急性重症胆管炎大鼠肝肺组织内TNF_α、IL-1β的mRNA表达及活血清解灵的调节作用

目的 :观察大鼠ACST时肝肺组织内TNFα、IL 1β的mRNA变化 ,以及应用活血清解灵进行中西医结合治疗的调节作用。 方法 :通过胆总管远端结扎 ,近端注入菌液并封闭的方法 ,造成大鼠ACST模型。采用单纯胆管减压、胆管减压配合活血清解灵两种不同方法治疗。应用原位杂交的方法检测肝肺组织内TNFα、IL 1β的mRNA表达。 结果 :IL 1β、TNFα 的mR NA杂交信号主要位于巨噬细胞内。模型组明显高于假手术组 ,中药组的阳性细胞数和表达量明显低于模型组 ,减压组与模型组相似。 结论 :ACST时肝肺巨噬细胞释放大量的炎性细胞因子 ,活血清解灵具有显著的免疫调节效应。     

The intubating laryngeal mask airway in severe ankylosing spondylitis

PURPOSE: To evaluate the use of inhalational induction followed by intubation through the intubating laryngeal mask (ILM) for patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia. METHODS: Nine patients undergoing a total of 11 procedures were enrolled in the study. Fentanyl 2 microg*kg(-1), midazolam 0.035 mg*kg(-1) and sevoflurane in oxygen 100% were used for induction. The ILM was inserted when the end-tidal sevoflurane concentration reached 3%. After an effective airway was established, atracurium 0.5 mg*kg(-1) was given. A polyvinyl chloride tube in the reversed position using a blind technique was used to intubate the trachea. RESULTS: The ILM provided an effective airway on 11/11 occasions at the first attempt. Intubation was successful at the first attempt on 7/11 occasions, at the second attempt on 2/11 and at the third attempt in 1/11. Intubation failed in one patient. The mean (range) minimal oxygen saturation was 99.4% (97-100%). There were no problems with ILM removal. CONCLUSION: Inhalational induction followed by ILM insertion and blind intubation is a reasonable option in patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia.     

Intoxicated motor vehicle passengers warrant screening and treatment similar to intoxicated drivers.

BACKGROUND: Alcohol interventions decrease alcohol consumption and recurrent injury. The study hypotheses are (1) intoxicated passengers are similar to intoxicated drivers in crashes and driving under the influence of alcohol (DUI), and (2) DUI conviction rates after injury are low. METHODS: Intoxicated motor vehicle occupants hospitalized for injury in 1996-1998 were matched to the state traffic database for crashes and DUI. Drivers and passengers were compared for crashes and DUI in the 2 years preceding and 1 year after admission. Driver DUI citation at the time of admission was also recorded. A logistic regression model for crash and DUI probability was constructed. RESULTS: Six hundred seventy-four patients met inclusion criteria. In the 2 years preceding admission, passengers and drivers were equally cited for crashes (14.7% vs 19.3%, p = 0.12). In 1 year after admission, they were also equally cited (7.1% vs 7.7%, p = 0.92). Driver/passenger status was not a predictor by logistic regression; 13.4% of intoxicated drivers were convicted of DUI for the admitting crash. CONCLUSION: Intoxicated passengers and drivers are equally likely to be cited for crashes and DUI before and after admission for injury. Few admitted intoxicated drivers are convicted of DUI. Screening and intervention for all intoxicated crash occupants is warranted.     

Intraarterial administration of marrow stromal cells in a rat model of traumatic brain injury.

To test the efficacy of various delivery routes of stem cells to treat cerebral injury, we investigated the parenchymal distribution of marrow stromal cells (MSCs) injected into the internal carotid artery (ICA) of the adult rat after traumatic brain injury (TBI). Bromodeoxyuridine (BrdU)-labeled MSCs were injected via the ipsilateral ICA at 24 h after TBI. Using histology and immunohistochemistry, the distribution of implanted MSCs was analyzed at 7 days after transplantation. Four groups (n = 4/group) were studied: group 1, animals transplanted with MSCs cultured with NGF and BDNF at 24 h after TBI; group 2, animals transplanted with MSCs cultured without NGF and BDNF; group 3, animals injected with a placebo, phosphate buffered saline into the ICA at 24 h after TBI; and group 4, rats subjected to TBI only. In groups 1 and 2, BrdU-positive cells were localized to the boundary zone of the lesion, corpus callosum and cortex of the ipsilateral hemisphere. The number of BrdU-positive cells was significantly higher in the ipsilateral hemisphere than in the contralateral hemisphere. More MSCs infused intraarterially engrafted in group 1 (18.9%) than in group 2 (14.4%, p < 0.05). Using double staining, BrdU-positive cells expressed MAP-2, NeuN, and GFAP in both groups 1 and 2, with this expression being greater in group 1 and the difference between two groups reaching statistical significance in case of MAP-2. Our data suggest that intraarterial transplantation of MSCs is a viable route for the intracerebral administration of MSCs for the treatment of TBI, since MSCs infused intraarterially after TBI survive and migrate into the brain. Some implanted MSCs express proteins specific to neurons and astrocytes. The addition of NGF and BDNF promote migration of MSCs into the brain and subsequent expression of neuronal protein MAP-2.     

