婴儿期体外循环术后床边紧急再开胸手术11例

目的总结婴儿期体外循环术后床边紧急再开胸手术经验及教训,以减少心脏术后2次开胸的发生率。方法回顾性分析婴儿心内直视手术365例,其中行监护病房床边紧急再次开胸手术11例,发生率3.12%。室间隔缺损并重度肺动脉高压2例,法洛四联症2例,完全性肺静脉异位引流(心上型)3例,完全性房室管畸形1例,重度肺动脉狭窄1例,右心室双出口1例,大动脉转位1例。体外循环时间53～240min,主动脉阻断时间30～130min。两次手术间隔3～60h,平均16h。结果再开胸的原因:活动性出血2例;广泛性渗血5例;心脏压塞2例;心包填塞1例;心肌收缩无力1例。床边紧急再开胸手术后,死亡1例,继发脑损害1例,败血症1例。结论采取缩短体外循环时间;术中有效的止血及必要地扩大纵隔容积;术后引流管的负压吸引;术后早期充分镇静条件下的气道护理等措施,可减少2次开胸的发生率。遇到:①怀疑心脏填塞;②出血不止,引流量多;③心搏骤停等严重情况或经药物治疗无效时,应紧急开胸手术抢救,任何犹豫与延误,将失去对患者的抢救机会。虽然是紧急手术,仍必须注意无菌操作。     

Novel insights into the consequences of obesity: a phenotype-wide Mendelian randomization study

Obesity is thought to significantly impact the quality of life. In this study, we sought to evaluate the health consequences of obesity on the risk of a broad spectrum of human diseases. The causal effects of exposing to obesity on health outcomes were inferred using Mendelian randomization (MR) analyses using a fixed effects inverse-variance weighted model. The instrumental variables were SNPs associated with obesity as measured by body mass index (BMI) reported by GIANT consortium. The spectrum of outcome consisted of the phenotypes from published GWAS and the UK Biobank. The MR-Egger intercept test was applied to estimate horizontal pleiotropic effects, along with Cochran’s Q test to assess heterogeneity among the causal effects of instrumental variables. Our MR results confirmed many putative disease risks due to obesity, such as diabetes, dyslipidemia, sleep disorder, gout, smoking behaviors, arthritis, myocardial infarction, and diabetes-related eye disease. The novel findings indicated that elevated red blood cell count was inferred as a mediator of BMI-induced type 2 diabetes in our bidirectional MR analysis. Intriguingly, the effects that higher BMI could decrease the risk of both skin and prostate cancers, reduce calorie intake, and increase the portion size warrant further studies. Our results shed light on a novel mechanism of the disease-causing roles of obesity.Subject terms: Lifestyle modification, Genetic predisposition to disease     

临床学院教务管理系统的需求分析与设计

临床学院教务管理与大学的教务管理有所不同.文章分析了临床学院教务管理内容及规律特点,设计了该系统由学生管理、教师管理、教材与课程管理、教案管理、评教管理、授课津贴管理、题库管理、考试管理及教学计划、教学大纲和系统操作说明等9个模块组成,并明确了相关功能.     

纵行神经束内电极与周围神经生物相容性的实验研究

目的　研究纵行神经束内电极长期植入家兔坐骨神经神经束中的生物相容性 ,并探讨应用纵行神经束内电极记录的周围神经束的信号对电子假手控制的可能性。方法　将纵行神经束内电极长期植入 12只新西兰大白兔坐骨神经的神经束内 ,分别作为记录和刺激电极 ,通过经颅刺激系统 ,在术后不同时间记录运动诱发电位 (MEP)和皮层体感诱发电位 (CSEP) ,观察电极长期植入神经束内所记录到的信号的变化 ;术后 6个月信号记录结束后 ,取电极植入处的神经束进行组织学检查 ,了解电极对神经束的影响。然后 ,将纵行神经束内电极植入一名前臂残肢志愿受试者残肢的三条主要神经的神经束中 ,记录志愿受试者在意识控制中完成不同手的动作时的信号 ,并将其应用于电子假肢的实时控制。结果　不同时间记录的MEP和CSEP潜伏期间的差异均具有显著性意义 (方差分析 ,均P <0 .0 0 1)。经组间比较 ,MEP和CSEP的潜伏期在术后 1个月内无明显变化 ,以后明显延长 ,但 3个月以后趋于稳定 ;不同时间记录的MEP峰间波幅间的差异有显著意义 (方差分析 ,P <0 0 0 1)。经组间比较 ,在术后 1个月内变化不明显 ,以后明显降低 ,3个月后又趋于平稳。不同时间记录的CSEP峰间波幅虽然随时间延长有下降的趋势 ,但其间的差异无显著意义 (方差分析 ,P >0 0     

BMI型双腔可卷式主动咏内气囊(IAB)的研究

本文报道了BMI型双腔,可卷式主动咏内气囊(IAB)的研究。这种新型IAB的结构是由卷子,双腔导管和气囊三部分组成。通过体外频率响应试验,静态破坏性实验,动态疲劳试验及一系列的动物实验结果证明,BMI型双腔可卷经皮穿刺插入式IAB具有先进的结构,安全可靠的机械性能,良好的血液动力学反搏效果,适于临床使用。     

