踝关节骨折的手术治疗

目的:探讨踝关节骨折的手术治疗及效果分析。材料与方法:通过对40例踝关节骨折的手术治疗,对手术结果分析评价。结果:40例踝关节骨折的手术治疗效果良好。结论:本组全部使用钢板螺钉固定,除一例外踝粉碎复位不良外,其余全部接近或达到解剖复位,术后关节功能恢复良好。     

哺乳期母体接触氯氰菊酯对子代雌鼠学习记忆的损害效应

目的 研究哺乳期母鼠接触氯氰菊酯对子代成年雌鼠学习记忆能力的损害作用及其可能机制.方法 12只ICR母鼠随机分成对照组、6.25和25.00 mg/kg染毒组(每组4只母鼠,每窝10只仔鼠,雌雄各半,即每组20只雌鼠),于子代雌鼠出生后第1～21天(PNDl～ PND21),每天经口灌胃给予母鼠氯氰菊酯(6.25和25.00 mg/kg)染毒1次,对照组母鼠给予玉米油.染毒后39d,采用六臂放射状水迷 宫检测PND60雌鼠的学习记忆能力.检试结束后,称体重,处死动物取脑称重并分离海马组织,用蛋白质免疫印迹(Western blotting)法检测海马中N-甲基-D-门冬氨酸(NMDA)受体NR1亚单位蛋白表达水平.结果 各组子代雌鼠体重和脑重的差异无统计学意义(P＞0.05).经重复测量资料方差分析显示,在学习期,25.00 mg/kg染毒组子代雌鼠潜伏期[(31.3±17.0)s]长于对照组[(21.0±14.0)s];在记忆期,25.00 mg/kg染毒组子代雌鼠潜伏期[(24.6±21.1)s]较对照组[(14.1±16.3)s]延长,差异均有统计学意义(P＜0.05).各组子代雌鼠在学习期和记忆期的错误数比较,差异均无统计学(P＞0.05).与对照组相比,25.0 mg/kg染毒组子代雌鼠海马组织NR1蛋白表达水平明显降低,差异有统计学意义(P＜0.01).结论 哺乳期母鼠接触氯氰菊酯在一定程度上损伤子代成年雌鼠学习记忆能力,可能与海马组织中NR1亚单位蛋白表达水平下降有关.     

抑郁在大学生负性生活事件和自杀意念关系中的中介效应

目的 探讨负性生活事件与大学生自杀意念的关系及其抑郁的介导作用.方法 采用整群抽样方法,调查某综合性大学本科生共1145名,通过症状自评量表(SCL-90)评定大学生近1周内自杀意念和抑郁症状,通过基本情况问卷了解大学生经历的负性生活事件,包括重大疾病、学习困难、经济困难和人际冲突,并通过中介分析探讨抑郁在负性生活事件与自杀意念关系中的介导作用.结果 负性生活事件中重大疾病(OR=2.5,P=0.028)、人际冲突(OR=7.2,P=0.002)和经济困难(OR=1.6,P=0.026)均导致自杀意念的产生,学业困难与自杀意念无相关性(OR=1.8,P=0.090).调整抑郁变量后,重大疾病和人际冲突对自杀意念的影响不再具有统计学意义,而经济困难对抑郁无影响,学业问题对抑郁和自杀意念均无影响,故抑郁是重大疾病和人际冲突与自杀意念的完全中介变量,而抑郁在经济困难、学业问题与自杀意念的关系无中介作用.结论 抑郁在不同负性生活事件和自杀意念的关系路径中所起的中介作用不同.     

重复离心对监测碳酸锂药物浓度可靠性研究

目的 针对锂(Li+)盐的治疗剂量(0.4～1.5mmol/L)与中毒剂量(1.6mmol/L)十分接近但又难以避免的状况,探讨样本反复离心后Li+浓度监测的可靠性.方法 选择临床服用碳酸锂治疗达稳态的住院患者,采集血清及肝素钠抗凝血标本,采用离子选择电极直接法分别测定Li+、钾(K+)、钠(Na+)、氯(Cl-)离子浓度,比较对照组和研究组的差异.结果 血清重复离心后K+浓度有升高趋势,但差异无统计学意义(P＞0.05),血浆组K+浓度重复离心后显著升高(P＜0.01),同时血清K+浓度显著高于血浆(P＜0.001);重复离心对血清Na+、Cl-浓度无影响(P＞0.05);虽然血浆Na+、Cl-浓度高于血清(P＜ 0.001),并随离心次数增加显著下降(P＜ 0.001),但无临床实用价值.结论 临床上基于某些无法抗拒的原因所导致的反复离心样本对Li+浓度监测无影响,可以认为是安全和有效的,但为了提高对临床的应答速度而使用肝素抗凝血测定Li+、K+、Na+浓度,应建立新的参考范围.     

