新型冠状病毒肺炎疫情下非疫情中心区域耳鼻咽喉头颈外科急诊防护的思考与建议

2019新型冠状病毒（SARS CoV 2）引起的肺炎具有较高的传染性,人群普遍易感,能通过飞沫及接触传播;气溶胶和粪-口等传播途径尚待明确。耳鼻咽喉头颈外科的急诊诊疗存在医患室内近距离接触,检查过程中患者喷嚏、咳嗽和恶心等反应均极易产生携带病毒的飞沫及气溶胶,且医患直接接触机会多,导致医患暴露风险明显增加。非疫情中心区域,大部分耳鼻咽喉头颈外科急诊患者多为无疫区接触及暴露的人群,如何在保障医疗安全和效果的同时,防范于未然、做好防护、避免医患院内感染显得尤为重要。     

The nitric oxide synthase inhibitor, Ng-nitro-l-arginine-methyl-ester, attenuates the delay in gastric emptying induced by hyperglycaemia in healthy humans

Abstract The aim of this study was to determine whether the nitric oxide (NO) synthase inhibitor, N^g‐nitro‐l ‐arginine‐methyl‐ester (l ‐NAME), reverses the effects of acute hyperglycaemia on gastric emptying and antropyloroduodenal (APD) motility. The study had a four‐way randomized crossover (hyperglycaemia vs euglycaemia; l ‐NAME vs placebo) design in a clinical laboratory setting. Seven healthy volunteers [four males; age 30.3 ± 3.8 years; body mass index (BMI) 23.6 ± 1.2 kg m^?2] were the study subjects. After positioning a transnasal manometry catheter across the pylorus, the blood glucose concentration was maintained at either 15 or 5 mmol L^?1 using a glucose/insulin clamp. An intravenous infusion of l ‐NAME (180 μg kg^?1 h^?1) or placebo (0.9% saline) was commenced (T = ?30 min) and continued for 150 min. At T = ?2 min, subjects ingested a drink containing 50 g of glucose made up to 300 mL with water. Gastric emptying was measured using 3D ultrasound, and APD motility using manometry. Hyperglycaemia slowed gastric emptying (P < 0.05), and this effect was abolished by l ‐NAME. l ‐NAME had no effect on gastric emptying during euglycaemia. Hyperglycaemia suppressed fasting antral motility [motility index: 3.9 ± 0.8 (hyperglycaemia) vs 6.5 ± 0.6 (euglycaemia); P < 0.01]; l ‐NAME suppressed postprandial antral motility [motility index: 3.6 ± 0.2 (l ‐NAME) vs 5.1 ± 0.2 (placebo); P < 0.001]. Postprandial basal pyloric pressure was higher during hyperglycaemia (P < 0.001), and lower after administration of l ‐NAME (P < 0.001). Slowing of gastric emptying induced by hyperglycaemia is mediated by NO, and may involve the modulation of tonic pyloric activity.     

人防御素5研究进展

目的　探讨人防御素 5 (humandefensin 5 ,HD 5 )的分子结构、抗菌活性、基因表达等特点 ,展望HD 5作为抗肠源性感染新药的开发前景。方法　采用文献回顾的方法对有关HD 5研究资料进行综合比较和综述。结果　HD 5是一种不含糖链的碱性阳离子多肽 ,相对分子质量为 ( 3～ 5 )× 10 3 ,成熟肽由 32个氨基酸残基组成 ,富含精氨酸、半胱氨酸 ;分子内含有 3对由半胱氨酸形成的二硫键 ,并以此行使其对革兰氏阳性菌、革兰氏阴性菌、真菌、螺旋体、原生动物、有包膜病毒等的抗菌功能。HD 5的编码基因DEFA5位于第 8条染色体P2 1 pter区 ,全长4 4 9bp。其中 1～ 4 0为 5′端非翻译区 ,4 1～ 97为信号肽序列 ,98～ 2 2 6编码HD 5前片段 ,2 2 7～ 32 2为HD 5成熟肽编码序列 ,PolyA序列位于 4 33～ 4 38。 结论　HD 5是一种广谱、高效、不产生耐药性的内源性抗微生物小分子肽 ,如能解决其大量生产的难点 ,则可望成为新型抗肠源性感染新药     

溴杀灵灭鼠效果观察

本文报道了灭鼠经－－溴杀灵在实验室内对小白鼠适口性试验及现场对居民区内家鼠的杀灭观察。试验表明小白鼠对０．０１％溴杀灵毒米的平均摄系数为１．２８,对家鼠的现场杀灭率达８０．８４％,校正杀灭率达８１．８１％。     

