甲磺酸罗比卡因与盐酸罗比卡因用于硬膜外阻滞的效应比较

目的 评价甲磺酸罗比卡因用于硬膜外阻滞的效应和安全性。方法 45例择期行下腹或下肢手术病人,随机分别接受用甲磺酸罗比卡因(8.94 mg/ml,观察组)或盐酸罗比卡因(7.5mg/ml,对照组)施行的硬膜外阻滞。观察两组在感觉阻滞、运动阻滞、镇痛和肌肉松弛方面的效果,同时观察用药前后肝肾功能变化。结果 观察组和对照组感觉阻滞平面达到T6以上的病例分别为84.3％和76％(P>0.05),Bromage≥3级的病例分别90％和92％(P>0.05)。两组感觉阻滞平面固定时间、Bromage达到最大级别时间、最大级别维持时间和运动阻滞维持时间均无显著性差异(P>0.05)。两组镇痛及肌松满意率无显著性差异。观察组术中2例发生低血压,2例发生心动过缓,而对照组仅1例发生低血压。两组术后24 h天冬氨酸氨基转移酶(AST)、天冬氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)均在正常范围。结论 甲磺酸罗比卡因与盐酸罗比卡因行硬膜外阻滞的效应基本相同,且无明显毒性。     

多站点综合性毕业考试的改革与实践

我校改革临床医学专业毕业考试模式与方法，在临床实习过程中组织多站点综合性考试，采用闭卷笔试方法考核临床理论知识，占70％；采用实践操作与现场口试方法考核临床技能及相关知识，占20％；采用开卷笔试方法考核医疗文书书写，占10％。实践证明，此项改革能促进医学生端正实习态度，调动实习的积极性与主动性，引导医学生在实习中重视理论学习与临床实践的密切结合，促进临床教学质量的提高。     

神经导航下经岩骨幕上下联合入路中面神经管的解剖研究

OBJECTIVE: To study the value of neuronavigation in the transpetroal approach, and to provide anatomic data for the protection of the nerves in the facial nerve canal (FNC) during surgeries. METHODS: Simulated surgery through the transpetroal approach was performed on 16 sides of 8 adult cadaver heads with the assistance by neuronavigation. The anatomy of the facial nerve and the relationship of related structures were observed and the distances from the utmost external edge of the mastoid to different segments of the FNC were measured. RESULTS: Neuronavigation was successful with all the FNC, with the mean error of less than 0.9 mm. The FNC could be divided into 3 segments, the labyrinthine, the tympanic and the mastoid segments, stretching 3.6+/-1.2 mm, 11.2+/-2.5 mm and 16.1+/-3.6 mm respectively and with diameters of 1.2+/-0.3 mm, 1.4+/-0.1 mm and 1.7+/-0.2 mm, respectively. CONCLUSION: Neuronavigation may help protect the FNC during surgical procedures, and a thorough knowledge of the anatomic features of the FNC can be significant for preservation of the facial nerves.     

市级医院临床护士工作压力调查

目的:调查分析邯郸市第四医院141名临床护士的工作压力情况,为寻找减轻压力措施及提高护理工作质量提供实验数据。方法:2004-02-06/2004-02-10对邯郸市第四医院141名护士采用自填式问卷进行调查,问卷内容分为引起护士压力的常见因素及压力程度两部分。引起压力常见因素包括:担心差错事故、生活规律改变、晋升问题、人际关系、工作任务繁重、工资收入、学习考试。压力程度:压力很大指护理人员自我感觉疲惫心慌,对日常工作和生活造成显著的影响;压力较大指自我感觉压力较大,对日常工作和生活有一定程度的影响;压力一般指自我感觉存在一定程度的压力,但主观上能够适应,对自己不是一种负担;没有压力指工作轻松愉快,主观感觉没有任何不适应。结果:①不同科室压力分布:内科系统45名中有8名认为压力很大或较大,外科系统62名中有34名认为压力很大或较大,急诊科15名中有13名认为自己的工作压力较大。与内科系统比较,外科系统、急诊科普遍认为工作压力较大(P<0.01或0.05)。②年龄、性别、职称、学历对压力分布的影响:年龄、性别、职称、学历对护士压力分布无明显影响(P>0.05)。③各种压力因素及所占比例分析:担心差错事故的发生位居首位,高达78.01%;其次为生活规律改变及晋升问题,分别为48.94%和47.52%。结论:临床护士压力分布是不平衡的,外科系统和急诊科的工作压力相对较大,担心差错事故发生是引起护士压力的主要因素。     

Angiopoietin1/Tie2 and VEGF/Flk1 induced by MSC treatment amplifies angiogenesis and vascular stabilization after stroke.

