塑料/碘填充剂在CT三维成像和标本铸型中的应用

目的:探求一种既可用于CT三维成像又可用于标本铸型的塑料/碘填充剂(plastic bulking agent mixed with iodine,PBAI)。方法:以0·2、0·5、0·9、1·0、1·2、1·8、2·0、2·5g碘分别溶于10ml乙酸乙酯,再加1·5g聚氯乙烯配成15%塑料填充材料;做成10ml注射器铸件CT扫描,筛选最佳碘浓度灌注材料。选择正常SD大鼠以最佳碘浓度材料行全身血管灌注。MDCT扫描,分别用CT机自带软件和Mimics软件获得大鼠全身血管三维图像,对图像质量进行优良比率评估。结果:最佳碘浓度灌注材料为250g/L。灌注满意大鼠9只,其全身血管三维图像优秀率CT机、Mimics图像分别为88·5%和87·6%;血管铸型优秀率为88·9%。结论:250g/L碘浓度、15%PBAI是一种既可用于CT三维成像,又可用于标本铸型的优良填充剂。     

葛根素对星形胶质细胞肿胀及大鼠脑水肿的对抗作用

为观察葛根素是否有对抗星形胶质细胞肿胀及脑水肿的作用 ,体外实验用培养的星形胶质细胞进行 ,整体实验用Wistar雄性大鼠tACPD(5 0 0nmol,2 μL)尾状核内微量注射的方法 ,分别测定星形胶质细胞水含量、脑组织水含量和Na+ 、K+ 、Ca2 + 含量 ,部分脑组织进行电镜观察。结果显示葛根素可以阻断tACPD引起的星形胶质细胞水含量增加 ,减轻由tACPD尾状核内注射引起的脑组织水含量和Na+ 含量增加 ,电镜检查证实葛根素可以减轻tACPD引起的星形胶质细胞肿胀及足突肿胀对毛细血管的挤压。提示葛根素可以对抗星形胶质细胞肿胀及脑水肿。     

地塞米松诱发大鼠卡氏肺孢子虫肺炎实验研究

目的 在地塞米松磷酸钠诱导下建立大鼠卡氏肺孢子虫肺炎的动物模型。方法 将40只雌性SD大鼠随机分为实验组和对照组,前者皮下注射地塞米松磷酸钠,1mg/次,2次/w;后者不做任何处理。观察两组大鼠的发病情况,并每隔3周两组各取5只动物进行病原学检查。结果 实验组大鼠第6周开始发病,肺印片、支气管肺泡灌洗液沉渣中查到卡氏肺孢子虫包囊及滋养体;对照组大鼠无异常表现,病原学检查阴性。结论 在地塞米松磷酸钠诱导下可成功建立大鼠卡氏肺孢子虫肺炎动物模型。     

鼻腔、鼻窦部砂粒性骨化纤维瘤6例临床分析

为探讨临床上比较罕见的砂粒性骨化纤维瘤（psammomatoid ossifying fibroma,POF）的临床特征、诊断与治疗方法,分析了6例POF的临床资料并综合文献,提出POF是一种以青少年为主、具有局部侵袭性的良性肿瘤,有明确的组织形态特征,临床症状特别是CT扫描是临床诊断的基础,治疗原则是在彻底清除病灶的基础上,兼顾面容与功能的保护。     

一氧化氮对红内期约氏疟原虫感染的影响

目的：探讨的氏疟原虫感染早期一氧化氮（nitric oxide,NO)对红内期疟原虫的影响。方法：通过ELISA和Griess反应,观察疟原虫感染早期宿主体内细胞因子和NO对红内期虫体血症的影响及其效应。结果：疟原虫感染早期随着以IFN-γ分泌增加为主的Th1细胞免疫应答产生的过程,NO合成逐渐增加,红内期原虫血症受到抑制,一旦解除高水平NO的作用,虫体的增殖能力即可迅速得以恢复。结论：NO通过抑制裂殖子的侵袭力发挥抗红内期原虫感染的保护性免疫效应。     

Effects of diuretics on intradialytic hypotension in maintenance dialysis patients: a systematic review and meta-analysis

Purpose

Intradialytic hypotension (IDH) is a serious complication in dialysis patients. Diuretics might reduce the incidence of IDH by decreasing ultrafiltration. However, the effect of diuretics on IDH in maintenance dialysis patients is still unclear.

Methods

We searched Medline, Embase, the Cochrane Library, China National Knowledge Infrastructure and clinical trials registries from 1945 to May 2019. Randomized controlled trials (RCTs) or observational studies about IDH in maintenance dialysis with diuretics were included.

