不同胰胃吻合方式对腹腔镜胰十二指肠切除术后患者胃排空障碍影响研究

目的探究胰胃吻合在腹腔镜胰十二指肠切除术(LPD)的临床疗效,分析引起胃排空障碍(DGE)的影响因素。 方法回顾性分析2015年1月至2018年3月60例接受LPD的资料,根据术中消化道重建方式不同分为胰胃吻合(PG)和胰肠吻合(PJ)两组。PG组28例,PJ组32例。使用SPSS 21.0统计学软件进行分析,围手术指标、营养指标等采用( ±s)表示,采用独立t检验;并发症发生率采用χ²检验。利用单/多因素进行分析,探究影响胃排空障碍的危险因素,P<0.05认为差异有统计学意义。 结果两组均顺利完成手术,无中转开腹病例;PG组近期并发症6例(21.4%),远期1例(3.6%);PJ组近期并发症12例(37.5%),远期4例(12.5%);PG组近、远期并发症少于PJ组(P<0.05); 60例PD患者术后共8例(13.3%)发生胃排空障碍,单因素分析发现,吻合方式、术后出血、胰瘘是引发胃排空障碍的影响因素(P<0.05)。多因素分析发现,胰瘘是引发胃排空障碍的独立危险因素(P<0.05),吻合方式是减少胃排空障碍的保护因素(P<0.05)。 结论LPD术后PG较PJ对降低术后胰瘘、胃排空障碍更有优势,吻合方式及胰瘘与DGE的发生显著相关。     

解剖性肝叶切除术在肝胆外科中的临床研究

目的 探讨肝叶切除术采用第一肝门阻断法（Pringle法）和解剖性肝叶阻断两种阻断技术各自对肝脏血生化指标、手术时间、出血量、住院时间的影响.方法 对采用第一肝门阻断法（Pringle法）、解剖性肝叶阻断法,共30例肝叶切除病例的临床资料进行回顾性分析,分析不同的肝血流阻断对肝脏血生化指标（AST,ALT,ALB,TBIL）、手术时间、术中出血量、住院时间的影响.结果 术后均出现肝功能酶学指标不同程度升高,以第一肝门阻断肝脏血生化升高较解剖性阻断明显,经统计分析,于术后3天两者有差异（P＜0.05）.解剖性肝叶切除较第一肝门阻断术中出血量少,术后恢复快,住院时间短,经统计分析,两者有统计学差异（P＜0.05）.结论 解剖性肝叶切除术,术中出血量减少,避免了肝脏缺血再灌注损伤,术中肝损伤小,术后肝脏功能恢复快,在保证患者安全,降低患者住院时间,节约患者住院费用等方面有着明显优势,有着良好的经济和社会效益.     

标准大骨瓣与传统去骨瓣减压术治疗颅脑损伤致大面积脑梗死的临床疗效比较

目的探讨标准大骨瓣减压术治疗颅脑损伤致大面积脑梗死的临床效果。方法对我院收治的36例颅脑损伤致大面积脑梗死患者行去骨瓣减压术治疗,其中18例行标准大骨瓣减压术（治疗组）,另18例行常规去骨瓣减压术（对照组）,比较两组患者术后的临床疗效及并发症情况。结果术后1周治疗组患者脑梗死面积明显小于对照组,术后3个月治疗组的死亡率（11．1％）显著低于对照组（38．9％）,中残／良好率（50％）显著高于对照组（16．7％）,差异均有统计学意义（P〈0．05）。结论标准大骨瓣减压术是治疗重型颅脑损伤致大面积脑梗死的有效方法。     

参倍固肠胶囊治疗腹泻型肠易激综合征开放、多中心、Ⅳ期临床试验

为了评价参倍固肠胶囊在广泛使用条件下治疗腹泻型肠易激综合征(脾肾阳虚证)的安全性和有效性,在国内16家医院的药物临床试验中心进行了参倍固肠胶囊治疗腹泻型肠易激综合征多中心、开放、自身前后对照、Ⅳ期临床试验。药物临床试验获得四川省医学科学院·四川省人民医院伦理委员会的批准后实施。试验开始之前,按照研究方案筛选和入选符合要求的受试者,签署知情同意书后进入14 d的研究。所有受试者均按试验方案用药,进行评价和填写CRF表,以提供对参倍固肠胶囊安全性和有效性进行评估的数据和资料。2011年06月10日—2012年11月29日临床试验入组2 123例。参倍固肠胶囊在较广泛使用(2 123例)条件下治疗腹泻型肠易激综合征,2 029例进入FAS集,痊愈+显效+有效 1 921例,综合疗效有效率为94.68%;2 010例进入PPS集,痊愈+显效+有效 1 906例,综合疗效有效率为94.83%。IBS主症腹痛、腹泻治疗后与治疗前基线比较,不论腹痛还是腹泻,差异均具有显著性(P < 0.000 1);中医证候评分,不论是治疗后第7天,还是治疗后第14天,与治疗前比较,差异均具有显著性(P < 0.000 1)。试验期间共发生35例不良事件,发生率1.65%,其中与药物有关的不良事件(不良反应)有12例,发生率0.57%,主要为恶心、腹胀、口干等,未采取任何措施,大多自行缓解,无严重不良事件发生。已上市药品参倍固肠胶囊,经在较广泛人群(2 123例)使用条件下,对治疗腹泻型肠易激综合征(脾肾阳虚证)患者是安全、有效的,临床可继续推广运用。     

