体外冲击波碎石的护理

我院自1999年运用HB-ESWL-V型体外冲击波碎石机施行ESWL治疗泌尿系结石623例，治愈率97％，效果良好，现将护理经验报告如下。     

探讨体外冲击波碎石治疗肾结石疗效的影响因素

目的研究分析肾结石体外冲击波碎石术(ESWL)的临床疗效和影响因素。方法对2011年5月至2013年在我院采用ESWL治疗的400例肾结石患者病例资料进行回顾性分析。结果 400例碎石的成功率为78.0%。结石直径<2.0 cm,2.0³.0cm及>3.0 cm的肾结石,肾结石体外冲击波碎石后清石率(4个月后)差异均有统计学意义(P<0.05);两组在肾盂结石与肾盏结石方面比较后成功率差异有统计学意义(P<0.05);单发结石与多发结石两组成功率比较差异有统计学意义(P<0.05),其他因素对成功率影响均无统计学意义(P>0.05)。结论结石位置、大小和数量是影对ESWL治疗肾结石的疗效有重要影响作用。     

国产替比培南体外杀菌及耐药性

目的评价国产替比培南对我国2009—2011年临床分离致病菌的体外杀菌作用及耐药菌产生情况。方法 53株致病菌为2009—2011年北京、济南、上海、广州、深圳、武汉、重庆、长沙和昆明9座城市的9家医院临床分离而得。替比培南的最低杀菌浓度(MBC)测定采用标准肉汤二倍稀释法,替比培南及对照抗菌药的杀菌曲线绘制及耐药研究采用菌落计数法。结果 MBC和杀菌曲线测定表明,替比培南对所测53株菌中50株菌的MBC/最低抑菌浓度(MIC)≤2,且随药物浓度升高,杀菌速率无明显提升,为时间依赖性杀菌药物。耐药频率及诱导耐药试验显示,替比培南药物浓度≥4倍MIC时,自然耐药突变频率基本≤10-8,连续14代诱导的MIC值改变不超过4倍,不易诱导产生耐药。结论国产替比培南对我国2009—2011年临床分离革兰阳性及阴性致病菌均具有很强的杀菌作用,且不易诱导产生耐药,值得进一步研究。     

吲哚美辛肠溶滴丸的研制及其体外释药研究

研制吲哚关辛（IDM）肠溶滴丸,并考察其体外释药特性。方法：选用PEG6000为基质,用正交试验筛选IDM滴丸的最佳处方及工艺,并采用聚丙烯酸树脂Ⅱ为肠溶材料对其进行包衣,制备IDM肠溶滴丸。转篮法对其体外释药特性进行考察,并与市售IDM肠溶片进行比较。结果：筛选出IDM滴丸最佳制备条件为：IDM与总基质的质量比为1：3,滴速为65滴／min,滴制温度为90℃,冷凝液温度为5℃。IDM肠溶滴丸及市售IDM肠溶片在酸性介质中几乎不释药,而在pH为6.8的磷酸盐缓冲液中,IDM肠溶滴丸的释药速度显著高于市售肠溶片（P〈0．05）。结论：IDM肠溶滴丸具有明显肠溶效果,同时可加快IDM在肠道中的释放速度,值得进一步研究。     

抗菌药物对解脲支原体的体外抗菌活性考察

目的：探讨抗菌药物对解脲支原体的体外抗菌活性,为临床合理用药提供参考.方法：710例标本应用支原体培养鉴定及药敏试剂盒检测解脲支原体的体外抗菌活性.结果：阳性检出408例（57.5％）,其中单纯解脲支原体阳性301例（42.4％）,两种支原体混合阳性107例（15.1％）,对解脲支原体分离株的敏感性较高的依次为多西环素、交沙霉素为克拉霉素及阿奇霉素,敏感性较差的为四环素、氧氟沙星、环丙沙星.结论：检测解脲支原体的耐药性,可为临床合理用药提供较重要的参考.     

