直肠肛管损伤的早期诊断和手术原则

肛管直肠紧贴盆腔骶骨凹，有坚实的骨盆保护，故损伤发病率较低。直肠肛管损伤虽不多见，但有以下特点：(1)内容物是粪便，细菌含量最多，一旦损伤，极易感染，危害极大；(2)直肠下端周围组织结构间隙多，内有较多的疏松脂肪结缔组织．其血运差易感染，且易向周围扩散；(3)常伴有其他组织器官的损伤，其合并伤约为56．2％～79．6％，常有骨盆骨折、尿道损伤等；(4)因发病率低，如诊治经验不足，易误诊、漏诊，或处理失误。     

自体和异体肌腱移植重建前十字韧带后止点转归的组织学研究

目的：比较自体和异体肌腱移植重建前十字韧带后韧带止点的组织学转归。方法：取12只健康成年杂种犬，切除双膝前十字韧带，切取伸趾肌腱，对折成双股后移植重建前十字韧带，韧带的两端分别通过胫骨和股骨骨隧道后用缝线和螺钉固定．将每条犬的左右侧膝关节随机建成自体或异体的腱-骨愈合模型，采用HE染色，观察比较韧带重建后其止点在6周、12周、6个月时的组织学表现。结果：正常犬的前十字韧带止点具有四层移行结构，即致密结缔组织、纤维软骨、钙化纤维软骨和骨组织，在纤维软骨和钙化纤维软骨之间可见清晰连续的“潮线”。术后6周，自体和异体肌腱重建韧带止点均可见韧带与骨隧道之间充满疏松结缔组织。12周时．自体韧带与骨隧道之间胶原纤维排列有序．并已形成明显的“潮线”．但不连续．四层结构不清；异体韧带与骨隧道之间胶原纤维排列无序，无明显的“潮线”形成，6个月时，自体韧带与骨隧道之间形成明显的“潮线”．且连续，四层结构清晰；异体韧带与骨隧道之间也已形成“潮线”，但“潮线”的起伏性、连续性及结构均较自体韧带差，结论：无论是自体肌腱还是异体肌腱移植重建前十字韧带．6个月后均可初步形成韧带-软骨止点：但在相同时间点．自体肌腱止点的组织学形态优于异体肌腱。     

生物降解聚丙交酯膜对椎管术后瘢痕粘连预防作用的研究

健康成年新西兰兔40只，在L3、L5部位切除椎板1．0×0．6cm，一缺损作为空白对照，另一缺损在硬膜外放置聚丙交酯（PLA）膜或明胶海绵，分别于手术后3、6、9、12周进行CT和大体形态观察。大体观察：PLA膜3周时开始降解，6周时分解成较大碎片，9周时吸收50％～70％，仅1例硬膜外产生少量薄膜状肉芽组织，12周时仅残留部分小碎片；明胶海绵组和对照组无明显差异，疤痕粘连发生率为95％和100％。CT观察：静脉增强造影前后，明胶海绵组和空白对照组硬膜外组织CT值各个周期均比同一周期的PLA膜组为高（P＜0．01）；PLA膜组各周期组CT值及同一周期造影前后CT值均无明显差异。提示PLA膜能防止椎管术后疤痕粘连。     

氟泡沫对小儿龋齿的预防保健效果

目的 分析对龋齿患儿采用氟泡沫预防保健的效果和临床价值。方法 选择2020年1月-12月于本院 行口腔检查的80例龋齿患儿为研究对象，采用随机数字表法分为参考组和试验组，各30例。参考组使 用安慰剂处理，试验组使用氟泡沫处理。随访1年，比较两组新发龋齿率、再矿化率、龋齿值、生 活质量评分及不良反应发生率。结果 试验组新发龋齿率低于参考组，矿化率高于参考组，差异有统 计学意义（P ＜0.05）；两组保健后龋齿值均低于保健前，且试验组低于参考组，差异有统计学意义 （P ＜0.05）；试验组心理状态、生活环境、生理职能及社会关系评分均高于参考组，差异有统计学意 义（P ＜0.05）；两组不良反应发生率比较，差异无统计学意义（P ＞0.05）。结论 氟泡沫在龋齿患儿中的 预防保健效果确切，能够有效控制龋齿进展并促进牙釉质再矿化，有利于预防新发龋齿，从而提升患儿的 生活质量，且安全性理想，值得临床应用。     

