自体血管内皮祖细胞移植治疗高肺血流量肺动脉高压

目的 观察自体血管内皮祖细胞(EPCs)移植对高肺血流肺动脉高压(PAH)的治疗作用.方法 将30头实验幼猪随机分为3组,每组10头.假手术组(Sham组)仅开胸;对照组(Control组)行左胸后外侧切口,降主动脉与主肺动脉分流术;EPCs治疗组(EPCs组)手术操作同对照组,术后2周给予EPCs 2×10 7个细胞,颈静脉输入.术前与术后30 d,观察3组猪的肺动脉收缩压(PASP)、肺血管阻力(PVR),血清基质金属蛋白酶(MMP)-9、内皮素-1(ET-1)、白细胞介素(IL)-6、IL-8水平变化,以及肺组织p38丝裂原激活蛋白激酶(p38 MAPK)表达活性,肺动脉标本的组织学变化.结果 术后30 d,与Sham组比较,PASP、PVR、MMP-9、ET-1、IL-6、IL-8、p38MAPK在Control组[(6.63±1.20) kPa、(10.44 ±2.53) wood's U、(76.63±10.39) μg/L、(103.66±17.31) μg/L、(43.00 ±7.33) ng/L、(67.39±9.65) ng/L、3.63 ±0.33]和EPCs组[(4.07 ±0.77) kPa、(6.27±0.65) wood's U、(64.11 ±9.73) μg/L、(90.44±13.11) μg/L、(30.44±8.17) ng/L、(53.23±7.37) ng/L、1.73 ±0.37]明显升高(P＜0.01);EPCs组明显低于Control组(P＜0.05);肺组织病理学改变,Control组最为明显,EPCs组轻度改变,Sham组未见明显病理改变.结论 EPCs移植对高肺血流肺动脉高压具有治疗作用,其机制可能为抑制MMP-9、ET-1等致肺组织重构因素的水平,以及抑制肺动脉高压过程中的炎症损伤而发挥作用.     

Risk factors for cardiovascular and cerebrovascular morbidity and mortality in maintenance hemodialysis patients

Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2±16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI: 1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P＜0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.     

心血管CT检查在小儿复杂先天性心脏病中的应用进展

近年来随着CT检查设备的更新和扫描方法的改进,心血管CT检查在小儿复杂先天性心脏病中的应用越来越广泛。心血管CT作为一项无创检查,既安全、简便又相对廉价,与超声优势互补,其图像质量能够满足诊断的需求,辐射剂量进一步降低,安全性大为提高。CT具有的较高空间分辨率和强大的三维后处理技术,弥补了超声对心腔外和冠状动脉畸形的诊断缺陷,其作为小儿复杂先天性心脏病的术前检查日益受到重视。本文结合近年来国内外的相关研究成果,简要总结心血管CT检查在小儿复杂先天性心脏病中的应用价值,旨在为临床提供参考,为临床进一步的推广应用提供依据。     

住院患者健康教育评价标准的应用研究

目的：形成完善的住院患者健康教育评价标准,对健康教育活动起到系统的监测作用。方法选取2013年7—12月1297例住院患者作为研究对象,按照随机数字表法分为研究组540例和对照组757例。对照组采用常规健康教育,研究组采用健康教育评价标准确定后的健康教育。比较两组患者健康教育评价标准结果及患者满意度。结果入院时两组患者健康知识的知晓率比较差异无统计学意义(P>0.05),出院时研究组健康知识知晓率为93.1%,高于对照组的82.6%,差异有统计学意义(χ2=31.20,P<0.05)。出院时研究组患者满意度得分为(98.88±2.88)分,高于对照组的(95.95±6.63)分,差异有统计学意义(t=-9.26,P<0.01)。研究组患者在参与计划、寻求健康教育方式、控制疾病疼痛的方法、病情自我观察、生活自理能力、执行药物计划、选择食物、健康及功能锻炼的健康行为评价积极率分别为88.9%,92.7%,91.1%,85.1%,80.4%,83.3%,87.2%,81.1%,均优于对照组,差异有统计学意义(χ2值分别为141.6,176.8,178.3,59.3,36.5,64.6,91.4,30.2;P<0.01)。结论住院患者健康教育评价标准的形成对临床护理人员实施系统化、规范化的健康教育与提高健康教育评价有很大帮助。     

成人全麻患者术后早期少量饮水安全性和可行性分析

目的：探讨成人全麻患者术后早期少量饮水的安全性和可行性。方法将200例麻醉后监测治疗室全麻患者按随机数字表法分为观察组和对照组各100例。观察组患者实施麻醉后监测治疗室常规护理的同时给予早期少量饮水;对照组患者实施麻醉后监测治疗室常规护理。分别评价两组患者口干程度变化、复苏满意度、呕吐误吸发生率和再次饮水人数。结果观察组患者口干评分为(7.51±1.48)分,明显高于对照组口干评分(1.39±1.20)分,差异有统计学意义(t=32.12,P<0.05);观察组发生误吸4例,对照组6例,两组比较差异无统计学意义(χ2=0.42,P>0.05);观察组复苏满意度评分为(92.35±2.64)分,明显高于对照组的(67.94±7.46)分,差异有统计学意义( t=30.85,P<0.05);观察组有再次饮水意愿者96例,对照组为91例,两组比较,差异有统计学意义(χ2=2.06,P>0.05)。结论全麻患者术后早期饮水具有安全性和可行性。     

