超声引导下神经阻滞麻醉联合全身麻醉对股骨头置换老年患者麻醉效果及术后认知功能的影响

摘要 目的：研究超声引导神经阻滞麻醉联合全身麻醉对股骨头置换老年患者的麻醉效果及对术后认知功能的影响。方法：选取2019年1月至2021年12月期间我院收治的150例拟行股骨头置换术的老年患者,随机分为对照组和观察组,各75例。对照组患者行常规全身麻醉,观察组在对照组的基础上行超声引导下神经阻滞麻醉,比较两组患者的血流动力学指标,拔管时间、苏醒时间和复苏室停留时间,苏醒后疼痛,术后认知功能及不良反应的发生率。结果：观察组患者各时间点的心率（HR）和平均动脉压（MAP）均较对照组低（P＜0.05）。观察组拔管时间、苏醒时间和复苏室停留时间均较对照组短（P＜0.05）。观察组患者术后视觉模拟评分（VAS）均低于同一时间点的对照组（P＜0.05）。与对照组相比,观察组患者术后1 h、12 h和24 h的简易智力状态检查（MMSE）评分均较高（P＜0.05）,观察组术后1 h、12 h和24 h术后认知功能障碍（POCD）发生率较对照组低（P＜0.05）。两组患者不良反应发生率无差异（P＞0.05）。结论：超声引导神经阻滞麻醉可稳定血流动力学,缩短拔管、苏醒及复苏室停留时间,减轻术后疼痛,改善术后认知功能,减少POCD的发生,值得临床推广。     

超声引导下隐神经联合IPACK阻滞对老年全膝关节置换术患者应激反应、炎性细胞因子及膝关节活动度的影响

摘要 目的：探讨超声引导下隐神经联合腘动脉与膝关节后囊间隙（IPACK）阻滞对老年全膝关节置换术（TKA）患者应激反应、炎性细胞因子及膝关节活动度的影响。方法：根据随机数字表法,将无锡市中医医院2021年3月~2022年9月期间收治的102例初次行TKA的老年患者分为观察组（超声引导下隐神经联合IPACK阻滞镇痛处理）和对照组（超声引导下隐神经镇痛处理）,每组各51例。对比两组疼痛情况、炎性细胞因子、应激反应指标、不良反应发生率、膝关节活动度。结果：观察组术后6 h、术后12 h、术后24 h视觉模拟评分法（VAS）评分低于对照组（P<0.05）。观察组术后48 h肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-1β、β-淀粉样蛋白（Aβ）低于对照组（P<0.05）。观察组术后48 h血管紧张素Ⅱ（AngⅡ）、皮质醇（COR）低于对照组（P<0.05）。观察组术后24 h、术后48 h膝关节活动度大于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：超声引导下隐神经联合IPACK阻滞用于TKA患者,具有较好的镇痛效果,可减轻应激反应,抑制炎性细胞因子过度分泌,改善膝关节活动度,麻醉效果较好。     

Dynamic changes of mechanically activated channels and K+ channels at injury site of peripheral nerve in rat

Ectopic ion channels developed locally at the injury site after nerve damage by light ligation around common sciatic nerve of the rats. Different channel types have different processes of formation, accumulation and degeneration. During the first three days after injury, mechanically activated channels that are modulated by Ca++ channel activities first appeared. As the nerve fibers begin to be excited by TEA, a blocker of K+ channels, suggesting that the accumulation of K+ channels, the responsibility of mechanically activated channels was declining. Onset of K+ channels was from the 3rd postoperative day and lasted up to the fiftieth day. This time course of K+ channel development was closely related to allodynia and hyperalgesia of neuropathic animal behaviour. The results suggest that chronic contraction injury induces a dynamic change in the ectopic mechanically activated channels and K+ channels at the injury site of nerve and there is an interchange in the development time courses of the mechanic     

大鼠正中神经一级传入纤维在脊髓胶状质定位投射的定量分析——FRAP法

本文用抗氟化物酸性磷酸酶(FRAP)法和显微测量,对大鼠正中神经一级传入纤维在脊髓胶状质(SG)的定位投射进行了定量分析.大鼠正中神经向SG的纵向投射主要为C_5～T_1.C_5～T_1各节段SG水平向眉毛状反应带所测均值(mm)分别为0.888、0.935、0.957、0.905和 0.776,而正中神经向C_5～T_1各节段SG水平向投射所测均值(mm)分别在0～0.204、0～0.303、0～0.409、0～0.432和0～0.336的范围,这显示了正中神经投射区均位于SG的内侧带和部分中间带.     

脑室内注入TRH对大鼠肝胆生化影响机理的研究

在大鼠的脑室内注入ＴＲＨ（三肽酰胺）,观察其对大鼠肝胆汁分泌的影响．实验结果表明,侧脑室内注入ＴＲＨ对胆汁分泌量有明显的增强作用,并且随ＴＲＨ剂量加大其作用逐渐增强．而且在侧脑室内注入ＴＲＨ期间,胆汁中Ｋ＋、Ｃｌ－、Ｎａ＋、ＨＣＯ３－离子的排出量亦有增加．其机理在于,侧脑室内注入ＴＲＨ,激活中枢胆碱能系统,并通过送走神经而使肝的新陈代谢发生变化．     

