术中超声在脑肿瘤切除术中的应用价值

摘 要 目的：采用术中超声观察颅脑肿瘤的超声图像特点，探讨其在神经外科手术中的应用价值。材料与方法：2007年3月～2008年3月，11例颅脑肿瘤患者在手术中接受了术中超声检查，以确定肿瘤的位置，手术切除范围，及切除术后是否有肿瘤残余。结果：术中超声清晰的显示了肿瘤的部位，形态及回声，11例患者全部经手术完整切除肿瘤，均未损伤颅脑功能区。术后病理提示星形胶质细胞瘤5例、胶质增生1例、海绵状血管瘤2例、转移性肿瘤2例、恶性淋巴瘤1例。结论：术中超声作为一种实时、无创、简便的辅助检查方法，可帮助手术医师确定肿瘤的部位及边界，避开功能区，提高手术安全性及治疗效果。     

阿托伐他汀治疗非心脏瓣膜病阵发性心房颤动的疗效观察

目的:观察阿托伐他汀治疗非心脏瓣膜病阵发性心房颤动窦性心律维持中的作用.方法:110例阵发性心房颤动患者随机分为A组54例,B组56例.A组仅给予厄贝沙坦+胺碘酮治疗;B组在给予厄贝沙坦+胺碘酮治疗的同时联合服用阿托伐他汀治疗,随访12个月,观察终点为房颤动转复后至3、6、12个月时的窦性心律维持情况及血浆C反应蛋白浓度.结果:B组阵发性心房颤动转复为窦性心律后的维持比率在3月时与A组相比无明显差异(86.54％ VS 82.35％,P＞0.05),血浆C反应蛋白浓度与A组相比也无明显差异(P＞0.05);但至6、12个月时仍维持窦性心律的比率高于A组(82.69％ VS 62.75％;78.85％ VS 60.78％,均P＜0.05),同时血浆C反应蛋白浓度也低于A组(P＜0.05).结论:在胺碘酮、沙坦类药物治疗非心脏瓣膜病所致的阵发性心房颤动的同时联合使用阿托伐他汀治疗,其维持窦性心律的作用口可能优于仅使用胺碘酮及沙坦类药物,机制可能与阿托伐他汀的抗炎作用等有关.     

硫酸钙人工骨对山羊下颌骨牵引成骨的影响

目的建立山羊双侧下颌骨牵张成骨实验动物模型,探讨硫酸钙人工骨对山羊下颌骨牵引成骨区新骨生成的作用及局部使用硫酸钙对血清总钙的影响。方法8只山羊随机分为A组（硫酸钙组）和B组（对照组）．建立牵引成骨（Distraction Osteogenesis,DO）模型。A组预牵开3mm间隙,注入硫酸钙人工骨;B组常规牵引：两组均于术后第5天开始,以0．5mm／12h的速度牵引,A组连续牵引7d,B组连续牵引10d,两组颌骨总延长距离均达到10mm。术前及术后早期检测血清碱性磷酸酶（ALP）和血清总钙浓度。牵引结束后第6周取材,对新生骨大体标本、影像学、组织学、骨密度及生物力学等指标进行观察检测。结果所有山羊下颌骨均延长了约10／mm,A组血清ALP浓度、新生骨小梁面积百分比、骨密度及三点弯曲断裂最大载荷值均比B组高（P〈0．05）,而血清总钙浓度与B组相比差别无显著性（P〉0．05）。结论动物实验表明,硫酸钙人丁骨在牵引成骨的早期对新骨的形成具有促进作用．且局部应用硫酸钙对血清总钙浓度无明显影响．具有良好的生物相容性。     

内踝前穿支蒂隐神经营养血管皮瓣的临床应用

Objective To explore distally-based the interal ankle perforator saphenou neuro-veno-fasciocutaneous flap has been universally adopted for the repairment of the foot and the ankle soft-tissue defects.Methods Lay a foundation of anatomic studying,using the interal ankle perforator saphenous neuro-venofasciocutaneous flap 10 cases, the flap axis point was 1-3 cm above the pink of the interal ankle, average 2 cm. The scope of the flap were 4.0 cm× 3.0 cm-8.0 cm× 6.0 cm. Results All the perforator saphenous neuro-veno-fasciocutaneous flap were lively. About all, 2 cases had the small distant part necrosis, 1 case accompanying with subcutaneous tissue heels after change dressings, another heels after skin grating. All case can walk as usual, the flap had wear-resisting and keenly feel. Conclusion Distally-based the interal ankle perforator saphenous neuro-veno-fasciocutaneous flap, near ankle, donner area exiting fine, utlizing scope large, skin nice, grating easy, no hurting important blood vessle, alive rate high, it is an good donner area in repairing the foot and the ankle soft-tissue defects.     

