超声内镜精准评估肿瘤起源及组织学特征可提高食管平滑肌瘤的手术疗效

目的 探讨超声内镜评估肿瘤起源及组织学特征能否提高内镜下切除食管平滑肌瘤的手术疗效。 方法 回顾性分析2016年1月～2020年6月因食管黏膜下肿瘤于消化内科治疗并经病理证实为平滑肌瘤患者的临床资料。共58例食管平滑肌瘤患者接受术前超声内镜检查评估后进行内镜下切除。统计患者的肿瘤完整切除率、手术时间、住院时长及并发症发生情况。 结果 术前超声内镜提示,平滑肌瘤起源于黏膜肌层39例,固有肌层19例。瘤体平均直径1.50（0.2～6.5）cm,其中20例行内镜黏膜切除术(EMR),32例行内镜黏膜下挖除术(ESE),6例行黏膜下隧道内镜肿瘤切除术(STER)。总体完整切除率为96.6%。平均手术时间为38.29（15～100）min。术后并发症发生率15.5%（9/58）,均经保守治疗后好转。在39例黏膜肌层起源平滑肌瘤中,20例行EMR,19例行ESE,两组患者的肿瘤大小及并发症发生上差异不显著,但EMR组的手术时间及患者术后住院天数明显更短（P<0.05）。在19例固有肌层起源平滑肌瘤中,13例行ESE,6例行STER,两组患者在肿瘤大小、手术时间、术后住院天数及并发症发生上差异均无显著统计学意义。 结论 术前超声内镜精准评估肿瘤起源及组织学特征可提高食管平滑肌瘤手术疗效。     

胸腔镜下肺叶切术在基层单位的应用的体会

30例行胸腔镜下肺叶切除均顺利完成,无死亡及重大并发症发生,l例术中出血而中转开胸.术后无出血、漏气、积液等并发症发生.平均手术时间125 min,术中出血215 ml,住院平均时间9d.术后随访12 ～ 36个月.患者恢复好,无复发.基层医院应用VATS(电视胸腔镜)行肺叶切除术,创伤小,恢复快,疗效确切安全,临床效果显著.     

基层医院胸腔镜胸腺扩大切除治疗重症肌无力的临床应用

目的探讨基层医院采用胸腔镜胸腺扩大切除术(VATS)治疗重症肌无力(MG)的可行性。方法回顾分析我院采用胸腺扩大切除术治疗的重症肌无力(非胸腺瘤)患者68例,其中胸腔镜手术34例,胸骨劈开术34例,术后随访1~6年。结果VATS组患者均在胸腔镜下完成,手术时间(90.1±15.0)min,出血(45.0±5.5)mL,胸腔引流(2.5±1.2)d,术后住院时间(7.0±1.2)d,无严重并发症,无手术死亡。胸骨劈开组手术时间(98.0±12.5)min,出血(118.5±17.5)mL,胸腔引流(4.5±1.3)d,术后住院日(11.0±2.5)d,肌无力危象2例。2组患者中远期疗效差异无统计学意义。结论胸腔镜下胸腺扩大切除治疗MG,较胸骨劈开胸腺扩大切除治疗MG更具优势,具有并发症少、疗效可靠等优点,值得基层医院推广应用。     

胸腔镜在食管良性疾病中的应用

本组应用电视胸腔镜(Videothoracoscopy,VATS)为12例食管良性疾病(食管平滑肌瘤、食管憩室、贯门失弛缓症)患施行了手术治疗。吞咽困难和胸骨后疼痛是三种疾病的主要症状。而疼痛并不是疾病本身造成,是由于返流性食管疾病及食管运动紊乱所致。对于某些症状较轻的病人,采用开胸手术的方法,其手术本身会给病人造成更大的伤害。胸腔镜不但可以避免开胸创伤的损害,而且可以获得良好的手术效果。本组无手术死亡及并发症。     

