急诊体外循环抢救急性心脏损伤8例

0　引言　体外循环技术已越来越普及,为了推广该项技术,我们介绍体外循环技术在急诊室的应用.1　临床资料　1993-03/1999-05我们遇到急性心脏损伤8例,全部为男性,年龄23～78(平均44.5)岁;急诊体外循环下行手术治疗,存活5例,死亡3例,成活率62%.1例老年患者,因急性心梗发作,心肌破裂5min来院,急诊开胸手术.见左室壁3处大面积梗死,后壁破裂,急建体外循环,,行修补术.但复温过程中前壁及后壁均发生破裂,无法修补而至手术失败.1例工人,施工中不慎被高压电击伤,从右肩至左踝穿出.来院后行急诊开胸心脏按摩,左室呈石头心样改变,急诊体外循环进行辅助…     

Functional trait space and the latitudinal diversity gradient

The processes causing the latitudinal gradient in species richness remain elusive. Ecological theories for the origin of biodiversity gradients, such as competitive exclusion, neutral dynamics, and environmental filtering, make predictions for how functional diversity should vary at the alpha (within local assemblages), beta (among assemblages), and gamma (regional pool) scales. We test these predictions by quantifying hypervolumes constructed from functional traits representing major axes of plant strategy variation (specific leaf area, plant height, and seed mass) in tree assemblages spanning the temperate and tropical New World. Alpha-scale trait volume decreases with absolute latitude and is often lower than sampling expectation, consistent with environmental filtering theory. Beta-scale overlap decays with geographic distance fastest in the temperate zone, again consistent with environmental filtering theory. In contrast, gamma-scale trait space shows a hump-shaped relationship with absolute latitude, consistent with no theory. Furthermore, the overall temperate trait hypervolume was larger than the overall tropical hypervolume, indicating that the temperate zone permits a wider range of trait combinations or that niche packing is stronger in the tropical zone. Although there are limitations in the data, our analyses suggest that multiple processes have shaped trait diversity in trees, reflecting no consistent support for any one theory.Species richness increases toward the equator (1, 2) in major clades of both extant and extinct species of plants and animals (3, 4). The generality of the pattern hints at a correspondingly general explanation, yet the latitudinal gradient in species richness remains one of ecology’s greatest unsolved puzzles. Long-running debates over the causes of the latitudinal gradient of species richness have focused on ecological, evolutionary, and geographic explanations (5–10). Although there has been some progress (11), it is also increasingly clear that there are numerous obstacles to understanding the primary drivers of the latitudinal gradient, including an ever-increasing number of hypotheses (12, 13), challenges in clearly separating their interdependencies (14, 15), and difficulties in rigorously falsifying their assumptions and predictions (16).More powerful tests of biodiversity theories need to move beyond species richness and instead explicitly focus on the mechanisms generating the gradient, by recasting the theories in terms of other measures of diversity, such as functional diversity (17–19). For example, explanations that assume species richness is limited by resource availability have often focused on the strength of species interactions, life history differences, and environmental constraints on how species pack into niche space (20). Evolutionary hypotheses have focused on differences in diversification rates, as well as the influence of species interactions on diversification rates (9). These interaction-based explanations implicitly refer to the degree of ecological differentiation among species, and therefore to trait dispersion within clades and assemblages, suggesting that patterns of functional diversity may provide a more powerful test of theory than taxonomic richness (21).A particularly important concept that unifies many ecological and evolutionary theories is the concept of the Hutchinsonian multidimensional niche (22). Hutchinsonian niches can be quantified by assessing the functional trait hypervolumes that characterize phenotypic space occupied by a set of species. Quantifying the volume, overlap, and packing of functional trait space at different spatial scales enables inferences about how differing ecological and evolutionary processes structure functional diversity and ecological strategies (23, 24).Here, we recast several contrasting hypotheses for the latitudinal gradient in terms of functional trait space. We focus on the proximate ecological mechanisms that ultimately can influence evolutionary processes. We quantify tree functional trait space across latitude at three spatial scales: (i) within assemblages (alpha), (ii) among assemblages (beta), and (iii) among biomes (gamma). For alpha and beta analyses, we use tree species assemblage data from 620 standardized 0.1-ha forest plots (Fig. 1A); for gamma analyses, we calculated the latitudinal range distributions for 520 New World tree species where we had sufficient data on geographic distribution and functional traits. In total, across all analyses, we used paired geographic occurrence data with trait data for 6,839 tree species.Open in a separate windowFig. 1.(A) Spatial distribution of the 620 0.1-ha forest plots used in this study. Plots are colored by richness. Plots cover most of the New World forested climate space (Fig. S1). (B) Relationship between absolute latitude and alpha hypervolume for tropical (red triangles) and temperate (blue pluses) plots. (C) Alpha hypervolume as a function of effective species richness (number of species with full trait coverage). We compare this hypervolume with a null expectation based on sampling the same number of species from the regional pool (median, dark gray line; 90% quantile range, light gray envelope).We primarily measured hypervolumes for three central traits hypothesized to characterize major axes of ecological strategy variation (25): specific leaf area (SLA), maximum height, and seed mass. SLA represents the tradeoff between leaf longevity and maximum photosynthetic rate (26); height is important for light competition and dispersal (27); and seed mass represents tradeoffs between fecundity, dispersal, and seedling survival (27). Although whole-plant resource strategies can be more fully assessed in higher dimensions (28, 29), we focus on these traits because of data availability (Materials and Methods). We use a hypervolume algorithm for calculating the volume and overlap of trait space (30) (Materials and Methods). All hypervolumes are reported in units of SDs of centered and scaled log-transformed trait values, raised to the power of the number of trait dimensions used.At all scales, our overall results and conclusions are similar (i) with and without gap-filling missing data, (ii) if we use convex hulls instead of hypervolumes to calculate trait spaces, and (iii) if we include additional trait axes. Additional details are given in Figs. S2–S7.     

