氟对大鼠甲状腺过氧化物酶mRNA表达的影响

目的 观察长期氟过量对大鼠甲状腺过氧化物酶(TPO)活性、TPO mRNA表达的影响,并探讨其可能的机制.方法 选用雄性SD大鼠40只,按体质量分为对照组、低氟组、中氟组、高氟组,每组10只,分别饮用含氟化钠0.40(普通自来水)、15.00、30.00和60.00 mg/L的自来水,均食用普通粮食配制的饲料.喂养180 d后处死.测定血清FT3和FT4;采用改良愈创木酚法测定甲状腺TPO活性;半定量RT-PCR方法检测甲状腺TPO mRNA表达水平.结果 低、中、高氟组血清FL3水平[(3.62±0.47)、(3.57±0.55)和(3.30±0.68)pmol/L]与对照组[(3.64±0.45)pmol/L]相比虽呈下降趋势,但差异无统计学意义(P＞0.05);高氟组血清FT4水平[(8.64±1.72)pmol/L]低于对照组、低、中氟组[(13.08±1.69)、(12.68±1.32)、(12.05±1.43)pmol/L,P均＜0.05].对照组、低氟组、中氟组、高氟组甲状腺细胞TPO活性[(1.572±0.064)、(1.414±0.086)、(1.322±0.049)、0.960±0.083)U/L]随着氟浓度的升高而明显降低,任意两组组间比较差异均有统计学意义(P均＜ 0.05),TPO活性与氟浓度呈显著负相关(r=-0.955,P＜0.05).半定量RT-PCR结果显示:对照组、低氟组、中氟组、高氟组甲状腺TPO mRNA表达水平(0.936±0.160、0.368±0.095、0.115±0.018、0.016±0.008)随着氟浓度升高而明显降低,任意两组组间比较差异均有统计学意义(P均＜0.05).结论 长期摄入过量氟抑制甲状腺TPO活性和TPO的表达,影响甲状腺激素合成.     

血管成形术后血管外膜改变与血管重塑的相关性研究

目的:探讨大鼠胸主动脉血管成形术后血管外膜激活与血管重塑的相关性。方法:用6F人冠状动脉快速交换球囊损伤大鼠胸主动脉,术后2周和6周取材,行血管形态学定量分析,并行增殖细胞核抗原(PCNA)免疫组织化学染色,观察PCNA在血管外膜上的表达。结果:血管成形术组血管外膜细胞数量、血管外膜细胞增殖指数,外膜面积、厚度均较对照组显著增大(P<0.05),血管外弹力板围绕面积、内弹力板围绕面积和管腔面积较对照组显著减小(P<0.05),血管呈收缩性重塑。结论:血管成形术后,血管外膜被牵拉激活,导致外膜细胞分裂、增殖,以及血管收缩性重塑,参与再狭窄的发生。     

ST段抬高型急性下壁心肌梗死并心力衰竭患者的冠状动脉病变特征

目的:探讨ST段抬高型急性下壁心肌梗死(AIMI)并心力衰竭(HF)患者的冠状动脉病变特点及临床特征。方法:对108例行急诊冠状动脉介入治疗的ST段抬高型AIMI患者的临床资料进行分析,根据心功能分为2组,HF组32例,无HF组76例,比较2组临床特征及冠脉病变特点。结果:HF组年龄偏大(P<0.05),血清肌酐水平、恶性心律失常、心源性休克需要主动脉内球囊反搏比例(均P<0.01),三度房室传导阻滞发生率显著高于非HF组(P<0.05);罪犯血管为右冠状动脉,合并前降支血管病变,HF组显著高于非HF组(P<0.05和P<0.01)。结论:ST段抬高型AIMI罪犯血管为右冠状动脉,同时合并有前降支血管病变时,易发生心力衰竭。     

