Long-term prognostic analysis of thymectomized patients with myasthenia gravis

目的　探讨重症肌无力胸腺切除术后影响远期生存的因素。 方法　采用胸腺切除术治疗170例重症肌无力患者,其中124例术后获得超过40个月的远期随访,运用COX回归模型分析可能影响远期预后生存的有关因素,包括胸腺的各病理类型、性别、年龄、病程、术前临床Osserman分型和治疗。 结果　本项研究表明,胸腺的不同病理类型是影响胸腺切除术后远期生存的唯一重要因素,术后远期生存率有明显差异,表现为胸腺增生>良性胸腺瘤>胸腺萎缩>恶性胸腺瘤（P<0.05）。 结论　胸腺的不同病理类型是影响重症肌无力胸腺切除术远期生存的重要因素。     

40例重症肌无力手术治疗体会

目的总结1993年3月～2005年12月手术治疗重症肌无力并发胸腺瘤，胸腺增生的手术疗效。方法对40例MG并发胸腺瘤，胸腺增生患者行胸腺及胸腺瘤切除术，随访结果进行分析。结果术后患者肌无力症状缓解13例（占32．5％），改善19例（占47．5％），无效5例（占12．5％），恶化2例（占5．0％），死亡1例（占2．5％），患者手术后的疗效与Osserman分型、胸腺的病理类型及术前病程的长短有关，与性别、年龄无关。结论胸腺切除治疗MG的效果满意，对MG患者应及早手术治疗。     

13例重症肌无力胸腺扩大切除术疗效分析

目的探讨胸腺扩大切除术治疗重症肌无力的远期疗效以及影响预后的相关因素。方法回顾性分析1999年3月至2009年7月13例重症肌无力胸腺扩大切除术的病例资料以及术后的远期疗效。结果在平均为5年（0.5～10年）的随访期内,13例患者中完全缓解8例,部分缓解3例,无效2例,完全缓解率为61.5%,有效率为84.6%。不同性别、年龄的患者有效率差异无统计学意义。术前病程短和Ossermann分型为I型I、Ia型的患者有效率更高。术后病理中胸腺囊肿或增生者的有效率显著高于胸腺瘤者。结论胸腺扩大切除术治疗重症肌无力可以获得较好的疗效;术前病程、Osserman分型以及胸腺病理为胸腺瘤者可能是影响疗效的相关因素。     

重症肌无力84例胸腺和胸腺瘤切除疗效评价

目的:研究胸腺和胸腺瘤切除对重症肌无力的疗效。方法：采用手术切除胸腺治疗各型重症肌无力的患者共84例，其中存在胸腺瘤的有47例。结果：手术完全切除81例，手术中无死亡。术后随访73例，按Mondon标准来判定疗效，缓解29例，改善33例，无变化或加重8例，死亡3例。结论：认为胸腺和胸腺瘤切除是治疗重症肌无力的一种较为有效的方法，应及早手术，同时重症肌无力的远期疗效与性别、胸腺病理无关，与手术切除的彻底性、年龄差别、Osserman临床分型及病程有关。     

21例重症肌无力外科治疗体会

目的评价外科治疗重症肌无力（MG）的效果,探讨影响术后肌无力危象发生及治疗效果的因素。方法回顾我院2000-2007年外科治疗21例重症肌无力患者的临床资料,对其疗效及影响术后肌无力危象发生及影响治疗效果的因素进行分析。结果重症肌无力的症状完全缓解有5例（23.8％）部分缓解14例（66.7％）无效1例（4.8％）,死亡1例（4.8％）。病程长短、Osserman分型和胸腺的病理类型是术后肌无力危象发生的相关危险因素,治疗效果与病程、Osserman临床分型有关。结论外科治疗重症肌无力有良好的效果及可行性。     

胸腺瘤外科治疗体会

目的：了解胸腺瘤及合并有重症肌无力患者的手术治疗与预后的关系。方法：回顾总结128例胸腺瘤患者的一般资料及治疗方法。结果：完整手术切除109例（85．2％），姑息性切除14例（10．9％），探查活检5例（3．9％），其中有1例死亡（0．8％）。结论：胸腺瘤治疗应尽可能完整地切除肿瘤及部分周围组织，以达到手术彻底切除。胸腺瘤合并重症肌无力的围手术期处理至关重要。     

