内扎外切弧形缝合术治疗环状混合痔100例疗效分析

目的探讨内扎外切弧形缝合术治疗环状混合痔的l临床疗效。方法对100例环状混合痔患者施行内扎外切弧形缝合术,就术后愈合时间、肛缘水肿、肛门狭窄及术后复发率进行回顾性研究。结果100例均一次性治愈,切口愈合时间10～25d,平均14．7土5．3d,肛缘水肿发生率6％,无1例出现术后肛门狭窄,术后1年复发率5％。结论在治疗环状混合痔时,内扎外切弧形缝合术具有治愈率高、复发率低等优点,较好地解决了环状混合痔术后肛门狭窄、肛门水肿等并发症的发生。     

Brutal decrease in pulse oxymetry in paediatric anaesthesia: a story of artefact

Pulse oxymetry is frequently used in anaesthesia, notably in paediatric anaesthesia. This device can however present artefacts. We report the case of a sudden decrease in pulse oxymetry during surgical exploration of wound of the face in a child. This was preceded by the injection of patent blue, used for vascular cartography, and interfering with pulse oxymetry. After excluding real oxygen desaturation, this error of measurement has to be confirmed by arterial gazometry. In our case, pulse oxymetry normalized few hours later, without complication.     

Characterization of active and inactive states of CB1 receptor and the differential binding state modulation by cannabinoid agonists, antagonists and inverse agonists

Cannabinoid 1 (CB1) receptors have the ability to change conformation between active (R*) and inactive (R) receptor states. Herein, we further characterize these receptor states using series of saturation radioligand binding studies and their differential displacement binding by various CB1 receptor ligands. Binding experiments were carried out in naïve rat/dog whole brain membranes using radioligands [³H]CP55,940 (for R* state) & [³H]SR141716A (both R* and R states) and various agonist, antagonist & inverse agonist ligands at CB1 receptors. In the saturation binding experiments, of the total number of CB1 receptor binding sites (R* + R) in the rat and dog whole brain membranes, only about 18.3 and 11.6% were in the active (R*) state recognized by [³H]CP55,940, respectively. In the competitive binding studies, all the CB1 receptor agonists investigated had significantly very high affinity for the active R* state recognized by [³H]CP55,940 and lower affinity for the inactive R state mainly recognized by [³H]SR141716A in the presence of a non-hydrolyzable analogue of GTP [Gpp(NH)p]. In contrast, various CB1 receptor antagonists/inverse agonists had similar nanomolar affinities at both [³H]CP55,940 and [³H]SR141716A recognized binding states. These results clearly characterize the significant differences between the active R* and inactive R binding states of CB1 receptors in naive rat and dog brain. In addition, these results also demonstrates that the CB1 agonists and antagonists/inverse agonists can be differentiated by their relative affinities at active (R*) and inactive (R) binding states of the CB1 receptor.     

模拟480m氦氧饱和潜水实验潜水员体能训练效果观察

目的 探讨大深度饱和潜水潜水员体能训练方法,以提高潜水员在长时间高气压暴露下体能消耗的承受能力。方法 采取定距离计时跑、定距离蹼泳等方法对9名海军男性潜水员进行有氧训练,记录训练前、后和4名进舱潜水员480 m饱和潜水实验后的训练成绩和心率并进行比较。结果 通过训练,3000 m计时跑体能基础较差的3人（训练前测试达不...     

模拟480m氦氧饱和-493m巡回潜水实验研究的设备保障

目的 保障模拟480 m氦氧饱和-493 m巡回潜水实验的顺利进行,检验饱和潜水设备保障方案.方法 4名潜水员利用500 m饱和潜水系统和KMB18(B)潜水装具,在实验室进行模拟大深度饱和-巡回潜水.实验前通过维修、调试设备,使其处于备便状态.实验中按照设备保障方案,控制舱内环境压力、氧(O2)分压、二氧化碳( CO2)分压及温湿度参数,保障潜水员完成水下巡潜作业及日常饮食起居,确保潜水员按时、顺利、安全出舱.结果 经过82 h加压后,达到的饱和深度为480 m,4名潜水员在此深度下停留49.6h,达到巡潜最大深度493m;减压时间约302.4 h,高压暴露总时间为434 h.加压过程和饱和逗留期间维持O2分压35 ～45 kPa,减压时维持O2分压48～52 kPa,减压至12 m后,维持O2浓度21％ ～23％;CO2分压一般限制在0.5 kPa以内.相对湿度60％～80％;居住舱内温度29～32℃.结论 潜水员出舱后身体状况良好,感觉舱内环境控制比较舒适,设备保障结果与预想方案吻合,设备保障方案成功.     

