急性胰腺炎患者空腹高血糖发生率及其危险因素分析

目的:回顾性分析急性胰腺炎(AP)患者空腹高血糖发生率及其危险因素。方法:收集2018-01—2018-12武汉大学人民医院胰腺外科133例AP且无糖尿病(DM)病史的住院患者病历资料,按照不同性别、年龄、AP临床分型、病因、CT指数评分(CISI)等分组,χ2检验分析各组临床因素与空腹高血糖(FPG≥6.1mmol/L)发生率的关系,多因素二元logistic回归分析空腹高血糖独立危险因素。结果:AP临床分型(χ2=5.494,P=0.019)和CTSI(χ2=6.236,P=0.013)与AP患者空腹高血糖相关(P<0.05)。CTSI≥6分(P=0.015,OR=2.920,95%Cl=1.234—6.905)为AP患者空腹高血糖的独立危险因素(P<0.05)。结论:临床分型中重症+重症及CTSI≥6分的AP患者易发生空腹高血糖,尤其CTSI≥6分是AP后空腹高血糖的独立危险因素,临床应高度关注。     

全膝关节置换后不放置引流的相关管理策略

背景:近年来,随着全膝关节置换技术提升、手术时间缩短、术中及术后止血药的应用,其总失血量不断减少,术后引流量也逐渐减少,术后快速康复理论应运而生,引流管放置也再次成为骨科医生所热议的问题,越来越多的医生认为可以常规取消放置引流,引流似乎已可有可无。目的:旨在复习既往文献,对全膝关节置换后引流放置的相关问题归纳总结,提供围术期引流管理的相关经验。方法:检索中国知网、万方、维普、中国生物医学文献数据库等中文数据库,以及PubMed、The Cochrane Library、WebofScience、EMBASE、OVID等外文数据库,以"引流,膝关节置换术"及"totalknee arthroplasty,drainage"为检索词,检索自建库始至2020年2月为止所有与主题相关的文献,总结归纳全膝关节置换后不放置引流管围术期各方面需综合考虑的要素。结果与结论:①引流管的放置问题关乎全膝关节置换手术的最终结果,与术后出血、血肿、血栓、感染等并发症的发生关系密切;②目前全膝关节置换术后不推荐常规放置引流,但不意味着不需要管理,其实际上对临床医护在围术期各方面的管理提出更高的要求,包括但不限于术前适应证选择、手术操作、止血带使用、术中及术后药物使用、物理疗法的使用等。     

盲人智能探路手杖的研究

本文介绍了盲人智能探路手杖的研究.该系统由单片机控制,采用两只超声波传感器的探测模式,对盲人行进路上的路况进行探测和分析,并针对不同的路况发出相应的提示信息,以达到辅助盲人安全行走的目的.     

Platelet-activating factor (PAF)-dependent biochemical, morphologic, and physiologic responses of human platelets: demonstration of translocation of protein kinase C associated with protein phosphorylation

Platelet-activating factor (PAF) is a potent stimulus for platelet aggregation and secretion. PAF has been shown to stimulate the phosphatidylinositol (PI) pathway in platelets, which implies that PAF should activate protein kinase C. In this study, measurements of PI metabolites, the elevation of intracellular free calcium concentration, (Ca2+)i, the activation of protein kinase C, and the phosphorylation of platelet proteins (using a two-dimensional gel electrophoretic technique) were performed before and after the addition of 10(-8) M PAF to human platelets. These findings were correlated with morphologic changes in the platelets as determined by immunoelectron microscopic studies on the cytoskeleton and by X-ray analysis of dense bodies. The results show that PAF stimulates the production of PI metabolites and causes an increase in the membrane-associated activity of protein kinase C. These changes are accompanied by a rise in the (Ca2+)i and protein phosphorylation. The increase in protein kinase C activity reaches a maximum at approximately 60 s, a time frame that is consistent with the protein phosphorylation and the subsequent morphologic and secretory events. X-ray analysis revealed two types of dense bodies containing various amounts of calcium which appeared to be released sequentially after PAF activation. These results suggest that the protein phosphorylation that controls the physiologic events resulting from PAF activation of human platelets is catalyzed by protein kinase C.     

