兔坐骨神经挤压伤的MRI与SEP对比研究

目的:探讨磁共振成像和体感诱发电位以及两者结合在坐骨神经急性挤压伤中的诊断价值。方法:24只兔按钳夹力的不同随机分为A、B两组,左后肢为损伤侧,右后肢为对照侧,建立坐骨神经急性挤压伤模型,于伤后1、2、4、8周行MR扫描,同时行双侧体感诱发电位检查。结果:损伤侧24条神经,有23条MR显示异常,诊断正确率95.8%,假阴性率4.17%(1/24);24条损伤侧坐骨神经,有22条SEP显示异常,诊断正确率91.6%,假阴性率8.3%(2/24)。MRI与SEP对神经损伤的正确诊断率无统计学差异(P>0.05)。MRI与SEP结合起来,24条损伤神经均显示异常,诊断正确率100%。结论:MR与SEP检查可无创、准确地判断神经损伤,两者结合可明显提高神经损伤的正确诊断率,重复性好,可作为神经损伤的较好诊断手段。     

Detailed Analysis of Mucosal Restoration of the Small Intestine After the Cavitary Two-Layer Cold Storage Method

Small bowel transplantation (SBT) is associated with a high incidence of infectious complications because of ischemia/reperfusion (I/R) mucosal injury concomitant with potent immunosuppression. In this study, we evaluated whether the cavitary two-layer method (cTLM) could reduce I/R injury and allow early mucosal restoration, particularly after prolonged preservation and transplantation. Canine heterotopic segmental SBT was performed immediately without preservation (group 1), after 24-h preservation in UW solution (group 2) or by the cTLM (group 3). The graft samples were taken 1 h after reperfusion and on days 1, 4 and 7. We assessed graft mucosa with detailed microscopic and electromicroscopic analyses. In Group 3, histological injury and cell apoptosis after transplantation were significantly alleviated and rapidly recovered to a similar level of group 1. The mucosal restoration was morphologically completed within 4 days. In contrast, in group 2, more pronounced mucosal injury and delayed recovery were noted. Crypt cell proliferation activity was well maintained in groups 1 and 3 throughout the experimental period. Our ultrastructural analysis suggested that mitochondrial integrity achieved by the cTLM was a basal mechanism under the prompt mucosal restoration. The cTLM could reduce I/R injury, facilitate mucosal regeneration and restore the nearly normal structure early after SBT.     

大鼠脊髓横断性损伤后细胞周期蛋白D3的表达变化

目的 探讨细胞周期蛋白D3（Cyclin D3）在横断性脊髓损伤（tSCI）后的表达变化以及定位情况。方法 将48只成年SD大鼠随机分为8组：正常对照组，T9横断伤2、8h、1、3、5、7和14d组，每组6只。采用Western blot测定损伤后各时间段Cyclin D3蛋白水平在脊髓中的表达变化。采用免疫组织化学方法检测Cyclin D3在正常以及损伤后脊髓中的分布和定位。结果 West—emblot显示，Cyclin D3蛋白水平在tSCI后头、尾段均呈现先升高后下降的趋势，尾段明显：Cyclin D3的表达于损伤后8h开始逐渐升高，3d达到高峰，一直持续到第5天，之后逐渐下降。免疫组织化学表明Cyclin D3在正常脊髓中均匀分布，损伤后3d，Cyclin D3在脊髓白质和灰质中表达明显增强；免疫荧光双标记表明Cyclin D3与神经元的标记物neuronal nucleus（NeuN）、少突胶质细胞标记物cyclic nucleotide 3’phosphohydrolase（CNPase）有明显共定位，与星形胶质细胞标记物gtial fibrillary acidic protein（GFAP）和小胶质细胞标记物OX-42也存在部分共定位。结论脊髓损伤后Cyc—lin D3蛋白水平呈现明显的时相变化，并且与神经元、少突胶质细胞、星形胶质细胞和小胶质细胞存在共定位，提示Cyclin D3参与了脊髓损伤后的病理生理过程。     

The Hemodynamic Mechanisms of Lung Injury and Systemic Inflammatory Response Following Brain Death in the Transplant Donor

Brain-dead donors are the major source of lungs for transplantation. Brain death is characterized by two hemodynamic phases. Initially, massive sympathetic discharge results in a hypertensive crisis. This is followed by neurogenic hypotension. Up-regulation of pro-inflammatory mediators occurs in all organs and lung injury develops; this can adversely affect graft function post-transplantation. The mechanisms of the systemic and lung inflammation are unknown. We hypothesized that the hemodynamic changes are responsible for these inflammatory phenomena. Brain death was induced by intra-cranial balloon inflation in rats. This resulted in hypertensive crisis, followed by hypotension. There was a significant increase in blood neutrophil CD11b/CD18 expression and pro-inflammatory cytokine levels in serum and bronchoalveolar lavage, compared with control animals. Rupture of the capillary-alveolar membrane was demonstrated by electron microscopy. Elimination of the hypertensive response by α-adrenergic antagonist pre-treatment prevented inflammatory lung injury, reduced the systemic inflammatory markers and preserved capillary-alveolar membrane integrity. Correction of the neurogenic hypotension with noradrenaline ameliorated the systemic inflammatory response and improved oxygenation. We conclude that the sympathetic discharge triggers systemic and lung inflammation, which can be further enhanced by neurogenic hypotension. Management of the brain-dead donor with early anti-inflammatory treatment and vasoconstrictors is warranted.     

