寒冷干燥地区平时火器伤的早期处理

目的　探讨寒冷干燥地区平时火器伤伤情特点与早期救治方法。方法　对 1991年 1月— 2 0 0 2年 12月间 40例火器伤病人的临床救治进行回顾分析。结果　 2 4例枪伤中 ,2 0例一期缝合伤口 ,均一期愈合 ,另外 4例只清创未一期缝合的伤口 ,3例愈合 ,1例感染 ;4例骨折内固定均愈合良好 ,无骨髓炎发生。 16例炸伤病人局部软组织损伤及污染比枪弹伤重 ,14例一期缝合伤口中 ,10例一期愈合 ,4例感染 ,骨折内固定 2例 ,均愈合良好 ,无骨髓炎发生。结论　寒冷干燥地区火器伤早期伤道清创时限可适当延长 ,在平时火器伤的救治中 ,对软组织条件较好的创面 ,早期清创后可一期闭合伤口和骨折内固定 ,这样可减少感染和伤残 ,促进康复     

靶控输注异丙酚意识消失时血浆和效应室浓度的EC50与脑电双频谱指数的关系多中心大样本临床研究

目的 研究择期手术患者靶控输注（TCI）异丙酚意识消失时血浆、效应室靶浓度的50%患者意识消失时的药物浓度（EC50）与脑电双频谱指数（BIS）的关系。方法 5家医疗中心405例择期手术患者（国人）,ASAⅠ或Ⅱ级。靶控输注异丙酚,以血浆靶浓度1．2μg/ml为起点,到达预期血浆靶浓度后每30秒递增0．3μg/ml,直至患者意识消失。采用概率单位回归分析计算患者意识消失时异丙酚血浆靶浓度、效应室靶浓度的EC05、EC50和EC95及其所对应的BIS。结果 择期手术患者TCI异丙酚意识消失时异丙酚血浆靶浓度EC05、EC50和EC95分别是2．9μg/ml、3．8μg/ml和4．8μg/ml,效应室靶浓度EC05、EC50和EC95分别是1．3μg/ml、2．2μg/ml和3．2μg/ml,50%患者意识消失的BIS是58,5%和95%患者意识消失的BIS分别是77和40。结论 择期手术患者TCI异丙酚意识消失时血浆靶浓度和效应室靶浓度EC50及95%置信区间分别是3．8μg/ml（3．8～3．9μg/ml）和2．2μg/ml（2．2～2．3μg/ml）, 50%患者意识消失的BIS用95%置信区间是58（58～59）。     

不同治疗方法在急诊剖宫产恶心呕吐中的应用

目的观察不同治疗方法在急诊剖宫产术中恶心呕吐的应用。方法选择ASAI~II级104例急诊剖宫产手术患者,随机分为五组:指揉组(n=21)、恩丹西酮组(n=21)、甲氧氯普胺组(n=21)、氟哌利多组(n=21)和生理盐水组(n=20)。采用腰-硬联合阻滞麻醉,术毕实施术后镇痛(patient controlled epidural analge-sia,PCEA)。结果指揉组、恩丹西酮组与甲氧氯普胺组与氟哌利多组VAS评分基本相当,与生理盐水组比较(P>0.01),各实验组之间比较(P>0.05),表明指揉组、恩丹西酮组、甲氧氯普胺组和氟哌利多组疗效相同。结论指揉法在防治急诊剖宫产恶心呕吐中,简便易行,效果确切,副作用少,适用于术中轻度恶心呕吐;而甲氧氯普胺和恩丹西酮更适于程度较重的恶心呕吐;氟哌利多抗恶心呕吐的作用时间相对较长。     

老年腰椎间盘突出症的手术治疗

目的 探讨老年腰椎间盘突出症的特点与手术治疗效果.方法 对62例老人腰椎间盘突出症患者的临床与病理特点进行分析.均行腰椎后路椎板减压髓核摘除术,其中小切口开窗35例,半椎板切除20例,全椎板切除7例,根据手术前后JOA评分评价手术疗效.结果 老年腰椎间盘突出症病理以髓核组织的脱水,纤维环的破裂,小关节囊、周围韧带及软骨终板退变为主要特点.临床特点为下肢疼痛多发,腰部活动受限较多;双下肢神经系统检查肌力下降明显,生理反射改变明显.62例平均随访1.9年,JOA评分术后平均改善率为68.9%,手术前后JOA评分比较差异有显著性意义(P＜0.05).结论 老年腰椎间盘突出症患者病程长,体征多,病理改变明显,行腰椎后路椎板减压髓核摘除术,手术效果满意.     

