5例毒蛇咬伤患者的急救与护理

毒虼咬伤的发病率以夏秋季节最高,常因延误就诊或处理不当而在短时间内出现蛇毒中毒致休克、急性呼吸衰竭、弥散性血管内凝血、急性心力衰竭、急性肾功能衰竭等危重症。因此．及时有效的护理措施是争取抢救时机．改善病情。促进救治成功的关键。我院2006年1月～2008年12月成功救治了s5例毒蛇咬伤的患者,现将急救与护理介绍如下。     

养殖乌鳢类立克次体感染的组织病理学研究

本文系统报道了养殖乌鳢类立克次体(Rickettsia-like organism,RLO)感染的各器官(脑、眼、鳃、心脏、头肾、肝、胰腺组织、脾、肾、肠和卵巢)的组织病理变化,探讨了炎症发展的基本规律。感染乌鳢病理解剖学特征和最具病理诊断意义的是体内各器官普遍出现的白色结节。这些结节的显微结构为肉芽肿炎症即一种慢性增生性炎症。在严重病变的肾脏,由于组织坏死区域较大和周围明显的细胞增生形成了境界较为清楚的巨大“肉瘤”状肿物。内脏器官的血管(特别是造血器官的血管)出现明显纤维素性血栓、混合血栓、弥散性血管内凝血(disseminated intravascu-lar coagulation,DIC)和组织细胞大范围的变性或坏死、溶解。大多数器官的组织细胞主要是上皮性细胞、吞噬性细胞,胞质内富含嗜酸性包涵体(eosinophilic intracytoplasmic inclusion),这种细胞多位于鳃上皮处、鳃部和体内器官血管内皮及血管周边结缔组织。血管内皮细胞及周边细胞内大量包涵体的出现导致血管内皮细胞的肿胀和破坏。     

细菌内毒素以血管内皮细胞的激活损伤作用

细菌内毒素可激活、损伤血管内皮细胞,引起机体产生局部炎症反应和弥散性血管内凝血（ＤＩＣ）等病理反庆,甚至导致机休我、死亡。内毒素激活血管内皮细胞有两条途径：其一是与ＬＰＳ结合蛋白、ＬＰＳ／ＬＰＳ结合蛋白复合物受体结合后,直接激活血管内皮细胞;其二是先激活单核细胞、Ｔ细胞等免疫活性细胞,使其释放ＴＮＦ－α、ＩＦＮ和ＩＬ－１β等细胞因子,间接激活血管内皮细胞。两条激活途径关系密切,以间接激活途径为主。     

细菌性败血症引起鲫凝血障碍的研究

以嗜水气单胞菌感染体重７０ｇ左右的鲫并检测了感染鱼和对照鱼的血液学及播散性血管内凝血判定指标等参数。结果表明细菌性败血症病鱼严重贫血,存在明显的凝血障碍,在疾病发展过程中存在播散性血管内凝血现象。这一些象导致了病鱼全身性出血,并在疾病的病理生理过程中起了重要作用。     

内皮细胞与脓毒症

血管内皮细胞是凝血启动和炎症反应激活过程中最重要的效应细胞,而脓毒症的主要病理生理学变化是严重全身感染引起的炎症反应过度激活及凝血机能障碍。因此,血管内皮细胞活化和功能障碍是脓毒症发展恶化的中心环节。更好地理解血管内皮细胞功能对于脓毒症治疗的探索及对预防多器官衰竭和弥漫性血管内凝血发生有重要意义。本文就这方面的研究进展作一简要综述。     

急性早幼粒细胞白血病合并弥散性血管内凝血亚砷酸诱导治疗疗效分析

目的:探索急性早幼粒细胞白血病(APL)合并弥散性血管内凝血(DIC)患者亚砷酸(ATO)诱导治疗的疗效及治疗过程中凝血相关临床特征及实验室指标的变化情况。方法:前瞻性收集我院血液内科2014年7月-2016年12月期间收治的初诊和复发APL合并DIC患者24例,于给予ATO诱导治疗前(第0周)及治疗第1、2、3周,血液学完全缓解(HCR)时完善相关检查。每例患者设立正常对照1名。结果:24名患者中初发21例,复发3例,所有患者均有出血症状。最常见出血为皮肤粘膜出血。经过ATO诱导治疗后,21例患者(87.5%)达HCR,2例患者死于脑出血,1例患者达部分缓解。患者第0周(治疗前)凝血酶原时间(PT)显著延长,D-二聚体(DD),纤维蛋白原(FIB)显著降低,纤维蛋白原降解产物(FDP)明显增高(P0.001),ATO治疗1周时出血症状、PT、FIB基本纠正,DD、FDP改善明显,但DD、FDP直到HCR时仍高于正常。结论:ATO单药治疗APL合并DIC的HCR率高,并能在1周内迅速减轻凝血紊乱,但患者达HCR时凝血紊乱仍不能完全纠正。PT、FIB、DD、FDP可作为判断ATO治疗APL合并DIC疗效的重要参数。     