两种不同时期生产的中／长链脂肪乳注射液（卡路）的质量比较

目的对原国内主要的脂肪乳生产厂家生产合资并进行生产工艺改进前后所生产的20％的中／长链脂肪乳注射液各三批进行质量比较研究。方法参考国家标准、美国药典和《脂肪乳注射液（C14-C24）质量标准》（征求意见稿）要求，从pH值、乳粒大小和分布、酸值、过氧化值、甲氧基苯胺值、溶血磷脂、脂肪、中链三酰甘油、磷、甘油含量等方面进行比较。结果pH值为8．1～8．3；平均粒径为0．226—0．256μm，大于1μm的乳粒为0．4％～1．3％，无大于5μm的乳粒；酸值为0．2，过氧化值为0；甲氧基苯胺值为0．7～1．6；溶血磷脂为0．050～0．089g/L；脂肪、甘油和中链三酰甘油等含量均达到标示量的98％以上；磷含量为0．45～0．48g/L。合资前后生产的中，长链脂肪乳注射液所有指标均符合国家标准的规定，但合资改进生产工艺后的产品在乳粒大小和分布、甲氧基苯胺值等项目的批间差异较小。结论该厂家合资后优化了生产工艺，加强了中／长链脂肪乳注射液生产过程中的质量监控，产品质量的稳定性达到国内外先进水平，临床用药的安全性更高。     

中西医结合治疗原发性膜性肾炎肾病综合征的临床观察

目的：探讨中西医结合治疗原发性膜性肾炎肾病综合征的临床疗效。方法：对48例原发性膜性肾炎肾病综合征分为治疗组和对照组。治疗组24例，用强的松、环磷酰胺并辨证加用中药；对照组24例，单纯用西药治疗，观察临床缓解率和副反应。结果：治疗组完全缓解率为54．11％，总缓解率为91．6％；对照组完全缓解率41．6％，总缓解率66．6％。治疗组总缓解率高于对照组（P＜0．05）；治疗组副反应率25％，对照组为66．6％。治疗组副反应低于对照组（P＜0．01）。结论：中西医结合是治疗原发性膜性肾炎肾病综合征的有效方法。     

人类低质量卵裂期胚胎体外发育至囊胚能力的研究

目的探讨体外受精（IVF）治疗中D3低质量胚胎培养至囊胚的发育潜能，为囊胚的培养和冷冻提供依据。方法2010年6～12月进行IVF治疗的患者398例，D3移植后剩余的总胚胎数2，180枚。其中形态学较低质量胚胎1，546枚，采用序贯法微滴培养，D3～D6连续观察囊胚形成情况，比较不同细胞数、碎片含量不同的胚胎囊胚形成的比例。结果1，546枚低质量胚胎，于D5～D6形成426枚囊胚，囊胚形成率为27．56％。其中6Ⅲ、Ⅳ级为40．9％（318／778）；5Ⅰ、Ⅱ级为28．8％（30／104）；4Ⅰ、Ⅱ级为8．9％（16／180），4Ⅲ、Ⅳ级为19．7％（56／284）；2～3I、Ⅱ级为3．0％（6／200）。经统计学分析，碎片较多的胚胎中，卵裂球数目较多的胚胎，囊胚形成率较高。结论D3形态学较低质量胚胎仍有部分具有发育至囊胚的潜能，因此在D3时对这些胚胎继续进行培养至D6，可能减少胚胎的浪费并得到更好临床结局。     

