平片式与充填式无张力疝修补术式的对比研究

腹股沟疝修补术的发展迄今已有100余年的历史，术式改进的重点是在尽量不改变腹股沟区正常解剖的情况下，无张力修补腹壁薄弱区。近10年间无张力修补技术和新型人工材料的引进，使无张力疝修补术逐步取代了传统疝修补术，被认为是疝治疗史上的一场革命。但对选择何种术式和应用何种材料更为合理尚无定论。作者自2001年2月至2005年6月采用平片和网塞充填＋平片2种术式，对62例腹股沟疝患者进行无张力疝修补术治疗，对比研究报道如下。     

腹股沟疝气患者不同手术治疗方式的效果分析

目的探究腹股沟嵌顿疝患者行不同术式治疗后临床疗效及术后情况。方法选取我院2009年4月—2011年4月腹股沟疝住院手术患者76例,按不同手术方式分为两组:观察组38例,行无张力疝补片修补术,术式为无张力疝环充填式(Rutkow)修补术;对照组38例,予传统疝修补术,术式为Bassini修补术。结果本研究中对照组平均手术时间较观察组短11min,住院时间较观察组短1.1d;观察组术后应用止痛药物行止痛治疗者3例,占7.89%,对照组12例,占31.58%,观察组术后疼痛率较对照组低24.31%;追踪患者术后复发率情况,观察组复发1例,占2.63%,对照组8例,占10.53%,观察组术后复发率较对照组低7.90%。结论对无张力修补术患者行积极术前准备、术中严格无菌操作,行预防感染治疗,术后密切监控病情,对腹股沟疝患者病情恢复起积极作用。     

开放式与腔镜下完全腹膜外腹股沟疝修补术效果比较

目的对比开放式完全腹膜外腹股沟疝修补术(TEP)与腔镜下TEP的手术疗效。方法采用随机双盲对照方法,对45例双侧腹股沟疝患者分别采用开放式TEP(26例)和腔镜下TEP(19例),观察两组复发率、术中并发症、术后早期及远期并发症、手术时间、住院天数、平均恢复正常活动时间、治疗费用。结果开放TEP组随访时间平均为(22.5±1.7)个月,腔镜TEP组(23.7±1.8)个月,完成随访率为97.78%。开放TEP组1例术后1个月复发(3.85%),腔镜组1例术后2个月1侧复发(5.26%),两组疝复发率、尿潴留、切口感染、慢性疼痛或感觉异常、术中出血和精索损伤发生例数均无明显差异(P>0.05);手术时间、治疗费用、阴囊气肿、腹膜破裂等评价指标开放TEP组优于腔镜下TEP组,而腔镜TEP组在皮下血肿概率、止痛药使用例数、住院时间、恢复正常活动时间等评价指标方面优于开放下TEP组(P<0.05)。结论开放式TEP与腔镜下TEP治疗双侧腹股沟疝中各有优缺点,多数情况下是等效的,临床疗效确切。     

完全腹膜外疝修补术与Lichtenstein修补术治疗成人腹股沟疝随机对照试验的Meta分析

目的:对比分析完全腹膜外疝修补术(totally extraperitoneal prosthetic,TEP)与Lichtenstein修补术治疗成人腹股沟疝临床疗效和安全.方法:计算机检索中国知识资源总库、中国生物医学文献数据库、万方数据库、维普网、西文生物医学期刊文献数据库、Pub Med、Cochrane图书馆等数据库,查找自建库以来至2014-05国内外关于TEP与Lichtenstein修补术临床疗效分析的随机对照研究(randomized controlled trials,RCT).按照纳入与排除标准选择文献、提取资料、评价质量后,采用Rev Man5.1软件进行Meta分析.结果:共纳入1 2项前瞻性随机对照研究,3249例患者,其中TEP修补术1591例Lichtenstein修补术1658例.Meta分析结果显示:(1)手术时间:10项研究(n=2642)的手术时间差异具有统计学意义(MD=6.2395%C I:2.07-10.38,P=0.003);(2)术后并发症:9项研究(n=2740)术后并发症的发生率差异具有显著统计学意义(OR=0.5695%CI:0.46-0.69,P<0.0001);(3)住院时间:6个研究(n=348)住院时间差异无统计学意义(MD=-0.84,95%CI:-1.81-0.13,P=0.09)(4)恢复正常活动时间:7项研究(n=2329)两组间差异具有显著统计学意义(MD=-4.2795%CI:-5.58--2.96,P<0.0001).结论:与Lichtenstein修补术相比,TEP能显著减少成人腹股沟疝修补术后并发症和恢复正常活动时间,其手术时间却较长,但仍需要更多长期的、高质量、大样本、多中心的研究加以验证.     

