主动脉瓣下隔膜的外科矫治

目的总结主动脉瓣下隔膜的外科治疗经验及临床疗效。方法回顾性分析2009年3月至2013年9月北京安贞医院32例主动脉瓣下隔膜行主动脉瓣下隔膜切除术的临床资料,其中男22例,女10例;年龄0．5～14．0（3．6±3．2）岁;体重5．5～43．0（17．2±9．5）kg。32例中单纯主动脉瓣下隔膜7例,非单纯主动脉瓣下隔膜25例,其中合并室间隔缺损21例,合并二尖瓣关闭不全和动脉导管未闭各1例;动脉导管封堵术后和主动脉缩窄矫治术后再发主动脉瓣下隔膜各1例。18例合并不同程度的主动脉瓣关闭不全。结果术前超声心动图漏诊1例。全组体外循环时间（71．7±21．7）min,主动脉阻断时间（48．7±15．1）min,住ICU时间（2．2±1．7）d,术后住院时间（7．9±2．5）d。全组无手术死亡。术后发生Ⅱ°房室传导阻滞1例,于术后第6d恢复。所有患儿随访2～54个月,单纯主动脉瓣下隔膜患儿术后主动脉瓣关闭不全有6例好转,非单纯主动脉瓣下隔膜患儿主动脉瓣关闭不全术后有5例好转（P=0．003）;4例术前中度主动脉瓣关闭不全的单纯主动脉瓣下隔膜患儿中术后有3例转为轻度,1例转为微量反流;3例轻度反流中2例术后转为微量反流。8例术前轻度主动脉瓣关闭不全非单纯SM患儿中3例转为微量反流,术前3例中度反流中各有1例转为轻度和微量反流。随访期间全组均无主动脉瓣下隔膜再发。结论主动脉瓣下隔膜超声诊断易遗漏,一经诊断应尽早手术治疗;术中操作要求精细;术后因有再发可能,需定期随访观察。     

基于翻转课堂理念的《中药学》混合式教学模式初探

目的:探讨基于翻转课堂理念的《中药学》混合式教学模式的应用及成效。方法将学生随机分为甲、乙两组,分别采用翻转课堂的混合教学模式与传统教学模式,比较两种模式对学生平均成绩及教学满意度的影响。结果甲组单元测试总成绩及客观题成绩、形成性评价总成绩及课堂抢答、讨论发言成绩、综合性平均成绩及各分数段人数变化均明显高于乙组(P<0.05或P<0.01);两组间的满意度差异极显著(P<0.01)。结论基于翻转课堂理念的的混合教学模式确实能极大地发挥学生在学习过程中的主体地位,提升教学效果。可为今后的深入探索提供借鉴。     

Distribution of Avian Influenza A Viruses in Poultry-Related Environment and Its Association with Human Infection in Henan, 2016 to 2017

ObjectiveTo survey avian influenza A viruses (AIVs) in the environment and explore the reasons for the surge in human H7N9 cases.MethodsA total of 1,045 samples were collected from routine surveillance on poultry-related environments and 307 samples from human H7N9 cases-exposed environments in Henan from 2016 to 2017. The nucleic acids of influenza A (Flu A), H5, H7, and H9 subtypes were detected by real-time polymerase chain reaction.ResultsA total of 27 H7N9 cases were confirmed in Henan from 2016 to 2017, 24 had a history of live poultry exposure, and 15 had H7N9 virus detected in the related live poultry markets (LPMs). About 96% (264/275) Flu A positive-environmental samples were from LPMs. H9 was the main AIV subtype (10.05%) from routine surveillance sites with only 1 H7-positive sample, whereas 21.17% samples were H7-positive in H7N9 cases-exposed environments. Samples from H7N9 cases-exposed LPMs (47.56%) had much higher AIVs positive rates than those from routine surveillance sites (12.34%). The H7+H9 combination of mixed infection was 78.18% (43/55) of H7-positive samples and 41.34% (43/104) of H9-positive samples.ConclusionThe contamination status of AIVs in poultry-related environments is closely associated with the incidence of human infection caused by AIVs. Therefore, systematic surveillance of AIVs in LPMs in China is essential for the detection of novel reassortant viruses and their potential for interspecies transmission.     

颅内髓外造血组织瘤样增生1例及文献复习

目的探讨髓外造血组织瘤样增生的临床表现、诊断及治疗方法. 方法髓外造血组织瘤样增生1例,经开颅手术切除,经病理学检查得以确诊. 结果随访至今近一年,患者未见复发,生活如常.结论颅内髓外造血组织瘤样增生是一种罕见的特殊的良性增生性病变,CT、MRI等可定位诊断,其定性诊断依赖于病理学检查.治疗学上除按原发病治疗外,大的颅内病变需手术切除.     

