腹腔镜联合胆道镜行胆总管探查术后一期缝合45例临床分析

目的:探讨腹腔镜联合胆道镜临床用于胆总管探查取石、一期缝合术的可行性。方法:腹腔镜行胆囊切除后,切开胆总管,联合胆道镜探查、取石,然后行胆总管一期缝合术。结果:手术时间平均110min,平均出血20ml,1例出现胆漏,全组病例均痊愈,随访1~18个月未见胆道狭窄及残余结石等并发症发生。结论:只要严格掌握手术适应证,两镜联合行胆总管一期缝合是安全可行的。     

自体富血小板凝胶的制备及其生长因子分析

目的 探讨不同离心方法 制备自体富血小板凝胶(autologous platelet-rich gel,APG)的方法 ,通过改变离心速度比较不同的离心力对PLT富集的影响分析全血和APG中5种生长因子浓度.方法 对13例糖尿病难治性皮肤溃疡患者行APG治疗.取11例自身外周静脉血,分别用3种离心速度制备富血小板血浆(platelet-rich plasma,PRP).A组(n=6)先以529×g离心4 min,再以854×g离心6 minB组(n=5)先以313×g离心4 min,再以1252×g离心6 min;C组(n=5)先以176×g离心5 min,再以1 252×g离心5 min.将离心后制得的PRP与凝血酶.钙剂以101混合凝固后制备APG,用于患者皮肤溃疡的治疗.采用全自动血细胞分析仪计数各组全血和PRP中PLT数量.采用酶联免疫吸附法测定全血和APG中PDGF.BB、VEGF、IGF.1、EGF和TGF.a1 5种生长因子浓度.结果 A组PRP中PLT数量为(779.67±352.39)×109/L,较全血的(263.50±76.63)×109/L提高(2.98±1.42)倍,差异有统计学意义(P＜0.05);PLT回收率为51.5%±22.2%.B组PRP中PLT数量最高,为(1363.80±919.74)X 109/L,较全血的(232.80±127.99)×109/L提高(5.91±2.04)倍,差异有统计学意义(P＜0.05);PLT回收率为75.2%±21.0%,明显高于A组(P＜0.05).全血和APG中PDGF-BB、EGF、IGF-1以及TGF-a.浓度分别为(145.94±133.24)、(503.81±197.86)pg/mL,(160.73±71.10)、(265.95±138.43)pg/mL,(14.54±35.34)、(110.56±84.36)ng/mL,(3.31±2.27)、(5.67±4.80)ng/mL,差异有统计学意义(P＜0.05);VEGF浓度升高,两者间差异无统计学意义(P＞0.05).对数转换后的PLT数量与PDGF-BB、TGF-a1浓度成正相关,相关系数r分别为0.627和0.437(P＜0.05).13例患者共行18次APG治疗,其中9例治疗12周溃疡愈合,愈合率为69.2%;10例窦道愈合,愈合率为83.3%.结论 以313×g离心4 min,再以1252×g离心6 min是制备PRP的最佳方法 ;APG中生长因子浓度高于全血;PLT数量与PDGF-BB、TGF-a1浓度成正相关.     

间隙连接蛋白家族新成员Cx36

Cx36是哺乳动物间隙连接蛋白(connexin,Cx)家族γ亚类的第一个成员,它参与形成间隙连接,介导相邻细胞间的物质和信息的直接交换。间隙连接是神经系统构成电突触的结构基础,参与调控神经冲动信息的传递和复杂神经网络的整合,而Cx36是唯一一个在神经系统中优先表达的Cx,因此成为电生理研究领域的热点。就Cx36的发现过程、结构和定位进行了总结,并着重介绍它在神经系统中的功能和调节机制。     

