首发精神分裂症患者治疗前后血清游离脂肪酸和血脂水平变化及临床意义

目的 探讨首发精神分裂症患者治疗前后游离脂肪酸及血脂水平变化及临床意义.方法 选取2013年1月～2014年1月于淮安市第三人民医院诊治的首发精神分裂症患者40例为病例组,选取同期37例健康人为对照组.检测并比较精神分裂症患者治疗前后及健康人血清游离脂肪酸及血脂水平.结果 病例组治疗前游离脂肪酸水平[(0.88±0.54) mmol/L]显著高于对照组[(0.60±0.21)mmol/L](P=0.004),校正年龄、性别后差异仍有统计学意义(P=0.005);治疗前总胆固醇[(3.80± 1.14) mmol/L]显著低于对照组[(4.49±0.78)mmol/L] (P=0.003);治疗前低密度脂蛋白胆同醇[(1.75±0.61) mmol/L]显著低于对照组[(2.19±0.61)mmol/L](P=0.002);治疗前载脂蛋白B[(0.53±0.15)g/L]低于对照组[(0.81±0.19)g/L](P＜ 0.001).病例组治疗后与治疗前比较,游离脂肪酸水平显著降低[(0.61±0.31)mmol/L](P=0.003).进一步分析发现,校正年龄、性别和病程后,低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和载脂蛋白A1变化与游离脂肪酸的变化存在显著线性关系,标化回归系数分别为0.389(P=0.019)、0.380(P=0.021)、0.364(P=0.030).结论 首发精神分裂症患者治疗前血清游离脂肪酸高于正常人群,经治疗后显著降低,并受血脂水平变化影响.     

磷酸肌酸钠对大鼠肢体缺血再灌注心肌损伤的影响

目的研究磷酸肌酸钠对肢体缺血再灌注后心肌损伤有无保护作用及其机制。方法选取SD大鼠24只,将其随机分为三组:①空白对照组(C组);②肢体缺血再灌注组(LIR组);③磷酸肌酸钠组(P组),每组8只。分别检测血清肌钙蛋白I(c-TnI)、磷酸肌酸激酶同工酶(CK-MB),心肌组织中丙二醛(MDA)、超氧化物歧化酶(SOD)、钙调蛋白(CaM)的含量,并且观察各组心肌组织的病理变化。结果 LIR组与C组相比,血清c-TnI、CK-MB及心肌组织中MDA、CaM的含量都显著增高,而SOD含量明显下降,心肌组织有明显的病理变化;P组与LIR组相比,SOD活性相对升高,c-TnI、CK-MB、MDA、CaM含量相对降低,病理变化有所改善。结论肢体缺血再灌注可诱发心肌组织的损伤;外源性磷酸肌酸钠可减少肢体缺血再灌注心肌组织内氧自由基的产生,维持细胞内钙平衡,起到保护心肌的作用。     

抚顺市农村孕妇孕中期免费超声筛查出生缺陷项目成效评估

目的评估抚顺市开展农村孕妇孕中期免费超声筛查出生缺陷项目三年项目成效。方法对2010~2012年期间农村孕妇孕中期免费超声筛查情况进行回顾分析。结果孕中期超声筛查可有效提高胎儿畸形的检出率,提高出生缺陷28周前确诊率及终止妊娠率,2010~2012年围产儿出生缺陷发生率分别为117.9/万、105.9/万和93.5/万(P<0.01)。在胎儿畸形的类型和构成比中,泌尿系统畸形11例最多,占22.9%;其次为复合畸形8例,占16.7%;之后依次为神经系统畸形、颜面部畸形、肌肉骨骼肢体畸形、消化系统畸形、心脏、心血管畸形、胸腔畸形、前腹壁畸形2例、胎儿腹腔肿物。结论农村孕中期免费超声筛查胎儿出生缺陷三年中取得良好成效,应持续长久开展下去。     

依达拉奉对脓毒性休克大鼠肾损伤的作用

目的观察依达拉奉对脓毒性休克大鼠存活率的影响及肾损伤的保护作用。方法 Wistar大鼠96只(200±20)g,第一批46只分4组,即脓毒性休克模型组(L组,n=16),脓毒性休克1h后予依达拉奉(6.0、3.0和1.5mg/kg)3个剂量组(EH、EM、EL组,n=10)治疗,观察其24h动物存活情况;另一批50只分手术对照组(仅予生理盐水治疗)、L组、EH组、EM组、EL组5组,每组各10只。大鼠脓毒性休克1h后予如前处理,于休克6h后取肾组织测取超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、乳酸脱氢酶(LDH)活性和乳酸(LD)、丙二醛(MDA)含量,并观察形态学改变。结果与脓毒性休克组比较,依达拉奉治疗后死亡率明显低于模型组(P<0.05),且其作用呈量效关系,3个剂量组死亡率分别为10%、10%、30%。同时,依达拉奉可显著升高肾组织中的SOD并降低LDH、MDA活性、降低LD水平。组织学观察可见未治疗组肾小球肿胀、间质水肿、出血、炎性细胞浸润等变化,依达拉奉治疗后上述变化明显改善。结论依达拉奉能明显降低脓毒性休克大鼠的死亡率,减少肾组织损伤,其机制与提高脓毒性休克机体的抗氧化能力有关。     

