复方补肾活血颗粒对肾虚血瘀证绝经后非老年骨质疏松症患者视觉模拟评分和骨密度影响的临床观察

目的观察复方补肾活血颗粒对绝经后非老年骨质疏松症患者视觉模拟评分(Visual Analog Scale,VAS)和骨密度(Bone Mineral Density,BMD)的影响。方法研究对象选自2015年6月-2015年12月在本院诊治的肾虚血瘀证绝经后非老年骨质疏松症患者60例,将患者按照随机函数随机分为两组(对照组和治疗组),每组30例。两组均给予一般治疗,对照组予仙灵骨葆胶囊治疗,治疗组予复方补肾活血颗粒。两组观察时限均为6个月,治疗前后需按照研究方案定期计算中医证候积分,BMD和VAS等指标。结果临床观察表明,复方补肾活血颗粒治疗组中医证候有效率为90%,对照组为60%,与对照组相比,疗效明显优于对照组(P0.01)。治疗组中医证候积分为7.96±3.86分,对照组为10.16±3.85分,两组比较具有统计学差异。治疗后治疗组BMD和VAS分别为2.24±0.55 g/cm~2、1.96±1.47分,对照组为2.50±0.41 g/cm~2、2.86±1.79分,治疗组改善情况优于对照组。结论复方补肾活血颗粒能显著改善绝经后非老年骨质疏松症患者中医临床症状、BMD和VAS,未见不良事件的发生,复方补肾活血颗粒治疗绝经后非老年骨质疏松症是安全有效的。     

α-骨化醇治疗绝经后骨质疏松患者的疗效观察

目的：观察α-骨化醇治疗对绝经后骨质疏松症患者的临床疗效。方法120例绝经后骨质疏松患者随机分为α-骨化醇治疗组（治疗组）及安慰剂对照组（对照组），治疗1年，分别在治疗前、后检测患者骨密度。结果试验后两组患者骨密度均降低，对照组试验后骨密度显著低于试验前（P＜0．05），但试验组骨密度显著高于对照（P＜0．05）。结论α-骨化醇可有效治疗绝经后骨质疏松。     

基因表达谱芯片分析续苓健骨方治疗去卵巢大鼠骨质疏松症的基因表达差异

目的 基因表达谱芯片筛选续苓健骨方治疗骨质疏松症模型大鼠的差异表达基因。方法 将15只大鼠按随机数法分为3组：假手术组、模型组、续苓健骨方组,每组5只。去卵巢造模后1周开始灌胃给药,实验组按照体重给予续苓健骨方,另外两组灌胃与实验组等体积的生理盐水,给药连续13周,每日1次。13周后取大鼠左腿股骨进行基因表达谱芯片检测,分析芯片得到组间差异表达基因并进行功能和通路分析。结果 以丨log2 Fold change丨≥1,q＜0.05为条件筛选出10个造模后表达显著降低但用药后显著提高的基因,218个造模后表达显著提高但用药后表达显著降低的基因。KEGG信号通路富集分析发现PI3K/Akt通路是关键作用通路之一。设置条件（丨log2 Fold change丨≥2,q＜0.01）进一步筛选获得差异基因Rplp0和Cnpy2。结论 续苓健骨方的治疗作用机制可能与PI3K/AKT信号通路及Rplp0、Cnpy2基因相关。     

续苓健骨方对骨质疏松模型大鼠miRNA表达谱的作用研究

目的通过分析骨质疏松症大鼠模型miRNA表达谱变化,探讨续苓健骨方治疗骨质疏松症的分子机制。方法建立去卵巢法骨质疏松模型大鼠12只,分为模型组6只、续苓健骨方组6只。假手术组6只为对照。造模1个月后,续苓健骨方灌胃12周,检测大鼠胫骨骨密度,检测腰椎miRNA表达谱,对差异表达的miRNAs进行生物信息学分析。结果与假手术组比较,模型组腰椎miRNAs 58条显著下调、97条显著上调;与模型组比较,续苓健骨方组腰椎miRNAs下调的50条显著上调、上调的60条显著下调;与假手术组比较,续苓健骨方组腰椎miRNAs仅8条有差异。生物信息学分析发现,差异miRNAs靶基因主要参与HIF-1、甲状腺激素、Hedgehog、GnRH、自噬、c AMP及MAPK等信号通路。结论建立了续苓健骨方治疗骨质疏松模型大鼠的miRNA表达谱;差异miRNAs可能通过调控HIF-1、甲状腺激素、Hedgehog、GnRH、自噬、c AMP及MAPK等信号通路参与续苓健骨方对骨质疏松大鼠的治疗过程。     

