胰十二指肠切除术后胃排空障碍的诊疗进展

目的总结胰十二指肠切除术(PD)后胃排空障碍诊疗的现状与进展。方法检索近年来国内外有关PD后胃排空障碍的相关研究文献并进行综述。结果目前胃排空障碍的病因及发病机制尚未完全阐明,与手术创伤、患者高龄、合并糖尿病、伴有其他腹部并发症等多种高危因素有关。保留幽门PD并不增加术后胃排空障碍的风险,而幽门环切除、结肠前吻合、Braun吻合、微创手术对降低其发生是有利的。胃排空障碍的治疗目前国内外仍无明显进展,但绝大多数患者可通过对症保守治疗获得痊愈。结论 PD后胃排空障碍应以预防为主,围术期应用术后加速康复策略可能是目前临床解决术后胃排空障碍的关键所在,但需进一步研究。     

褪黑素对大鼠脑缺血再灌注损伤及胞浆型磷脂酶A_2蛋白表达的影响

目的观察褪黑素在脑损伤时对脑细胞凋亡和胞浆型磷脂酶A2(cPLA2)蛋白的表达及相关介质的影响。方法采用线栓法制作大脑中动脉缺血再灌注模型,将78只雄性Wister大鼠随机分为假手术组(6只)、模型组(36只)、治疗组(36只)。用HE染色和TUNEL法检测各组海马CA1区神经细胞凋亡;用免疫组织化学法检测海马CA1区神经细胞中cPLA2蛋白表达;用ELISA法检测血清中TNF-α和前列腺素E2(PGE2)水平。结果与假手术组比较,模型组不同时间点凋亡细胞及cPLA2蛋白表达增强,且血清中TNF-α和PGE2水平也显著增高(P<0.01)。与模型组比较,治疗组能明显降低海马CA1区细胞凋亡数和cPLA2蛋白表达,同时也能降低血清中TNF-α和PGE2水平(P<0.01)。结论褪黑素对大鼠大脑中动脉缺血再灌注脑损伤有良好的保护作用:降低缺血再灌注后血清中TNF-α和PGE2水平,抑制缺血再灌注后海马CA1区cPLA2蛋白表达。     

酵母菌2号培养最佳条件的选择

成人特发性乳糖酶缺乏症的发生率极高，这些人进食牛奶后会出现胃肠胀气、腹痛、腹泄等对牛奶不耐受的消化不良症状。为解决这一问题，自１９８９年起，国内外不少学者是主张有产替代疗法，即将人工培养制备纯化的乳糖酶直接加入牛奶中以水解其中的乳糖来弥补成人乳糖酶的缺乏。     

肠系膜上动脉闭塞性休克过程中肺对血液抗凝物质及纤溶活力的影响

以犬(9只)肠系膜上动脉闭塞性休克为模型,测定了蛋白C活性、纤溶个原激活物总活力以及抗凝血酶Ⅲ活性。结果表明:正常犬出肺血蛋白C活性明显高于入肺血(P<0.05)、纤溶酶原激活物总活力也高于入肺血,而抗凝血酶Ⅲ活性明显低于入肺血(P<0.01)。正常及肠系膜上动脉闭塞性休克过程中,出肺血蛋白C活性在松夹后10分钟之前基本稳定,之后略微下降;纤溶酶原激活物总活力在松夹后30分钟时才开始下降,二者的变化呈显著正相关(r=0.8804,P<0.05)。入、出肺血抗凝血酶Ⅲ活性呈一定的波动性变化,尤以入肺血更为明显,且二者波动的方向相反。提示:1)正常肺血管内皮细胞参与抗凝物质蛋白C、纤溶活力以及抗凝血酶Ⅲ的调节;2)肠系膜上动脉闭塞性休克早期,肺对血液抗凝物质具有一定的调整作用;3)体内不同抗凝系统发挥作用的特征不尽相同,它们之间可能协同发挥作用。     

腋神经和桡神经与肱骨的关系及其临床意义

目的　观测腋神经、桡神经与肱骨骨性标志的关系 ,为肱骨手术或外固定提供帮助。方法　在 30例 6 0侧成人上肢标本上观、测了腋神经、桡神经与肱骨有关骨性标志的距离。结果　肱骨最大长 (30 6 6 5± 17 4 8)mm ;肱骨最近端到腋神经(5 8 10± 5 6 1)mm ;肱骨最近端到桡神经穿外侧肌间隔处 (177 75± 11 86 )mm ;解剖颈最低点到腋神经 (16 2 4± 2 78)mm ;肱骨最近端到肱骨肌管入口处 (118 4 9± 6 6 1)mm ;并测量计算了各段占肱骨最大长的比例。结论　腋神经在肱骨近端 1/ 5处容易受损 ,而桡神经在肱骨下 3/ 5段为易损伤部。从术前和术中的影像 ,能测量和计算出神经的基本位置 ,可减少或避免神经损伤     