Bone marrow stromal cells (MSCs) increase vascular endothelial growth factor (VEGF) expression and promote angiogenesis after stroke. Angiopoietin-1 (Ang1) and its receptor Tie2 mediate vascular integrity and angiogenesis as does VEGF and its receptors. In this study, we tested whether MSC treatment of stroke increases Ang1/Tie2 expression, and whether Ang1/Tie2 with VEGF/ vascular endothelial growth factor receptor 2 (VEGFR2) (Flk1), in combination, induced by MSCs enhances angiogenesis and vascular integrity. Male Wistar rats were subjected to middle cerebral artery occlusion (MCAo) and treated with or without MSCs. Marrow stromal cell treatment significantly decreased blood-brain barrier (BBB) leakage and increased Ang1, Tie2, and occludin (a tight junction protein) expression in the ischemic border compared with MCAo control. To further test the mechanisms of MSC-induced angiogenesis and vascular stabilization, cocultures of MSCs with mouse brain endothelial cells (MBECs) or astrocytes were performed. Supernatant derived from MSCs cocultured with MBECs significantly increased MBEC expression of Ang1/Tie2 and Flk1 compared with MBEC alone. Marrow stromal cells cocultured with astrocytes also significantly increased astrocyte VEGF and Ang1/Tie2 expression compared with astrocyte culture alone. Conditioned media from MSCs alone, and media from cocultures of MSCs with astrocytes or MBECs, all significantly increased capillary tube-like formation of MBEC compared with control Dulbecco's modified Eagle's medium media. Inhibition of Flk1 and/or Ang1 significantly decreased MSC-induced MBEC tube formation. Knockdown of Tie2 expression in MBECs significantly inhibited MSC-induced tube formation. Our data indicate MSC treatment of stroke promotes angiogenesis and vascular stabilization, which is at least partially mediated by VEGF/Flk1 and Ang1/Tie2.     

海水浸泡对腹部开放伤实验犬肝脏功能及形态学的影响

目的 探讨腹部开放伤后海水浸泡对实验犬肝功能及肝脏病理形态学的影响.方法 20只实验犬致伤后随机分为对照组(n=10)和浸泡组(n=10).对照组为单纯腹部外伤,浸泡组于致伤后置入人工配制的海水中.分别于致伤前(0h)及出水后4、8、12、16、20h取血测定总胆红素(TB)、ALT、AST、LDH、血氨(NH3)、凝血酶原时间(PT)、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、内毒素(ETX)水平,于24h处死动物对肝组织进行病理检查.结果 与对照组比较,浸泡组TB、ALT、AST和PT增高,16h后升高明显.浸泡组伤后4h和12h LDH明显高于对照组,伤后4h血NH3明显高于对照组(P＜0.05).TNF-α、IL-6和ETX的变化与肝功能的损害程度呈正比.与对照组比较,浸泡组肝脏的病理形态学改变明显.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.     

The upregulation of glial glutamate transporter-1 participates in the induction of brain ischemic tolerance in rats.

Glial glutamate transporter-1 (GLT-1) plays an essential role in removing glutamate from the extracellular space and maintaining the glutamate below neurotoxic level in the brain. To explore whether GLT-1 plays a role in the acquisition of brain ischemic tolerance (BIT) induced by cerebral ischemic preconditioning (CIP), the present study was undertaken to observe in vivo changes in the expression of GLT-1 and glial fibrillary acidic protein (GFAP) in the CA1 hippocampus during the induction of BIT, and the effect of dihydrokainate (DHK), an inhibitor of GLT-1, on the acquisition of BIT in rats. Immunohistochemistry for GFAP showed that the processes of astrocytes were prolonged after a CIP 2 days before the lethal ischemic insult, which could protect pyramidal neurons in the CA1 hippocampus against delayed neuronal death induced normally by lethal ischemic insult. The prolonged processes extended into the area between the pyramidal neurons and tightly surrounded them. These changes made the pyramidal layer look like a 'shape grid'. Simultaneously, the prolonged and extended processes showed a great deal of GLT-1. Western blotting analysis showed significant upregulation of GLT-1 expression after the CIP, especially when it was administered 2 days before the subsequent lethal ischemic insult. Neuropathological evaluation by thionin staining showed that DHK dose-dependently blocked the protective role of CIP against delayed neuronal death induced normally by lethal brain ischemia. It might be concluded that the surrounding of pyramidal neurons by astrocytes and upregulation of GLT-1 induced by CIP played an important role in the acquisition of the BIT induced by CIP.     

