快速骨髓腔穿刺输液在创伤性休克患者院前急救中的应用

目的探讨快速骨髓腔穿刺输液在创伤性休克患者院前急救中的应用。方法选取2016年1月至2017年12月院前急救中遇到的创伤性休克患者60例,并按输液方式的不同等分为常规静脉输液组和骨髓腔穿刺输液组。观察两组患者建立有效输液通道的时间、输液速度、血压回升所需时间、抢救有效率及并发症发生率。结果快速骨髓腔穿刺输液组建立有效输液通道所用时间明显短于常规静脉输液组,差异有统计学意义(P0.05);快速骨髓腔穿刺输液组并发症发生率低于常规静脉输液组,但差异无统计学意义(P0.05);快速骨髓腔穿刺输液组抢救有效率明显高于常规静脉输液组,差异有统计学意义(P0.05)。结论创伤性休克患者在院前急救中采用快速骨髓腔穿刺输液可有效缩短静脉通道建立时间,提高抢救有效率,临床应用效果较优。     

高效液相色谱法测定大鼠心肌中腺苷的含量

目的：建立高效液相色谱法测定大鼠心肌组织中腺苷的含量。方法 SD大鼠随机分为心肌缺血再灌注组（ IRI）、106 Treg细胞转输＋IRI组、107Treg细胞转输＋IRI 组和假手术对照组。色谱柱为 VP-ODS C18柱（250mm ×4.6mm,5μm）;流动相为甲醇：10mmol· L-1乙酸铵（10∶90）;流速为1.0mL· min -1;柱温25℃;检测波长260nm;进样量20μL。结果腺苷的标准液与峰面积均呈良好的线性关系（r＝1.000）,平均回收率分别为100.1％。日内和日间精密度分别在4.56％和4.84％以下。结论本法操作简便、准确、快速,可以用于测定大鼠心肌组织中腺苷的含量。     

腕管综合征30例高频超声特点

腕管综合征(CTS)是神经卡压综合征中最常见的一种〔1〕,为各种原因致腕管内压力增高、正中神经受压,引起手指麻木、疼痛、感觉异常和功能障碍的一组征候群,严重影响中老年人,尤其是女性患者的手部功能。任何增加腕管内压的因素,都会导致正中神经受到压迫。本文分析CTS患者高频超声检查特点。     

心房颤动患者心房组织肿瘤坏死因子-α的表达

目的观察肿瘤坏死因子-α(TNF-α)在心房颤动(简称房颤)患者心房组织中基因转录和蛋白表达的改变,探讨房颤患者心房结构重构的分子机制。方法75例风湿性心脏瓣膜病接受换瓣手术者分为三组,其中窦性心律组34例、阵发性房颤组11例、持续性房颤组30例,于术中取右心耳组织,采用苦味酸天狼猩红染色法对心房组织胶原沉积量及分布情况进行分析,分别采用半定量逆转录-聚合酶链反应技术和免疫印迹法测定TNF-α的mRNA含量和蛋白含量。结果①房颤组心房组织存在明显纤维化,纤维化程度与左房内径、房颤持续时间呈正相关(r=0.390,0.320,P均<0.05);②持续性房颤组心房组织中TNF-α的mRNA及蛋白水平较窦性心律组、阵发性房颤组明显增加(P<0.01)。TNF-α的mRNA水平与房颤持续时间呈正相关(r=0.298,P=0.01);蛋白表达水平与左房内径、房颤持续时间、胶原容积分数呈正相关(r分别为0.280,0.334,0.383,P均<0.05)。结论房颤患者心房组织中TNF-α的表达增加可能是引起房颤患者心房结构重构的分子机制之一。     

Hypoxia Down-regulates Secretion of MMP-2, MMP-9 in Porcine Pulmonary Artery Endothelial and Smooth Muscle Cells and the Role of HIF-1

Summary： Primary cell culture, techniques of gene transfection, gelatin zymography, and Western blot were used to investigate the effect of hypoxia on the secretion of MMP 2 and MMP-9 in pulmonary artery endothelial cells （PAEC） and smooth muscle cells （PASMC）, and the role of HIF-1. Our results showed that （1） after exposure to hypoxia for 24 h, the protein content and activity of MMP-2 in the PAEC medium as well as these of MMP-2 and MMP-9 in PASMC medium （P〈0. 01 ） decreased significantly in contrast to those in normoxic group （P（0.05） ; （2） after transfection of wild type EPO3＇ enhancer, a HIF-1 decoy, the content and activity of MMP 2 and MMP-9 in hypoxic mediums became higher than those in normoxic group （P〈0. 01）, while transfection of mutant EPO3＇-enhancer didn＇t affect the hypoxia-induced down-regulation. It is concluded that hypoxia could inhibit the secretion and activity of MMP 2 and MMP-9 in PAEC and PASMC, which could he mitigated by the transfection of EPO3 ＇-enhancer and that H1F-1 pathway might contribute to hypoxia-induced down regulation of MMP-2 and MMP-9.     

