激光多普勒血流仪测定兔后肢电损伤局部血流变化

目的:应用激光多谱勒血流仪监测局部血流变化以判断高压电损伤程度。方法:实验于2003-10/2005-01在深圳市第二人民医院烧伤整形科实验室完成。选择健康新西兰兔32只,采用自制电击设备建立电损伤重度损伤模型,将电击区域均分为A,B,C,D,E5个区,依次为肢体远端到近端。在A,B,E区于伤前、伤后0,2,4,24,48,72h,4,5,6,7d测定局部皮肤表面及肌肉中血流值变化情况。结果:①损伤前A、B、E区皮肤表面平均血流值分别为75.74,78.86,84.21PU,表明肢体近端至远端血流值逐渐减少,各点之间血流值差异无显著性意义(P>0.05)。②A区皮肤表面伤后2h血流值明显低于伤后0,4,24,48h,差异有显著性意义[分别为(27.22±22.80),(91.60±74.37),(63.97±44.41),(58.80±52.50),(58.72±39.02)PU,t=2.357,2.856,2.364,2.998,P<0.05],此时组织学表现为细胞水肿明显,有少量中性粒细胞浸润。A区皮肤表面伤后4h血流值增加,但至伤后4d才逐渐恢复到伤前水平。A区肌肉伤后2h血流值低于伤后24h,4d,差异有显著性意义[分别为(83.70±73.30),(135.10±63.07),(160.26±71.32)PU,t=2.383,2.367,P<0.05]。此时组织学表现为肌纤维肿胀,部分横纹消失,肌纤维的胞浆呈红染的疏松水波状和网状结构。③B区皮肤表面伤后4,24h血流值低于损伤前和伤后0h,差异有显著性意义[分别为(50.75±41.69),(47.23±35.36),(78.86±26.47),(83.89±32.77)PU;t=2.324,2.732,2.826,3.189,P<0.05,0.01],组织学表现同A区。B区局部肌肉伤后4h血流值低于伤后0,48,72h,差异有显著性意义[分别为(64.65±34.08),(107.11±36.50),(130.30±75.04),(180.56±72.59)PU,t=2.545,2.712,2.963,P<0.05]。此时组织学表现基本上同A区伤后2h。④E区皮肤表面各时相点之间血流值差异无显著性意义(P>0.05)。组织学表现同A区。E区局部肌肉伤后2h血流值低于伤后0,24,72h,差异有显著性意义[分别为(129.11±65.08),(175.02±71.67),(169.14±71.05),(196.64±67.34)PU,t=2.776,2.521,2.895,P<0.05]。此时组织学表现为肌纤维溶解断裂及中性粒细胞浸润。结论:用激光多谱勒血流仪监测损伤局部血流变化可以判断高压电损伤程度。     

单纯肥胖者与代谢综合征患者血管内皮功能的比较

目的:比较单纯肥胖者与代谢综合征患者的血管内皮功能。方法:观察对象来自石家庄市2000-09/2001-06参加社区健康体检者。①体质量指数≥25kg/m2的超重/肥胖者中,单纯肥胖组295例,代谢综合征组219例,另选172例体质量指数<25kg/m2的健康人作为对照。②将肥胖者按体质量指数分为轻度肥胖(25～29.9kg/m2)和重度肥胖(≥30kg/m2),按腰围分为腹部脂肪轻度堆积(男<104cm,女<88cm)和重度堆积(男≥104cm,女≥88cm)。③血管内皮舒张功能测定:所有受试者采用NAS-1000HF彩超诊断系统测定反应性充血时及含服硝酸甘油后肱动脉内径的变化。结果:686例受试者全部进入结果分析。①单纯肥胖组和代谢综合征组体质量指数、腰围、臀围和腰臀比均高于对照组(P<0.01～0.001),其中体质量指数和臀围在男女间比较差异不显著,腰围和腰臀比男性高于女性(P<0.05),而男性代谢综合征组又高于男性单纯肥胖组(P<0.05)。②血管内皮舒张功能检测显示,反应性充血时,单纯肥胖组和代谢综合征组相对于基础血管内径变化的百分率均低于对照组[(7.79±3.93)%,(5.54±4.46)%,(11.25±3.98)%,P<0.05～0.01];代谢综合征组男性低于单纯肥胖组男性(P<0.05);男性代谢综合征组重度肥胖者低于轻度肥胖者(P<0.05);单纯肥胖组男性重度脂肪堆积低于男性轻度脂肪堆积者(P<0.05),代谢综合征组无论男女,重度脂肪堆积均低于轻度脂肪堆积者(P<0.05)。结论:①单纯肥胖者已存在血管内皮功能异常,而代谢综合征患者中内皮功能损伤程度更显著,并且与腹部脂肪堆积密切相关。②代谢综合征患者中男性血管内皮功能损伤较女性更明显。     