Tegillarca granosa extract Haishengsu (HSS) suppresses expression of mdr1, BCR/ABL and sorcin in drug-resistant K562/ADM tumors in mice

PurposeTo evaluate the effect of Haishengsu (HSS), a protein extract from Tegillarca granosa, on multidrug-resistance genes mdr1, BCR/ABL and sorcin in transplanted tumors.Material/MethodsMice were inoculated subcutaneously with a drug resistant leukemia cell line K562/ADM. Tumor-bearing animals were divided into control, adriamycin, HSS and combination therapy (adriamycin plus HSS) groups. Flow cytometry was used to detect apoptosis of tumor cells, and RT-PCR was used to evaluate the expression of mdr1, BCR/ABL and sorcin.ResultsThe apoptosis rate in the high (71.8%), medium (72.3%) and low doses HSS group (72.4%) was higher than in control (1.2%, p<0.01), adriamycin (34.4%, p<0.05) or combination therapy group (46.4%, p<0.05). The mean optical density of mdr1, BCR/ABL and sorcin in HSS groups was lower than in control, adriamycin and combination therapy group (p<0.01). The optical density of the three genes in high HSS group was lower than in medium and low HSS group (p<0.01).ConclusionsHaishengsu promotes apoptosis of drug-resistant K562/ADM tumors in mice in a dose-dependent manner. The pro-apoptotic effect of Haishengsu may be related to a reduced expression of multidrug-resistance genes mdr1, BCR/ABL and sorcin.     

