漂浮导管对重症急性胰腺炎继发脓毒血症患者临床治疗的价值研究

目的探讨分析漂浮导管技术对指导重症急性胰腺炎继发脓毒血症患者临床治疗的价值研究。方法选取2017年1月至2019年4月我院收治的重症急性胰腺炎继发脓毒血症患者60例,跟踪病情变化,其中病情好转患者40例（A组）,病情恶化患者20例（B组）。对比观察两组患者的治疗前后48 h的中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）、心率（HR）、心脏指数（CI）、外周血管阻力指数（SVRI）等指标的血流动力学变化,同时观察记录病情好转组治疗后1～6 d的血流动力学改变。结果相比于治疗前,A组患者治疗48 h后CVP、CI指标明显下降（P<0.05）,SVRI、HR、PCWP、MPAP指标明显升高（P<0.05）; B组患者治疗前后血流动力学指标差异均无统计学意义（P>0.05）。与对照值相比,A组患者治疗后1～3 d CI、CVP明显降低（P<0.05）,PCWP、SVRI明显升高（P<0.05）;治疗后4～6 d内SVRI明显降低（P<0.05）;治疗后6 d内MPAP和HR明显升高（P<0.05）。结论漂浮导管技术应用于重症急性胰腺炎继发脓毒血症患者,能够及时检测外周血管扩张和低血容量的问题,评估病情,在临床治疗的监测指导和预后评估有着重要价值     

1598例经颈内静脉带隧道中心静脉导管置入术分析

目的 探讨颈内静脉入路的带隧道中心静脉导管置管准确性和安全性的影响因素. 方法 回顾性分析2011年～2019年行颈内静脉带隧道中心静脉导管置入术的病例资料.收集人口学资料,手术相关资料,包括置管位置,是否用X线,置管失败原因,介入干预情况,干预失败原因等.研究主要终点是置管成功率和失败原因. 结果 1598例患者纳入...     

突触后密度蛋白-95在大鼠坐骨神经损伤后的表达

为了探讨突触后密度蛋白-95(PSD-95)在周围神经损伤过程中的表达变化,本实验建立大鼠坐骨神经夹伤模型,采用荧光定量PCR(real-timePCR)和Western blotting对PSD-95 mRNA及其蛋白水平进行定量检测,应用免疫荧光双标技术观察PSD-95与神经型一氧化氮合酶(nNOS)的共定位情况。结果显示,PSD-95 mRNA及其蛋白在正常坐骨神经中度表达,损伤后迅速下降;PSD-95 mRNA从损伤后2d开始表达上调;而其蛋白水平于损伤后1周明显升高。免疫荧光双标染色证实在坐骨神经损伤后1周PSD-95与nNOS共定位于Schwann细胞上,而与神经丝蛋白NF-200共定位不明显。本研究结果提示PSD-95通过nNOS参与了周围神经损伤修复过程。     

GAD67-GFP转基因小鼠三叉神经脊束核吻侧亚核和极间亚核内GABA和甘氨酸共存神经元的观察

本文以GAD67-GFP基因敲入小鼠为研究工具,利用免疫荧光组织化学双重染色技术观察了小鼠三叉神经脊束核(spi-nal trigeminalnucleus,V)的吻侧亚核(Vo)和极间亚核(Vi)神经元内谷氨酸脱羧酶67[GAD67,γ-氨基丁酸(GABA)能神经元的标识物质]和甘氨酸(glycine,Gly)的定位分布和共存情况。结果显示,在Vo和Vi内均有比较密集分布的GAD67和Gly阳性神经元。此外,在Vo和Vi内也可见一些GAD67阳性神经元同时呈Gly阳性反应,即存在GAD67/Gly双标神经元。结果表明,Vo和Vi内有GABA和Gly共存神经元,它们可能在初级传入信息的传递和调制中发挥重要作用。     

p27kip1和Skp2在损伤后大鼠坐骨神经中的表达变化

为了探讨损伤后周围神经p27kip1和S期激酶相关蛋白2(Skp2)的定位表达和变化,本实验将成年SD大鼠随机分为正常对照组、夹伤组和切断组,运用Western blot结合免疫组织化学及免疫荧光双标,在大鼠坐骨神经损伤时,对p27kip1和Skp2表达的影响进行了研究。结果表明:(1)坐骨神经夹伤后,p27kip1蛋白表达先逐渐下降,后又逐渐上升;坐骨神经切断后,远侧段p27kip1蛋白表达持续下降,而近侧段p27kip1蛋白表达在切断后6h明显下降,后又逐渐升高至正常水平,而Skp2表达变化与之相反;(2)免疫组织化学染色结果显示,坐骨神经切断后1w,远侧段从断端到末端,p27kip1阳性信号逐渐增加,而Skp2阳性信号逐渐减弱;(3)免疫荧光双标显示,正常和损伤坐骨神经的雪旺氏细胞中都有p27kip1和Skp2表达。以上结果提示:周围神经损伤后影响雪旺氏细胞中p27kip1和Skp2的表达变化,为进一步研究它们在周围神经损伤和修复中的作用机制奠定基础。     

骨髓间充质干细胞不同移植方法治疗脊髓损伤的实验研究

为探讨骨髓基质干细胞(MSCs)不同的移植方法对脊髓损伤修复的影响,我们采用静脉移植、蛛网膜下腔移植或腹腔移植荧光标记MSCs的方法检测MSCs在损伤处的分布迁移情况及运动功能恢复情况。结果显示:各种移植方法在损伤脊髓节段上、下均可检测到荧光标记的MSCs,不同移植方法在损伤脊髓内荧光标记的MSCs数量有所不同。损伤脊髓节段和非损伤脊髓节段内的细胞数量和密度也有明显差异(P<0.05)。BBB评分显示:术后第2d各组平均未超过1分者,移植后的1周内无明显差异(P>0.05);3周后,各组间差异也不大(P>0.05),但各移植组同对照组相比有明显差异(P<0.05)。以上结果提示:通过各种移植方法MSCs均可迁移到损伤脊髓节段,并在该部位存活、聚集和向损伤部位迁移,说明MSCs不同的移植方法对于治疗脊髓损伤均有一定的作用。     

