免疫抑制剂对大鼠坐骨神经损伤修复后细胞因子表达的影响

目的初步探讨3种免疫抑制剂对大鼠坐骨神经损伤修复后细胞因子表达的影响。方法42只W istar大鼠制作动物模型,切断双侧坐骨神经,并予以端端吻合,分别联合给予不同组合的甲基强的松龙、环孢素A(C sA)和FK 506,A组(对照组,n=9)不给药,B组(n=9)术后使用2 d甲基强的松龙20 m g/(kg.d);C组(n=9)在B组的基础上,术后使用2周FK 506,剂量为1 m g/(kg.d);D组(n=3)在B组的基础上,术后使用4周FK 506,剂量同C组;E组(n=9)在B组的基础上,于术后使用2周C sA,剂量为2 m g/(kg.d);F组(n=3)在B组的基础上,于术后使用4周C sA,剂量同E组。于术后1、2和4周各组分别取双侧坐骨神经,进行白细胞介素1β(in terleuk in 1,βIL-1β)、肿瘤坏死因子α(tum or necros is factor,αTNF-α)、干扰素γ(in terferon,γIFN-γ)和巨噬细胞游走因子(m acrophage m igration inh ib itoryfactor,M IF)的免疫组织化学染色,并对染色结果进行分析、比较。结果A组修复后的坐骨神经IL-1β和IFN-γ的表达高峰出现于术后第1周,术后第2周表达量明显减少,至第4周就难以发现阳性染色;TNF-α和M IF的表达则只出现在第1周,且表达水平较低。各实验组IL-1β、TNF-α和IFN-γ的表达高峰均出现于术后第2周,且持续至第4周仍有表达,M IF的表达高峰出现在第1周,其表达也可持续至第4周。各实验组组间比较发现C~F组间细胞因子的表达无明显差异,B组的表达介于A组和其它实验组之间。结论免疫抑制剂的使用可以延缓周围神经损伤后IL-1β、TNFα-、IFN-γ和M IF表达的峰值,而且可以明显延长其表达时间。     

氨甲环酸在开胸手术中的应用

目的评价氨甲环酸在开胸手术中的止血作用和对开胸手术围术期凝血纤溶功能的影响。方法选择因罹患肺或食管肿瘤的开胸手术患者40例,随机分为两组:氨甲环酸组(A组,n=20)在麻醉诱导后切皮前静脉滴注10mg/kg氨甲环酸,术中持续泵注1mg.kg-1.h-1至术毕;对照组(B组,n=20)持续泵注生理盐水。分别于术前,术中3h,术后第1天和第3天抽取中心静脉血检测血栓弹力图(TEG),凝血常规,包括凝血酶原时间(PT),部分活化凝血酶时间(APTT)和纤维蛋白原(Fib)含量,及血浆D-二聚体含量,并记录术中出血量和术后24h胸腔引流量。结果T组术中、术后CI均明显高于对照组,术后LY30显著低于对照组(P<0.05);T组术中和术后D-二聚体含量均明显低于C组(P<0.01);T组术中出血量和术后24h胸腔引流量明显少于C组(P<0.01)。结论氨甲环酸抑制了纤溶活性的增强,改善了开胸手术后早期的低凝状态,显著减少了开胸手术围术期的血液丢失。     

Using Interrupted Time Series Design to Analyze Changes in Hand, Foot, and Mouth Disease Incidence during the Declining Incidence Periods of 2008-2010 in China

ObjectiveTo identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010.MethodsReported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years.ResultsOver 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P<0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P<0.005), but not 2009 to 2008.ConclusionIncremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.     

Bioaccumulation of PBDE congener 2,2′,4,4′-tetrabromodiphenyl ether by Heterosigma akashiwo in response to different nutrient concentrations

