低血钾患者应用超声雾化吸入补钾的疗效观察

试用了人体经气道补钾的新途径，证实经气道补钾可有效提高血钾浓度，与静脉滴注无差异。由于经气道给入，使临床上早期呼吸肌麻痹能及时缓解。临床应用中无任何副作用     

系统性红斑狼疮患者超声心动图改变的研究

本文采用二维多普勒超声心动图（超声心动图）对１２９例系统性红斑狼疮（ＳＬＥ）患者进行前瞻性研究。有超声心动图异常的７９例（６１．２４％）。其中瓣膜异常５２例，８２．６％（４３／５２）的瓣膜异常患者无临床症状及血液动力学改变；心包积液３６例，其中轻度２３例无血液动力学改变；心肌异常２４例。兼有不同程度的瓣膜、心肌或心包病变者３４。有抗磷脂抗体的患者心瓣膜损害的发病率较高（３３／４９），提示这种抗体在ＳＬＥ患者心瓣膜病变的发病机制中可能有突出促进作用     

经腹全肝血流阻断巨大肝肿瘤切除术血液动力学的调控

目的　探讨全肝血流阻断 (THVE)巨大肝肿瘤切除术围麻醉期血液动力学的调控措施。方法　 10例全肝血流阻断下巨大肝肿瘤切除术病人 ,用多巴胺 (3～ 5 μg·kg- 1· min- 1 )支持心血管功能 ,阻断前输血补液 ,提高中心静脉压至 1.2 k Pa水平 ,采用Swan- Ganz导管技术监测围麻醉期血液动力学变化。结果　肝血流阻断后 ,CVP下降 (2 7.6 % ) ,HR增快 ,SVRI增加 (2 4.3% ) ,CI(17.8% )和 L VSWI(2 2 .6 % )明显下降 ,MAP仅下降 14.3% ,以阻断 5 min为甚 ,肝血流开放后 ,各参数均恢复稳定。结论　小剂量多巴胺支持循环 ,阻断前提高 CVP,阻断后快速输血补液 ,是防止 THVE引起的血液动力学剧变的有效措施     

Drug Absorption Through Mucosal Membranes: Effect of Mucosal Route and Penetrant Hydrophilicity

The influence of mucosal route and penetrant hydrophilicity on the in vivo absorption of a model lipophilic compound, progesterone, was investigated in ovariectomized rabbits. The absorption rate and systemic bioavailability of progesterone and its monohydroxy, dihydroxy, and trihydroxy derivatives were evaluated and compared following oral, nasal, rectal, and vaginal administrations. Nasal delivery resulted in a significantly higher rate and extent of progesterone absorption than oral, rectal, or vaginal administration. The rate and extent of mucosal absorption decreased as penetrant hydrophilicity increased for the nasal, rectal, and vaginal routes. The results of this investigation indicate that the absorption characteristics of a lipophilic compound, such as progesterone, are influenced by the properties of both the mucosa and the drug.     

结核菌素试验复强反应免疫机理的探讨

为探讨结核菌素试验复强反应免疫机理，我们在对河南省禹州市神地区常住人口３８９７人作了结核菌素（ＰＰＤ人型）皮试调查。试验分四组，即试验前组、皮试阴性组、皮试阳性组及复强反应组。随机抽样作外周血免疫学检测，结果显示：复强反应组与其他组相比，ＣＤ－３、ＣＤ－４阳性率均有所升高（Ｐ＜０．０５），但ＣＤ－４／ＣＤ－８比值无显著性差异（Ｐ＞０．０５）：血清免疫球蛋白及Ｃ－３测定，复强反应组ＩｇＭ高于皮试前及阴性组，但无统计学意义（Ｐ＞０．０５）；血清ＳＩＬ－２Ｒ检测，各组均比皮试前组升高，尤以复强反应组与皮试前组或阴性组比较为甚（Ｐ＜０．００１）；结核特异抗体测定复强反应组虽有升高，但与皮试前或阴性组相比差异不显著（Ｐ＜０．０５）；特异性结核循环免疫复合物测定，复强反应组与皮试前组及阴性组相比有显著性差异（Ｐ＜０．００１）。揭示复强反应的免疫机理很可能是ＰＰＤ刺激机体使Ｔ细胞免疫反应为主的特异性回忆应答。     