Ⅳ型胶原、MMP-9和TIMP-1基因表达在早期放射性肺纤维化启动中的作用

目的 观察早期放射性肺纤维化启动过程中Ⅳ型胶原、明胶酶B(MMP-9)、金属蛋白酶1组织抑制剂(TIMP-1)的基因表达特点,探讨其在放射性肺损伤中的作用.方法 C57小鼠于20Gy 60Co γ射线全肺照射后照射后1、2、4周活杀,每个时间点分别配有相应的正常对照组.RT-PCR检测Ⅳ型胶原、MMP-9、TIMP-1 mRNA水平的变化,并应用图像分析仪测定电泳条带的平均光密度值.结果 Ⅳ型胶原mRNA于照射后1周开始增高(0.202),4周达高峰(0.340);MMP-9 mRNA于照射后1周即有明显增高并且达到高峰(0.730),于第2周开始降低(0.592);TIMP-1 mRNA于照射后1周开始轻度增加(0.987),4周时达高峰(2.027).结论 60Co γ射线可刺激Ⅳ型胶原、MMP-9和TIMP-1 mRNA的表达,但随照射后时间的延长呈现不同的变化趋势,它们之间的相互制约导致了放射性肺损伤早期的组织重建,与后来形成的肺纤维化有必然的内在联系.     

Fas和mdr-1在急性白血病的表达及其相关性研究

本研究应用流式细胞仪 (FCM)直接免疫荧光法和半定量RT PCR方法分别测定 5 9例初发急性白血病(AL)患者治疗前及完全缓解 (completeremission ,CR)后骨髓Fas和mdr 1mRNA表达情况 ,旨在探讨Fas和mdr 1在AL的表达及二者在多药耐药 (multidrugresistance ,MDR)中的相关性。结果显示 :Fas在初发AML阳性表达率比ALL高 ,两表达率间有差异 (P <0 .0 5 ) ,mdr 1在AML和ALL阳性表达率间无差异 (P >0 .0 5 ) ,Fas 与mdr 1 有负相关性 (r =- 0 .2 82 ,P <0 .0 5 ) ;经单因素及多因素COX分析 ,Fas和mdr 1独立于其他参数 ,更具判断预后价值 ;在Fas 与Fas-的AML和AL ,CR率均有显著性差异 (P <0 .0 1) ,在mdr 1 、mdr 1-的AML和AL中的CR率有显著性差异 (P <0 .0 1) ;经Logrank检验 ,Fas 与Fas-组CR率及中数缓解时间有显著性差异 (χ2 =7.35 ,P =0 .0 0 6 7) ,mdr 1 与mdr 1-组CR率及中数缓解时间有显著性差异 (χ2 =10 .71,P =0 .0 0 11)。结论 :Fas、mdr 1与疗效高度相关 ;Fas阳性表达可能是AL预后良好因素 ;mdr 1为疗效差、预后不良的重要因素。     

老年人与青年人皮肤血流量比较研究

目的 判定增龄对皮肤血流量的影响。方法 用PIM2-LDPI检测皮肤血流量。结果 老年组前额、左手指背、命门穴部位皮肤血流量分别为:(1.94±0.86)V,(1.92±0.52)V和(0.71±0.19)V,与青年组比较差异无显著性。但是,老年男性在命门穴的皮肤血流量明显高于青年男性(P<0.05),老年女性前额的皮肤血流量明显降低(P<0.01)。男性比女性的皮肤血流量高。结论 皮肤血流量的差异无年龄相关性,男性组的皮肤血流量比女性组高。