肛肠疾病手术前后肛管直肠压力测定的应用

目的:探讨肛肠疾病手术前后肛管直肠压力测定的应用。方法:将2018年5月-2019年5月在上海市松江区方塔中医医院及上海中医药大学附属曙光医院肛肠科行手术治疗的826例肛肠疾病患者作为研究对象,其中,选择性痔上黏膜吻合术246例、单纯外剥内扎术115例、外剥内扎结合内痔套扎术(Automatic Ligation of Hemorrhoids,RPH)153例、低位肛瘘切除术177例、高位肛瘘切开挂线术135例,分别于术前及术后1个月测定肛管直肠压力。结果:选择性痔上黏膜吻合术后直肠静息压、肛管静息压明显低于术前,肛管舒张压高于术前(P<0.05),但肛管最大收缩压与术前相比无明显差异(P>0.05);单纯外剥内扎术术后直肠静息压、肛管静息压明显低于术前,肛管舒张压、肛管最大收缩压明显高于术前(P<0.05);外剥内扎结合内痔套扎术术后直肠静息压、肛管静息压明显低于术前,肛管舒张压、肛管最大收缩压明显高于术前(P<0.05);低位肛瘘切除术术后直肠静息压、肛管静息压、肛管舒张压均高于术前(P<0.05),而肛管最大收缩压与术前相比无明显差异(P>0.05);高位肛瘘切开挂线术术后直肠静息压高于术前,肛管静息压、肛管舒张压低于术前(P<0.05),而与肛管最大收缩压术前相比无明显差异(P>0.05)。结论:肛肠疾病手术前后肛管直肠压力测定的应用效果显著,能准确判断手术效果及患者恢复情况,为医师的进一步诊治奠定了良好基础。     

结直肠癌化疗患者营养状况及营养治疗研究进展

结直肠癌是常见的消化道肿瘤，其营养不良发生率高且严重。化疗是结直肠癌常见治疗方式之一，并与营养不良独立相关，化疗后患营养不良风险增大且营养不良进一步加重。同时，营养不良可导致患者化疗疗效差及预后不良，并增加化疗相关不良反应、影响患者生活质量及降低生存率等。营养治疗能够有效改善患者营养状况，在肿瘤综合治疗中有重要作用，且多学科团队合作是有效的营养干预模式。目前营养治疗主要包括营养咨询、口服营养补充剂、肠内营养和肠外营养等，相关指南和研究表明在营养治疗时应首选口服营养补充剂及肠内营养，仅在采用以上治疗后仍存在营养不足或无法进行肠内营养时行肠外营养。本文主要对结直肠癌患者营养状况与化疗之间关系、营养治疗的最新研究进展及相关指南进行综述，以期引起临床上对结直肠癌化疗患者营养治疗方面重视并提供参考。     

VEGF在膀胱移行细胞癌中的表达研究

目的研究血管内皮生长因子（VEGF）在膀胱移行细胞癌（TCC）中的表达。方法应用免疫组织化学染色方法观察62例TCC标本VEGF的表达情况。结果TCC组中VEGF的阳性表达率为56．5％（35，62），而8例正常膀胱粘膜组织VEGF表达均为阴性，两组比较差异有高度显著性p〈0．01（x^2=9．032）；VEGF表达与膀胱肿瘤病理分级、临床分期、复发密切相关。结论VEGF的异常表达在TCC的发生、发展过两组比较差异有程中起重要作用；该指标的检测有助于预后判断。     

实时三维超声对室间隔缺损的直视效果及影响因素分析

目的探讨实时三维超声（RT3DE）对室间隔缺损（VSD）全貌的直视效果及其影响因素。 方法应用RT3DE对238例VSD患者进行检查，其中包括法洛四联症（TOF）36例、完全型心内膜垫缺损（TECD）2例和十字交叉心2例。获取并切割“全容积三维”图像，寻找最佳视角显示病变结构全貌。 结果RT3DE对中型和大型VSD（直径≥5mm）的直视效果优于小型VSD（〈5mm）。可显示缺损的形状、部位及毗邻结构。胸骨旁四腔位和心底短轴位RT3DE图像效果最佳，胸骨旁长轴位及心尖五腔位次之。 结论VSD的大小、部位及三维图像质量是决定RT3DE观察效果的主要因素。RT3DE可清晰直视中型及大型VSD的全貌。     

Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK(-/-) mice.

Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.     

外剥、内扎硬化注射术治疗混和痔800例

目的观察和评价外剥、内扎硬化注射术治疗混合痔的近期疗效.方法作者采用外剥、内扎硬化注射术治疗混和痔800例.结果近期治愈788例,治愈率98.5%,好转12例,好转率1.5%.治愈天数10～21天.结论外剥、内扎硬化注射术治疗混合痔简单实用,手术时间短,术后痛苦小,伤面愈合快,并发症少,无后遗症,复发率低,是治疗混合痔的较好方法.     

变温培养对泰乐菌素发酵的影响

在泰乐菌素发酵过程中的不同阶段采用不同的培养温度,通过实验考察其对泰乐菌素发酵的影响。实验结果表明,变温培养的发酵水平要高于其它恒温培养的发酵水平。     

Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program

Background  

Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time.