老年腹股沟疝修补术的改进（附23例临床分析）

由于老年人腹股沟的肌肉、腱膜和韧带都有不同程度的退行性变，加之老年人存在的某些伴随病和病人就诊时间晚、病程长等原因，使得术后复发率较高。我科１９９５～１９９７年共对２３例６０岁以上的腹股沟疝患者用聚酯纤维的网状材料进行修补，由于嵌入的网片能搭接腹股沟...     

二尖瓣置换术后左室破裂

二尖瓣置换术后左室破裂是一种少见、但后果却很严重的并发症，其发生率约为1．2％（0．59／6～2．0％）。大部分左室破裂是由医源性损伤或二尖瓣瓣下结构切除过多所导致。左室破裂后修补困难，死亡率高，往往需要再次建立体外循环。对于Ⅱ、Ⅲ型破裂多采用心外修补，对于Ⅰ型破裂多采用心内修补，必要时可以联合修补和使用一些特殊修补方法。该病的有效预防最为重要，包括治疗活动性风湿、改善营养、重视左室小的高龄女性患者，提高手术操作技术。术后减轻心脏前、后负荷等。左室破裂患者的预后尚缺少大样本随访资料。     

二尖瓣置换术后左室破裂

二尖瓣置换术后左室破裂是一种少见、但后果却很严重的并发症,其发生率约为1.2%(0.5%～2.0%).大部分左室破裂是由医源性损伤或二尖瓣瓣下结构切除过多所导致.左室破裂后修补困难,死亡率高,往往需要再次建立体外循环.对于Ⅱ、Ⅲ型破裂多采用心外修补,对于Ⅰ型破裂多采用心内修补,必要时可以联合修补和使用一些特殊修补方法.该病的有效预防最为重要,包括治疗活动性风湿、改善营养、重视左室小的高龄女性患者,提高手术操作技术,术后减轻心脏前、后负荷等.左室破裂患者的预后尚缺少大样本随访资料.     

传统开腹与腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔临床疗效对比分析

目的:分析对比传统开腹与腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔临床疗效。方法:选取84例胃十二指肠溃疡穿孔患者分为观察组和对照组,分别给予传统开腹修补和腹腔镜穿孔修补,比较两组患者手术情况,术后恢复情况、住院时间/费用及并发症发生率。结果:两组患者住院费用和溃疡愈合率,差异无统计学意义(P>0.05),观察组患者手术切口、手术时间、术中出血量、术后肛门排气时间、胃肠功能恢复时间、术后下床活动时间及并发症发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论:腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔创伤小、出血量少、缩短患者术后恢复时间,降低并发症的发病率,溃疡与愈合率与开腹手术无异,值得进一步推广应用。     

腹膜外腹腔镜疝气修补术与传统疝修补术治疗腹股沟疝的疗效对比

腹股沟疝是普通外科常见病、多发病,早期症状不典型,一旦出现嵌顿,因嵌顿的肠管坏死、穿创,可导致急性腹膜炎,甚至中毒性休克,危及生命[1].腹股沟疝最有效的治疗方法是手术修补,修补方式和技术各有千秋.本研究对比观察腹膜外腹腔镜疝气修补术与传统疝修补术治疗腹股沟疝的疗效.     

腹腔镜下修补外伤性肝破裂

例1 患者男性,20岁,闭合性腹部外伤3 h,急诊入院。体检:神志清楚,心率115次/min,血压12/7 kPa,腹胀,伴明显腹膜刺激症状,B超及腹腔穿刺拟诊:外伤性肝破裂并腹腔内出血。立即在全麻下行腹腔镜探查术。建立气腹后,脐下缘刺入10 mm穿刺器套管,置入腹腔镜观察,发现全腹腔内有积血,以左膈下为甚,左肝内侧叶膈面有凝血块及鲜血     

钛网数字化塑形技术在颅骨修补中的应用研究

目的 探讨钛网数字化塑形技术在颅骨修补中的应用价值.方法 选取2011年1月-2013年1月在我院行二维钛网数字化塑形颅骨修补患者23例作为观察组,另选取同期在我院行传统二维钛网颅骨修补患者22例作为对照组.比较两组患者钛钉使用数、手术时间、恢复时间、引流量、患者满意度和积液感染率.结果 观察组患者钛钉使用数、手术时间、恢复时间、引流量、积液感染率均低于对照组（P＜0.05）;观察组患者满意度高于对照组（P＜0.05）.结论 钛网数字化塑形修补颅骨缺陷操作简单,可缩短手术时间和恢复时间,减少术后并发症发生,提高患者满意度.     

