映山红花总黄酮对盐酸异丙肾上腺素诱导大鼠心肌缺血的保护作用

目的观察映山红花总黄酮(TFR)对盐酸异丙肾上腺素诱导的实验性心肌缺血的保护作用。方法采用皮下(sc)注射盐酸异丙肾上腺素(Iso)(8 mg·kg^-1×2 d)诱导大鼠实验性心肌缺血模型,测定血清中MDA含量、GSH-PX活力、SOD及心肌组织中ATPase活性。同时行心肌组织病理组织学检查。结果TFR 30 mg·kg^-1显著降低血清中MDA的生成,30,15 mg·kg^-1及60,30 mg·kg^-1升高SOD,GSH-PX的活力,60,30 mg·kg^-1TFR可抑制心肌组织中Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-AT-Pase,总ATPase活力的降低,TFR 60,30 mg·kg^-1能显著改善sc Iso后心肌病理损伤程度,降低其病理损伤评分。结论TFR对盐酸异丙肾上腺素诱导的实验性心肌缺血有保护作用,其机制可能与减少体内自由基生成、改善心肌能量代谢有关。     

糖皮质激素促进β-淀粉样蛋白对海马神经元损伤的研究

目的在体外实验条件下,观察糖皮质激素是否促进β-淀粉样蛋白的神经元毒性作用。方法通过LDH释放率法检测细胞活力、TUNEL法测细胞凋亡以及LSCM测胞内Ca²⁺浓度的变化。结果单独的地塞米松(10^-8,10^-7,10^-6mol·L^-1)组或Aβ25-35(0.5μmol·L^-1)组分别作用海马神经元后,细胞活力变化不明显(P>0.05);但与同剂量的DEX、Aβ_25-35组相比,DEX+Aβ_25-35组的细胞活力明显降低(P<0.05),同时胞内Ca²⁺显著上升(P<0.05),神经元的凋亡率增加明显,细胞内出现凋亡的典型形态学特征。结论糖皮质激素可能通过促进Aβ引起海马神经元胞内Ca²⁺升高增加神经元毒性作用。     

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??Abstract?? Objective To study balloon dilatation with cryotherapy under bronchoscope for subglottic stenosis in infants and young children??and to explore the efficacy of this new technology??the timing of treatment and safety. MethodFrom July 2009 to May 2014 in 28 SGS cases aged from 1 month to 3 years?? bronchoscopic balloon dilatation treatment with CO2 cryotherapy was performed?? and different types of SGS treated by minimal invasi were assessed regarding efficacy, complications and outcome. Results The infant SGS were divided into ??°~??° by severity?? and soft membrane SGS and scarring SGS by the causes of stenosis. ??° SGS included 16 cases, in which 8 cases soft membrane SGS were treated by balloon dilatation effectively?? 9 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 4 cases after combined therapy; ??° SGS included 8 cases?? soft membrane SGS were treated effectively in 2 cases?? 4 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 2 cases after combined therapy; ?? °SGS included 4 cases?? 1 case of soft membrane SGS and 1 case of scarring SGS responded well to integrated treatment .Conclusion MSCT and bronchoscopy assessment is used in grading the extent and causes of stratification in infants with subglottic stenosis?? and then we can select the appropriate treatment programs to improve the prognosis of the disease and improve life quality of SGS children.     

CITED2基因突变与先天性心脏病关系研究

目的 研究CITED2基因突变与先天性心脏病（CHD）的关系。方法 2013年1月至2015年1月山东大学齐鲁儿童医院收集368例散发型CHD患儿和200名健康儿童血液样本进行DNA抽提, PCR扩增CITED2外显子区, Sanger测序后, 进行GeneBank对比和氨基酸序列分析。结果 发现4例杂合突变。病例1室间隔缺损患儿为c.399C＞T同义突变（p.His133His）; 病例2室间隔缺损患儿为SGJ区c.574A＞G的错义突变（p.Ser192Gly）; 病例3房间隔缺损患儿为已知 SNP位点（rs191856368）; 病例4动脉导管未闭患儿为新发现的错义突变（p.Ser96Phe）。这些突变在对照组中均未检测到。结论 CITED2基因Ser192Gly和p.Ser96Phe突变可能与CHD发生有关。     

胎儿大脑中动脉血流监测在产科中的应用

胎儿大脑中动脉（MCA）血流频谱反映了其心血管对缺氧或血流再分布的早期适应,其测量要求标准化、规范化,是近年来胎儿血流动力学临床应用研究的热点之一。国内外近期出现了一些大样本的回顾性及前瞻性临床研究,对MCA评估指标、参考值范围以及临床各疾病中运用的截断值进行了报道。文章结合2021年版国际妇产科超声学会（ISUOG）胎儿多普勒血流频谱监测指南,对胎儿MCA血流频谱相关的高质量研究进行分析总结,为其临床规范化运用提供参考。     