血管内照射（He－Ne）对患者外周血淋巴细胞中凋亡细胞（PCD）的影响

本文报道了用氦氖激光血管内照射（ＩＬＩＢ）治疗九例患者过程中,应用流式细胞仪检测外周血淋巴细胞中凋亡细胞的发生,结果提示,照射后凋亡细胞百分率为（６．４３±５．０７％）与照射前比较（０．３８±０．５３％）,ｐ＜０．０５。     

The Second Messenger, Cyclic AMP, Is Not Sufficient for Myelin Gene Induction in the Peripheral Nervous System

Abstract: The adenylyl cyclase-cyclic AMP (cAMP) second messenger pathway has been proposed to regulate myelin gene expression; however, a clear correlation between endogenous cAMP levels and myelin-specific mRNA levels has never been demonstrated during the induction or maintenance of differentiation by the myelinating Schwann cell. Endogenous cAMP levels decreased to 8–10% of normal nerve by 3 days after crush or permanent transection injury of adult rat sciatic nerve. Whereas levels remained low after transection injury, cAMP levels reached only 27% of the normal values by 35 days after crush injury. Because P₀ mRNA levels were 60% of normal levels by 14 days and 100% by 21 days after crush injury, cAMP increased only well after P₀ gene induction. cAMP, therefore, does not appear to trigger myelin gene induction but may be involved in myelin assembly or maintenance. Forskolin, an activator of adenylyl cyclase, increased endoneurial cAMP levels only in the normal nerve, and in the crushed nerve beginning at 16 days after injury, but at no time in the transected nerve. Only by treating transected nerve with 3-isobutyl-1-methylxanthine (IBMX), an inhibitor of cAMP phosphodiesterases, in combination with forskolin was it possible to increase cAMP levels. No induction of myelin genes, however, was observed with short- or long-term treatment with IBMX and forskolin in the transected nerve. A three-fold increase in phosphodiesterase activity was observed at 35 days after both injuries, and a nonmyelinated nerve was shown to have even higher activity. These experiments, therefore, suggest an important role for phosphodiesterase in the inactivation of this second messenger-dependent stimuli when Schwann cells are non-myelinating, such as after sciatic nerve injury or in the nonmyelinated nerve, which again implies that cAMP may be required for the maintenance of the myelin sheath.     

Inhibition of Kinesin Synthesis In Vivo Inhibits the Rapid Transport of Representative Proteins for Three Transport Vesicle Classes into the Axon

Abstract: We have previously demonstrated that the in vivo vitreal injection of an antisense oligonucleotide directed to the kinesin heavy chain inhibits retinal kinesin synthesis by 82% and concomitantly inhibits rapid transport of total protein into the optic nerve by 70%. These results establish a major role for kinesin in rapid axonal transport in vivo. Recently, the cloning of a family of kinesin-like molecules from the mammalian brain has been reported, and some of these proteins are also expressed in neurons. To assign a specific function to the kinesin heavy chain we inhibited the kinesin synthesis with an antisense kinesin oligonucleotide and assessed the axonal transport into the optic nerve of representative proteins from each of three vesicle classes that contain rapidly transported proteins. Marker proteins used were substance P for peptide-containing synaptic vesicles, the amyloid precursor protein for plasma membrane precursor vesicles, and several integral synaptic vesicle proteins. Our results indicate that the major anterograde motor protein for all three vesicle classes utilizes kinesin heavy chain, although we discuss alternative explanations.     

神经生长因子结构与功能研究进展

神经生长因子(NGF)是神经营养因子家族的典型代表, 它控制着脊椎动物周围和中枢神经系统中部分神经元的发育和存活.NGF的三维结构是以“胱氨酸结”和β折叠为基础,它以二聚体的形式结合细胞表面的受体从而发生生物学效应.参与这些反应的氨基酸残基已通过化学修饰和定点突变法加以确定,这有助于更进一步理解其结构与功能的关系.     

Axonal Contact Regulates Expression of α2 and β2 Isoforms of Na+,K+-ATPase in Schwann Cells: Adhesion Molecules and Nerve Regeneration

Abstract: Three isoforms of catalytic α subunits and two isoforms of β subunits of Na⁺,K⁺-ATPase were detected in rat sciatic nerves by western blotting. Unlike the enzyme in brain, sciatic nerve Na⁺,K⁺-ATPase was highly resistant to ouabain. The ouabain-resistant α1 isoform was demonstrated to be the predominant form in rat intact sciatic nerve by quantitative densitometric analysis and is mainly responsible for sciatic nerve Na⁺,K⁺-ATPase activity. After sciatic nerve injury, the α3 and β1 isoforms completely disappeared from the distal segment owing to Wallerian degeneration. In contrast, α2 and β2 isoform expression and Na⁺,K⁺-ATPase activity sensitive to pyrithiamine (a specific inhibitor of the α2 isoform) were markedly increased in Schwann cells in the distal segment of the injured sciatic nerve. These latter levels returned to baseline with nerve regeneration. Our results suggest that α3 and β1 isoforms are exclusive for the axon and α2 and β2 isoforms are exclusive for the Schwann cell, although axonal contact regulates α2 and β2 isoform expressions. Because the β2 isoform of Na⁺,K⁺-ATPase is known as an adhesion molecule on glia (AMOG), increased expression of AMOG/β2 on Schwann cells in the segment distal to sciatic nerve injury suggests that AMOG/β2 may act as an adhesion molecule in peripheral nerve regeneration.