膝关节镜下膝后侧腔室联合手术入路的探讨

[目的]探讨在关节镜下膝关节后侧腔室联合手术入路的重要性和可操作性。[方法]经过前内侧、前外侧和股骨髁切迹以及后内侧、后外侧和后纵隔内切口联合入路分别入镜、入器械，进行膝关节后侧腔室的探查和手术操作。[结果]216例（239膝）应用联合入路探查和治疗，其中5例膝因关节僵硬操作失败；175例膝用于治疗后侧腔室疾病，膝关节后侧腔室手术视野显著改善，探查和手术操作完善，均达到手术目的。1例膝内侧隐神经不全损伤，没有腘后神经、腓总神经、腘后血管、交叉韧带等重要组织损伤。[结论]膝关节后侧腔室病变较多，是检查和治疗的重要部位，并非“技术盲区”。这种联合手术入路，手术风险低，具备可操作性，可以提高手术效率和质量，可作为膝关节镜下常规手术入路。     

In vitro metabolism and toxicity assessment of toxin T-514 (Peroxisomicine A1) of Karwinskia humboldtiana in microsomes and primary cultured hepatocytes.

T-514 (Peroxisomicine A(1)) from Karwinskia humboldtiana is a dimeric hydroxyanthracenone with a highly selective cytotoxic effect on tumor cells. We evaluated the metabolism of this compound in two in vitro systems (liver microsomes and hepatocytes) and assessed the cytotoxicity of its metabolites on normal and tumor cells. Microsomes (12.5, 125 and 250 microg of protein/ml) and hepatocytes (1 x 10(6) cells/ml) were incubated with the toxin (25 microM) for 0.5, 1, 3, 6, 9, 12 and 24 h and the samples were examined using chromatographic analysis and UV spectra. Two metabolites (M1 and M2) were detected in the rat microsomes and one (M1) in the monkey microsomes. The retention times and UV spectra of the peaks were very similar to those of the toxin T-514. M1 was isolated and identified as a mixture of two isomers. The cytotoxicity of the metabolites was evaluated in Chang liver and Hep G2 cells but they did not show the selective cytotoxic effect on tumor cells seen in the original compound.     

急性胆源性胰腺炎的微创治疗

目的探讨应用十二指肠镜及腹腔镜治疗急性胆源性胰腺炎(ABP)的有效性。方法回顾性分析5年间对94例ABP患者进行微创治疗的临床资料。ABP合并胆囊结石的59例行行单纯腹腔镜胆囊切除术(LC);胆总管结石14例内镜下乳头括约肌切开取石术(EST),同时置入鼻胆管引流(ENBD),其中3例联合LC;对胆囊结石合并胆总管结石21例行ERCP EST,联合LC治疗。结果全组术后再次发作胰腺炎1例,胆道出血1例,均为ERCP EST患者;另肺部感染2例,切口感染1例,5例均经非手术治疗痊愈。全组有效率100%。结论十二指肠镜及腹腔镜联合应用于治疗ABP效果好。微创技术是目前ABP理想的治疗方法。     

两种隐匿阴茎大鼠模型的建立及比较

目的:建立稳定的大鼠隐匿阴茎模型,为探索阴茎包埋对海绵体结构和功能的影响提供实验动物模型。方法:90只2周龄雄性SD大鼠随机均分为A、B、C3组,A组采用阴茎根部内荷包缝合法,B组采用包皮折叠缝合法包埋阴茎,C组为假手术组。在180d内观察两种方法的包埋效果。结果:A组术后4只死于急性尿潴留,5只因尿道口周围软组织感染、皮肤破溃导致包埋失败,3只因包埋过松阴茎伸出;B组术后1只死于麻醉,2只死于急性尿潴留;因阴茎发育和勃起,A组有7只、B组有10只阴茎伸出;C组1只死于麻醉。A组和B组中其余大鼠均有较好的包埋效果,A组包埋成功率为36.7%,B组为56.7%,而且可以在实验中任何时候解除包埋。结论:包皮折叠缝合法和阴茎根部内荷包缝合法均能建立稳定的、且与人类隐匿阴茎自然病程较为一致的2周龄大鼠隐匿阴茎动物模型。     

兔肢体爆炸伤合并海水浸泡后在不同复温速率及维持浅低体温下机体炎症反应的特征

Objective To investigate effects of different rewarming rates and maintenance of light hypothermia on inflammatory response in rabbits after limb blast injury, coupled with seawater immersion. Methods First, the model of limb blast injury coupled with seawater immersion was reproduced [the animals were immersed to low body temperature of (31.0±0.5℃)]. Then, 24 adult rabbits were randomly divided into group Ⅰ [the rapid rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (8.94±0.93)℃/h], group Ⅱ [the slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (3.88±0.22)℃/h], group Ⅲ [another slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (2.18±0.12)℃/h], and the H group [the hypothermia group, n =6, rewarmed to (34 - 35)℃ at a rate of (4.49±0.66)℃/h and kept at that temperature till termination of the experiment]. Regulation of ambient temperature and warm transfusion were used to restore body temperature to target levels and maintained there for 6 hours. Blood samples were taken at 5 different times, I.e. Pre-injury time(T0), post-immersion time (T1), the time when rewarming started (T2), 3 h after rewarming (T3), and 6 h after rewarming (T4). Tissue samples from heart, liver, intestinum, lung and kidney were also collected. Levels of TNF-α (tumor necrosis factor-α), IL-1β (interleukin-1β) and IL-6 (interleukin-6) in plasma and MPO (myeloperoxidase) in homogenate were detected. Results Following rewarming, TNF-α, IL-1β, IL-6 concentrations in the plasma of the animals in group Ⅰ and group H were significantly higher when compared with those of the animals in group Ⅱ and group Ⅲ (P<0.05, P<0.01), and MPO activity in homogenate was significantly higher when compared with that of the animals in group Ⅱ and group Ⅲ(P<0.01, P<0.05), and no statistical difference could be seen between group Ⅱ and Ⅲ (P>0.05). Conclusions Rapid rewarming and maintenance of light hypothermia could obviously elevate TNF-α, IL-1β, IL-6 concentrations in plasma and MPO activity in homogenate, following limb blast injury coupled with hypothermia induced by seawater immersion, while slow rewarming (with a rewarming rate of 2-4℃/h) could significantly inhibit TNF-α, IL-1β, IL-6 levels and PMN activity.     

