腰交感神经节微创介入置管连续给药在糖尿病足治疗中的应用价值

目的:探讨腰交感神经节微创介入置管连续给药在糖尿病足治疗中的应用价值。方法:选取2016年6月-2017年6月期间在我院诊治的40例糖尿病足患者。按随机数字表法分为研究组(n=20)和对照组(n=20)。对照组给予常规治疗,研究组使用腰交感神经节微创介入置管连续给药治疗。对比分析两组视觉模拟评分(VAS)、治疗总有效率、并发症发生情况。结果:两组治疗前VAS评分比较差异无统计学意义(P0.05);两组治疗后VAS评分均下降,且研究组较对照组降低(P0.05)。研究组治疗后的临床总有效率为95.00%(19/20),高于对照组的70.00%(14/20)(P0.05)。治疗后研究组踝肱指数(ABI)和皮温高于对照组,震动感觉阈值(VPT)低于对照组,差异均有统计学意义(P0.05);治疗后研究组患者溃疡愈合时间和住院时间短于对照组,两组比较差异具有统计学意义(P0.05)。两组治疗后并发症发生率比较无统计学差异(P0.05)。结论:使用腰交感神经节微创介入置管连续给药治疗糖尿病足,可显著提高治疗总有效率,减轻患者疼痛,缩短溃疡愈合时间及住院时间,减少截肢率,且安全性较好。     

丙泊酚靶控输注复合瑞芬太尼对腹腔镜直肠癌根治术患者血流动力学及术后认知功能的影响

摘要 目的：探讨丙泊酚靶控输注复合瑞芬太尼对腹腔镜直肠癌根治术患者血流动力学及术后认知功能的影响。方法：选取2017年4月~2019年4月期间我院收治的行腹腔镜直肠癌根治术患者101例,根据随机数字表法将患者分为对照组（n=50,静吸复合麻醉）和研究组（n=51,丙泊酚靶控输注复合瑞芬太尼麻醉）,比较两组围术期指标、血流动力学、术后认知功能及不良反应情况。结果：研究组麻醉诱导时间、拔管时间、清醒时间、自主呼吸恢复时间均较对照组缩短,丙泊酚使用剂量、瑞芬太尼使用剂量均少于对照组（P<0.05）。两组患者麻醉诱导后（T2）~手术结束时（T5）时间点心率(HR)呈先升高再下降的趋势（P<0.05）,平均动脉压(MAP)呈持续升高趋势（P<0.05）;研究组T2时间点HR高于对照组,插管即刻（T3）~手术开始时（T4）时间点HR则低于对照组（P<0.05）;研究组T2~T5时间点MAP均高于对照组（P<0.05）。两组拔管时的简易智能精神状态量表（MMSE）评分均降低,但研究组高于对照组（P<0.05）。两组不良反应发生率比较无统计学差异（P>0.05）。结论：腹腔镜直肠癌根治术中使用丙泊酚靶控输注复合瑞芬太尼麻醉,可有效改善围术期指标,减轻血流动力学波动,对患者术后的认知功能影响较轻。     

持续皮下输注赖脯胰岛素治疗老年非初诊2型糖尿病患者临床观察

目的：观察比较持续皮下输注赖脯胰岛素与常规注射预混赖脯胰岛素对老年非初诊2型糖尿病患者的疗效与安全性。方法：将58例老年2型糖尿病患者随机分为观察组（29例）与对照组（29例）,观察组用赖脯胰岛素经胰岛素泵持续皮下输注（CSI-I）,对照组用精蛋白锌重组赖脯胰岛素25注射液,2次／d,常规皮下注射。两组患者均给予糖尿病教育、饮食控制及适量运动,共治疗2周。比较治疗前后两组患者的血糖、胰岛素用量、血糖达标时间以及低血糖发生率。结果：治疗后两组患者空腹血糖、餐后血糖均较治疗前下降（P〈0．05）,观察组血糖达标时间、胰岛素用量均明显低于对照组（P〈0．05）。两组低血糖发生率无明显差异。结论：持续皮下输注赖脯胰岛素具有较好的疗效与安全性,是控制老年非初诊2型糖尿病患者较佳的方法。     

