高原地区自体输血及血液稀释的临床研究

目的研究高原地区自体输血、血液稀释在围手术期应用的可行性及意义。方法选择ASAⅠ-Ⅱ级,年龄23-68岁,术前Hb≥130g/L,HCT≥0.4L/L,术中出血约在800ml以上的择期外科手术病例80例,分为两组。实验纽40例,于术前或(和)麻醉后采集自体血400-800ml,用以自体血回输,术中给予扩容行血液稀释,通过监测HCT和Hb控制输血。对照组按常规方法输血和输液。结果实验组术中输血量为(462±220)ml,比对照组(1297±640)ml减少60%,术中输血费用:实验组为46636.2元,比对照组(93379.08元)减少49.9%。术中实验组动脉血气正常,血流动力学稳定,凝血功能变化不大。结论在高海拔地区可以采用自体输血与术中扩容血液稀释相结合的方法达到节约用血的目的。     

分子排阻色谱法测定水解蛋白注射液中高分子物质

目的:采用分子排阻色谱法测定水解蛋白注射液中小分子肽的分子量。方法:采用TSK-GEL G2000SWXL色谱柱(7.8mm×300 mm,5μm),以磷酸盐缓冲液(pH 6.8)(含0.1 mol.L-1Na2SO4与0.05%NaN3)为流动相,流速1.0 mL·min-1,柱温30℃,检测波长280 nm。结果:水解蛋白注射液中分子量大于胰岛素的高分子物质含量均在5%以下。结论:该方法简单,重现性好,可以作为控制水解蛋白注射液中高分子物质的方法。     

Mothers’ insightfulness regarding their children’s inner world: associations with mothers’ history of sexual abuse and lack of resolution of the trauma

ABSTRACT

The study examined the insightfulness of mothers who experienced Childhood Sexual Abuse (CSA). Based on attachment theory, we hypothesized that mothers who experienced CSA will be less insightful than those who did not experience CSA, and that state of mind with no marked signs of lack of resolution of the trauma can buffer against its negative effects. The insightfulness of 30 mothers who experienced CSA and 30 demographically matched mothers but with no CSA was assessed using the Insightfulness Assessment. Mothers’ lack of resolution of the trauma was assessed using the Adult Attachment Interview. In addition, maternal psychopathology was assessed using the Brief Symptom Inventory. As hypothesized, mothers who experienced CSA were less insightful than mothers who did not experience CSA. In addition, mothers who experienced CSA but who were not unresolved were more insightful than those who were unresolved, and no different than mothers who did not experience CSA. These results expand our understanding regarding the risk embedded in parenting in light of unresolved traumatic past and the importance of resolution as a buffer.     

高强度聚焦超声阻滞腰交感神经节对周围动脉闭塞动物模型外周血5-羟色胺及前列腺素E2的影响

目的 使用高强度聚焦超声(HIFU)对犬周围动脉闭塞模型进行腰交感神经节阻滞,观察对外周血5-羟色胺(5-HT)及前列腺素E2(PGE₂)的影响,探讨其治疗缺血性疼痛的可能机制。 方法 26只杂种家犬随机分为3组: HIFU疗组(A组),非治疗组(B组),正常对照组(C组)。A组和B组在无菌条件下制作后肢缺血模型, A组术后2周用HIFU阻滞第2~6腰交感神经节,B组不予处理。A组和B组每次随机选2只犬在治疗0周(造模后2周)、治疗后1周、2周、1个月、2个月、4个月分别抽血检测血5-羟色胺及前列腺素E2。 结果 A组和B组在治疗0周外周血5-HT和PGE₂含量与C组相比,均明显升高且差异有统计学意义(P<0.05)。A组治疗1周后外周血5-HT及PGE₂浓度呈逐渐下降趋势,而B组则总体呈现增高趋势。两组治疗1周后各时间点外周血5-HT及PGE₂比较,差异均有统计学意义(P<0.05)。 结论 慢性周围动脉闭塞缺血致痛可使犬外周血5-HT和PGE₂含量升高,HIFU阻滞腰交感神经节缓解疼痛的机制可能与降低外周血5-HT和PGE₂含量有关。     

Stability and Chemical Conversion of the Purified Reference Material of Gymnodimine-A under Different Temperature and pH Conditions