输卵管积水患者体外受精-胚胎移植前行介入栓塞术6例的护理

体外受精-胚胎移植（in vitro fertilization and embryo transfer,IVF-ET）术前对输卵管积水预处理的主要目的是最大限度地提高其妊娠率,传统治疗方法有输卵管切除术、输卵管造口术、输卵管近端结扎术及在B超监视下抽吸输卵管积水。输卵管介入栓塞术是一种创新性的微创治疗方法,2013年7月至2014年1月本院在输卵管再通术的基础上开展了弹簧圈介入栓塞术,共收治6例患者,手术效果满意,现将护理体会报道如下。     

放射状体外冲击波治疗慢性肱骨内上髁炎

<正>肱骨内上髁炎是常见的运动系统疾病,特别在从事体力劳动或者经常进行体育训练的人群中发病率极高,临床可出现肘内侧疼痛和肘关节功能障碍而影响正常生活。对于慢性肱骨内上髁炎,传统上以非手术治疗为主,包括局部封闭及肘关节制动等,但治疗效果特别是远期疗效欠佳。近年来有人主张采用手术治疗并取得了良好的疗效[1],但手术毕竟是侵入性治疗,不易被患者接受,且花费昂贵、需住院治疗,康复时间长,这使得一些症状并不是十分严重的患者不愿接受     

Bornyl caffeate induces apoptosis in human breast cancer cells in vitro via the ROS- and JNK-mediated pathways

Aim： To investigate the effects of bornyl caffeate discovered in several species of plant on human breast cancer cells in vitro and the underlying mechanisms.
Methods： Human breast cancer cell line MCF-7 and other tumor cell lines （T47D, HepG2, HeLa, and PC12） were tested. Cell viability was determined using MTT assay, and apoptosis was defined by monitoring the morphology of the nuclei and staining with Annexin V-FITC. Mitochondrial membrane potential （MMP） was measured using JC-1 under fluorescence microscopy. Intracellular reactive oxygen species （ROS） were assessed by flow cytometry. The expression of apoptosis-associated proteins was determined by Western blotting analysis.

Results： Bornyl caffeate （10, 25, and 50 μmol/L） suppressed the viability of MCF-7 cells in dose- and time-dependent manners, but neither caffeic acid nor borneol showed cytotoxicity at a concentration of 50 μmol/L. Bornyl caffeate also exerted cytotoxicity to HepG2, Hela, T47D, and PC12 cells. Bornyl caffeate dose-dependently induced apoptosis of MCF-7 cells, increased the expression of Bax and decreased the expression of Bcl-xl, resulting in the disruption of MMP and subsequent activation of caspase-3. Moreover, bornyl caffeate triggered the formation of ROS and activated p38 and c-Jun JNK. In MCF-7 cells, the cytotoxicity of bornyl caffeate was significantly attenuated by SB203580 （p38 inhibitor）, SP600125 （JNK inhibitor）, z-VAD （pan-caspase inhibitor） or the thiol antioxidant L-NAC.

Conclusion： Bornyl caffeate exerts non-selective cytotoxicity against cancer cells of different origin in vitro. The compound induces apoptosis in human breast cancer MCF-7 cells via the ROS- and JNK-mediated pathways.     

Age-dependent contribution of Rho kinase in carbachol-induced contraction of human detrusor smooth muscle in vitro

Aim： Activation of muscarinic receptors on the detrusor smooth muscle is followed by contraction, which involves both myosin light chain kinase （MLCK） and Rho kinase （ROCK）. The aim of this study was to determine the relative contributions of MLCK and ROCK to carbachol-induced contraction of human detrusor smooth muscle in vitro.
Methods： Detrusor smooth muscle strips were prepared from the macroscopically unaffected bladder wall of patients underwent cystectomy. The strips were fixed in an organ bath, and carbachol or KCl-induced isometric contractions were measured by force transducers.

Results： Addition of carbachol （0.4-4 μmol/L） into the bath induced concentration-dependent contractions of detrusor specimens, which was completely abolished by atropine （1 μmol/L）. Pre-incubation of detrusor specimens with either the MLCK inhibitor ML-9 or the ROCK inhibitors HA1100 and Y-27632 （each at 10 μmol/L） significantly blocked carbachol-induced contractions as compared to the time-control experiments. Moreover, MLCK and ROCK inhibition were equally effective in reducing carbachol-induced contractions. The residual carbachol-induced contractions in the presence of both MLCK and ROCK inhibitors were significantly smaller than the contractions obtained when only one enzyme （either MLCK or ROCK） was inhibited, suggesting an additive effect of the two kinases. Interestingly, ROCK-mediated carbachol-induced contractions were positively correlated to the age of patients （r=0.52, P〈0.05）.

Conclusion： Both MLCK and ROCK contribute to carbachol-induced contractions of human detrusor smooth muscle. ROCK inhibitors may be a new pharmacological approach to modulate human bladder hyperactivity.