带非可吸收线锚钉系统治疗跟腱断裂

<正>跟腱断裂是创伤外科中较常见的疾病。临床大多采取手术治疗,术式和所用材料多样,各种并发症也多见报道。尤其是接近于止点处跟腱断裂的治疗,临床疗效不佳,腱骨融合率低,出现感染及跟腱再断概率较大。自2006年5月至2009年2月应用带非可吸收线锚钉系统治疗跟腱断裂28例,疗效满意,报告如下。1临床资料     

口内切口内窥镜直视下下颌角缩小整形术

目的：口内切口下颌角整形由于切口和解剖结构的限制,手术视野和操作空间较为局限,我们希望借助内窥镜技术,来探寻一种直视下操作的下颌角整形手术方法。方法：采用全口内切口,内窥镜下设计画线,磨削减薄下颌骨外板、弧形切除肥大的下颌角、斜面修整下颌缘,在直视下使下颌骨三维立体缩小。结果：2005年以来,我们应用全口内切口入路内窥镜下下颌角缩小整形术256例,效果满意。结论：①全口内切口入路,体表不会遗留任何手术痕迹;②内窥镜下设计画线,准确对称;手术操作均在直视下进行,安全可靠;③手术采用弧形去除肥大的下颌角,使下颌角弧度自然完美;完整削薄下颌骨外板,使面部正面完整缩小;精细修整下颌缘,使整个下颌部位轮廓更加流畅柔美,从而面中下部位立体有效地缩窄。     

体外受精-胚胎移植妇女取卵前焦虑与家庭亲密度和适应性的相关分析

目的探讨体外受精-胚胎移植妇女取卵前焦虑状态及相关因素。方法采用自评焦虑量表(SAS)和家庭亲密度和适应性量表(FACES II-CV),对128例在北京市某三级甲等医院生殖中心接受体外受精-胚胎移植的妇女进行测评。结果体外受精-胚胎移植妇女取卵前焦虑状态的评分为(40.48±7.88),有13例(10.16%)妇女处于焦虑状态;家庭亲密度得分显著高于普通家庭(P0.05),家庭适应性得分与普通家庭无差异(P0.05);焦虑与患者的年龄、家庭月收入、家庭适应性和家庭亲密度呈负相关(P0.05)。结论本次调查的体外受精-胚胎移植妇女焦虑状态较轻,仅少数处于轻、中度焦虑状态。良好的家庭亲密度和适应性及较高的家庭月收入,有助于缓解体外受精-胚胎移植妇女的焦虑情绪。     

药物流产妇女对相关知识认知及需求状况调查

目的了解药物流产妇女对相关知识的认知及需求状况。方法采用自设问卷对在计划生育门诊接受药物流产的91例妇女进行调查。结果妇女药物流产相关知识平均得分为(5.1±1.8)分,84.6%～98.9%的妇女很需要和需要了解药物流产的不良反应、成功指征、禁忌证、药物流产的具体方法等知识,34.1%～49.5%的妇女选择个体指导、知识手册和电话咨询的健康教育形式。结论药物流产妇女缺乏药物流产相关知识,其对药物流产相关知识的需求较强烈,护理人员应采取针对性进行药物流产相关知识教育,并加强对其生殖健康知识的指导。     

专科护生对临床带教教师教学行为的评价

目的比较专科护生实习前对临床带教教师教学行为的理想评价及其实习后的实际评价。方法采用临床带教教师有效教学行为问卷(NCTEI)对191名二年级专科护生于实习前后进行调查。结果实习前护生对NCTEI5个维度的理想评价从高到低排序为教学能力4.27±0.66、评价4.24±0.67、人际关系4.21±0.70、护理能力4.13±0.65、个性特征4.05±0.71,实习后其实际评价从高到低排序为个性特征4.02±0.19、教学能力4.01±0.15、人际关系4.01±0.23、评价3.98±0.06、护理能力3.93±0.23,除个性特征外,其余4个方面的理想评价显著高于实际评价得分(P0.05,P0.01)。前10位教学行为中仅有1项教学行为,护生的理想评价与实际评价之间没有差异(P0.05);后10位教学行为中有1项教学行为,护生的理想评价与实际评价之间有差异(P0.01)。结论临床带教教师的有效教学行为总体得到专科护生的认可,但与护生期望值仍存在差距,应建立健全临床教学相关制度或机制,以进一步改善临床带教教师的教学行为。     

硬脊膜内背侧动静脉瘘的显微外科治疗

目的 探讨硬脊膜内背侧动静脉瘘的显微外科治疗及其疗效,初步探索术中吲哚菁绿荧光血管造影的应用.方法 2004年1月至2008年8月共有24例硬脊膜内背侧动静脉瘘患者进行了半椎板切除显微外科治疗并获得随访.其中2例为先接受介入栓塞治疗,后因复发再接受外科手术治疗.3例接受术中吲哚菁绿荧光血管造影.脊髓功能评价采用改良阿米诺夫量表,结合影像学检查结果对术后疗效进行综合评价.结果 术后平均随访36个月,影像学随访未见病变残留或复发.脊髓功能评价16例为优,阿米诺夫评分平均0.7分;4例为良,平均4.8分;3例为中,平均6.7分;1例为差,平均9.0分.综合疗效评价,治愈16例,改善6例,无变化2例.结论 单侧半椎板切除入路显微外科治疗足对硬脊膜内背侧动静脉瘘的有效治疗方法,术中吲哚菁绿荧光血管造影有助于手术.