柠檬酸添加壳聚糖及明胶固化液与α-磷酸三钙和羟基磷灰石复合制备骨水泥的黏度及形状特点

目的：利用在柠檬酸中添加壳聚糖、明胶配制的固化液与α-磷酸三钙和羟基磷灰石复合的粉剂调和制备骨水泥试样,观察其黏度和形状. 方法：实验于2005-03/2006-08在兰州交通大学材料系实验室完成.①实验方法：骨水泥固相粉末是α-磷酸三钙和羟基磷灰石混合均匀制得的骨水泥粉料,液相部分是将壳聚糖和明胶按体积分数为0.03,0.06,0.09,0.12,0.15与柠檬酸溶液混合配制的固化液,将二者调和制得骨水泥.②实验评估：采用X射线衍射仪测试试样晶型及组成;测定骨水泥凝固时间;通过MTS-810型材料试验机测试骨水泥压缩强度;扫描电镜观察固化体微观结构;将骨水泥样本置于37℃生理盐水中,并在1,3,5,7,9,12,24 h测试生理盐水的pH值. 结果：①骨水泥组成：X射线衍射仪显示粉剂中仅存在两个晶相：羟基磷灰石/高温型磷酸三钙.②骨水泥凝固时间：调和液的黏度明显增加,试样调拌时像口香糖一样黏性很大,固化时间延长,抗水冲性能提高,样品塑型容易操作.在（2.0±0.2）min时出现初凝,骨水泥的黏性逐渐减退,在（8.0±0.2）min时骨水泥完全固化,骨水泥固化时间有所延长.③骨水泥压缩强度：固化液中壳聚糖-明胶体积分数为0.09时压缩强度较高（26.0±3.2）MPa;骨水泥于浸泡6 h的强度已达其最大强度的85%以上,24 h基本达到最大强度,在48 h后强度几乎不再变化.④固化体微观结构：完全固化后,形成棒状结晶和花朵状的结晶,晶体很小,在低倍镜下观察,似无定形物质.固化后形成的磷酸钙结晶在形态学上与自然骨非常相似.⑤生理盐水的pH值：pH值随着水化反应的进行逐渐上升,浸泡12 h时上升为6.89±0.02,浸泡24 h时pH值达到7.02±0.02,接近生理盐水的pH值. 结论：制备的骨水泥克服了陶瓷型羟基磷灰石烧结形成、修整困难等缺点,具有塑型容易、使用方便、固化时放热小等优点,可应用于体内骨修复材料.     

猪胸腰段脊髓火器贯通伤后p53基因的早期表达

目的:建立家猪胸腰段脊髓火器贯通伤模型和改良Allen's打击伤后全瘫模型,观察伤后促凋亡基因p53基因的早期表达。方法:实验于2005-05/08在解放军第一七五医院实验室完成。取健康雄性家猪20只,单纯随机分为3组:①火器伤组:9只,在全麻状态下制作胸腰段(L1～L2)脊髓火器伤模型,分为伤后1,3,6h3个时间处死。②打击伤组:9只,L1节段脊髓行改良Allen’s打击,致伤力为500g·cm,处死时间同前。③空白对照组:2只,只麻醉,不造模,伤后6h处死。伤后不同时间点(伤后1,3,6h)和不同节段(伤点、近伤点、中伤点及远伤点)取材,采用SP法进行P53蛋白免疫组化染色,用TJTY-300型全自动图像分析仪测量P53免疫组织化学染色阳性物质吸光度。结果:经补充后20只猪进入结果分析。①脊髓损伤后3h打击伤组伤点,火器伤组近伤段脊髓P53蛋白的表达高于空白对照组(P<0.001),随着时间推移,打击伤组和火器伤组P53蛋白的表达呈升高趋势(P<0.001),且火器伤组要高于打击伤组(P<0.0001)。②在脊髓损伤后6h,打击伤组仅在伤点和近伤段P53蛋白的表达高于空白对照组(5.57±0.82,3.21±0.43,P<0.05),而火器伤组近伤段、中伤段及远段伤均高于空白对照组(6.46±0.66,4.27±0.39,1.16±0.17,P<0.05)。结论:①细胞凋亡基因p53在脊髓损伤中的表达有一定的时空性,在脊髓损伤后3h出现P53蛋白表达量的增加。②脊髓火器伤的波及范围较打击伤更为广泛。     

