胃食管反流病与功能磁共振技术

随着对胃食管反流病研究的深入,大脑和食管感觉及胃排空的相互作用越来越受到重视,功能磁共振成像技术,有助于进一步了解胃食管反流病的发病机制。     

脓毒症的诊断与治疗

近年来对于脓毒症及其并发症的认识和治疗研究有了很大进展,但严重的脓毒症、脓毒性休克的死亡率仍高达30%~50%,特别是真菌菌血症病死率高达50%。本文概述脓毒症的概念和诊断,着重从早期目标治疗、血管收缩药物的应用、抗生素的使用、控制感染源、肾上腺皮质激素的应用、机械通气策略、重组人活化蛋白C的应用、镇静剂和止痛剂及神经肌肉阻断剂的使用、脓毒症的辅助治疗和支持治疗等方面阐述脓毒症的治疗进展。希望能引起临床工作者对脓毒症的重视,提高脓毒症患者的生存率。     

胎儿期完全型大动脉转位超声诊断的特征

目的探讨胎儿完全型大动脉转位(C-TGA)超声心动图的特征及诊断价值。方法分析6例经手术或尸解证实的C-TGA的新生儿超声心动图检查,并回顾分析其胎儿期漏诊误诊原因,总结胎儿C-TGA超声心动图的诊断体会。结果6例新生儿大动脉转位,其中胎儿期超声漏诊5例,误诊1例。其中产前仅诊断室间隔缺损或右室双出口,经出生后手术证实的C-TGA4例,尸解证实C-TGA 1例。结论C-TGA在胎儿期已有明确超声声像特征,加强医师对先天性心脏病知识的系统学习,降低漏诊误诊率是提高筛查质量的关键。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

现代教育技术在执业药师远程继续教育中的应用研究

利用计算机技术，搭建执业药师网上远程继续教育的平台，将主管部门审核的有关执业药师继续教育的教学内容放到网上，供参加执业药师继续教育的人员浏览学习。通过加强管理，严格考核，变传统教学模式为现代教育方式，实现教育的个性化，有效提高执业药师的继续教育质量。     

谷氨酸对腺苷A2A受体调节一氧化氮合酶活力的影响

目的探讨谷氨酸是否能够影响腺苷A2A受体对一氧化氮合酶（NOS）活力的调节。方法用1000ng／ml脂多糖（LPS）刺激小胶质细胞，分别加入100nmol／L A2A受体激动剂CGS21680以及不同浓度的谷氨酸（0，1，0，25，0，5mmol／L）干预，观察NOS活力变化。结果LPS诱导NOS活力增高，激活A2A受体可以产生抑制作用；0，25及0．5mmoL／L谷氨酸和A2A受体激动剂同时存在时，NOS活力进一步增高。结论高浓度谷氨酸可逆转腺苷A2A受体激动剂抑制升高NOS活力的作用。     

Dexamethasone treatment attenuates early seawater instillation-induced acute lung injury in rabbits.

There is very little evidence on the value of giving corticoids in cases of seawater drowning induced acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Therefore, this study aimed to investigate whether dexamethasone treatment can attenuate seawater instillation-induced acute lung injury in rabbits. Seawater (4 ml/kg body weight) was instilled into the lower trachea of ventilated, anesthetized rabbits. Then these rabbits were assigned randomly 20 min later to receive intravenous injection of 1mg/kg body weight of dexamethasone (dissolving in 2 ml of normal saline) or 2 ml of normal saline. All animals demonstrated immediate drops in arterial oxygen tension (PaO2) and the total thoracic compliance, which were significantly improved after 2 h of dexamethasone treatment. Histopathological study also indicated that dexamethasone treatment markedly attenuated lung histopathological changes, alveolar hemorrhage and inflammatory cells infiltration with evidence of decreasing of myeloperoxidase (MPO) activity and tumor necrosis factor-alpha (TNF-alpha) concentration in lung tissue. In addition, dexamethasone treatment reduced extravascular lung water and lung epithelial-endothelial barrier permeability, up-regulated the expression of surfactant protein-A (SP-A) and alpha-epithelial Na+ channel, and increased Na+/K+-adenosine triphosphatase (Na+/K+-ATPase) activity and Na+/K+-ATPase-alpha1 protein abundance. Thus, these data indicate that dexamethasone treatment might be of benefit in patients with seawater aspiration-induced ALI.     

注射后臀肌挛缩症的分型及手术治疗

目的 探讨注射后臀肌挛缩症的分型、分型与病变的关系和手术范围。方法 根据臀肌挛缩症特有的临床表现.分为轻型、中型、重型：根据分型术中分别显露髂胫束、臀大肌、臀中肌、臀小肌至髋关节囊后方。结果 153例均手术治疗，随访141例、随访时间1～10年，平均6．8年，优良率96．5％。结论 将臀肌挛缩症进行分型？更有利于准确的区别病情轻重程度，选择相应的手术范围和评估预后。     

生物安全柜的控制

生物安全柜是重要的一级屏障设备，适当的控制方式对生物安全柜的防护能力是很重要的。文中主要介绍了生物安全柜的控制要点和几种控制方式及其特点。