超早期脑梗死溶栓治疗联合应用依达拉奉后神经功能缺损症状的临床观察

目的观察超早期脑梗死溶栓治疗联合应用新型自由基清除剂依达拉奉的神经功能缺损症状情况。方法选择69例入我院的超早期脑梗死患者,随机分为重组组织型纤溶酶原激活剂（rt-PA）溶栓联合自由基清除剂依达拉奉治疗组（35例）和单独使用rt-PA溶栓治疗组（34例）,比较治疗15 d、30 d和90 d时的美国国立卫生院卒中量表评分（NIHSS）。结果联合溶栓组治疗后15 d时NIHSS评分0-1分28.6%（10/35）与单纯溶栓组17.6%（6/34）比较有统计学意义（P〈0.05）;30 d时分别为34.3%（12/35）和23.5%（8/34）,比较有显著性意义（P〈0.05）;90 d时分别为42.9%（15/35）和23.5%（8/34）,比较有也显著性意义（P〈0.05）。两组15 d、30 d和90 d的疗效差异有统计学意义。结论超早期脑梗死溶栓治疗联合应用新型自由基清除剂依达拉奉的能够更有效地改善病人的神经功能缺损症状。     

Postoperative pneumoperitoneum after colorectal surgery: Expectant vs surgical management

Postoperative pneumoperitoneum poses a clinical dilemma.Depending on the cause,its management includes a spectrum from simple observation and supportive care to surgical exploration.The aim of this paper is to present four clinical cases and propose an algorithm for the management of postoperative pneumoperitoneum based on available literature.The causes,diagnosis and possible complications arising from pneumoperitoneum will also be discussed.Three of the four cases presented were successfully managed conservatively and one had an exploratory laparotomy with negative findings.In such scenarios,it is important to consider the nonsurgical causes of pneumoperitoneum,which include pseudopneumoperitoneum,thoracic,abdominal,gynecological and idiopathic.These causes do not always require emergent exploratory laparotomy.The surgical team needs to consider the history,physical exam and diagnostic workup of the patient.If a patient presents with peritoneal signs,then exploratory laparotomy is a must.Since 10%of the cases of pneumoperitoneum are caused by nonsurgical entities,managed expectantly,a negative exploratory laparotomy and its associated risks are avoided.     

Role of the free radical release process in the pathogenesis of morphea in contrast to systemic sclerosis

Abstract

The objective of this study was to assess the importance of the free radical release process in the pathogenesis of localized scleroderma and compare it with that in systemic sclerosis. The study was conducted on 20 randomly collected cases of morphea (4 single plaque, 7 linear, and 9 disseminated), 16 cases of systemic sclerosis, and 10 age- and sex-matched healthy volunteers. Blood samples and homogenized skin biopsies from lesional and nonlesional skin of patients and controls were examined for superoxide dismutase (SOD) activity using spectrophotometric assay, and for lipid peroxide level using the thiobarbituric acid assay. Morphea and systemic sclerosis cases showed significant elevation of blood, lesional, and nonlesional skin lipid peroxide levels and SOD activity compared with normal controls. When each of the subtypes of morphea were compared with the controls, a significant elevation of SOD was found in lesional skin in all groups, in plasma of linear and disseminated morphea, and in nonlesional skin of cases of disseminated morphea. A comparison of systemic sclerosis and morphea cases revealed no significant differences in blood or tissue SOD activity or lipid peroxide level. In both groups, the degree of skin induration could be correlated with changes in lesional SOD activity and lipid peroxide levels, respectively, but no correlation could be found between SOD or lipid peroxide and antinuclear antibody titer. The free radical release process is as important in the pathogenesis of morphea as it is in systemic sclerosis, where it appears to be involved in the development of skin induration.     

奥曲肽与丹参多酚酸盐合用对急性胰腺炎大鼠氧自由基影响的研究

[目的]探讨奥曲肽与丹参多酚酸盐合用对急性胰腺炎(AP)大鼠氧自由基的影响.[方法]SD大鼠75只,随机分为5组,每组15只.通过胰胆管逆行性注射牛磺胆酸钠制成AP大鼠模型.分别观察各实验组血清超氧化歧化酶(SOD)、丙二醛(MDA)的变化.[结果]①AP组与假手术组相比,血清SOD水平明显降低(P＜0.05),血清MDA水平明显升高(P＜0.05).②奥曲肽治疗组、丹参多酚酸盐治疗组及奥曲肽、丹参多酚酸盐合用组与AP组相比,血清SOD水平明显升高(P＜0.05),血清MDA水平明显降低(P＜0.05).③奥曲肽、丹参多酚酸盐合用组与奥曲肽、丹参多酚酸盐单用组相比,血清SOD水平明显升高(P＜0.05),血清MDA水平明显降低(P＜0.05).[结论]奥曲肽、丹参多酚酸盐通过升高SOD(保护性因素)、降低MDA(损伤性因素),对AP有明显治疗作用,且奥曲肽、丹参多酚酸盐合用效果更显著.