脑脊液分流术治疗64例脑肿瘤临床效果分析

目的:通过观察脑脊液分流术在64例脑肿瘤患者中的临床应用效果,探讨其临床应用的价值。方法:收集2009年1月-2010年3月我院64例脑肿瘤患者病例资料,其临床诊断均有颅内高压,对照组32例患者给予常规手术进行肿瘤切除;观察组在对照组的基础上给予脑脊液分流术,比较两组治疗效果。结果:治疗后两组颅内压均降低,观察组降低更为明显(P0.05)。对照组完全缓解率为15.6%,部分缓解率为21.8%,病程稳定率为31.3%,病程进展率为31.3%。观察组分别为28.1%、31.3%、25%和15.6%。观察组完全缓解率和部分缓解率明显高于对照组(P0.05.),病程进展率对照组明显高于观察组(P0.05)。对照组术后两年内复发5例,生存超过三年的17例,生存超过五年的12例。观察组术后两年内复发的2例,生存超过三年的20例,生存超过5年的15例。和对照组比较,观察组术后病情复发率更低,生存指数更高,比较有明显差异(P0.05)。结论:脑脊液分流术在伴颅内高压或脑积水的脑肿瘤手术中的使用效果显著,后期的手术成功率和患者生存率提高,临床上可予以更为深入的探索。     

计算机模拟技术结合多媒体教学法在心肺复苏培训中的应用

目的:探讨和评价计算机模拟技术结合多媒体教学法在心肺复苏培训中的应用价值。方法:对62名急诊医生进行心肺复苏理论和技能测试,应用算机模拟技术结合多媒体教学模式,进行综合模拟演练并再次考核,比较两次成绩的差异;并发放调查问卷,分析对教学方法的评价及满意度。结果:培训后再次考核理论成绩、技能成绩和团队合作能力较初步测试成绩有显著提高,P0.05;98.3%喜欢该教学法,95.1%认为该教学法可以提高团队合作能力。结论:计算机模拟技术结合多媒体教学法在心肺复苏培训中具有重要的应用价值,可以显著提高团队合作能力。     

Direct measurement of shear strain in adherent vascular endothelial cells exposed to fluid shear stress

Functional and morphological responses of endothelial cells (ECs) to fluid shear stress are thought to be mediated by several mechanosensitive molecules. However, how the force due to fluid shear stress applied to the apical surface of ECs is transmitted to the mechanosensors is poorly understood. In the present paper, we performed an analysis of an intracellular mechanical field by observation of the deformation behaviors of living ECs exposed to shear stress with a novel experimental method. Lateral images of human umbilical vein ECs before and after the onset of flow were obtained by confocal microscopy, and image correlation and finite element analysis were performed for quantitative analyses of subcellular strain due to shear stress. The shear strain of the cells changed from 1.06 ± 1.09% (mean ± SD) to 4.67 ± 1.79% as the magnitude of the shear stress increased from 2 to 10 Pa. The nuclei of ECs also exhibited shear deformation, which was similar to that observed in cytoplasm, suggesting that nuclei transmit forces from apical to intracellular components, as well as cytoskeletons. The obtained strain-stress relation resulted in a mean shear modulus of 213 Pa for adherent ECs. These results provide a mechanical perspective on the investigation of flow-sensing mechanisms of ECs.     

Measurements of strain on single stress fibers in living endothelial cells induced by fluid shear stress

Fluid shear stress (FSS) acting on the apical surface of endothelial cells (ECs) can be sensed by mechano-sensors in adhesive protein complexes found in focal adhesions and intercellular junctions. This sensing occurs via force transmission through cytoskeletal networks. This study quantitatively evaluated the force transmitted through cytoskeletons to the mechano-sensors by measuring the FSS-induced strain on SFs using live-cell imaging for actin stress fibers (SFs). FSS-induced bending of SFs caused the SFs to align perpendicular to the direction of the flow. In addition, the displacement vectors of the SFs were detected using image correlation and the FSS-induced axial strain of the SFs was calculated. The results indicated that FSS-induced strain on SFs spanned the range 0.01-0.1% at FSSs ranging from 2 to 10 Pa. Together with the tensile property of SFs reported in a previous study, the force exerted on SFs was estimated to range from several to several tens of pN.     

