高血压病患者血压40例昼夜模式分析

目的 探讨高血压病患者的血压昼夜模式,为临床治疗提供依据。方法 按WHO标准选40例高血压病人,用美国罗京公司产2420－2020型动态血压仪连续观察血压24h,结束后使用该机器配置的计算机回放进行分析,观察24h昼夜间平均收缩压、舒张压及标准差,观察血压负荷及血压模式。统计方法采用t检验。结果 构型组昼夜平均收缩压、舒张压、血压变异均值昼＞夜（P＜0．05）;收缩压和舒张压负荷昼＝夜,差异无显著性（P＞0．05）;非构型组平均收缩压、舒张压及血压变异昼夜差异无显著性（P＞0．05）,但收缩压与舒张压负荷夜间明显高于日间,差异有显著性（P＜0．01）。结论 血压昼夜变化受交感神经与肾素血管紧张素系统等双重作用有关。     

Is the Parkland formula still the best method for determining the fluid resuscitation volume in adults for the first 24 hours after injury? — A retrospective analysis of burn patients in Germany

BackgroundR Rapid fluid resuscitation is a crucial therapy during the treatment of patients with extensive burns. In 1968, the Parkland Formula was introduced for the calculation of the estimated volume of the resuscitation fluid. Since then, different methods for the calculation of fluid resuscitation volume have been developed. We aimed to evaluate if the Parkland formula is still the most effective method for fluid resuscitation volume calculation in burn patients.MethodsIn the period between January 2015 and January 2019, data from 569 patients over 16 years old with burns of more than 20% total body surface area (TBSA) and at least 15% TBSA full thickness burns were entered in the German burn registry. The patients were divided into 5 groups (0, +1, ?1, +2, ?2) according to the volume of the resuscitation fluid they received. Group 0 patients received the amount of fluid calculated according to the Parkland formula (n = 83). The 4 other groups received reduced (-1, -2) or increased (+1, +2) fluid volumes in comparison to the value obtained by the Parkland formula.ResultsPatients in Group 0 presented a significantly lower mortality in the first week (4.5%) compared to groups –2 (16.7%) and group +2 (19.5%) (p = 0.021). Furthermore, the mean number of operations in group +2 (5.81) was higher than in group ?2 (3.81). Surviving patients from group +2 presented a longer hospital stay (68.1 days) compared to the other groups. Additionally, the logistic regression analysis showed a higher survival of patients in groups ?2 and ?1 (regression coefficients ?0.11 and ?0.086; Odds Ratio 0.896 and 0.918; 95% Confidence Interval (CI) 0,411–1.951 and 0.42–2.004).ConclusionIn this retrospective study, register based analysis a restrictive fluid regime was associated with a higher survival compared to the liberal Parkland guided fluid regime.     

肩关节上关节囊重建治疗肩袖损伤适应证和移植物处理方法研究进展

目的对肩关节上关节囊重建治疗肩袖损伤适应证和移植物处理方法的研究进展进行综述。方法广泛查阅近年来国内外有关肩关节上关节囊重建治疗肩袖损伤的文献，并进行总结分析。结果肩关节上关节囊重建可以有效恢复肩关节上方稳定性，其手术适应证包括不可修复巨大肩袖撕裂、巨大肩袖撕裂合并肩关节假性麻痹、肩袖分层撕裂以及中或大的肩袖撕裂合并肩袖严重退变。为了获得较好的腱骨愈合以及降低移植物远期再撕裂率，必须选择合适厚度的移植物，并以适当的强度固定移植物并恢复其连续性。结论肩关节上关节囊重建的手术应用已发展至上关节囊加强重建，手术适应证从肩袖实质性巨大缺损扩展至肩袖严重退变。移植物处理是上关节囊重建手术成功的关键。     

以动脉蒂远端作为回流静脉的改良踇趾腓侧皮瓣修复手指远节创面

目的探讨以动脉蒂远端作为回流静脉的改良踇趾腓侧皮瓣修复手指远节创面的临床效果。方法2018 年 6 月—2020 年 1 月收治 15 例手指远节缺损患者，其中男 12 例，女 3 例；年龄 24～56 岁，平均 40.2 岁。均为机器挤压伤所致。拇指 2 例，示指 6 例，中指 3 例，环指 3 例，小指 1 例；均为远节指腹部分或全部缺损，伴骨、肌腱外露。手指创面缺损范围为 1.7 cm×1.3 cm～3.0 cm×2.0 cm。受伤至入院时间 0.6～4 h，平均 2.3 h。切取皮瓣时，将血管蒂中腓侧趾固有动脉向远端继续游离，将其作为回流静脉与受区静脉吻合。皮瓣切取范围为 2.0 cm×1.5 cm～3.2 cm×2.2 cm。结果术后皮瓣全部成活，均未发生血管危象，创面均Ⅰ期愈合。足部供区除 1 例缝合过紧，拆线后切口部分裂开，予以换药后自行愈合外，其余患者供区切口愈合良好，足部功能正常。15 例患者均获随访，随访时间 3~18 个月，平均 9.3 个月。手指指腹外形满意，指腹饱满有螺纹；皮瓣颜色、质地、弹性良好，末次随访时两点辨别觉达 6～8 mm；手指屈伸活动正常。末次随访时，按中华医学会手外科学会上肢部分功能评定试用标准评价手功能，获优 13 例，良 2 例。结论以动脉蒂远端作为回流静脉的改良踇趾腓侧皮瓣，在不增加额外损伤前提下改善了皮瓣静脉回流，提高了皮瓣使用成功率。     

