不同时间点?法按摩器对骨骼肌损伤家兔炎症反应的影响

目的观察不同时间点?法按摩器对骨骼肌损伤家兔局部组织形态, 以及骨骼肌组织及血清中TNF-α、IL-1β水平的影响, 探究?法作用于骨骼肌损伤的时间效应机制。方法 72只新西兰兔按随机数字表法分为空白组、模型组、?法治疗组, 每组24只, 每组按损伤时间点分为1、3、5、7、9、11 d亚组, 每组4只。模型组、?法治疗组采用钝挫伤法建立股四头肌损伤模型。?法治疗组各亚组采用自制?法按摩器进行?法干预3 d, 2次/d, 3 min/次。干预完成后24 h, 采用HE染色观察骨骼肌形态学变化, ELISA法检测血清和受损骨骼肌中TNF-α、IL-1β水平。结果与空白组比较, 模型组炎症细胞浸润明显, 水肿严重, 肌纤维断裂;1 d?法治疗组炎症细胞浸润加剧, 肌细胞凋亡, 肌纤维断裂坏死更严重;7 d?法治疗组炎症明显改善, 和正常健康肌肉组织相差较小。造模后, 3 d模型组骨骼肌组织中TNF-α和IL-1β水平及血清TNF-α水平高于1 d模型组(P<0.05)。与空白组比较, 模型组各亚组及?法治疗组各亚组骨骼肌组织及血清中TNF-α和IL-1β水平升高(P<0.01)...     

轻中度与重度PD-1/PD-L1免疫检查点抑制剂相关性肺炎的临床和CT特征比较

目的 探讨轻中度与重度程序性死亡受体1(PD-1)/程序性死亡配体1(PD-L1)免疫检查点抑制剂（ICI）相关性肺炎的临床和CT特征的差异。方法 选取2018年9月至2021年9月在浙江省肿瘤医院接受PD-1/PD-L1 ICI治疗且发生ICI相关性肺炎的21例患者为研究对象,依据美国卫生和公共服务部发布的不良事件评定标准5.0版将ICI相关性肺炎患者分为轻中度14例和重度7例,比较两组患者临床特征（主要包括ICI治疗至肺炎发生时间、原发灶病理类型、放疗史、免疫治疗方式、临床症状等）和CT特征（主要包括CT分型、病灶密度、病灶位置、有无胸腔积液等）。结果 临床特征比较发现,轻中度组女性、无症状患者占比以及BMI均明显高于重度组（均P<0.05）;两组患者在年龄、ICI治疗至肺炎发生时间、吸烟史、原发灶分类、原发灶病理类型、放疗史、ICI类型、免疫治疗方式、免疫治疗线数、胸闷气急、咳嗽咳痰、发热、呼吸衰竭等方面比较,差异均无统计学意义（均P>0.05）。轻中度组CT分型为机化性肺炎型、病灶位于肺外周、病灶两肺未对称的占比均明显高于重度组（均P<0.05）;两组患者在病...     

抗心律失常肽与溶血磷脂酸对兔室性心律失常影响的研究

Objective To investigate the effect and potential mechanism of lysophosphatidic acid (LPA) and antiarrhythmic peptide (AAP10) on rabbit ventricular arrhythmia. Methods Twenty-four rabbits were randomly divided into three groups (n =8 each): control group, LPA group and AAP10 + LPA group. Using arterially perfused rabbit ventricular wedge preparations, transmural ECG and action potentials from both endocardium and epicardium were simultaneously recorded in the whole process of all experiments with two separate floating microeletrodes. The incidence of ventricular arrhythmia post S1S2 stimulation was recorded. Protein levels of nonphosphorylated Cx43 and total Cx43 were evaluated by Western blot. The distribution of nonphosphorylated Cx43 was observed by confocal immunofluorescence microscopy. Results Compared with the control group, the QT interval, endocardial action potential duration, transmural repolarization dispersion (TDR) and incidence of ventricular arrhythmia were significantly increased and nonphosphorylated Cx43 expression was significantly upregulated in the LPA group. Compared with the LPA group, cotreatment with AAP10 can reduce the QT interval, endocardial action potential duration, TDR and incidence of ventricular arrhythmia (25.0% vs 62. 5%, P ＜ 0. 01 ) and downregulate nonphosphorylated Cx43. Conclusions LPA could promote the arrhythmia possibly by upregulating nonphosphorylated Cx43 and subsequent gap junction transmission inhibition. Gap junction enhancer AAP10 could attenuate the proarrhythmic effect of LPA probably by downregulating myocardial nonphosphorylated Cx43 expression.     

