超声引导改良婴幼儿颈内静脉穿刺置管术的临床研究

目的:探讨超声引导改良婴幼儿颈内静脉穿刺置管术的临床应用价值。材料和方法:随机抽取行先天性心脏病手术的婴幼儿60例分为2组(n=30)。A组:对照组,首选右颈内静脉中路,用20GY形穿刺针穿刺,再经Y型穿刺针置入J形引导钢丝,然后置入中心静脉导管。B组:实验组,在超声引导下用18GBD静脉外套管穿刺,经静脉外套管置入J形引导钢丝,然后置入中心静脉导管。记录两组穿刺置管总成功率、一次穿刺成功率、失败率及并发症。结果:B组总穿刺成功率高于A组(P<0.05),B组一次穿刺成功率显著高于A组(P<0.01),B组的穿刺并发症明显低于A组。结论:超声引导下经18G静脉留置针穿刺置管,大大提高了婴幼儿中心静脉置管的成功率,并降低了并发症的发生率,有很高的临床应用价值。     

早产儿经鼻持续气道正压通气鼻部系带固定方法的改良

目的 降低早产儿经鼻持续气道正压通气鼻部系带固定所致的相关并发症。 方法 将符合纳入标准的136例早产儿随机分为两组,观察组67例采取改良系带固定法,对照组69例采用贴膜无张力包裹棉球及系带固定法,比较两组早产儿眼部肿胀、朝天鼻、鼻部皮肤损伤等发生情况、持续正压通气时间及住院时间。 结果 观察组眼部肿胀、朝天鼻、鼻部皮肤损伤发生率显著低于对照组,持续正压通气时间、住院时间显著短于对照组（均P＜0.05）。 结论 改良鼻部系带固定法可以有效地固定鼻塞的位置,保证有效的通气时间,降低相关并发症发生率,缩短早产儿住院时间。     

颈椎横突后结节间沟神经阻滞麻醉治疗效果

目的研究分析对颈椎间盘突出症患者采用颈椎横突后结节间沟神经阻滞麻醉治疗的临床效果。方法选取我院2016年5月—2017年5月收治的64例颈椎间盘突出症患者作为研究对象,采用单盲随机法将患者分为对照组与研究组,各32例;研究组采用颈椎横突后结节间沟神经阻滞麻醉,对照组采用颈椎后根神经阻滞麻醉,对比收集两组患者治疗前后症状、体征评分的改变情况,并评估治疗效果。结果治疗后,患者的临床症状与体征在一定程度上得到了改善,研究组JOA评分中临床症状、临床检查和日常生活分数分别为(25.78±6.28)分、(25.49±5.64)分、(26.21±3.75)分,明显优于对照组的(14.49±6.24)分、(15.43±5.37)分、(16.24±3.51)分,P<0.05;研究组中治疗效果为优的例数是18,明显高于对照组的10例,P<0.05;此外研究组和对照组间出现不良反应的例数分别是1例与2例,复发现象的例数分别为2例与3例,数据差异无统计学意义,P>0.05。结论针对颈椎间盘突出症的临床治疗中,采用颈椎横突后结节间沟神经阻滞麻醉,能有效的改善患者的临床症状,提高生活质量,促进治疗效果与预后情况,具有较高的临床价值。     

神经衰弱的脑电图分析

目的:了解神经衰弱患者脑电图主节律α波。方法:对38例神经衰弱患者与42例健康者的脑电图主节律α波分析。结果:神经衰弱组主节律多分布在11～13c/s,健康组主节律多分布8～11c/s(P<0.01)。结论:脑电图主节律α波增快,出现方式减弱,说明大脑皮层兴奋性增高并存在兴奋与抑制的失调。     