单侧输尿管梗阻大鼠肾脏组织基质金属蛋白酶3、基质金属蛋白酶2和金属蛋白酶组织抑制因子2的表达及益气活血法的影响

目的:肾间质纤维化是肾脏疾病进展到肾功能衰竭的共同通路。通过观察益气活血法中药制剂对肾间质纤维化大鼠肾组织基质金属蛋白酶3,基质金属蛋白酶2和金属蛋白酶组织抑制因子2表达的影响,探讨其抗肾间质纤维化的作用机制。方法:实验于2006-12/2007-06在首都医科大学解剖与组织胚胎学系实验室完成。①实验动物:Wistar雄性大鼠30只,采用随机数字法分为模型组、西药蒙诺组、中药小剂量组、中药中剂量组、中药大剂量组和假手术组。实验过程中对动物处置符合动物伦理学要求。②实验方法:其中前5组行单侧输尿管梗阻致肾小管间质纤维化模型手术,假手术组打开大鼠腹腔后,分离其左侧输尿管,不结扎即关闭腹腔。益气活血法中药制剂主要由生黄芪,当归,赤白芍,丹参,黄芩,车前草,牛膝等组成。西药组、中药小剂量组、中药中剂量组和中药大剂量组于手术前2d开始灌胃给药,1次/d,其药量分别为:西药组蒙诺10mg/(kg·d)、小剂量组0.018mL/(kg·d)、中剂量组0.036mL/(kg·d)、大剂量组0.072mL/(kg·d),连续给予2周。模型组及假手术组用相同体积的生理盐水灌胃。③实验评估:6组大鼠于术后14d麻醉后处死,观察梗阻肾脏病理改变,并用免疫组织化学方法检测肾组织对基质金属蛋白酶2、基质金属蛋白酶3和金属蛋白酶组织抑制因子2的表达,通过医学病理图像分析系统对基质金属蛋白酶2、基质金属蛋白酶3和金属蛋白酶组织抑制因子2的积分光密度进行统计学分析。结果:30只大鼠全部进入结果分析。肾组织切片免疫组织化学方法结果显示:基质金属蛋白酶2、基质金属蛋白酶3和金属蛋白酶组织抑制因子2主要表达部位在肾小管上皮,少量表达在肾间质和肾小球。基质金属蛋白酶2和基质金属蛋白酶3在模型组的表达较假手术组明显减弱,两组间积分光密度比较差异有显著性意义(P<0.05);中药大、中剂量组及西药蒙诺组的表达较模型组显著增强,积分光密度差异有显著性意义(P<0.05)。金属蛋白酶组织抑制因子2在模型组的表达较假手术组显著增强,两组间积分光密度比较差异有显著性意义(P<0.05);中药大、中剂量组及西药蒙诺组的表达较模型组有所减弱,两组间积分光密度比较差异有显著性意义(P<0.05);中药小剂量组无论基质金属蛋白酶2和基质金属蛋白酶3还是金属蛋白酶组织抑制因子2的表达与模型组相比均较为相似,两组间积分光密度比较差异无显著性意义(P>0.05)。结论:大鼠输尿管梗阻后呈现出的病理损害可能和肾组织基质金属蛋白酶3,基质金属蛋白酶2与金属蛋白酶组织抑制因子2的表达失衡有关,益气活血法可以上调基质金属蛋白酶2,基质金属蛋白酶3的表达,下调金属蛋白酶组织抑制因子2的表达,显示在抑制或延缓肾间质纤维化的进程中具有一定的作用。     

长骨干骨折脂肪栓塞综合征患者内固定植入物及其方式的选择：26例随访分析

目的:通过长骨干骨折脂肪栓塞综合征患者内固定植入物及其方式的合理选择,以最大限度减少手术创伤及减少对骨折端的刺激,有效避免脂肪栓塞综合征的复发。方法:①对象:选择1998-02/2006-03唐山市第二医院创伤科收治长骨干骨折行内固定植入的脂肪栓塞综合征患者26例。②方法:采用非扩髓髓内钉固定股骨干、胫骨干中段骨折及多段骨折、微创经皮钢板内固定股骨干远端骨折及胫骨干远近端骨折、钢板固定肱骨干、桡骨骨折;术后早期进行系统的康复治疗;并接受随访。术后定期复查X线片,并观察材料及宿主反应。结果:①术后随访:16例患者术后随访12～24个月,10例患者随访25～108个月。②X线摄片评定骨折愈合结果:长骨干骨折髓内钉固定于术后10～17周临床愈合;微创经皮钢板固定,于术后9～19周临床愈合;钢板固定,于术后13～20周临床愈合。无髓内钉松动及断钉、断板等并发症,肌力5级,未发现脂肪栓塞综合征后遗症。③植入物与组织的生物相容性能评估:术后无切口感染、局部炎症反应、排异反应。结论:对于长骨干骨折的脂肪栓塞综合征患者,非扩髓髓内钉、微创经皮钢板及钢板3种内固定植入物及植入方式均可满足不同部位及类型长骨干骨折的需要,植入物与人体具有良好的生物相容性,不增加脂肪栓塞综合征复发率及后遗症。     

