硬膜外腔阻滞对胸部手术应激反应的影响

目的 观察硬膜外腔阻滞对胸部手术应激激素和细胞因子的影响。方法20例食管癌手术病人,随机分为两组,每组10例,即全麻复令硬膜外腔阻滞(GEA)组和全麻(GA)组,分别测定麻醉诱导前、手术2h、手术4h、术毕、术后1d及术后3d的血浆去甲肾上腺素、肾上腺素、血清促肾上腺皮质激素(ACTH)、皮质醇、C-反应蛋白、IL-6及IL-10的水平。结果 血浆去甲肾上腺素和血清皮质醇GEA组术中术后无显著改变,但GA组术毕和术后1d显著升高(P<0.05),术后3d恢复至术前水平,组间比较前者有显著差异(P<0.05)。两组血浆肾上腺素、IL-10术中术后均无显著变化。两组血清ACTH、IL-6及CRP术中术后均显著升高(P<0.05),组间比较无显著差异。结论 硬膜外腔阻滞可以减轻胸部手术的应激反应。IL-6是较CRP更灵敏的反映组织损伤的炎性指标。     

头孢呋辛酯制备工艺的改进

以头孢呋辛钠为原料，从制备（R，S）-乙酸1-溴乙酯开始。经酯化反应的溶剂沉淀过程无须分离直接制得高纯度非晶型的头孢呋辛酯。本制备方法简便，适于工为化生产。     

脊髓运动诱发电位在脊髓肿瘤手术中的监测应用

目的探讨脊髓运动诱发电位(SCMEP)在脊髓肿瘤手术中监测的应用价值.方法采用硬膜外电极在椎管内直接刺激脊髓记录脊髓运动诱发电位(SCMEP)监测脊髓肿瘤手术,并对17例肿瘤患者的手术监测的记录结果进行回顾性分析.结果SCMEP由于病变部位及性质、刺激电极与记录电极间的距离不同,波幅及潜伏期的差异较大,电极安放后与手术结束时的结果个体对照,相差不显著(P=0.083;P=0.387).7例术中波幅降低超过预警值20%,5例经短暂休息或改变手术方向后,波幅恢复正常.结论SCMEP的波幅变化是提示脊髓损伤的可靠性灵敏指标,对辅助医生进行手术安全操作,缩短手术时间,提高手术质量,减少术后神经功能障碍起到重要作用.     

Expression pattern of the CCAAT/enhancer-binding protein C/EBP-beta in gestational trophoblastic disease.

The CCAAT/enhancer-binding protein (C/EBP) family consists of several factors that are important regulators of intracellular processes and hormone action. C/EBP-beta, the most important member of the C/EBP family, was shown recently to be expressed in the normal human placenta where it is localized in villous syncytiotrophoblast and in the extravillous (intermediate) trophoblast but not the villous cytotrophoblast. The purpose of this study was to investigate the expression pattern of C/EBP-beta in gestational trophoblastic disease (GTD) which has not been studied so far. We used immunohistochemistry on a total of 15 cases of GTD including nine complete hydatidiform moles, one placental site nodule (PSN), one placental site trophoblastic tumor (PSTT), and four choriocarcinomas. All our tested specimens showed positivity for C/EBP-beta. The strongest C/EBP-beta expression could be observed in villous syncytiotrophoblast and in the trophoblast proliferations on the villous surface of hydatidiform moles; villous cytotrophoblast was negative. The PSN also showed positive nuclear staining but the expression was not as strong as it was in the hydatidiform moles and the total amount of stained cells was the lowest of all GTD. The PSTT also showed immunoreactivity but with a weaker and more heterogeneous staining than in the choriocarcinomas. The specific expression pattern of C/EBP-beta in GTD indicate that C/EBP-beta could potentially be an additional marker of such lesions.     