脊髓损伤后热休克蛋白27、表皮脂肪酸结合蛋白和金属蛋白酶组织抑制因子-1的基因表达及甲基强的松龙对其表达的影响

目的研究脊髓损伤后热休克蛋白27(HSP27)、表皮脂肪酸结合蛋白(FABPs)和金属蛋白酶组织抑制因子-1(TIMP-1)的基因表达及甲基强的松龙(MP)对其表达的影响.方法SD大鼠30只.随机分为假手术组、单纯脊髓损伤组(损伤组)及脊髓损伤+大剂量MP治疗组(MP组),每组10只.应用改良的Allen's打击法致T8脊髓损伤.MP组大鼠伤后即刻从尾静脉内注射大剂量MP(30mg/kg).损伤后24h切取损伤平面上下0.5cm的脊髓组织,进行RT-PCR反应,检测HSP27、FABPs和TIMP-1的基因表达.结果术后24h假手术组HSP27、FABPs和TIMP-1的基因表达相对丰度分别为0.0643±0.0152、0.6413±0.1005和0.7091±0.0577;损伤组上述三个因子的表达升高,分别为1.0013±0.3861、1.2187±0.2851和0.8971±0.1092,与假手术组比较差异有显著性(P＜0.01、P＜0.05、P＜0.05);MP组上述三个因子的表达继续升高,分别为1.2858±0.1384、1.7122±0.1766和1.2081±0.1093,与损伤组比较差异有显著性(P＜0.05、P＜0.01和P＜0.01).结论脊髓损伤后,邻近损伤处的脊髓组织中HSP27、FABPs及TIMP-1的基因表达显著增高,大剂量MP能进一步促进三个因子表达,发挥组织保护作用.     

临床护士锐器伤调查与预防

目的探讨护士预防锐器伤的对策。方法对某所综合性医院193名护士在2004年1月~2005年6月发生的锐器伤进行问卷调查。结果46.1%护士发生锐器伤,人均1.6次;发生锐器伤的锐器主要是注射器针头(36.7%),其次是玻璃(32.4%);护士主要在掰安瓿(29.5%)、使用后处理锐器(22.3%)、安装调整针头(15.8%)、医护配合传递锐器(10.1%)等环节容易发生锐器伤;有79.1%护士发生锐器伤时未戴手套。结论护士面临锐器伤职业危险,各方应当采取对策,预防和控制锐器伤。     

复方葡萄籽提取物对乙醇及四氯化碳肝损伤的影响

目的：探讨复方葡萄籽提取物（GSE）对化学性肝损伤的预防和治疗作用。方法：用小鼠建造四氯化碳肝损伤和乙醇肝损伤模型，观察乙醇灌胃前预先给予复方GSE及乙醇或四氯化碳灌胃后再给予复方GSE后小鼠血清谷丙转氨酶（ALT），肝细胞超氧化物歧化酶（SOD）、谷光甘肽（GSH）、丙二醛（MDA）。结果：预先给予GSE可增强SOD活性，防止乙醇导致的肝GSH减少，有效降低小鼠血清ALT和肝细胞MDA上升程度，在乙醇或四氯化碳灌胃后再给予复方GSE，也可降低小鼠血清中ALT和肝细胞脂质过氧化产物。结论：复方GSE对乙醇肝损伤有预防和治疗作用。对四氯化碳肝损伤也有一定治疗作用。     

Incretin mimetics as a novel therapeutic option for hepatic steatosis.

BACKGROUND: Fat accumulation in the liver or non-alcoholic fatty liver disease (NAFLD) is regarded as a key pathogenic factor and component of the metabolic syndrome. It was reported that administration of the incretin mimetic exenatide reversed hepatic steatosis in an obese mouse model. We had the opportunity to study the effect of additional exenatide administration on liver fat content in a patient with type 2 diabetes. CASE REPORT: A 59-year-old male with poorly controlled type 2 diabetes was treated with exenatide in addition to metformin monotherapy. Following 44 weeks of exenatide therapy, mean the liver fat measured by liver spectroscopy declined from 15.8% to 4.3%. This dramatic decrease in liver fat was accompanied by significant beneficial changes in several cardiovascular disease risk factors and improvement of all liver enzymes, in particular alanine aminotransferase, the most important marker of liver steatosis. CONCLUSION: This case report suggests that the incretin mimetic exenatide decreases hepatic fat accumulation and may play a role in the future treatment of NAFLD, and the associated insulin resistance and cardiovascular risk factors in an ever-growing high-risk population.     

葛根素对家兔肢体缺血再灌注后心脏功能的保护作用

目的:观察葛根素对家兔肢体缺血再灌注所致心脏损伤的保护作用并探讨其机制.方法:家兔40只,随机分4组:Ⅰ组为假手术对照组、Ⅱ组为缺血再灌注组、Ⅲ组为葛根素低剂量治疗组、Ⅳ组为葛根素高剂量治疗组.免疫组化法检测心肌组织Bcl-2和Bax蛋白表达;原位缺口末端标记法(TUNEL)检测心肌细胞凋亡;比色法测定心肌组织超氧化物岐化酶(SOD)和髓过氧化物酶(MPO)活性,丙二醛(MDA)含量,测定血清乳酸脱氢酶(LDH)活性;通过生理记录仪观察心功能指标.结果:与Ⅱ组比较,Ⅲ、Ⅳ组左心室功能增强,且Ⅳ组的左心室收缩功能比Ⅲ组增强,同时,Ⅲ、Ⅳ组心肌组织MDA含量和血清LDH活性减少,Bax蛋白表达减少,Ⅳ组的心肌凋亡指数低于Ⅱ组,心肌Bcl-2表达高于Ⅱ组.结论:葛根素促进肢体缺血再灌注后心脏功能的恢复,表现为剂量依赖效应,其作用机制与抗氧化损伤和抗细胞凋亡有关.