｆｉｂｒｏｂｌａｓｔ,ＦＢ)是创伤愈合中的主要修复细胞 ,不仅有旺盛的合成功能 ,还可以分化成一种类似平滑肌细胞、具有收缩功能的细胞亚型肌成纤维细胞 (ｍｙｏｆｉｂｒｏｂｌａｓｔ,ＭＦＢ)。ＭＦＢ表达有平滑肌细胞特有的α -平滑肌肌动蛋白 (α -ｓｍｏｏｔｈｍｕｓｃｌｅａｃｔｉｎ ,α -ＳＭＡ) ,其特征还包括双极型的细胞形态 ,大量的应力纤维及转膜连接的形成。ＭＦＢ的出现促进了伤口收缩 ,有利于创面愈合。ＭＦＢ可短暂地出现在正常愈合的伤口中 (如手术切口 ) ,创面愈合后便很快消失 ,如果ＭＦＢ持续存在 ,则导致…     

c-fos和c-myc 原癌基因与bFGF在烧伤后早期创面组织中的表达规律

目的：探讨烧伤后创面组织原癌基因ｃ－ｆｏｓ、ｃ－ ｍｙｃ 和碱性成纤维细胞生长因子（ｂＦＧＦ） 的表达顺序及分布规律。方法：采用深Ⅱ度烫伤模型,将４２ 只大鼠分为７ 组,即正常对照组、烫伤后３ ｈ、６ ｈ、１ ｄ、３ ｄ、７ ｄ 和１４ ｄ 组。用ＳＰ免疫组化方法研究烫伤后不同时间点内源性ｃ－ｆｏｓ、ｃ－ ｍｙｃ 和ｂＦＧＦ蛋白的表达规律及分布特征。结果：烧伤可以诱导ｃ－ｆｏｓ、ｃ－ ｍｙｃ 和ｂＦＧＦ表达,但三者的表达模式不尽相同,正常皮肤即有ｃ－ｆｏｓ 表达,伤后３ ｈ 达峰值,以后逐渐下降,１ 天以后降至最低水平,其阳性颗粒主要分布于表皮基底细胞胞浆及真皮成纤维细胞的胞核内。ｃ－ ｍｙｃ 的表达在伤后３ 天达最高值,阳性信号分布于真皮层成纤维细胞的胞浆中;而ｂＦＧＦ则在伤后６ ｈ 开始出现,伤后第１ 天达最高值,主要分布于真皮层的成纤维细胞的胞浆中。结论：烧伤可以诱导皮肤创面组织原癌基因ｃ－ｆｏｓ、ｃ－ ｍｙｃ 及ｂＦＧＦ的表达,其表达具有时相与部位分布特征。三者表达的时相性提示在烧伤后早期原癌基因与生长因子基因之间具有相互调控作用,而这种调控作用对后期组织修复将产生一定的影响。     

剖宫产术后大出血选择性动脉栓塞1例报告

剖宫产术后大出血选择性动脉栓塞１例报告ＴｈｅＳｅｌｅｃｆｉｖｅＡｒｔｅｒｉａｅＥｍｂｏｌｉｓｍｏｆｔｈｅＭａｓｉｖｅＨｅｍｏｒｒｈａｇｅＰｏｓｔ－ｈｙｓｔｅｒｏｔｏｍｙ：ＯｎｅＣａｓｅ宋锦文①刘璋①刘无非①蒋宁②①兰州军区总医院放射科７３００５０②总...     

D -山梨醇清除率法推测肝储备功能的临床应用研究

 目的通过D-山梨醇肝脏清除率评价肝功能性血流量,推测肝脏储备功能,探讨其临床应用价值.方法研究对象为肝硬化组12例和对照组18例,静脉稳态滴注D-山梨醇注射液,于不同时间取血和相应时段的尿液,用酶分光光度法测量D-山梨醇血浆浓度和尿液浓度,计算出D-山梨醇肝脏清除率.结果(1)肝硬化组和对照组比较,D-山梨醇肝脏清除率明显减低,二者差异有显著性意义(P＜0.01);(2)肝硬化组D-山梨醇肝脏清除率随Child-pugh分级得分的增加而呈现下降趋势,但有交错现象.结论采用稳态滴注方法可以无创测定D-山梨醇肝脏清除率,它是评价肝功能性血流量和推测肝脏储备功能可靠而有效的方法,可做为肝功能Child-Pugh分级的补充.     