BaFe12O19血管内无机微粒栓塞材料的生物相容性研究

目的:本研究旨在探讨BaFe12O19微粒的生物相容性.方法:对BaFe12O19微粒进行一系列生物相容性实验,包括Ames致突变试验、细胞毒性试验、全身急性和亚急性毒性试验、溶血试验、出血和凝血时间测定、凝血试验等.结果:BaFe12O19微粒无毒性,无致突变性,对出血和凝血时间无影响,不引起溶血和凝血.结论:BaFe12O19微粒具有良好的生物相容性,有可能成为一种全新的血管内栓塞材料.     

过敏性紫癜患者银杏达莫注射液治疗前后血管内皮功能、凝血功能的变化及相关性研究

摘要 目的：探讨过敏性紫癜（HSP）患者银杏达莫注射液治疗前后血管内皮功能、凝血功能的变化,并分析HSP患者血管内皮功能与凝血功能的相关性。方法：选择2018年2月至2020年2月期间我院收治的HSP患者93例,按照随机数字表法将患者分为对照组（n=46）和观察组（n=47）,其中对照组给予糖皮质激素治疗,观察组给予银杏达莫注射液治疗,对比两组疗效、血管内皮功能、凝血功能的变化及紫癜性肾炎的发生率,并分析HSP患者血管内皮功能与凝血功能的相关性。结果：观察组治疗2周后的总有效率95.74%（45/47）,较对照组的76.09%（35/46）升高（P<0.05）。两组患者治疗2周后血清血管内皮生长因子（VEGF）、内皮素-1（ET-1）水平均降低,且观察组低于对照组（P<0.05）。两组患者治疗2周后纤维蛋白原（FIB）、D-二聚体（D-D）、血小板计数（PLT）均降低,且观察组低于对照组（P<0.05）,凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）均升高,且观察组高于对照组（P<0.05）。两组紫癜性肾炎发生率对比无统计学差异（P>0.05）。观察组患者中VEGF、ET-1均与FIB、D-D、PLT呈正相关,而与PT、APPT、TT呈负相关（P<0.05）。结论：HSP的发病过程中存在血管内皮细胞损伤及血液高凝状态,采用银杏达莫注射液治疗HSP患者,疗效显著,可有效改善患者血管内皮功能、凝血功能,且血管内皮功能与凝血功能存在一定的相关性。     

急性髓系白血病患者血小板输注疗效不佳及短期死亡的危险因素分析

摘要 目的：分析急性髓系白血病（AML）患者血小板输注疗效不佳及短期死亡的危险因素。方法：将2019年4月至2021年1月期间南部战区总医院收治的97例AML患者作为研究对象,在常规化疗的基础上,所有患者均进行血小板输注治疗。将血小板输注24 h后血小板计数增加指数<4.5视为输注疗效不佳,反之则为输注疗效良好。随访1年,根据短期预后的不同将患者分为死亡组和生存组。采用单因素和多因素Logistic分析AML患者血小板输注疗效不佳及短期死亡的危险因素。结果：97例AML患者中,疗效良好的患者65例,疗效不佳的患者32例,根据血液输注疗效将患者分为疗效不佳组（n=32）和疗效良好组（n=65）。随访结束时,97例AML患者中,有21例患者病死,病死率为21.65%。将病死的患者纳为死亡组（n=21）,存活的患者纳为生存组（n=76）。AML患者血小板输注疗效不佳与白细胞计数（WBC）、输注次数、出血量、脾脏大小、感染发热、血小板种类有关（P<0.05）,而与性别、年龄、血型、疾病类型、降钙素原（PCT）、血红蛋白（Hb）、乙肝表面抗原无关（P>0.05）。AML患者血小板输注疗效不佳的多因素Logistic分析结果表明：WBC＞50×10⁹/L、输注次数≥7次、出血量≥400 mL、脾大、感染发热、血小板种类为冰冻是AML患者血小板输注疗效不佳的危险因素（P<0.05）。AML患者短期死亡与弥散性血管内凝血、感染发热、血小板抗体、应用烷化剂化疗药物、脾脏大小有关（P<0.05）,AML患者短期死亡的多因素Logistic分析结果表明：血小板抗体阳性、感染发热、脾大、弥散性血管内凝血是AML患者短期死亡的危险因素（P<0.05）。结论：AML患者血小板输注疗效不佳受到WBC、输注次数、出血量、脾脏大小、感染发热、血小板种类等因素的影响。此外,感染发热、弥散性血管内凝血、血小板抗体、脾脏大小等是AML患者血小板输注后短期预后的影响因素。     