血清抗精子抗体的酶联免疫吸附定量测定

目的：研究抗精子抗体（AsAb)的酶联免疫吸附试验（ELISA）定量测定方法。方法：对ELISA－SPC310试剂盒的线性，回收率，重复性，批内变异值（CV）及最终颜色产物的呈色稳定性进行测定，并用试剂盒对42例不育夫女进行了血清抗精子抗体的定量测定。结果：抗精子抗体总抗体（TIg),IgG,IgA的浓度在250U／ml以下具有良好的线性；回收率在96．5％－98．7％之间；CV值在6．7％－9．3％之间；在自然条件下，最终颜色产物在20min内吸光度减退8．2％。不育夫妇血清中TIg浓度超过参考值上限的比例，男性为25．9％，女性为33．3％。结论：ELISA－SPC 310试剂盒是一种可靠的定量测定AsAb的方法。     

防针刺海绵泡沫胶布的研制与应用

目的探讨一种更为经济有效的预防针刺伤的方法。方法将800例住院患者随机分为观察组与对照组各400例，均由相同10名护士进行输液操作，对照组输液时用常规胶布固定；观察组用自制防针刺泡沫胶布固定，拔取针头后立即将针头插入泡沫内，将输液器连同泡沫胶布一同置入锐器桶或预处理桶。结果两组患者均无不适及局部反应；处理针头时对照组操作者均有恐惧心理，观察组仅1名有恐惧心理；观察组护士被针刺伤率显著低于对照组（P〈0．01）；拔针及处理针头所需时间显著短于对照组（P〈0．01）。结论防针刺泡沫胶布能安全有效防止针刺伤，提高工作效率，有利于护士的身心健康。     

透明质酸钠对大鼠成肌细胞增殖和分化的影响

目的 研究透明质酸钠对成肌细胞增殖和分化的影响。方法 采用酶消化法将新生SD大鼠骨骼肌组织分离、纯化、原代培养及传代培养；取第3代成肌细胞，分别加入浓度为0．05%、0．1％及0．2％的透明质酸钠溶液作为生长培养基行体外培养为实验A、B及C组，加入常规生长培养基为对照D组，观察各组成肌细胞增殖情况，并采用细胞计数及MTT法绘制生长曲线。另选择0．1%透明质酸钠融合培养基行体外成肌细胞培养，常规融合培养基作对照，观察透明质酸钠对成肌细胞分化功能的影响。结果A、B及C组成肌细胞增殖表现相似，2d时进入对数生长期，4d时均达顶峰；D组成肌细胞于3d时进入对数生长期，5d时细胞数倍增，6d时达顶峰。MTT法所测吸光度（A）值的变化反映成肌细胞的增殖情况，与细胞计数的结果一致，以B组细胞增殖作用最明显，B组A值在2～8d时均高于C、D组（P〈0．05），8d时高于A组（P〈0．05）。0．1％透明质酸钠融合培养基中的成肌细胞融合率较低且上升缓慢，7d时融合率最高，为11．7％；常规融合培养基成肌细胞融合率于6d时达到峰值，约为35．0%。结论 透明质酸钠与成肌细胞的细胞相容性较好，可以作为良好的成肌细胞培养基。     

The effect of partial and full weight-bearing on venous return in the lower limb

We studied the effect of full and partial weight-bearing on venous peak velocity in the legs of 73 subjects. We used colourflow Duplex ultrasound to determine the minimal amount of weight-bearing required to produce the same venous peak velocity as full weight-bearing. We found that the venous peak velocity remains the same in the femoral vein during partial weight-bearing (196 N and above). This is important for postoperative physiotherapy and thromboprophylaxis. The median peak velocity was 30 cm/s. This corresponds to an amplification factor of four in relation to the individual resting level (peak velocity). In addition, we found that partial weight-bearing at 196 N can reliably be reproduced. The median value of partial weight-bearing after a three-day training programme was 206 N.     

Unusual Clinical Presentation of Regression in a Congenital Melanocytic Nevus

BACKGROUND: Regression of congenital melanocytic nevi is usually accompanied by the halo phenomenon and is considered a rare event. OBJECTIVE: A 15-year-old woman presented for the evaluation of multiple halo nevi. She had on her trunk a figure-of-eight pigmentary lesion, which had been developed after the coalescence of two distinct congenital melanocytic nevi. Close to the indentation between the two portions of the lesion, there was an achromic rounded area, extending from the perinevic skin to the nevus, causing its partial regression. METHODS AND MATERIALS: Dermoscopic examination disclosed a globular and homogeneous pattern, which was irregularly present at the edge of the achromic area. The histopathologic diagnosis was compound congenital melanocytic nevus with an eccentric area of regression. CONCLUSIONS: In our case, the presence of a regression area in the surrounding skin and the association with multiple halo nevi suggest a similarity with halo phenomenon, despite the atypical "halo," which was discontinuous and eccentric.     