Intraarterial infusion of papaverine in experimental cerebral vasospasm.

PURPOSETo determine the effectiveness of intraarterial infusion of papaverine hydrochloride (PPV) in an experimental model of cerebral vasospasm and to measure the mean blood flow velocity of the middle cerebral artery (MCA).METHODSSeven Japanese monkeys were divided into three groups: those studied 3 days-after surgery (the third-day group, n = 3); those studied 7 days after surgery (the seventh-day group, n = 3); and a control group (n = 1). Vasospasm was induced in the experimental groups by placing a blood clot in the subarachnoid space around the top of the internal carotid siphon. PPV (5 mg/kg) was infused (over 60 minutes) into the internal carotid artery (ICA). The vascular diameters of the ICA and MCA were measured on angiograms before and after infusion. The mean blood flow velocity in the MCA was measured on transcranial Doppler sonograms before and 24 hours after infusion. After fixation, the MCA was dissected out, stained, and examined microscopically.RESULTSAfter vasospasm induction, both arteries were narrowed more than 30% in the third-day group and more than 50% in the seventh-day group. After PPV infusion in both groups, vascular dilatation of about 20% was seen. The mean increase in blood flow velocity in the third-day group (30%) was smaller than in the seventh-day group (70%). The mean blood flow velocity in the MCA decreased by about 30% in both groups, but increased again after 24 hours nearly to the level before PPV infusion. The intimal layer was more corrugated in the seventh-day group, and hypertrophy in the smooth muscle layer was also seen. Clinical examination showed no neurologic deficit in the third-day group 24 hours after PPV infusion; neurologic deficits were observed in the seventh-day group.CONCLUSIONPPV infusion may be more effective in early stages of vasospasm when vascular walls have fewer histologic changes.     

体表面积烧伤复苏公式补液探讨

目的 探讨大面积烧伤休克期液体复苏的方法。方法 156例以体重指数(BMI)分为三组,1组BMI<24、2组BMI24-27和3组BMI>27。全部病例假以60%TBSA,分别用中国复苏公式和体表面积复苏公式计算补液量,进行对比分析。结果 体表面积补液公式估算量为6620.79ml,稍多于中国烧伤复苏公式估算量6287.02ml(p<0.01)。进一步分析,体重指数24-27,两公式计算量无差异;BMI<24中国烧伤液体复苏公式估算量偏少;BMI>27估算量偏多。结论 传统公式估算补液量受体重影响,新公式去除体重参数避免了对估算量的影响,并引入体表面积参数矫正烧伤面积,扩大了公式的适用范围,可用于各类人群烧伤补液量的估算。     

Randomized controlled trial of a computer-assisted learning program to improve caries detection from bitewing radiographs

OBJECTIVES: To investigate whether using a computer-assisted learning (CAL) calibration program improves the accuracy of dental students in caries detection from bitewing radiographs. METHODS: Dental students were assigned to an experimental (n=33) and control (n=34) group using a randomized block design. The experimental group used the CAL program with feedback to calibrate themselves against experts in radiographic caries detection and a histological gold standard of the actual clinical condition. Feedback was provided visually of the actual tooth surface condition and in the form of graphics showing diagnostic accuracy performance measures. Performance was tested before the program (for the control group) and after the program (for the experimental group) by assessing surfaces (n=56) from a new independent digital test set of evaluation radiographs for the presence, histologically, of dentine caries (n=23). The summary receiver operating characteristic (SROC) method for summarizing true positive ratio (TPR) (sensitivity) and false positive ratio (FPR) (1-specificity) was used to analyse the dichotomous data. Differences between the control and experimental groups were tested for (a) the area under the SROC curve (A(z)) and (b) the TPR, FPR and diagnostic odds ratio (DOR) using the Mann-Whitney test (P<0.05). RESULTS: The mean TPR for dentine caries detection was 76.3% (SD 13.0%) for the experimental group and 66.9% (SD 14.8%) for the control group (P=0.005). Mean FPRs were similar (experimental 28.1% and control 28.7%; P>0.5). The area under the SROC curve A(z) was 0.832 for the experimental group and 0.773 for the control group (P=0.002). The mean DOR for dentine caries in the experimental group (12.4) was better than that in the control group (8.8) (P=0.003). CONCLUSIONS: The CAL program does improve diagnostic performance. Improving the cognitive feedback provided by the program should be considered before implementation.     