Gymnodimines (GYMs) are a group of fast-acting phycotoxins and their toxicological effects on human beings are still unclear due to the lack of sufficiently well-characterized large quantities of purified toxins for toxicology studies. In this study, a certified reference material (CRM) of GYM-A was prepared from the dinoflagellate Karenia selliformis, followed by multi-step chromatography separation and purification. Subsequently, the stability of GYM-A in methanolic media was evaluated at different temperature (−20, 4, and 20 °C) and pH (3, 5, and 7) conditions for 8 months, and the conversion products of GYM-A were explored by liquid chromatography–high resolution mass spectrometry (LC-HRMS). The results show that the stability of GYM-A decreased with increasing temperature and pH values. The GYM-A was stable during storage at −20 °C regardless of pH, but it decreased rapidly (81.8% ± 9.3%) at 20 °C in pH 7 solution after 8 months. Moreover, the concentrations of GYM-A did not significantly change at all temperatures in solutions with pH 3 (p > 0.05). It is recommended that GYM-A should be stored at low temperature (≤−20 °C) and pH (≤3) conditions for long-term storage in aqueous methanolic media. In addition, two conversion products of GYM-A, tentatively named as GYM-K (m/z 540) and GYM-L (m/z 524), were identified in the samples stored at high levels of pH and temperature. Based on the LC-HRMS data, the hypothetical chemical structures of both converting derivatives were proposed. A useful strategy for long-term storage of GYM-A CRM in aqueous methanolic media was suggested and two hypothesized conversion products of GYM-A were discovered in this study.     

中美高等医学教育比较及启示

美国高等医学教育是特色鲜明和比较成功医学教育模式之一，与之相比，我国高等医学教育存诸多方面存存着较大的差距。借鉴美国医学教育的经验，对我国新的历史时期建设一流高等医学院校将大有裨益。     

Development of magnifying video endoscopes with high resolution

Background: The diagnostic capability of a video‐endoscope has been remarkably enhanced by using a high pixel count charge‐coupled device (CCD) and is getting closer to that of the stereomicroscope as its image quality is improved. From this standpoint, the authors have been developing high‐resolution magnifying video‐endoscopes. Methods: There are two methods available to increase the resolution of a video‐endoscope: (i) use a CCD with large pixel number and (ii) optically magnify the image impinging on the CCD. Since the video‐endoscope using a 410 Kilo (K) pixel count CCD was introduced in 1993, the authors have been developing a video‐endoscope using a large pixel count number CCD in pursuit of obtaining better image quality and resolution. Also, the technological innovations in CCD manufacturing have allowed CCDs to become much smaller in size with higher pixel numbers. As the CCD size decreases, the distal part of a video‐endoscope can be made thinner. With respect to optical magnification, two methods are available, the fixed close‐focusing system and variable focus. Results: With combined use of the variable focus magnification and the electronic magnification, a magnification more than × 100 can be achieved on a 14″ television monitor with higher resolution power and wider depth of field. Conclusions: The images captured by the latest magnifying video‐endoscope prove that the image quality of video‐endoscopy is improving and is approaching the diagnostic capability of the stereomicroscope.     

Function and Clinical Significance of Platelet-Derived Microparticles

Microparticles released from platelets (PMPs) may play a role in the normal hemostatic response to vascular injury because they demonstrate prothrombinase activity. PMPs were first observed as released vesicles from platelets following adhesion to vessel walls, and flow cytometry is now the most widely used method for studying PMPs. PMPs are thought to play a role in clinical disease because they express phospholipids that function as procoagulants. High shear stress can initiate both platelet aggregation and shedding of procoagulant-containing PMP, suggesting that PMP generation by high shear stress occurs in small diseased arteries and arterioles under various clinical conditions. In addition, the possibility that PMPs evoke cellular responses in their immediate microenvironments has recently been suggested. Despite many interesting findings, the significance of PMPs in various clinical conditions remains controversial. For example, it is not known whether PMPs found in peripheral blood vessels cause thrombosis, or if they are the results of thrombosis. There has been some question about whether the PMPs found in thromboses are consumed locally, meaning that PMPs circulating in the peripheral blood are not functionally important. Currently, the number of clinical disorders associated with elevated PMPs is increasing.     

超声对腹膜间皮瘤诊断价值探讨

目的　探讨超声对腹膜间皮瘤的诊断价值。方法　回顾性分析 7例经病理证实的腹膜间皮瘤的超声表现。结果　 7例病人自出现腹水至确诊前曾反复多次行超声检查 ,早期用 3 .5MHz探头检查 ,除腹水外无阳性发现 ,后改用高频探头可在腹膜壁层、大网膜及肠系膜探及形状各异的实质性肿块。结论　超声检查特别是用高频探头对腹膜间皮瘤的诊断有很大的实用价值