99Tc-亚甲基二膦酸盐对胶原诱导性关节炎大鼠滑膜及软骨凋亡相关因子的影响

Objective Collagen induced arthritis (CIA) rats is an animal model of human rheuma-toid arthritis (RA). It is widely used in research of the pathogenesis and the therapeutic targets of RA. This paper was to investigate the therapeutic action of 99Tc-methylene diphosphonic acid (MDP) on CIA rats and its effects on the expression of apoptosis associated factor bcl-2 and bax in synoviocytes and articular chon-drocytes. Methods CIA rat models were carried out by subcutaneous injection with bovine collagen Ⅱ and incomplete Freud's adjuvant. Rats were divided into four groups: control group, CIA model group (the CIA rats were infused with physiological saline via tail vein daily), 99Tc-MDP group (the C1A rats were injected with 99Tc-Mi)P 0.04 μg 99Tc/kg via tail vein daily) and methotrexate (MTX) group (the CIA rats were in-jected with MTX 1 mg/kg via tail vein weekly). The signs of arthritis were evaluated by arthritis index (AI) scores. Immunohistochemistry was performed to detect the expression of bcl-2 and bax in synoviocytes and articular chondrocytes. SPSS 13.0 was used for data analysis. Results (1) The signs of arthritis, AI scores and pathological changes of arthrosynovitis in CIA rats were significantly improved by 99Tc-MDP orMTX. (2) The expression of bcl-2 and box in the synoviocytes of CIA model group [(39.30 ± 0.53) %, (27.37 ±2.45)%] was significantly increased compared with control group [(7.56 ± 1. 18)% , (6.14 ± 1.71) % ; q = 46.27, 24.57, all P < 0.001]. In the synovioeytes of 99Tc-M DP group and MTX group, the level of bcl-2 was remarkably decreased [(30.24 ± 2.09) %, (27.25 ± 3.33) %] compared with CIA model group (q = 13.20, 17.56, all P <0.001), while the level of bax was slightly increased and the ratio of bcl-2/bax was significantly decreased. (3)The expression level of bcl-2 and bax in the articular chondro-cytes of CIA model group [(20.20 ± 2.78) %, (36.40 ± 1.67) %] was significantly higher than control group [(9.91±4.09)%, (6.71 ±3.50)%; q=10.51, 37.01, allP<0.001]. Compared with CIA model group, the expression level of bcl-2 in articular chondrocytes of 99Tc-MDP group [(26. 58 ± 2. 52) %] and MTX group [(27.06 ± 1.92) %] was remarksbly increased [(24.26 ± 2.75) %, (23.53 ± 0.74) % ; q = 6.53, 7.01, all P < 0.001]. And the expression level of bax was significantly decread (q = 15.12, 16.04, all P <0. 001) and the ratio of bcl-2/bax was significantly increased. Conclusions The ab-normal expression of apoptosis associated factor bcl-2 and bax in synoviocytes and articular chondrocytes was closely related to the occurrence and progression of signs in CIA rats. 99Tc-MDP could improve the signs of arthritis, meanwhile regulate the expression of bcl-2 and bax in synoviocytes and articular ehondrocytes, suggesting that one of the therapeutic mechanisms of 99Tc-MDP might be related to stimulated synoviocytes apoptosis and reduced articular chondrocytes apoptosis.     

