舌下含服硝酸异山梨酯对16层螺旋CT冠状动脉成像的影响

目的探讨舌下含服硝酸异山梨酯对16层螺旋CT冠状动脉成像质量和管腔直径的影响。方法50例临床怀疑冠心病者随机分为A(不含服硝酸异山梨酯,25例)、B(含服硝酸异山梨酯5mg,25例)两组,进行16层螺旋CT冠状动脉成像,分别观测右冠状动脉、左主干、左前降支、左旋支四个主要节段的管腔直径和14个节段的显示情况以及患者副反应。结果B组冠状动脉4个主要血管节段直径明显大于A组;两组右冠状动脉(第1、2、3段)、左主干(第5段)、左前降支(第6、7段)、左旋支(第11段)可评价例数相同;左室后支(第14段)、左前降支(第8段)、第1、2对角支(第9、10段)、钝缘支(第12段)、左旋支(第13段)显示差异有显著性,而两组副反应差异无显著性。结论含服硝酸异山梨酯可扩张冠状动脉,提高MSCT冠状动脉细小分支的显示率和成像质量,而不增加副反应率。     

Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial

Maureen O. Meade, MD, MSc; Deborah J. Cook, MD, MSc; Gordon H. Guyatt, MD, MSc; Arthur S. Slutsky, MD; Yaseen M. Arabi, MD; D. James Cooper, MD; Andrew R. Davies, MD; Lori E. Hand, RRT, CCRA; Qi Zhou, PhD; Lehana Thabane, PhD; Peggy Austin, CCRA; Stephen Lapinsky, MD; Alan Baxter, MD; James Russell, MD; Yoanna Skrobik, MD; Juan J. Ronco, MD; Thomas E. Stewart, MD; for the Lung Open Ventilation Study Investigators

JAMA. 2008;299(6):637-645.

Context  Low-tidal-volume ventilation reduces mortality in critically ill patients with acute lung injury and acute respiratory distress syndrome. Instituting additional strategies to open collapsed lung tissue may further reduce mortality.

Objective  To compare an established low-tidal-volume ventilation strategy with an experimental strategy based on the original "open-lung approach," combining low tidal volume, lung recruitment maneuvers, and high positive-end–expiratory pressure.

Design and Setting  Randomized controlled trial with concealed allocation and blinded data analysis conducted between August 2000 and March 2006 in 30 intensive care units in Canada, Australia, and Saudi Arabia.

Patients  Nine hundred eighty-three consecutive patients with acute lung injury and a ratio of arterial oxygen tension to inspired oxygen fraction not exceeding 250.

Interventions  The control strategy included target tidal volumes of 6 mL/kg of predicted body weight, plateau airway pressures not exceeding 30 cm H₂O, and conventional levels of positive end-expiratory pressure (n = 508). The experimental strategy included target tidal volumes of 6 mL/kg of predicted body weight, plateau pressures not exceeding 40 cm H₂O, recruitment maneuvers, and higher positive end-expiratory pressures (n = 475).

Main Outcome Measure  All-cause hospital mortality.

Results  Eighty-five percent of the 983 study patients met criteria for acute respiratory distress syndrome at enrollment. Tidal volumes remained similar in the 2 groups, and mean positive end-expiratory pressures were 14.6 (SD, 3.4) cm H₂O in the experimental group vs 9.8 (SD, 2.7) cm H₂O among controls during the first 72 hours (P < .001). All-cause hospital mortality rates were 36.4% and 40.4%, respectively (relative risk [RR], 0.90; 95% confidence interval [CI], 0.77-1.05; P = .19). Barotrauma rates were 11.2% and 9.1% (RR, 1.21; 95% CI, 0.83-1.75; P = .33). The experimental group had lower rates of refractory hypoxemia (4.6% vs 10.2%; RR, 0.54; 95% CI, 0.34-0.86; P = .01), death with refractory hypoxemia (4.2% vs 8.9%; RR, 0.56; 95% CI, 0.34-0.93; P = .03), and previously defined eligible use of rescue therapies (5.1% vs 9.3%; RR, 0.61; 95% CI, 0.38-0.99; P = .045).