Autonomic dysregulation as a basis of cardiovascular, endocrine, and inflammatory disturbances associated with obstructive sleep apnea and other conditions of chronic hypoxia, hypercapnia, and acidosis

Obstructive sleep apnea has traditionally been viewed as a structural disease. A multitude of systemic endocrine and cardiovascular abnormalities have been previously attributed to the prevalence of obesity in these patients. A growing body of clinical evidence, however, points to a relationship between sleep apnea and its systemic abnormalities independent of obesity. We hypothesize that this association is based on a maladaptive autonomic response of chemoreceptors, reacting to the hypoxia, hypercapnia, and acidosis of sleep apnea. The elevated sympathetic response triggers an inflammatory cascade that results in a myriad of downstream consequences including insulin resistance, hypertension, diabetes, atherosclerosis and metabolic syndrome. The sympathetic bias and endocrine disturbances may further exacerbate sleep disturbance in a potentially pernicious cycle. Our proposal may extend to any chronic respiratory or metabolic conditions that manifest hypoxia, hypercapnia, and acidosis and elicit a maladaptive autonomic and inflammatory response.     

Rapid leukocyte integrin activation by chemokines

Summary: Chemokines control selective targeting of circulating leukocytes to the microvasculature by triggering inside-out signal transduction pathways leading to integrin-dependent adhesion. Integrin activation by chemokines is very rapid, is downmodulated within minutes and appears to involve both enhanced heterodimer lateral mobility on the plasma membrane, facilitating encounters with dispersed ligand, as well as induction of a high-affinity state. These two modalities of integrin activation by chemokines involve distinct signaling pathways in the cell, yet complement each other functionally, allowing binding of rolling cells under conditions of low as well as high ligand density. Recent data show that chemokines generate both pro- and anti-adhesive intracellular signaling events, whose equilibrium is likely to be relevant to the kinetics of adhesion and de-adhesion, and to cell movement during diapedesis and chemotaxis. Importantly, chemokines utilize different signaling mechanisms to modulate the activity of distinct integrin subtypes. These recent advances suggest that chemokines may regulate adhesive responses of immune cells based not only on patterns of chemokine receptor expression, but also on variable signaling pathways that can modulate the pro-adhesive responses of leukocytes as a function of their differentiated state, and of the local microenvironment.     

Map location of the kanamycin resistance determinant in P1Km0.

The kanamycin resistance determinant in P1Km lies between am33 and gene 2 on the P1 genetic map. This is within the invertible region (C loop) of P1 DNA.     

心音信号的分形研究

本文通过引入分形概念,首次为描述心音信号的复杂程度给出了一个定量的指标——分数维数。研究结果表明:心音信号确实存在着“无标度区”,具有典型的分形特性;心音信号的分维值能显著性地区分正常心音、二尖瓣病变心音(包括二尖瓣狭窄、二尖瓣关闭不全及二尖瓣狭窄加关闭不全)和主动脉瓣病变心音(主动脉瓣狭窄、主动脉瓣关闭不全及主动脉瓣狭窄加关闭不全)。     

中国人群DXS102座位多态性鉴定及其应用

目的探讨中国人群中ＤＸＳ１０２座位的多态分布。方法应用ＰＣＲ扩增片段长度多态性（Ａｍｐ－ＦＬＰ）研究了无亲缘关系的２３４条Ｘ染色体。结果ＤＸＳ１０２座位等位片段有８个，核心单元ＡＣ二核苷酸重复数为１３～２１，频率分布在０．０１３～０．１５６之间，杂合度观察值和无偏估测值分别为０．８７和０．８０，多态信息含量（ＰＩＣ）０．８０，女性基因型数为２２个，男性基因型数为８个，该座位多态分布符合Ｈａｒｄｙ－Ｗｅｉｎｂｅｒｇ平衡定律。ＤＸＳ１０２座位在中国人群和欧洲人群的分布有明显的种族差异，在中国人群中发现了两个新的等位片段。应用ＤＸＳ１０２座位的短串联重复序列多态性对一接受基因治疗的血友病Ｂ家系进行分析和携带者筛查。结论ＤＸＳ１０２座位连锁分析有望成为一种有效的血友病Ｂ基因诊断的方法。     

c-myc反义寡核苷酸对肿瘤细胞表面抗原和对CD3AK杀伤敏感性的调节作用

目的：观察c-myc反义寡核苷酸上调人高转移性肺巨细胞腺癌PG细胞表面抗原分子的表达水平，提高免疫效应细胞杀伤敏感性的作用和机制。方法：PT－PCR方法检测c-myc mRNA表达水平的变化。MTT法检测细胞增殖活性和CD3AK杀伤活性的变化。流式细胞术检测细胞表面抗原表达的变化以及c-myc蛋白表达水平的变化。结果：c-myc反义寡核苷酸（1μmol/L）明显地抑制PG细胞c-myc mRNA和蛋白表达水平，显著提高细胞表面HLA－ABC、ICAM－1分子的表达，其表达率分别从68．44％、38．40％增高到83．16％和42．09％（P＜0．01）。CD3AK对反义寡核苷酸处理的PG细胞的不同效靶比杀伤活性，分别从40．0％、65．0％、74．0％增高到52．0％、74．0％、91．0％（P＜0．01）。结论：c-myc反义寡核苷酸通过抑制PG细胞c-myc mRNA和蛋白表达，上调PG细胞表面HLA－ABC、ICAM－1分子的表达水平，提高其对免疫效应细胞的杀伤敏感性。