竹叶青蛇咬伤致类DIC综合征的临床治疗观察

毒蛇伤可引起弥散性血管内凝血 (DIC)血液学方面的改变 ,但毒蛇咬伤常出现实验室血液学检查非常典型而临床症状较轻的矛盾现象 ,我们称之为类 DIC综合征。作者自 2 0 0 1年 4月至 2 0 0 3年 8月收治 8例由竹叶青蛇咬伤引起的类 DIC综合征病例 ,经综合治疗 ,效果满意 ,现报道如下。1　临床资料1 .1　一般资料　本组 8例 ,其中男 7例 ,女 1例 ;年龄 5～ 54岁 ,平均 2 8.4岁 ;农民 4例 ,民工 2例 ,学生 1例 ,儿童 1例。被咬伤部位 :上肢 3例 ,下肢 5例。咬伤至就诊时间最短 1 h,最长 78h。1 .2　临床诊断及临床分型　有毒蛇咬伤史 ,8例患者…     

Oxygen inhibition of dissolved inorganic carbon uptake in unicellular green algae

Unicellular green algae have a dissolved inorganic carbon (DIC) concentrating mechanism, commonly known as the DIC pump, to concentrate inorganic carbon into cells and chloroplasts. The DIC pump activity is normally measured as the K_0.5(DIC) that equals the CO₂ plus HCO₃‐ concentration at a cited pH at which the rate of DIC‐dependent photosynthetic O₂ evolution is half‐maximal, or by the amount of intra‐cellular DIC accumulation in 15–60 s, using a limited amount of NaH¹⁴CO₃, measured by the silicone oil cen‐trifugation technique. The dissolved oxygen in the assay inhibits or reduces the DIC uptake by the cells of unicellular green algae Chlamydomonas reinhardtii Dangeard, strain 137 and in a cell wall‐less marine algae Dunaliella tertiolecta Butcher. The algal cells concentrated the highest amount of DIC when little or no oxygen was present in the assay medium. The results suggest that the amount of O₂ and DIC must be carefully monitored before DIC‐pump assay.     

Penalized loss functions for Bayesian model comparison

The deviance information criterion (DIC) is widely used for Bayesian model comparison, despite the lack of a clear theoretical foundation. DIC is shown to be an approximation to a penalized loss function based on the deviance, with a penalty derived from a cross-validation argument. This approximation is valid only when the effective number of parameters in the model is much smaller than the number of independent observations. In disease mapping, a typical application of DIC, this assumption does not hold and DIC under-penalizes more complex models. Another deviance-based loss function, derived from the same decision-theoretic framework, is applied to mixture models, which have previously been considered an unsuitable application for DIC.     

Molecular identification of three Arabidopsis thaliana mitochondrial dicarboxylate carrier isoforms: organ distribution, bacterial expression, reconstitution into liposomes and functional characterization

Screening of the Arabidopsis thaliana genome revealed three potential homologues of mammalian and yeast mitochondrial DICs (dicarboxylate carriers) designated as DIC1, DIC2 and DIC3, each belonging to the mitochondrial carrier protein family. DIC1 and DIC2 are broadly expressed at comparable levels in all the tissues investigated. DIC1-DIC3 have been reported previously as uncoupling proteins, but direct transport assays with recombinant and reconstituted DIC proteins clearly demonstrate that their substrate specificity is unique to plants, showing the combined characteristics of the DIC and oxaloacetate carrier in yeast. Indeed, the Arabidopsis DICs transported a wide range of dicarboxylic acids including malate, oxaloacetate and succinate as well as phosphate, sulfate and thiosulfate at high rates, whereas 2-oxoglutarate was revealed to be a very poor substrate. The role of these plant mitochondrial DICs is discussed with respect to other known mitochondrial carrier family members including uncoupling proteins. It is proposed that plant DICs constitute the membrane component of several metabolic processes including the malate-oxaloacetate shuttle, the most important redox connection between the mitochondria and the cytosol.     

