不同钙浓度透析液对血液透析患者透析前后电解质变化的影响及其相关关系

目的:研究两种不同钙浓度透析液对维持性血液透析患者透析过程中电解质的影响及其相关关系。方法:筛选中山大学附属第五医院和浙江省立同德医院血液净化中心维持性血液透析患者共160人,分别使用两种不同钙浓度(1.75 mmol/L和1.25 mmol/L)的透析液进行透析,即普通钙组和低钙组,检测透析前后血清电解质,并进行部分电解质间的相关分析。结果:(1)两组透析后血清总钙(t Ca)显著升高,血K+、Mg2+、Cl-、P、HCO3-均显著降低(P0.01)。和普通钙组相比,低钙组透后t Ca显著下降,K+、Cl-、HCO3-显著增加(P 0. 01)。透析后血P和Mg2+在两组间无统计学意义(P0.05)。血Na+在普通钙组透后显著降低(P0.01),在低钙组透析前后差异无统计学意义(P=0.71)。(2)血清t Ca与Na+、K+、Cl-均呈显著负相关,而与Mg2+、P无显著相关性,Cl-与HCO3-呈显著正性相关。结论:不同钙浓度透析液影响透后血钙、钠、钾、氯的变化,但不影响血磷和镁水平。1.75 mmol/L钙浓度透析液会增加钙负荷,故临床维持性血透患者应个体化选择不同钙浓度透析液。     

不同体位对经尿道前列腺等离子双极电切术患者术中冲洗液吸收的影响

目的:观察头低足高截石体位(LP)对接受经尿道前列腺等离子双极电切术(PKRP)患者术中冲洗液吸收的影响。方法:80例BPH患者,择期在腰硬联合麻醉下行PKRP术,随机分为两组,每组40例:0°LP组,常规截石体位,手术床保持水平;-10°LP组,常规截石体位,手术床头低足高倾斜10°。采用含1%乙醇的生理盐水溶液作为术中冲洗液。手术开始即刻,以及随后每10 min应用数字乙醇检测仪对患者呼出气中乙醇浓度进行测试并记录。同时记录两组手术时间,手术期间静脉输注晶体及胶体液量和切除前列腺组织的重量。监测并记录患者的平均动脉血压(MAP)和心率(HR),比较两组患者手术开始前5 min,开始后30 min,手术结束时的MAP和HR。通过动脉血气分析,测定手术开始前、开始后1 h动脉血Na^+、K^+、Cl^-、Ca^2+浓度。结果:两组患者年龄、身高、体重、前列腺体积等无显著差异,术中各时间点MAP和HR亦无显著差异。与术前5 min相比,0°LP组患者手术开始后1 h测得K^+及Ca^2+浓度显著低于术前水平[K^+:(3.49±0.33)mmol/L vs(3.64±0.29)mmol/L,P=0.002;Ca^2+:(1.13±0.04)mmol/L vs(1.16±003)mmol/L,P=0.001],Cl-浓度显著高于术前水平[(108.7±2.3)mmol/L vs(106.9±2.2)mmol/L,P=0.006],而Na^+浓度无明显变化[(139.4±1.6)mmol/L vs(139.7±1.5)mmol/L,P=0.231]。-10°LP组患者Ca^2+浓度低于术前[(1.13±0.04)mmol/L vs(1.14±0.04)mmol/L,P=0.016],Na^+[(140.0±2.0)mmol/L vs(140.3±1.8)mmol/L,P=0.156]、K+[(3.47±0.34)mmol/L vs(3.49±0.36)mmol/L,P=0.506]及Cl^-[(109.1±2.5)mmol/L vs(108.2±2.6)mmol/L,P=0.071]浓度均无明显变化。0°LP组有6例患者(15%),-10°LP组有4例(10%)患者术中冲洗液吸收量>1500 ml,两组比较无统计学差异。结论:头低足高倾斜10°截石位,显著减轻PKRP手术导致的K^+降低,Cl^-升高,但不影响其他电解质变化。     