转化生长因子β细胞内信号转导负调控蛋白Smad6，7在肾间质纤维化大鼠肾脏表达与益气活血法的影响

目的:观察肾间质纤维化大鼠肾组织中转化生长因子β细胞内信号转导负调控蛋白Smad6,7表达变化与益气活血法中药制剂的影响。方法:实验于2006-12/2007-06在首都医科大学解剖与组织胚胎学系实验室完成。①实验动物:Wistar雄性大鼠30只,采用随机数字法随机分为模型组、中药大剂量组、中药中剂量组、中药小剂量组、西药蒙诺组、假手术组,每组5只。益气活血法中药提取液(生黄芪15g,当归10g,赤白芍10g,丹参30g,黄芩10g,车前草15g,牛膝15g等)经水提醇沉得4.4kg/L生药提取液。实验过程中对动物处置符合动物伦理学要求。②实验方法:其中前5组行单侧输尿管梗阻致肾小管间质纤维化模型手术。假手术组打开大鼠腹腔后分离左侧输尿管,并不结扎即关闭腹腔。中药大剂量组、中药中剂量组、中药小剂量组、西药蒙诺组,于手术前2d给予灌胃给药0.072mL/(kg·d),0.036mL/(kg·d),0.018mL/(kg·d),10mg/(kg·d),1次/d,连续2周。模型组及假手术组用相同体积的生理盐水灌胃。③实验评估:6组大鼠于术后14d麻醉后处死,观察梗阻肾组织病理改变,用免疫组化方法检测肾组织Smad6,7蛋白表达,通过医学病理图像分析系统对Smad6,7蛋白的积分光密度进行统计学分析。结果:30只大鼠全部进入结果分析。苏木精-伊红染色显示模型组肾小管上皮细胞萎缩,大部分肾小管管腔扩张,间质纤维组织增生,大量炎性细胞浸润,肾小球数目明显减少。中药大剂量组、中剂量组、西药蒙诺组较模型组肾间质炎性细胞浸润、纤维组织增生、肾小管扩张情况明显减轻。Smad6,7蛋白主要在肾皮质肾小管上皮细胞内表达,在模型组它们的表达较假手术组明显减弱且分布面积减少,两组间积分光密度差异具有统计学意义(P<0.05);中药中剂量组、大剂量组、西药蒙诺组Smad6,7蛋白的表达较模型组明显增强、面积增加,积分光密度差异具有统计学意义(P<0.05)。结论:益气活血法可以通过诱导肾组织Smad6,7蛋白表达而抑制肾间质纤维化。     

Semantic-phonologic treatment for noun and verb retrieval impairments in aphasia

Nouns and verbs differ in their neural and psycholinguistic attributes. It is not known whether these differences lead to distinct patterns of response to treatment for individuals with word retrieval impairments associated with aphasia. Eight participants with naming disorders induced by left hemisphere strokes were treated with a semantic-phonologic treatment protocol for nouns and verbs using a single participant multiple baseline design. We measured treatment gains in a picture naming measure and other secondary language and communication measures. Treatment led to improved picture naming for trained nouns and verbs in five of eight patients, with no difference evident between nouns and verbs. Improvements for untrained words were minimal. Improvement in verb retrieval was associated with increases on a functional measure of communicative effectiveness. Improvement for nouns and verbs was associated with severity of word retrieval impairment at onset. Although distinct in neural and psycholinguistic attributes, nouns and verbs were affected by treatment in a similar pattern in this group of individuals. Training-specific effects suggest the need for careful selection of training words to have potential for functional benefit in daily communication.     

人工神经元网络用于复方氯丙嗪的含量测定

将误差反向传播(BP)的人工神经元网络(ANN)模型，用于复方氯丙嗪紫外重叠光谱分 析。对ANN模型的参数进行了优化。采用f(x)二1/(1+e^-x)作为网络节点的输入输出转换函数的三 层神经网络具有较佳性能，当取隐含节点数为15时，该网络预测结果的最小平均相对误差为1.22％， 将研制的ANN模型用于复方氯丙嗪含量测定，其结果与药品标准法和偏最小二乘法(PLs)一致。