高压氧对脑缺血再灌注大鼠的海马诱导型一氧化氮合酶mRNA表达的影响

目的　观察高压氧对脑缺血再灌注大鼠的海马诱导型一氧化氮合酶信使核糖核酸 (iNOSmRNA)表达的影响。方法　将 5 4只大鼠随机分为脑缺血再灌注组 (IR组 )、脑缺血再灌注加高压氧处理组(HBO组 )和对照组 ,建立脑缺血再灌注大鼠动物模型。应用荧光定量逆转录 聚合酶链反应 (RT PCR )技术检测各组在再灌注 6h、2 4h、48h、96h时相点大鼠的海马iNOSmRNA表达。结果　再灌注各时相点的IR组和HBO组的海马iNOSmRNA表达均显著高于对照组 (均P <0 .0 1) ;HBO组大鼠再灌注 2 4h、48h、96h时海马iNOSmRNA表达均显著低于IR组 (P <0 .0 5 ,P <0 .0 1,P <0 .0 1)。结论　高压氧治疗可以显著抑制再灌注后大鼠海马iNOSmRNA表达 ,从而减少延迟性NO的产生 ,有助于减轻脑缺血再灌注损伤。     

一氧化碳中毒临床治疗指南(一)

急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)是常见的中毒之一,也是急性中毒死亡的最主要原因.为指导我国现场救治及临床医生及时、规范、有效地抢救治疗ACOP患者,减轻缺氧性损伤,减少迟发脑病发生率,笔者通过收集和分析已经完成的国内外有关ACOP抢救治疗文献,以循证医学证据为基础,采用国际通用的方法,多次与临床医生反复认真讨论,并经有关专家审议,做出了比较客观科学的结论,以期规范ACOP诊断和治疗.指南中的推荐意见依据2001年国际感染论坛提出的Delphi分级标准(表1),将指南中涉及的文献按照研究方法和结果分成Ⅰ～Ⅴ级5个层次,推荐意见的推荐级别分为A～E级,A级为最高.     

主动脉夹层手术的麻醉管理

<正>本研究对StanfordA型主动脉夹层动脉瘤患者手术中麻醉管理的方法进行总结,并探讨术中对器官的保护措施,以降低术后并发症的发生。1资料与方法1.1一般资料选择2009年2月—2010年12月于本院心外科行主动脉夹层动脉瘤手术患者7例,男性5例,女性2例,     

七氟醚在体外循环冠状动脉旁路移植术中的心肌保护作用

冠状动脉旁路移植术（GABG）是常见的心脏手术,患者的冠状动脉狭窄阻塞,心肌长期慢性缺血缺氧,导致心肌细胞对缺血缺氧的耐受能力差,因此术中保证氧供需的平衡,预防缺血缺氧的发生,充分的心肌保护尤为重要,而七氟醚是目前临床中对心血管的抑制最轻的吸入性麻醉药,而且七氟醚具有可控性好,比较安全、有效,     

散发型克雅病1例并文献复习

正克雅病(Creutzfeldt-Jakob disease,CJD)最早在1929年由Creutzfeldt和Jakob先后报道,是最常见的一种朊蛋白病。现今全世界已有50多个国家和地区发现CJD,年发病率1~2/100万。此病临床较为少见,常表现为快速进展的认知障碍但不典型,容易误诊,暂无有效治疗方法,但同样以认知障碍发病的其他疾病或可有较好的预后,故临床工作中应重视认知障碍患者的诊断及鉴别诊断,避免错过可治     

吗啡加入心肌停跳液中在瓣膜置换术围术期心肌保护作用的研究

目的:吗啡加入心肌停跳液中在瓣膜置换术围术期心肌保护作用的研究。方法:20例行瓣膜置换术的患者随机均分成2组:吗啡组,心肌停跳液中加吗啡2μmol/L;对照组,停跳液中未加吗啡作为对照。比较2组心肌细胞凋亡率、细胞超微结构变化、术后低心排和严重心律失常发生率、拔除气管导管时间、ICU停留时间、平均住院天数,测定主动脉开放后2、12、24小时磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)水平。结果:2组术后心肌细胞凋亡率均较术前显著增加(P<0.01),但吗啡组较对照组明显减少(P<0.05)。吗啡组在主动脉开放后2、24小时的血cTnI的水平较对照组明显降低(P<0.05)。结论:心肌停跳液中加入一定剂量的吗啡对瓣置换术者缺血再灌注心肌功能有显著保护作用。     

