乳突区皮瓣法在先天性中重度杯状耳三维重建中的应用

目的 探讨中重度杯状耳三维立体重建的有效方法及临床效果.方法 采用乳突区皮瓣及自体肋软骨切取的Ⅱ期再造方法对中重度杯状耳进行三维重建.Ⅰ期行外耳皮肤脱套、乳突区皮瓣分离;切取肋软骨与耳轮软骨桥接重建耳上极及乳突区皮瓣包盖.Ⅱ期行再造耳上极掀起,耳后筋膜瓣覆盖及植皮重建.结果 18例中重度杯状耳畸形患者,1例桥接处糜烂,软骨部分坏死,其余均Ⅰ期成活,随访3～26个月,外形满意.结论 应用乳突区皮瓣法重建中重度杯状耳,强调细节亚单位构建,再造耳更加安全、美观,手术成功率和医患满意率高,并发症少.     

Activation of postsynaptic 5-HT1A receptors improve stress adaptation

Rationale

Serotonin-1A (5-HT_1A) receptors modulate the stress response and have been implicated in the etiology and treatment of depression and anxiety disorders. A reduction in postsynaptic 5-HT_1A receptor function in limbic areas has consistently been observed following exposure to chronic stress.

Objectives

To investigate the hypothesis that increased activation of 5-HT_1A receptors in rats having reduced 5-HT function may improve stress adaptation and the behavioral sequelae commonly associated with chronic stress.

Methods

One hundred forty-four Sprague–Dawley rats received injections of para-chlorophenylalanine to partially deplete 5-HT then were given daily systemic pretreatment with the 5-HT_1A receptor agonist, 8-hydroxy-2- (di-n-propylamino) tetralin (8-OH-DPAT), the antagonist, WAY 100635, or vehicle prior to either restraint stress (6 h/day for 10 daily sessions) or control conditions. Anxiety- and depressive-like behaviors were then assessed using the open field and sucrose preference tests. Protein level of hippocampal glucocorticoid receptors (GR) and mineralocorticoid receptors was detected by immunohistochemistry and brain-derived neurotrophic factor (BDNF) was determined by in situ hybridization.

Results

8-OH-DPAT pretreatment prior to stress exposure attenuated later stress-induced anxiety- and depression-like behaviors and increased GR and BDNF mRNA expression in the hippocampus relative to vehicle- and WAY 100635-pretreated, stressed animals.

Conclusion

The stress-related impairments associated with 5-HT deficiency can be improved by 8-OH-DPAT pretreatment prior to stress exposure and are associated with an augmentation of GR-like immunoreactivity and BDNF mRNA expression in the hippocampus. It suggested that selective activation of 5-HT_1A receptors may be a potential treatment strategy for stress-related disorders such as anxiety and depression.     

Delayed Noradrenergic Activation in the Dorsal Hippocampus Promotes the Long-Term Persistence of Extinguished Fear

Fear extinction has been extensively studied, but little is known about the molecular processes that underlie the persistence of extinction long-term memory (LTM). We found that microinfusion of norepinephrine (NE) into the CA1 area of the dorsal hippocampus during the early phase (0 h) after extinction enhanced extinction LTM at 2 and 14 days after extinction. Intra-CA1 infusion of NE during the late phase (12 h) after extinction selectively promoted extinction LTM at 14 days after extinction that was blocked by the β-receptor antagonist propranolol, protein kinase A (PKA) inhibitor Rp-cAMPS, and protein synthesis inhibitors anisomycin and emetine. The phosphorylation levels of PKA, cyclic adenosine monophosphate response element-binding protein (CREB), GluR1, and the membrane GluR1 level were increased by NE during the late phase after extinction that was also blocked by propranolol and Rp-cAMPS. These results suggest that the enhancement of extinction LTM persistence induced by NE requires the activation of the β-receptor/PKA/CREB signaling pathway and membrane GluR1 trafficking. Moreover, extinction increased the phosphorylation levels of Erk1/2, CREB, and GluR1, and the membrane GluR1 level during the late phase, and anisomycin/emetine alone disrupted the persistence of extinction LTM, indicating that the persistence of extinction LTM requires late-phase protein synthesis in the CA1. Propranolol and Rp-cAMPS did not completely disrupt the persistence of extinction LTM, suggesting that another β-receptor/PKA-independent mechanism underlies the persistence of extinction LTM. Altogether, our results showed that enhancing hippocampal noradrenergic activity during the late phase after extinction selectively promotes the persistence of extinction LTM.     