燕麦米汤对严重烧伤患者休克期肠道复苏的影响

目的：研究严重烧伤患者休克期经肠道给予燕麦米汤对肠道复苏的影响。方法：选取烧伤面积≥30%TBSA的患者42例,并随机分为：燕麦米汤组,伤后24h内开始经鼻肠管给予燕麦米汤;对照组,伤后24h内开始经鼻肠管给予50g/L葡萄糖盐水,连续4d,每组21例。在伤后1、2、3、4 d分别检测其血清二氨氧化酶（DAO）值及动脉血乳酸（LAC）含量,观察两组患者腹胀缓解时间、肠鸣音恢复时间等临床指标。结果：两组患者伤后血清二氨氧化酶及动脉血乳酸含量均呈下降趋势,燕麦米汤组血清二氨氧化酶在伤后2、3、4d显著低于对照组（P〈0.01）,而脉血乳酸含量在伤后2、3d显著低于对照组（P〈0.05或0.01）,治疗过程中燕麦米汤组其腹胀缓解时间、肠鸣音恢复时间、排气时间、开始完全肠内营养时间、继发感染例数均优于对照组（P〈0.01）。结论：在严重烧伤休克期尽早鼻饲燕麦米汤能较好地促进肠道复苏。     

燕麦米汤对严重烧伤患者休克期肠道复苏的影响

目的:研究严重烧伤患者休克期经肠道给予燕麦米汤对肠道复苏的影响。方法:选取烧伤面积≥30%TBSA的患者42例,并随机分为:燕麦米汤组,伤后24h内开始经鼻肠管给予燕麦米汤;对照组,伤后24h内开始经鼻肠管给予50g/L葡萄糖盐水,连续4d,每组21例。在伤后1、2、3、4 d分别检测其血清二氨氧化酶(DAO)值及动脉血乳酸(LAC)含量,观察两组患者腹胀缓解时间、肠鸣音恢复时间等临床指标。结果:两组患者伤后血清二氨氧化酶及动脉血乳酸含量均呈下降趋势,燕麦米汤组血清二氨氧化酶在伤后2、3、4d显著低于对照组(P<0.01),而脉血乳酸含量在伤后2、3d显著低于对照组(P<0.05或0.01),治疗过程中燕麦米汤组其腹胀缓解时间、肠鸣音恢复时间、排气时间、开始完全肠内营养时间、继发感染例数均优于对照组(P<0.01)。结论:在严重烧伤休克期尽早鼻饲燕麦米汤能较好地促进肠道复苏。     

不同液体复苏对失血性休克大鼠肠粘膜的影响

目的:观察不同液体复苏对失血性休克大鼠肠粘膜的影响以及肠粘膜的变化。方法:利用大鼠失血性休克模型以及不同的补液方式,在复苏后120分钟时处死大鼠,取回肠4cm,做病理切片并根据Chiu等方法评估回肠黏膜上皮损伤指数。结果:液体复苏组的肠粘膜损伤程度小于休克不补液组(p<0.05),而限制型液体复苏组的肠粘膜损伤程度小于充分液体复苏组(p<0.05)。结论:通过本实验对肠粘膜的观察可以得出,对于失血性休克,液体复苏时有效的抗休克方式,而对于复苏的方式来说,从肠黏膜的保护方面来说,限制型液体复苏是优于传统的充分液体复苏的。     

Oxygen-binding Heme Complexes of Peptides Designed to Mimic the Heme Environment of Myoglobin and Hemoglobin