巨头刺草皂甙D对人肝癌Hep3b细胞的抑制作用

目的 探讨巨头刺草皂甙D(GD)对人原发性肝癌Hep 3b细胞的抑制作用及其作用机制.方法 采用MTT法及细胞克隆法检测GD对肝癌细胞Hep 3b的抑制作用;运用光学显微镜和Hoechst荧光染色观察细胞形态的变化和凋亡现象;应用流式细胞术检测细胞周期的变化以及线粒体膜电位的变化;运用Western blotting检测细胞内Bcl-2、PARP蛋白及MAPK通路关键蛋白的变化.结果 GD具有较强的抗肝癌细胞Hep 3b作用,并且其抑制作用具有时间和剂量依赖性,在72 h处的半数抑制浓度IC50=16.08 μmol·L-1.细胞周期分析表明,随着GD浓度增加,Hep 3b细胞出现sub-G1凋亡峰,凋亡率从3.3％增加到33.6％.但细胞周期无明显改变.Hoechst荧光染色及流式细胞术分析发现GD作用Hep 3b细胞后,细胞核能发出明显的蓝色荧光点,并降低该细胞线粒体膜电位.通过Western Blotting发现,GD作用Hep 3b细胞后,Bcl-2蛋白表达减少,凋亡标志分子PARP活化.MAPK通路蛋白Erk磷酸化形式表达下降,p38和JNK磷酸化形式表达增加.结论 GD可通过诱导肝癌细胞凋亡发挥抗肝癌活性,该作用可能与MAPK通路有关.     

穴位敷贴治疗腹泻型肠易激综合征的系统评价

目的 系统评价中医穴位敷贴治疗腹泻型肠易激综合征(IBS-D)的有效性及安全性.方法 检索建库至2016年12月间CNKI、VIP、CBM、SCI、PubMed、Embase、Cochrane等中英文数据库中采用穴位敷贴治疗IBS-D的临床随机对照试验,并辅以手工检索.按照纳入排除标准筛选文献,RevMan 5.3软件进行系统评价.结果 (1)最终纳入11项临床随机对照研究,合计803例患者,其中,穴位敷贴治疗组402例,西药对照组401例;(2)文献方法质量学方面,3分以上文献7篇,文献质量普遍较高;(3)有效性方面,与西医对照组相比,穴位敷贴治疗组临床总有效率的总优势比OR[95％CI]为3.29[2.25,4.82],差异有统计学意义(P<0.05).其中,穴位使用频次前5位的依次是神阙、中脘、脾俞、足三里及肝俞穴;(4)安全性方面,除1项研究外,其余穴位敷贴治疗组不良反应发生率均低于西药对照组.结论 穴位敷贴可以提高IBS-D临床效果且不良反应少,但仍需更多高质量的多中心、大样本随机对照试验证实.     

床旁超声联合血浆NT-proBNP检测指导脓毒症休克液体复苏的临床研究

目的:探讨床旁超声联合N末端B型利钠肽原(NT-proBNP)检测指导脓毒症休克液体复苏的应用效果.方法:选取2018年6月至2020年12月收治的50例脓毒症休克患者为研究对象,随机分为观察组和对照组;对照组患者进行脉搏指示连续心排血量监测(PICCO)指导液体复苏,观察组患者进行床旁超声联合血浆NT-proBNP检测指导液体复苏;比较两组患者治疗前后各项生命体征、机械通气时间、ICU住院时间及28 d内病死率.结果:治疗前、治疗6 h后两组患者的心率、平均动脉压、中心静脉压、血乳酸水平、尿量、APACHEⅡ评分差异无统计学意义(P>0.05);治疗6 h后两组患者的心率、平均动脉压、中心静脉压、血乳酸水平、尿量、A-PACHEⅡ评分较治疗前均改善(P<0.05);两组患者的机械通气时间、ICU住院时间、28 d内病死率比较,差异无统计学意义(P>0.05).结论:床旁超声联合血浆NT-proBNP检测指导脓毒症休克患者实施体液复苏效果与PICCO监测相似,但是床旁超声联合血浆NT-proBNP检测指导脓毒症休克患者实施体液复苏更加安全、方便易行、价格低廉,值得应用.     

Evaluation of the clinical value of carbon nanoparticles as lymph node tracer in differentiated thyroid carcinoma requiring reoperation

Background

The incidence of parathyroid injury in patients with differentiated thyroid carcinoma (DTC) who underwent reoperation is significantly higher than that incurred from the initial surgery. The aim of this study was to investigate the clinical value of carbon nanoparticles (CN) as tracers for lymph nodes to guide cervical lymph node dissection and protect the parathyroid during reoperation for DTC.

Methods

Our study recruited 116 patients with DTC who previously underwent thyroidectomy and later received remedial surgical treatment at the Department of Breast and Thyroid Surgery, Hunan Provincial People’s Hospital, China, between February 2011 and February 2014. Those patients were randomly divided into the experimental group (the CN group) with 64 cases and the control group with 52 cases. Carbon nanoparticle suspension (CNS, 0.1–0.3 ml) was intraoperatively injected into the residual thyroid or enlarged lymph nodes in the CN group; in the control group, CNS was not applied intraoperatively. The differences in identification of the parathyroid glands, the number of lymph nodes resected intraoperatively, and the incidence of common complications after thyroidectomy in both groups were recorded and analyzed.