超声内镜诊断与内镜下微创治疗食管平滑肌瘤

目的 评价超声内镜对食管平滑肌瘤的诊断及治疗中的价值.探讨内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)治疗食管平滑肌瘤的疗效和安全性.方法 对内镜检查中发现的40例食管黏膜下肿瘤行超声内镜检查,其中30例为起源于黏膜肌层的食管平滑肌瘤,4例为起源于同有肌层的食管平滑肌瘤.对30例起源于黏膜肌层的食管平滑肌瘤,根据病变大小决定行内镜下EMR或ESD治疗,完整切除病变.对4例起源于固有肌层的食管平滑肌瘤,考虑穿孔可能性大,未予内镜下治疗.结果 40例食管黏膜下肿瘤,病变直径0.4～2.5 cm(中位直径1.45 cm).24例行内镜下EMR治疗,6例病变直径超过1.5 cm行内镜下ESD治疗,ESD手术时间15～45 min(中位时间30min).2例术中出血较多.经内镜喷洒止血药物、电凝、氩离子束凝固治疗及金属钛夹钳夹止血,无术后出血,无ESD穿孔.所有EMR或ESD切除病变送检病理确诊,基底和切缘未见病变累及.术后1.5个月及6个月随访,创面愈合,无病变残留和复发.结论 超声内镜能够准确地诊断食管平滑肌瘤并指导其治疗.大多数食管平滑肌瘤的EMR治疗是简便和安全的.对于病灶较大、EMR难以完整切除的病变可行ESD治疗,也是安伞有效的,它可以完整切除食管病变,并提供完整的病理诊断资料.     

全胸腔镜与开胸手术治疗孤立性肺小结节的对比分析

目的 探讨全胸腔镜与开胸手术治疗孤立性肺小结节的疗效。方法 回顾性分析我院2014年1月~2016年6月手术治疗的100例孤立性肺小结节患者,按照手术方式分为开胸组和VATS组,各50例。开胸组采用传统开胸手术治疗,VATS组采用全胸腔镜手术治疗。比较两组患者的手术时间、术中出血、术后当日引流量、术后拔引流管时间、镇痛时间和住院时间。结果 两组患者生存率、病理性质比较,差异无统计学意义（P＞0.05）。与开胸组比较,VATS组手术时间短 [（114.3±29.5）min vs（151.2±47.3）min],术中出血少[（41.5±12.9）ml vs（145.1±65.8）ml],术后当日引流量少[（150.2±46.3）ml vs（220.1±55.4）ml],镇痛时间短[（2.2±1.3）d vs（7.5±1.6）d],术后拔引流管时间短[（2.2±1.3）d vs（5.8±2.6）d],术后住院时间短[（8.1±2.1）d vs（14.1±1.8）d],差异具有统计学意义（P＜0.05）。术后发生肺部感染、肺不张、心律失常VATS组分别为1例、1例、0例,开胸组为3例、2例、1例,两组差异无统计学意义（P＞0.05）。结论 全胸腔镜手术治疗孤立性肺小结节比开胸手术创伤小、术中出血少、手术时间短、疼痛轻、术后恢复快、并发症少,适合在临床基层医院开展应用。     

胸腔镜手术治疗纵隔肿瘤137例临床分析

目的 探讨胸腔镜手术治疗纵隔肿瘤的临床疗效。方法 回顾性分析安徽省立医院胸外科2009年1月—2014年12月行胸腔镜手术治疗的137例纵隔肿瘤患者的临床资料。其中男62例,女75例;年龄13～78岁,平均34岁。均在全身麻醉下行胸腔镜纵隔肿瘤切除术,观察患者手术时间、术中出血量,以及术后胸引管引流时间、住院时间和并发症发生情况。结果 137例患者,全胸腔镜下手术110例(80.3%),辅助小切口25例(18.2%),中转开胸2例(1.5%)。135例完成腔镜手术患者手术时间(105±48)min,术中出血量(92±36)mL,术后胸引管引流时间(4.8±1.7)d,术后住院时间(5.2±1.8)d。住院期间无一例死亡。术后并发症发生率5.8%(8/137),其中胸腔活动性出血行再次手术止血2例,术后肌无力危象3例,膈肌麻痹2例,单侧肢体无汗1例。结论 胸腔镜手术治疗纵隔肿瘤安全有效,患者创伤小,恢复快,值得临床推广。     

电视胸腔镜下治疗自发性气胸135例

目的探讨电视胸腔镜(VATS)治疗自发性气胸的疗效.方法回顾性分析电视胸腔镜下手术治疗135例自发性气胸的临床资料.结果全组均治愈出院,平均手术时间1.5h,手术出血110ml,平均住院时间9d,术后半年、1 年行胸片检查提示患侧肺恢复良好.结论电视胸腔镜手术具有手术创伤小、操作方便、术后恢复快、疗效满意等优点,是治疗自发性气胸的首选方法.     

