评估体外循环过程中三种血液回收设备对红细胞功能的影响

目的评估三种血液回收设备在体外循环（CPB）回收清洗过程中对红细胞功能的影响。方法将30例CPB的成年患者随机分配3组：C组（CellSaver5^＋;Haemonetics,n=10）,M组（Autolog;Medtronic,n=10）和F组（CATS;FreseniusHe-moCa．re,n=10）。分别从回收罐及清洗后的输血袋中采血样。对其进行红细胞聚集指数（AI）,变形性指数（DI）,红细胞比容（Hct）并校正的全血黏度（HV）,2,3-二磷酸甘油酸（2,3-DPG）,Het,血红蛋白（Hb）,葡萄糖（Glu）,乳酸（Lac）,血尿素氮（BUN）,游离血红蛋白清除率（AFHB）的比较。结果经血液处理后,AI值在三组之间没有统计学差异（P〈0．05）。DI值c组和M组与F比较有相对较高的DI值（P〈0．05）。同时M组有最低的HV（P〈0．05）。△2,3-DPGc组较低,与M组和F组比较有极显著差异（P〈0．01）。Hct和HbF组〉C组〉M组。C组和M组具有较高AFHB,于F组相比均有显著统计学差异（P〈0．05）。结论三种血液回收设备具有相同的以离心为基础的工作原理,但基于其设计的不同,对处理过的红细胞功能的影响,以及对有害物质的清除效果在不同的设备之间却有明显的差异。     

中国灌注师职业倦怠及工作压力源调查与分析

目的调查灌注师职业倦怠情况和工作压力源,并分析二者相关性。方法采用国内修订后的工作倦怠量表（M—GS）测量212名灌注师的工作倦怠情况并观察其与人口学特征、职称及收入的关系。采用临床医生工作压力源量表测量灌注师的工作压力源。分析灌注师工作倦怠与各压力源分量之间的相关性。结果调查显示灌注师的工作倦怠情况与国内医务人员常模相似。男性灌注师的成就感高于女性（P〈0．05）;情绪耗竭和情感疏远以30～39岁年龄组为最高（P〈0．01）。硕士研究生情绪衰竭较高（P〈0．01）;中级职称灌注师的情绪耗竭和情感疏远最高（P〈0．01）,随着年龄的增长和职称的升高成就感逐渐升高（P〈0．05）;月收入在5000～10000元的人员情感疏远程度最高。问卷显示使灌注师最感压力的工作问题依次是外部环境、工作负荷、组织管理、职业兴趣、职业发展、医患关系和人际关系;而与职业倦怠相关系数较高（〉0．4）的压力源依次是职业兴趣、工作负荷、职业发展和人际关系。结论30一39岁年龄组职业倦怠程度最高,教育程度高者的职业倦怠较高,随着年龄的增长和职称的升高职业倦怠程度逐渐降低。与职业倦怠相关性较高的工作压力源分量包括职业发展、工作负荷、人际关系和职业兴趣。     

S-1-based therapy versus 5-FU-based therapy in advanced gastric cancer: a meta-analysis

We set out to evaluate the efficacy and safety of S-1-based therapy versus fluorouracil (5-FU)-based therapy in advanced gastric cancer (AGC). Eligible studies were identified from Pubmed, EMBASE, and Cochrane Library. Additionally, abstracts presented at American Society of Clinical Oncology (ASCO) conferences held between January 2000 and November 2009 were searched to identify relevant clinical trials. The outcome included overall survival (OS), overall response rate (ORR), and grade 3/4 advent events. Four randomized controlled trials (one full text and three abstracts) with 2,115 participants in AGC were identified in our analysis(1,065 patients were in the S-1-based group, 1,050 patients were in the 5-FU-based group). Meta-analysis showed there was significant OS benefit in favor of S-1-based therapy (hazard ratio [HR] = 0.87, 95% confidence interval [CI]: 0.79 to 0.96). Pooled estimate for ORR showed no significant difference between S-1-based group and 5-FU-based group (OR = 1.25, 95%CI: 0.31 to 5.09). Lower incidence of grade 3/4 neutropenia was observed in patients with S-1-based therapy (OR = 0.33, 95%CI: 0.25 to 0.44). With regard to grade 3/4 anemia (OR = 1.20, 95%CI: 0.74 to 1.96), leucopenia (OR = 1.09, 95%CI: 0.43 to 2.74), stomatitis (OR = 2.65, 95%CI: 0.12 to 58.89), diarrhea (OR = 0.53, 95% CI: 0.00 to 229.10), nausea (OR = 1.36, 95%CI: 0.68 to 2.72), and treatment-related deaths (OR = 1.84, 95%CI: 0.95 to 3.54), equivalent frequencies were found between groups. S-1-based therapy significantly improved OS in relation to 5-FU-based therapy. ORR and safety profile were considerable between two groups. These results needed to be confirmed by high-quality trials and further studies in the West.     