Multi-component synthesis of fluorophores via catalytic generation of alkynoyl intermediates

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翼状胬肉转位术联合羊膜移植加绷带型角膜接触镜治疗翼状胬肉

目的：探讨翼状胬肉转位术与羊膜移植加绷带型角膜接触镜治疗翼状胬肉的临床疗效。

方法：本研究纳入观察对象为2014-12/2016-12于我院治疗的翼状胬肉患者72例80眼,按照治疗方式不同分为两组,对照组35例39眼行翼状胬肉转位术联合羊膜移植治疗,观察组37例41眼在此基础上加用绷带型角膜接触镜治疗; 随访1a,观察术后视力变化,评价手术疗效,比较两组患者术后疗效、复发率以及角膜愈合天数,术前、术后1d,1、3、6、12mo采用非接触式眼压计检测眼压变化,记录术后并发症发生情况。

结果：观察组术后疗效Ⅰ级19眼、Ⅱ级11眼、Ⅲ级8眼、Ⅳ级3眼,对照组Ⅰ级16眼、Ⅱ级12眼、Ⅲ级8眼、Ⅳ级3眼,两组比较差异无统计学意义(P>0.05); 观察组视力提升20眼、无变化17眼、视力下降4眼,对照组视力提升16眼、无变化17眼、视力下降6眼,两组比较差异无统计学意义(P>0.05); 观察组角膜愈合时间为3.43±1.03d,对照组为5.13±1.16d,差异具有统计学意义(P<0.05); 两组患者术前和术后1d,1、3、6、12mo眼压比较差异无统计学意义(P>0.05); 术后对照组出现1眼角膜瘢痕,两组患者均未出现眼压升高、角膜散光等并发症。

结论：采用翼状胬肉转位术联合羊膜移植加绷带型角膜接触镜能显著提高角膜愈合时间,疗效确切,安全有效。     

Angiogenesis as a new target for cancer control

Tumour angiogenesis is essential for cancer growth and metastasis. Many new pathways have been recognised in the last few years, including genes involved in embryonic development of the vasculature, e.g. the notch/delta, ephrin/eph and the HOX genes. Furthermore, vascular mimicry, intussusception and recruitment of circulating endothelial cells may contribute to tumour vessels, as well as endothelial proliferation. A close link has emerged between hypoxia and the regulation of angiogenesis, with many angiogenic factors involved in hypoxia in endothelial cells and cancer cells. Examples include vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), adrenomedullin, oxygen-regulated protein 150, tumour necrosis factor (TNF) alpha, endothelins. Conversely, anti-angiogenic molecules such as thrombospondin are downregulated. The main pathway regulating these responses seems to be via the hypoxia inducible factor I alpha and its modulation by proline hydroxylases. Many oncogenes amplify the effects of the hypoxia pathway, e.g. PTEN mutations. Thus, a plethora of targets is now available for therapy. Most tumours express many different pathways, but some key ones are emerging. VEGF seems to be a core factor for endothelial growth, and blockade of hypoxia signalling also inhibits angiogenesis. One of the difficulties in assessing response to therapy, if only new vessels are inhibited, is that only small amounts of regression may occur. However, clinical trials are now incorporating pharmacodynamic measurements such as vascular permeability and responses have been reported for a wide range of anti-angiogenic agents, in particular the VEGF pathway inhibitors. Marked synergy with conventional treatment modalities has been shown in preclinical models and this paradigm is being followed in clinical trial development. Second generation drugs are now entering phase III trials and are likely to enter routine practice.     

Alcohol drinking in rats injected ICV with 6-OHDA: Effect of 8-OHDPAT and tropisetron (ICS 205930)

6-Hydroxydopamine (6-OHDA) was administered ICV to Wistar male rats. Lesioned animals displayed lower preference for ethanol (ETOH) than sham-operated rats. Among 6-OHDA lesioned rats only 9% became high-preferring whereas 20% of sham-operated animals became high-preferring ones. Both tropisetron (the antagonist of 5-HT₃ receptors) and 8-OHDPAT (the 5-HT_1A receptor agonist) reduced ETOH drinking in high-preferring rats. However, in 6-OHDA lesioned rats the effect of tropisetron was reduced although 8-OHDA retained its effect on ETOH consumption. These results suggest that brain DA neurons are involved in tropisetron action but are not responsible for antipreference effect of 8-OHDPAT.