大鼠心室肌缝隙连接蛋白增龄性变化对心律失常发生率的影响

目的 研究大鼠心室肌缝隙连接蛋白(Cx43)增龄性改变及增龄导致室性心律失常发生率增高的原因.方法 随机取3～6月龄(幼年组)、9～12月龄(青年组)、18～21月龄(中年组)及24～26月龄(老年组)F344健康雄性大鼠,通过监测其肢体导联心电图,记录其心律失常发生情况.各组心室肌分别用苏木素-伊红、马森三色复合染色...     

骨盆骨折后尿道损伤78例诊治分析

在多发性损伤合并尿道损伤时能及时正确地应用尿道会师术加牵引术,拔管后及时尿扩,是治疗尿道损伤的首选方法.     

床旁联合检测NT-proBNP、cTnT、D-二聚体在

目的　观察床旁联合检测N末端B型脑钠肽原（NT-proBNP）、心肌肌钙蛋白T（cTnT）、D-二聚体在心血管急症早期诊断中的价值。方法　入选2012年7月至2013年12月在我科就诊的以急性胸闷、胸痛、呼吸困难等为主要表现的心血管急症患者257例，随机分为常规组、快检组，另选2012年1月至6月在我科就诊的类似患者132例为对照组。比较3组患者入院初步诊断准确率差异和3组患者30天生存率差异，比较快检组与常规组快检时间差异。结果　对照组、常规组及快检组入院诊断与出院诊断符合率分别为90.8%、97.6%、96.1%，快检组与常规组入院初步诊断准确率无差异（P>0.05），但快检组、常规组入院初步诊断准确率均显著高于对照组（均P<0.05）；快检组床旁检测时间显著少于常规组送检验科检测时间（P<0.01）；快检组与常规组患者30天生存率比较无差异（93.1%比92.2%，P>0.05），但均显著高于对照组30天84.1%的生存率（均P<0.05）。结论　床旁联合检测NT-proBNP、cTnT、D-二聚体能准确而快速地协助心血管急症早期诊断，显著提高心血管急症患者生存率，值得推广。     

Speckle Tracking Echocardiography Assessment of Global and Regional Contraction Dysfunction in the Mice Model of Pressure Overload