Alfentanil for intubation under halothane anaesthesia in children

Intubating conditions under halothane anaesthesia aided with alfentanil 20 micrograms.kg-1 were compared with suxamethonium 2 mg.kg-1 in 40 children presenting for day dental procedures. The condition of vocal cords, jaw relaxation and presence of movement and coughing were scored to give the overall intubating conditions. Successful intubation was achieved in 100% of the suxamethonium group and 94.7% of the alfentanil group. The cardiovascular response to intubation was attenuated in the alfentanil group. Some 43.7% of those receiving suxamethonium developed myalgia the day after surgery compared with 0% in the alfentanil group (P < 0.01).     

Erythromycin treatment for gastrointestinal dysmotility in preterm infants

To report our clinical experience on the use of oral erythromycin for the treatment of severe gastrointestinal dysmotility in preterm infants.

Methodology:

A case series study of seven preterm infants (six were very low birthweight) with severe intestinal dysmotility in a tertiary neonatal centre.

Results:

All responded favourably without adverse effects and tolerated full enteral feeding within 1–2 weeks of the commencement of the drug.

Conclusions:

As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.     

通过基因芯片筛选创伤修复差异表达基因

目的通过基因芯片筛选同真皮间充质干细胞相关的创伤修复差异表达基因。方法利用贴壁生长的特性分离大鼠真皮间充质干细胞，用Hpure提取伤口液刺激前后dMSCs和创伤前后大鼠皮肤组织中总RNA。PCR扩增已构建抑制消减杂交差异表达文库中485个克隆的插入片断，送北京博奥制作基因芯片。提取的RNA反转录后分别同芯片杂交，找出在细胞水平和组织水平同时高表达的克隆。将这些克隆测序，进行生物信息学分析。结果分离的大鼠真皮间充质干细胞呈纺锤形，在体外显示多向分化潜能。抽提伤口液刺激前后dMSCs和创伤前后大鼠皮肤组织中总RNA，反转录后和基因芯片杂交，发现可能同创伤愈合相关的13条基因，其中热休克蛋白70（HSP70），基质金属蛋白酶3（MMP3），白细胞蛋白酶抑制因子（SLPI）等可能在创伤愈合中有重要意义。结论抑制消减杂交和基因芯片结合是筛选差异表达基因的一种有效方法。伤口液刺激前后dMSCs中差异表达基因的发现能为从基因水平探讨dMSCs参与创伤愈合的分子机制提供新的研究靶点。     

不同碘营养状态对大鼠肝组织Ⅰ型5′脱碘酶的影响

目的研究不同碘营养状态对大鼠肝组织甲腺氨酸Ⅰ型5′脱碘酶（DI）表达水平及活性的影响。方法正常1月龄Wistar大鼠根据碘摄入量不同分为6组，饲养3个月后处死。放免法测定血清甲状腺激素水平。提取肝组织总RNA，以β—actin为内对照，半定量RT-PCR分析DI基因的表达水平。Chopra氏方法测定肝组织匀浆液中DI的脱碘活性。结果LI组TT4和FT4显著低于其他5组（P〈0．05），100HI组TT3和FT3显著低于其他5组（P〈0．05），100HI组TT4和FT4显著低于NI、5HI、10HI和50HI组（P〈0．05）。大鼠肝组织DI基因mRNA表达量6组间差异有统计学意义（P〈0．01），LI组显著高于其他5组（P〈0．05），不同剂量HI组和NI组相比差异均无统计学意义（P〉0．05）。大鼠肝组织DI活性6组间差异有统计学意义（P〈0．01），LI组显著高于其他5组（P〈0．05），50HI组和100HI组显著低于其他4个组（P〈0．05）。结论在碘缺乏状态下。大鼠出现以低T4为主要表现的甲状腺功能减退（甲减），DI活性和DI基因表达水平代偿性上调，使机体维持足够的T3水平，以避免周围组织出现器官性甲减。高碘仅在转录后水平影响DI，表现为直接抑制DI的活性。使血清TT3和FT3下降，机体出现失代偿性周围组织器官性甲减。DI对碘过量有一定的耐受能力，这种耐受性有一定的阈值。