Moderate global reduction in maternal nutrition has differential stage of gestation specific effects on {beta}1- and {beta}2-adrenergic receptors in the fetal baboon liver

Hepatic β-adrenergic receptors (β-ARs) play a pivotal role in mobilization of reserves via gluconeogenesis and glycogenolysis to supply the animal with its energy needs during decreased nutrient availability. Using a unique nutrient-deprived baboon model, we have demonstrated for the first time that immunoreactive hepatic β(1)- and β(2)-AR subtypes are regionally distributed and localized on cells around the central lobular vein in 0.5 and 0.9 gestation (G) fetuses of ad libitum fed control (CTR) and maternal nutrient restricted (MNR) mothers. Furthermore, MNR decreased fetal liver immunoreactive β(1)-AR and increased immunoreactive β(2)-AR at 0.5G. However, at 0.9G, immunohistochemistry and Western blot analysis revealed a decrease in β(1)-AR and no change in β(2)-AR levels. Thus, MNR in a nonhuman primate species has effects on hepatic β(1)- and β(2)-ARs that are receptor- and gestation stage-specific and may represent compensatory systems whose effects would increase glucose availability in the presence of nutrient deprivation.     

正常学龄前儿童脑干诱发电位波形特点

目的 探讨正常学龄前儿童听觉脑干施展电位的特点，以指导临床工作。方法 对正常学龄前儿童１００只耳进行检测并与１００例（２００只耳）正常成人检测结果进行比较。结果和结论 显示学龄前儿童脑干听觉７诱发电位潜伏期较正常人有延长趋势，但两者相比较除Ⅰ波外无明显差异（Ｐ〉０．０５），学龄前儿童组内结果比较未见性别及左右侧差异。     

VIP innervation: sharp contrast in fetal sheep and baboon adrenal glands suggests differences in developmental regulation

Immunocytochemical technique and light microscopy were used to ascertain the relationship between vasoactive intestinal polypeptide (VIP) and tyrosine hydroxylase in fetal sheep and fetal baboon adrenal cortices and medullae at 85% of gestation. VIP immunostaining was extremely robust in fetal sheep adrenal cortical neurofibers and cells while weak in fibers and nonexistent in cells of fetal baboon. Also, tyrosine hydroxylase-immunopositive cells, present throughout the adrenal cortices of both fetal sheep and baboons, were heavily innervated by VIP-immunoreactive neurofibers in fetal sheep, but not in fetal baboons. Adrenal cortical VIP-immunopositive fibers occurred in greater (P<0.05) frequency in fetal sheep than in fetal baboons (14.82±3.10 vs. 0.84±0.26 fibers/field), were larger in diameter (2.93±0.34 vs. 0.93±0.07 μm) and ran for longer distances in the plane of section (127.85±5.16 vs. 74.53±4.93 μm). VIP immunogenicity in cells (ganglion and chromaffin) and fibers was robust in fetal adrenal medulla of sheep while nonexistent in baboons. VIP fibers in fetal sheep medulla were smaller in diameter compared to fetal sheep cortex (1.22±0.13 vs. 2.93±0.34 μm, P<0.05), but not compared to extrinsic nerve fibers (1.30±0.09 μm). We hypothesize that in fetal sheep of this age, medullary neurofibers derive primarily from extrinsic sources while cortical fibers arise from cortical ganglion cells. We conclude that at 85% of gestation the potential for VIP neural control of paracrine (e.g., glucocorticoid/catecholamine) interactions in both adrenal cortex and medulla is much greater in fetal sheep compared to fetal baboons.     

