通心络胶囊治疗心绞痛43例疗效观察

我们于2004年1～12月间用通心络胶囊治疗冠心病心绞痛患者43例,并设对照组进行比较,从患者症状和心电图改善等方面观察其疗效,现报道如下.     

Peripheral Nerve Injury Sensitizes the Response to Visceral Distension but Not Its Inhibition by the Antidepressant Milnacipran

Background: Manipulations that cause hypersensitivity to visceral stimuli have been shown to also result in hypersensitivity to somatic stimuli coming from convergent dermatomes, but the converse has not been examined. The authors tested whether lumbar spinal nerve ligation in rats, a common model of neuropathic pain that results in hypersensitivity to somatic stimuli, also leads to hypersensitivity to visceral stimuli coming from convergent dermatomes and whether pharmacology of inhibition differed between these two sensory modalities.

Methods: Female Sprague-Dawley rats were anesthetized, and the left L5 and L6 spinal nerves were ligated. Animals received either intrathecal saline or milnacipran (0.1-3 [mu]g), and withdrawal thresholds to mechanical testing in the left hind paw, using von Frey filaments, and visceral testing, using balloon colorectal distension, were determined.

Results: Nerve ligation resulted in decreases in threshold to withdrawal to somatic mechanical stimulation (from 13 +/- 1.8 g to 2.7 +/- 0.7 g) and also in decreases in threshold to reflex response to visceral stimulation (from 60 mmHg to 40 mmHg). Intrathecal milnacipran increased withdrawal threshold to somatic stimulation in a dose-dependent manner but failed to alter the response to noxious visceral stimulation.     

Nuclear Factor κB and Anesthetic Preconditioning during Myocardial Ischemia-Reperfusion

Background: Volatile anesthetic preconditioning (APC) protects against myocardial ischemia-reperfusion (IR) injury, but the precise mechanisms underlying this phenomenon remain undefined. To investigate the molecular mechanism of APC in myocardial protection, the activation of nuclear factor (NF) [kappa]B and its regulated inflammatory mediators expression were examined in the current study.

Methods: Hearts from male rats were isolated, Langendorff perfused, and randomly assigned to one of three groups: (1) the control group: hearts were continuously perfused for 130 min; (2) the IR group: 30 min of equilibration, 15 min of baseline, 25 min of ischemia, 60 min of reperfusion; and (3) the APC + IR group: 30 min of equilibration, 10 min of sevoflurane exposure and a 5-min washout, 25 min of global ischemia, 60 min of reperfusion. Tissue samples were acquired at the end of reperfusion. NF-[kappa]B activity was determined by electrophoretic mobility shift assay. The NF-[kappa]B inhibitor, I[kappa]B-[alpha], was determined by Western blot analysis. Myocardial inflammatory mediators, including tumor necrosis factor [alpha], interleukin 1, intercellular adhesion molecule 1, and inducible nitric oxide synthase, were also assessed by Western blot analysis.

Results: Nuclear factor [kappa]B-DNA binding activity was significantly increased at the end of reperfusion in rat myocardium, and cytosolic I[kappa]B-[alpha] was decreased. Supershift assay revealed the involvement of NF-[kappa]B p65 and p50 subunits. APC with sevoflurane attenuated NF-[kappa]B activation and reduced the expression of tumor necrosis factor [alpha], interleukin 1, intercellular adhesion molecule 1, and inducible nitric oxide synthase. APC also reduced infarct size and creatine kinase release and improved myocardial left ventricular developed pressure during IR.     

Morphine Enhances Pharmacological Preconditioning by Isoflurane: Role of Mitochondrial KATP Channels and Opioid Receptors

Background: Adenosine triphosphate-regulated potassium channels mediate protection against myocardial infarction produced by volatile anesthetics and opioids. We tested the hypothesis that morphine enhances the protective effect of isoflurane by activating mitochondrial adenosine triphosphate-regulated potassium channels and opioid receptors.

Methods: Barbiturate-anesthetized rats (n = 131) were instrumented for measurement of hemodynamics and subjected to a 30 min coronary artery occlusion followed by 2 h of reperfusion. Myocardial infarct size was determined using triphenyltetrazolium staining. Rats were randomly assigned to receive 0.9% saline, isoflurane (0.5 and 1.0 minimum alveolar concentration [MAC]), morphine (0.1 and 0.3 mg/kg), or morphine (0.3 mg/kg) plus isoflurane (1.0 MAC). Isoflurane was administered for 30 min and discontinued 15 min before coronary occlusion. In eight additional groups of experiments, rats received 5-hydroxydecanoic acid (5-HD; 10 mg/kg) or naloxone (6 mg/kg) in the presence or absence of isoflurane, morphine, and morphine plus isoflurane.