The Relationship between Ribulose Bisphosphate Concentration, Dissolved Inorganic Carbon (DIC) Transport and DIC-Limited Photosynthesis in the Cyanobacterium Synechococcus leopoliensis Grown at Different Concentrations of Inorganic Carbon

To examine the factors which limit photosynthesis and their role in photosynthetic adaptation to growth at low dissolved inorganic carbon (DIC), Synechococcus leopoliensis was grown at three concentrations (as signified by brackets) of DIC, high (1000-1800 micromolar), intermediate (200-300 micromolar), and low (10-20 micromolar). In all cell types photosynthesis varied from being ribulose bisphosphate (RuBP)-saturated at low external [DIC] to RuBP-limited at high external [DIC]. The maximum rate of photosynthesis (P_max) was achieved when the internal concentration of RuBP fell below the active site density of RuBP carboxylase/oxygenase (Rubisco). At rates of photosynthesis below P_max, photosynthetic capacity was limited by the ability of the cell to transport inorganic carbon and to supply CO₂ to Rubisco. Adaptation to low DIC was reflected by a decrease in the [DIC] required to half-saturate photosynthesis. Simultaneous mass-spectrometric measurement of rates of photosynthesis and DIC transport showed that the initial slope of the photosynthesis versus [DIC] curve is identical to the initial slope of the DIC transport versus [DIC] curve. This provided evidence that the enhanced capacity for DIC transport which occurs upon adaptation to low [DIC] was responsible for the increase in the initial slope of the photosynthesis versus [DIC] curve and therefore the decrease in the half saturation constant of photosynthesis with respect to DIC. Levels of RuBP and in vitro Rubisco activity varied only slightly between high and intermediate [DIC] grown cells but fell significantly (65-70%) in low [DIC] grown cells. Maximum rates of photosynthesis followed a similar pattern with P_max only slightly lower in intermediate [DIC] grown cells than in high [DIC] grown cells, but much lower in low [DIC] grown cells. The changing response of photosynthesis to [DIC] during adaptation to low DIC, may be explained by the interaction between DIC-transport limited and [RuBP]-limited photosynthesis.     

Tendon strain measurements with dynamic ultrasound images: evaluation of digital image correlation

Strain is an essential metric in tissue mechanics. Strains and strain distributions during functional loads can help identify damaged and pathologic regions as well as quantify functional compromise. Noninvasive strain measurement in vivo is difficult to perform. The goal of this in vitro study is to determine the efficacy of digital image correlation (DIC) methods to measure strain in B-mode ultrasound images. The Achilles tendons of eight male Wistar rats were removed and mechanically cycled between 0 and 1% strain. Three cine video images were captured for each specimen: (1) optical video for manual tracking of optical markers; (2) optical video for DIC tracking of optical surface markers; and (3) ultrasound video for DIC tracking of image texture within the tissue. All three imaging modalities were similarly able to measure tendon strain during cyclic testing. Manual/ImageJ-based strain values linearly correlated with DIC (optical marker)-based strain values for all eight tendons with a slope of 0.970. DIC (optical marker)-based strain values linearly correlated with DIC (ultrasound texture)-based strain values for all eight tendons with a slope of 1.003. Strain measurement using DIC was as accurate as manual image tracking methods, and DIC tracking was equally accurate when tracking ultrasound texture as when tracking optical markers. This study supports the use of DIC to calculate strains directly from the texture present in standard B-mode ultrasound images and supports the use of DIC for in vivo strain measurement using ultrasound images without additional markers, either artificially placed (for optical tracking) or anatomically in view (i.e., bony landmarks and/or muscle-tendon junctions).     

