莱菔硫烷对ox-LDL诱导血小板活化的抑制作用

目的：探讨莱菔硫烷（sulforaphane,SFN）对氧化低密度脂蛋白（oxidized low-density lipoprotein,ox-LDL）诱导血小板活化的影响及其可能的分子机制。方法：在体外实验中,将健康人纯化血小板与不同浓度的SFN(1.0、2.5、5.0μmol/L)共同孵育40 min,然后用ox-LDL激活血小板20 min,并检测血小板活化的指标,包括CD62P的表达、胞内血小板因子4(platelet factor4,PF4)和趋化因子配体5(chemokine ligand 5,CCL5)的释放水平。机制上,用Western blot蛋白免疫印迹法检测血小板肉瘤酪氨酸激酶（sarcoma tyrosine kinase,Src）及其下游的脾酪氨酸激酶（spleen tyrosine kinase,Syk）磷酸化水平;用活性氧（reactive oxygen species,ROS）检测试剂盒测定胞内总ROS水平。结果：ox-LDL诱导的血小板CD62P的表达以及PF4和CCL5的释放水平均可被SFN显著抑制（P <0.05）;SFN显著下调ox-LD...     

指侧方静脉动脉化再植末节断指

目的：探讨指侧方静脉动脉化再植末节断指的疗效。方法2007年3月至2012年4月,收治末节断指患者34例,均在正常指动脉多次吻合失败后行静脉动脉化。20例采用指侧方静脉动脉化再植,将近端指动脉与远端指侧方静脉吻合（A组）;14例采用指腹静脉动脉化再植,用近端指动脉与远端指腹静脉吻合（B组）。结果 A组患者末节断指全部成活,创面均Ⅰ期愈合;B组中有4例坏死。本组中有27例随访6～14个月（A组18例,B组9例）。 A组再植末节断指指腹饱满,指体无明显萎缩,B组指体轻度萎缩;A组指甲长度（15.6±2.7） mm,长于B组（11.9±2.2） mm;A组DIPJ活动度（62±4）°,大于B组（45±3）°;A组两点分辨觉（4.6±0.3） mm,小于B组（7.4±0.6） mm;A组再植断指感觉测定为S（3.49±0.33）,高于B组S（2.47±0.44）;手指各关节活动度参照TAM标准：A组优良率94.4%,B组优良率87.5%,两组优良率比较差异无统计学意义（P=0.534）。结论指侧方静脉动脉化是正常供血失败后的末节断指再植的有效方法。     

Subthalamotomy for advanced Parkinson disease

OBJECT: The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD). METHODS: The authors performed microelectrode mapping-guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery. At 3 months into the "off" period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the "on" period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa. CONCLUSIONS: These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage of levodopa, diminish complications of the drug therapy, and improve the quality of life.     

The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy

Both dextromethorphan (DM) and IV lidocaine improve postoperative pain relief. In the present study, we evaluated the interaction of DM and IV lidocaine on pain management after laparoscopic cholecystectomy (LC). One-hundred ASA physical status I or II patients scheduled for LC were randomized into four equal groups to receive either: (a) chlorpheniramine maleate (CPM) intramuscular injection (IM) 20 mg and IV normal saline (N/S) (group C); (b) DM 40 mg IM and IV N/S (group DM); (c) CPM 20 mg IM and IV lidocaine 3 mg . kg(-1) . h(-1) (group L); or (d) DM 40 mg IM and IV lidocaine (group DM+L). All treatments were administered 30 min before skin incision. Analgesic effects were evaluated using visual analog scale pain scores at rest and during coughing, time to meperidine request, total meperidine consumption, and the time to first passage of flatus after surgery. Patients of the DM+L group exhibited the best pain relief and fastest recovery of bowel function among groups. Patients in the DM and L groups had significantly better pain relief than those in the C group. The results showed an additional effect on pain relief and a synergistic effect on recovery of bowel function when DM was combined with IV lidocaine after LC.     

HPLC-ELSD法测定黄芪注射液浓缩液微乳中黄芪甲苷含量

目的:建立黄芪注射液浓缩液微乳中黄芪甲苷的含量测定方法。方法:采用(HPLC-ELSD)。色谱柱:Zorbax C18柱(4.6 mm×250 mm,5μm);流动相:乙腈∶水(36∶70);检测波长:206nm;灵敏度为0.08 AUFS,流速:1.0 ml/min;柱温:25℃。ELSD参数:漂移管温度为55℃,空气气压280 kPa。结果:黄芪甲苷在0.004 145 6~0.040 456 0 mg/ml时有良好的线性关系(r=0.999 1),平均回收率为96.53%,RSD为0.76%。结论:HPLC-ELSD法具有准确、简便、灵敏度高、无干扰而且重现性好的优点,适合用于黄芪注射液微乳中黄芪甲苷含量的测定。     