海军陆战队员高温强训中注射丹参液前后血液流变学与凝血功能的变化

目的:观察高温高湿环境下负荷30kg野外强训时,注射丹参液前后海军陆战队员血液流变学和凝血系统的变化。方法:于2005-08在南海海面和某岛屿上选择男性解放军海军陆战队员112名,经医院全面检查身体合格,18～32岁,军龄1～14年。成建制的随机抽取55名作为训练组,负重30kg参加高温高湿环境下各种强训,另外57名陆勤人员作为对照组。训练组注射丹参液前后高温强训各8h,训练末各取1次血标本,检查两组队员凝血功能5项指标及血液流变学14项指标。结果:112名海军陆战队员均进入结果分析。①未注射丹参液前训练组全血低切黏度、全血中切黏度、全血高切黏度、血浆黏度、红细胞比积、红细胞沉降率、全血低切还原黏度、全血中切还原黏度、全血高切还原黏度、血沉方程K值、红细胞聚集指数、红细胞刚性指数、红细胞变性指数、红细胞电泳指数均高于对照组[训练组:(9.4±0.3)mPa.s,(5.6±0.4)mPa.s,(4.7±0.3)mPa.s,(1.5±0.2)mPa.s,(47.4±3.1)%,(7.3±1.1)mm/h,(19.4±3.8)mPa,s,(9.7±1.5)mPa.s,(8.0±1.5)mPa.s,(61.4±10.5),(2.7±0.2),(5.5±1.0),(0.8±0.1),(6.4±1.3);对照组:(8.1±0.5)mPa.s,(4.7±0.3)mPa.s,(4.1±0.3)mPa.s,(1.3±0.2)mPa.s,(44.8±3.3)%,(8.5±1.4)mm/h,(15.5±2.4)mPa.s,(8.2±1.5)mPa.s,(7.4±1.6)mPa.s,(51.8±9.7),(2.4±0.4),(4.5±0.8),(0.7±0.3),(5.3±1.1),P<0.05,P<0.01]。注射丹参液后训练组全血低切黏度、红细胞比积高于对照组[(8.7±0.3)mPa.s,(46.5±3.1)%;(8.1±0.5)mPa.s,(44.8±3.3)%,P<0.05]。②注射丹参液前训练组凝血酶原时间、部分活化凝血酶原时间、纤维蛋白原、D-二聚体、血清纤维蛋白降解产物、血小板与对照组相比,差异显著[训练组:(10.2±0.2)s,(23.9±1.1)s,(3.8±0.2)g/L,(309.6±13.3)mg/L,(7.7±0.4)mg/L,(270.1±14.2)×109L-1;对照组:(11.6±0.3)s,(28.4±1.4)s,(2.9±0.4)g/L,(241.5±13.7)mg/L,(5.9±1.2)mg/L,(174.5±22.0)×109L-1,P<0.01]。注射丹参液后训练组血小板、D-二聚体、纤维蛋白降解产物高于对照组[训练组:(236.2±11.2)×109L-1,(279.3±13.8)mg/L,(8.2±0.6)mg/L;对照组:(174.5±22.0)×109L-1,(241.5±13.7)mg/L,(5.9±1.2)mg/L,P<0.05,P<0.01],凝血酶原时间、部分凝血活酶时间、纤维蛋白原与对照组相比无差异。结论:注射丹参液可增强红细胞的柔软性,改善红细胞变形和聚集能力,降低纤维蛋白原含量,防止血液高黏发生。     

消化系肿瘤的介入治疗

编者按 胃、结直肠癌、肝癌是我国常见的消化系统恶性肿瘤,约占整个消化系肿瘤的50%以上,严重影响患者的生存质量.如何进行早期诊断、治疗并提高患者的生存质量一直是临床医生研究的方向.近年来,随着内镜和放射介入技术的不断发展,介入治疗已经成为一个介入传统内科学和外科学之间的临床治疗体系,具有安全、简便、并发症小等优点.     