脑卒中后遗症老年人易患肺炎及其影响预后的因素

目的分析影响脑卒中后遗症老年人易患肺炎及其影响预后的因素。方法分析117例脑卒中后遗症老年人因肺炎而反复住院的病史资料,对存活与病死不同转归的病人进行比较。结果53例死亡,占45．3％。单因素分析显示性别、卧床不起时间、吞咽反射障碍、血清白蛋白水平是影响脑卒中后遗症老年病人易患肺炎及其影响预后的因素。结论脑卒中后遗症老年人患肺炎及其影响预后有多方面因素,对吞咽反射障碍的病人置入鼻饲管可以改善预后。     

Evolution of ischemic stroke drug clinical trials in mainland China from 2005 to 2021

BackgroundTo assess the temporal changes in the characteristics of ischemic stroke drug clinical trials conducted in mainland China in 2005–2021.MethodsA statistical analysis of registered clinical trials on ischemic stroke was performed using the platform of the Center for Drug Evaluation of China National Medical Products Administration, the Chinese Clinical Trial Registry, and ClinicalTrials.gov websites.ResultsFrom January 1, 2005 to August 1, 2021, a total of 384 registered drug clinical trials on ischemic stroke were identified in mainland China. Over time, the number of trials gradually increased each year, with a significant growth in 2014, from 16 in 2013 to 42 in 2014. Phase IV trials (31.8%) accounted for the majority, followed by phase II (16.4%), phase I (10.9%), and phase III (8.6%). In terms of sponsorship, the proportion of investigator‐initiated trials (IITs) (60.7%) was higher than industry‐sponsored trials (ISTs) (39.3%). Additionally, trials involving traditional Chinese medicines (TCMs) (36.2%) accounted for the largest proportion, followed by trials involving antithrombotic therapy (19.5%) and cerebral protection agents (16.7%). Furthermore, over the past 17 years, the number of leading drug clinical trial units for ischemic stroke in mainland China has continuously increased. The leading principal units from Beijing, Shanghai, Guangdong, Jiangsu, and Liaoning accounted for the majority of the trials (67.4%).ConclusionIn the past 17 years, great progress has been made in the research and development (R&D) of drugs and clinical trials for ischemic stroke in mainland China. The most extensive progress was observed in TCMs, antithrombotic therapy, and cerebral protection agents. More clinical trials are needed to confirm whether the newly developed drugs can improve the clinical efficacy of ischemic stroke. Simultaneously, more pharmaceutical R&D efforts of innovative drugs are warranted.     

愈疡胶囊对细菌感染皮炎模型大鼠的抗炎作用及对TLR/NF-κB通路的影响

目的:研究愈疡胶囊对细菌感染皮炎模型大鼠的抗炎作用及对Toll样受体/核因子κB(TLR/NF-κB)通路的影响.方法:采用肉汤稀释法测定愈疡胶囊对金黄色葡萄球菌的最低抑菌浓度(MIC)和最低杀菌浓度(MBC).将50只大鼠随机分为模型组、阳性对照组(阿莫西林克拉维酸钾,以阿莫西林计120 mg/kg)和愈疡胶囊高、中...     

Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

The present study aimed to evaluate the postoperative complications and the impact of an enhanced recovery programme in patients who underwent primary surgery (including extensive upper abdominal surgery) for epithelial ovarian carcinoma (EOC). All patients with stage I–IV ovarian carcinoma who underwent primary surgery were identified, and postoperative complications were evaluated and graded according to the Clavien-Dindo classification. Of 161 patients, 46 (28.57%) underwent surgical staging, 27 (16.77%) standard cytoreduction, 12 (7.45%) en bloc debulking and 76 (47.20%) extraradical debulking. A total of 157 patients (97.52%) achieved optimal tumor reduction (<1 cm). The mean postoperative hospitalization time was 17.33±11.29 days after completion of the initial postoperative chemotherapy (IPC), and the IPC interval was 16.22±10.09 days. A total of 13 patients (8.07%) had grade 3 complications (9 with wound dehiscence, 3 with digestive tract leakage and 1 with a bladder fistula). A total of 2 patients (1.24%) had grade 4–5 complications [1 patient with severe pneumonia returned to the intensive care unit (ICU) for tracheotomy and respiration rehabilitation; the other patient died of septicemia on day 19]. The multivariate analysis of the preoperative factors revealed that a human epididymis protein 4 (HE4) level of ≥717 pM (P=0.015) and Federation International of Gynecology and Obstetrics (FIGO) stage IV (P=0.004; compared with stage IIIC) were associated with grade 3–5 complications. The bootstrap analysis revealed that a cancer antigen 125 (CA125) level of ≥1,012 U/ml (P=0.034), a HE4 level of ≥717 pM (P=0.007) and FIGO stage IV (P=0.002; compared with stage IIIC) were significantly associated with grade 3–5 complications. Meanwhile, the multivariate analysis of the postoperative factors did not reveal any risk factors associated with grade 3–5 complications; the bootstrap analysis revealed that only transfer to the ICU after surgery (P=0.026) was significantly associated with grade 3–5 complications. In conclusion, the study found that application of enhanced recovery after surgery protocols is feasible in patients with EOC, especially in those undergoing advanced extensive upper abdominal surgery, and CA125, HE4 and FIGO stage IV were related with the occurrence of adverse perioperative outcomes.