Results

The accuracy of identification of the parathyroid in the CN group and control group was 92.2 % and 28.8 %, respectively, and the identification rate of three glands or more in both groups was 75 % and 36.5 %, respectively; those differences were statistically significant between the two groups (P < 0.05). There was also a significant difference between the two groups in the number of lymph nodes removed in the central and lateral cervical compartments (P < 0.05). There was no increase in common complications after the second surgery compared with the previous surgery; in addition, there was a decline in the incidence of transient hypoparathyroidism (HPT) (P < 0.05).

Conclusions

By tracing the thyroid and cervical regional lymph nodes with carbon nanoparticles, the parathyroid glands can be easily identified and protected to reduce the complications of transient hypoparathyroidism resulting from reoperation for residual or missed DTC. Carbon nanoparticle tracers also facilitate radical resection of lymph nodes at the central and lateral compartments of the neck.

     

Differential sensitivity of five cyanobacterial strains to ammonium toxicity and its inhibitory mechanism on the photosynthesis of rice-field cyanobacterium Ge-Xian-Mi (Nostoc)

Effects of two fertilizers, NH(4)Cl and KCl, on the growth of the edible cyanobacterium Ge-Xian-Mi (Nostoc) and four other cyanobacterial strains were compared at pH 8.3+/-0.2 and 25 degrees C. Their growth was decreased by at least 65% at 10mmolL(-1) NH(4)Cl but no inhibitory effect was observed at the same level of KCl. Meanwhile, the strains exhibited a great variation of sensitivity to NH(4)(+) toxicity in the order: Ge-Xian-Mi>Anabaena azotica FACHB 118>Microcystis aeruginosa FACHB 905>M. aeruginosa FACHB 315>Synechococcus FACHB 805. The 96-h EC(50) value for relative growth rate with regard to NH(4)(+) for Ge-Xian-Mi was 1.105mmolL(-1), which was much less than the NH(4)(+) concentration in many agricultural soils (2-20mmolL(-1)). This indicated that the use of ammonium as nitrogen fertilizer was responsible for the reduced resource of Ge-Xian-Mi in the paddy field. After 96h exposure to 1mmolL(-1) NH(4)Cl, the photosynthetic rate, F(v)/F(m) value, saturating irradiance for photosynthesis and PSII activity of Ge-Xian-Mi colonies were remarkably decreased. The chlorophyll synthesis of Ge-Xian-Mi was more sensitive to NH(4)(+) toxicity than phycobiliproteins. Thus, the functional absorption cross section of Ge-Xian-Mi PSII was increased markedly at NH(4)Cl levels >/=1mmolL(-1) and the electron transport on the acceptor side of PSII was significantly accelerated by NH(4)Cl addition >/=3mmolL(-1). Dark respiration of Ge-Xian-Mi was significantly increased by 246% and 384% at 5 and 10mmolL(-1) NH(4)Cl, respectively. The rapid fluorescence rise kinetics indicated that the oxygen-evolving complex of PSII was the inhibitory site of NH(4)(+).     

A parallel and quantitative cell migration assay using a novel multi-well-based device

Cell migration assays for different chemical environments are important for both scientists and clinicians searching for new therapeutics. In this study, we developed a multi-well-based microfluidic chip that has multiple units for different conditions. In each unit, cells can be patterned and then released to observe their migration. Automatic image analysis and model-based data processing were developed to describe the integrated cell migration assay precisely and quickly. As a demonstration, the migration behaviors of two types of cells in eight chemical conditions were studied. The results showed that supplementation with transforming growth factor-β(TGF-β) significantly promoted the migration of MCF-7 and MCF-10 A cells compared to several growth factors, such as Epidermal Growth Factor(EGF) and basic fibroblast growth factor(bFGF), as well as a control sample. Cells can migrate particularly fast with two or more mixed supplementary factors, such as TGF-β + bFGF + EGF, which indicated a synergy effect. Thus, this chip could be used to quantitatively observe cancer cell migration and demonstrated great potential for use in quantitative migration studies and chemical screening.