Development of effective resuscitation agents for blood-loss replacement in trauma or surgery is extremely important despite substantial improvements in screening methods of blood from human donors. This paper reports the design and synthesis of peptides that mimic the natural environment of the heme group in myoglobin (Mb) and in the - and -subunits of human adult hemoglobin (Hb). The designs were based on the fact that the heme group in the aforementioned proteins is sandwiched between helices E and F. Fifteen test peptides and six control peptides were synthesized, and their ability to form stable complexes with heme was investigated. It was found that none of the control peptides or proteins was able to bind heme. However, each of the peptides that were designed to mimic the E--F helices, and even shorter designs, which removed from this region residues that do not contribute to contacts with the heme group, were each able to bind one mole of heme per mole of peptide forming peptide–heme complexes that were stable to manipulation and behaved as single molecular species. Oxygen binding measurements on the reduced peptide–heme complexes showed that these compounds bind oxygen and give visible spectra that were typical of oxygenated heme-proteins. In oxygen binding measurements done under different partial pressures of oxygen, the heme–peptide complexes gave hyperbolic oxygen-saturation curves, but showed slight differences in their P₅₀ values. The P₅₀ values ranged from 3.8 mmHg for the heme–peptide B7 complex to 13.7 mmHg for the heme–peptide D13 complex (under the same conditions, P₅₀ values for Hb and Mb were 34.0 and 5.5 mmHg, respectively). It is concluded that peptide constructs designed to mimic the heme-binding regions of Mb or the Hb subunits were able to form coordinate 1:1 complexes with heme, and these complexes bind oxygen in a manner expected for single subunit heme proteins.     

Actin redistribution in mosquito malpighian tubules after a blood meal and cyclic AMP stimulation

Fluid secretion by mosquito Malpighian tubules is critical to maintaining fluid and electrolyte balance after a blood meal. Endogenous cAMP levels increase in Malpighian tubules after a blood meal. Here, we determined if corresponding changes in intracellular actin distribution occur after a blood meal or dibutyryl-cAMP (db-cAMP) stimulation and whether altering actin turnover inhibits secretion. In untreated Malpighian tubules, beta-actin immunostaining was more intense in the apical region of adult Malpighian tubules than in the cytoplasm. Stimulation by a blood meal or db-cAMP significantly decreased beta-actin immunostaining in the non-apical region of the cell. Db-cAMP had similar effects in larvae and pupae Malpighian tubules. In contrast, no detectable shift in F-actin distribution was detected; however, F-actin bundles within the cytoplasm increased in size after treatment with db-cAMP. Pretreatment of Malpighian tubules with agents perturbing actin fiber assembly and disassembly decreased basal secretion rates and inhibited the stimulatory effects of db-cAMP. Our results show (1) beta-actin redistributes toward the apical membrane after a blood meal and this correlates temporally with increase urine flow rate and intracellular cAMP levels, (2) Malpighian tubules from all developmental stages exhibit this same response to db-cAMP-stimulation, and (3) dynamic assembly and disassembly of beta-actin is required for db-cAMP-stimulated secretion.     

Role of lateral cell-cell border location and extracellular/transmembrane domains in PECAM/CD31 mechanosensation

Phosphorylation of tyrosine residues on platelet-endothelial cell adhesion molecule-1 (PECAM-1), followed by signal transduction events, has been described in endothelial cells following exposure to hyperosmotic and fluid shear stress. However, it is unclear whether PECAM-1 functions as a primary mechanosensor in this process. Utilizing a PECAM-1-null EC-like cell line, we examined the importance of cellular localization and the extracellular and transmembrane domains in PECAM-1 phosphorylation responses to mechanical stress. Tyrosine phosphorylation of PECAM-1 was stimulated in response to mechanical stress in null cells transfected either with full length PECAM-1 or with PECAM-1 mutants that do not localize to the lateral cell-cell adhesion site and that do not support homophilic binding between PECAM-1 molecules. Furthermore, null cells transfected with a construct that contains the intact cytoplasmic domain of PECAM-1 fused to the extracellular and transmembrane domains of the interleukin-2 receptor also underwent mechanical stress-induced PECAM-1 tyrosine phosphorylation. These findings suggest that mechanosensitive PECAM-1 may lie downstream of a primary mechanosensor that activates a tyrosine kinase.