普通人及医学专家的医疗保健规则

普通人的八条保健规刚1.找到一位受过良好教育的,可以信赖的保健专家.2.具备健康知识,有能力处置健康风险,确定你自己的生命质量标准.3.广泛利用预测医学和预防医学.4.虽期望通过医疗得到康复或缓解,但也意识到医疗本身的局限和风险.5.要从医生和其他保健专家那里得到信息和咨询,在治疗中做他们的负责的和可靠的同伴.     

盐酸曲马多硬膜外注药用作术后镇痛54例报告

<正>我院自1993年6月至9月选择持硬麻醉的手术病人54例,用曲马多作硬膜外注射,观察术后止痛效果、持续时间及副作用等,现报告如下。 临床资料 男性18例,女性36例,年龄最小18岁,最大76岁,体重45～77kg,择期手术48例,急诊手术6例,病情按ASA分级:Ⅰ～Ⅱ级45例,Ⅲ级8例,Ⅳ级1例。     

E1 Tor Vibio Cholerae Strain SM_6 and Jiangsu 1d Strain

Ｅ１ＴｏｒＶｉｂｉｏＣｈｏｌｅｒａｅＳｔｒａｉｎＳＭ_６ａｎｄＪｉａｎｇｓｕ１ｄＳｔｒａｉｎ￥ＪｉａｎｇＸｉａｏｗａｎ，ｅｔａｌ．ＡＣＴＡＡＣＡＤＥＭＩＡＥＭＥＤＩＣＩＮＡＥＮＡＮＪＩＮＧ，１９９４，１４（２）：１６３－１６４ＡｂｓｔｒａｃｔＥ１Ｔｏ?..     

全肝MR灌注成像早期监测肝VX2肿瘤经皮酒精注射疗效的实验研究

目的研究全肝MR灌注成像（MRPI）早期监视兔肝VX2瘤经皮酒精注射（PEI）疗效的价值。方法新西兰大白兔10只，经开腹手术于肝内注射VX2肿瘤细胞悬液0．1ml，分别在种瘤后第2、3周进行MRT。WI、T2WI检查监视肿瘤生长情况。在种瘤后第3周时，于CT引导下，于肿瘤一侧的早期强化最明显处注射无水乙醇1.0ml，治疗1周后应用MRPI观察治疗效果。灌注参数包括：对比剂到达时间（T0）和最大上升斜率（ss），应用t检验比较治疗区与肿瘤未治疗区的灌注参数。结果10只兔肿瘤均种植成功，第3周时肿瘤直径（2．6±0．6）cm。治疗过程中3只兔死亡，PEI治疗1周后的治疗区呈无或低度强化。肿瘤未治区与治疗区的11D分别为（16．0±1．2）、（50，8±5．9）S，ss分别为38．9±2．2、6．0±1．2，差异均有统计学意义（t值分别为15．8、-39．6，P值均〈0．05）。常规T1 WI、T2 WI无法清晰显示治疗区与未治疗区的差异。结论全肝MRPI可以较敏感的早期监测PEI疗效，早期强化的消失可作为PEI治疗有效的标志。     

Morphine Preconditions Purkinje Cells against Cell Death under In Vitro Simulated Ischemia-Reperfusion Conditions

Background: Morphine pretreatment via activation of [delta]1-opioid receptors induces cardioprotection. In this study, the authors determined whether morphine preconditioning induces ischemic tolerance in neurons.

Methods: Cerebellar brain slices from adult Sprague-Dawley rats were incubated with morphine at 0.1-10 [mu]m in the presence or absence of various antagonists for 30 min. They were then kept in morphine- and antagonist-free buffer for 30 min before they were subjected to simulated ischemia (oxygen-glucose deprivation) for 20 min. After being recovered in oxygenated artificial cerebrospinal fluid for 5 h, they were fixed for morphologic examination to determine the percentage of undamaged Purkinje cells.