Determination of the solute removal index for urea by using a partial spent dialysate collection method

In 22 hemodialysis patients, during a dialysis session, the solute removal index (SRI) for urea obtained from the use of a partial spent dialysate collection method was compared with that derived from the use of a total spent dialysate collection technique. The partial spent dialysate collection method was used to harvest a small representative sample of the total spent dialysate. The volumes of spent dialysate collected by the partial and the total spent dialysate collection methods were 1.7 +/- 0.4 L and 129.6 +/- 15.3 L, respectively. The total amount of urea nitrogen removed by dialysis as estimated by the partial spent dialysate collection method was similar to that determined by the total spent dialysate collection approach. As a result, the SRI value for urea obtained by the partial spent dialysate collection method (namely, 63% +/- 8%) correlated very well (r = 0.95, P < 0.001) with that derived by the total spent dialysate collection technique (namely, 62% +/- 8%). Our data suggest that it is feasible to use a simple partial spent dialysate collection method to obtain SRI results in patients treated with hemodialysis.     

短串联重复序列多态性分析在鉴别妊娠早期葡萄胎和水肿性流产中的临床应用

目的探讨短串联重复序列(STR)多态性分析在鉴别妊娠早期葡萄胎(HM)和水肿性流产(HA)中的临床应用价值。方法收集2015年9月至2016年11月于北京妇产医院计划生育科行高危流产手术、疑似HM的17例患者为研究对象,常规取材固定后分别采用传统组织病理学方法及STR分析方法进行分析。评价STR方法在HM和HA鉴别中的效果。结果 17例可疑HM病例,经组织病理学检查发现9例符合HM[其中完全性HM(CHM)6例,部分性HM(PHM)3例],8例符合HA。STR基因分型结果为10例HM,其中6例CHM(单精纯合型CHM 4例,双精杂合型CHM 2例),4例PHM(均为双精杂合型);7例符合HA。组织病理学诊断中有1例PHM漏诊,1例双精杂合型PHM被误诊为HA。结论STR多态性分析可以作为一种快速、简洁、精准的方法,有效用于妊娠早期HM和HA的鉴别诊断。     

Importance of surgical margins in the management of renal cell carcinoma

Surgical resection remains the standard treatment for clinically localized renal cell carcinoma. Pathological features of the surgical specimen, including the margin status, play an important part in determining the patient's prognosis. Negative surgical margins have traditionally been sought to maximize the efficacy of treatment. Initial concerns that partial nephrectomy might have high local recurrence rates compared with radical nephrectomy have now been minimized as a result of technological advances and refinements in surgical technique. Current concerns in relation to partial nephrectomy include the width of parenchymal tissue that should be removed to avoid positive surgical margins, effects of positive margins on recurrence-free survival, and the use of frozen-section analysis to determine margin status. Size of the surgical margin in partial nephrectomy does not seem to affect the risk of local tumor recurrence, and not all positive surgical margins lead to recurrent disease. Intraoperative frozen-section analysis is not definitive and its value in guiding the surgical management of renal tumors remains to be defined. Laparoscopic partial nephrectomy is emerging as an attractive approach for selected renal masses. Intraoperative use of ultrasound, cold-scissor parenchymal transection, embolization, and hilar clamping to achieve a bloodless operative field with clear visibility, may minimize the risk of positive margins during partial nephrectomy.     