99Tc-亚甲基二膦酸盐对胶原诱导性关节炎大鼠滑膜及软骨凋亡相关因子的影响

Objective Collagen induced arthritis (CIA) rats is an animal model of human rheuma-toid arthritis (RA). It is widely used in research of the pathogenesis and the therapeutic targets of RA. This paper was to investigate the therapeutic action of 99Tc-methylene diphosphonic acid (MDP) on CIA rats and its effects on the expression of apoptosis associated factor bcl-2 and bax in synoviocytes and articular chon-drocytes. Methods CIA rat models were carried out by subcutaneous injection with bovine collagen Ⅱ and incomplete Freud's adjuvant. Rats were divided into four groups: control group, CIA model group (the CIA rats were infused with physiological saline via tail vein daily), 99Tc-MDP group (the C1A rats were injected with 99Tc-Mi)P 0.04 μg 99Tc/kg via tail vein daily) and methotrexate (MTX) group (the CIA rats were in-jected with MTX 1 mg/kg via tail vein weekly). The signs of arthritis were evaluated by arthritis index (AI) scores. Immunohistochemistry was performed to detect the expression of bcl-2 and bax in synoviocytes and articular chondrocytes. SPSS 13.0 was used for data analysis. Results (1) The signs of arthritis, AI scores and pathological changes of arthrosynovitis in CIA rats were significantly improved by 99Tc-MDP orMTX. (2) The expression of bcl-2 and box in the synoviocytes of CIA model group [(39.30 ± 0.53) %, (27.37 ±2.45)%] was significantly increased compared with control group [(7.56 ± 1. 18)% , (6.14 ± 1.71) % ; q = 46.27, 24.57, all P < 0.001]. In the synovioeytes of 99Tc-M DP group and MTX group, the level of bcl-2 was remarkably decreased [(30.24 ± 2.09) %, (27.25 ± 3.33) %] compared with CIA model group (q = 13.20, 17.56, all P <0.001), while the level of bax was slightly increased and the ratio of bcl-2/bax was significantly decreased. (3)The expression level of bcl-2 and bax in the articular chondro-cytes of CIA model group [(20.20 ± 2.78) %, (36.40 ± 1.67) %] was significantly higher than control group [(9.91±4.09)%, (6.71 ±3.50)%; q=10.51, 37.01, allP<0.001]. Compared with CIA model group, the expression level of bcl-2 in articular chondrocytes of 99Tc-MDP group [(26. 58 ± 2. 52) %] and MTX group [(27.06 ± 1.92) %] was remarksbly increased [(24.26 ± 2.75) %, (23.53 ± 0.74) % ; q = 6.53, 7.01, all P < 0.001]. And the expression level of bax was significantly decread (q = 15.12, 16.04, all P <0. 001) and the ratio of bcl-2/bax was significantly increased. Conclusions The ab-normal expression of apoptosis associated factor bcl-2 and bax in synoviocytes and articular chondrocytes was closely related to the occurrence and progression of signs in CIA rats. 99Tc-MDP could improve the signs of arthritis, meanwhile regulate the expression of bcl-2 and bax in synoviocytes and articular ehondrocytes, suggesting that one of the therapeutic mechanisms of 99Tc-MDP might be related to stimulated synoviocytes apoptosis and reduced articular chondrocytes apoptosis.     

腹部手术后沙袋压迫预防切口出血无临床意义

临床护理中腹部手术后常用沙袋压迫切口,以防止切口出血,然而我们通过临床观察,沙袋压迫腹壁切口无临床意义,现总结如下。一、临床资料随机抽样我院1984年至今1245例腹部手术病人,其中659例术后用1000克沙袋压迫切口6至8小时,其余586例未用沙袋压迫。两组病例年龄、性别、身体状况、出凝血时间、手术切口大小及手术操作者技术等因素无明显差异。观察结果见表1。     

吉西他滨联合表柔比星治疗转移性肝癌的临床研究

目的：观察吉西他滨联合表柔比星方案治疗转移性肝癌的疗效。方法：吉西他滨1000mg／m^2,静脉滴注,30分钟滴完,第1,8天;表柔比星60mg／m^2,静脉推注,第1天,21天为～周期。连用2—3周期。结果：45例可评价疗效患者,共化疗113个周期,肿瘤完全缓解（CR）0例,部分缓解（PR）34例,稳定（SD）7例,进展（PD）4例。总有效率为64．4％,其中鼻咽癌肝转移有效率为66．7％,胰腺癌肝转移有效率为83．3％,乳腺癌肝转移有效率80％,非小细胞性肺癌肝转移有效率52．9％,胃癌肝转移有效率62．5％。结论：吉西他滨联合表柔比星治疗转移性肝癌,是安全有效的,尤其是胰腺癌及乳腺痛肝转移疗效尤为昂著。