The effect of cranioplasty in cognitive and functional improvement: Experience of post traumatic brain injury inpatient rehabilitation

To investigate the effect of cranioplasty on rehabilitation of post-traumatic brain injury (TBI) patients, 37 patients with TBI were arranged by retrospectively assessment study. Those TBI patients receiving in-hospital rehabilitation in the Department of Rehabilitation in a medical center of South Taiwan from 2010 to 2015 were assigned into two groups: A and B. All patients entered the multidisciplinary holistic in-patient rehabilitation training for about 1 month. Patients in Group A received decompressive craniectomy (DC), patients in Group B received DC and cranioplasty. All assessments were arranged right on admission and before discharge. The functional activity evaluation included muscle power and Barthel index (BI), and cognitive function evaluation, including the Rancho Los Amigo Scale, Mini Mental State Examination (MMSE), Community Mental State Examination (CMSE), and the Luria-Nebraska Neuropsychological Battery-Screening Test Short Form (LNNBS). The results showed that there were synergetic effects of cranioplasty on post-TBI patients with rehabilitation training, especially in the BI score, and cognitive improvement in CMSE and LNNBS.     

3D打印聚醚醚酮材料在颅脑损伤后颅骨成形术中的应用疗效分析

目的对比分析聚醚醚酮（PEEK）和钛网在颅脑损伤（TBI）后颅骨成形术中的临床疗效,并探讨PEEK材料的潜在优势。 方法选取解放军联勤保障部队第九〇一医院神经外科自2017年1月至2021年1月行颅骨成形术的48例TBI患者为研究对象,按照使用材料的不同将患者分为PEEK组（20例）和钛网组（28例）。比较2组患者手术出血、平均手术时间、住院时间、术后并发症、塑形效果及总治疗费用方面的差异。术后随访12个月,采用Karnofsky功能状态（KPS）评分评估患者的远期效果。 结果所有患者均于术后12~14 d拆除缝线,且切口为甲级愈合。2组患者手术出血、手术时间及住院时间比较,差异无统计学意义（P>0.05）。PEEK组术后总的并发症发生率（65.00%）与钛网组（60.71%）比较,差异无统计学意义（P>0.05）;2组术后颅内迟发性出血、术区硬膜下积液、术区颅内感染、癫痫及迟发性脑积水的发生率比较,差异无统计学意义（P>0.05）;钛网组患者的皮下积液发生率及治疗费用均低于PEEK组,差异具有统计学意义（P<0.05）。2组患者术后的平均满意度均较高,但PEEK组优于钛网组,差异具有统计学意义（P<0.05）。术后随访12个月,2组患者均未出现迟发性切口感染及材料外露,KPS评分比较差异无统计学意义（P>0.05）。 结论应用3D打印PEEK材料对TBI患者行颅骨成形术,总体并发症发生率与钛网材料相比无明显差异,但3D打印PEEK材料与颅骨契合更加完美,适合儿童、青少年及女性患者在经济情况好的条件下使用。     

颅脑创伤去骨瓣减压术后低颅压脑积水

目的探讨颅脑创伤患者去骨瓣减压术后低颅压脑积水（LPH）的发病机制、诊断及治疗。 方法选择晋中市第一人民医院神经外科自2012年10月至2020年5月收治的6例去骨瓣减压术后LPH患者,均采用可调压非抗虹吸分流管行脑室-腹腔分流术。4例患者二期行颅骨缺损钛网成形术,2例患者同期行颅骨缺损钛网成形术。于术前及术后1周、1个月、3个月统计患者认知功能、步态、尿便功能,采用头部螺旋CT影像学检查,评价手术效果。 结果6例患者术后均未发生严重并发症。脑室-腹腔分流术后1周~2个月患者症状明显改善,且脑室系统明显回缩。分期行脑室-腹腔分流与钛网成形术,术后患者症状及影像学检查表现改善较快。 结论可调压非抗虹吸分流管行脑室-腹腔分流术是治疗去骨瓣减压术后LPH的有效方法,并且在二期行钛网成形术的治疗效果可能更佳。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.