微小RNA-362在脑星形细胞瘤中的表达

目的研究微小RNA(microRNA,miR)-362在不同级别星形细胞瘤中的表达,探讨其临床意义及价值。方法使用定量聚合酶链反应(PCR)方法比较长治医学院附属和平医院32例星形细胞瘤患者和4例正常脑组织中miR-362的表达。多组间比较采用单因素方差分析,两组间比较使用配对t检验。结果所有星形细胞瘤组织miR-362表达(0.194±0.052)明显低于正常脑组织miR-362表达(0.436±0.044,t=8.887,P<0.05),差异有统计学意义,其中低级别星形细胞瘤组织miR-362表达(0.172±0.045)和高级别星形细胞瘤(0.202±0.070)均明显低于正常脑组织miR-362表达(t=10.101,t=6.386,P<0.05),差异有统计学意义,但低级别星形细胞瘤组织miR-362表达与高级别星形细胞瘤miR-362表达之间差异无统计学意义(t=1.284,P>0.05)。结论miR-362在星形细胞瘤组织中表达下调,但在低级别与高级别星形细胞瘤间无差异。     

北京市和长治市三级妇幼专科医院女性不孕症患者病因的对比分析

目的调查分析北京市和长治市三级妇幼专科医院女性不孕症患者的病因和特点,为不同级别城市的妇幼医疗保健机构开展更有针对性的不孕症诊治提供参考依据。方法选取2019年3~6月在首都医科大学附属北京妇产医院生殖医学科(A组,3652例)和长治医学院附属长治市妇幼保健院妇科(B组,196例)就诊的不孕不育夫妇为调查对象,比较两组女性患者的一般情况、不孕症的病因构成及男女方不孕不育病因特点等。结果A组女性患者的平均年龄和不孕年限显著高于B组(P<0.05)。不孕病因上,A组女性患者由盆腔因素和男方因素引起不孕的比例显著高于B组(分别为32.12%vs.13.27%和51.23%vs.21.94%,P<0.05);排卵障碍引起不孕的比例显著低于B组(42.61%vs.77.55%,P<0.05)。两组女性患者均以卵巢性闭经或月经失调引起的不孕症为首位,A组显著低于B组(70.24%vs.80.92%,P<0.05)。男方因素中两组患者均以弱精子症占首位,且A组显著高于B组(98.24%vs.90.70%,P<0.05)。A组患者由2个病因引起不孕的比例显著高于B组(P<0.05)。A组患者由男方因素及男女双方因素引起不孕的比例均显著高于B组(P<0.05)。结论北京市和长治市三级妇幼专科医院的不孕症病因构成有显著差异,应在现有优势医疗资源的情况下,分别开展有侧重、有针对性的诊治。     

Risk factors for sleep disturbance in patients with cervical myelopathy and its clinical significance: a cross-sectional study

BACKGROUND CONTEXTSleep disturbance is highly prevalent in patients with spinal cord injury and is one of the most important clinical issues affecting their quality of life. However, it has not been properly measured or treated in patients with cervical myelopathy (CM), although most typical or atypical symptoms of CM are known to be risk factors for sleep disturbance. In addition, previous studies identified that the presence of sleep disturbance is unintentionally missed under the current evaluation process for degenerative spinal disease without direct investigation using validated tools for sleep. Therefore, studies about sleep disturbances in patients with CM are essential.PURPOSEThe purpose of this study was to investigate the prevalence of sleep disturbance in patients with CM using validated tools and to understand its mechanism by identifying high-risk patients.STUDY DESIGN/SETTINGCross-sectional study.PATIENT SAMPLEConsecutive patients diagnosed with CM.OUTCOME MEASURESPittsburgh sleep quality index.METHODSThis study was performed on patients diagnosed with CM. Sleep disturbance was determined using the Pittsburgh sleep quality index. Variables associated with sleep disturbance including demographics, lifestyle, medical history, and radiologic parameters were investigated. Independent risk factors related to sleep disturbance were identified using multivariate logistic regression analysis.RESULTSA total of 203 patients with CM were included in our study. Among them, 126 patients (62.1%) were men, and the mean age was 63.0 years. Despite male predominance, sleep disturbance was identified in 71.4% of patients (145 of 203). Multivariate analysis identified a worse depression scale score, a lower modified Japanese Orthopedic Association score, chronic shoulder joint pain, smaller spinal cord area, and decreased cervical range of motion as independent risk factors for sleep disturbance.CONCLUSIONSIn patients with CM, sleep disturbance was associated with a more severe type of myelopathy. Further studies including polysomnography and measurement of melatonin will be helpful to identify the mechanisms of the sleep disturbance in patients with CM and to improve their quality of life and clinical outcomes.