前列腺液白细胞计数在慢性前列腺炎诊断中的意义

目的　探讨慢性前列腺炎患者前列腺液白细胞计数在诊断中的意义。　方法　门诊慢性前列腺炎患者 75例 ,测定前列腺按摩液 pH(EPS pH)并送常规检查 ,膀胱充盈后经腹行前列腺B超检查。　结果　EPS pH 6 .4～ 7.7,平均 6 .9± 0 .4;EPS白细胞数量 (EPS WBC) 3～ 38个 /HP ,平均(18.2± 8.8)个 /HP。前列腺B超阳性率 6 0 % (4 5 / 75 )。EPS pH值和B超诊断慢性前列腺炎的阳性率与前列腺EPS WBC呈正相关 (P <0 .0 1) ,与患者年龄、病程无相关性 (P >0 .0 5 )。分组比较显示EPD pH随EPS WBC增多而增高 (P <0 .0 1) ,并逐渐接近或稍超过血浆pH。随EPS WBC增多 ,B超诊断慢性前列腺炎的阳性率先增加 ,后维持不变。EPS WBC与患者年龄、病程无相关性 (P >0 .0 5 )。　结论　慢性前列腺炎患者EPS WBC计数与前列腺超声异常和EPS pH升高呈正相关 ,对慢性前列腺炎的诊断和治疗有指导意义     

慢性前列腺炎细菌及免疫学研究

目的　了解慢性前列腺炎细菌感染情况 ,提高治疗水平。　方法　对 132例慢性前列腺炎患者行尿及前列腺液细菌五步培养法、药物敏感试验及前列腺液免疫球蛋白IgA和lgG测定 ,并根据药敏试验结果对部分患者进行治疗。　结果　前列腺液细菌培养阳性者 74例 ,其中金黄色葡萄球菌 32例 (耐药金黄色葡萄球菌 5例 ) ,表皮葡萄球菌 17例 ,大肠杆菌 10例 ,其它细菌 15例 ;细菌培养阴性者 5 8例。细菌培养阳性者前列腺液中IgG和IgA分别平均为 1.12 g/L和 0 .32 g/L(n =34 ) ,显著高于细菌培养阴性者 (0 .2 3g/L和 0 .0 2 g/L ,n =37;P =0 .0 31和P =0 .0 36 )。　结论　慢性前列腺炎患者前列腺液细菌培养阳性率较高 (5 6 .1% ) ,以革兰阳性菌多见 (6 6 .2 % ) ,细菌可能来源于女性生殖道。下尿路细菌定位诊断可简化为“两杯法”。前列腺液细菌培养阳性者的前列腺液中免疫球蛋白IgG和IgA水平较高     

慢性前列腺炎合并男性不育患者精浆生化指标的变化

目的探讨慢性前列腺炎(CP)所致男性不育患者精液生化指标以及电解质的变化。方法自门诊选择无CP正常生育健康志愿者对照组(A组)17例;以及慢性前列腺炎患者54例,按精液液化时间分为B组(液化时间正常组)和C组(延迟液化组),分别测定精浆中前列腺特异性抗原、酸性磷酸酶、唾液酸以及果糖的浓度,并测定钾、钠、钙、氯等浓度。结果正常生育组、CP液化正常组及CP液化异常组精浆PSA浓度有显著性差异(P<0.001)。K 浓度有差异性(P<0.05)。Ca2 浓度有差异性(P<0.05)。PAP浓度无统计学意义(P>0.05)。唾液酸以及果糖浓度无差异性(P>0.05)。Na 浓度无差异性(P>0.05)。Cl-浓度无差异性(P>0.05)。结论CP所致男性不育患者与健康正常组相比,精浆PSA以及K 、Ca2 存在差异。     