发热并腹泻1 d 抽搐1次——牛奶蛋白过敏 模拟脓毒症临床分析

 第一阶段病历资料         患儿女,42 d。因“发热、腹泻1 d,抽搐1次”于2011-10-02就诊于天津市儿童医院。经急诊医生抗惊厥处理后于当晚转入儿童重症监护病房（PICU）。转入时查体：体温（肛表测试）36.8℃,呼吸20次/min,脉搏110次/min,血压80/50 mmHg（1 mmHg = 0.133 kPa）。营养状态中等,体重43 kg,精神反应弱,哭声弱,少泪,眼窝稍凹陷,皮肤弹性尚可,肢端温度稍低,末梢循环充盈时间正常。双肺呼吸音稍粗,心音有力,心率110次/min。腹平,未见肠型及蠕动波,腹壁软,肝脾无肿大,未触及包块。肠鸣音活跃,性质无异常。神经系统检查未见异常。门诊及入院实验室和影像学检查见表1。初步诊断：腹泻病（感染性）,脱水（轻-中度）,支气管炎,发热惊厥原因待查。入院10 h内治疗：予以抗生素和液体疗法（1/2张力葡萄糖盐水）,纠正脱水和电解质紊乱。经鼻管饲深度水解配方奶和水。入院第10小时,患儿突然出现口唇紫绀,意识不清,经皮血氧饱和度（SO2）逐渐下降至50% ~ 60%,心率逐渐减慢至80次/min。随即予以肾上腺素和呼吸中枢兴奋剂、气管内插管、呼吸机辅助呼吸［通气模式为间歇正压通气（IPPV）+ 呼气末正压（PEEP）2 cm,呼吸频率40次/min,吸气末峰压（PIP）20 cmH2O（1 cmH2O = 0.098 kPa）,吸呼比（I/E）1∶1.5,吸入氧浓度（FiO2）0.5］。SO2和心率逐渐恢复,血压80/50 mmHg。2 h后因肝脏增大和心率增快予以强心药地高辛。再次检测血液生化提示低钠血症     

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??Study on surgical anatomy and histology of mesopancreas WU Wen-guang*??GUAN Wen-bin??LIU Yong-chen??et al. *Department of General Surgery??Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine??Shanghai 200092??China
Corresponding author??LIU Ying-bin??E-mail??laoniulyb@163.com
Abstract Objective To investigate the surgical anatomical and histological data for the mesopancreas and mesopancreatic excision. Methods The anatomic structures of the peripancreatic space??the important vessels and the retroperitoneal structures of 5 cadaveric specimens between January and December 2016 in Basic Medicine Faculty of Shanghai Jiao Tong University were observed in the study. The structures of the vessels and retroperitoneum were histological studied. Results Posterior pancreatic space was an important anatomical plane of mesopancreatic excision. Celiac trunk and superior mesenteric artery were important anatomic landmarks of mesopancreatic excision. The No.16 lymph node was the extra anatomy structure of mesopancreas. There was a natural surgical space between the adventitia and sheath of the artery. There was a great deal of nerve and lymphatic vessel distribution on and outside the arterial sheath of the peripancreatic arteries. Conclusion Mesopancreas and mesopancreatic excision have the corresponding basis of surgical anatomy. Arterial sheaths dissection strategy for improving the dissection effect has certain anatomical basis.     

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??Case analysis of conversion therapy by laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy for gastric cancer peritoneal metastasis XUE Kan*??LI Zi-yu??LI Shuang-xi??et al. * Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author??LI Zi-yu??E-mail??ligregory@outlook.com
Abstract Objective To investigate the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) combined intraperitoneal and systemic chemotherapy in gastric cancer patients with peritoneal metastasis. Methods A gastric cancer patient whose peritoneal cancer index was 39 during laparoscopic exploration was admitted at Peking University Cancer Hospital Gastrointestinal Center. The patient received laparoscopic HIPEC with docetaxel, followed by 6 courses of intraperitoneal and intravenous PTX??along with S-1 orally. Results CT scan showed distinct response during post-treatment evaluation. A second look by laparoscopy was suggested by MDT. No tumor cell was found in the lavage fluid through abdominocentesis and no metastasis can be seen by laparoscopic exploration. Then total gastrectomy plus D2 minus No.10 lymph node dissection was performed. The patient recovered smoothly after surgery. The pathology confirmed a ypT3N2M1, moderate to poor-differentiated adenocarcinoma, from gastric antrum to body. By September 2017, the patient was still in postoperative treatment. Conclusion Laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy showed effective interim results in gastric cancer peritoneal metastasis conversion therapy and is deserved for further researches.     

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??Protection of Oddi sphincter function and its significance in endoscopic sphincterotomy LU Xin-liang*??LIANG Ting-bo. *Department of Gastroenterology, the Second Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, China.
Corresponding author: LIANG Ting-bo, E-mail:liangtingbo@
zju.edu.cn
Abstract The sphincter of Oddi is a neuromuscular structure located at the junction of the bile and pancreatic ducts with the duodenum. The primary functions of the sphincter of Oddi are to regulate the delivery of bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents restrograde infection. EST damage the integrity of the Oddi sphincter, leading to sphincter relaxation or stenosis, causing partial or complete loss of the original physiological function of the Oddi sphincter. Therefore, surgeons should strictly control the indications of EST, retain the sphincter function as far as possible, so as to provide patients with more reasonable and standardized treatment strategy.