CD44s和CD15在前列腺癌组织中的表达及其意义

Objectives To investigate expression of cell adhesion molecule CD44 sand CD15 in prostate carcinoma(PCa), and to evaluate its clinical significance. Methods Forty two cases of PCa and 15 of benign prostate hyperplasia(BPH) were detected by immunolhistochemical technique and the intensity of CD44s and CD15 expression was assessed by computer image analysis system. Results (1) The intensity of CD44s expression was significantly lower in PCa than that in BPH. PCa showed significant loss of CD44s expression, which correlated with the rise of tumor Gleason grade and clinical stage( p＜0.01 ), The intensity of CD44s expression was significantly lower inmetastasis group than that in nonmetastasis group( p ＜ 0.01 ). (2)The intensity of CD15 expression was significantly higher in PCa than that in BPH. The upregnlation of the CD15 correlated with the rise of tumor Gleason grade and clinical stage( p＜0.01 ). The intensity of CD15 expression was significantly higher in metastasis group than in nonmetastasis group. (3)There was significant reverse correlation between the expression level of CD44s and CD15 (r = -0.785, p＜0.001). Conclusions Aberrant expressions of CD44s and CD15 may be correlated with clinical stage, Gleason grade and metastasis in PCa. CD44s and CD15 play an important role in the malignant progression of PCa, and could be used as a marker of malignant potention and prognosis of patient with PCa.     

Effects of hyperbaric oxygen on TF、TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head

Objective To investigate dynamic changes in serum TF and TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head ( SANFH) and also to explore the mechanism of SANFH, as well as effects of hyperbaric oxygen ( HBO) on SANFH. Methods Seventy-eight New Zealand male rabbits were randomly divided into 3 groups:the normal control (group N) (7 animals), the model group (group M) (41 animals) and the HBO group (group H) (30 animals). The model group was subdivided into the immediate model group (the M0 group) (10 animals), the two-week model group (the M2 group) (10 animals), the four-week model group (the M4 group) (10 animals) and the six-week model group (the M6 group) (11 animals). The HBO group was further divided into the 2-week HBO therapy group (HBO2) (7 animals), the 4-week HBO therapy group (HBO4) (11 animals) and the 6-week HBO therapy group (HBO6) (12 animals). Through injection of endotoxin and methyl-prednisolone, rabbits in the group HBO2, HBO4 and HBO6 received HBO therapy 1 hour daily from the second day of the experiment. The durations of HBO therapy were 2 weeks ( HBO2), and 4 weeks respectively. The animals were sacrificed after blood samples were taken at respective blood collection time. Then, levels of TF, TNF-α in the serum were measured and the histological changes in the femoral heads were observed. Results Levels of TF and TNF-α in group M0 increased significantly, when compared with those of group N (P ＜0. 05 or P ＜0.01), while for the HBO subgroups the expression of TF and TNF-α measured at the same time points all decreased, when compared with that of the model subgroups (P＜0. 05 or P ＜0.01). To elaborate, TF levels in group M2 and M4 were much higher than those in group HBO2 and HBO4 ( P＜0. 01 ). TF level in group M6 was higher than that in group HB06 ( P ＜ 0.05). TNF-α in group M0 also increased significantly, when compared with that in group N( P ＜0.01). TNF-α levels in group M2 and M6 were also much higher than those in group HBO2 and HBO6 ( both P ＜0. 01 ). TNF-α in group M4 was higher than that in group HBO4 (P＜0.01). Histological examination revealed that tissues of the femoral heads in group N were normal, osteonecrosis and thrombus could be noted in group M2 and M4, hyperplasia fibrosis could be found in group M6, and osteonecrosis in HBO2 and HB04 groups seemed less severer than that in M2 and M4 groups, no thrombi in HBO2, HBO4 groups were noted, and growth of new bones were detected in HBO4 and HBO6. Conclusions The levels of TF and TNF-α levels increased in the rabbit model of SANFH, inducing blood coagulation. Thrombosis at the femoral heads was one of the causes of SANFH. HBO therapy could inhibit the release of TF and TNF-α, thus improving the abnormality of blood coagulation and enhancing treatment of osteonecrosis.