体外反搏治疗血清对培养内皮细胞基因表达的影响

目的探讨经体外反搏治疗的冠心病患者血清对血管内皮细胞基因表达的调控效应。方法分别取接受体外反搏治疗的冠心病患者1、24和36h时间点的血清，用于培养人脐静脉血管内皮细胞。用cDNA基因芯片检测3个治疗时点反搏前、后血管内皮细胞基因表达谱。结果反搏前后比较，有10个基因（核转录因子、真核转录启动因子-4、平滑肌的肌球蛋白重链、α2-肌动蛋白、微管蛋白β肽链、组织相容蛋白G、黑色素黏附分子、神经介素B受体、蛋白激酶4K2、血小板凝血酶敏感蛋白-1）的表达在3个治疗时点上出现显著改变。在1h点均为上调，在24h、36h时点均为下调。结论体外反搏治疗冠心病患者血清对血管内皮细胞的炎症反应、细胞凋亡相关基因表达有调效应，并随体外反搏治疗时间的增加早抑制其表达的趋势。     

Management of congenital tracheal stenosis

Objectives: Congenital tracheal stenosis is a rare disease. Various methods for treatment exist but there is still much debate as to the appropriate surgical procedure. We present our surgical experiences of patch tracheoplasty and slide tracheoplasty as viable methods for the treatment of congenital tracheal stenosis. Methods: From 1994 to 2002, 13 patients were diagnosed with congenital tracheal stenosis. Eight patients (7 symptomatic and 1 asymptomatic) had their stenosis corrected, three by means of pericardial patch tracheoplasty, four by slide tracheoplasty, and one by resection and anastomosis. Concomitant operations were performed on six patients to treat congenital cardiovascular disease. Five patients showing no significant symptoms did not undergo tracheal surgery and received only cardiac procedures. A retrospective review of the hospital course, complications, and long-term results was conducted. Results: Among the patch tracheoplasty group, every patient suffered from granulation tissue formation. One patient died of respiratory acidosis and one was hospitalized due to recurrent granulation tissue, which required frequent bronchoscopy. The third patient from this group is free of all symptoms. Among the slide tracheoplasty group, one patient died of anastomosis disruption. The three remaining patients are alive and well. The one patient who received resection and anastomosis is alive without symptoms. Conclusions: Surgical repair of long-segment congenital tracheal stenosis exhibited high mortality and morbidity rates. Every patient that underwent pericardial patch tracheoplasty suffered from troublesome granulation tissue. As slide tracheoplasty provided relatively good results in the short and mid-term follow-up periods, it seems to be a preferred method for the treatment of long-segment congenital tracheal stenosis.     

Nuclear Factor κB and Anesthetic Preconditioning during Myocardial Ischemia-Reperfusion

Background: Volatile anesthetic preconditioning (APC) protects against myocardial ischemia-reperfusion (IR) injury, but the precise mechanisms underlying this phenomenon remain undefined. To investigate the molecular mechanism of APC in myocardial protection, the activation of nuclear factor (NF) [kappa]B and its regulated inflammatory mediators expression were examined in the current study.

Methods: Hearts from male rats were isolated, Langendorff perfused, and randomly assigned to one of three groups: (1) the control group: hearts were continuously perfused for 130 min; (2) the IR group: 30 min of equilibration, 15 min of baseline, 25 min of ischemia, 60 min of reperfusion; and (3) the APC + IR group: 30 min of equilibration, 10 min of sevoflurane exposure and a 5-min washout, 25 min of global ischemia, 60 min of reperfusion. Tissue samples were acquired at the end of reperfusion. NF-[kappa]B activity was determined by electrophoretic mobility shift assay. The NF-[kappa]B inhibitor, I[kappa]B-[alpha], was determined by Western blot analysis. Myocardial inflammatory mediators, including tumor necrosis factor [alpha], interleukin 1, intercellular adhesion molecule 1, and inducible nitric oxide synthase, were also assessed by Western blot analysis.

Results: Nuclear factor [kappa]B-DNA binding activity was significantly increased at the end of reperfusion in rat myocardium, and cytosolic I[kappa]B-[alpha] was decreased. Supershift assay revealed the involvement of NF-[kappa]B p65 and p50 subunits. APC with sevoflurane attenuated NF-[kappa]B activation and reduced the expression of tumor necrosis factor [alpha], interleukin 1, intercellular adhesion molecule 1, and inducible nitric oxide synthase. APC also reduced infarct size and creatine kinase release and improved myocardial left ventricular developed pressure during IR.     

水杨酸钠中耳灌注对庆大霉素耳毒性的防护作用

目的 观察水杨酸钠经中耳局部灌注给药对庆大霉素耳毒性的防护作用。方法 24只健康杂色豚鼠均接受圆窗置管术，然后随机分成3组：Ⅰ组为生理盐水对照组；Ⅱ组为庆大霉素组，腹腔注射庆大霉素，经听泡灌注生理盐水；Ⅲ组为庆大霉素加水杨酸钠组，腹腔注射庆大霉素，经听泡灌注水杨酸钠。观察各组给药前后听性脑干反应阈的变化和给药后4周毛细胞损失情况。结果 听泡置管术后ABR反应阈无明显改变；给药后2周和4周，庆大霉素组ABR反应阈较庆大霉素加水杨酸组显著增高（P〈0．01），对照组ABR反应阈无显著变化。耳蜗铺片、毛细胞计数显示庆大霉素组外毛细胞严重缺失，以底回最明显，庆大霉素加水杨酸钠组外毛细胞损失较庆大霉素组轻（P〈0．05）。对照组无明显外毛细胞缺失。结论 水杨酸钠经中耳局部给药途径可减轻庆大霉素所致听功能损害和毛细胞缺失，可在一定程度上有效预防庆大霉素的耳毒性。     