VEGF-C和受体Flt-4mRNA在舌鳞癌中的表达及临床意义

目的　研究舌鳞状细胞癌组织中血管内皮生长因子C(vascularendothelialgrowthfactorC ,VEGF C)及其受体VEGFR 3(flt 4 )的表达情况 ,分析其在淋巴转移中的作用。方法　采用RT PCR法分析 2 2例新鲜标本VEGF C/flt 4mRNA的表达情况 ,并统计分析其与各临床病理特点之间的关系。结果　 2 2例中 1 6例VEGF CmRNA表达阳性 ,其中 1 2例flt 4mRNA阳性 ,VEGF C和flt 4mRNA的表达高度一致 (P <0 .0 1 )。舌鳞癌VEGF C明显高于正常组织和良性病变 ;和肿瘤病理分级、肿瘤颈淋巴结转移显著相关 ,和肿瘤发病年龄、性别以及肿瘤T分期无相关性。结论　VEGF C/flt4在舌癌表达高于正常组织和良性病变 ;与肿瘤的预后密切相关。在肿瘤淋巴转移中起重要作用     

Intra‐Articular Biomechanical Changes of the Meniscus and Ligaments During Stance Phase of Gait Circle after Different Anterior Cruciate Ligament Reconstruction Surgical Procedures: A Finite Element Analysis

ObjectiveThe debate on the superiority of single‐ or double‐bundle for anterior cruciate ligament reconstruction has not ceased. The comparative studies on intra‐articular biomechanics after different surgical reconstructions are rare. This study is to evaluate the biomechanical stress distribution intra‐knee after single‐ and double‐bundle anterior cruciate ligament reconstruction by three‐dimensional finite element analysis, and to observe the change of stress concentration under the condition of vertical gradient loads.MethodsIn this study, magnetic resonance imaging data were extracted from patients and healthy controls for biomechanical analysis. Patients included in the three models were matched in age and sex. The strength and distribution of induced stresses were analyzed in two frequently used procedures, anatomical single‐bundle anterior cruciate ligament reconstruction and anatomical double‐bundle anterior cruciate ligament reconstruction, using femoral‐graft‐tibial system under different loads, to mimic a post‐operation mechanical motion. The three‐dimensional finite‐element models for normal ligament and two surgical methods were applied. A vertical force simulating daily walking was performed on the models to assess the interfacial stresses and displacements of intra‐articular tissues and ligaments. The evaluation results mainly included the stress of each part of ligament and meniscus. The stress values of different parts of three models were extracted and compared.ResultsThe stress of ligament/graft at femoral side of three finite‐element models was significantly higher than at tibial side, while the highest level was observed in single‐bundle reconstruction finite‐element model. With the increase of force, the maximum stress in the medial (7.1–7.1 MPa) and lateral (4.9–7.4 MPa) meniscus of single‐bundle reconstruction finite‐element model shifted from the anterior horn to the central area (p = 0.0161, 0.0479, respectively). The stress was shown to be at a lower level at femoral side and posterior cruciate ligament of intra‐knee in two reconstruction finite‐element models than that in normal finite‐element models, while presented higher level at the tibial side than normal knee (p = 0.3528). The displacement of the femoral side and intra‐knee areas in reconstruction finite‐element models was greater than that in normal finite‐element model (p = 0.0855).ConclusionCompared with the single‐bundle technique, the graft of double‐bundle anterior cruciate ligament reconstruction has better stress dissipation effect and can prevent postoperative meniscus tear more effectively.     

Na~+-H~+交换抑制剂在心肌缺血与再灌注损伤中的研究进展

抑制肌膜Na+ H+ 交换能减少心肌缺血与再灌注损伤。动物实验显示 ,Na+ H+ 交换抑制剂能减少心肌缺血与再灌注时的严重心律失常发生率 ,延缓心功能不全的发生 ,限制组织坏死。临床试验显示 ,Na+ H+ 交换抑制剂可减少心肌梗死后再灌注损伤 ,改善左室功能不全的恢复     

人源性空回肠粘膜防御素-5基因的克隆

目的 克隆人防御素-5基因(HD-5 cDNA)，构建其真核表达质粒载体。方法 从人小肠粘膜中提取总RNA，并分离mRNA，经过逆转录．聚合酶链反应(RT-PCR)扩增出HD-5 cDNA，并将其插入经BamH Ⅰ和EcoR Ⅰ双酶切的真核表达质粒载体pcDNA3．1( )中，构建重组质粒载体pcDNA3．1( )-HD5 cDNA。结果 经过限制性酶切鉴定和测序确定，HD-5 cDNA全长282bp，编码94个氨基酸，由编码信号肽、前片段和成熟肽的3部分序列组成。理论推导的氨基酸序列中，决定HD-5活性的6个半胱氨酸残基和2个保守的精氨酸残基处于正确的位置。结论 成功获得了HD-5 cDNA，构建了含HD-5 cDNA的真核表达质粒载体，为研究重组HD-5的抗菌功能奠定了基础．     

高效抗凝血杀鼠剂氯鼠酮的性能和应用

要本文报告了抗凝血杀鼠剂氯鼠酮的生物活性和灭鼠性能,观察了实验室和现场大面积推广应用的灭鼠效果。试验结果表明,该药对生物无致癌,畸变和突变反映,对皮肤和粘膜无明显的刺激性,使用安全。现场使用50ppm毒饵,饱和投饵7天,检查校正灭鼠率为95.22～96.5％。3年多来,通过全国几个省市大面积灭鼠效果考核,结果证明,该药对鼠类毒力强,使用浓度低,适口性好,杀灭鼠种广谱,灭鼠效果好,成本较低,有推广使用价值。