Results: The survival rate of Purkinje cells was significantly higher in slices preconditioned with morphine (>= 0.3 [mu]m) before the oxygen-glucose deprivation (57 +/- 4% at 0.3 [mu]m morphine) than that of the oxygen-glucose deprivation alone (39 +/- 3%, P < 0.05). This morphine preconditioning-induced neuroprotection was abolished by naloxone, a non-type-selective opioid receptor antagonist, by naltrindole, a selective [delta]-opioid receptor antagonist, or by 7-benzylidenenaltrexone, a selective [delta]1-opioid receptor antagonist. However, the effects were not blocked by the [mu]-, [kappa]-, or [delta]2-opioid receptor antagonists, [beta]-funaltrexamine, nor-binaltorphimine, or naltriben, respectively. Morphine preconditioning-induced neuroprotection was partially blocked by the selective mitochondrial adenosine triphosphate-sensitive potassium channel antagonist, 5-hydroxydecanoate, or the mitochondrial electron transport inhibitor, myxothiazol. None of the inhibitors used in this study alone affected the simulated ischemia-induced neuronal death.     

Mild Hypercapnia Induces Vasodilation via Adenosine Triphosphate-sensitive K+ Channels in Parenchymal Microvessels of the Rat Cerebral Cortex

Background: Carbon dioxide is an important vasodilator of cerebral blood vessels. Cerebral vasodilation mediated by adenosine triphosphate (ATP)-sensitive K+ channels has not been demonstrated in precapillary microvessel levels. Therefore, the current study was designed to examine whether ATP-sensitive K+ channels play a role in vasodilation induced by mild hypercapnia in precapillary arterioles of the rat cerebral cortex.

Methods: Brain slices from rat cerebral cortex were prepared and superfused with artificial cerebrospinal fluid, including normal (Pco2 = 40 mmHg; pH = 7.4), hypercapnic (Pco2 = 50 mmHg; pH = 7.3), and hypercapnic normal pH (Pco2 = 50 mmHg; pH = 7.4) solutions. The ID of a cerebral parenchymal arteriole (5-9.5 [mu]m) was monitored using computerized videomicroscopy.

Results: During contraction to prostaglandin F2[alpha] (5 x 10-7 m), hypercapnia, but not hypercapnia under normal pH, induced marked vasodilation, which was completely abolished by the selective ATP-sensitive K+ channel antagonist glibenclamide (5 x 10-6 m). However, the selective Ca2+-dependent K+ channel antagonist iberiotoxin (10-7 m) as well as the nitric oxide synthase inhibitor NG-nitro-l-arginine methyl ester (10-4 m) did not alter vasodilation. A selective ATP-sensitive K+ channel opener, levcromakalim (3 x 10-8 to 3 x 10-7 m), induced vasodilation, whereas this vasodilation was abolished by glibenclamide.     

不同剂量顺式阿曲库铵用于全麻气管插管的临床观察

顺式阿曲库铵是肌松作用强、组胺释放作用较弱的中效非去极化肌松药,体内代谢通过霍夫曼效应降解[1,2]。据文献报道[3],2~8倍ED95顺式阿曲库铵(cisatracurium,Cis)用于全麻诱导气管插管可达到满意的肌松效果,对血流动力学影响小,无组胺释放作用。本研究比较3~6倍ED95顺式阿曲库     

Paul R.Harrington-脊柱侧凸治疗先驱

尽管近年来在脊柱侧凸的手术矫正中有许多重要的进展，但Harrington仍被尊为这一领域内无可争议的先驱。在他之前，差不多没有什么像样的矫形器械；在他之后，所有的发展几乎都建立在他的理论和器械的基础上。     

放大胃镜在胃病中的应用

放大内镜由于具有变焦放大的功能，可以在消化道检查中清晰显示胃肠黏膜的腺管开口、微细血管等微细结构的变化，结合黏膜色素染色，可以比较准确地反映病变组织的病理学背景，更容易地在镜下区分不同性质的病变，提高了早期癌的镜下检出率。使得镜下诊断出现了新的标准，使内镜诊断提高到了一个新的水平，是医学发展的又一次革命性进步。