电视胸腔镜下治疗自发性气胸135例

目的探讨电视胸腔镜(VATS)治疗自发性气胸的疗效.方法回顾性分析电视胸腔镜下手术治疗135例自发性气胸的临床资料.结果全组均治愈出院,平均手术时间1.5h,手术出血110ml,平均住院时间9d,术后半年、1年行胸片检查提示患侧肺恢复良好.结论电视胸腔镜手术具有手术创伤小、操作方便、术后恢复快、疗效满意等优点,是治疗自发性气胸的首选方法.     

电视胸腔镜治疗胸外伤的临床研究

目的 评价电视胸腔镜手术(VATS)诊断与治疗胸部外伤的临床价值.方法 将70例需行手术处理的胸部外伤患者按时间顺序平均分为两组:研究组(胸腔镜组)应用VATS对37例胸外伤患者进行探查与治疗;对照组(开胸组)33例胸外伤患者采用后外侧切口进胸,其他处理与胸腔镜组相同.结果 研究组手术时间短、术中出血和输血量少、术后恢复快(均P＜0.05),两组病人均无手术死亡及严重并发症.结论 VATS治疗胸部外伤是一种安全、有效、微创的方法,具有较高的临床价值的.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Studien zur humoralen Regulation des erythropoetischen Proliferationsspeichers beim Menschen

Zusammenfassung Die Beeinflussung der Erythroblasten-Proliferation durch das Mikromilieu wurde in vitro mittels Auswertung durch Differential- und Mitosezählungen und Signifikanzberechnung vieler Versuchsreihen auch unter verschiedenen pathologischen Bedingungen getestet.Sowohl die Mitosehäufigkeit wie die Ausreifung waren positiv mit dem Erythropoetingehalt des Medium korreliert. Der Effekt wurde durch Folsäure, Ätiocholanolon und cAMP verstärkt. Cobalt stimulierte ebenso wie Testosteron und Methenolon in vitro unabhängig von der Erythropoetinkonzentration im Medium die Erythroblastenproliferation. Ein vermindertes Eisenangebot störte die endgültige Ausreifung der Erythroblasten zu Retikulozyten und bewirkte dadurch eine Ineffektivität der Erythorpoese. Anhaltspunkte für ein Erythrozyten-Chalon oder einen Erythropoetinhemmkörper ließen sich aus unserem Versuchsansatz nicht gewinnen, weil er die Transformation der pluripotenten in die erythropoetin-sensible Stammzelle nicht einschließt. Als Nebenbefund ergab sich eine Stimulation des granulozytopoetischen Proliferationsspeichers durch Serumzusatz zum Medium von Patienten nach akutem Blutverlust und bei Polycythämia vera.Unterstützt durch die Deutsche Forschungsgemeinschaft     

HLA study in Amerindian Bolivia La Paz Aymaras

Aymara people has been a relatively homogeneous group since Spanish Conquest by 1,532 CE, even if previously represented a group of various cultural defined populations who gave rise to them. They were and are established in Andean Altiplano around Titikaka Lake (Bolivia, Peru), Argentina and Chile neighborhood, speak Aymara language and have been maintained after Europeans arrival at a lower social status than Quechua (Inca) speaking people. However, both Aymara and Quechua populations acknowledge Titikaka Lake as center of their origins; both languages are also related. Specific high frequencies of HLA-A*02, -A*24 and -A*68, HLA-B*35, -B*39 and -B*48, HLA-DRB1*08:02, -DRB1*09:01, and -DRB1*14:02, and HLA-DQB1*04:02, -DQB1*03:02 and -DQB1*03:01 alleles are found in Aymaras and HLA class II haplotypes common to Andean Amerindians (DRB1*08:02-DQB1*04:02 and DRB1*04:03-DQB1*03:02), like Quechua, Aymara, Uros, Lamas and Mapuche are also found in Easter and other Pacific Islands. Giant human head stone statues at Tiwanaku (Titikaka Lake, Bolivia) are also found at Easter Island. Thus, it is possible a gene and cultural flow between Andean Amerindians and Easter and other Pacific Islands, as it was demonstrated by Thor Heyerdahl in his Kon-Tiki expedition which reached Pacific Islands sailing from El Callao Harbour (Lima, Peru).     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Lipid composition of metacestodes of Taenia taeniaeformis and lipid changes during growth