Conclusions  For patients with acute lung injury and acute respiratory distress syndrome, a multifaceted protocolized ventilation strategy designed to recruit and open the lung resulted in no significant difference in all-cause hospital mortality or barotrauma compared with an established low-tidal-volume protocolized ventilation strategy. This "open-lung" strategy did appear to improve secondary end points related to hypoxemia and use of rescue therapies.

Trial Registration  clinicaltrials.gov Identifier: NCT00182195

     

Low expression of S100P associated with paclitaxel resistance in ovarian cancer cell line

Background Recent studies indicate that S100P expression may be a biomarker that can predict the success of cancer chemotherapy. Whether it is relevant to chemotherapeutics in ovarian cancer is unknown. In this study, we investigated the association of S100P expression with paclitaxel sensitivity in ovarian cancer cell lines. Methods We measured S100P expression and paclitaxel resistance profiles in parent SKOV3 and OVCAR3 cell lines. Then, the two cell lines were transiently transfected with S100P siRNA. We also constructed an OVCAR3 cell clone that stably overexpressed S100P. The effect of S100P expression level on the survival of cells exposed to paclitaxel was measured using the MTT assay. S100P expression was evaluated by semi-quantitative RT-PCR and Western blotting. Significance of differences was calculated using independent samples t-test and one way analysis of variance （ANOVA）. Results Lower S100P expression was associated with a survival advantage in OVCAR3 cells exposed to paclitaxel; the survival advantage in SKOV3 cells was smaller （P 〈0.05）. The survival advantage associated with decreased S100P expression was even greater for SKOV3 and OVCAR3 cells that had been transfected with S100P siRNA before being exposed to paclitaxel （P 〈0.05）. Consistent with this, the OVCAR3 cell clone that was transfected to overexpress S100P was more sensitive to paclitaxel （P 〈0.05）. Conclusions Low S100P expression contributes to drug resistance to paclitaxel in ovarian cancer cell lines. S100P expression thus might be a marker that can predict the effectiveness of paclitaxel based chemotherapy. Such a marker could be helpful in improving individual medication regimens for ovarian cancer patients.     

铁超负荷与胰岛素抵抗的相关性研究进展

铁作为机体必需的营养元素,起着重要的生物学功能。但是,铁过多也会对细胞和组织产生危害。已经发现,铁超负荷与胰岛素抵抗之间存在某些联系。胰岛素抵抗可引起铁代谢的异常,反之,铁超负荷可加重胰岛素抵抗。本文就此方面的研究进展予以综述。     

电话回访对糖尿病患者遵医行为的影响

目的:探讨电话回访对糖尿病患者遵医行为的影响。方法:将在我院经住院治疗后出院的糖尿病患者80例随机分为实验组与对照组,每组40例,对实验组进行电话回访,对照组不作任何干预,6个月后对两组患者遵医率及生活指标达标率进行调查。结果:实验组患者遵医率及生化指标达标率明显高于对照组(P<0.05,或P<0.01)。结论:对出院糖尿病患者进行电话回访密切了护患关系,提高了患者的遵医行为,对防止糖尿病并发症,提高生命质量有重要意义。     

药物代谢转化和样品前处理技术的研究进展

本文对近年来药物代谢转化研究方法和样品前处理技术进行了综述。介绍了药物体内和体外代谢研究模型，以及代谢产物的分离和鉴定技术新进展，重点对固相萃取和固相微萃取的原理、提取步骤、各种实验参数的影响、与分析仪器联用技术的研究进展和应用进行了评述。     

