Neural control of the endocrine rat heart.

Although atrial stretch is the accepted stimulus for atrial natriuretic factor (ANF), in vivo studies suggest a stretch-independent, neurally induced ANF release mechanism. Thus the hypothesis that cardiac nerves can stimulate ANF secretion was tested in the Langendorff-perfused, paced rat heart. Venom from the scorpion Centruroides sculpturatus was used to activate neuronal sodium channels, veratridine was added to activate sodium channels (predominantly in myocytes), and electrical stimulation was applied to the right atrial appendage. The efficacy of nerve stimulation was verified by measurements of increased neuropeptide Y in the effluent. ANF levels in the effluent increased by 120% over baseline with 0.5 microM scorpion venom and by 88% with 0.5 microM veratridine (P < 0.01). Cardiac mechanics did not explain the large, concentration-dependent ANF response to the scorpion venom, since changes in the left ventricular developed pressure were small, opposite to those induced by veratridine, and unaffected by sympathectomy or adrenergic receptor blockade. Prior chemical sympathectomy and adrenergic receptor blockade almost abolished the ANF response to scorpion venom but hardly affected the ANF response to veratridine. Addition of 1 microM tetrodotoxin abolished all ANF responses. Electrical stimulation of the atrial appendage increased the ANF secretion by 60.2% (P < 0.02), in conjunction with neuropeptide Y, whereas control stimulations were ineffective. These studies unequivocally demonstrate that stimulation of cardiac sympathetic nerves potently stimulates ANF secretion.     

跟腱再断裂的手术治疗15例报告

目的了解跟腱再断裂的临床表现及再手术的方法与疗效。方法15例跟腱再断裂的患者在我所进行手术治疗,术中全面观察跟腱再断裂的表现,根据不同的断裂情况选择手术方式。结果15例患者再断裂部位均为跟骨结节上3~4cm,均为原断裂部位。跟腱断端瘢痕化增粗,粘连明显。其中12例为横行断裂,2例为短马尾状断裂,1例为大部分撕裂。15例患者中9例为闭合性再断裂,6例为开放性再断裂。10例患者坚持随访至少1年,按Amer-Lindholm评分优良率为70%。结论跟腱再断裂均发生在原断裂部位,断端瘢痕化,粘连明显,多为横行断裂,急诊再手术缝合修补效果满意。     

微卡辅助治疗菌阳肺结核的近期效果观察

目的评价微卡（Vaccae）治疗菌阳肺结核的临床疗效.方法 169例初治菌阳肺结核和90例复治菌阳肺结核,随机分为A、B、C、D组,A组（85例）、B组（84例）采用2HRZS（E）/4HR方案;C组（45例）、D组（45例）采用3HRZA（E）/6HR方案;A、C 2组加用微卡.观察治疗后肺部病灶吸收、痰菌阴转情况.结果 3个月末痰菌阴转率：A、B组分别为80.0%和65.5%,C、D组分别为71.1%和62.2%;疗程结束时痰菌阴转率A、B组分别为97.6%和84.5%,C、D组分别为95.6%和77.8%.疗程结束时胸部X线显著吸收率：A、B组分别为90.6%和75.0%,C、D组分别为82.2%和60.0%.空洞闭合：A、B、C、D组分别为85.9%、64.3%、77.8%、57.7%.结论微卡辅助治疗菌阳肺结核能提高痰菌阴转率,促进肺部病灶吸收,提高免疫细胞活性,是一种较好的免疫制剂,建议推广使用     

幽门螺杆菌血清CagA抗体与消化系统恶性肿瘤的关系

目的探讨幽门螺杆菌(Hp)血清CagA抗体与胃癌和非胃癌消化系统恶性肿瘤的关系。方法以结直肠癌和肝胆胰癌为非胃癌对照组,检测胃癌患者血清抗-Hp-CagA-IgG和抗-Hp-IgG,并分析它们与胃癌和对照组的关系。结果胃癌组患者共50例,结直肠癌和肝胆胰癌各35例(非胃癌组70例),它们的年龄(F=0.01,P>0.1)和性别(χ2=1.65,P>0.1)组成具有可比性;CagA抗体( )率胃癌(58.0%)比非胃癌组(28.6%)高(χ2=10.46,P<0.01),OR(优势比)=3.45(95%C I 1.61~7.42);抗-Hp-IgG( )率胃癌(68.0%)比非胃癌组(35.7%)高(χ2=12.16,P<0.01),OR=3.83(95%C I 1.77~8.23);结直肠癌和肝胆胰癌间CagA抗体( )率(34.3%vs 22.9%,χ2=1.12,P>0.1)和抗-Hp-IgG( )率(34.3%vs 37.1%,χ2=0.06,P>0.1)相当。结论血清Hp抗体与胃癌关系极为密切,抗-Hp-IgG和CagA抗体对胃癌具有同样的预示性;CagA抗体和抗-Hp-IgG阳性者检出胃癌的危险性分别是非胃癌消化系统恶性肿瘤的3.5倍和3.8倍。     

