目的 研究利多卡因對海馬的神經毒性是否會對大鼠空間學習記憶能力產生影響，并探討大鼠空間學習能力的變化與海馬CA3區錐體細胞數目的相關性。 方法 將成年Wistar雄性大鼠隨機分為基礎值組（n=7）和利多卡因驚厥組（n=40）。基礎值組大鼠靜脈給予生理鹽水后使用Y迷宮測定大鼠的空間學習能力。利多卡因驚厥組大鼠尾靜脈持續輸注利多卡因造成驚厥，待大鼠恢復正常運動以后放入鼠籠重新飼養。并于驚厥后第1、3、5、7天從中隨機抓取大鼠測試其空間學習能力以及組織學改變。根據對應天數將利多卡因驚厥組的40只大鼠隨機細分為Day-1、Day-3、Day-5、Day-7亞組，每亞組10只。所有大鼠在測定空間學習能力之后立即處死，取出大腦并做石蠟包埋，冠狀面切片后進行組織學檢測，顯微鏡下評估海馬CA3區錐體細胞狀態。 結果 ① 基礎值組和Day-1、Day-3、Day-5、Day-7亞組大鼠的Y迷宮穿梭次數分別為（25.2 ± 3.7）、（27.1 ± 8.1）、（36.9 ± 9.9）、（38.7 ± 10.6）、（40.6 ± 16.3）次，除Day-1亞組與基礎值組比較差異無統計學意義（P＞0.05）外，其余各亞組與基礎值組差異均有統計學意義（P＜0.05）；② 與基礎值組單位面積（10.3 ± 4.5）個（異常錐體）細胞比較，利多卡因驚厥組大鼠海馬CA3區異常錐體細胞數增加，Day-1、Day-3、Day-5、Day-7亞組計數值分別為13.0 ± 7.2、15.6 ± 5.0、19.6 ± 8.1、18.1 ± 5.1，且與大鼠Y迷宮穿梭次數呈正相關（r=0.711，P＜0.05）。 結論 利多卡因引起的驚厥使成年大鼠海馬依賴性空間學習能力下降，利多卡因的神經毒性引起的海馬異常錐體細胞增多可能是造成這一現象的一種原因。
目的:調查分析神經外科護士工作壓力因素,采取相應對策以減輕壓力,積極應對工作。方法:采用問卷調查法,對在神經外科工作的護士工作壓力程度,工作壓力源,壓力源前五位,與其它科室護士進行比較,并通過統計學方法進行分析。結果:神經外科護士工作壓力程度以重度壓力為主。排序前5位的壓力源為:工作量大,擔心工作出差錯,社會地位低,上班護士數量少,護理的患者病情過重。結論:正確分析神經外科護士工作壓力因素,采取有效的對策,對于提高護理質量,保障護理安全,具有十分重要的意義。
Implantable left ventricular assist device (LVAD) has become an essential treatment for end-stage heart failure, and its effect has been continuously improved. In the world, magnetic levitation LVAD has become mainstream and is increasingly used as a destination treatment. China has also entered the era of ventricular assist device. The continuous improvement of the ventricular assist device will further improve the treatment effect. This article reviews the current situation and development trend of LVAD treatment in China and abroad.
Objective To study palliative surgical strategies for patients with complex congenital heart diseases， and improve their clinical outcomes and survival rate.?Methods We retrospectively analyzed clinical data of 95 patients with complex congenital heart diseases who underwent palliative surgical repair in Union Hospital of Tongji Medical College，Huazhong University of Science and Technology from January 2004 to May 2011. There were 68 male patients and 27female patients with their age ranging from 1 month to 37 years. Modified Blalock-Taussig shunt （B-T shunt） was performed in 12 patients， modified Brock’s procedure in 23 patients， bidirectional Glenn procedure in 55 patients and pulmonary artery banding in 5 patients. Surgical strategies and influential factors of treatment outcomes were analyzed.?Results There were 10 in-hospital death with the overall mortality of 10.5% （10/95）. All the surviving patients were discharged successfully. Main postoperative complications included low cardiac output syndrome， hypoxemia and pneumonia. All the surviving patients were followed up for 5 months to 6 years， and in New York Heart Association （NYHA） functional class ⅠorⅡduring follow-up. During follow-up， nine patients after modified Brock’s procedure received radical repair， and 6 patients after bidirectional Glenn procedure received total cavopulmonary connection.?Conclusion A considerable numberof patients with complex congenital heart diseases may miss their best timing for surgical repair， which significantlyinfluences their surgical outcomes. We need to choose best palliative surgical strategy for these patients according to their pulmonary artery development condition， heart malformation characteristics and final treatment goal.
