影响急性外份性硬脑膜外血肿疗效的相关因素分析（附484例报告）

目的探讨影响急性外伤性硬脑膜外血肿疗效的相关因素。方法对1994年5月至2004年5月收治的484例外伤性硬脑膜外血肿患者的临床资料进行回顾性分析。结果无脑疝症状者手术死亡率7.7%,有脑疝症状者死亡率21.3%。手术距脑疝发生时间<1h死亡率8.2%,1～2h死亡率40.0%,>2h死亡率72.2%。结论影响外伤性硬脑膜外血肿疗效的相关因素较多,除脑疝形成及手术距脑疝发生的时间外,创伤性低血压、合并脑损伤的程度、呼吸功能不全、大面积脑梗塞、血糖与血浆渗透压升高及肝功能异常等均对患者预后有重要影响。     

重型颅脑损伤后应激性溃疡防治与胃肠道感染的相关性及对策

目的探讨重型颅脑损伤患者应用洛赛克对应激性溃疡进行防治与胃肠道感染几率增加之间的关系及治疗对策。方法回顾近3年来我院收治的重型颅脑损伤并存活30 d以上病人176例,测定不同时间胃液pH值并分析防治应激性溃疡与发生胃肠道感染的相关性以及相应对策。结果在126例持续应用洛赛克的患者中,持续应用＞7 d的患者胃肠道感染发生率明显高于持续应用≤7 d的病人。其余50例间隔应用洛赛克患者与126例持续应用洛赛克患者相比,应激性溃疡发生率无明显差别,但间隔应用洛赛克患者胃肠道感染发生率较持续应用洛赛克＞7 d的患者明显下降。结论重型颅脑损伤患者应激性溃疡防治＞7 d者,由于胃酸分泌严重抑制,增加胃肠道感染发生率。间隔性应用洛赛克治疗在抑制胃酸分泌,减少应激性溃疡发生的同时,可明显减少胃肠道感染的发生。     

大鼠急性脊髓损伤时IκBα的表达及其意义

目的 研究大鼠急性脊髓损伤时抑制蛋白α(IkBa)表达变化规律。方法 将60只SD大鼠随机分为两组：损伤组48只大鼠，行脊柱椎板切除及脊髓打击术。对照组12只大鼠，仅行椎板切除术。应用免疫组织化学及Western blot分别测定脊髓细胞浆内IkBα的表达变化情况。免疫组织化学以细胞浆出现棕黄色颗粒为阳性结果，Western blot以醋酸纤维素膜上出现棕色条带为阳性结果。结果 在损伤后1h，IkBα表达开始下降，12h降到最低点，损伤后24h表达开始回升，5d逐步恢复正常。结论 IkBα活性变化可作为急性创伤性脊髓损伤时炎症反应程度的一项观测指标，通过抑制IkBα磷酸化降解环节，成为抑制炎症反应的新途径。     

转录信号传导子和激活子3信号传导通路调控选择性环氧化酶2抑制剂抗结肠癌的机制

目的探究转录信号传导子和激活子3(Stat3)信号传导通路与选择性环氧化酶2(COX-2)抑制剂抗结肠癌细胞株HT-29机制的关系,明确COX-2抑制剂抗结肠癌细胞内信号传导机制。方法将选择性COX-2抑制剂NS-398,作用于结肠癌细胞系HT-29,运用MTT法检测细胞增殖状态;流式细胞仪观察NS-398对细胞凋亡的影响,进一步用RT-PCR检测药物作用前后HT-29中COX-2mRNA的表达;ELISA法测定体系前列腺素E2(PGE2)水平;Westernblot检测药物作用前后Stat3通路相关蛋白JAK2、Stat3的磷酸化活性和cyclinD1、Bcl-2的表达。结果结肠癌细胞系HT-29中COX-2mRNA呈高表达,NS-398呈时间、剂量依赖性方式抑制HT-29细胞增殖,促进其凋亡。NS-398使HT-29细胞COX-2mRNA和PGE2表达水平显著下降。同时p-JAK2、p-Stat3、cyclinD1、Bcl-2表达水平随作用时间延长而下降。结论癌基因Stat3信号传导通路调控了NS-398抗结肠癌的细胞内信号传导机制,最终通过其下游靶基因cyclinD1、Bcl-2影响结肠癌细胞系HT-29的增殖与凋亡。     

中性粒细胞在高浓度氧诱发急性肺损伤中的作用

目的:测定鼠支气管肺泡清洗液中细胞成分,阐明高浓度氧诱发急性肺损伤的发生机制。方法:20只雄性6周龄[(226±53.6)g]Wistar鼠被分为3组:(1)对照组(空气中饲养,n=6)。(2)实验组1(暴露在90%～95%氧气中24～48h,n=7)。(3)实验组2(暴露在90%～95%氧气中72h,n=7)。实验中动物可自由进食和水。结果:与对照组相比,实验组2的支气管肺泡清洗液中总细胞数减少[(3.81±0.35)×105/ml,(2.53±0.77)×105/ml];巨噬细胞数减少[(3.80±0.36)×105/ml,(2.09±0.59)×105/ml];而中性粒细胞计数明显增多[0,(43.56±42.63)×103/ml]。实验组2的动物都出现双侧胸水。结论:中性粒细胞动员并进入肺组织是高浓度氧诱发急性肺损伤的明显特征,损伤的发生与暴露时间有关。提示早期抑制中性粒细胞进入肺组织是治疗高浓度氧诱发急性肺损伤的重要途径。     