肾盂灌注冲洗对肾脏功能和结构的影响

目的：探讨经皮肾镜碎石术肾盂灌注冲洗压对肾脏结构和功能的影响。方法：建立20头活体猪高压肾盂冲洗模型,建立24F肾造瘘通道,分别在0mmHg（作自身对照,只造瘘不灌注）、150mmHg、200mmHg、250mmHg、300mmHg压力下各冲洗30分钟。术中取肾组织送病理检查,监测肾单位光镜和电镜下的形态学改变;术后5天留取尿标本,应用免疫比浊测定法（ITM）检测尿微量白蛋白（ALB）和β2-微球蛋白（β2-MG）;并于术后第5天再次取肾组织行病理检查观察肾单位的形态学改变。结果：所有灌注组术后都出现尿蛋白的增高,术后第1天和术前相比,都有显著差异（P〈0.01）。形态学观察：当肾盂灌注冲洗压在150-200mmHg时,光镜下观察见肾小囊腔轻度扩张,压力超过250mmHg,肾小囊腔见红细胞和蛋白渗出物,肾小管扩张。电镜下见肾近曲小管上皮细胞内空泡形成,微绒毛排列杂乱、稀疏、部分微绒毛脱落。结论：肾盂灌注冲洗安全压不应超过200mmHg。     

Analysis of cholesteryl esters and diacylglycerols using lithiated adducts and electrospray ionization-tandem mass spectrometry

Cholesteryl ester (CE) and diacylglycerol (DAG) molecular species are important lipid storage and signaling molecules. Mass spectrometric analyses of these lipids are complicated by the presence of isobaric molecular ions shared by these lipid classes and by relatively poor electrospray ionization, which is a consequence of an inherently weak dipole moment in these lipid classes. The current study demonstrates that lithiated adducts of CE and DAG molecular ions have enhanced ionization and lipid class-specific fragmentation in tandem mass spectrometry (MS/MS) scan modes, thereby allowing the implementation of strategies capable of lipid class-specific detection. Using neutral loss (NL) mode for the loss of cholestane from cholesterol esters (NL 368.5) and specific selected reaction monitoring for DAG molecular species, the response of specific molecular species to that of internal standards was determined. CE and DAG molecular species were quantified in human coronary artery endothelial cells (HCAECs) incubated with both palmitic acid and oleic acid. Furthermore, NL 368.5 spectra revealed the oxidation of the aliphatic fatty acid residues of CE molecular species. Taken together, these studies demonstrate a new analytical approach to assessing CE and DAG molecular species that exploits the utility of lithiated adducts in conjunction with MS/MS approaches.     

静脉输注新型溶瘤腺病毒在体内复制活性与抑瘤的关系*

目的:观察新型溶瘤腺病毒M1在体内代谢的时间及对肿瘤生长的抑制作用。方法:建立人胃癌裸鼠原位移植瘤动物模型,在指定时间点处死动物,观察瘤体大小,分离原发瘤及转移瘤进行病毒滴度测定,采用免疫组化及原位杂交来检测病毒的分布和活性复制。结果:在人胃癌裸鼠原位模型上,M1经静脉输注后不仅分布于胃原发瘤,而且存在于转移灶,但用M1静脉内给药可以减缓肿瘤生长速度。结论:静脉内输注溶瘤腺病毒可以选择性的作用于肿瘤及转移灶,并发挥溶瘤和靶向灭活plk1的双重效应。     

天窗加自排气输液器在临床应用中的体会

目的:观察临床应用中传统输液器与天窗自排气输液器的排气效果.方法:随机抽取2010年1月-2012年1月在心内科输液的200名患者,随机分成两组A组与B组,各100例,对照组用传统输液法,观察组用天窗加自排气输液器,比较两组一次与二次排气成功率.结果:观察组与实验组在一次与二次排气成功率差异有统计学意义.结论:天窗自排气输液器作为一种新的输液器,一次排气成功率显著高于传统的输液器,而且还可以进行二次排气,临床效果比传统的输液器更好.     