“J”状塑型双腔气管导管插管操作对成功率及术后声音嘶哑、咽喉痛的影响

目的 观察双腔气管导管(double-lumen endotracheal tube,DLT)塑型对插管成功率及术后声音嘶哑(声嘶)、咽喉痛的影响,从而为寻求更好的DLT塑型插管提供依据. 方法 择期全身麻醉下行胸科手术患者160例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,参照随机数字表法分成DLT插管塑型组和非塑型组(每组80例),两组根据左右DLT插管各分为两组(A、B、C、D组,每组40例),又根据性别再各分为两个亚组(A1、A2、B1、B2、C1、C2、D1、D2组,每组20例).两组均采用经口明视气管插管,塑型组采用塑成“J”状的DLT进行插管,非塑型组采用未经塑型保留原有弯度的DLT进行插管.观察DLT插管时间、插管尝试次数及插反情况,患者术后声嘶、咽喉痛发生率及严重程度. 结果 塑型组插管时间[(154±6)s]明显短于非塑型组[(185±13)s](P＜0.05);塑型组插管尝试次数[(1.4±0.4)次]明显少于非塑型组[(1.7±0.8)次](P＜0.05);塑型组插反情况(3次)明显比非塑型组少(11次)(P＜0.05),且与性别无关,但左DLT比右DLT易于插反(P＜0.05).患者术后声嘶发生率塑型组(15/80)明显低于非塑型组(33/80)(P＜0.05);患者术后咽喉痛发生率塑型组(15/80)明显低于非塑型组(31/80) (P＜0.05),且与性别有关,女性较男性术后易发生声嘶、咽喉痛. 结论 “J”状DLT塑型插管成功率高、刺激小,可降低患者术后声嘶、咽喉痛发生率,具有一定的临床推广意义.     

Evaluation of Intraductal Ultrasonography,Endoscopic Brush Cytology and K-ras,P53 Gene Mutation in the Early Diagnosis of Malignant Bile Duct Stricture

Background:In qualitative diagnosis of bile duct stenosis,single diagnostic measure is difficult to make a correct diagnosis,to combine several diagnostic techniques may be helpful to make an accurate ...     

Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤4 cm) at 3.0T Magnetic Resonance Imaging

Background:

The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤4 cm).

Methods:

In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm² and values compared via the Kruskal–Wallis and Mann–Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression.

Results:

The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10⁻³ mm²/s), ccRCCs ([1.53 ± 0.31] × 10⁻³ mm²/s) and the normal renal parenchyma ([2.22 ± 0.12] × 10⁻³ mm²/s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10⁻³ mm²/s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs.

Conclusions:

DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.     

右美托咪定对大鼠移植肝缺血/再灌注所致急性肺损伤中细胞凋亡及CCAAT增强子结合蛋白同源蛋白的影响

目的 探讨右美托咪定预处理对大鼠原位移植肝缺血/再灌注(I/R)所致急性肺损伤(ALI)中细胞凋亡及CCAAT增强子结合蛋白(C/EBP)同源蛋白(CHOP)的作用.方法 选择雄性SD大鼠40只,按随机数字表法分为假手术组、I/R模型组、右美托咪定低剂量组和右美托咪定高剂量组,每组10只.采用二袖套法结扎并切断肝动脉,供体肝脏移植入后即可完全开放门静脉复制肝I/R模型;假手术组开腹后只游离肝周韧带,不进行其他特殊处理;右美托咪定低剂量组和高剂量组分别于I/R前1 h静脉泵注右美托咪定 2.5μg·kg-1·h-1和5.0μg·kg-1·h-1,1 h内完成.实验结束后留取肺组织,检测肺组织湿/干质量(W/D)比值;光镜下观察肺组织病理学变化并进行肺泡损伤定量评估(IQA),电镜下观察肺组织超微结构变化;反转录-聚合酶链反应(RT-PCR)检测CHOP mRNA表达水平;蛋白质免疫印迹法(Western Blot)检测CHOP的蛋白表达水平;原位末端缺刻标记法(TUNEL)检测肺组织细胞凋亡情况,并计算凋亡指数(AI).结果 与假手术组比较,I/R模型组肺W/D比值(4.94±0.84比2.29±0.54)、IQA〔(40.52±5.15)%比(4.55±1.85)%〕和AI〔(36.57±5.85)%比(2.85±0.95)%〕均明显升高(均P<0.0l);光镜和电镜下均显示肺组织结构发生明显的损伤.与I/R模型组比较,右美托咪定低剂量组和右美托咪定高剂量组肺W/D比值(3.29±0.85,2.68±0.78比4.94±0.84)、IQA〔(23.69±2.62)%,(15.86±3.61)%比(40.52±5.15)%〕 和AI〔(25.73±3.71)%,(14.66±2.61)%比(36.57±5.85)%〕均明显降低(均P<0.01),光镜和电镜下可见肺组织结构损伤明显减轻.I/R模型组有大量肺血管内皮细胞和肺泡上皮细胞发生凋亡,而右美托咪定低剂量组和高剂量组细胞凋亡则明显减少.与假手术组比较,I/R模型组CHOP mRNA〔吸光度(A)值:0.96±0.18比0.43±0.08〕及蛋白(灰度值:2.79±0.74比1.02±0.27)表达水平均明显升高(均P<0.01).与I/R模型组比较,右美托咪定低剂量组和高剂量组CHOP mRNA(A值:0.69±0.13、0.56±0.12比0.96±0.18)及蛋白(灰度值:1.96±0.58、1.34±0.49比2.79±0.74)表达水平均明显降低,且以高剂量组的降低更显著(均P<0.01).结论 右美托咪定对移植肝I/R肺组织具有保护作用,该作用可能与其抑制CHOP的活化、减少肺组织细胞凋亡有关.