Laparoscopic Local Resection Based on Sentinel Node Evaluation for Early Gastric Cancer: A Preliminary Report

We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric cancer.     

鼻胃管胃肠减压在择期腹部手术中的应用价值

鼻胃管胃肠减压曾被常规应用于择期和急诊的腹部手术后，目的是预防急性胃扩张的发生、治疗梗阻、降低吻合口压力等。但是，鼻胃管置入也会带来一些副作用，如呼吸道并发症、胃-食道反流、体液和电解质的丢失、声带的损伤，以及越来越被重视的患者的不适感。近年来的研究结果也对择期的腹部手术后常规应用鼻胃管胃肠减压提出不同的看法。现重新评价应用鼻胃管胃肠减压的理论基础及相关临床研究的结果，并对鼻胃管胃肠减压在择期腹部手术中的价值作一综述。     

原发性高血压患者微量白蛋白尿与血压及左室重塑的关系

目的探讨原发性高血压(EH)患者微量白蛋白尿(MCA)与血压及左室重塑的关系.方法 84名EH患者按24h尿微量白蛋白值分为微量白蛋白尿组(MCA组)和正常白蛋白尿组(NMCA组),进行动态血压、心脏超声检测,比较两组动态血压值、左室重量指数(LVMI)及左室重塑的特点.结果 MCA组平均收缩压、平均舒张压、脉压、平均动脉压均高于NMCA组(均P＜0.01);MCA组LVMI、左室肥厚与向心性肥厚的发生率均高于NMCA组(均P＜0.01),正常构型率低于NMCA组(P=0.01).LVMI与尿微量白蛋白值、平均收缩压、平均舒张压均呈显著的正相关(均P＜0.05).结论合并有MCA的EH患者血压较高,LVMI较大,左室肥厚与向心性肥厚的发生率较高.MCA与血压及左室重塑密切相关.     

两种后牙根管预备方法的临床效果比较

目的 :评估 2种后牙根管预备方法的临床效果。方法 :采用机用镍钛扩大锉 (ProFile)和手用不锈钢扩大锉 (K file)扩大后牙根管 ,并对 2组病例术后疼痛以及充填情况加以比较。结果 :发现机用镍钛扩大锉扩大后牙根管 ,具有去除根管感染物质彻底 ,根管形态保持良好 ,速度快 ,术后疼痛率较低的优点 ,但易出现断针。而手用不锈钢扩大锉扩大后牙根管速度较慢 ,术后疼痛率略高 ,但不易出现断针 ,操作上容易掌握。结论 :2种后牙根管方法都有优缺点 ,可结合起来使用。     

骨骼肌肉恶性肿瘤增强减影MRI

目的　评估增强减影在骨骼肌肉恶性肿瘤MRI中的临床应用价值。方法　 5 0例骨骼肌肉恶性肿瘤病人进行MR增强扫描 ,MR对比剂采用钆喷替酸葡甲胺 (Gd DTPA ,0 1mmol/kg) ,用T1W增强后的图像与增强前的图像进行减影。通过对比度 /噪声比值 (C/Ns值 )以及肿瘤影像征象清晰程度的比较 ,对MR减影与否进行评估。结果　MR对比增强减影图像比传统的T1W增强图像显示更清晰、更直观。所有病例都经手术和病理证实。 5 0例骨骼肌肉恶性肿瘤图像MR减影的C/Ns值比传统T1W增强图像的C/Ns值高。MR减影图像的C/Ns值为 10 9 74± 5 10 ( x±s) ,传统T1W增强图像的C/Ns值为 2 3 6 1± 3 16 (t=10 1 5 1,P <0 0 5 )。减影前后肿瘤影像征象的比较结果显示 :不规则边缘 (χ2 =7 86 ,P <0 0 5 )、肿瘤分叶 (χ2 =7 16 ,P <0 0 5 )和环形强化 (χ2 =7 4 4 ,P <0 0 5 ) ,对肿瘤影像征象清晰度差异的检出具有显著性意义。结论　MR对比增强减影比传统T1WI增强更能有效地显示骨骼肌肉恶性肿瘤。对比增强减影为检出和评估骨骼肌肉恶性肿瘤方面 ,提供了一个全新的诊断工具。     

Effect of AVP on brain edema following traumatic brain injury

Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤8) and moderate traumatic brain injury group ( MTBI, GCS >8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group) and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan. Results: plasma AVP levels (ng/L) were (mean±SD): control, 3. 06±1. 49; MTBI, 38. 12±7. 25; and STBI, 66. 61±17. 10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0. 01). And the AVP level was correlated with the severity (STBI r =0.919, P < 0.01; MTBI r = 0.724, P < 0.01) and the duration of brain edema (STBI r = 0. 790, P < 0. 01; MTBI r = 0. 712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.     

Pertussis: A Reemerging Threat

Pertussis, commonly known as whooping cough, is associated with high rates of morbidity and mortality in infants. Immunity to the childhood pertussis vaccine wanes over time. This creates reservoirs for disease among susceptible adults. Adult caregivers and health care workers can transmit pertussis to those infants and children not fully immunized. Two new vaccines are available for adolescents and adults to protect these age groups from pertussis and thus avoid transmission to infants. Pertussis rates in the United States are increasing dramatically. This disease can present a diagnostic dilemma to providers not accustomed to seeing this infection. Providers can now encourage older patients to receive these newly formulated vaccines and prevent the further spread of pertussis.     

(His)6 -eIF3s4融合蛋白在人乳腺癌细胞Bcap37中的表达

目的：构建真核细胞翻译起始因子3第4亚单位（eIF3s4）真核表达载体用于进一步功能研究。方法：设计引物,以K562细胞的总RNA为模板,采用RT-PCR方法扩增eIF3s4的全长编码区cDNA,克隆于pGEM-TEasy载体,经DNA测序并与GenBank数据库序列进行比对后,将该cDNA序列亚克隆于真核表达载体pcDNA4/HisMaxB载体,构建成（His）6-eIF3s4融合蛋白的表达载体,用LipofectamineTM2000瞬时转染人乳腺癌细胞株Bcap37,利用Westernblot方法检测（His）6-eIF3s4融合蛋白的表达。结果：DNA序列测定表明,利用RT-PCR方法克隆的eIF3s4全长编码区cDNA序列与GenBank数据库序列一致,Westernblot结果证实（His）6-eIF3s4融合蛋白在Bcap37细胞中获得预期表达。结论：成功地构建了eIF3s4的真核表达载体并在人乳腺癌细胞Bcap37中表达,为建立稳定的eIF3s4高表达细胞系,进而研究eIF3s4与肿瘤细胞多药耐药相关性打下了基础。     

以人为本的医院总务保障体系

邵逸夫医院的总务工作在借鉴国外先进管理模式,改变传统观念,建立强有力的后勤保障体系方面做了大量卓有成效的工作。从医院建筑平面布置、确保医院设施正常运作,营造整洁舒适医院环境和引进全程服务机制等方面介绍了建立以人为本、以病人为中心的总务保障体系的做法。