Prolactin gene expression in human thymocytes.

Recent evidence suggests that lymphocytes produce prolactin (PRL). Here, we report the cDNA cloning and expression of PRL from normal human thymocytes. Sequence analysis showed that the thymocyte cDNA encodes a 23 kDa protein which is identical to pituitary PRL. RNA blot analysis showed that the thymocyte PRL mRNA is approximately 170 nucleotides larger than the pituitary PRL message. PRL message was also detected in several non-pituitary human cell lines including Jurkat T, HeLa, and JEG cells. Furthermore, PRL gene expression in JEG cells was inhibited by glucocorticoid treatment. Our data support the hypothesis that PRL is a T cell-derived cytokine.     

人骨髓间充质干细胞的贴壁分离与体外培养

目的:验证贴壁方式分离人骨髓间充质干细胞,并进行体外扩增培养的可行性。方法:实验于2006-02/12在解放军济南军区总医院脊髓修复科完成。①实验材料:骨髓来源于解放军济南军区总医院脊髓修复科收治的脊髓完全性损伤患者,对本实验知情同意。基础培养液由含体积分数为0.15胎牛血清和低糖α-MEM配置。②实验方法:无菌条件下髂后上棘穿刺抽取骨髓组织6mL,进行细胞培养,观察细胞生长情况,待细胞融合成片、长满培养瓶底部后,用质量浓度为2.5g/L的胰蛋白酶流过所有细胞表面。倒置显微镜下观察细胞变圆、部分脱壁后,立即加入有血清培养液终止消化。③实验评估:取第3代生长状态良好的细胞,胰蛋白酶消化制成细胞悬液,接种,以细胞数为纵坐标,时间为横坐标,绘制细胞生长曲线。同时每隔2h进行细胞贴壁率检测。结果:①骨髓间充质干细胞的形态学观察:倒置显微镜下,骨髓间充质干细胞接种1d即贴壁,去除悬浮细胞后继续培养3d贴壁细胞开始增殖,伸展为椭圆型、短梭型、多角型及不规则型等。至14d细胞密集在集落中心,基本铺满瓶底,第3～5代细胞呈均匀一致的长梭型,排列成旋涡状或放射状。②骨髓间充质干细胞的生长曲线:细胞传代后3d内处于潜伏期,3d后进入生长期,7d后进入平台期。③骨髓间充质干细胞的贴壁率:随着培养时间的延长,骨髓间充质干细胞贴壁率逐渐升高。传代后2,4,6,8,10,12,14,16,18,20h细胞贴壁率分别为(20.20±0.25)%,(33.00±0.29)%,(46.50±0.32)%,(69.20±0.30)%,(76.60±0.34)%,(86.50±0.27)%,(90.30±0.20)%,(96.10±0.28)%,(98.50±0.12)%,(99.00±0.07)%。结论:贴壁法分离骨髓间充质干细胞操作简便,经体外扩增培养后细胞增殖活性强,传代周期为7d,是比较理想的骨髓间充质干细胞培养方法。     

Contraceptive self‐efficacy and contraceptive knowledge of Hong Kong Chinese women with unplanned pregnancy

Aim and objectives. The purpose of this study was to explore contraceptive practice, the level of knowledge and self‐efficacy of contraception among Chinese women with unplanned pregnancy and to determine the relationships between these variables. Background. The construct of self‐efficacy can be employed as a theory to design a nursing intervention to prevent sexually active women from unplanned pregnancy. Only a few western studies have investigated the relationships between self‐efficacy and contraception behaviour yet none targeted at the Chinese population. Design. Cross‐sectional survey. Methods. This study employed a cross‐sectional survey design. A convenience sample of 117 eligible Chinese females completed all the questionnaires, which included the Chinese version of the Contraceptive Self‐efficacy Scale and Contraceptive Knowledge Scale. Results. The findings in this study suggested that younger, unmarried women at the lower income group, who adopted male condoms are at risk for unplanned pregnancy. The sample demonstrated an above medium level of knowledge and self‐efficacy in contraception. However, no significant relationship was found between contraceptive self‐efficacy and knowledge (p>0·05). Conclusions. Contraceptive obstacles were revealed by participants’ moderate level of contraceptive self‐efficacy and contraceptive knowledge. The relationship between contraceptive knowledge of specific methods and contraceptive self‐efficacy need further exploration in future studies. Relevance to clinical practice. The dominant use of male condoms by the sample of this study sheds light on future direction in the development of educational programmes and contraceptive promotion strategies appropriate for women with unplanned pregnancy.     

