心脏瓣膜置换术后胸骨裂开伤口的护理

目的 探讨心脏瓣膜置换术后胸骨裂开伤口的护理.方法 造口治疗师合理选用银离子和藻酸盐敷料处理伤口.结果 1个月后患者伤口愈合良好出院.结论 造口治疗师在做好患者心理护理及全身支持的前提下,运用湿性愈合伤口护理理论,不断调整局部和全身护理计划,促进了伤口的愈合.     

小鼠暴发型病毒性肝炎肝组织基因表达谱的分析

目的 分析小鼠暴发型病毒性肝炎肝组织基因表达谱,初步确定参与暴发型病毒性肝炎发病分子机制的相关基因.方法 100 PFU 3型鼠肝炎病毒(MHV-3)感染Balb/cJ小鼠,建立了暴发型病毒性肝炎模型,同等量病毒感染A/J小鼠后24 h取肝组织作为对比分析标本.应用含有16 463条Oligo DNA的小鼠基因表达芯片,检测两组小鼠间的基因差异表达谱.荧光定量逆转录聚合酶链反应法检测目标基因H2-EA的表达变化,验证芯片分析的初步结果.结果 MHV-3感染Balb/cJ小鼠和A/J小鼠后其肝组织差异表达基因共140条,包括细胞代谢、细胞信号、细胞运输,转录调控以及免疫相关类等基因.其中2倍以上差异表达基因中与免疫功能密切相关的基因22条.结论 暴发型肝炎过程中宿主基因表达谱发生了变化,共同参与了免疫致病机制,其中主要为细胞代谢和免疫相关类基因.     

Clinical characteristics and gene mutation analysis of methylmalonic aciduria

Methylmalonic aciduria（MMA） is a common inherited autosomal recessive disorder resulting from defects in the enzyme methylmalonyl CoA mutase（MCM,mut complementation group） or in the synthesis of the MCM cofactor adenosylcobalamin（cbl complementation groups）.The defects in the mut complementation group accounts for the largest number of patients with isolated MMA.At least 200 mutations in the MUT gene on chromosome 6p12 have been identified in MMA patients until now.This study aimed to investigate the clinical characteristics of MMA and genomic variations in the MUT gene of Chinese patients.Genomic DNA was extracted from 18 patients who were diagnosed as having isolated MMA by gas chromatography/mass spectrometry（GC-MS）,and from some of their parents as well.Amplification and direct sequencing of the MUT coding regions（exon 2-13） and their adjacent intronic consensus splice sites were performed in order to identify the disease causing mutations.In this group,six novel mutations in the MUT gene,c.424A>G（p.T142A）,c.786T>G（p.S262R）,c.808G>C（p.G270R）,c.1323₁324insA,c.1445-1G>A and c.1676+77A>C were identified.p.T142A and p.G270R were respectively detected at a heterozygous level in one patient.Two previously reported mutations,c.682C>T（p.R228X） and c.323G>A（p.R108H） were also found in this study.In addition,six previously described single nucleotide polymorphism（SNP）,c.636A>G（p.K212K）,c.1495G>A（p.A499T）,c.1595A>G（p.H532R）,c.1992G>A（p.A664A）,c.2011G>A（p.V671I） and c.1677-53A>G were identified.In this study,we updated the spectrum of MUT mutations and identified the main MMA-causing mutations in Chinese MMA patients.     

颅骨Rosai-Dorfman病的病理诊断临床分析

目的探讨发生于颅骨Rosai-Dorfman病的临床病理特点、诊断及鉴别诊断。方法复习1例颅骨Rosai-Dorfman病患者的临床及影像学资料,进行病理学观察及免疫组化分析,并复习相关文献。结果 RosaiDorfman病病灶呈不规则结节状分布。结节周边染色较深,主要为成片的淋巴细胞、浆细胞、中性粒细胞及少数嗜酸性粒细胞浸润,可见淋巴滤泡。中央区为组织细胞,呈三五成群簇状分布或弥漫片状分布,细胞体积大,多边形或卵圆形,胞浆丰富,淡染或透明状;胞浆内可见吞噬淋巴细胞及红细胞,具有诊断意义。免疫组化方面组织细胞表达S-100蛋白、CD68、Lysozyme、Vim,不表达CK、EMA、CD1α、CD21、CD23、CD35、PR。结论累及颅骨的RosaiDorfman病罕见,病理学检查是确诊的唯一依据。     

甲状腺转移癌的CT诊断

目的 探讨甲状腺转移癌的CT表现及CT诊断价值.方法 6例甲状腺转移癌中,4例经手术病理证实,2例经细针穿刺细胞学证实.原发食道癌2例,肺癌、直肠癌、恶性黑色素瘤、肉瘤各1例.CT平扫加双期增强扫描.结果 单发结节型4例,表现为甲状腺叶内单个结节状低密度灶,重度强化,但仍呈相对低密度,边缘清楚或部分模糊,其中1例伴颈淋巴结转移及边缘强化.多发结节肿大型2例,表现为甲状腺显著肿大伴内多发结节低密度灶,不均强化伴内不规则坏死区,其中1例伴有粗钙化灶.结论 甲状腺转移癌CT表现多种多样,单发结节型,多发结节肿大型,厚壁囊变型,病灶内可伴钙化及有颈淋巴结转移,与原发性甲状腺良恶性病变CT表现相似,无特征性,确诊需病理组织学及免疫组化.但有恶性肿瘤既往史,年龄大于50岁,CT发现甲状腺单发结节、多发结节肿大或厚壁囊性灶的患者应考虑甲状腺转移癌可能,CT能为临床提供转移灶更多的影像学信息及有无同时伴颈淋巴结转移,邻近器官的推移、侵犯.     