187例肾移植受者死亡原因分析

目的分析肾移植受者的死亡原因。方法回顾性分析1978年至2003年期间进行同种肾移植的1400例受者资料。对肾移植后受者的死亡率、死亡原因和时间进行分析。结果1400例肾移植受者中,共死亡187例,死亡率为13.36%。187例受者的死亡原因依次为感染、心脑血管疾病和肝功能衰竭;所占比率分别为37.97%、31.56%和14.97%。死亡的受者中,移植肾有功能的87例,占46.5%。结论感染、心脑血管疾病及肝功能衰竭是肾移植后受者死亡的主要原因。将近一半的受者死亡时移植肾有功能。     

应用颈椎椎间融合器27例的临床分析

目的分析颈椎椎间融合器（CFC）临床应用的疗效。方法对27例植入CFC的脊髓型颈椎病随访3个月～3年，平均1．8年，观察CFC临床应用疗效。结果本组术后均无发生严重的并发症。影像学资料证实脊髓和神经根减压明显，椎间融合器（Cage）融合良好。术后JOA评分均恢复至15分以上，无症状恶化或复发者。结论Cage融合固定术治疗颈椎病有手术创伤小、无供区并发症、术后恢复快及手术成功率高等优点。     

Effect of curcumin on nitric oxide synthase expression in Iipopolysaccharide-activated microglia cells and the anti-oxidative effect of curcumin

BACKGROUND: It has been demonstrated that curcumin can increase the activities of various anti-oxidase in blood and tissue, effectively eliminate various free radicals, reduce the production of peroxisome, and alleviate oxidative stress reaction. Whether it has the same effect on microglia? OBJECTIVE: To observe the effects of curcumin on the expressions of inducible nitric oxide synthase (iNOS), nuclear factor-κB (NF-κB), and superoxide dismutase (SOD) in microglial cell line BV stimulated by lipopolysaccharide (LPS). DESIGN: An observational comparative study. SETTING: Research Room of Biochemistry, Medical College of Nantong University. MATERIALS: Mice microglia cell line BV, iNOS and NF-κB reporter gene plasmids were presented by Dr. Bhat.NR. from the Medical University of South Carolina (USA). Curcumin was produced by the Xi'an Branch of China Chengdu Scholar Bio-Tech. Co.,Ltd.; LPS (E.Coli O26:B6), anti-mice iNOS monoclonal antibody, horseradish peroxidase labeled goat-anti-mice IgG were the products of Sigma Company (USA). METHODS: The experiments were carried out in the Research Room of Biochemistry, Medical College of Nantong University from May 2006 to April 2007. ① Detection of iNOS: The cells were seeded onto 24-well plate at the density of 1×105, After the cells had adhered to the cover glasses, the cells were grouped as negative control group (the primary antibody was replaced by phosphate buffered solution PBS); normal control group (the cells were normally cultured); LPS-treated group (the cells were treated with LPS for 24 hours); curcumin+LPS group (the cells were treated with curcumin for 1 hour and LPS for 24 hours). The expressions of iNOS protein were detected with immunocytochemical staining. ② Determination of iNOS and NF-κB gene activities: According to the introduction of the kit for transfection, iNOS or NF-κB report gene plasmids were transiently transfected with LipofectamineTM2000 liposomes into the cells in the 24-well plate for 24 hours. The cells were divided into normal control group (the cells were normally cultured after transfected with report gene plasmids); blank plasmid group (the cells were normally cultured after transfected with blank plasmids); LPS-treated group (the cells were treated with LPS for 4 hours after transfected with report gene plasmids); curcumin+LPS group (the cells were treated with curcumin for 1 hour and LPS for 24 hours after transfected with report gene plasmids). The content of luciferase in the cell lysis buffer was determined after cell lysis. ③ Determination of SOD activity: The cells were seeded into culture bottle at the density of 1×106, and the divided into four groups, including normal control group (the cells were normally cultured); LPS-treated group (the cells were treated with LPS for 24 hours); curcumin+LPS group (the cells were treated with curcumin for 1 hour and LPS for 24 hours); vitamin C+LPS group (the cells were treated with vitamin C for 1 hour and LPS for 24 hours). The SOD activity was determined with xanthine oxidase and quantitative colorimetric assay. MAIN OUTCOME MEASURES: The expressions of iNOS protein, iNOS and NF-κB, and the activity of SOD were observed. RESULTS: ① Expression of iNOS protein in microglia: The expression of iNOS protein in the LPS-treated group was obviously higher than that in the negative control group (P < 0.01); Those in the curcumin+LPS group were significantly decreased as compared with that in the LPS-treated group (P < 0.01). ② Expressions of iNOS and NF-κB genes: The expressions of iNOS and NF-κB genes in the LPS-treated group were significantly higher than those in the normal control group (P < 0.01); Those in the curcumin+LPS group were significantly lower than those in the LPS-treated group (P < 0.01). ③ SOD activity: The activity of SOD in the LPS-treated group was significantly lower than those in the normal control group (P < 0.01). It in the curcumin+LPS group and vitamin C +LPS group was significantly higher than that in the LPS-treated group (P < 0.01). CONCLUSION: Curcumin could inhibit the expression of iNOS in the activated microglia, and it also has the abilities in eliminating free radicals and antagonizing lipid peroxidation.     