Patient-controlled analgesia after arthroscopic rotator cuff repair: subacromial catheter versus intravenous injection

BACKGROUND: No study has compared pain control results between patient-controlled subacromial infusion and intravenous injection after arthroscopic shoulder surgery. HYPOTHESIS: Subacromial infusion of analgesics are more effective in pain alleviation than intravenous injection. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHODS: The authors prospectively analyzed 40 cases of arthroscopic rotator cuff repair that received patient-controlled analgesia. They divided the 40 cases into 2 groups: subacromial infusion group with 0.5% bupivacaine (group 1, 20 cases) and intravenous injection group with fentanyl and ketorolac tromethamine (group 2, 20 cases). The visual analog scale was used to record the patient's level of pain every 12 hours until postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analog scale score during motions was 6.8 in group 1 and 5.8 in group 2. The immediate postoperative visual analog scale score was 7.6 and 7.4, respectively, for each group. At postoperative time periods, most of the scores of subacromial infusion at rest and during motions were lower than those of intravenous injection, but significant differences were not found between groups 1 and 2. CONCLUSION: Patient-controlled analgesia after arthroscopic rotator cuff repair showed that both subacromial infusion of bupivacaine and intravenous injection of fentanyl and ketorolac tromethamine were equally effective and clinically equivalent pain control methods.     

前列地尔改善慢性肾衰竭患者肾功能的作用

目的：研究分析前列地尔对慢性肾衰竭患者肾功能的治疗作用。方法选取n＝90例慢性肾衰竭患者,随机分为研究组和对照组,对照组进行常规传统治疗,研究组在常规传统治疗的基础上静脉滴注前列地尔,通过肾功能生化指标、24 h尿蛋白定量和肾脏血流动力学指标,对比分析治疗结果。结果研究组治疗效果显著好于对照组,各种检测指标明显优于对照组（P＜0.05）。结论静脉滴注前列地尔注射液,能够改善慢性肾衰竭患者的肾功能。     

术前介入化疗及栓塞对贲门癌的治疗价值

目的 探讨术前经胃左动脉灌注化疗药物及栓塞对贲门癌的治疗价值。方法 将入选病例随机分成两组:①试验组(介入化疗栓塞+手术组)30例;②对照组(单纯手术组)30例。试验组采用Seldinger穿刺插管技术将导管插至胃左动脉,采用FAM或FAD方案进行区域性灌注化疗并以明胶海绵颗粒栓塞,栓塞后7～10d行贲门癌根治术,对手术所见、病理表现及生存状况进行对照研究。结果 试验组手术所见病灶缩小(占83％),肿瘤轻度水肿,缺血,术中出血量少,手术易切除。按病理所见分为4级:0级:无效(0例);Ⅰ级:轻度有效(2例);Ⅱ级:中度有效(25例)Ⅲ级:显效(3例)。两组比较差异有显著性(P<0.01)。生存期试验组术后1、2、3年生存率分别为90.0％、80.0％和60.0％,较对照组1、2、3年生存率76.7％、66.7％和46.7％明显延长(P<0.05)。结论 术前介入化疗及栓塞能使肿瘤缩小,肿瘤显著坏死,可减少术后复发及转移,提高生存期。     

55例严重烧伤休克延迟复苏患儿补液方案分析

目的探讨严重烧伤休克延迟复苏患儿的补液方案,并分析其相关影响因素。方法回顾性分析2012年4月至2017年4月安徽医科大学第一附属医院收治的55例严重烧伤休克延迟复苏患儿的临床资料及液体复苏方案,对比补液前后患儿尿量、血红蛋白、红细胞比容变化情况,以及不同延迟复苏时间、年龄、烧伤面积、烧伤深度患儿第1个24 h平均补液量及尿量。结果根据患儿症状、体征、血生化指标以及临床监测指标对补液量及补液速度做出适当调整后,补液前8 h实际补液量为第1个24 h公式计算量的(94.8±37.1)%,第1个24 h实际补液量为第1个24 h公式计算量的(112.6±34.8)%,第2个24 h实际补液量为第2个24 h公式计算量的(78.1±23.6)%;补液后8、24、48、72 h患儿尿量均较补液前明显增多(t=5.733、13.283、17.437、14.371,P均=0.000),补液后24 h患儿血红蛋白及红细胞比容均较补液前明显降低(t=3.875、4.411,P均=0.000);年龄<3岁及烧伤面积≤30%TBSA患儿第1个24 h平均补液量明显多于年龄≥3岁、烧伤面积>30%TBSA者(t=7.117、5.662,P均=0.000);年龄<3岁患儿第1个24 h平均尿量明显多于年龄≥3岁者(t=4.803,P=0.000)。结论严重烧伤休克延迟复苏患儿液体复苏过程中应综合考虑年龄、烧伤面积等因素对补液量的影响,实施个体化液体复苏方案,而不能完全遵循补液公式。     