内镜黏膜下剥离术治疗上消化道固有肌层肿瘤的探讨

目的探索内镜黏膜下剥离术治疗上消化道固有肌层肿瘤的可行性、疗效和安全性。方法经胃镜和内镜超声、CT证实上消化道固有肌层肿瘤35例,其中食管15例,胃20例。行内镜黏膜下剥离术,若出现较大的穿孔或操作困难则改为胃镜联合腹腔镜治疗。结果 35例病灶全部成功进行内镜黏膜下剥离术,未发生严重并发症。操作时间45~240 min,平均82.4 min。术后病理诊断食管平滑肌瘤14例,食管间质瘤1例,胃平滑肌瘤6例,胃间质瘤14例。病灶直径0.8~4.2 cm,平均1.9 cm。术中发生穿孔3例,2例用金属夹成功封闭,1例行腹腔镜下穿孔修补术。结论内镜黏膜下剥离切除术治疗消化道固有肌层肿瘤是微创、有效并且安全的治疗方法。     

依帕司他联合甲钴胺对糖尿病患者神经传导速度的影响

目的探讨依帕司他与甲钴胺联合治疗对糖尿病周围神经病变(DPN)患者神经传导速度的影响。方法将68例DPN患者随机分为依帕司他组、甲钴胺组、依帕司他加甲钴胺联合治疗组和对照组,3个治疗组分别给予相应药物治疗,对照组仅基础治疗,疗程共12周,比较4组疗效及神经传导速度的改变。结果联合治疗组有效率为94.44%,依帕司他组为76.47%,甲钴胺组为70.59%,对照组为43.75%,差异有统计学意义(P<0.05)。3个治疗组神经传导速度改善均优于对照组,其中联合治疗组改善效果最好。结论依帕司他和甲钴胺联合治疗能更有效改善DPN患者的神经传导速度。     

Exercise two-dimensional echocardiography: a technique for improving ultrasound images during exercise stress

A system of exercise stress echocardiography was developed in which, during exercise on a bicycle ergometer in a semirecumbent position, the echocardiographic transducer is held by a special device which maintains a relatively constant position between the transducer and the heart. The system was evaluated in 21 healthy subjects and technically satisfactory studies were obtained in 20. In these, the resolution and relative position of the cardiac image remained stable throughout exercise. Blood pressure and heart rate increased appropriately with our protocol with supine exercise; 95% of the subjects reached 90% of their predicted maximum heart rate for age. Ejection fraction measured by echocardiography increased from 54 +/- 1% to 70 +/- 1%. It is concluded that the use of our transducer-holding device in subjects performing exercise in the supine position significantly improves ultrasonic image quality and should enhance the clinical usefulness of exercise stress echocardiography.     

Platelet-derived growth factor promotes polymorphonuclear leukocyte activation

The platelet-derived growth factor (PDGF) has several well defined important biologic activities. Platelet-derived growth factor is the major mitogen in human serum for cells of mesenchymal origins; it is a potent chemoattractant protein for human monocytes, neutrophils, fibroblasts, and smooth muscle cells; and has been implicated in transformation by simian sarcoma virus and perhaps in transformation by other agents as well. In this article, PDGF has been shown to stimulate activation of human peripheral blood neutrophils defined by loss of membrane associated calcium as reflected by loss of chlortetracycline fluorescence, release of superoxide anion and specific granule enzymes, and enhanced neutrophil adherence and aggregation. These responses occurred in a dose-dependent fashion at concentrations of PDGF between 10 ng/mL (0.4 nmol/L) and 40 ng/mL (1.5 nmol/L) and were comparable to effects obtained with optimal concentrations of fMLP and C5a. Degranulation induced by PDGF was selective for secondary (specific) granules and not primary (azurophil) granules. Platelet-derived growth factor thus is ideally suited for a pivotal role in attracting inflammatory cells locally and initiating neutrophil activation at sites of blood vessel injury. Platelet-derived growth factor or a closely related protein also may play an important role in attracting and activating neutrophils in association with inflammatory tumors.