基于辨证论治结合网络药理学探析六味地黄丸治疗绝经后骨质疏松症作用机制

目的 基于临床试验结合网络药理学探析六味地黄丸治疗绝经后骨质疏松症的作用机制。方法 ①将60例肾阴虚证绝经后骨质疏松症患者随机分为治疗组和对照组,两组患者在口服维生素D和钙剂的同时,治疗组口服六味地黄丸、对照组口服雷洛昔芬,治疗6个月后测定并比较两组患者腰椎（L1～4）、右侧股骨颈骨密度值、血清骨钙素(OCN)及血清抗酒石酸酸性磷酸酶-5b（TRAP-5b）水平。②依据TCMSP数据库筛选出六味地黄丸活性成分及其对应的靶点,通过GeneCards、OMIM、Drugbank 3个数据库获取绝经后骨质疏松症相关靶点,将活性成分靶点与绝经后骨质疏松症相关靶点取交集所得靶点即为六味地黄丸治疗绝经后骨质疏松症靶点。采用Cytoscape3.7.2软件构建活性成分、靶点以及蛋白间的相互作用网络,使用STRING数据库进行PPI网络分析,运用Metascape数据分析平台进行GO生物过程富集以及KEGG通路富集分析。结果 与治疗前比较两组均可提升骨密度,反映骨形成指标的OCN值明显升高,骨吸收指标的TRAP-5b值则明显降低,且治疗组优于对照组（P＜0.05）。而通过网络药理学预测显示六味地黄丸作用于绝经后骨质疏松症的活性成分有36个,位居前三位的活性成分为槲皮素、山奈酚、儿茶素,主要靶点为干扰素调节因子-1（IRF1）、抑瘤素M（OSM）、白介素6（IL-6）。GO富集分析显示,生物过程主要涉及到细胞因子介导的信号通路、细胞凋亡信号通路等;细胞组成主要包括蛋白激酶复合物、质膜蛋白复合物等;分子功能主要包括转录因子结合、核受体活性等。KEGG富集分析获取相关信号通路为JAk-STAT、Wnt及NF-κB信号通路。结论 六味地黄丸可显著增加骨密度、促进骨形成、抑制骨吸收,而其作用机制在于应用槲皮素、山奈酚、儿茶素等活性成分,以IRF1、OSM及IL-6为主要靶点,通过JAk-STAT、Wnt及NF-κB等信号通路发挥改善绝经后骨质疏松症的作用。     

健骨颗粒抗去卵巢大鼠骨质疏松的血清代谢组学研究

目的 运用代谢组学方法从物质代谢角度探讨健骨颗粒治疗绝经后骨质疏松症的机制。 方法 60只大鼠随机分为正常组、模型组和健骨颗粒组，健骨颗粒组给予健骨颗粒药液灌胃，其余组分别给予等量生理盐水灌胃干预。分别于术后6周和12周取股骨、胫骨、腰椎骨进行骨密度及骨生物力学检测，取腹主动脉血进行液相色谱-质谱（LC-MS）检测，综合单变量和多变量统计分析，鉴定并筛选血清代谢物。结果 模型组较正常组骨密度和骨最大载荷显著下降，健骨颗粒组与模型组相比明显恢复，表明造模成功且健骨颗粒组有恢复正常的趋势。模型组血清代谢谱与正常组分离，健骨颗粒组接近正常组。筛选出硬脂酸、皮质酮及泛酸等27个差异代谢物，分别与不饱和脂肪酸、类固醇激素的生物合成及泛酸和辅酶A生物合成等通路有关，涉及脂代谢、核酸代谢及氨基酸代谢等。结论 健骨颗粒可能通过调节多种代谢通路改善绝经后骨质疏松症。     

绝经后骨质疏松症中医证型与握力的研究

目的探讨绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者中医证型与握力的关系。方法选取2017年11月至2018年10月在济南各社区及山东中医药大学附属医院骨质疏松门诊纳入的绝经后骨质疏松症女性142例(骨质疏松组)、绝经后非骨质疏松症女性39例(非骨质疏松组)。依照中医辨证分型将骨质疏松组患者分为肝肾阴虚、脾肾阳虚及肾虚血瘀三型,采集所有受试者一般指标,研究握力在绝经后骨质疏松症中医证型上是否存在差异。结果骨质疏松组年龄、绝经年限高于非骨质疏松组,差异有统计学意义(P<0.05),骨质疏松组身高、体重、体质量指数(body mass index,BMI)、握力和骨密度(bone mineral density,BMD)水平均低于非骨质疏松组,差异有统计学意义(P<0.05)。三组中医证型的年龄、绝经年限、身高、BMI比较差异无统计学意义(P>0.05),肝肾阴虚组体重大于脾肾阳虚组,差异有统计学意义(P<0.05)。三组中医证型的握力由大到小依次为肝肾阴虚组、肾虚血瘀组、脾肾阳虚组,三组之间两两比较均有统计学意义(P<0.05)。结论脾肾阳虚型骨质疏松症患者握力较低,脾肾对肌力的影响具有普遍性的意义。     