米索前列醇联合催产素预防剖宫产术后出血临床效果观察

目的对米索前列醇配合催产素用于预防剖宫产术后出血的效果进行比较.方法 168例剖宫产患者随机分为3组,A组：胎儿娩出后宫体肌注催产素20U,并静滴林格氏液500 ml＋催产素20U.B组胎儿娩出后宫体肌注催产素20U,术毕清理阴道血后直肠置米索前列醇600 μg.C组胎儿娩出后宫体肌注催产素20U,并静滴林格氏液500 ml＋催产素20U,术毕清理阴道血后直肠置米索前列醇600 μg.观察各组术中和术后2 h、术后2～24 h出血量,手术前后血红蛋白及血压的变化.结果三组术中失血量A、C组明显少于B组,且术中失血量〉500 ml者均发生在B组.术后2 h及2～24 h失血量,使用米索前列醇的B、C组明显少于A组,差异有显著性.结论米索前列醇与催产素联合使用可明显加强子宫收缩,减少剖宫产术后出血量.     

肝脏自然杀伤细胞在小鼠急性肝衰竭中的作用

目的 探讨肝脏自然杀伤(NK)细胞在3型鼠肝炎病毒(MHV-3)诱导的小鼠急性肝衰竭中的作用.方法 取6～8周龄雌性Balb/cJ小鼠,腹腔注射100 pfu MHV-3,采用流式细胞术检测感染MHV-3 0、24、48、70 h后的Balb/cJ小鼠肝脏、脾脏、外周血和骨髓中NK细胞的百分率及肝脏NK细胞表面活化分子CD69表达的百分率.细胞内细胞因子染色法检测肝脏NK细胞分泌干扰素γ的水平.非放射性细胞毒试验检测肝脏NK细胞的杀伤活性. 结果Balb/cJ小鼠感染MHV-3后,肝脏NK细胞的比例显著升高,在感染48 h后达到峰值(43.9%±2.3%),约为感染前的4倍,随后仍维持在较高水平至小鼠死亡;外周血NK细胞比例同样明显升高,在感染48 h后达到峰值(18.0%±5.4%),但随后显著同落,至70 h仅为1.3%±0.6%,脾脏和骨髓NK细胞比例均先明显减少后又有所上升.肝脏NK细胞在MHV-3感染48 h后其表面活化分子CD69表达明显上调,杀伤活性显著增强,同时分泌干扰素Y的水平也显著增加. 结论 Balb/cJ小鼠感染MHV-3后,来自骨髓和脾脏的NK细胞在肝脏迅速大量募集和活化,且杀伤活性显著增强,分泌干扰素Y水平也显著增加,表明肝脏NK细胞在MHV-3导致的急性肝衰竭中可能发挥着关键作用.     

微型腹腔镜下小儿腹股沟斜疝的手术配合

总结了1200例微型腹腔镜下疝手术的手术配合,重点强调手术室护士必须熟悉手术步骤,熟练掌握手术仪器、器械的性能及其灭菌方式与使用,术中密切配合实施气腹的完成,做好各种导线、导管的连接,器械的准备,患儿生命体征的监测以及一切意外情况的处理等。1200例手术均顺利完成,手术室的护理配合起到了非常重要的作用。     

Copper ions stimulate the proliferation of hepatic stellate cells via oxygen stress in vitro

This study examined the effect of copper ions on the proliferation of hepatic stellate cells (HSCs) and the role of oxidative stress in this process in order to gain insight into the mechanism of hepatic fibrosis in Wilson’s disease. LX-2 cells, a cell line of human HSCs, were cultured in vitro and treated with different agents including copper sulfate, N-acetyl cysteine (NAC) and buthionine sulfoximine (BSO) for different time. The proliferation of LX-2 cells was measured by non-radioactive cell proliferation assay. Real-time PCR and Western blotting were used to detect the mRNA and protein expression of platelet-derived growth factor receptor β subunit (PDGFβR), ELISA to determine the level of glutathione (GSH) and oxidized glutathione (GSSG), dichlorofluorescein assay to measure the level of reactive oxygen species (ROS), and lipid hydroperoxide assay to quantify the level of lipid peroxide (LPO). The results showed that copper sulfate over a certain concentration range could promote the pro- liferation of LX-2 cells in a time- and dose-dependent manner. The effect was most manifest when LX-2 cells were treated with copper sulfate at a concentration of 100 μmol/L for 24h. Additionally, copper sulfate could dose-dependently increase the levels of ROS and LPO, and decrease the ratio of GSH/GSSG in LX-2 cells. The copper-induced increase in mRNA and protein expression of PDGFβR was significantly inhibited in LX-2 cells pre-treated with NAC, a precursor of GSH, and this phenome- non could be reversed by the intervention of BSO, an inhibitor of NAC. It was concluded that copper ions may directly stimulate the proliferation of HSCs via oxidative stress. Anti-oxidative stress therapies may help suppress the copper-induced activation and proliferation of HSCs.     

产后出血的原因分析及护理对策

目的 探讨产后出血的原因及护理措施.方法 回顾性分析31例产后出血的原因及护理措施.结果 发生产后出血的原因依次为宫缩乏力、凝血功能障碍、软产道裂伤、胎盘因素.结论 重视产前管理,准确评估出血量,积极处理第三产程,及时查找出血原因及时处理,能有效控制产后出血,降低产后出血发生率.