犬烟雾吸入性损伤早期肺洗出液灌注大鼠肺所致损伤的研究

目的　研究犬烟雾吸入性损伤早期肺洗出液的生物学活性。　方法　获取犬急性烟雾吸入性损伤早期肺洗出液及正常犬肺洗出液。将Wistar大鼠随机分为A(2 8只 )、B(2 9只 )、C(37只 )组 ,每组各取 7只不作处理作为正常对照 ,其余大鼠肺部作如下处理 :A组注入等渗盐水 ,B组注入正常犬肺洗出液 ,C组注入致伤犬肺洗出液。处死各组中正常对照大鼠 ,并于灌注后 4、12、2 4h处死灌注大鼠 ,观察各组大鼠处死前的存活情况、处死后双肺大体变化及组织病理学改变。检测肺组织匀浆中 6 酮 前列腺素F1α/血栓素B2 (PGF1α/TXB2 )、肿瘤坏死因子α(TNF α)、髓过氧化物酶 (MPO)含量及肺毛细血管通透性。　结果　A、B组大鼠处死前均存活 ,C组大鼠非处死死亡 9只。犬吸入性损伤早期肺洗出液可引起大鼠肺产生类似于烟雾吸入性损伤样的病理变化。A、B组大鼠灌注后肺组织PGF1α/TXB2 均有升高倾向 ;C组大鼠灌注后PGF1α/TXB2 逐渐降低 (P <0.0 1),A、B组灌注后肺组织TNF α、MPO含量均无明显变化 (P >0.0 5 ),C组灌注后 4h肺组织TNF α、MPO含量显著增加 ,分别为 (1.0 2± 0 .0 4 )ng/ml、(1.0 1± 0.0 9)U/g肺组织湿重 ,随后下降 (P <0.0 5～ 0.0 1)。肺灌注后4hC组大鼠肺组织毛细血管通透性高于A、B组 (P <0.0 1)。结论　犬     

102例甲状腺癌中央区淋巴清除术中甲状旁腺保护体会

目的:总结甲状腺切除+中央区淋巴清除中甲状旁腺保护的体会。方法:回顾性分析102例于我院行甲状腺切除+中央区淋巴清除的患者,统计术后患者出现低甲状旁腺激素血症、低钙血症、症状性低钙血症的发生率。结果:术后暂时性低甲状旁腺激素血症发生率35.29%(36/102);低钙血症发生率69.61%(71/102);症状性低钙血症发生率36.27%(37/102);无一例出现永久性低钙血症。结论:各种甲状腺术式对甲状旁腺功能均有不同程度的影响,手术范围越大,术后并发甲状旁腺功能减退的可能性越大。术后甲状旁腺功能减退的预防,就在于术者必须秉承高度负责的态度,术中仔细识别甲状旁腺,精细化操作,注意对甲状旁腺动脉及回流静脉的保护,采取以原位保留为主,自体移植为辅的原则。     

高良姜素下调Bcl-2通过线粒体途径促进人肝癌Hep3B细胞凋亡

目的 研究高良姜素对人肝癌Hep3B细胞凋亡的影响并探讨相关机制. 方法 体外培养人肝癌Hep3B细胞,经高良姜素处理后,RT-PCR和Western blot检测Bcl-2 mRNA和蛋白的表达水平,MTT法测定细胞生长抑制率,Annexin V-FITC/PI双标记法测定细胞凋亡率,流式细胞仪分析线粒体膜电位,Western blot检测Caspase-3、9及Cytochrome C蛋白的表达水平. 结果 高良姜素使Hep3B细胞中Bcl-2 mRNA和蛋白的表达水平明显下降.不同剂量的高良姜素(40、80、120 μmol/L)对细胞生长抑制率分别为6.38％±1.32％,21.58％±1.97％和43.18％±3.89％,明显高于对照组(t低剂量组=13.01,t中剂量组=15.12,t高剂量组=14.79,均P＜0.01);细胞凋亡率分别为21.58％±1.97％,34.18％±3.89％和43.18％±3.89％,明显高于对照组(分别t低剂量组=24.67,t中剂量组=32.35,t高剂量组=25.89,均P ＜0.01);线粒体膜电位绿色荧光蛋白表达百分比分别为18.93％±2.3％,31.11％±2.67％和46.06％±2.95％,明显高于对照组(分别t低剂量组=16.70,t中剂量组=31.38,t高剂量组=48.15,均P ＜0.01);Caspase-3、9和胞质内Cytochrome C表达水平明显高于对照组(Caspase-3:分别t低剂量组 =11.94,t中剂量组=10.18,t高剂删量组=18.82,均P＜0.01;Caspase-9:分别t低剂量组=15.11,t中剂量组=20.41,t高剂量组=21.25,均P＜0.01;Cytochrome C:t低剂量组=15.11,t中剂量组=28.47,t高剂量组=16.01,P＜0.01),而线粒体中Cytochrome C表达水平明显低于对照组(分别t低剂量组=16.70,t中剂量组=12.00,t高剂量组=27.61,均P＜0.01). 结论 高良姜素可下调Bcl-2 mRNA和蛋白表达促进人肝癌Hep3B细胞凋亡,其作用机制可能与线粒体途径相关.     

侧入路水平穿刺单极射频热凝纤维环修补术治疗L3-4、L4-5盘源性腰痛

目的探讨侧入路水平穿刺单极射频热凝纤维环修补术治疗盘源性腰痛临床疗效。方法16例患者DSA引导下将射频套管针侧入路水平穿刺,到达椎间盘后缘行热凝纤维环修补。患者于术前,术后1周、1个月、6个月及12个月时行腰痛VAS评分,术后末次VAS评分时按照改良Mac-Nab评定标准,评价临床疗效。结果 16例患者腰痛VAS评分,术前与术后比较,差异有统计学意义(P<0.05),术后末次VAS评分时,根据Macnab评定标准进行疗效评价,优12例(75%),良4例(25%),优良率100%。结论侧入路水平穿刺单极射频热凝纤维环修补术适用于L3-4、L4-5盘源性腰痛患者,手术安全性高,创伤小,疗效确切。     

肺切除术影响围手术期右心功能

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.     

一种新型开菲尔奶制作工艺

将草莓汁、菠萝汁、白砂糖加入鲜牛奶中经杀菌冷却后接种开菲尔粒制作的发酵剂,25℃恒温发酵,采用正交试验法对其它工艺参数进行了研究.结果表明,草莓汁和菠萝汁的添加体积分数均为3%,白砂糖质量分数为8%,接种发酵剂体积分数4%,发酵16h后获得了一种口感、组织状态、风味俱佳的新型开菲尔奶.