人膀胱癌上皮细胞株T24分泌LAK细胞诱导因子（LAK—IF）

从人膀胱上皮癌细胞株T24的亚克隆株T24-8的无血清培养上清液经55%硫酸铵沉淀,再对无离子水透析,得到了有诱导LAK 细胞活性的粗提品。有此作用的因子称为LAK 细胞诱导因子(LAK-IF)。它的分子量为67KD,等电点为pH3.1～3.5。抗人IL-6单抗不能阻断LAK-IF 的作用。LAK-IF 粗提品经Mono-Q 柱快速蛋白液相层析见3个峰。第2峰蛋白质有LAK-IF 活性。     

Endometrial assessment in a group of infertile women on stimulated cycles for IVF: immunohistochemical findings

An immunohistochemical assessment of the endometrium was carried out in a group of IVF patients on stimulated cycles, in order to evaluate this technique against standard histological methods and to consider its application in a clinical situation. Monoclonal antibodies to the two cycle-dependent proteins: pregnancy associated endometrial alpha 2-globulin (alpha 2-PEG) and 24K (a protein originally isolated from an oestrogen-dependent breast tumour line, MCF-7) were used in the experiment. Immunohistochemical results concerning the effect of drug stimulation, age and date of biopsy on the secretory state of the endometrium revealed trends which were consistent with previous histological data, helping to confirm the value of this new technique. In addition, several specimens were found to have a normal, i.e. in phase, histological appearance but to have an atypical pattern of protein secretion. These observations suggest that biochemical monitoring of the uterus should be used in conjunction with routine histological dating.     

诺贝得对大鼠实验性肝损伤的保护作用

目的：探讨中药制剂诺贝得对大鼠实验性肝损伤的影响。方法：建立四氯化碳（ＣＣＬ４）诱导的大鼠实验性肝损伤模型,观察诺贝得对大鼠血清丙氨酸转氨酶（ＡＬＴ）、天冬氨酸转氨酶（ＡＳＴ）、碱性磷酸酶（ＡＫＰ）活性的影响以及大鼠肝组织甘油三酯（ＴＧ）、蛋白质（Ｐ）含量和组织学的变化情况。结果：诺贝得组ＡＬＴ、ＡＳＴ和ＡＫＰ值以及ＴＧ和Ｐ含量均较肝损伤组明显降低（Ｐ＜０．０１）,肝组织损伤程度轻。结论：诺贝得对     

Characterization of uronic-acid-rich inhibitor of calcium oxalate crystallization isolated from rat urine

Human urine contains several macromolecules which inhibit calcium oxalate crystallization. Uronic-acid-rich protein (UAP), a glycoprotein with a molecular weight of approximately 35 kDa, is one such inhibitor. Here we report the characterization of UAP extracted from rat urine using three chromatographic steps including diethylaminoethanol (DEAE)-Sephacel, Sephacryl S-300 and Mono Q column and compare it with human UAP. The molecular weight of rat UAP (UAP_r) is similar to that of human UAP (UAP_h), being approximately 35 kDa as estimated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Their amino acid compositions are identical, they contain a high percentage of aspartic and glutamic acids and they react positively in the carbazole reaction, suggesting that they contain uronic acid. The inhibitory activities of UAP_h and UAP_r were assayed on a calcium oxalate crystallization system in vitro using [⁴⁵Ca]calcium chloride. Both exert a strong inhibition, suggesting that UAP_r, like UAP_h, plays an important role in preventing and reducing calcium oxalate crystallization in the urine. On Western blot analysis, both UAP_h and UAP_r immunoreact with inter--trypsin inhibitor (ITI) antibody. Nevertheless, using the Ouchterlony immunodiffusion technique, there was no precipitation line between ITI antibody and UAP. Therefore, we hypothesize that UAP is related to ITI and that they may have the same epitope but are not completely identical. We conclude that UAP belongs to the ITI superfamily of macromolecules which contribute to the regulation of the calcium oxalate crystallization process.     

Recovered memories of abuse in women with documented child sexual victimization histories

This study provides evidence that some adults who claim to have recovered memories of sexual abuse recall actual events that occurred in childhood. One hundred twenty-nine women with documented histories of sexual victimization in childhood were interviewed and asked about abuse history. Seventeen years following the initial report of the abuse, 80 of the women recalled the victimization. One in 10 women (16% of those who recalled the abuse) reported that at some time in the past they had forgotten about the abuse. Those with a prior period of forgetting—the women with recovered memories—were younger at the time of abuse and were less likely to have received support from their mothers than the women who reported that they had always remembered their victimization. The women who had recovered memories and those who had always remembered had the same number of discrepancies when their accounts of the abuse were compared to the reports from the early 1970s.     

Dreaming in agenesis of the corpus callosum: laboratory and home assessment of four cases

Laboratory and home dream recall was studied in four subjects with agenesis of the corpus callosum and in four control subjects who were matched for age, gender, and handedness. In addition, the structural and emotional content of home dreams was compared for these two groups. Results indicate that acallosal subjects recalled fewer dreams in the laboratory than did control subjects, but recalled the same number of dreams at home. They also reported more contentless dreams in both situations. Furthermore, although acallosal subjects used fewer words to describe their dream content in both contexts, the number of content categories they reported differed little from the number reported by control subjects. However, some trends were found for acallosal's home dreams to differ from those of controls, i.e. more dreams with known characters and fewer dreams with unknown characters, animals, and colours. Differences in emotional contents were few; acallosals reported more distress than controls. The shorter length of acallosals' dreams might be explained, in part, by their lower verbal IQs. Other characteristics of dream content (e.g. more distress, fewer dreams with unknown and animal characters) may reflect limited social experiences in this group. However, the greater frequency of contentless dreams and the lower frequency of dreams with colour are trends consistent with the possibility that the corpus callosum may be implicated in processes of dream production and dream recall.