Diagnostic criteria for detection of postinfarction ischemia by quantitative analysis of stepwise dobutamine radionuclide ventriculography

BACKGROUND: Application of the traditional diagnostic criteria validated for exercise testing may be inappropriate when dobutamine infusion is associated with radionuclide ventriculography (RNV). The objective of this study was to establish appropriate diagnostic criteria for evaluation of dobutamine stress testing with RNV for the detection of early postinfarction ischemia. METHODS: RNV was performed at baseline and during dobutamine infusion in 10 control subjects and in 30 patients who were studied within 1 week after uncomplicated myocardial infarction. Several quantitative parameters including left ventricular ejection fraction (EF), regional EF, and absolute change in global and regional EF were tested. In addition, regional wall-motion changes were scored by visual analysis. The limit of normal response for each quantitative parameter was defined as the 95th percentile of the distribution observed in control subjects. On the basis of predischarge clinical evaluation and exercise stress testing, patients were grouped as having evidence of residual ischemia (group 1, 15 patients) or no evidence of ischemia (group 2, 15 patients). Sensitivity, specificity, and accuracy in the detection of postinfarction ischemia were calculated for each parameter, and empiric receiver-operating characteristic curves were generated. RESULTS: The limits of the normal response to dobutamine infusion in the control subjects were found to be a 7.5% and a 12.5% increase in global EF at low and high dose, respectively. Median baseline EF was significantly lower in patients than in control subjects (Mann-Whitney U test: P < .001). There were no differences in resting EF between group 1 and group 2 patients. However, median high-dose EF and increase in EF were significantly lower in group 1 as compared with group 2 patients (56% vs 72% and 5% vs 17%, respectively; Mann-Whitney U test: P < .0001 for both). A biphasic (up-and-down) response with initial increase at low dose followed by decrease or no change in EF at high dose was observed in 66% of group 1 patients and only in 13% of group 2 subjects. The best criterion for detection of postinfarction ischemia was a change of <12.5% in global EF at high-dose dobutamine infusion, with 80% predictive accuracy. The traditional criterion, a change of <5 % or a decrease in EF, yielded an accuracy of only 63%. The association of a change of <12.5% with a biphasic response increased accuracy to 87%, with a sensitivity of 93% and a specificity of 80%. Quantitative regional wall motion analysis showed greater diagnostic accuracy than visual wall motion scoring (83% vs 70%). CONCLUSIONS: Application of appropriate criteria and stepwise quantitative analysis of RNV during dobutamine infusion may increase accuracy in the detection of early postinfarction ischemia.     

Cisplatin as a radiosensitizer in the treatment of solid tumours--a clinical pilot study

A variety of experimental tumour models have shown that cisplatin in combination with ionizing radiation enhances tumour regression. To evaluate the feasibility, efficacy and toxicity of a combined regimen, 25 patients with different solid tumours were treated with cisplatin and photon irradiation. A local tumour control was achieved in 22 cases. Thirteen patients with squamous cell carcinoma of the lung (T1-3, N1-2, M0) received cisplatin (20 mg/m2 per day) on 5 consecutive days with NaCl hyperhydratation (0,9% NaCl, 2400 ml/24 hours as continuous infusion) in the first and last week of radiotherapy (5 X 2 Gy/week, 56 Gy target volume dose). 12 of 13 patients have shown local tumour control. Increased clinically evident side effects were not observed. From the underlying data the conclusion is drawn that the experimental results are reproducable under clinical conditions and that improved local tumour response rates can be achieved.