ΔNp63蛋白在膀胱移行上皮癌中的表达及其临床意义

目的 :探讨 p5 3基因家族新成员截短型p6 3(△Np6 3)在膀胱癌组织中的表达及其意义。 方法 :采用免疫组织化学SP法检测 4 0例膀胱移行上皮癌 (TCC)、6例膀胱内翻性乳头状瘤和 8例正常膀胱移行上皮中△Np6 3的表达 ,并分析△Np6 3表达与膀胱癌病理类型、临床分期的关系。 结果 :正常膀胱移行上皮、膀胱内翻性乳头状瘤、TCC中△Np6 3的阳性表达率分别为 37.5 % (3/ 8)、6 6 .7% (4/ 6 )、10 0 % (40 / 4 0 ) ,组间差异有统计学意义 (P <0 .0 1)。TCCG3 级与G2 级△Np6 3的强阳性、中度阳性表达率显著高于G1级 (P <0 .0 1)。Ta～T1期以△Np6 3弱阳性为主 (6 6 .7% ) ,随TCC浸润程度的增加 ,△Np6 3染色强度逐渐增强。T2 期△Np6 3强阳性表达率为 35 .3% ,T3 ～T4期增至 6 3.6 %。结论 :△Np6 3在TCC中高表达 ,与TCC病理分级、临床分期密切相关 ;△Np6 3可能参与TCC的发生、发展 ,是评估TCC预后的潜在因素之一。     

护士社会支持与焦虑状况相关因素调查分析

目的了解护士的社会支持与焦虑状况的相关因素,为心理干预提供理论依据.方法采用社会支持评定量表、状态焦虑量表(S-AT)对100名女护士进行调查,并分析其相关因素.结果护士社会支持评分为(37.22±6.94)分,S-AT评分(42.70±7.20)分;护士社会支持与焦虑状态呈负相关,即社会支持越高,焦虑状态越低;年龄<25岁、工龄<5年、未婚、合同护士社会支持明显偏低.结论良好的社会支持有助于减轻护士心理压力,是维护护士身心健康的重要因素.     

丁螺环酮和阿普唑仑治疗广泛性焦虑研究

目的：比较国产丁螺环酮和阿普唑仑治疗广泛性焦虑的疗效和不良反应。方法：对78例广泛性焦虑按照就医顺序分为两组，分别服用丁螺环酮(38例)和阿普唑仑(40例)。疗程6周。于治疗前及治疗第1、2、4、6周末进行汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)评定疗效和不良反应。结果：丁螺环酮和阿普唑仑的疗效相仿，丁螺环酮的不良反应少且轻微，无过度镇静和肌肉松弛作用，不产生药物依赖。结论：丁螺环酮是治疗广泛性焦虑较为理想的药物。     

Naturlatexallergie

As a consequence of AIDS prevention strategies, the use of powdered disposable latex gloves in hospitals and private medical practices has increased conspicuously in the past 10 years, and allergic reactions to natural latex have become a frequently observed problem. The clinical picture of type I allergies (immediate hypersensitivity) to natural latex ranges from slight, local allergic symptoms (urticaria, rhinitis, and conjunctivitis) to asthmatic complaints up to severest anaphylactic reactions. In addition to health care employees, patients are being affected with an increasing tendency during a variety of surgical and other medical interventions. Due to its enormous hygienic and economic significance, natural latex has become one of the most frequently studied sources of allergies. Efforts were undertaken to identify the causes and triggering factors, to develop diagnostic tools and continue to improve upon them, and to establish preventive measures and implement them successfully.     

粗糙脉孢菌漆酶基因的克隆及在毕赤酵母中的初步表达

采用连续延伸PCR方法克隆到粗糙脉孢菌（Neurospora crassa）漆酶基因，并将其克隆到表达载体pPIC9k，重组质粒经线性化、电激转化Pichia pastoris KM71，部分阳性克隆的PCR结果表明：漆酶基因已整合到巴斯德毕赤酵母染色体上，重组菌经甲醇诱导后3～5d产漆酶量最高，为2-3U／mL。     

络合碘在预防阑尾炎术后切口感染中的作用

目的络合碘预防阑尾切除术后切口感染。方法0．05％络合碘冲洗切口65例。结果络合碘冲洗的化脓、坏疽或穿孔性阑尾炎切口无感染，与传统组感染率9．1％（6／66）比较p〈0.05（x^2=4．266）。结论0．05％络合碘冲洗切口是预防阑尾切除术后切口感染的有效方法。