猪心脏移植缺血再灌注损伤中NO和NOS的表达

①目的　了解猪同种原位心脏移植术后早期一氧化氮 (NO)、一氧化氮合酶 (NOS)含量的变化 ,及其与早期缺血再灌注损伤的关系。②方法　建立猪同种原位心脏移植模型。供心在移植前低温保存 (Thomas液 ,4℃ ) 4h ,移植成功心脏复搏后 2h取材。应用组织化学方法测定心肌组织中NO、NOS的含量 ,应用核酸原位末端标记法 (TUNEL)测定心肌细胞凋亡指数 ,作为评价心肌缺血再灌注损伤的指标。以正常心肌及单纯缺血心肌组织作为对照。③结果　移植后心肌组织NO、NOS的含量较缺血组与正常组低 ,差异有显著意义 (F =2 7.2 2 9、16 .2 0 3,q =5 .716～ 6 .4 12 ,P <0 .0 1)。移植组心肌细胞凋亡指数与正常组及缺血组比较明显升高 ,差异有显著性(F =16 3.884 ,q =7.4 82、6 .975 ,P <0 .0 1)。心肌组织NO、NOS含量与心肌细胞凋亡指数呈负相关关系 (r =- 0 .886、- 0 .795 ,P <0 .0 1)。④结论　猪心脏移植后早期心肌缺血再灌注损伤所致的细胞死亡主要表现为心肌细胞凋亡 ;再灌注期间内源性NO、NOS的减少参与了心脏移植后早期缺血再灌注损伤的发生     

跟痛症的发病机制与临床诊断方法

跟痛症是一种临床常见多发疾病，以中老年患者居多，对于其发病机制与临床诊断鉴别方法不同的学者有着不同的见解。结合周福贻教授的理论与临床经验从发病机制、诊断、鉴别诊断及辅助检查等方面对跟痛症加以阐述。     

Hyperfractionated radiation therapy combined with concomitant chemotherapy for inoperable stage III non-small cell lung cancer: clinical analysis of 70 cases]

OBJECTIVE: To evaluate the effect of hyperfractionated radiation therapy and concomitant chemotherapy for inoperable stage III non-small cell lung cancer (NSCLC). METHODS: Seventy patients were randomized equally into two group. The therapy group received radiotherapy with hyperfractionated radiation therapy combined with concomitant chemotherapy, and the control group was treated with chemotherapy only. RESULT: The overall response rate, including the rate of both complete (CR) and partial responses (PR), in the therapy group was 60.0% with a CR rate of 8.6%. The overall response rate in the control group was 40.0% with a CR rate of 5.7%. The difference in overall response rate was statistically significant between the two groups (P<0.05). The median survival time, 1- and 2-years survival rate were 12.8 months, 48.6%, and 25.7%, respectively, in the hyperfractionated radiotherapy group, and 9.4 months, 34.3%, and 17.1%, respectively, in the chemotherapeutic group (P 0.031). The major toxic effects of the chemotherapy were myelosuppression and radiation esophagitis. CONCLUSION: Hyperfractionated radiation therapy plus concomitant chemotherapy with paclitaxel for inoperable stage III NSCLC improves the short-term response of the patients, but fail to raise the survival rate.     

老年人肱骨近端二部分和三部分移位骨折19例临床分析

目的 探讨老年人肱骨近端二部分和三部分移位骨折的手术治疗方法。方法 回顾性分析19例老年肱骨近端二部分和三部分移位骨折患者的临床资料，其中二部分骨折13例、三部分骨折6例，采用切开复位，肱骨近端解剖钢板固定治疗。结果 二部分骨折术后优良率为76．9％，未出现骨折不愈合及肱骨头坏死；三部分骨折术后优良率为66．7％，肱骨头坏死率16．7％。结论 老年人肱骨近端二部分和三部分骨折应尽量采用有限切开复位，选择肱骨近端解剖钢板固定。     

左双腔支气管导管管端位置与吸气峰压变化的关系

目的 观测无隆突钩双腔支气管导管(DLT)管端位置与吸气峰压(Ppeak)以及肺顺应性环形状改变的关系，探讨用Ppeak和顺应性环的变化评估DLT管端位置的可行性。方法 拟行右侧剖胸手术的成年患者32例，静脉诱导后插入左Mallinckrodt DLT，吸入氧化亚氮和地氟醚维持麻醉。按纤维支气管镜(FOB)确认DLT管端位置和通气方式将观测过程分为四个阶段：第一阶段(S1)，管端位置正确的双肺通气；第二阶段(S2)，管端位置正确的左侧单肺通气；第三阶段(S3)，管端插入左下支气管(置管过深)的左侧单肺通气；第四阶段(S。)，管端处在左支气管开口(置管偏浅)的左侧单肺通气。每阶段均机械通气15min。结果 回归方程预计插管深度与FOB检查符合者占71．9％。S2时Ppeak值比S1时增加50．8％，肺顺应性(Cdyn)值减少36．2％；S3时Ppeak值比S1时增加87．4％，Cdyn值减少56．8％。PV环曲线斜率向右明显移位，环体显著延长。结论 用无隆突钩DLT行肺隔离，在无FOB定位的条件时，联合应用听诊法、回归方程预计插管深度、动态监测气道峰压和P-V环的变化综合评估，可提高DLT管端的正确到位率。单肺通气的气道峰压超过双肺通气时的1．65倍，且气道峰压超过25cm H2O．应高度怀疑DLT管端发生过深移位。     

Nuclear Factor κB and Anesthetic Preconditioning during Myocardial Ischemia-Reperfusion

Background: Volatile anesthetic preconditioning (APC) protects against myocardial ischemia-reperfusion (IR) injury, but the precise mechanisms underlying this phenomenon remain undefined. To investigate the molecular mechanism of APC in myocardial protection, the activation of nuclear factor (NF) [kappa]B and its regulated inflammatory mediators expression were examined in the current study.