Effect of 5-Aminoisoquinolinone on the Adhesion of Colon Carcinoma

Objective： 5-Aminoisoquinolinone, a water-soluble, potent inhibitor of the activity of poly （adenosine 5＇-diphosphate ribose） polymerase, plays an important role in the tissue injury associated with ischaemia-reperfusion injury and inflammation by inhibiting the activity of poly （adenosine 5＇-diphosphate ribose） polymerase and the expression of cell adhesion molecules such as ICAM-1, P-selectin et al. But how about it in the tumor is not clear. The aim of the present study was to study the effects of 5-Aminoisoquinolinon on the adhesion of colon carcinoma line HT-29 cells to human umbilical vein endothelial cells; and the effects of 5-Aminoisoquinolinon on the expression of ICAM-1, P-selectin and the activity of poly （adenosine 5＇-diphosphate ribose） polymerase in colon carcinoma HT-29 cells. Methods： The adhesion of HT-29 cells to human umbilical vein endothelial cells was detected by adhesive experiment. Immunocytochemically Streptavidin-Peroxidase method was used to investigate the expression of ICAM-1, P-selectin and Poly （adenosine 5＇-diphosphate ribose）（ the product of poly （adenosine 5＇-diphosphate ribose） polymerase activation）. Results： the results of the adhesion assay of HT-29 cells to HUVEC showed that the OD570 value in each 5-AIQ-treated group was significant lower than that in the control group （5-AIQ-untreated） in a dose-dependent manner. The expression of ICAM-1, P-selectin and Poly （adenosine 5＇-diphosphate ribose） was significant lower in 5-Aminoisoquinolinone-treated HT-29 cell group than that in 5-Aminoisoquinolinoneuntreated groups. Conclusion： The data suggest that 5-Aminoisoquinolinone can inhibit the adhesion of HT-29 cells to human umbilical vein endothelial cells. 5-Aminoisoquinolinone also can inhibit poly （adenosine 5＇-diphosphate ribose） polymerase activation and the expressions of ICAM-1 and P-selectin in HT-29 cells. 5-Aminoisoquinolinone probably contributes to the prevention of tumor cell metastasis. Further study is needed.     

A method to quantitate axonal injury

The quantitation of diffuse axonal injury provides a more objective approach to the assessment of tissue damage in head injuries. The method designed in this study takes into account the anisotropy and structural inhomogeneity of the brain, and the distribution of lesions in diffuse axonal injury. The number of counts required for the statistical analysis is inversely proportional to the square of the desired accuracy, specified as the percentage of the mean value of the axonal balloons since the true mean is unknown from the outset. The number of fields are examined using an indexed-squares graticule in 10 different areas of the brain. Silver-stained sections from the brains of head injured patients that survived longer than 12 h must be used with this method. Difficulties may arise when patients of different survival times are compared since it takes some time for the axonal balloons to develop. A correlation with the survival time can be established with the quantitative data collected. The morphometric principles and the statistical rationale on which this methodology is based are briefly presented.     

African histoplasmosis masquerading as carcinoma of the colon

A case of African histoplasmosis primarily affecting the large bowel—a very unusual manifestation—is reported. In the absence of classical clinical features, pathognomonic of large bowel histoplasmosis, the macroscopic appearance at surgery was confused with large-bowel cancer. The diagnosis was, therefore, retrospective and based on demonstration of large yeast cells ofHistoplasma capsulatum var.duboisii in tissue sections of the lesions.     

Effect of prostaglandin E1 on graft function of kidneys from living related donors

Prostaglandin E₁ (PGE₁) was used in renal transplant recipients with living related donors. The drug was given intravenously from day 1 to day 7 after transplantation at a dose of 40 µg/kg twice a day. A total of 45 patients were studied divided into two groups: 25 patients were treated with PGE₁ (group B) and the remaining 20 patients did not receive the drug (group A). In group B, 24-h creatinine clearance (Ccr) was 66 ± 12.8 ml/min compared with 40.3 ± 13.4 ml/min in group A on the fifth postoperative day (P < 0.05). Urinary levels of N-acetyl-β-d -glucosaminidase (NAG) and serum levels of platelet factor 4 (PF4) in group B were significantly lower than in group A. On the fourth postoperative day, the urinary excretion of thromboxan B₂ (TxB₂) in group A was higher than in group B, but not significantly (5.1 ± 3.0 ng/day and 2.8 ± 1.1 ng/day, respectively). Acute rejection occurred in four patients in group B and in 10 patients (40%) in group A. The percentage of Leu2a-positive lymphocytes in group B was higher than in group A. We conclude that postoperative administration of PGE₁ improves graft function in kidneys from living related donors.     

高压氧治疗尺桡神经损伤疗效观察

应用高压氧治疗尺桡神经损伤修复术后１１例，与同期单纯手术修复１４例相比，优良率明显提高，二组间有显著差异。Ｐ＜０．０５，提示高压氧对尺桡神经损伤的修复有促进作用