慢性乙型肝炎患者肝组织中HBV抗原表达特征及其临床意义

目的探讨慢性乙型病毒性肝炎肝活检组织中检测乙肝表面抗原(HBsAg)和乙肝核心抗原(HBcAg)表达强度及表达方式的必要性。方法采用EnVision免疫组织化学法检测196例慢性乙型肝炎患者肝穿组织中HBsAg和HBcAg的表达水平,并用荧光定量PCR检测其血清中的HBV DNA的含量。对肝组织进行炎症活动度分级和纤维化分期。结果肝组织中的HBsAg表达强度和表达方式与炎症分级、纤维化分期和血清乙肝病毒载量均无相关性(P>0.05)。HBcAg表达强度与炎症分级无相关性(r=-0.02,P>0.05);与纤维化分期呈负相关(r=-0.28,P<0.01);与血清乙肝病毒载量呈正相关(r=0.53,P<0.01)。HBcAg表达方式与炎症分级为负相关(r=-0.27,P<0.01),其中浆型组炎症活动度分级高于核型组和混合型组(P<0.01),混合型组高于核型组(P<0.01)。HBcAg表达方式与纤维化分期亦呈较弱的负相关(r=-0.23,P<0.01),其中浆型组纤维化分期高于核型组和混合型组(P<0.05)。HBcAg表达方式与血清乙肝病毒载量呈正相关(r=0.22,P<0.01)。结论区分肝组织中的HBsAg表达强度和表达方式无益于了解慢性乙型肝炎患者肝损害的程度,而检测肝组织中的HBcAg则有助于临床抗病毒治疗。     

A Ser(365)-->Cys mutation of fibroblast growth factor receptor 3 in mouse downregulates Ihh/PTHrP signals and causes severe achondroplasia

Missense mutations in fibroblast growth factor receptor 3 (FGFR3) result in several types of human skeletal dysplasia, including the neonatally lethal dwarfism known as thanatophoric dysplasia. An engineered Ser(365)-->Cys substitution in mouse FGFR3, which is equivalent to a mutation associated with thanatophoric dysplasia-I in humans, has now been shown to cause severe dwarfism but not neonatal death. The mutant mice exhibit shortened limbs as a result of markedly reduced proliferation and impaired differentiation of growth plate chondrocytes. The receptor-activating mutation also resulted in downregulation of expression of the Indian hedgehog (IHH) and parathyroid hormone-related protein (PTHrP) receptor genes, both of which are important for bone growth. Interactions between FGFR3- and PTHrP-receptor-mediated signals during endochondral ossification were examined with embryonic metatarsal bones maintained in culture under defined conditions. Consistent with the in vivo observations, FGF2 inhibited bone growth in culture and induced downregulation of IHH and PTHrP receptor gene expression. Furthermore, PTHrP partially reversed the inhibition of long bone growth caused by activation of FGFR3; however, it impaired the differentiation of chondrocytes in an FGFR3-independent manner. These observations suggest that FGFR3 and IHH-PTHrP signals are transmitted by two interacting parallel pathways that mediate both overlapping and distinct functions during endochondral ossification.     

经皮微创植入锁定钢板治疗胫骨远端骨折

目的探讨应用胫骨远端锁定钢板经皮微创植入治疗胫骨远端骨折的疗效。方法自2010年1月~2012年12月应用小切口植入胫骨远端锁定钢板治疗32例胫骨远端骨折,男19例,女13例,年龄13~77岁,平均39.8岁。其中开放性骨折4例,闭合性骨折28例,均为新鲜骨折。结果 29例获得随访,随访时间6~15个月,平均11.7个月。所有骨折均愈合,平均愈合时间为13.6周,均无感染、骨不连、钢板松动等并发症。按照Mazur踝关节功能评分:优19例,良8例,可2例,优良率为93.1%。结论微创钢板内固定手术创伤小,固定可靠,骨折愈合率高,符合生物学固定原则。     

聚焦超声结合原卟啉Ⅸ对S180肿瘤细胞杀伤作用的研究

采用频率为2.2 MHz及不同强度的聚焦超声激活原卟啉Ⅸ对小鼠腹水型S180肿瘤细胞的杀伤作用进行研究.台盼蓝拒染法检测了不同处理后细胞的相对存活率,通过扫描电镜和透射电镜观察细胞超微结构的变化.实验结果表明:单纯原卟啉Ⅸ对S180肿瘤细胞几乎没有影响,单纯超声和超声结合原卟啉Ⅸ对细胞均有一定的损伤,肿瘤细胞受损程度随着声照强度的增加而加剧,并且在一定范围内随着原卟啉剂量浓度的加大,细胞受损也逐渐增强.当原卟啉Ⅸ浓度为120 μM时,超声激活原卟啉Ⅸ对腹水型S180肿瘤细胞的协同杀伤效应表现最为明显.     

内毒素介导的肾脏病变及其发生机理的实验研究

研究内毒素介导的大鼠肾功能和形态变化，并探讨其发生机理。结果发现：肾功能于注射内毒素（ＬＰＳ）后１ｈ明显减退，５ｈ达高峰，４８ｈ基本恢复。肾小球出现早期短暂的毛细血管收缩，随后扩张，肾小球内中性粒细胞和血小板聚集，内皮细胞和系膜细胞肿胀或增生，足细胞足突融合，基底膜局部增厚等形态学改变，并且有肾组织中ＴＸＢ＿２，６－ｋｅｔｏ－ＰＧＦ＿（１α）及丙二醛含量增高。作者推测，ＴＸＢ＿２、６－ｋｅｔｏ－ＰＧＦ＿（１α）含量升高和两者间比例失衡可能是ＬＰＳ介导肾功能障碍的重要起始因素，氧自由基在ＬＰＳ介导的肾功能障碍发生、发展中起重要作用。