肺癌合并肝硬化患者术后胸腔闭式引流观察和护理特点

目的通过对我科近4年中18例肺癌合并肝硬化患者术后胸腔闭式引流进行观察,探讨此类患者的护理特点。方法 18例患者术后3d每天均有500ml以上引流胸腔积液,有10例(A组)在术后3d仍有800ml胸腔积液,给予自体血胸膜固定术,8例(B组)仍予常规支持对症治疗,比较两组术后恢复时间和住院费用。结果 A组平均住院时间为26d,平均住院费用为4.1万元;B组平均住院时间为19d,平均住院费用为3.2万元,差异均有统计学意义(P<0.05)。结论肺癌合并肝硬化患者术后需加强观察胸腔积液的变化,及时的自体血胸膜固定术并加强指导翻身护理,可在临床上加快此类患者的康复,同时减少住院费用。     

婴幼儿室间隔缺损合并重度肺动脉高压术后心排量与氧代谢的变化规律

目的:总结分析婴幼儿期室间隔缺损合并重度肺动脉高压心脏直视术后心排量与氧供、氧耗的变化规律及临床意义。方法:室间隔缺损合并重度肺动脉高压患儿25例,男性15例,女性10例。年龄0.5～2.75(1.25±0.68)岁,体质量5～13.7(8.68±2.49)kg,术前经皮血氧饱和度(SPO2)0.95～0.99(0.97±0.70),超声心动图检查平均肺动脉压力65～82(67.86±21.35)mmHg(1 mmHg=0.133 kPa)。合并心脏畸形包括:房间隔缺损9例,动脉导管未闭5例,主动脉弓缩窄3例。麻醉时经颈内静脉置入4F Swan-Ganz漂浮导管,经桡动脉置入动脉测压管。分别于手术结束即刻、术后4 h、8 h、12h、24 h、48 h及72 h,由桡动脉及漂浮导管抽取动脉和混合静脉血标本行血气分析。热稀释法测定心排量(CO),PHLIPS M:8007 A计算心排指数(CL)、氧供指数(DO2I)、氧耗指数(VO2I)、氧摄取率(O2ER)。结果:①术后DO2I与VO2I显著相关,术后即刻呈线性依赖;②术后8 h CI、DO2I、VO2I最低;O2ER最高。结论:婴幼儿期室间隔缺损合并重度肺动脉高压,术后即刻存在着病理性氧供依赖,术后8 h既存在氧供不足又有氧耗下降,应积极提高心排量改善组织氧分。     

类风湿关节炎合并间质性肺病患者血清中转化生长因子-β1骨形成蛋白-4检测及其意义

目的 探讨类风湿关节炎(RA)合并间质性肺病( ILD)患者的临床特点和转化生长因子(TGF)-β1、骨形成蛋白(BMP)-4在血清中的水平.方法 人选28例RA-ILD患者、32例单纯RA患者和20名健康对照,RA-ILD组进一步分为早期组(16例)和中晚期组(12例),酶联免疫吸附试验(ELISA)法测定血清中TGF-β1、BMP-4水平,并分析血清TGF-β1、BMP-4水平与实验室指标的相关性.采用t检验、单因素方差分析及Spearman相关分析法进行数据分析.结果 与单纯RA患者相比,RA-ILD组患者初次发生关节炎时年龄较大,关节功能优于单纯RA组患者,血清类风湿因子(RF)滴度高(P＜0.05,P＜0.05,P＜0.01),出现肺间质病变时间为2～6年,平均(3.0±1.2)年.TGF-β1水平在RA-ILD组稍增高,但3组相比差异无统计学意义(P＞0.05).早期RA-ILD组患者TGF-β1血清水平明显增高,与中晚期RA-ILD组及单纯RA组、健康对照组相比较差异均有统计学意义(P＜0.01).RA-ILD组患者BMP-4水平低于单纯RA组及健康对照组,差异有统计学意义(P＜0.05),且早期RA-ILD组患者BMP-4水平显著下降,与中晚期RA-ILD组及单纯RA组、健康对照组相比较差异均有统计学意义(P＜0.05).血清BMP-4水平与TGF-β1水平之间无相关性(P＞0.05),血清TGF-β1、BMP-4水平与实验室指标红细胞沉降率、C反应蛋白、RF、抗环瓜氨酸肽(CCP)抗体等均无明显相关性(P均＞0.05).结论 在早期RA-ILD患者中血清TGF-β1水平增高,BMP-4水平减低,二者可能参与了RA患者ILD的发生.     