经尿道前列腺汽化电切术后后尿道狭窄的防治(附19例报告)

目的探讨经尿道前列腺汽化电切(TVP)术后后尿道狭窄的防治。方法结合文献,回顾分析19例TVP术后并发后尿道狭窄患者诊治经过。结果19例患者中13例经尿道扩张术治愈,5例行冷刀内切开术 电切术治愈,1例腔内手术失败改开放手术治愈。结论后尿道狭窄为TVP术后常见并发症,多数可用尿道扩张术治愈,对尿道扩张失败者应进行冷刀内切开术 电切术,早期及时处理效果好。     

Effect of schisandrin B and sesamin mixture on CCl(4)-induced hepatic oxidative stress in rats

To study the effects of schisandrin B and sesamin mixture on carbon tetrachloride (CCl(4))-induced hepatic oxidative stress in male Sprague-Dawley rats. The rats were randomly assigned to five groups: control group (olive oil injection), CCl(4) group (CCl(4) injection), silymarin group (CCl(4) injection combined with supplementation of silymarin, 7.5 mg/kg/day), low dose group (CCl(4) injection combined with supplementation of schisandrin B and sesamin mixture at a low dose, 43 mg/kg/day) and high dose group (CCl(4) injection combined with the supplementation of schisandrin B and sesamin mixture at a high dose, 215 mg/kg/day). The hepatic superoxide dismutase and glutathione peroxidase activities of rats in the low dose and high dose groups were increased significantly compared with those in the CCl(4) group. The hepatic reduced glutathione concentration in the silymarin, low dose and high dose groups were increased significantly (48%, 45% and 53%, respectively) when compared with those of the CCl(4) group. In addition, the concentration of glutathione in the erythrocytes of the low dose group was significantly higher than the CCl(4) group by 25%. These results suggest that the schisandrin B-sesamin mixture exerted a hepatoprotective effect by improving the antioxidative capacity in rats under CCl(4)-induced hepatic oxidative stress.     

上尿路梗阻性急性肾功能不全内、外引流的选择

目的探讨内、外引流在上尿路梗阻急性肾功能不全时的选择和效果。方法25例各种原因引起的上尿路梗阻（15例肿瘤性梗阻,10例非肿瘤性梗阻）合并急性肾功能不全,分别或先后对12例行输尿管内置双J管（doub le J,D J）内引流15次,对19例行经皮肾穿刺造瘘（percutaneous nephrectomy,PCN）外引流23次。结果引流成功23例,PCN外引流成功率86.9%（20/23）,双J管内引流成功率60.0%（9/15）,PCN术后继发出血1例。结论对于盆腹腔进展期或广泛转移肿瘤导致的梗阻,PCN解除梗阻优于输尿管支架内引流;非肿瘤性梗阻宜先尝试D J内引流。     

How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.