MRI测量颈胸角在选择颈胸段脊柱手术入路中的临床应用

目的 :探讨在颈胸段脊柱术前应结合患者的颈胸段MRI的个体特征和疾病情况 ,选择手术创伤最小的手术入路。方法 :共 76例患者 ,其中 2 6例为颈胸段脊柱损伤 ,35例为颈胸段脊柱肿瘤 ,脊髓型颈椎病 12例 ,以及 3例颈胸段椎板减压术后后凸畸形。男 4 7例 ,女 2 9例。平均年龄 4 5 5岁 ,年龄范围 19～ 6 5岁。同时抽取 95套颈胸段MRI片。作胸骨上切迹向后水平延长线和胸骨上切迹向后上方至C7T1椎间盘前缘中点的连线 ,测量两线之夹角 ,称为颈胸角 (cervicothoracicangle ,CTA)。结果 :CTA平均为 4 7 6 4°(范围 2 5°～ 73°)。大于此平均角度且病灶在胸骨切迹水平线以上时可考虑低位下颈椎入路 ,5 0例 ;CTA较小 ,且病灶范围广 ,或尚累及T3 、T4,可以考虑经胸骨柄入路 ,13例 ;病灶范围广泛 ,经全胸骨入路 3例 ;Ⅰ期或Ⅱ期前后联合入路 5例 ;经右侧肩胛下后外侧胸腔入路 5例。结论 :颈胸段脊柱手术应尽量选择低位下颈椎入路等创伤较小的入路 ,其次考虑经胸骨柄入路。长节段脊柱受累的患者才考虑经右侧肩胛下后外侧胸腔或经全胸骨等创伤较大的入路。术前可以结合患者的病灶累及范围和颈胸手术角等MRI影像学表现 ,从而利于选择最合适的手术入路 ,减少手术风险、手术创伤和并发症 ,利于患者早日康复     

全反式维甲酸抗肿瘤作用的研究进展

 维甲酸类药物包括维生素A的天然及人工合成的衍生物。维生素A（视黄醇）进入人体后转变成视黄醛，再经氧化变成维甲酸。维甲酸是维持生长发育不可缺少的物质，尤其在促进上皮组织分化生长及维持其正常功能方面起重要作用。     

新生儿重症呼吸道感染氧气雾化吸入疗效分析

新生儿重症呼吸系统感染引起的新生儿慢性肺部疾病、重症肺炎、胎粪吸入性肺炎,病情重,发展快,易导致呼吸衰竭,死亡率高. 常用的方法除抗炎、改善通气、纠正缺氧和上用呼吸机外，雾化吸入治疗也起到重要的辅助作用。传统的地塞米松超声雾化吸入治疗，疗效差，且具有许多副作用。     

米非司酮对妊娠中期胎儿心脏超微结构的影响

目的:探讨米非司酮对妊娠中期胎儿心脏超微结构的影响。方法:将计划引产孕妇随机分为两组:对照组(水囊组)10例,实验组(米非司酮+水囊)15例。实验组按孕龄分为实验Ⅰ组(10例,16~22周),实验Ⅱ组(5例,23~28周)。实验组口服米非司酮100mg,连服3天,行水囊引产,对照组只行水囊引产。胎儿娩出后取心肌组织进行样本制备,然后在电镜下观察组织的超微结构。结果:细胞肿胀、空化,细胞膜不完整,闰盘分离,部分细胞连接消失。细胞核多呈不规则形,核内染色质凝聚呈块状,部分细胞核空化,核周围可见脂褐素。大部分肌丝断裂,肌节结构消失,少数可辩残留肌节结构,其间可见少量核糖体,但各带结构不清。线粒体肿胀,高度空化,嵴断裂,细胞基质局部空化。毛细血管内皮细胞肿胀。心肌组织细胞的超微结构有改变,且孕龄越小,超微结构改变越明显。结论:米非司酮可以引发胎儿心脏的缺血缺氧性改变。     

VEGF、EGF在再生障碍性贫血患者血清中的表达及意义

目的 检测再生障碍性贫血患者血清中血管内皮生长因子(VEGF)与表皮生长因子(EGF)的浓度,探讨VEGF和EGF在再生障碍性贫血患者血液中的表达及二者之间的关系和意义.方法 应用酶联免疫技术(ELISA法)检测20例再障患者及40名健康人血清中VEGF和EGF浓度.结果 20例再生障碍性贫血患者血清VEGF的含量为50.5±34.8pg/ml,对照组血清VEGF的含量为108.5±50.6 pg/ml,两组比较有统计学意义(P＜0.05).20例再生障碍性贫血患者血清EGF含量为0.15±0.11 μg/L,40例正常对照组血清EGF含量为0.76±0.80 μg/L.结论 再生障碍性贫血患者血清VEGF、EGF浓度显著低于健康对照组,且二者呈显著正相关.     

生理学网络教学的开发与应用

利用计算机多媒体技术，开展生理学网络教学是医学教学的一项重要任务，本文主要从生理学网络教学系统的开发、网络教学的优势和实践应用及思考作简要阐述。