Marking bark beetle parasitoids within the host plant with rubidium for dispersal studies

A technique using rubidium chloride (RbCl), a trace element, as internal label is proposed for marking hymenopteran parasitoids attacking a concealed host, Ips typographus L. (Coleoptera: Scolytidae). RbCl was introduced directly into spruce via the vascular system using glass tubing. RbCl passed through the food chain and was detected at the parasitoid level by electrothermal atomic absorption spectroscopy (EAAS) or flame emission spectroscopy (FES). Mark persistency until day 8 after emergence was tested in labelled Rhopalicus tutela (Walker) (Hymenoptera: Pteromalidae). The mark decreased with time only in fed females, probably due to excretion and/or egg resorption. The proportion of marked males did not vary with time or treatment.     

右美托咪啶减少小儿腭裂手术后苏醒期躁动的研究

目的:探讨是否持续静脉泵注右美托咪啶能够减少小儿腭裂修补手术全麻后恢复期躁动的发生。方法:选取择期行唇腭裂检查的患儿60例,随机分为右美托咪定组(D组)和生理盐水组(C组),D组于全麻诱导后给于持续泵注右美托咪啶(0.6μg/kg min),C组则给与相同体积的生理盐水。两组的诱导方法相同:芬太尼0.005 mg/kg,异丙酚2mg/kg,维库溴铵0.2 mg/kg,麻醉维持主要是泵注瑞芬太尼0.1μg/kg·h及吸入2%-3%的七氟醚。记录患者在手术开始时刻(T1),手术后15 min(T2),30 min(T3)和拔管时刻(T4)的生命体征,记录患者呼吸恢复时间和拔管时间,术后躁动情况,使用躁动行为评分表,对记录的数据进行组间比较,计量资料采用x±s,采用t检验,计数资料采用X~2检验。结果:C组患者的心率在手术开始时刻(T1),手术后15 min(T2),30 min(T3)和拔管时刻(T4)明显高于D组(P0.05);C组平均动脉压在各个时刻明显高于D组;D组的躁动评分明显的低于C组(P0.05),D组的躁动发生率是20%,C组的发生率是80%(P0.05)。结论:右美托咪啶持续泵注下行小儿腭裂修补对循环影响较小,可以显著地降低全麻后患儿的躁动发生率。     

Wheat leaf lipids during heat stress: II. Lipids experiencing coordinated metabolism are detected by analysis of lipid co‐occurrence

Identifying lipids that experience coordinated metabolism during heat stress would provide information regarding lipid dynamics under stress conditions and assist in developing heat‐tolerant wheat varieties. We hypothesized that co‐occurring lipids, which are up‐regulated or down‐regulated together through time during heat stress, represent groups that can be explained by coordinated metabolism. Wheat plants (Triticum aestivum L.) were subjected to 12 days of high day and/or night temperature stress, followed by a 4‐day recovery period. Leaves were sampled at four time points, and 165 lipids were measured by electrospray ionization‐tandem mass spectrometry. Correlation analysis of lipid levels in 160 leaf samples from each of two wheat genotypes revealed 13 groups of lipids. Lipids within each group co‐occurred through the high day and night temperature stress treatments. The lipid groups can be broadly classified as groups containing extraplastidic phospholipids, plastidic glycerolipids, oxidized glycerolipids, triacylglycerols, acylated sterol glycosides and sterol glycosides. Current knowledge of lipid metabolism suggests that the lipids in each group co‐occur because they are regulated by the same enzyme(s). The results suggest that increases in activities of desaturating, oxidizing, glycosylating and acylating enzymes lead to simultaneous changes in levels of multiple lipid species during high day and night temperature stress in wheat.