罗库溴铵预注效果的临床研究

目的：研究较库溴争的预注效果。方法：ＡＳＡⅠ－Ⅱ级择期全麻手术４６例,男２５例,女２１例,分为三组。Ⅰ组用罗库溴铵预注法导插管,应用正交试验Ｌ（３＾７）方法,观察０．０４５、０．０６、０．０７５ｍｇ／ｋｇ三种不同水平的预注量（ＰＤ）,２、３、４分钟预注时间（ＰＩ）及０、３、０．４５、０．６ｍｇ／ｋｇ插管剂量（ＩＤ）地预注效果的影响,Ⅱ组（ｎ＝１８）用罗库溴铵０．３、０．４５、０．６ｍｇ／ｋｇ常规诱     

Upregulation of HMGB1 in wall of ruptured and unruptured human cerebral aneurysms: preliminary results

A growing body of evidence suggests that inflammation plays a crucial role in cerebral aneurysm initiation, progression, and rupture. High-mobility group box 1 (HMGB1) is a non-histone nuclear protein that can serve as an alarmin to drive the pathogenesis of inflammatory disease. The purpose of this study was to investigate the expression of HMGB1 in the wall of ruptured and unruptured human cerebral aneurysms. Human cerebral aneurysms (25 ruptured and 16 unruptured) were immunohistochemically stained for HMGB1. As controls, four specimens of the middle cerebral arteries obtained at autopsy were also immunostained. Immunofluorescence double staining was used to determine HMGB1 cellular distribution. HMGB1 was nearly undetectable in the controls. All aneurysm tissues stained positive for HMGB1 monoclonal antibody, and expression of HMGB1 was more abundant in ruptured aneurysm tissue than unruptured aneurysms (p < 0.05). Furthermore, the expression of HMGB1 had no correlation with aneurysm size and time resected after the rupture. HMGB1 nuclear immunoreactivity was co-localized with immunoreactivity of CD3 in T lymphocytes, CD20 in B lymphocytes, CD68 in macrophages, α-SMA in smooth muscle cells, and CD31 in endothelial cells. Cytoplasmic HMGB1 localization was also detected in macrophages and T lymphocytes. Taken together, HMGB1 is expressed in the wall of human cerebral aneurysms and is more abundant in ruptured aneurysms than in unruptured ones. These data indicate a possible role of HMGB1 in the pathophysiology of human cerebral aneurysms.     

Expression of intestinal CD40 after experimental traumatic brain injury in rats

Background

Nuclear factor kappa B (NF-κB) has been shown to be activated in the intestine after traumatic brain injury (TBI), and results in gastrointestinal mucosal injury. In addition, CD40 has a major role in the activation of NF-κB and is up-regulated in inflammatory bowel disease. However, we found no study in the literature investigating the intestinal expression of CD40 after TBI. Hence, we designed the current study to explore the intestinal expression pattern of CD40 after TBI in rats. We hypothesized that CD40 could mediate inflammation and ultimately contribute to acute intestinal mucosal injury after TBI.

Methods

We randomly divided rats into control and TBI groups at 3, 6, 12, 24, and 72 h, respectively. We assessed the expression of CD40 by quantitative real-time polymerase chain reaction, Western blotting, and immunohistochemical study, and detected the levels of tumor necrosis factor-α (TNF-α), intracellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) by enzyme-linked immunosorbent assay.

Results

The mRNA and protein levels of -CD40 increased by 3 and 6 h, peaked at 6 and 12 h, and remained elevated until 24 and 72 h post-injury, respectively. Levels of TNF-α, VCAM-1, and ICAM-1 also markedly increased in jejunum tissue after TBI. Interestingly, there was a positive relationship between the expression of CD40 and that of TNF-α, VCAM-1, and ICAM-1.

Conclusions

CD40 could be markedly elevated in intestine after TBI in rats, and it might have an important role in the pathogenesis of acute intestinal mucosal injury mediated by inflammatory response.     