踝关节软组织撞击综合征的关节镜治疗

目的总结踝关节软组织撞击综合征(ankle soft tissue imp ingem ent syndrom e,ASTIS)的临床和病理特点以及关节镜手术治疗的效果。方法2000年11月~2005年4月,21例ASTIS伤后1~48个月,(13.6±9.9)月接受关节镜手术,镜下切除撞击组织,并进行病理检查。术后采用AOFAS(美国足踝外科协会)后足-踝评分法评定手术效果。结果关节镜下显示20例存在滑膜组织撞击(14例合并以下其他组织撞击),下胫腓前韧带远侧束撞击5例、纤维瘢痕组织撞击4例、距腓前韧带组织撞击3例和半月板样组织撞击3例。16例合并关节软骨损伤。21例术后随访7~60个月,(34.3±9.4)月,AOFAS主客观评分术后较术前均明显提高,总体评分术前(67.0±9.7)分,术后(94.0±6.4)分(t=-7.205,P=0.000),主观评分术前(20.7±6.6)分,术后(35.7±4.9)分(t=-5.003,P=0.000)。结论踝关节软组织撞击综合征多继发于踝关节创伤。发生部位以踝关节前外侧更多见。撞击组织为滑膜、韧带、瘢痕组织及半月板样组织。关节镜治疗ASTIS效果满意。     

Dysbaric osteonecrosis by X-ray and CT scan in Chinese divers.

OBJECTIVE: To compare the results of X-ray and CT scan for dysbaric osteonecrosis in Chinese divers. METHODS: Both shoulders, hips and knees of 66 asymptomatic divers with diving duration of more than one year were examined by X-ray and CT scan. RESULTS: The most frequent locations of dysbaric osteonecrosis were the upper femurs, followed by the upper humerus, lower femurs and upper tibias, and the most frequent radiographic lesions were calcification spots and cystic changes. Of the lesions detected, 38% (27/71) and 42% (95/229) werejuxta-articular of the femoral and humeral heads by X-ray and CT respectively. The detection rates of dysbaric necrosis (juxta- and/or other lesions) of X-ray and CT scan were 42.4% (95% confidence interval: 30.5%-54.3%) and 81.8% (95% CI: 72.4%-91.2%) respectively (p<0.05). If CT scan was used as the gold standard, the sensitivity of X-ray was 100% and the specificity was 31.6%. CONCLUSION: CT scan showed a higher detection rate of dysbaric necrosis than X-ray. We recommend that CT scan be used for early diagnosis of dysbaric osteonecrosis.     

医疗资源分配的伦理思考

医疗资源分配是医务工作者在诊疗过程的个体行为,带有很大的个体性和主观随意性,不免烙有个人道德的许多色彩.正因如此,医疗物质资源分配更要注意伦理问题,本文论述医务工作者在工作中应引起关注的四个伦理思考.     

分离临床细菌性感染患者1320株细菌分析及其药物敏感趋势监测

[目的]了解临床细菌性感染患者细菌感染的流行趋势和对其药物敏感趋势进行监测，为临床合理用药提供依据。[方法]通过对2004年1月1日～2004年12月31日，东方医院临床细菌性感染患者的标本中分离出的1320株病原菌进行凋查分析和对其药物敏感趋势进行监测。[结果]东方医院临床细菌感染患者的标本中共分离出1320株细菌。东方医院临床细菌感染患者的病原性细菌的分布情况及主要致病菌依次为：大肠埃希菌234株，占19.02％；铜绿假单胞菌120株，占9.76％；肺炎克雷伯菌81株，占6.59％；醋酸钙-鲍蔓复合不动杆菌69株，占5.61％；阴沟肠杆菌67株，占5.45％。在东方医院临床细菌感染患者的标本中分离出的1320株细菌中，200株大肠埃希菌中共测得产超广谱β-内酰氨酶（ESBLs）株80株，产酶率40％，在76株肺炎克雷伯菌中共测得ESBLs产酶株18株，产酶率24％；43株金黄色葡萄球菌中共测得耐甲氧西林的金黄色葡萄球菌（MRSA）株18株，产酶率43％；多重耐药现象严重。[结论]临床细菌耐药严重，应根据细菌检验结果合理用药。     

Isolation and purification of CWF－Ⅰ derived from Serratia marcescens and its antitumor activities in vitro

ＩｓｏｌａｔｉｏｎａｎｄｐｕｒｉｆｉｃａｔｉｏｎｏｆＣＷＦ－ⅠｄｅｒｉｖｅｄｆｒｏｍＳｅｒｒａｔｉａｍａｒｃｅｓｃｅｎｓａｎｄｉｔｓａｎｔｉｔｕｍｏｒａｃｔｉｖｉｔｉｅｓｉｎｖｉｔｒｏ￥ＪｉａｏＢｉｎｇｈｕａ（焦炳华）；ＺｈａｏＨｕ（赵虎）；ＹｕＷｅ...     

发酵用离心式空压机组的噪声控制

介绍了发酵用离心式空压机噪声的水平和特点。调研发现，近几年噪声的控制现状，工程上没有进展，单机入口流量≥500m^3／min的空压站的机器间，没有控制噪声达标的实例，主要原因是经济上的。通过引进入口流量700m^3／min国外机组成套隔声罩的工程实践，试图把机器间的噪声控制在85dB（A），结果尚可。看来把机器间的噪声控制在90dB（A），也需要付出艰辛的努力。