【Abstract】 Objective To reduce restenosis in vein grafts after coronary artery bypass grafting, to investigate theeffect of human tissue factor pathway inhibitor(TFPI) gene del ivery on neointima formation. Methods The eukaryotic expressed plasmid vector pCMV-(Kozak) TFPI was constructed. Forty-eight Japanese white rabbits were randomly divided into 3 groups with 16 rabbits in each group: TFPI group, empty plasmid control group and empty control group. Animal model of common carotid artery bypass grafting was constructed. Before anastomosis, vein endothel iocytes were transfected with cationic l iposome containing the plasmid pCMV- (Kozak) TFPI (400 μg) by pressurizing infusion (30 min) in TFPI group. In empty plasmid control group, vector pCMV- (Kozak) TFPI was replaced by empty plasmid pCMV (400 μg). In empty control group, those endothel iocytes were not interfered. After operation, vein grafts were harvested at 3 days for immunohistochemical, RTPCR and Western-blot analyses of exogenous gene expression and at 30 days for histopathology measurement of intimal areas, media areas and calculation of intimal/media areas ratio. Luminal diameter and vessel wall thickness were also measured byvessel Doppler ultrasonography and cellular category of neointima was analyzed by transmission electron microscope at 30 days after operation. Results Human TFPI mRNA and protein were detected in TFPI group. The mean luminal diameter of the TFPI group, empty plasmid control group and empty control group was (2.68 ± 0.32) mm, (2.41 ± 0.23) mm and (2.38 ± 0.21) mm respectively. There were statistically significant differences between TFPI group and control groups (P lt; 0.05). The vessel wall thickness of the TFPI group, empty plasmid control group and empty control group was (1.09 ± 0.11) mm, (1.28 ± 0.16) mm and (1.34 ± 0.14) mm respectively. There were statistically significant differences between TFPI group and other control groups (P lt; 0.01). The mean intimal areas, the ratio of the intimal/media areas of the TFPI group were (0.62 ± 0.05) mm2and 0.51 ± 0.08 respectively, which were reduced compared with those of the two control groups(P lt; 0.05). The mean media areas had no significant differences among three groups (P gt; 0.05). Through transmission electron microscope analyses, no smoothmuscle cells were seen in neointima of TFPI group in many visual fields, but smooth muscle cells were found in neointima of two control groups. Conclusion Human TFPI gene transfection reduced intimal thickness in vein grafts.
Objective To evaluate the accuracy of preoperative 64 multidetector spiral computed tomography (MDCT) in the diagnosis of stage Ⅳ gastric cancer. Methods The data of patients with stage Ⅳ gastric cancer between July 2007 and April 2008 were collected. Twenty-nine patients underwent preoperative 64 MDCT were retrospectively analyzed. All computed tomography scans were prospectly analyzed by 2 abdominal radiologists separately. Pathological tumor stage was based on TNM stage according to the revised Japanese Classification of Gastric Carcinoma from the Japanese Gastric Cancer Association. All CT results were compared with clinical, surgical and histopathologic results. Results The 65.2% (15/23), 47.8% (11/23) and 70.8% (17/24) of the stage Ⅳ patients were accurately predicted of T, N and M stage, respectively. Moreover, 58.6% (17/29) of the stage Ⅳ patients were accurately predicted of TNM stage. But 6/9 cases with peritoneal metastases were not detected by preoperative 64 MDCT. Conclusion The 64 MDCT is a promising technique for detection and preoperative staging of stage Ⅳ gastric cancer. It was difficult to detect peritoneal metastases, but it may not increase the rate of exploratory laparotomy.