Results

Seven studies including 28,226 patients were included, of which 4 were RCTs involving mineralocorticoid receptor antagonists (MRAs) and 3 were observational studies involving loop diuretics. There was a trend that a lower incidence rate of IDH in maintenance dialysis patients who used loop diuretics than control, although the result was not statistically significant (OR 0.65, 95% CI 0.34–1.22, P?=?0.18). Similarly, lower incidence rate of all-cause mortality (OR 0.92, 95% CI 0.87–0.99; P?=?0.02) and cardiovascular (CV) mortality (OR 0.86, 95% CI 0.75–0.99, P?=?0.03) in dialysis patients who used loop diuretics than control. On the contrary, there were no significant difference in the incidence of IDH (OR 1.35, 95% CI 0.78–2.34, P?=?0.29) and all-cause mortality (OR 0.73, 95% CI 0.26–2.01; P?=?0.54) and CV mortality (OR 0.57, 95% CI 0.14–2.25; P?=?0.42) in maintenance dialysis patients who used MRAs compared with control.

Conclusion

Loop diuretics, but not MRAs, might have a potential benefit to reduce the incidence rate of IDH, all-cause mortality and CV mortality. More high-quality studies are needed to strengthen the arguments.

     

健脾祛湿方对脾虚湿盛型高脂血症大鼠血脂、胃肠功能、水液代谢的影响及作用机制

目的：观察健脾祛湿方对脾虚湿盛型高脂血症大鼠血脂、胃肠功能、水液代谢的影响及作用机制。方法：将56只SD大鼠随机分为空白组（n=8）和造模组（n=48）,采用“劳倦过度+饮食不节+高脂饲料喂养”复制脾虚湿盛型高脂血症大鼠模型。造模4周后,根据总胆固醇（TC）水平将造模组随机分成6组：即模型组,血脂康组,参苓白术颗粒组,健脾祛湿方低、中、高剂量组,每组8只。分组后开始给药,灌胃剂量为1 mL/100 g,空白组、模型组给予生理盐水,其余组给予相应的受试物,连续给药6周。测定血脂四项TC、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-Ch）和高密度脂蛋白胆固醇（HDL-Ch）,胃肠激素,即胃动素（MTL）、促胃液素（GAS）和血管活性肠肽（VIP）,水液调节激素醛固酮（ALD）、抗利尿激素（ADH）和心房利尿钠肽（ANP）,以及白蛋白（ALB）和总蛋白（TP）,采用苏木精-伊红（HE）染色法观察胃、结肠组织形态,免疫荧光法检测结肠水孔蛋白(AQP)3、胃AQP4的表达位置及水平,采用蛋白质印迹法（Western Blotting）检测结肠、胃组织中闭合蛋白（Occludin）的表达量。结果：与正常组比较,模型组大鼠血清TC、TG、LDL-Ch水平升高（P<0.001）,HDL-Ch水平降低（P<0.05）,血清MTL、GAS水平降低（P<0.001,P<0.01）,VIP升高（P<0.001）,ALD、ADH升高（P<0.05,P<0.001）,ANP水平显著降低（P<0.001）,TP、ALB水平降低（P<0.001,P<0.05）。结肠绒毛、胃黏膜出现大量脱落情况,结肠AQP3荧光强度降低,胃AQP4荧光表达增强,结肠、胃组织Occludin表达水平降低。与模型组比较,血脂康组、参苓白术颗粒组、健脾祛湿方低、中、高剂量组大鼠血清TC、TG、LDL-Ch水平呈下降趋势,HDL-C水平升高,MTL、GAS显著升高,VIP水平显著降低,ALD、ADH水平降低,ANP显著升高,结肠、胃组织形态结构有所改善。结肠AQP3荧光表达增强,胃AQP4荧光强度减弱,结肠、胃组织Occludin表达水平增强。结论：健脾祛湿方可降低脾虚湿盛型高脂血症大鼠血脂,有健脾祛湿之功,其作用机制可能是通过调节Occludin、AQP3、AQP4的表达,保护紧密连接结构的完整性达到促进胃肠消化吸收功能,改善水液代谢障碍的作用。     

Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy

BackgroundThis study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types.MethodsTwo optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed.ResultsFor 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA.ConclusionsThrough different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.     

新型数字显示式颈总动脉压迫器

本文介绍了新近研制的数显便携式颈总劝脉压迫器的工作原理、电路设计和调试结果，该仪器增强了患侧动脉切术前施行压迫锻炼改善脑侧支循环的效果并为临床实时监测提供客观数据指标。