Recurrent Implantable Cardioverter‐Defibrillator Replacement Is Associated with an Increasing Risk of Pocket‐Related Complications

Background: Despite beneficial effects of implantable cardioverter‐defibrillator (ICD) therapy, limited service life results in replacement within the majority of patients. Data concerning the effect of replacement procedures on the occurrence of pocket‐related adverse events are scarce. In this study, the requirement for pocket‐related surgical re‐interventions following ICD treatment and the effect of device replacement were evaluated. Methods: From 1992 to 2008, 2,415 patients receiving an ICD at the Leiden University Medical Center were analyzed. Pocket‐related complications requiring surgical re‐intervention following ICD implantation or replacement were noted. Elective device replacement, lead failure, and device malfunction were not considered pocket‐related complications. Results: A total of 3,161 ICDs were included in the analysis. In total, 145 surgical re‐interventions were required in 122 (3.9%) ICDs implanted in 114 (4.7%) unique patients. Three‐year cumulative incidence for first surgical re‐intervention in all ICDs was 4.7% (95% confidence interval [CI] 3.9–5.5%). Replacement ICDs exhibited a doubled requirement for surgical re‐intervention (rate ratio 2.2, 95% CI 1.5–3.0). Compared to first implanted ICDs, the occurrence of surgical re‐intervention in replacements was 2.5 (95% CI 1.6–3.7) times higher for infectious and 1.7 (95% CI 0.9–3.0) for noninfectious causes. Subdivision by the number of ICD replacements showed an increase in the annual risk for surgical re‐intervention, ranging from 1.5% (95% CI 1.2–1.9%) for the first, to 8.1% (95% CI 1.7–18.3%) for the fourth implanted ICD. Conclusions: ICD replacement is associated with a doubled risk for pocket‐related surgical re‐interventions. Furthermore, the need for re‐intervention increases with every consecutive replacement. (PACE 2010; 1013–1019)     

ICAM-1,VCAM-1在Hp阳性良性胃粘膜病变及胃癌中的表达

目的观察ICAM-1及VCAM-1在Hp阳性良性胃粘膜病变及胃癌组织中的表达并探讨其可能临床和病理意义.方法良性病变胃粘膜33例(慢性胃炎患者胃粘膜23例,胃癌癌旁良性病变胃粘膜10例),胃癌组织10例,经冰冻切片SP免疫组化染色后,结果进行半定量分析.结果 Hp阳性的良性病变胃粘膜中粘液细胞表达ICAM-1者为42.4%(14/33),表达VCAM-1者为27.3%(9/33);基质表达ICAM-1者为84.8%(28/33),表达VCAM-1者为81.8%(27/33).胃癌癌细胞中这两种细胞粘附分子阳性表达的例数及积分均高于它们在良性病变胃粘膜粘液细胞中的表达(P＜0.05或P＜0.01);胃癌组织中这两种粘附因子阳性表达的积分高于它们在良性病变胃粘膜基质中的表达(P＜0.05);癌旁良性病变胃粘膜粘液细胞中VCAM-1阳性表达积分高于其在慢性胃炎患者胃粘膜中的表达.结论胃癌时ICAM-1和VCAM-1表达增高,但可能不足以产生针对肿瘤细胞的宿主免疫监视,反而有利于提高这些细胞的运动能力.     

一种新的阿片受点不可逆激动剂7α-二(β-氯乙基)胺甲基-6,14-乙烯撑基四氢奥利文的药理研究

α-CAM是一新的阿片受点不可逆激动剂,在离体组织(GPI,MVD,RVD和RbVD)及大鼠脑P_2膜制备上均表现不可逆作用。对小鼠镇痛(icv)ED_(50)为0.12 nmol/鼠,镇痛作用可持续2～3 d,是迄今所知镇痛时间最长的化合物。一次注射(icv)即可使小鼠成瘾,可作为研究成瘾机理的工具药。