Speckle tracking echocardiography(STE) has been applied to the evaluation of cardiac contraction dysfunction. However, there were few studies on alteration of global and regional STE parameters in the process of myocardial hypertrophy and heart failure. In this study, STE was applied to evaluate the global and regional cardiac function under heart failure and hypertrophy in the mice model of pressure overload. Adult mice were subjected to mild or severe aortic banding with a 25 Gauge(G) or 27 G needle. After surgery, STE and conventional echocardiography were used in the sham group(n=10), mild trans-aortic banding(TAB) group(n=14) and severe TAB group(n=10) for 8 weeks. The results showed that the mice subjected to severe TAB showed a significant change in fractional shortening(FS), left ventricular(LV) mass, and left ventricular end diastolic diameter(LVEDD)(P<0.05 for each). Meanwhile, there were no significant differences in FS and LVEDD between the sham group and mild TAB group during the experimental procedures(P>0.05 for both). STE analysis revealed that longitudinal strain(LS) was significantly decreased in the severe TAB group as compared with the sham and mild TAB groups(P<0.05 for both) from the postoperative week 1. LS in the mild TAB group was reduced as compared to the sham group(P<0.05). Radial strain(RS) and circumferential strain(CS) were significantly decreased in the severe TAB group as compared to the sham group and the mild TAB group(P<0.05 for both) from the postoperative week 1(P<0.05 for both). Compared to the sham group, CS in the mild TAB group maintained unchanged during the test period, and RS was reduced only on the postoperative week 6(P<0.05). Finally, regional contraction dysfunction was analyzed in both hypertrophic and failing myocardium in longitudinal and radial directions. It was found that LS was largest in the apex region and RS was smallest in the apex region in the healthy and hypertrophic myocardium. It was also found that compared to the sham group, only base longitudinal strain in the mild TAB group was decreased. Each of regional strain in the severe TAB group was uniformly depressed in radial and longitudinal directions. It is concluded that STE has provided a non-invasive and highly feasible way to explore the global and regional contraction dysfunction in hypertrophic and heart failure myocardium in the murine model of pressure overload.     

数学建模在输尿管镜术前预测尿源性脓毒血症的作用

目的探究输尿管镜术前预测尿源性脓毒血症的危险因素,初步建立数学模型预测术后尿源性脓毒血症。方法收集2011年12月至2016年12月在本院及浙江省人民医院进行输尿管镜治疗的2105例输尿管结石患者的一般病史资料,通过多元回归分析确定输尿管镜术前预测尿源性脓毒血症的危险因素并建立预测模型。结果肾积水程度、结石直径以及菌尿是输尿管镜术后尿源性脓毒血症发生的危险因素(P0.05);Logistic预测概率模型,公式为P=1/(1+exp-(3.17+1.88×肾积水程度+1.27×结石直径+1.67×菌尿),其作为预测指标,ROC曲线,曲线下面积约为0.891,灵敏度为84.21%,特异度为82.19%。结论肾积水程度、结石直径以及菌尿是输尿管镜术后尿源性脓毒血症发生的独立危险因素,通过这3个独立危险因素建立的输尿管镜术后尿源性脓毒血症发生概率模型预测尿源性脓毒血症的发生具有可行性。     

探讨一种新型输尿管通道鞘内芯在输尿管软镜术中的应用研究

目的探讨一种新型的输尿管通道鞘内芯在输尿管软镜术中的应用。方法根据目前临床手术中所使用的输尿管软镜通道鞘结构自行设计出一种新型的输尿管通道鞘内芯,进行体外模型试验以及猪输尿管软镜术实验,观察其使用效果。结果体外模型试验中,通道鞘置入模型后,在显示器屏幕可见模型内管壁,输尿管软镜内灌注冲洗液,同样可见模型内管壁图像;猪输尿管软镜术实验均顺利完成,并且随着操作次数的增加,置鞘时间逐渐变短。实验后所有猪均正常苏醒,未发现输尿管壁损伤,无严重并发症发生。结论新型输尿管通道鞘内芯经过体外模型试验及动物实验,达到了可视下置鞘的目的,并可较好地放置到位,避免了C臂机使用所引起的辐射损伤,是一种全新的置鞘方式,缩短了输尿管软镜术的学习曲线。     

脑转移瘤放射性坏死与肿瘤复发的影像学鉴别研究进展

脑转移瘤是脑内常见的多灶性肿瘤,其治疗以放射性治疗为主。放疗后肿瘤组织会出现放射性坏死和肿瘤复发的病理转归,两者的临床症状相似但两者的鉴别对临床治疗及预后评估非常重要。MRI和CT检查等影像学检查技术对两者的鉴别诊断有一定意义,相关影像学技术包括增强MRI、弥散加权成像、灌注加权成像、磁共振波谱成像和单光子发射计算机断层扫描成像等检查技术。笔者主要对脑转移瘤放射性坏死与肿瘤复发的影像学鉴别研究进行综述。