双J管临床应用及美蓝在置管术中的作用

目的探讨双J管(双J输尿管支架管)在泌尿系疾病治疗中的应用效果以及美蓝在置放术中的作用。方法对215例患者采用放置双J管作内支架和内引流治疗,近期48例术中以美蓝协助定位。结果术后留置尿管5~7d,无切口感染、尿瘘等并发症。术后1~3个月拔除双J管,随访3~6个月,肾功能、肾积水明显好转,吻合口通畅。以美蓝协助定位者无双J管上移致拔管困难。结论双J管具有内支架和内引流作用,操作简单,引流效果好,并发症少,缩短住院时间。以美蓝协助定位,值得推广应用。     

股骨颈骨折粗细双螺钉内固定生物力学研究

股骨颈骨折内固定方法繁多。本文采用一粗一细加压螺纹钉，采用先进电阻应变仪方法，对股骨颈的应力分布规律在中立、外展、内收不同位置上施加50kg荷载压力．通过电阻应变计测定一耗一细两钉所承受拉、压应力优于其它内固定形式。     

神经导航内窥镜辅助下单鼻孔入路垂体腺瘤切除

目的神经导航、内窥镜辅助下垂体腺瘤的经单鼻孔经蝶手术治疗。方法对6例经磁共振成像诊断垂体腺瘤的病人术前进行磁共振成像定位,将影像资料输入导航工作站,作术前手术计划。采用零度及45度镜经单鼻腔,在导航的动态指引下确认鞍底,于内窥镜下实施瘤实质切除。结果本组5例完全切除,1例因为瘤实质较韧而作大部分切除,术后病人的视力均得到了改善。导航预期误差1.48mm,实际误差1.8mm。结论神经导航引导下的经鼻蝶垂体腺瘤手术定位准确,内窥镜下操作对鼻腔的解剖结构影响小、组织损伤轻,病人恢复快。     

地塞米松对哮喘豚鼠肺组织Giα、Gqα的抑制作用

目的　研究糖皮质激素对豚鼠哮喘模型肺组织G蛋白α亚族表达的影响。方法　 18只豚鼠随机分为正常对照组(NS) ,哮喘组 (AS)和地塞米松治疗组 (DEX)。AS组用卵蛋白皮下及腹腔注射致敏 ,卵蛋白重复雾化吸入激发复制豚鼠哮喘模型。DEX组在每次激发前腹腔内注射地塞米松 2mg/kg进行干预。用Westernblot分析法测定豚鼠肺组织G蛋白α亚族的表达水平。结果　三组豚鼠肺组织Giα水平分别为NS组 10 0 % ,AS组 (15 3± 18) % ,DEX组 (113± 18) % ,AS组与NS组比较、DEX组与AS组比较差别显著 (P <0 .0 5 )。三组豚鼠肺组织Gqα水平分别为NS组 10 0 % ,AS组 (15 1± 19) % ,DEX组 (98± 4 ) % ,AS组与NS组比较、DEX组与AS组比较差别显著 (P <0 .0 5 )。在同样的条件下Gsα水平无显著变化 (P >0 .0 5 )。地塞米松能够显著抑制哮喘豚鼠肺组织中Giα、Gqα的高表达。结论　肺组织Giα ,Gqα的高表达变化参与了豚鼠哮喘模型的病理性信号传导 ,抑制哮喘肺组织Giα、Gqα的高表达可能是糖皮质激素治疗哮喘的机制之一。     

INVOLVEMENT OF NON-NMDA AND NMDA RECEPTORS IN GLUTAMATE-INDUCED PRESSOR OR DEPRESSOR RESPONSES OF THE PONS AND MEDULLA

1. Fifty-five intact and six baroreceptor denervated and vagotomized cats of either sex were anaesthetized intraperito-neally with urethane (400 mg/kg) and a-chloralose (40 mg/kg). Responses of the systemic arterial pressure (SAP), mean SAP (MSAP) and sympathetic vertebral nerve (VNA) and renal nerve activities (RNA) were recorded. 2. In intact animals, monosodium L-glutamate (Glu, 0.1 mol/L, 50 nL) was microinjected into pressor areas of the locus coeruleus (LC), gigantocellular tegmental field (GTF), rostral ventrolateral medulla (RVLM) and dorsomedial medulla (DM), and the depressor areas of caudal ventrolateral medulla (CVLM). The induced actions were compared before and after microinjection of either glutamate antagonists, glutamate diethylester (GDEE, 0.5 mol/L, 50–100nL), a competitive AMPA receptor blocker, or 2-amino-5-phosphonovaleric acid (D-AP5, 0.025 mol/L, 50–100 nL), a competitive N-methyl-D-aspartate (NMDA) receptor blocker. GDEE completely blocked the increases of SAP and VNA elicited from all pressor areas. D-AP5 only partially blocked the pressor but slightly blocked VNA and RNA responses from LC, GTF and DM, particularly those from RVLM. Neither GDEE nor D-AP5 blocked the depressor responses of SAP and two nerve activities elicited from CVLM. 3. In baroreceptor denervated animals, NMDA (2 mmol/L, 50–100 nL) and AMPA (0.2 mmol/L, 50–100 nL) were micro-injected into the same pressor areas of GTF, RVLM and DM and the depressor area of CVLM responsive to Glu activation (0.1 mol/L, 30 nL). In RVLM, DM and CVLM, the results of either NMDA or AMPA were similar to those induced by Glu. However, in GTF, microinjection of either NMDA or AMPA did not induce similar responses to Glu. This suggests that the nature of GTF may differ from RVLM and DM. 4. The above results suggest that the Glu-induced pressor responses from LC, GTF, DM and especially RVLM, are primarily mediated through AMPA receptors. The Glu-induced depressor responses from CVLM may not be predominantly mediated by either AMPA or NMDA receptors. 5. In both baroreceptor-intact and -denervated cats stimulation of the pressor areas often produced an increase of VNA and a decrease of RNA, while in the depressor CVLM decreased both VNA and RNA. The VNA, but not RNA were positively correlated with the pressor responses, while both VNA and RNA were positively correlated with the depressor responses. This may suggest that neurons of the sympathetic vertebral and renal nerves are topographically organized in the brain.