兔急性脊髓损伤后磁刺激运动诱发电位与病理变化的相关性

目的观察兔急性脊髓损伤后经颅磁刺激运动诱发电位（transcranial magnetic stimulation motor evoked pontentials,TMS-MEP）的变化规律,并与脊髓病理变化相比较,探讨其相关性。方法将日本大耳兔32只随机分为4组,每组8只。A组为对照组,B、C、D组为实验组（脊髓损伤组）。然后对每组动物分别于麻醉后、暴露脊髓后、伤后5min、30min、1h、6h、1d、3d、7d检测TMS-MEP,对所得波形数据进行统计学分析。于伤后1d、3d、7d采用后肢的Tarlov分级行运动功能评分。以损伤部位为中心切取脊髓标本,行HE染色光镜、电镜观察。结果随着脊髓损伤的加重,MEP的潜伏期逐渐延长,波幅在逐渐减小,病理显示白质纤维脱髓鞘越重,神经细胞损伤数目越多,MEP的潜伏期延长和波幅降低越明显。结论经颅磁刺激运动诱发电位与脊髓病理变化有明显的相关性,TMS-MEP对脊髓损伤十分敏感,能客观地检测脊髓运动功能,反映脊髓损伤程度。     

双频指数闭环反馈吸入麻醉药用药系统的研制

目的建立以双频指数为控制变量的闭环反馈吸入麻醉药用药系统,并通过临床验证确定该系统临床应用的可行性。方法整个研究分为建立用药系统和临床验证两个阶段。首先建立闭环控制用药系统,系统分为软件和硬件两部分。软件部分为吸入麻醉药闭环控制软件《吸入麻醉执行者》,在此软件中建立了吸入麻醉药生理药代动力学模型,软件的反馈算法采用PID算法,此软件与麻醉深度监护仪、注射泵、紧闭循环麻醉机等硬件共同组成闭环控制用药系统。临床验证阶段使用安氟醚、异氟醚、七氟醚等多种药物进行闭环反馈麻醉,并选择腹腔手术、开胸单肺通气手术、肥胖患者等不同人群进行了临床观察。结果使用安氟醚、异氟醚、七氟醚等多种药物闭环反馈麻醉控制双频指数的稳定性均达到或超过人工控制麻醉的水平,闭环反馈麻醉系统在开胸单肺通气手术、肥胖患者等药代动力学变异很大的患者中取得满意的效果,说明采用BIS作为控制变量是可行的,采用PID算法作为系统控制算法能够满足临床要求。结论采用BIS作为控制变量,PID算法作为控制算法的吸入麻醉药闭环反馈用药系统控制多种吸入麻醉药能够保证患者麻醉深度平稳,对单肺通气及肥胖患者等药代动力学变化较大的情况下,系统性能仍能满足临床需要。     

5-羟色胺受体及转运体在肠易激综合征发病机制中的作用

肠易激综合征(IBS)是一种慢性功能性肠道疾病。IBS具有肠道动力异常、肠内分泌紊乱和内脏高敏感等特点。5-羟色胺(5-HT)是肠道重要的神经递质,通过各受体亚型及转运体在IBS发病中介导了不同的生理及病理效应,引起肠道功能异常。近年研究发现5-HT受体及转运体的相关制剂在IBS治疗中显示了良好的应用前景。     

The Effect of Targeted Magnetic Nanopaticles on Hepatoma and the Expression of bcl-2/bax Protein

The effect of targeted magnetic nanoparticles on hepatoma and the underlying mechanism were examined. Nude mice transplanted with a human hepatoma cell line （HepG2 cells） were randomized into 5 groups, including： （1） group A, receiving normal saline, （2） group B, receiving 5-fluorouracil （5-Fu）, （3） group C, receiving magnetic nanoparticles containing 5-Fu, （4） group D, consisting of treatment with magnetic nanoparticles containing 5-Fu and inside magnetic field and （5） group E, receiving pure magnetic nanoparticles and inside magnetic field. Morphological features of transplanted tumors in mice in each group were observed under transmission electron microscope （TEM）. The expression of bcl-2/bax protein was immunohistochemically detected by SABC method. The results showed that a large number of apoptotic tumor cells were found in group B and group D under TEM. The expression of bcl-2 protein was significantly decreased and the expression of bax protein increased significantly in both group B and D as compared with those in group A, C and E （P〈0.01 for all）. The decrease in bcl-2 and the increase in bax were more in group D as compared with group B （P〈0.01）. It is concluded that the targeted magnetic nanoparticles containing 5-Fu can improve the chemotherapeutic effect of 5-Fu by decreasing bcl-2 expression, increasing bax expres- sion and inducing apoptosis of the liver cancer cells.