慢性前列腺炎患者EPS中IL-2、IL-10和TNF-α的表达的临床意义

目的 探讨慢性前列腺炎患者前列腺液中TNF-α、IL-10和IL-2的表达在慢性前列腺炎中发病的作用,评估这些细胞因子的变化与慢性前列腺炎分类、症状和前列腺液白细胞计数的关系.方法 通过尿常规、前列腺液常规检查、两杯法尿液细菌培养和NIH-CPSI评分,将58例前列腺炎患者按NIH前列腺炎诊断标准进行分型.采用双抗体夹心ELISA法检测患者及12例正常对照组前列腺液中的IL-2、TNF-α、IL-10的含量.用SPSS for Windows 12.0统计软件对测革数据进行统计学分析.结果 对照组、Ⅱ型、Ⅲ a型及Ⅲ b型CPPS患者EPS中TNF-αQ水平分别为(17.8±9.2)pg/ml、(91.5±34.8)pg/ml、(74.9±35.1)pg/ml、(23.9±12.9)pg/ml,IL-10水平分别为(234.9±56.6)pg/ml、(392.7±62.4)pg/ml、(364.1±77.1)pg/ml、(300.4±80.2)pg/ml,IL-2水平分别为(311.4±67.5)pg/ml、(247.7±96.1)pg/ml、(278.2±77.6)pg/ml、(299.7±78.6)pg/ml.Ⅱ型、Ⅲ a型患者EPS中TNF-α和IL-10水平与对照组及Ⅲ b犁比较差异均有统计学意义(P＜0.05),各型CP患者EPS中IL-2水平均低于对照组,但Ⅱ型与对照组比较差别有统计学意义(P＜0.05).TNF-a含量和白细胞计数呈正相关性(r=0.772,P＜0.01),而IL-10含量与患者疼痛评分呈正相关(r=0.549,P＜0.01).结论 慢性前列腺炎患者EPS中TNF-α、IL-10和IL-2表达变化,提示它们参与了前列腺的炎症反应.TNF-α、IL-10有可能成为CP诊断分型的一个依据,而IL-10水平有可能作为患者疗效评估的一个指标.     

慢性前列腺炎/慢性盆腔疼痛综合征病人对抗生素治疗反应预测因素的前瞻性多中心临床试验

抗生素治疗是对所有类型慢性前列腺炎 /慢性盆腔疼痛综合征最常用的治疗选择。作者确定将前列腺按摩前尿液ＶＢ2、前列腺液、前列腺按摩后尿液ＶＢ3的培养、前列腺标本白细胞和 (或 )抗体用于预测病人对抗生素治疗的反应。临床诊断为慢性前列腺炎 /慢性盆腔疼痛综合征的病人按照ＮＩＨ制定的下尿路的评价标准 ,包括显微镜检查、前列腺特异标本培养、并确定ＶＢ3和ＶＢ2的抗前列腺病原体的抗体水平 (酶联免疫吸附方法 )比率。症状评价包括 :ＮＩＨ慢性前列腺炎症状指数疼痛评分 0～ 2 1,症状严重指数评分 0～ 10 0 ,症状频率调查表评分 0～ 5…     