复方倍他米松联合5-氟尿嘧啶在增生性瘢痕中的应用效果分析

【摘要】 目的 对比分析复方倍他米松联合 5-氟尿嘧啶与单纯复方倍他米松注射治疗小面积增生性瘢痕的临床效果。方法 选取 2018年1月至2019 年7月毕节市第一人民医院收治的36例小面积增生性瘢痕患者作为研究对象, 按照随机数表法将其随机分为观察组与对照组, 每组18例。观察组患者采用复方倍他米松联合 5-氟尿嘧啶注射治疗, 对照组患者单纯采用复方倍他米松注射治疗, 对比观察两组患者温哥华瘢痕量表 (VSS) 评分及临床疗效。结果 治疗结束后1个月, 观察组患者VSS评分为 (2.00±0.77) 分, 明显低于对照组患者的VSS评分 (6.22±1.93) 分 (t = 8.616, P < 0.001); 随访1年后, 观察组患者中治愈8例、显效10例, 明显优于对照组患者的治愈3例、显效11例、无效4例 (Z = - 2.340, P = 0.019)。结论 与单纯应用复方倍他米松相比,应用复方倍他米松联合5-氟尿嘧啶治疗小面积增生性瘢痕可有效促进瘢痕组织消退, 改善瘢痕症状, 疗效更显著。     

定量MRI诊断直肠癌淋巴结转移的研究进展

评估直肠癌淋巴结转移对治疗和预后至关重要。常规MRI诊断直肠癌淋巴结转移主要依据淋巴结的短径和形态学特征,诊断效能较低。定量MRI包括动态增强MRI（DCE-MRI）、动态磁敏感增强MRI（DSC-MRI）、单指数模型扩散加权成像（DWI）、扩散峰度成像（DKI）、体素内不相干运动扩散加权成像（IVIM-DWI）等,可以对直肠癌淋巴结及原发灶进行定量分析,从而有助于诊断淋巴结转移。就常规MRI及定量MRI诊断直肠癌淋巴结转移的研究进展予以综述。     

空心钉治疗跟骨骨折疗效分析

目的探讨空心钉治疗跟骨骨折的临床疗效。方法对75例跟骨骨折患者中38例(45足)用空心钉治疗,37例(45足)用钢板内固定治疗。记录两组患者的手术时间、术中出血量、骨折愈合时间及术后功能,对两种疗效进行对比。结果 75例患者均获得随访,时间6～18(10.32±2.18)个月。空心钉组优良率为93.33%,钢板组优良率为91.11%,两组疗效差异无统计学意义(P>0.05)。与钢板组比较,空心钉组的手术时间和术中出血量明显缩短或者减少,差异有统计学意义(P<0.01);而骨折愈合时间、Bhler角、Gissane角、跟骨距骨宽度和踝关节活动范围两组差异无统计学意义(P>0.05);两组并发症发生率差异无统计学意义(P>0.05)。结论空心钉治疗跟骨骨折能有效防止关节面复位后再塌陷及骨折端再移位,手术简便、手术创伤小,是治疗跟骨骨折较理想的一种方法。     

腹腔镜胆囊切除术中肝中静脉及其属支误伤出血的防范及处理

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中肝中静脉及其属支误伤出血的预防和处理方法。方法对我院2008年1月至2010年1月期间27例行LC时肝中静脉及其属支损伤破裂出血患者的临床资料进行回顾性分析。结果 27例患者均在腹腔镜下止血成功,其中17例通过腹腔镜下填塞压迫止血,6例通过腹腔镜下钛夹钳夹止血,4例通过腹腔镜下缝扎止血。3种止血方法中以腹腔镜下填塞压迫止血法的手术时间最短、术中出血量最少,分别为(90.26±12.46)min和(240.32±80.15)ml,但3种止血方法的手术时间及术中出血量之间比较差异均无统计学意义(P>0.05)。结论 LC中要尽量在正确的层次分离胆囊床,以减少肝中静脉及其属支的损伤。采取正确的止血措施或止血困难时及时中转开腹,对安全完成手术至关重要。     

盐酸戊乙奎醚减少卡前列素氨丁三醇术中不良反应的效果观察

目的 观察盐酸戊乙奎醚对于剖宫产术中卡前列素氨丁三醇引起的不良反应的影响.方法 选择40例存在子宫收缩乏力危险因素的择期剖宫产的产妇,随机均分为盐酸戊乙奎醚组(A组)和生理盐水组(B组).A组术前静脉注射稀释2 ml的盐酸戊乙奎醚0.5 mg;B组术前静脉注射2 ml的生理盐水.监测两组产妇的MAP、HR、SpO2和RR,记录断脐开始至肌注卡前列素氨丁三醇注射液的时间和术中出血量、输液量、尿量,并观察宫体注射卡前列素氨丁三醇注射液后恶心、呕吐、心悸、胸闷憋气和面部潮红等不良反应.结果 B组产妇恶心、胸闷憋气和面部潮红等不良反应的发生率高于A组(P＜0.05).结论 盐酸戊乙奎醚可有效地减少剖宫产术中卡前列素氨丁三醇注射液引起的不良反应.