Influence of transgenic rice expressing a fused Cry1Ab/1Ac protein on frogs in paddy fields

As genetic engineering in plants is increasingly used to control agricultural pests, it is important to determine whether such transgenic plants adversely affect non-target organisms within and around cultivated fields. The cry1Ab/1Ac fusion gene from Bacillus thuringiensis (Bt) has insecticidal activity and has been introduced into rice line Minghui 63 (MH63). We evaluated the effect of transgenic cry1Ab/1Ac rice (Huahui 1, HH1) on paddy frogs by comparing HH1 and MH63 rice paddies with and without pesticide treatment. The density of tadpoles in rice fields was surveyed at regular intervals, and Cry1Ab/1Ac protein levels were determined in tissues of tadpoles and froglets collected from the paddy fields. In addition, Rana nigromaculata froglets were raised in purse nets placed within these experimental plots. The survival, body weight, feeding habits, and histological characteristics of the digestive tract of these froglets were analyzed. We found that the tadpole density was significantly decreased immediately after pesticide application, and the weight of R. nigromaculata froglets of pesticide groups was significantly reduced compared with no pesticide treatment, but we found no differences between Bt and non-Bt rice groups. Moreover, no Cry1Ab/1Ac protein was detected in tissue samples collected from 192 tadpoles and froglets representing all four experimental groups. In addition, R. nigromaculata froglets raised in purse seines fed primarily on stem borer and non-target insects, and showed no obvious abnormality in the microstructure of their digestive tracts. Based on these results, we conclude that cultivation of transgenic cry1Ab/1Ac rice does not adversely affect paddy frogs.     

GLP实验室供试品管理的常见问题与对策

目的规范供试品管理,使其符合《药物非临床研究质量管理规范》（Good Laboratory Practice,GLP）的要求。方法查找供试品管理各环节存在的问题。结果分析总结了保管、配制、分析等主要环节较易出现的问题并提出意见和建议。结论通过完善供试品管理,关注每一环节的细节操作,真正实现了供试品的有效管理。     

某院儿科万古霉素临床应用调查

目的：了解万古霉素在某院儿科中的使用情况。方法：调查2012年某院100例使用万古霉素病例,以《抗茵药物临床应用指导原则》、万古霉素临床应用中国专家共识（2011版）及《万古霉素在儿童MRSA的治疗地位》为依据,就其用药指征、用法用量及病原学检查等方面进行调查分析。结果：100例病例中,患儿平均年龄为（23．1±16．9）月,平均住院时间（26．4±16．6）d,应用万古霉素平均天数（9．6±5．2）d,按病原学检查结果用药33例,有效率71％。但该院应用万古霉素存在诸多问题,如经验性用药、适应证过宽、联合随意性大及用药时间过长或过短等。结论：针对临床应用万古霉素存在的问题,应建立特殊使用级抗菌药的限制性措施,严格控制用药指征,减少经验用药,以提高临床疗效。     

耐碳青霉烯类肠杆菌科细菌的分布及耐药性分析

目的：分析耐碳青霉烯类肠杆菌科细菌的分布情况及耐药性。方法：收集丽水市中心医院2010年12月～2013年6月临床分离的耐药菌株,采用法国梅里埃Vitek-2 compact细菌鉴定仪鉴定细菌,药物敏感性试验采用纸片扩散法（K-B法）。结果：共收集耐药菌株83株,其中肺炎克雷伯菌占68.67%,产气肠杆菌和阴沟肠杆菌各6.02%,大肠埃希菌2.41%。标本来源最常见为痰液（80.72%）,其次尿液（8.43%）和分泌物（4.82%）,科室分布最多者为重症监护病房（39.76%）,其次为神经外科（36.51%）。74例患者在检测出耐药菌株前1个月内使用过至少一种抗菌药。有69.88%和31.33%的患者使用过哌拉西林/他唑巴坦和头孢哌酮/舒巴坦,15.66%和10.84%使用过亚胺培南/西司他丁和美罗培南。耐药菌株对多黏菌素B高度敏感,对米诺环素和阿米卡星的耐药率为13.25%和28.92%,对其他抗菌药的耐药率多介于70%～100%。结论：耐碳青霉烯类肠杆菌科细菌在医院重症监护病房和神经外科相对集中,对多数临床常用抗菌药呈高度耐药,给临床治疗带来严重的挑战。医院应做好院感监测,合理使用抗菌药,从而有效预防和控制耐药菌株的产生和传播。