The mitochondrial dicarboxylate carrier is essential for the growth of Saccharomyces cerevisiae on ethanol or acetate as the sole carbon source

The dicarboxylate carrier (DIC) is an integral membrane protein that catalyses a dicarboxylate-phosphate exchange across the inner mitochondrial membrane. We generated a yeast mutant lacking the gene for the DIC. The deletion mutant failed to grow on acetate or ethanol as sole carbon source but was viable on glucose, galactose, pyruvate, lactate and glycerol. The growth on ethanol or acetate was largely restored by the addition of low concentrations of aspartate, glutamate, fumarate, citrate, oxoglutarate, oxaloacetate and glucose, but not of succinate, leucine and lysine. The expression of the DIC gene in wild-type yeast was repressed in media containing ethanol or acetate with or without glycerol. These results indicate that the primary function of DIC is to transport cytoplasmic dicarboxylates into the mitochondrial matrix rather than to direct carbon flux to gluconeogenesis by exporting malate from the mitochondria. The delta DIC mutant may serve as a convenient host for overexpression of DIC and for the demonstration of its correct targeting and assembly.     

大亚湾大辣甲水域溶解无机碳垂直分布特征及季节动态

于2007年10月～2008年9月进行了4个季节的垂直采样监测,对大亚湾大辣甲水域溶解无机碳(DIC)的垂向分布和季节动态特征进行了研究,分析了大亚湾溶解无机碳与各环境要素(pH、水温、溶解氧和叶绿素a等)的相关性。结果表明:在春、秋和冬季,大亚湾大辣甲水域DIC含量在垂直分布上差异较小,但夏季(2008年7月)变化较为显著,DIC含量的变化范围为16.79～26.52mg·L^-1;DIC高值基本集中在中、底层水域(8～16m),尤以底层水域(13～16m)为甚;DIC含量基本呈现出春、夏季较高,秋、冬季较低的分布趋势;DIC含量与pH值和水温含量显示出了负相关关系,而与盐度呈正相关关系。     

The relationship between the dissolved inorganic carbon concentration and growth rate in marine phytoplankton

A range of marine phytoplankton was grown in closed systems in order to investigate the kinetics of dissolved inorganic carbon (DIC) use and the influence of the nitrogen source under conditions of constant pH. The kinetics of DIC use could be described by a rectangular hyperbolic curve, yielding estimations of KG(DIC) (the half saturation constant for carbon-specific growth, i.e. C mu) and mu max (the theoretical maximum C mu). All species attained a KG(DIC) within the range of 30-750 microM DIC. For most species, NH4+ use enabled growth with a lower KG(DIC) and/or, for two species, an increase in mu max. At DIC concentrations of > 1.6 mM, C mu was > 90% saturated for all species relative to the rate at the natural seawater DIC concentration of 2.0 mM. The results suggest that neither the rate nor the extent of primary productivity will be significantly limited by the DIC in the quasi-steady-state conditions associated with oligotrophic oceans. The method needs to be applied in the conditions associated with dynamic coastal (eutrophic) systems for clarification of a potential DIC rate limitation where cells may grow to higher densities and under variable pH and nitrogen supply.     

Induction of CO2 and Bicarbonate Transport in the Green Alga Chlorella ellipsoidea (II. Evidence for Induction in Response to External CO2 Concentration)

The critical species and concentrations of dissolved inorganic carbon (DIC) required for the induction of DIC transport during adaptation to low CO2 were determined for the green alga Chlorella ellipsoidea. The concentration of dissolved CO2 needed for the induction of both CO2 and HCO3- transport was independent of pH during adaptation, whereas the total DIC concentration required increased at alkaline pH. At pH 7.5, the minimum equilibrium DIC concentration at which high CO2 characteristics were maintained, i.e. transport was repressed, was 2100 [mu]M, whereas the maximum equilibrium DIC concentration below which DIC transport was fully induced (DICIND) was 500 [mu]M. Intracellular DIC concentration during adaptation to DICIND decreased temporarily after 2 h to 60% of the maximum level but recovered after 3 h of adaptation. After 3 h of adaptation to DICIND, cells exhibited maximum O2 evolution rate at DICIND. When cells partially adapted to DICIND were returned to high CO2, there was an immediate halt to the induction of transport and a gradual decrease in transport capacity over 23 h. The capacity for the induction of transport was unaffected by the absence of light. These results indicate that changes in the internal DIC pool during adaptation to low CO2 do not trigger the induction of DIC transport and that the induction is not light dependent. Induction of DIC transport in C. ellipsoidea appears to occur in response to the continuous exposure of cells to a critical CO2 concentration in the external medium.