A lipid analysis was performed on developing metacestodes of Taenia taeniaeformis removed from the livers of rats at times varying from 3 to 35 weeks post infection. Lipid accounted for 7–21% of the dry weight of the parasites. The highest proportions were found at the earlier stages. The distribution was as follows; neutral lipid 27–45%; glycolipid 5–11%; and phospholipid 50–61%. The major neutral lipid was cholesterol, and minor neutral lipids were sterol esters, triglycerides, diglycerides and monoglycerides. Hydrocarbons were present throughout development, but in the highest amounts at the earlier stages. Five different glycolipids were found, all of which were identified as glycosphingolipids. An increase in the proportion of more complex glycolipids was noted as parasites grew older. Ten different phospholipids were identified, with the major components being phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine. Other phospholipids were: lysophosphatides, phosphatidylinositol, phosphatidic acid, diphosphatidylglycerol, sphingomyelin, and an unknown phospholipid component. Changes in the relative amounts of the two major phospholipids were found when the early and late stages were compared. Two lipids found throughout development were identified as glycosylated dolichol phosphates, and they comprised between 1 and 3% of the total phospholipid fraction. Nineteen fatty acids were detected, and the fatty acid distribution for each lipid class at each stage was determined. Seven major fatty acids were common to each. These were: hexadecanoic, octadecanoic, oleic, linoleic, arachidonic, docosanoic, and docosahexaenoic.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Simple Serological Assays for Detecting Rice Tungro Viruses

An attempt was made to produce sensitive and specific polyclonal antisera against the viruses causing rice tungro disease, and to assess their potential for use in simple diagnostic tests. Using a multiple, sequential injection procedure, seven batches of polyclonal antisera against rice tungro bacilliform virus (RTBV) and rice tungro spherical virus (RTSV) were produced. These were characterized for their sensitivity and specificity using ring-interface precipitin test and double antibody sandwich (DAS) ELISA. Thirty-one weeks after the first immunization, antiserum batch B6b for RTBV showed the highest ring interface titer (DEP = 1:1920). For RTSV, batches S3, S4b and S5b all had similar titres (DEP = 1:640). In DAS-ELISA, however, significant differences among purified antisera (IgG) batches were observed only at IgG dilution of 10^-3. At that dilution, IgGB4b showed the greatest sensitivity, while IgGS3 showed greatest sensitivity for RTSV. When all IgG batches were tested against 11 tungro field isolates (dual RTBV-RTSV infections) at sample dilution of 1:10, IgGB4b and IgGB6b for RTBV and IgGS3 and IgGS6b for RTSV performed equally well. However, after cross adsorption with healthy plant extracts in a specially prepared healthy plant-Sepharose affinity column, only IgGB6b could be used specifically to detect RTBV in a simple tissue-print assay.     

Is it worthy to take full-course immunotherapy for allergic rhinitis? About efficacy biomarker of allergen immunotherapy

Nowadays, people pay more attention to biomarkers that can predict clinical efficacy of immunotherapy for allergic rhinitis. As the only recognized aetiological treatment, the efficacy of allergen immunotherapy (AIT) has been proved by many studies. However, treatment success depends on compliance and persistence greatly, which can be impaired by the lengthy duration of AIT and socioeconomic status of patients. Besides, ineffectiveness is another factor that accounts for non-adherence. If the clinical efficacy can be predicted in the early stage of immunotherapy, it can help patients choose appropriate treatment plans, increase patient compliance and optimize the allocation of medical resources. This paper mainly focuses on five candidate biomarkers, the sIgE/tIgE ratio before treatment, serum inhibitory activity for IgE, decreased basophil activation, upregulation of Tregs and tolerogenic DCs, reviews the time when potential biomarkers can predict or monitor the efficacy of AIT, discusses the reason why these indicators could serve as efficacy biomarkers and interactions among potential biomarkers.     

Neurotransmitter signaling pathways required for normal development in Xenopus laevis embryos: a pharmacological survey screen

Neurotransmitters are not only involved in brain function but are also important signaling molecules for many diverse cell types. Neurotransmitters are widely conserved, from evolutionarily ancient organisms lacking nervous systems through man. Here, results are reported from a loss‐ and gain‐of‐function survey, using pharmacological modulators of several neurotransmitter pathways to examine possible roles for these pathways in normal embryogenesis. Applying reagents targeting the glutamatergic, adrenergic and dopaminergic pathways to embryos of Xenopus laevis from gastrulation to organogenesis stages, we observed and quantified numerous malformations, including craniofacial defects, hyperpigmentation, muscle mispatterning and miscoiling of the gut. These data implicate several key neurotransmitters in new embryonic patterning roles, reveal novel earlier stages for processes involved in eye development, suggest new targets for subsequent molecular‐genetic investigation, and highlight the necessity for in‐depth toxicology studies of psychoactive compounds to which human embryos might be exposed during pregnancy.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.