血液灌流对尿毒症透析患者血浆内皮素、一氧化氮、血管紧张素Ⅱ、肾素活性的影响及临床改善

目的探讨血液灌流对血管活性物质的影响及临床改善。方法选30例维持性血液透析患者，采用自身对照法，行血液透析（HD）串联血液灌流（HP）治疗设为HD＋HP组，行常规血透设为HD组。分别测定两种治疗前后的血浆内皮素（ET）、一氧化氮（NO）、血管紧张素Ⅱ（ATⅡ）、肾素活性（PRA）水平。观察灌流后患者高血压改善情况。结果1）HD＋HP组治疗后PRA升高（P〈0．05）；ET、NO均显著下降（P〈0．01）；ATⅡ稍有下降，但无统计学意义（P〉0．05）。2）HD组治疗后PRA、ATⅡ均显著升高（P〈0．01）；而NO显著下降（P〈0．01）；ET略微下降，但无显著差异（P〉0．05）。结论常规血透可以引起PRA、ATⅡ缩血管物质的水平升高，起扩张血管作用的NO下降，与患者透析后血压升高有一定联系。而行HD＋HP治疗可降低ET、ATⅡ水平，且NO下降程度相对小，故能改善透析后高血压情况，减少并发症。     

腹腔CT影像学检查在腹膜透析相关非感染性腹腔并发症中的诊断价值

目的：初步探讨腹腔CT影像学检查在诊断持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis，CAPD）患者非感染性腹腔并发症中的应用价值。 方法：前瞻性地对2005年至2007年间在我院进行CAPD治疗且临床高度怀疑为透析相关非感染性腹腔并发症的患者进行腹腔CT影像学检查。结合临床资料，综合分析患者是否存在腹腔渗漏、疝气、局部腹透液的聚集和大网膜包裹等情况，评估腹腔CT影像学检查的应用价值。 结果：腹腔CT造影检查发现，11例CAPD患者中有9例出现异常情况，其中包括腹股沟疝气3例，睾丸鞘膜积液1倒，脐疝1例，导管出口处渗漏2例，大网膜包裹2例；其中8例（腹股沟疝气2例，睾丸鞘膜积液1例，脐疝1例，导管出口处渗漏2例，大网膜包裹2例）有手术条件的患者经过手术均得到证实。 结论：在一些存在可疑腹膜透析相关非感染性腹腔并发症的CAPD患者中，腹腔CT影像学检查可能是一种无刨、可靠且灵敏度较高的检查技术，操作简便易行，有助于明确诊断，值得进一步研究。     

5/6肾切除大鼠早期模型中p38MAPK的动态变化

目的：研究5/6肾切除大鼠模型中p38MAPK磷酸化的动态表达情况。方法：82只雄性SD大鼠分为两组：5/6肾切除模型组72只,假手术对照组10只。模型组造模完成后,分别于肾切除早期（术后1/2h、1h、3h、6h、12h、1d、2d、4d）相应时间点处死,每组9只,假手术组于术后12h处死,称量各组体重及残余肾重,计算肥大指数;下腔静脉取血留取血清测定血肌酐（Scr）、尿素氮（BUN）;以Western blotting免疫印迹法检测肾皮质磷酸化p38MAPK活性的表达情况;以病理光镜和电镜观察肾小球、肾小管及肾间质组织形态学及超微结构的变化。结果：模型组与对照组相比,肾脏呈代偿性肥大,肥大指数增高（P〈0.05）,Scr和BUN升高（P均〈0.01）。免疫印迹法显示5/6肾切除术后1/2h、1h、3h、6h、12h磷酸化p38信号呈递增趋势,尤以12h信号最强,之后信号减弱,2d时几乎不可见,4d有较弱的信号,假手术组未见明显信号。光镜下,发现肾小球有轻度系膜细胞增生,基质增宽不明显,肾小管偶有轻度变性,间质偶有炎性细胞浸润。电镜下,偶见足突局灶融合。结论：5/6肾切除大鼠在造模完成后12h时磷酸化p38MAPK表达最强。     

鞍区肿瘤手术入路临床分析

目的:对鞍区肿瘤手术切除的入路进行评价.讨论额下、翼点、经蝶、纵裂等手术入路的缺点.方法:鞍区肿瘤103例,经额下入路42例;经翼点入路22例;经纵裂入路11例;经蝶入路23例;胼胝体入路3例;经侧脑室入路2例.结果:本组病例肿瘤全部切除76例,全切除率73.79%.结论:正确的手术入路选择对于肿瘤切除有着决定作用,全切肿瘤以适当的并发症为代价是值得的.视神经减压效果以及手术创伤,经蝶以及内窥镜垂体瘤切除手术十分具有优势.在鞍区巨大肿瘤操作中,切除彻底与否,下丘脑以及垂体的保护,翼点入路具备优势.在侵入三脑室内的鞍区肿瘤,纵裂入路给我们提供可开阔的操作术野.     

食管癌40例患者术后的护理

目的探讨和总结食管癌患者手术后的护理。方法对食管癌手术后患者，在治疗期间密切观察病情并做好相应护理。结果通过呼吸道护理、胃肠减压、胸腔闭式引流、输液及吻合口瘘的观察等方面的护理，提高患者治疗的有效率。结论通过精心治疗和护理，可解除患者食管梗阻，减轻症状，改善营养状况，提高患者的生存质量。