血管紧张素Ⅱ诱导肾小球系膜细胞纤维连接蛋白产生的实验研究

目的：观察不同浓度的血管紧张素Ⅱ（ＡｎｇⅡ）刺激后系膜细胞ＡｎｇⅡ受体基因表达和分泌纤维连接蛋白（ＦＮ）的情况。方法：从６月龄人胎肾培养系膜细胞，经ＡｎｇⅡ刺激后用逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）方法检测胎肾系膜细胞ＡＴ１和ＡＴ２受体ｍＲＮＡ的表达情况，分别用ＥＬＩＳＡ和ＲＴ－ＰＣＲ方法检测系膜细胞产生的ＦＮ和基因表达。结果：①经１０－８、１０－７、１０－６和１０－５ｍｏｌ／Ｌ的ＡｎｇⅡ刺激４８ｈ后，系膜细胞的ＡＴ１受体ｍＲＮＡ表达均有升高，并呈一定的浓度依赖性；而ＡＴ２受体ｍＲＮＡ仅在１０－５ｍｏｌ／Ｌ浓度的ＡｎｇⅡ刺激下才有微弱表达。②１０－７、１０－６和１０－５ｍｏｌ／Ｌ的ＡｎｇⅡ能明显促进系膜细胞产生ＦＮ和ＦＮ的ｍＲＮＡ表达的上调，并与ＡｎｇⅡ刺激浓度呈正相关。结论：ＡｎｇⅡ刺激后可使系膜细胞的ＡＴ１受体基因表达和ＦＮ的产生明显增加，并呈一定的浓度依赖性，而ＡｎｇⅡ高浓度可以使ＡＴ２受体表达上调     

Papillary fibroelastoma of the aortic valve with atypical chest pain: late presentation with acute myocardial infarction and cardiac arrest

We report a case of a 54-year-old female with papillary fibroelastoma of the aortic valve who presented with ST-elevation myocardial infarction and cardiac arrest. Though her initial symptom was only atypical chest pain, life-threatening complications such as acute myocardial infarction and cardiac arrest developed. After cardiopulmonary resuscitation, we promptly resected the fibroelastoma on cardiopulmonary bypass, and the patient was discharged without any other complications.     

Amygdala abnormalities across disease stages in patients with sporadic amyotrophic lateral sclerosis

To examine selective atrophy patterns and resting‐state functional connectivity (FC) alterations in the amygdala at different stages of amyotrophic lateral sclerosis (ALS), and to explore any correlations between amygdala abnormalities and neuropsychiatric symptoms. We used the King''s clinical staging system for ALS to divide 83 consecutive patients with ALS into comparable subgroups at different disease stages. We explored the pattern of selective amygdala subnucleus atrophy and amygdala‐based whole‐brain FC alteration in these patients and 94 healthy controls (HCs). Cognitive and emotional functions were also evaluated using a neuropsychological test battery. There were no significant differences between ALS patients at King''s stage 1 and HCs for any amygdala subnucleus volumes. Compared with HCs, ALS patients at King''s stage 2 had significantly lower left accessory basal nucleus and cortico‐amygdaloid transition volumes. Furthermore, ALS patients at King''s stage 3 demonstrated significant reductions in most amygdala subnucleus volumes and global amygdala volumes compared with HCs. Notably, amygdala‐cuneus FC was increased in ALS patients at King''s stage 3. Specific subnucleus volumes were significantly associated with Mini‐Mental State Examination scores and Hamilton Anxiety Rating Scale scores in ALS patients. In conclusions, our study provides a comprehensive profile of amygdala abnormalities in ALS patients. The pattern of amygdala abnormalities in ALS patients differed greatly across King''s clinical disease stages, and amygdala abnormalities are an important feature of patients with ALS at relatively advanced stages. Moreover, our findings suggest that amygdala volume may play an important role in anxiety and cognitive dysfunction in ALS patients.     

乳腺癌改良根治术后图像引导放疗图像配准的影响因素

目的:探讨乳腺癌改良根治术后图像引导放疗不同体位固定图像配准的效果.方法:乳腺癌改良根治术后20例患者采用泡沫负压真空垫行治疗体位固定(体模A组),20例患者采用热塑连体网罩行治疗体位固定(连体网罩C组),进行CBCT釆集图像并与计划CT图像配准,分别记录左右方向(X)、头脚方向(Y)、前后方向(Z)的平移误差及旋转误差值,计算其均值、标准差,进行统计学处理.结果:本研究A、C组釆集图像各100张,匹配结果平移误差在X、Y、Z方向,A组分别为(2.17±1.51) mm、(1.33±1.15) mm、(2.18±1.53) mm;C组分别为(1.35±1.28) mm、(1.25±1.13) mm、(1.46±1.33) mm.旋转误差在X、Y、Z方向,A组分别为(3.94±1.25)°、(2.31±1.32)°、(3.82±1.83)°;C组分别为(2.92±1.73)°、(2.43±1.12)°、(2.35±1.23)°.其中≤3°概率: A组分别为83.2%、82.6%、84.5%,最大值分别为5.1°、3.2°、4.8°;C组分别为87.3%、88.3%、85.8%,最大值分别为3.3°、3.1°、3.5°.两套体位固定装置在X、Y、Z三方向的平移误差经配对样本检验在Y方向P>0.05,在X、Z方向P<0.05,C组明显优于A组.两套装置测量差值有负相关关系.结论:乳腺癌改良根治术后放疗采用连体网罩行治疗体位固定,重复性好.C组能降低X、Z方向上的误差,其放疗靶区中心的平移误差中差异有统计学意义,因此建议乳腺癌改良根治术后放疗体位固定时优选连体网罩固定装置,提高图像引导放射治疗精准体位的要求,提高临床治疗效果.