超滤膜技术分离灵芝多糖的研究

目的:研究超滤膜技术应用于提纯灵芝多糖的可行性及工艺.方法:采用卷式超滤膜对灵芝多糖进行分离提纯研究.结果:膜截留分子量6 000 D、超滤温度45～50 ℃、超滤压力0.6 MPa、时间45 min,制得灵芝多糖的纯度为73.5%,回收率为69.4%.结论:超滤膜技术分离提纯灵芝多糖工艺简单,效果较好,有产业化前景.     

血管内超声显像在冠心病支架植入术中的应用

目的探讨血管内超声在冠心病支架植入中的作用。方法50例患者的52处病变在支架植入前后分别用血管内超声进行定量和定性分析,并根据血管内超声标准决定支架的直径以及植入的终点,分析CAG和IVUS对支架植入终点判断的差异和最终获得的管腔面积大小的差别以及支架后管腔面积增大的机制。结果IVUS比CAG判断的平均支架直径大[(3.48±0.29)mmvs(3.36±0.33)mm,P=0.011],支架囊的最终峰值压力明显增大[(17.7±2.9)atmvs(12.8±2.4)atm,P<0.001],QCA测得的支架面积狭窄百分比减小(13.2%±6.6%vs16.6%±9.1%,P=0.044);首次高压扩张后支架满意率CAG达96.2%,而IVUS只有37.7%。IVUS指导后最终的球囊压力更高[(16.13±1.87)atmvs(12.62±2.61)atm,P<0.001],获得的管腔直径更大[(3.64±0.53)mmvs(3.31±0.57)mm,P<0.001],管腔面积也更大[(9.90±2.05)mm2vs(8.84±1.67)mm2,P<0.001],面积狭窄百分比更小(49.15%±9.03%vs54.24%±10.05%,P<0.001];所有患者支架的近段和远段CAG均未发现明显的狭窄。而IVUS却发现支架近段血管有39例(75.0%),远段血管有23(44.2%)例存在动脉粥样硬化斑块;支架植入后非脂质斑块较脂质斑块获得的管腔面积更大[(4.50±1.67)mm2vs(3.68±0.97)mm2,P<0.001],其中脂质斑块血管面积增大较非脂质斑块小1.30mm2,斑块压缩程度却增加0.48mm2。结论IVUS较CAG能更好地判断病变的性质,指导支架更好地选择,可获得更大的管腔面积,更小的面积狭窄百分比。     

4例SRY阳性的46,XX男性综合征患者临床及细胞分子遗传学研究

目的:探讨SRY阳性的46,XX男性综合征患者的临床及细胞分子遗传学特征。方法:分析4例SRY阳性的46,XX男性综合征患者的临床特点,并进行染色体核型分析、荧光原位杂交(FISH)、SRY基因检测、Y染色体微缺失等细胞和分子遗传学检测。结果:4例患者社会性别均为男性,身材低于正常男性均值。均因不育就诊,双侧睾丸体积小、质地软,精液检查均为无精子症。阴茎发育正常。性激素检查示高促性腺激素性性腺功能不全。染色体核型均为46,XX,Y染色体微缺失检测示AZFa,b,c区域均缺失。SRY基因均存在,FISH结果3例患者显示SRY基因易位于X染色体短臂。结论:SRY阳性的46,XX男性综合征患者常为男性表型,但睾丸发育不良,多伴有身材矮小和不育。患者的男性表型是由于基因组中存在SRY基因。无精子表型是由于缺失AZF。Y染色体长臂上可能存在与身高相关的基因。深入进行细胞、分子遗传学研究有助于揭示46,XX男性综合征基因型-表型的关系。     

HPLC法测定滑膜炎颗粒中原儿茶醛的含量

目的建立滑膜炎颗粒剂中原儿茶醛的含量测定方法质量。方法采用高效液相色谱法对方中原儿茶醛进行含量测定。结果高效液相色谱法测定结果表明原儿茶醛在0．1005～1．005μg范围内呈线性关系，平均加样回收率为99．22％；RSD为0．72％。结论本法简便，重现性好、结果可靠，可作为控制滑膜炎颗粒剂的质量方法。     

护理导师制教学法的临床应用研究

目的:为培养适应在新医学模式下开展以病人为中心整体护理工作的护理人员,改革传统临床教学模式,采用护理导师教学法,以提高教学质量.方法:制定导师职责,制定导师的选择聘任标准,制定导师培训方案,实施导师制教学法的临床过程,实行双向教学评价,通过以上活动达到提高教学质量的效果.结果:320余名实习学生调查表明,12%的学生认为护理导师教学法形式明显优于其它教学形式,82%的学生认为优于其它教学形式.结论:护理导师教学法提高了临床教学水平和导师的整体素质,也促进了临床护理质量和临床教学质量的不断提高.