Role of surgery in severe ulcerative colitis in the era of medical rescue therapy

Despite the growing use of medical salvage therapy, colectomy has remained a cornerstone in managing acute severe ulcerative colitis (ASC) both in children and in adults. Colectomy should be regarded as a life saving procedure in ASC, and must be seriously considered in any steroid-refractory patient. However, colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems, including fecal incontinence, pouchitis, irritable pouch syndrome, cuffitis, anastomotic ulcer and stenosis, missed or de-novo Crohn's disease and, in young females, reduced fecundity. This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon. Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine, tacrolimus and infliximab, which seem equally effective in the short term. Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%. This accuracy is sufficiently high for initiating medical therapy, but usually not colectomy, early in the admission without delaying colectomy if required. This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays, and the mortality rate from over 70% in the 1930s to about 1%. In general, restorative proctocolectomy (ileoanal pouch or ileal pouch-anal anastomosis), especially the J-pouch, is preferred over straight pull-through (ileo-anal) or ileo-rectal anastomosis, which may still be considered in young females concerned about infertility. Colectomy in the acute severe colitis setting, is usually performed in three steps due to the severity of the inflammation, concurrent steroid treatment and the generally reduced clinical condition. The first surgical step involves colectomy and constructing an ileal stoma, the second - constructing the pouch and the third - closing the stoma. This review focuses on the role of surgical treatment in ulcerative colitis in the era of medical rescue therapy.     

Psychosocial determinants of irritable bowel syndrome

From a pure motor disorder of the bowel, in the past few years, irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity, alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system, alteration of the gut microflora, an increased intestinal permeability and minimum intestinal inflammation. Psychological and social factors can interfere with the communication between the central and enteric nervous systems, and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome. There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders. In order to explain clustering of IBS in families, genetic factors and social learning mechanisms have been proposed. The psychological features, such as anxiety, depression as well as the comorbid psychiatric disorders, health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.     

CEA、CYFRA21-1、NSE、LDH在良恶性胸腔积液中的鉴别诊断价值

目的 探讨血清及胸腔积液中癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、神经特异性烯醇化酶(NSE)、乳酸脱氢酶(LDH)在良恶性胸腔积液鉴别诊断价值.方法 分析我院55例肺癌患者和53例良性胸腔积液患者的血清及胸腔积液中CEA、CYFRA21-1、NSE、LDH检测水平,并根据受试者工作特性(ROC)曲线建立合理的临床判断临界值及检测的敏感性和特异性.结果 恶性患者胸水CYFRA21-1、NSE、CEA、LDH的水平高于良性患者(P<0.05).胸水CEA、CYFRA21-1、NSE、LDH的敏感性和特异性分别为90.9、63.6、72.7、36.4%和98.1、83、67.9、88.7%.血清CEA、CYFRA21-1、NSE、LDH的敏感性和特异性分别为89.1、87.3 、32.1、25.5%和92.5、79.2、90.6、92.5%.结论 胸水中CYFRA21-1、NSE、CEA、LDH检测在良恶性胸腔积液鉴别诊断中具有一定临床价值.     

Catheter ablation of idiopathic ventricular tachycardia originating from myocardial extensions into a noncoronary aortic cusp

We present a 34-year-old woman with idiopathic ventricular tachycardia that resisted 2 previous attempts for catheter ablation and was successfully ablated in the myocardial extension within the noncoronary aortic cusp.