Results: Isoflurane (1.0 MAC) and morphine (0.3 mg/kg) reduced infarct size (41 +/- 3%; n = 13 and 38 +/- 2% of the area at risk; n = 10, respectively) as compared to control experiments (59 +/- 2%; n = 10). Morphine plus isoflurane further decreased infarct size to 26 +/- 3% (n = 11). 5-HD and naloxone alone did not affect infarct size, but abolished cardioprotection produced by isoflurane, morphine, and morphine plus isoflurane.     

手腕部外伤早期处理失误的探讨

目的通过对41例手腕部外伤二次手术回顾性分析，探讨急诊处理失误的原因并提出相应的预防措施。方法1992年6月至2004年9月收治手腕部软组织损伤213例，术后41例需行二期修复，发现肌腱完全断裂18例，不完全断裂6例，正中神经与尺神经同时断裂4例，尺神经断裂7例，正中神经断裂4例，尺桡动脉同时断裂2例。结果41例行二期手术时发现有21例只缝合皮肤而未修复肌腱、神经、血管，正中神经与掌长肌肌腱吻合3例，正中神经与指浅屈肌腱吻合2例，肌腱吻合术后断裂7例，屈指肌腱术后粘连5例，桡侧腕屈肌与拇短伸肌吻合2例，尺神经结扎1例。肌腱吻合采用汤氏缝合法，术后早期主动被动功能锻炼。术后随访3～37个月功能恢复，肌腱吻合优良18例，可差6例，正中神经与尺神经损伤优良6例，可差9例，12个月后修复均为差。结论重视手外伤的急诊处理，一期正确修复是恢复手功能的关键，全面认真细致的检查是正确实施手术方案的基础，普及手部创伤修复知识、积极培养手外科专业人才是防止的有效手段。肌腱吻合我们提倡用汤氏缝合，术后早期功能锻炼，二期手术时间越长，效果越差。     

多巴胺转运体440bp等位基因与儿童孤独症的关系

目的探讨儿童孤独症(CA)与多巴胺转运体(DAT1)440bp等位基因的关系。 方法陕西省纺织医院等于2004年3~8月，采用PCR技术对来自西安市两所康复中心的汉族CA儿童与DAT1基因多态性进行遗传关联分析。 结果(1)DAT1基因多态性中共观察到5种等位基因(320bp，360bp，440bp，480bp，520bp)，6种基因型(480/480，480/320，520/480，480/360，480/440,440/440)。(2)使用相对危险度RR对CA与DAT1基因多态性的等位基因和基因型进行关联分析，显示480/440基因型和等位基因440与CA呈正关联，相对危险度分别为265和230，480/480基因型和等位基因480与CA呈负关联，相对危险度分别为064和077。但统计结果没有发现具有统计意义的差异。 结论中国汉族CA儿童与DAT1440bp等位基因无遗传关联。也许等位基因440bp与基因型480bp/440bp这两个因素是发病的风险因素,还有待今后的进一步研究。     

内镜检查患者的满意度与不良耐受:对其评估和预测工具的发展状况研究

本文目的是检验一种用于量化和预测内镜检查患者的不良体验的一种问卷调查的可靠性。分别给予目前常规接受内镜检查的患者2份问卷(操作前及操作后)。第1份问卷包括人口统计学资料、既往内镜检查史、用药或饮酒史、患者期望值、操作前的焦虑及紧张程度。内镜检查后,重新确定患者的耐受性和意愿。内镜检查后对患者进行重复内镜检查的总体满意度或不情愿的主要结果评分≥5确定为“内镜检查的不良体验”(A EE)。148例受试者中有13例报告有AEE。通过对与不良反应如疼痛、紧张和操作期间的损伤情况明显相关的可靠分析,确定测定主要结果的项目。…     

经尿道电灼术治疗腺性膀胱炎23例并文献复习

目的 探讨腺性膀胱炎的诊断和治疗及疗效.方法 对23例腺性膀胱炎的临床表现、辅助诊断及治疗情况进行回顾性分析.结果 23例均采用经尿道电灼术治疗及术后采用化疗药物常规作膀胱腔内灌注,无特殊并发症发生,无一例复发.结论 对于腺性膀胱炎膀胱镜检查是初步诊断的依据,主要靠病理来确诊.经尿道电灼术加腔内化疗是有效的方法.