右归丸对绝经后骨量减少肾阳虚型的临床研究

摘要：目的 观察右归丸对绝经后骨量减少肾阳虚型的临床研究。方法 选取2020年10月-2021年6月在陕西中医药大学附属医院康复医学科接受治疗的绝经后骨量减少肾阳虚型患者81人，通过随机数字法分为治疗组（n=40）和对照组（n=41），对照组口服碳酸钙维D3片及行温针灸，治疗组在对照组基础上加服右归丸，总疗程为12周。对比治疗组及对照组治疗后总有效率、治疗前和治疗后骨代谢标志物[（血清骨钙素（BGP）、25-羟维生素D3、β胶原降解产物（β-CTX）、Ⅰ型前胶原氨基端前肽（PINP）]、性激素[促黄体生成素（LH）、血清雌二醇（E2）、促卵泡激素（FSH）]水平变化、生活质量量表躯体健康总评分（PCS）、左髋关节和L1~4的骨密度（BMD）、中医证候评分和不良反应率。结果 治疗后对照组与治疗组总有效率分别为71.05 %、86.84 %（P<0.05）；治疗后两组患者骨代谢标志物水平、中医证候评分均显著低于治疗前，且治疗组较对照组显著降低（P<0.05）；治疗后两组患者BMD、LH、E2、FSH水平、PCS评分均较治疗前显著提高，且治疗组显著高于对照组（P<0.05）；治疗组不良反应发生率为（3/38）7.89 %，对照组为（2/38）5.26 %（P>0.05）。结论 右归丸治疗绝经后骨量减少肾阳虚型患者疗效较好，能够降低中医证候评分，增加骨密度，调节骨代谢，提高PCS评分，改善生活质量，且不良反应较少，值得临床推广。     

护骨胶囊治疗肾精亏虚证原发性骨质疏松症的随机对照临床试验

目的评价护骨胶囊治疗肾精亏虚证原发性骨质疏松症的有效性和安全性。方法将158例肾精亏虚证原发性骨质疏松症患者随机分为试验组79例,给予口服护骨胶囊治疗;对照组79例,给予口服仙灵骨葆胶囊治疗。两组患者均治疗12周。观察比较治疗前后SF-36量表各维度评分、骨密度(bone mineral density,BMD)值、疼痛视觉模拟评分(visual analogue pain score,VAS)、中医证候评分以及安全性情况。结果①基线期试验组与对照组受试者年龄、身高、体重、性别、骨密度值、疼痛评分、SF-36问卷量表维度评分、中医证候量表总分、中医证候单项评分等指标在两组间分布均衡(P0.05)。②SF-36量表各维度评分用药前后的变化:试验组治疗后总体健康维度评分较治疗前显著上升,差异有统计学意义(P0.05);而对照组的总体健康评分前后对比,差异无统计学意义(P0.05)。而且治疗后,两组躯体健康、躯体功能角色、社会功能、躯体疼痛维度的评分较治疗前均上升,差异有统计学意义(P0.05)。③骨密度测定值:试验组腰椎L2、L3、L4部位及腰椎L2-L4平均骨密度测定值治疗前后对照,差异均无统计学意义(P0.05)。对照组腰椎L2、L3、L4部位骨密度测定值治疗前后对照,差异均无统计学意义(P0.05),腰椎L2-L4的骨密度值治疗后较治疗前下降,差异有统计学意义(P0.05)。④疼痛评分:试验组与对照组疼痛评分较基线时均有明显降低,两者比较差异无统计学意义。⑤中医证候量表评分:试验组和对照组均能降低中医证候量化评分,两组组间比较差异无统计学意义。⑥安全性:试验期间发生的不良事件中,被判定为药物不良反应的有6例,其中试验组为1例(1.47%),对照组为5例(7.46%)。结论肾精亏虚证原发性骨质疏松症患者服用护骨胶囊后,显示有良好的治疗效果,且不良反应较少,安全性较佳。     

温针灸联合青娥丸对绝经后骨量减少肾虚血瘀证的疗效

目的研究温针灸联合青蛾丸治疗绝经后骨量减少肾虚血瘀证的临床疗效。方法对2019年6月-12月于武汉市中医医院接受治疗的80例绝经后骨量减少肾虚血瘀证患者进行分析。分为两组,每组各40例。对照组予以青蛾丸治疗,试验组在青蛾丸治疗的基础上辅以温针灸疗法,比较两组的临床疗效、骨代谢标志物水平、性激素水平、骨密度及不良反应。结果试验组(92.50%)总有效率显著高于对照组(72.50%),差异有统计学意义(P0.05);治疗后两组患者BGP、25-羟维生素D_3、β-CTX、PⅠNP、LH、E_2、FSH及骨密度均优于同组治疗前,同时试验组优于对照组(P0.05);对照组与试验组不良反应发生率比较差异无统计学意义(P0.05)。结论在青娥丸治疗的基础上辅以温针灸治疗绝经后骨量减少肾虚血瘀证的效果更优,骨量丢失情况得以明显改善,并且不会增加不良反应的发生率。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.