透析液碳酸氢根浓度对透析中血清钾离子浓度的影响

目的 分析使用不同碳酸氢根(HCO3)浓度透析液对慢性维持性血液透析患者透析过程中血清钾离子(K+)浓度下降程度的血液动力学影响.方法 8例稳定血液透析患者进入临床试验,采取双盲、随机、3阶段、交叉对照的设计方案,透析液碳酸氢根浓度制定为:低浓度透析液(LB,27mmol/L)、标准浓度透析液(SB,35 mmol/L)、高浓度透析液(HB,39 mmol/L),每次透析过程血流量均为300 ml/min,透析液流量为500 ml/min,分别在0(基础值)、15、30、60和240 min从透析管路动脉端留取血标本做血液生化检测和血气分析.对血液透析后1 h的血清K+浓度以及通过透析K+的清除量进行检测.每例患者完成3次检测,每次试验检测过程中有1周的实验间期.结果 在低浓度透析液组(LB组),K+浓度从[(5.4±0.26)mmol/L,基础值在15、30、60和240min时分别下降至(4.89±0.25)mmol/L、(4.89±0.22)mmol/L、(4.54±0.25)mmol/L和(4.26±0.44)mmol/L;在标准浓度透析液组(SB组),K+浓度从[(5.38±0.29),基础值]mmo/L在15、30、60和240min时分别下降至(4.89±0.24)mmol/L、(4.43±0.22)mmol/L、(4.08±0.23)mmol/L和(3.90±0.30)mmol/L;在高浓度透析液组(HB组),K+浓度从[(5.38±0.23)mmol/L,基础值在15、30、60和240 min时分别下降至(4.71±0.38)mmol/L、(4.38±0.33)mmol/L、(3.72±0.34)mmol/L和(3.32±0.16)mmol/L,其中高浓度与低浓度和标准浓度(HCO3)在60和240 min时点比较差异有统计学意义(P＜0.05);除了LB组,其他两组中血清K+浓度和HCO3比较差异有统计学意义(P＜0.05);对于LB组、SB组和HB组透析液,血清K+浓度的反弹率分别为(4.0±9.2)%、(5.2±3.2)%、(7.2±3.4)%.每次透析K+的清除量LB组为119.5±22.6(mmol/L)、SB组为85.5±14.9(mmol/L)、HB组为95.6±15.5(mmol/L).结论 高浓度透析液与在透析过程中血清K+的快速清除相关,该清除过程是因为加强了K+从细胞外移至细胞内的过程,而不是通过透析本身对K+的清除.     

慢性前列腺炎患者前列腺液IL-6和IL-8表达变化及意义

目的　探讨慢性前列腺炎患者前列腺液中IL 6和IL 8的变化与慢性前列腺炎类型、症状和前列腺液白细胞计数的相关关系。　方法　以两杯法尿液细菌培养、前列腺液常规检查和NIH CPSI评分 ,将 10 2例前列腺炎患者分型。放免分析法测定患者和 2 8例正常对照者前列腺液中IL 6和IL 8含量 ,比较结果并进行相关分析。　结果　 90例前列腺炎患者 (Ⅱ、ⅢA、Ⅳ型 )前列腺液IL 6和IL 8水平分别为 ( 0 .5 1± 0 .5 7)ng ml和 ( 10 .75± 7.96 )ng ml,高于正常对照组的 ( 0 .32± 0 .5 1)ng ml和( 4.5 6± 5 .6 8)ng ml(P <0 .0 5和P <0 .0 1)。Ⅱ型前列腺炎患者前列腺液IL 6和IL 8水平与ⅢA型和Ⅳ型者比较差别无显著性意义 (P >0 .0 5 )。前列腺炎患者前列腺液白细胞计数与IL 8水平呈正相关(r=0 .5 2 9,P <0 .0 1)。前列腺液IL 6和IL 8水平与NIH CPSI评分无相关性 (P >0 .0 5 )。　结论　慢性前列腺炎患者前列腺液IL 6和IL 8表达增高 ,并参与前列腺的炎症反应。前列腺液IL 6和IL 8水平可作为慢性前列腺炎的诊断依据之一。     

未成熟心肌停搏液成分的实验研究

目的　探讨停搏液中Ca2 、K 、葡萄糖、甘露醇和 pH值等成分不同浓度对未成熟心肌保护效果的影响。方法　使用正交设计方法进行各因素不同水平的相互组合 ,分析各因素中的最佳水平 ,找出各因素不同水平的最佳组合。结果　停搏液中的Ca2 为 1水平、K 为 2水平、pH、葡萄糖和甘露醇分别为 3水平时 ,其综合加权分为 13 2 8.5、95 3 .5、965 .0、115 1.5和 10 15 .0。结论　通过多指标综合加权分析 ,Ca2 0 .8mmol/L、K 16～ 2 0mmol/L、葡萄糖 15mmol/L、甘露醇 2 0～3 0mmol/L和 pH 7.4为未成熟心肌保护的停搏液中最适宜浓度     

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.     

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.     

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.     

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).