软式内镜清洗消毒保养体会

内镜设备和器械对于目前日新月异的微创技术来说有着举足轻重的作用,是开展内镜手术必需的工具.随着内镜器械的频繁使用,由内镜诊疗引起的医院感染的危险性大大增加.本文正式基于此,以软式内镜清洗消毒保养的相关注意事项为研究对象,通过对相关问题的阐述,提出了有效清洗消毒保养软式内镜的措施,旨在为相关操作实践提供指导和帮助.     

补肾中药密骨片对成骨细胞生长因子转化生长因子β1 mRNA表达的影响

背景:补肾中药密骨片可有效防治骨质疏松,但其具体的药理学机制仍不是很清楚。转化生长因子β1是调节骨吸收与骨形成的重要耦联因子。目的:探讨补肾方对成骨细胞转化生长因子β1mRNA表达的影响。设计:随机分组设计,对照实验。单位:华中科技大学同济医学院附属协和医院骨伤科研究室。材料:实验于2003-05/2004-04在华中科技大学同济医学院附属协和医院中西结合骨代谢实验室完成。动物:选择出生一两天清洁级SD大鼠16只。实验药:密骨片药液在华中科技大学同济医学院附属协和医院骨伤科研究室制备,主要成分为淫羊藿、杜仲、胡桃肉、干地黄、淮牛膝等;阳性对照药:重组碱性成纤维细胞生长因子由北京邦定公司提供。阴性对照组分为探针阴性对照和抗体阴性对照。方法:将体外分离培养的新生SD大鼠的颅骨成骨细胞加入100,1000,5000,10000mg/L补肾中药密骨片药液及阳性对照药5μg/L重组碱性成纤维细胞生长因子。24h后,利用自行制备的地高辛标记的鼠转化生长因子β1cDNA探针进行成骨细胞的核酸分子原位杂交分析,以其细胞内杂交阳性颗粒的平均光密度值代表转化生长因子β1mRNA的表达水平。在200倍视野下,每组随机选取40个成骨细胞,用TJTY-300型全自动图像分析仪测定细胞内杂交颗粒的平均光密度值(A)。主要观察指标:各组成骨细胞转化生长因子β1mRNA表达。结果:全自动图像分析显示,5000,10000mg/L密骨片药液组的细胞转化生长因子β1mRNA表达分别是阴性对照组的1.18倍和1.30倍,差异有显著性[5000,10000mg/L密骨片药液组、阴性对照组的细胞内杂交颗粒的平均光密度值(A)分别为0.21367±0.01500,0.23703±0.02173,0.18127±0.01528,P<0.05和P<0.01],5μg/L重组碱性成纤维细胞生长因子组的细胞内杂交颗粒的平均光密度值(A)(0.25445±0.02081)虽高于5000,10000mg/L密骨片药液组,但差异无显著性(P>0.05)。结论:补肾中药密骨片可刺激成骨细胞转化生长因子β1的分泌和合成,从而促进骨形成和抑制骨吸收。     

Effect of Minor Er Additions on the Microstructures and Mechanical Properties of Cast Al-Cu-Mg-Ag Alloys

The microstructures and mechanical properties of novel cast Al-Cu-Mg-Ag alloys with and without minor additions of Er (0.09 and 0.2 wt %) are investigated by Vickers hardness tests, tensile tests, optical metallographic examination, scanning electron microscopy (SEM), transmission electron microscopy (TEM), and X-ray diffraction (XRD). The results reveal that the Er addition decreases the hardness value of peak-aged Al-Cu-Mg-Ag alloy but has little influence on the time required for achieving the peak aging condition. Meanwhile, the Ω phase is suppressed in Er-added alloys, leading to a lower tensile strength at room temperature, which causes the (Mg, Ag, Er, V, Ti)-rich phase in the matrix in Er-added alloys. This blocky phase consumes available Mg and Ag atoms for Ω nucleation, leading to the low number density of Ω plates. The strength properties of Er-added alloys at 300 °C are found to be enhanced, which benefits from the pinning effect of the Al₈Cu₄Er phase on grain boundaries. Meanwhile, the brittle fracture of Er-added alloys at room temperature is directly associated with the Al₈Cu₄Er phase and the blocky (Mg, Ag, Er, V, Ti)-rich phase, which acts as the source of microcracks during deformation. In addition, no obvious grain refinement effect can be observed in Er-added alloys.     

