HPLC法测定藏药石榴莲花散中鞣花酸和胡椒碱的含量

目的:建立高效液相色谱法测定藏药石榴莲花散中鞣花酸和胡椒碱含量的方法。方法:采用HPLC法对制剂中石榴子和诃子的鞣花酸进行含量测定;采用HPLC法对制剂中荜茇的胡椒碱进行含量测定。结果:鞣花酸在5.065～25.325μg呈良好线性关系(r=0.9999),平均回收率为98.2%,RSD=2.8%(n=6);胡椒碱在10.414～52.071μg呈良好线性关系(r=1.0000),平均回收率为99.4%,RSD=1.1%(n=6)。结论:该方法简便、准确、重复性好,专属性高,结果可靠,可有效控制石榴莲花散中鞣花酸和胡椒碱成分的质量。     

上尿路微创手术的技术改良

Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it’s important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as “4TB principals”, which include “tension-free”, “water-tight”, “thin suture”, “no touch of the key area” and “protecting the blood supply”. Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.     

交错内痔套扎联合外痔切除治疗Ⅲ～Ⅳ期混合痔临床效果

目的:研究交错内痔套扎联合外痔切除与传统内扎外剥治疗Ⅲ～Ⅳ期混合痔的临床效果。方法:2020年4月至2021年2月在我科住院,明确诊断为Ⅲ～Ⅳ期混合痔,无特殊基础疾病且行手术治疗的患者90例,随机分为观察组和对照组两组。观察组采用交错内痔套扎联合外痔切除手术,对照组予以传统外剥内扎手术,观察对比两组患者术后治疗效果、疼痛不适程度、伤口愈合时间及并发症发生率。结果:观察组在术后治疗效果、术后疼痛不适程度、伤口愈合时间及并发症发生率明显低于对照组(P <0. 05)。结论:治疗Ⅲ～Ⅳ期混合痔,交错内痔套扎联合外痔切除的临床效果比传统内扎外剥的方法更优。     

子宫内膜癌变hMSH6与p53表达的意义

目的 子宫内膜癌因其逐年上升的发病率和年轻化趋势而备受关注,深入研究其癌变机制,对于子宫内膜癌的防治具有重要意义.本研究分析子宫内膜样腺癌、子宫内膜不典型增生和子宫内膜增生不伴非典型性内膜中hMSH6和p56的表达,探讨hMSH6和p53在子宫内膜癌变过程中的表达相关性及临床意义.方法 用免疫组化法检测滨州医学院附属医院病理科2010-08-01-2013-03-01刮宫及手术切除的65例子宫内膜癌,15例子宫内膜不典型增生及20例子宫内膜增生不伴非典型性组织中p53和hMSH6的表达情况,统计学分析其表达水平与临床病理因素之间的相关性.结果 子宫内膜样腺癌组织hMSH6蛋白表达率为27.6％ (18/65),明显低于子宫内膜不典型增生组织75.0％(15/20),及子宫内膜增生不伴非典型性组织73.3％(11/15).子宫内膜样腺癌组织p53蛋白表达率55.3％(36/65),明显高于子宫内膜不典型增生组织13.3％(2/15),及子宫内膜增生不伴非典型性5.0％(1/20),其中子宫内膜样腺癌组hMSH6及p53的表达与子宫内膜不典型增生组及子宫内膜增生不伴非典型性组织相比差异有统计学意义(x2=10.99,P=0.002;x2=10.99,P=0.004),而子宫内膜增生不伴非典型性组织与子宫内膜不典型增生组相比差异无统计学意义,P＞0.05;hMSH6及p53蛋白的表达均与手术病理分期和组织学分级有关,均P＜0.001.结论 hMSH6基因表达缺失及p53蛋白的表达与子宫内膜癌的发生有关,通过检测两者的表达水平可对子宫内膜癌的早期预防,早期诊断提供重要依据.     

医学文献检索与循证护理

介绍中国循证护理的发展现状和趋势,阐述医学献检索在循证护理中的重要作用,分析、探讨护理人员献检索能力的现状与培养,旨在普及和提高广大护理人员的循证能力,从而促进我国循证护理的发展。     

吸烟增加糖尿病肾病进展危险

糖尿病肾病（diabetic kidney,DK）是糖尿病（简称DM）患者最主要的微血管病变之一。吸烟可增加糖尿病患者发生肾功能衰竭的危险。吸烟不仅是糖尿病肾病发生的危险因素同时可以加速糖尿病肾病的发展。本文笔者对吸烟增加糖尿病肾病进展进行了综合性探讨。     

后腹腔镜下肿瘤吸除术与肾部分切除术治疗肾血管平滑肌脂肪瘤的安全性与有效性对比

目的：比较分析后腹腔镜下肿瘤吸除术与肾部分切除术治疗肾血管平滑肌脂肪瘤（又称肾错构瘤）的安全性和有效性。方法：回顾性分析2010年8月至2016年8月在北京大学第一医院就诊行手术治疗的肾血管平滑肌脂肪瘤患者,入组患者121例,能有效搜集资料并完成随访者共74例。将74例患者根据实施术式的不同分成两组：采用后腹腔镜下肿瘤吸除术治疗的共43例（A组）,采用后腹腔镜肾部分切除术治疗的共31例（B组）,将两组患者的围术期及术后复查数据进行统计及比较。结果：两组患者治疗前各项基本数据差异无统计学意义。A组与B组相比,手术出血量（48.7 mL vs. 102.9 mL）、热缺血时间（21.2 min vs. 28.5 min）、手术时间（70.1 min vs. 103.6 min）上差异有统计学意义（P<0.05）。A组患者围术期无并发症发生,B组患者发生出血2例、漏尿1例,均经保守治疗好转,两组患者并发症的发生率差异有统计学意义。A组患者术后平均肌酐水平1.13 mg/dL,B组患者术后平均肌酐水平1.08 mg/dL,两组间差异无统计学意义。在平均52.6个月的随访期内,A组患者复发3例（7.0%）, B组患者复发2例（6.5%）,两组患者无瘤复发生存率差异无统计学意义。结论：后腹腔镜下肿瘤吸除术治疗肾血管平滑肌脂肪瘤出血量更少、手术时间更短,与传统的肾部分切除术相比,安全性方面可能具有一定的潜在优势,且肿瘤复发率低、无瘤复发生存期长,能取得与肾部分切除术相同的有效性。