止吐剂止酸剂联合应用可减少化疗中的恶心呕吐反应

目的 探讨止吐剂和止酸剂联合应用减少化疗中的恶心呕吐反应。方法治疗组60例接受联合化疗患者，化疗前给予恩丹西酮8mg vi和法莫替丁40mg vi；对照组46例，化疗前仅给予恩丹西酮8mg vi。观察比较两组化疗中的恶心呕吐反应。结果治疗组化疗中、后发生恶心呕吐反应3例（5．00％），对照组化疗中、后发生恶心呕吐反应5例（10．86％）。结论化疗前止吐剂和止酸剂联合应用减少化疗中的恶心呕吐反应。     

弥漫性肺间质纤维化患者肺穿刺过程中死亡引起医疗纠纷分析

1 案情摘要 患者女,49岁,2006年11月23日因肺部疾病入院治疗,医院诊断为肺间质纤维化.相关术前检查确定无禁忌证后,于11月28日在病房接受肺穿刺活组织检查,术中突然休克,并伴随大量咯血,虽经抢救,但患者在持续昏迷10 d后,终因抢救无效死亡.     

基于有限元法分析钝力性脾损伤的机制

Objective To explore the biomechanical mechanism of blunt spleen injury based on finite element analysis. Methods A fist finite element model was used to simulate the impact at 4-8 m/s in the spleen area of THUMS4.0 human body model from the front of the left costal area, the left anterior axillary line and the rear scapular line. The strain distribution and damage of the spleen under different conditions were observed. The simulation results were compared with the clinical cases of spleen rupture to analyze the mechanism of spleen injury. Results The damage location and strain distribution of the spleen could vary under different conditions. Due to the special anatomical location of the spleen, a blunt impact at the speed of 4-8 m/s on the front side did not easily cause spleen injury, and the strain was distributed mainly in the front of the spleen and the spleen hilum; a similar blunt impact on the left side was likely to cause spleen diaphragmatic surface injury, the splenic visceral surface could be injured by the compression of the medial tissue and organs and the traction of the splenic pedicle, and the strain was distributed in the spleen diaphragmatic and visceral surfaces; an impact on the back side was likely to cause injuries in the posterior portion and hilum of the spleen, and the strain was mainly concentrated in the injured area. Conclusion Blunt spleen injuries caused by punches on the abdomen are mostly caused by direct impact on the ribs, the compression by the surrounding tissues and organs and the traction by the spleen pedicle.     

高级别子宫颈上皮内病变LEEP术后切缘累及患者病灶残留或复发的相关因素分析

目的探讨高级别子宫颈上皮内病变(HSIL)宫颈环形电切术(LEEP)术后切缘病灶残留复发的相关因素。方法回顾性分析因HSIL行LEEP、术后病理诊断为HSIL且切缘累及并行二次手术的84例的患者临床资料,比较术后累及切缘的病理、术后随访中LCT、HR-HPV DNA和二次手术病理结果的关系。结果84例HSIL首次LEEP术后切缘累及为LSIL者12例(14.29%),HSIL者72例(85.71%),术后3~12个月行二次手术,其中LEEP 8例、CKC 16例、全子宫切除术60例;二次手术后病理为HSIL者分别是4例(4/12)和24例(33.33%,24/72;包括5例宫颈浸润癌),两者比较,差异无统计学意义(P0.05)。首次LEEP术后随访LCT和(或)HR-HPV阳性者27例(32.14%,27/84),均阴性者57例(67.86%,57/84);两者二次手术后病理为HSIL者分别是17例(62.96%,17/27,包括5例宫颈浸润癌)和11例(19.30%,11/57),两者比较,差异有统计学意义(P0.05)。结论宫颈HSIL LEEP术后切缘累及患者随访中出现LCT和/或HR-HPV DNA阳性提示子宫颈有高级别病变残留和(或)复发,甚至有宫颈浸润癌可能,应及时行阴道镜检查,必要时二次手术。     

8-羟基脱氧鸟苷在胰岛素抵抗大鼠骨骼肌的表达及运动、吡格列酮的干预作用

目的:观察氧化应激标志物8-羟基脱氧鸟苷(8-OHdG)在胰岛素抵抗(IR)大鼠骨骼肌的表达及运动、吡格列酮对其的干预作用。方法:40只雄性Wistar大鼠随机分为对照组和模型组,分别给予普通饲料和高糖高脂饲料饲养;8周后再将模型组大鼠随机分为IR组、运动干预组和吡格列酮干预组,后两组分别进行游泳训练及吡格列酮(20mg/kg/天)灌胃,持续8周。16周末测量各组大鼠体重(BW)、空腹血糖(FPG)、空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR);采用黄嘌呤氧化酶法检测骨骼肌超氧化物歧化酶(SOD)活性、免疫组化法检测骨骼肌8-OHdG表达。结果:(1)IR组大鼠FBG、FINS、HOMA-IR水平升高,骨骼肌8-OHdG表达增强、SOD活性降低;运动、吡格列酮干预后SOD活性增加,其它指标均下降。(2)相关性分析发现,实验大鼠HOMA-IR与8-OHdG表达水平呈正相关,与SOD活性呈负相关。结论:运动、吡格列酮可通过抑制IR大鼠骨骼肌的氧化应激反应,改善IR。