Changes in the bioaccumulation of 2,2′,4,4′-tetrabromodiphenyl ether (BDE-47) in the marine alga Heterosigma akashiwo (Raphidophyceae) were examined for different concentrations of nitrate (0, 128, and 512 μmol dm^?3) and phosphate (0, 8, and 32 μmol dm^?3) in the semi-continuous culture with 20% renewal rate. The BDE-47 content per cell and per culture, as well as the accumulated percentage of available BDE-47, presented a significant decreasing trend with the increase in nitrate and phosphate concentrations. The N-0 (4.0 × 10^?6 ng cell^?1) and P-0 (5.8 × 10^?6 ng cell^?1) treatments had significantly higher BDE-47 content per cell than other treatments. In comparison, the difference in BDE-47 per algal culture and accumulated percentage between the nitrate treatments or phosphate treatments was not as obvious as the BDE-47 content per cell. BDE-47 per cell presented significantly negative correlation with nitrate and phosphate concentrations, and the accumulated BDE-47 was in positive correlation with lipid content. log BAF_lip for BDE-47 in H. akashiwo ranged from 6.70 to 7.25. The results of this study indicate that variation in BDE-47 accumulation by H. akashiwo corresponds to the change in cellular lipid content induced by different nitrate and phosphate concentrations.     

Sellar chordoma presenting as pseudo-macroprolactinoma with unilateral third cranial nerve palsy

We described a 61‐year‐old female with a sellar chordoma, which presented as pseudo‐macroprolactinoma with unilateral third cranial nerve palsy. Physical examination revealed that her right upper lid could not be raised by itself, right eyeball movement limited to the abduction direction, right pupil dilated to 4.5 mm with negative reaction to light, and hemianopsia in bitemporal sides. CT scanning showed a hyperdense lesion at sellar region without bone destruction. Magnetic resonance imaging (MRI) revealed the tumor was 2.3 cm×1.8 cm×2.6 cm, with iso‐intensity on T1WI, hyper‐intensity on T2WI and heterogeneous enhancement on contrast imaging. Endocrine examination showed her serum prolactin level increased to 1,031.49 mIU/ml. The tumor was sub‐totally resected via pterional craniotomy under microscope and was histologically proven to be a chordoma. Postoperatively, she recovered uneventfully but ptosis and hemianopsia remained at the 6th month.     

抗击严重急性呼吸综合征的医生与护士心理状态的比较与分析

为分析抗击严重急性呼吸综合征(SARS)的医生与护士的心理状态和差异,在SARS暴发的3个月中共收集了来自多家SARS定点医院的1532份医生和护士的心理健康问卷,应用时勘心理量表与Zung自评抑郁量表进行分析比较。发现无论处于一线还是二线,医生的一般心理健康得分要高于护士,自评抑郁量表得分低于护士,且护士的自评抑郁量表得分要高于常模组。逐步相关回归分析显示,抑郁量表得分同压力源,如“社会对医护人员的支持不够”,“治疗条件和生活环境不好”,“缺乏家庭亲人的支持和交流”等有关,同参加体育锻炼的程度,文化程度呈负相关。医生的心理状态和抑郁状态好于护士。提示应针对不同原因给予干预,同时应对于发现的相关因素予以改善。     

国产95式步枪所致猪肢体软组织贯通伤的MRI表现与病理学研究

目的分析猪肢体软组织枪伤后不同时间弹道及周围组织的MRI表现和病理学变化,为枪弹伤早期救治提供理论依据。方法将17只成年猪静脉麻醉后,取仰卧位,将右后肢悬吊固定于致伤架上,用国产95式步枪致伤,射击距离10m。于伤后2、6、12、24、48h及9、18d分别行MRI扫描和病理学检查。结果伤区组织的病理改变可分为原发弹道区、凝固性坏死区、碎裂区和变形区。凝固性坏死区宽1～3mm,在T2WI及增强T1WI上呈现"双低信号"现象;碎裂区和部分变形区呈现"双高信号"现象,但二者不能区分。结论国产95式步枪贯穿肢体软组织后伤区由内向外依次可分为原发弹道区、凝固性坏死区、碎裂区和变形区;MRI可清楚显示原发弹道和凝固性坏死区;碎裂区和变形区为围绕弹道外围的高信号区,病理组织学分界清楚。     

医疗联合体内冠心病双向转诊实施效果评价

目的：评价上海新华-崇明医疗联合体内冠心病双向转诊实施效果。方法：将转入新华医院设为实验组,未转入新华医院为对照组,通过对照比较分析,从住院天数、治疗费用等方面对转诊效果进行评价。结果：医疗联合体促进了冠心病患者双向转诊的开展,有效降低冠心病患者住院天数与住院费用。结论：建议明确医疗联合体的政策定义、加快建设区域医疗信息网络共享机制及激励约束机制,从而进一步发挥医疗联合体在促进冠心病双向转诊上的作用。