NOX4在高肺血流肺动脉高压大鼠中表达的意义

目的 观察NADPH氧化酶4(NOX4)在高肺血流肺动脉高压大鼠肺组织中表达的变化,探讨NOX4在高肺血流性肺动脉高压发病机制中的意义.方法 40只雄性SD大鼠随机分为对照组、分流4周组、分流8周组、分流11周组,通过腹主动脉-下腔静脉分流法建立高肺血流肺动脉高压大鼠模型,检测模型大鼠平均肺动脉压(mPAP)、右室肥厚指数(RVI),RT-PCR检测大鼠肺组织中NOX4 mRNA的表达情况.结果 随着分流时间的延长,各分流组大鼠逐步出现了右室肥厚、平均肺动脉压升高等肺高压的表现,肺组织中NOX4 mRNA表达亦逐步增强.结论 高肺血流肺动脉高压大鼠肺组织中存在着NOX4的显著表达,NOX4参与了高肺血流大鼠肺动脉高压的形成.     

Changes of Tumor Necrosis Factor-α and the Effects of Ulinastatin Injection during Cardiopulmonary Cerebral Resuscitation

The changes of tumor necrosis factor-a (TNF-a) and brain ultrastructure during cardiopulmonary resuscitation and the effects of ulinastation injection were observed, and the mechanism was investigated. Twenty-four adult healthy Sprague-Dawley rats were randomly divided into.control group (8 rats), resuscitation group (8 rats) and ulinastatin (UTI) group (8 rats). Rats in control group underwent tracheotomy without clipping the trachea to induce circulatory and respiratory standstill. Rats in resuscitation and ulinastatin group were subjected to the procedure of establishing the model of cardiopulmonary cerebral resuscitation (CPCR). Rats in ulinastatin group were given with UTI 104 U/kg once after CPCR. In the control group, the plasma was collected immediate,30 min, 2 h, 4 h, and 6 h after tracheotomy. In resuscitation group and UTI group, plasma was collected immediate after tracheotomy, 30 min, 2 h, 4 h and 6 h after successful resuscitation. The plasma levels of TNF-a were determined by radioimmunoassay (RIA). At the end of the experiment, 2 rats were randomly selected from each group and were decapitated, The cortex of the brain was taken out immediately to observe the ultrastructure changes. In control group, there were no significant differences in the level of TNF-a among different time points (P＞0.05). In resuscitation group, the level of TNF-a was increased obviously after resuscitation (P＜0.01) and reached its peak 2 h later after resuscitation. An increasing trend of TNF-a showed in UTI group. There were no differences in TNF-a among each sample taken after successful resuscitation and that after tracheotomy. The utrastructure of brains showed the injury in UTI group was ameliorated as compared with that in resuscitation group. In early period of CPCR, TNF-a was expressed rapidly and kept increasing. It indicated that TNF-a might take part in the tissue injury after CPCR. The administration of UTI during CACR could depress TNF-a and ameliorate brain injury. By regulating the expression of damaging mediator, UTI might provide a protective effect on the tissue injury after CPCR.     

心脏不停跳直视手术治疗主动脉窦瘤破裂的临床分析

目的探讨心脏不停跳直视手术在主动脉窦瘤破裂外科治疗上的临床应用价值。方法将55例先天性主动脉窦瘤破裂患者根据所接受的心肌保护方法分为浅低温不停跳组29例和低温停跳组26例,分别行浅低温心脏不停跳心内手术及低温停跳心内手术。对两组患者术前一般情况、心功能、手术时间、体外循环时间、失血量、术中最低温度、术后多巴胺使用量、呼吸机支持时间、CCU停留时间和住院天数进行统计分析。结果两组患者的手术时间、术中失血量、CCU停留时间、住院天数比较差异无统计学意义（P〉0.05）;不停跳组转机时间、呼吸机支持时间均短于停跳组（P〈0.05）,术中最低温度高于停跳组（P〈0.001）,多巴胺使用量少于停跳组（P〈0.01）。结论在浅低温心脏不停跳直视下治疗主动脉窦瘤破裂安全、有效。     

综合性与专科医院口腔急诊病例的对比分析

目前口腔夜间急诊越来越受到重视,多数口腔专科医院都设有夜间门诊,一些综合性医院也设有口腔科急诊,为急性牙痛和颌面外伤患者提供医疗服务.在急诊中,最常见的两大类疾病是口腔炎症和外伤,牙髓病、根尖周病数量通常位居第一,其次为外伤.综合性医院与专科医院口腔科急诊病例的情况是否有所不同,相关报道较少.本文通过对文献数据和我院急诊病例数据进行分析和比较,报道如下.     

移植途径对骨髓间充质干细胞调节小鼠心脏移植排斥反应的影响

目的 探讨不同途径注射骨髓间充质干细胞（BMSCs）对调节小鼠心脏移植排斥反应的影响。方法 BALB/c和C57小鼠分别作为供体和受体,建立颈部心脏移植模型,随机分为4组,每组12只,A组在移植成功后立即经移植心脏升主动脉注射C57来源绿色荧光BMSCs悬液30 μL（含1×106细胞）,B组同样时间点经移植心脏右心室腔内注射相同数量细胞,C组同样时间点移植心脏心肌内注射相同数量细胞,D组为空白对照组。移植后第7天各组处死4只小鼠,切取移植心脏,荧光显微镜下观察绿色荧光细胞的存活情况,HE染色观察移植心脏的病理学改变,流式细胞学检测移植物浸润白细胞中巨噬细胞的比例,其余8只小鼠用来观察移植心脏的存活时间。结果 术后第7天,仅A组移植心脏内可见绿色荧光细胞,病理学检测发现A组排斥反应受到明显抑制,心肌间质内细胞浸润明显减少,局灶性的心肌细胞损害,B组和C组移植心脏间质内可见多灶性淋巴细胞浸润并伴有心肌细胞变性坏死,而D组小鼠心脏见满视野大量白细胞浸润,心肌结构消失,心肌坏死。流式细胞学检测发现A组移植心脏内巨噬细胞的比例明显高于其他3组,A组的心脏存活时间明显长于其他3组。结论 BMSCs能减轻心脏移植排斥反应,动脉途径注射优于静脉和心肌局部注射途径,其机制可能与骨髓间充质干细胞在移植心脏内存活时间以及巨噬细胞比例增加有关。     

真菌性心内膜炎的外科治疗体会（附4例报告）

真菌性心内膜炎（Fungal Endocarditis,FE）是一种少见的深部真菌感染,属于感染性心内膜炎的范畴。近年来随着抗菌药物滥用、各种免疫抑制剂的长期使用、静脉药瘾者的增多以及心脏直视手术的大量开展,使得本不常见的FE的发病率有所增高。现对我科2002～2009年确诊并经手术治疗的4例FE患者的临床资料进行回顾分析,从外科角度浅谈治疗FE的一些体会。