Methods: Hearts from male rats were isolated, Langendorff perfused, and randomly assigned to one of three groups: (1) the control group: hearts were continuously perfused for 130 min; (2) the IR group: 30 min of equilibration, 15 min of baseline, 25 min of ischemia, 60 min of reperfusion; and (3) the APC + IR group: 30 min of equilibration, 10 min of sevoflurane exposure and a 5-min washout, 25 min of global ischemia, 60 min of reperfusion. Tissue samples were acquired at the end of reperfusion. NF-[kappa]B activity was determined by electrophoretic mobility shift assay. The NF-[kappa]B inhibitor, I[kappa]B-[alpha], was determined by Western blot analysis. Myocardial inflammatory mediators, including tumor necrosis factor [alpha], interleukin 1, intercellular adhesion molecule 1, and inducible nitric oxide synthase, were also assessed by Western blot analysis.

Results: Nuclear factor [kappa]B-DNA binding activity was significantly increased at the end of reperfusion in rat myocardium, and cytosolic I[kappa]B-[alpha] was decreased. Supershift assay revealed the involvement of NF-[kappa]B p65 and p50 subunits. APC with sevoflurane attenuated NF-[kappa]B activation and reduced the expression of tumor necrosis factor [alpha], interleukin 1, intercellular adhesion molecule 1, and inducible nitric oxide synthase. APC also reduced infarct size and creatine kinase release and improved myocardial left ventricular developed pressure during IR.     

关木通引起慢性间质性肾炎7例报告

目的　观察关木通所致慢性肾损伤的临床和病理改变特点。方法　本组 7例中 ,男 5例 ,女 2例。 3例服关木通汤药 ,4例服含关木通成药。分析服用时间、累积总量与肾损害首发症状及症状出现时间、肾功能和肾病理改变的关系。结果　汤药组 :服药时间平均 3 3 3个月 ,累积总量平均 82 9 3 g ,首发症状为乏力 3例 ,夜尿增多 2例 ,平均时间为 8 3个月 ,Cr平均 40 2 μmol/L。肾病理 :3例均为重度寡细胞性肾间质纤维化 ,肾小管广泛萎缩。成药组 :服药时间平均 7 5个月 ,累积总量平均 13 6g ,乏力 3例 ,夜尿增多 1例 ,恶心呕吐、头痛头晕 1例 ,平均18 8个月 ,Cr 3 62 8μmol/L。肾病理为重度寡细胞性间质纤维化和灶状纤维化各 2例 ,肾小管灶状萎缩 3例 ,广泛萎缩 1例。结论　汤药组关木通积累大 ,发病时间早 ,肾病理改变重。提示关木通所致肾损其临床表现、病理改变与服用关木通时间、剂量相关。     

多层螺旋CT尿路造影在尿路梗阻性疾病中的临床应用

目的探讨多层螺旋CT尿路造影在泌尿系梗阻性疾病诊断中的应用价值。方法对48例泌尿系统梗阻性疾病者,分别进行多层螺旋CT平扫及多时相期CT增强扫描。对增强后各期图像进行相关处理,以不同的三维重建方式获得CTA、CTU影像。所有病例均经临床及手术证实。结果48例中肾脏及输尿管先天畸形者15例;输尿管阴性结石致肾盂输尿管积水者4例;泌尿系炎症者5例;肾及输尿管、膀胱结核6例;外源性压迫导致肾盂及输尿管积水者8例;泌尿系肿瘤者10例。结论多层螺旋CT泌尿系造影对尿路梗阻性疾病的诊断具有很高的应用价值。     

1例乙酸钙不动杆菌致角膜溃疡病人的护理

不动杆菌为条件致病菌,致病力不强,一般情况下很少引起感染,但当机体抵抗力降低或正常免疫屏障被破坏时可引发疾病,确切的致病因子目前尚无定论[1].我院于2005年8月24日收治1例因乙酸钙不动杆菌所致角膜溃疡病人,经过及时、有效的治疗及精心护理,取得了较好的疗效,现将其护理总结如下.     

大鼠肾移植模型技术的改进

目的 为开展器官移植的实验研究，建立了大鼠异体肾移植模型。方法使用Wistar大鼠分别作为供者和受者，采用原位低温灌洗，肾动脉带一小段主动脉，肾静脉带一小段下腔静脉、输尿管末端带一直径约为0．5cm的膀胱瓣的供者手术方式；受者主动脉与供者主动脉、受者下腔静脉与供者下腔静脉进行端侧吻合，在受者膀胱上剪去一膀胱瓣与供者相同大小的圆瓣，然后进行一层膀胱吻合。结果 第一阶段为实验探索阶段，经过半年近150次的实验摸索，克服了移植物灌洗、血管吻合、膀胱吻合等技术难关，终于建立了比较稳定的大鼠同种异体肾移植模型。第二阶段为模型成熟阶段，冷热缺血时间、血管吻合的速度以及手术时间都比第一阶段有所缩短。手术成功率为85％左右，动物死亡的原因主要为血管吻合口出血、灌洗不良、休克、血栓形成以及膀胱漏尿致弥漫性腹膜炎等。结论 此模型容易掌握，可以在条件比较简单的实验室开展，除常规显微外科器械外不需要特殊的器械或设备。