Accuracy of nonorthogonal magnetic resonance imaging in acute disruption of the anterior cruciate ligament

A controlled, prospective study of 30 patients with suspected acute internal derangement of the knee was undertaken to evaluate the sensitivity, specificity, predictive value, and accuracy of nonorthogonal (oblique) sagittal magnetic resonance imaging (MRI) in the assessment of anterior cruciate ligament (ACL) injuries. Thirty patients with acute hemarthroses underwent MRI within 12 days of injury, followed by arthroscopy within 24 h of the MRI. A control population of 30 chondromalacia patients underwent similar evaluation. In the acute hemarthrosis patient population, the incidence at arthroscopy of acute complete ACL tears was 60% (18/30); of partial ACL tears, 13.3% (4/30); and of chronic tears, 10% (3/30). A normal ACL was found in 16.6% (5/30) of patients. In the MRI evaluation of patients with suspected ACL injury the following results were obtained for both acute and chronic complete disruption on orthogonal (sagittal) and nonorthogonal (oblique sagittal) imaging, respectively: sensitivity, 61 (16/26) versus 100%; specificity, 70 (21/34) versus 100%; positive predictive value, 61 (16/26) versus 100%; negative predictive value 70 (24/34) versus 100%; and accuracy, 66 (40/60) versus 100%. In the evaluation of partial ACL injury, four partial tears were correctly diagnosed on nonorthogonal MRI, with one false-positive diagnosis. Orthogonal imaging failed to correctly identify any of the partial ACL injuries. Two patients in the control population demonstrated evidence of chronic ACL tears. We believe that we have demonstrated the superiority of T2-weighted nonorthogonal sagittal over conventional orthogonal sagittal ACL MRI in the evaluation of ACL injury.     

Proton spin and computerized tomography in ligament injuries of the knee joint]

In a prospective study we evaluated the use of cat-scan an MRI in 106 patients with chronic complaints and acute injuries of the knee joint. All patients went to surgery afterwards. A total of 30 patients suffered from acute or chronic ligament ruptures. There were 20 ACL ruptures, 2 PCL ruptures, 3 MCL ruptures, and 2 LCL ruptures. In patients with ACL ruptures the MRI had a sensitivity of 80%, a specificity value of 80%, and a negative predictive value of 95%; whereas cat-scan had a sensitivity of 90%, a specificity of 95%, an accuracy of 94%, a positive predictive value of 82%, and a negative predictive value of 98%. All complete ACL ruptures we correctly diagnosed. However, 4 partial ACL ruptures were missed by MRI and 2 partial ruptures were missed by cat-scan. All other ligament ruptures (PCL, MCL, LCL) except one MCL rupture were correctly diagnosed by MRI as well as by cat-scan. Clinical relevance: In this study cat-scan and MRI proved to have a very high negative predictive value. Having a negative result in one of these imaging techniques means that a rupture of a ligament is highly unlikely. This may have influence on the number of unnecessary invasive arthroscopic procedures.     

彩色多普勒超声对肾积水肾功能可复性预测的价值

为探寻一种预测肾积水肾功能恢复的方法，应用一侧可复性输尿管部分梗阻模型，利用高分辨彩色多普勒显像ＣＤＦＩ测定肾动脉血流频谱，分析阻力指数（ＲＩ）在肾积不肾功能可复性预测中的价值。     

Congenital pseudarthrosis of the clavicle: a histopathological study in five patients

Congenital pseudarthrosis of the clavicle is usually situated on the right clavicle. Pathological data on pseudarthrosis are scant. The histological analysis of five cases treated by 'en bloc' surgical resection are reported. Enchondral ossification was observed on both sides of the resected pseudarthrosis in two cases. Less characteristic enchondral features were noted in three cases. These findings confirm that the pseudarthrosis is due to the failure of coalescence of the two primary ossification centers of the clavicle.     

A porcine model for the study of liver regeneration

A technique of 65% partial hepatectomy in the pig is described. Thymidine kinase activity and mitotic index were used as indices of liver regeneration. Thymidine kinase activity increased from a baseline value of 1526 +/- 256 to a maximum of 23992 +/- 4966 dpm/mg protein on the third day after partial hepatectomy. The mitotic index also increased from 0-13.3 +/- 1.66 on the third postoperative day. The indices of regeneration remained unchanged after sham operation.