小檗碱对早期ACM大鼠治疗效果及机制的研究

目的:观察小檗碱(BBR)对早期酒精性心肌病(ACM)大鼠的治疗作用,探讨其作用机制。方法:每日白酒灌胃以建立SD大鼠早期ACM模型,将已建模成功的28只SD大鼠随机分为小檗碱治疗组(14只)、安慰剂组(14只),并随机抽取10只正常SD大鼠作为正常对照组。干预4周后应用超声心动图测定两组大鼠心脏结构及功能参数,RT-PCR法检测心肌组织中MMP-2mRNA、TIMP-2 mRNA表达。结果:与对照组比较,安慰剂组LVEDD、LVESD、LA增大,左室舒张功能减低,心肌组织中的MMP-2 mRNA表达水平明显上升,TIMP-2mRNA表达水平下降,差异有统计学意义(P<0.05);与安慰剂比较,小檗碱组LVEDD、LVESD、LA减小,左室舒张功能有所改善,心肌组织中的MMP-2 mRNA表达水平显著下降,TIMP-2 mRNA表达显著升高(P<0.05)。结论:BBR逆转早期ACM大鼠心室重构,改善心功能,可能与减少心肌组织MMP-2表达有关。     

Isolation and Purification of a New Bacillus Subtilis Strain from Deer Dung with Anti-microbial and Anti-cancer Activities

Objective:Bacillus strains are well known for their natural bioactive products that have antimicrobial and/or anti-cancer activities.Many of Bacillus'structural...     

去肾交感神经术对自发性高血压大鼠肾胺酶及酪氨酸羟化酶的影响

目的:通过观察自发性高血压大鼠（SHR）去肾交感神经手术前后血压、肾胺酶浓度、肾脏酪氨酸羟化酶（TH）与肾胺酶表达水平的变化,探讨去肾交感神经术降低血压的可能机制。方法:将SHR 大鼠（n=48）随机分为基线组、手术组、假手术组和对照组,同批同周龄WKY 大鼠（n=12）作为基线对照组,同条件喂养至12 周龄测各组血压,首批处死SHR 基线组、WKY 组,采血、取肾脏组织送检;手术组、假手术组与对照组继续监测血压,于去肾交感神经术后1,6 周时分批处死每组大鼠各6 只,分别采血、取肾脏组织送检。采用ELISA 方法测定血浆肾胺酶浓度,Western 印迹测定肾脏TH、肾胺酶蛋白表达水平。结果:与WKY 组大鼠比较,SHR 基线组大鼠血压、肾脏TH 蛋白表达水平明显升高（P<0.05),血浆肾胺酶浓度及蛋白表达水平明显下降(P<0.05);术后1 周,手术组大鼠平均动脉压与TH 蛋白表达水平较基线组明显降低且明显低于假手术组及对照组(P<0.05),手术组肾胺酶水平较基线组明显增高并明显高于假手术组及对照组(P<0.05);术后6 周,手术组平均动脉压与TH 水平较术后1 周上升而肾胺酶浓度及水平较术后1 周降低,较基线组、假手术组与对照组差异无统计学意义(P>0.05);假手术组与对照组较基线组各项指标差异无统计学意义(P>0.05)。结论:去肾交感神经术降低血压的作用可能与其抑制交感神经,升高肾胺酶浓度及其蛋白表达水平有关。     

Chidamide stacked in magnetic polypyrrole nano-composites counter thermotolerance and metastasis for visualized cancer photothermal therapy

Photothermal therapy (PTT) has become one of the most promising therapies in cancer treatment as its noninvasiveness, high selectivity, and favorable compliance in clinic. However, tumor thermotolerance and distal metastasis reduce its efficacy, becoming the bottleneck of applying PTT in clinic. In this study, a chidamide-loaded magnetic polypyrrole nanocomposite (CMPP) has been fabricated as a visualized cancer photothermal agent (PTA) to counter tumor thermotolerance and metastasis. The efficacy of CMPP was characterized by in vitro and in vivo assays. As a result, this kind of magnetic polypyrrole nanocomposites were black spherical nanoparticles, possessing a favorable photothermal effect and the suitable particle size of 176.97 ± 1.45 nm with a chidamide loading rate of 12.92 ± 0.45%. Besides, comparing with PTT, CMPP exhibited significantly higher cytotoxicity and cellular apoptosis rate in two tumor cell lines (B16-F10 and HepG2). In vivo study, the mice showed obvious near-infrared (NIR) and magnetic resonance imaging (MRI) dual-modal imaging at tumor sites and sentinel lymph nodes (SLNs); on the other hand, magnetic targeting guided CMPP achieved a cure level on melanoma-bearing mice through preventing metastasis and thermotolerance. Overall, with high loading efficiency of chidamide and strong magnetic targeting to tumor sites and SLNs, CMPP could significantly raise efficiency of PTT by targeting tumor thermotolerance and metastasis, and this strategy may be exploited therapeutically to upgrade PTT with MPP as one of appropriate carriers for histone deacetylase inhibitors (HDACis).     

Protective effect of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after liver transplantation in rats

Background

The effect of glutamine-enriched early enteral nutrition (Gln-EEN) on intestinal mucosal barrier injury after liver transplantation (LT) remains uncertain.

Methods

The Wistar-to-Wistar rat LT model was used to explore the protective effect of Gln-EEN. Morphologic changes of intestinal mucosa, levels of intestinal malondialdehyde and secretory immunoglobulin (sIgA), plasma endotoxin, D-lactic acid, serum tumor necrosis factor-α (TNF-α), rates of bacterial translocation, and expression of intestinal nuclear factor-κB, TNF-α, and intercellular adhesion molecule-1 were determined.

Results

After LT, intestinal mucosa was damaged seriously. At 12, 24, and 48 hours posttransplantation, levels of intestinal sIgA were decreased; levels of malondialdehyde, endotoxin, D-lactic acid, and TNF-α, the ratio of bacterial translocation, and the expression of intestinal nuclear factor-κB, TNF-α, and intercellular adhesion molecule-1 all were increased. However, changes in earlier-mentioned parameters in recipients treated with Gln-EEN were attenuated remarkably at 24 to 48 hours.

Conclusions

Our data show that Gln-EEN is a potent protectant against intestinal mucosal barrier injury after LT.