心力衰竭患者甲状腺功能减退与睡眠呼吸障碍的相关性分析

目的探讨心力衰竭患者中甲状腺功能减退者睡眠呼吸障碍的临床特征及两者的相关性。方法连续纳入2019年8~12月就诊于北京阜外医院行甲状腺功能检测及睡眠呼吸监测的182例心力衰竭患者。根据甲状腺功能检测结果分为甲状腺功能减退组45例和非甲状腺功能减退组137例。比较两组患者的睡眠呼吸监测的相关指标,多元logistic回归分析甲状腺功能减退与睡眠呼吸障碍的相关性。结果甲状腺功能减退组女性患者比例、体重指数较非甲状腺功能减退组高(P<0.05)。两组多导睡眠监测的结果,甲状腺功能减退组睡眠平均血氧饱和度较非甲状腺功能减退组低(P=0.027)。甲状腺功能减退组睡眠低通气发生次数较非甲状腺功能减退组显著增多(P=0.01)。但甲状腺功能减退与睡眠呼吸暂停无相关性(P=0.533)。结论在心力衰竭患者中,甲状腺功能减退的患者睡眠平均血氧饱和度更低,并且夜间低通气次数更多。     

Na+ dependence of single-channel current and channel density generate saturation of Na+ uptake in A6 cells

 In high-resistance, salt-absorbing epithelia the apical amiloride-sensitive Na⁺ channel is the key site for regulation of salt and water balance. The saturation of macroscopic Na⁺ transport through these channels was investigated using A6 epithelial monolayers. The relation between transepithelial Na⁺ transport (I _Na) and apical Na⁺ concentration ([Na⁺]_ap) under short-circuit conditions was studied. Michaelis-Menten analysis of the saturable short-circuit current (I _sc) yielded an apparent Michaelis-Menten constant (K _m ^I ) of 5 mmol/l and a maximal current (I _max) of 8 μA/cm². The microscopic parameters underlying I _Na, namely the single-channel current (i) and the open channel density (N _o), were investigated by the analysis of current fluctuations induced by the electroneutral amiloride analogue CDPC (6-chloro-3,5-diaminopyrazine-2-carboxamide). A two-state model analysis yielded the absolute values of i (0.18 ± 0.01 pA) and N _o (65.38 ± 9.57 million channels/cm² of epithelium) at [Na⁺]_ap = 110 mmol/l containing 50 μmol/l CDPC. Our data indicate that in A6 cells both i and N _o depend on [Na⁺]_ap. Between 3 and ≈ 20 mmol/l the density of conducting pores, N _o, decreases sharply and behaves again as an almost [Na⁺]_ap-independent parameter at higher [Na⁺]_ap. The single-channel current clearly saturates with an apparent Michaelis-Menten constant, K _m ⁱ , of ≈ 17 mmol/l. Thus, the [Na⁺]_ap dependence of N _o as well as the limited transport capacity of the amiloride-sensitive Na⁺ channel are both responsible for the saturation of I _Na. Received: 2 June 1997 / Received after revision: 12 November 1997 / Accepted: 10 December 1997     

Dendritic integration of motion information in visual interneurons of the blowfly

Dendritic integration plays a key role in the way information is processed by nerve cells. The large motion-sensitive interneurons of the fly appear to be most appropriate for an investigation of this process. These cells are known to receive input from numerous local motion-sensitive elements and to control visually-guided optomotor responses (e.g., Trends Neurosci., 11 (1988) 351–358; Stavenga and Hardie, Facets of Vision, Springer, 1989). The retinotopic input organization of these cells allows for in vivo stimulation of selected parts of their dendritic tree with their natural excitatory and inhibitory synaptic input signals. By displaying motion in either the cells' preferred or null direction in different regions of the receptive field we found: (i) Responses to combinations of excitatory and inhibitory motion stimuli can be described as the sum of the two response components. (ii) Responses to combination of excitatory stimuli show saturation effects. The deviation from linear superposition depends on the distance and relative position of the activated synaptic sites on the dendrite and makes the responses almost insensitive to the number of activated input channels. (iii) The saturation level depends on different stimulus parameters, e.g. the velocity of the moving pattern. The cell still encodes velocity under conditions of spatial saturation. The results can be understood on the basis of passive dendritic integration of the signals of retinotopically organized local motion-detecting elements with opposite polarity.     

Transperineal Magnetic Resonance Imaging–Targeted Biopsy May Perform Better Than Transrectal Route in the Detection of Clinically Significant Prostate Cancer: Systematic Review and Meta-analysis

The diagnostic accuracy of magnetic resonance imaging (MRI)-targeted biopsy by using the transperineal (TP) versus transrectal (TR) route in the detection of clinically significant prostate cancer (csPCa) remains to be revealed. A systematic search of PubMed, Embase, Ovid, and the Cochrane Library up to April 2019 was conducted. We pooled odds ratios with 95% confidence intervals (CIs) for csPCa detected by TP and TR MRI-targeted biopsy. The relative sensitivity (or risk ratio) between TP and TR route was synthesized. We also pooled the diagnostic sensitivity of either approach using the combined biopsy results as the reference standard. A total of 328 patients with positive multiparametric MRI underwent TP MRI-targeted biopsy, and 315 patients underwent TR MRI-targeted biopsy. The TP route detected more csPCa, with a detection rate of 62.2% (204/328) compared to 41.3% (130/315) for the TR route (odds ratio = 2.37; 95% CI, 1.71-3.26). After adjusting for differences in cancer prevalence, TP MRI-targeted biopsy detected 91.3% (105/115) of csPCa compared to 72.2% (83/115) by the TR route (risk ratio = 1.26; 95% CI, 1.02-1.54). The pooled diagnostic sensitivity of the TP route (86%; 95% CI, 77-96) was better than the TR route (73%, 62-88%). The TR approach missed more csPCa located at the anterior zone of the prostate (20 vs. 3). The TP route performed better than the TR route in MRI-targeted biopsy, especially in detecting csPCa located at the anterior prostate. More large prospective randomized or head-to-head comparison studies comparing the two approaches are warranted.