双侧坐骨神经及股神经离断并固定大鼠神经肽Y水平对骨密度的影响

背景:以往研究认为,刺激坐骨神经及中枢神经受伤可使神经肽Y含量发生改变,神经肽Y对破骨细胞产生作用,影响骨代谢.目的:验证双侧坐骨神经、股神经失神经及固定后神经肽物质对大鼠双侧胫骨骨密度的影响,并进行相关性分析.设计、时间及地点:随机对照动物实验,于2006-09/11在湘南学院附属医院完成.材料:10周龄SD雄性大鼠96只,体质量220～250 g,用于制备失神经支配模型.方法:96只SD大鼠按数字表法随机分为3组,每组32只.①失神经支配组:切断大鼠两侧后肢坐骨神经和两侧股神经,远端游离5 mm,缝合切口.②固定组:大鼠切断神经,程序同前,继之采用管型石膏固定.③对照组:行假手术,仅暴露神经,然后缝合伤口.主要观察指标:实验期间大鼠的一般情况.造模后1,10,30,60 d每组分别处死大鼠8只,观察双侧胫骨骨密度和神经肽Y的变化及神经肽Y水平与骨密度水平的相关性.结果:96只SD大鼠均进入结果分析.①失神经后神经肽Y含量先降低,后升高,随着失神经支配时间的延长,神经肽Y持续升高,超过正常水平.②固定组神经肽Y含量先升高,后下降,但随着固定时间的延长,逐步升高并超过正常水平.⑧随着神经肽Y含量变化,大鼠双侧胫骨骨量也相应发生改变,大鼠失神经、固定30 d后双侧胫骨骨密度明显下降.失神经及固定后神经肽Y与骨密度含量变化高度相关(P＜0.01).结论:失神经支配及固定后大鼠神经肽Y含量变化均与骨密度改变具有高度相关,故可认为神经肽Y可作为骨质疏松形成的关键指标之一.     

An animal model of chronic rheumatic valvulitis induced by formalin-killed streptococci

Rheumatic heart disease is the most severe complication of rheumatic fever. Till date, very few successful animal models of rheumatic valvular disease have been reported. This study aimed at developing a suitable animal model of chronic rheumatic valvulitis for further investigation and prevention of rheumatic heart disease. Lewis rats were immunized with one administration of formalin-killed and sonicated group A streptococci together with Complete Freund’s Adjuvant every 7 days for three cycles followed by group A streptococci alone till killing. Control rats were administered adjuvants and saline. Rats in group 1 were killed 12 weeks after the initial injection. Rats in group 2 and control group were killed 24 weeks after the initial injection. Results 62.5% (5/8) of rats in group 1 developed myocarditis and 50% (4/8) developed valvulitis. Histological examination of cardiac sections showed only cellular infiltrates. In contrast, 75% (6/8) of rats in group 2 developed rheumatic-like myocarditis and 62.5% (5/8) developed chronic valvulitis. Histological manifestations of the hearts in group 2 animals involved not only acute damage such as cellular infiltrates, Aschoff-like cells, verrucous vegetation, but also chronic lesions such as fibrosis, vascular neogenesis. None of the rats (0/8) in control group presented myocarditis or valvulitis. Lewis rat repeatedly immunized with formalin-killed GAS may be a suitable animal model of chronic rheumatic valvulitis. It may be useful for future investigation of the pathogenesis and possible preventive strategies of human rheumatic heart disease.     

Hepatitis E virus infection after haploidentical haematopoietic stem cell transplantation: incidence and clinical course

Hepatitis E virus (HEV) is increasingly found to cause hepatitis in allogeneic haematopoietic stem cell transplantation (HSCT) patients. However, little is known about HEV infection in patients receiving haploidentical HSCT (haplo-HSCT). Here, we retrospectively evaluate the incidence and clinical course of HEV infection in haplo-HSCT patients. From January 2014 to July 2017, 177 patients with unexplained elevated transaminases after receiving haplo-HSCT at Peking University Institute of Haematology were screened for HEV using HEV serology. HEV RNA was assessed in blood samples when HEV-IgG and/or IgM antibodies were positive. Acute HEV infection was identified in 7 patients (3·9%), 1 of whom had developed a chronic HEV infection. The median time from haplo-HSCT to HEV infection was 17·5 (range, 6–55) months. HEV infection was confirmed by the presentation of anti-HEV IgM + anti-HEV IgG (rising) (n = 5) or HEV-RNA + anti-HEV IgM + anti-HEV IgG (n = 2). None of the patients died of HEV infection directly: 2 patients with HEV infection died showing signs of ongoing hepatitis, and 5 patients cleared HEV with a median duration of HEV infection of 1·5 (range, 1·0–5·7) months. In conclusion, HEV infection is a rare but serious complication after haplo-HSCT. We recommend screening of HEV in haplo-HSCT.     

急性ST段抬高型心肌梗死患者VDBP水平与Syntax评分相关性研究

【目的】探讨血清维生素D结合蛋白水平（vitamin D binding protein,VDBP）与急性ST段抬高型心肌梗死（acute ST-segment elevation myocardial infarction,STEMI）发生风险的相关性;通过分析VDBP与Syntax评分的相关关系,探讨其与冠状动脉病变严重程度的关系。【方法】选取74例STEMI患者,另选取同期在本院进行健康体检的50例健康志愿者作为对照组。采用酶联免疫吸附实验（enzyme-linked immunosorbent assay,ELISA）检测上述研究对象的血清VDBP水平,收集研究对象的临床资料,并进行Syntax评分。根据Syntax评分将试验组分为高危组（Syntax≥33,n=21）、中危组（23≤Syntax≤32,n=25）及低危组（Syntax≤22,n=28）,比较组间VDBP水平差异,并分析VDBP水平与Syntax评分的相关性。【结果】STEMI患者血清VDBP水平明显高于对照组[（3.43±1.11）μg/mL vs （2.28±1.15）μg/mL,p＜0.05]。STEMI患者各组间VDBP水平差异无统计学意义（F=1.020,P=0.366）。VDBP水平与Syntax评分无显著相关关系（r=0.143,p=0.223）。【结论】STEMI患者的血清VDBP水平较正常人明显升高,可能成为临床STEMI诊断的重要指标,但不能提示冠脉病变严重程度。