重症肌无力173例胸腺切除远期疗效及预后分析

目的 探讨重症肌无力胸腺切除术后的预后因素。方法 对173例经胸骨正中切口行胸腺切除术的重症肌无力患进行定期随访,并扫性别、年龄、病程、临床分型、病理分型、伴发甲亢、伴发危象等因素进行统计分析。结果 缓解49例,改善82例,无变化20例,恶化12例,晚期死亡10例,总缓解率28．3％,有效率75．7％。结论 胸腺切除治疗重症肌无力临床切实可行,以病程较短、临床Ⅱ型、胸腺增生可获得较好疗效;伴胸腺瘤及50岁以上患疗效较差;伴发危象或甲亢不影响疗效。     

胸腺切除后出现重症肌无力实施护理干预的临床分析

目的探讨胸腺切除术后护理干预工作对重症肌无力患者生活质量的影响。方法选取我院2011年3月-2013年6月42例拟行胸腺切除术治疗成人重症肌无力患者作为试验组，行护理干预；另外取同一时期50例胸腺切除满3年的成人重症肌无力患者为对照组，行常规护理。采用调整后的欧洲癌症研究与治疗组织QLQ—C30量表，随访3年后比较二组患者的生活质量。结果二组的SAS、SDS评分均较治疗前下降，差异有统计学意义（P均=0．000），观察组的SAS、SDs评分下降幅度大于对照组，差异有统计学意义（t=5．766，P=0．000；t=6．788，P=0．00），试验组患者的生活质量较对照组的生活质量有明显改善。结论护理干预可有效改善成人重症肌无力胸腺切除术后患者心理健康程度，降低患者心理压力，进而改善患者术后恢复，改善患者远期的生活质量。     

单纯胸腺瘤与胸腺瘤合并重症肌无力的外科治疗及预后分析

目的：探讨外科治疗单纯胸腺瘤与合并重症肌无力的胸腺瘤的临床、病理差异及预后分析。方法：回顾性分析 2008年1月—2018年12月于南京医科大学第一附属医院胸外科接受手术治疗的胸腺瘤患者临床和术后病理资料，对比分析单纯胸腺瘤患者与合并重症肌无力胸腺瘤患者围术期疗效及远期预后之间的差异。结果：共354例患者纳入本研究。单纯胸腺瘤组301例，男139例，女162例，平均年龄（54.11±12.57）岁，平均肿瘤直径（6.42±2.94）cm，Masaoka-Koga分期：Ⅰ期147例 （48.8%）、Ⅱ期68例（22.6%）、Ⅲ期15例（5.0%）、Ⅳ期71例（23.6%），腔镜手术比例55.5%，R0切除比例96.3%，后续治疗患者比例21.9%。胸腺瘤合并重症肌无力组共53例，男31例，女22例，平均年龄（53.74±10.21）岁，平均肿瘤直径（5.12±2.11）cm， Masaoka-Koga 分期：Ⅰ期24例（45.3%）、Ⅱ期16例（30.1%）、Ⅲ期4例（7.6%）、Ⅳ期9例（17.0%），腔镜手术比例56.6%，R0切除比例98.1%，后续治疗患者比例13.2%。两组术后总生存率差异无统计学意义。多因素分析提示，年龄≥55岁、肿瘤直径 ≥6 cm、术后病理分型为 B 型、Masaoka-Koga 分期Ⅲ~Ⅳ期及需要后续治疗是影响胸腺瘤患者预后的独立因素。结论：相比单纯胸腺瘤，胸腺瘤合并重症肌无力患者更年轻，肿瘤直径更小。完整切除是改善胸腺瘤患者预后的重要因素，术后准确的病理分型及分期可以更好地预测患者预后。     

重症肌无力胸腺切除术后复发22例治疗分析

目的 分析重症肌无力(MG)胸腺切除术后复发肌无力的因素及治疗。方法 对确诊为(MG)作胸腺切除术后肌无力加重的22例应用类固醇激素和／或硫唑嘌呤治疗，并作40个月随访。结果 MG伴胸腺增生10例全部缓解、缓解率100．0％，其中完全缓解9例(90．0％)，药物缓解1例(10．0％)，缓解率和肌无力改善程度随术后时间延长而增高；MG伴胸腺瘤12例、缓解10例、缓解率83．3％，其中完全缓解3例(25．0％)、药物缓解6例(50．0％)、显著改善1例(8．3％)、死亡2例(16．7％)。结论 MG在胸腺切除后宜常规应用类固醇激素和其他免疫抑制剂，以提高远期疗效，避免再发肌无力加重。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.