氨力农对大鼠离体心肌缺血/再灌注损伤的保护作用

目的　氨力农预处理大鼠离体缺血 /再灌注心肌或心肌经历缺血 /再灌注后灌注液加用氨力农 ,观察其有无心肌保护作用。方法　将 3 0只SD大鼠随机平均分对照组 (A组 )、停跳前灌注液加氨力农组 (B组 )和复跳后灌注液加氨力农组 (C组 ) ,应用离体灌注心模型 ,全心 2 5℃停跳3 0min ,再灌注复跳 12 0min ,测定复跳后 10、3 0、60、12 0min左室发展压 (LVDP)恢复率、冠脉流量(CF)恢复率、心肌含水量、心肌细胞ATP含量、心肌超微结构。结果　复跳后C组LVDP恢复率、CF恢复率、心肌含水量、ATP含量、心肌显微结构明显优于A组 (P <0 .0 5 ) ,其CF恢复率优于B组 (P <0 .0 1) ;复跳后 60、12 0minLVDP恢复率B组优于A组 (P <0 .0 5 )。结论　离体大鼠心肌缺血 /再灌注后加用氨力农有明显心肌保护作用 ,氨力农预处理对心肌缺血 /再灌注损伤也有改善作用。     

CyclinD1、TGF-β1、GST-π在食管鳞癌组织中的表达和意义

目的:研究细胞周期蛋白D1(CyclinD1)、转化生长因子β1(TGF-β1)、胎盘型谷胱甘肽硫转移酶(GST-π)在食管鳞癌及正常食管组织中的表达,探讨其与食管鳞癌发生、发展及转移的关系。方法:采用免疫组织化学法,对81例食管鳞癌组织和43例正常食管组织Cyclin-D1、TGF-β1、GST-π的表达进行检测。结果:食管鳞癌和正常食管组织中Cyclin-D1、TGF-β1和GST-π的阳性表达差异均有统计学意义(P<0.05),3者在伴有和不伴有淋巴结转移癌组织的阳性表达差异均无统计学意义(P>0.05)。Cyclin-D1和TGF-β1随食管鳞癌组织分化程度的降低其表达增强,但其表达与组织分型比较差异无统计学意义,GSTπ随着食管鳞癌组织分化程度的降低表达减弱。结论:Cyclin-D1、TGF-β1可能与食管鳞癌的发生、恶性程度有关,GST-π在诊断早期癌方面具有一定的意义。Cyclin-D1、TGF-β1、GST-π可作为对食管鳞癌的诊断指标,尤其是GST-π对食管鳞癌早期诊断有一定的参考价值。     

兔体外循环中聚乙二醇牛血红蛋白偶联物对平均动脉压、胶体渗透压及p50的影响

目的探讨在体外循环(CPB)预充液中加入聚乙二醇牛血红蛋白偶联物(PEG-bHb)对兔平均动脉压(MAP)、胶体渗透压(COP)及p50的影响。方法24只成年健康大耳白兔(2．59±0．19)kg,通过股动脉、颈静脉插管建立体外循环通路,转流1h。随机分成3组,对照组(n =8),以晶／胶体液作为体外循环预充液；实验组1(n=8),在预充液中加入PEG-bHb,PEG-bHb占总容量(兔循环血量+预充量)的5％；实验组2(n=8),预充液中加入PEG-bHb,占总容量(兔循环血量+预充量)的15％,体外循环开始后放出自体血(放血量占兔循环血量的20％),CPB结束后将自体血回输。每组监测CPB前和CPB中平均动脉压；在CPB前、CPB中15、50 min、CPB后1 h测胶体渗透压及动脉血p50值。结果实验组1和实验组2在CPB中的MAP均高于对照组,但只有实验组2在转中10 min时与对照组相比差异有统计学意义(P＜0．05)；实验组2在CPB中COP值均较高；实验组1动脉血p50值较对照组高。结论PEG-bHb占实验兔循环血量+预充量的5％对CPB中和CPB后MAP和COP无明显影响,并且由p50提示向组织释放O_2量增多,此量可安全用于CPB预充；另外,在CPB前放出部分自体血将对CPB中血液保护发挥一定作用。