目的 研究利多卡因对海马的神经毒性是否会对大鼠空间学习记忆能力产生影响，并探讨大鼠空间学习能力的变化与海马CA3区锥体细胞数目的相关性。 方法 将成年Wistar雄性大鼠随机分为基础值组（n=7）和利多卡因惊厥组（n=40）。基础值组大鼠静脉给予生理盐水后使用Y迷宫测定大鼠的空间学习能力。利多卡因惊厥组大鼠尾静脉持续输注利多卡因造成惊厥，待大鼠恢复正常运动以后放入鼠笼重新饲养。并于惊厥后第1、3、5、7天从中随机抓取大鼠测试其空间学习能力以及组织学改变。根据对应天数将利多卡因惊厥组的40只大鼠随机细分为Day-1、Day-3、Day-5、Day-7亚组，每亚组10只。所有大鼠在测定空间学习能力之后立即处死，取出大脑并做石蜡包埋，冠状面切片后进行组织学检测，显微镜下评估海马CA3区锥体细胞状态。 结果 ① 基础值组和Day-1、Day-3、Day-5、Day-7亚组大鼠的Y迷宫穿梭次数分别为（25.2 ± 3.7）、（27.1 ± 8.1）、（36.9 ± 9.9）、（38.7 ± 10.6）、（40.6 ± 16.3）次，除Day-1亚组与基础值组比较差异无统计学意义（P＞0.05）外，其余各亚组与基础值组差异均有统计学意义（P＜0.05）；② 与基础值组单位面积（10.3 ± 4.5）个（异常锥体）细胞比较，利多卡因惊厥组大鼠海马CA3区异常锥体细胞数增加，Day-1、Day-3、Day-5、Day-7亚组计数值分别为13.0 ± 7.2、15.6 ± 5.0、19.6 ± 8.1、18.1 ± 5.1，且与大鼠Y迷宫穿梭次数呈正相关（r=0.711，P＜0.05）。 结论 利多卡因引起的惊厥使成年大鼠海马依赖性空间学习能力下降，利多卡因的神经毒性引起的海马异常锥体细胞增多可能是造成这一现象的一种原因。
目的:调查分析神经外科护士工作压力因素,采取相应对策以减轻压力,积极应对工作。方法:采用问卷调查法,对在神经外科工作的护士工作压力程度,工作压力源,压力源前五位,与其它科室护士进行比较,并通过统计学方法进行分析。结果:神经外科护士工作压力程度以重度压力为主。排序前5位的压力源为:工作量大,担心工作出差错,社会地位低,上班护士数量少,护理的患者病情过重。结论:正确分析神经外科护士工作压力因素,采取有效的对策,对于提高护理质量,保障护理安全,具有十分重要的意义。
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.