胃肠癌化疗患者实施临床路径的可行性探讨

目的 探讨针对肿瘤化学治疗所呈现的周期性规律，探索胃肠癌患者在化疗期间实施临床路径流程的可行性。方法 选择有病理诊断的晚期胃肠癌患者140例，随机分成实验组和对照组各70例，实验组实施临床路径流程，对照组实施传统流程，比较两组住院天数、医疗费用、医疗质量及患者满意度。结果 实验组患者的住院天数明显缩短(P＜0．05)，医疗费用明显降低(P＜0．05)，医疗质量及患者满意度均有较大幅度的提高(P＜0．05)。结论 胃肠癌患者化疗期间实施临床路径流程切实可行。     

普外科住院患者营养状况评价

目的　调查本院 2 0 0 2～ 2 0 0 3年间普外科住院患者的营养状况。方法　采用多项营养评价指标测定 4 0 12例非急诊住院患者营养状况 ,分析年龄、疾病等因素与营养状况之间关系。结果　各项指标进行营养评价得出本院普外科非急诊患者营养不良的发生率分别是 :BMI 2 1 3% ,TSF5 0 6 % ,MAC 2 0 5 % ,AMC 2 1 2 % ,SGA 38 0 % ,MNA 2 0 8% ,ALB 2 4 2 % ,PA 35 4 % ,TLC 5 5 8%。 >6 0岁组老年患者、消化道疾病患者及恶性肿瘤患者营养不良发生率分别高于≤ 6 0岁患者、消化道外疾病患者及良性疾病患者 ,差异有显著性 (P <0 0 5 )。结论　本院普外科住院患者的营养不良发生率为 2 0 5 %～ 5 5 8% ,不同的营养评价指标得出的营养不良发生率不同。     

房室折返性心动过速RP‘时距的特征及对旁道定位的意义

应用食管调搏，检测６４例旁道参与的房室折返性心速患者Ⅰ、Ⅱ、Ⅴ１和食管导联的室房时距、Ｐ＇ｖ，Ｐｅｔ时距。发现左侧ＡＰ者ＲＰ＇１较ＲＰ＇Ｖ１短（Ｐ＜０．０１），而右侧ＡＰ时较ＲＰ＇ｖ１长（Ｐ＜０．０１）。     

细胞内钙信号的变化调节血管平滑肌细胞增殖

目的探讨细胞内钙信号的变化对大鼠血管平滑肌细胞(VSMC)增殖作用的影响及其对细胞内信号转导机制的变化。方法以培养的大鼠VSMC为模型,用雷尼丁(RY)剌激VSMC内贮Ca2 释放入胞浆,用3H亮氨酸及3H胸腺嘧啶掺入量作为反应VSMC增殖的指标,加入不同的细胞内信号转导阻断剂,观察对RY效应的影响。结果与对照组相比,RY浓度依赖性地促进细胞内游离钙浓度的增高,差异显著(P<0.05或0.01)。RY剌激组蛋白核酸合成速率明显增高,与对照组相比差异显著(P<0.01);尼卡地平(Nicardipine),蛋白激酶C抑制剂(H7),钙调素激酶(CaMPK)抑制剂(W7)和丝裂素活化蛋白激酶(MAPK)抑制剂(PD98059)能明显抑制RY介导的VSMC蛋白核酸合成速率增高,与RY剌激组相比差异显著(P<0.01)。结论细胞内钙信号的变化明显促进VSMC增殖,但其效应可能通过Ca2 、PKC、MAPK来介导。钙离子拮抗剂可抑制血管平滑肌细胞增殖。     

上矢状窦旁脑膜瘤致上矢状窦阻塞时侧支静脉通路的意义

目的 分析上矢状窦旁脑膜瘤致上矢状窦(SSS)阻塞时其侧支静脉通路的建立情况，确定其在肿瘤切除术中的意义。方法 总结归纳86例上矢状窦旁脑膜瘤行MRA及DSA检查时的静脉系表现。结果 27例发生SSS完全阻塞，59例部分阻塞。18例在阻塞的SSS周围出现了由表浅皮层静脉所形成的侧支静脉环；通过表浅皮层静脉与蝶顶窦及小脑幕静脉系建立端—端吻合的16例；通过与Troland或Labbe静脉建立吻合的14例；通过大脑镰与下矢状窦吻合的9例；通过脑膜静脉并经板障静脉引流到颈外静脉系的17例；混合型12例。结论 上矢状窦旁脑膜瘤致SSS阻塞时，肿瘤周围存在广泛侧支静脉通路，术中应注意保护。脑DSA及MRA检查对术前了解SSS通畅性及侧支静脉通路建立有帮助。     

Pinacidil抑制线粒体和死亡受体通路减少大鼠脑缺血再灌注后神经元凋亡(英文)

目的探讨ATP敏感性钾通道开放剂pinacidil对大鼠脑缺血再灌注后神经元凋亡的保护作用及信号转导机制。方法 100 只Wistar 雄性大鼠随机分为四组:A 组(假手术组)、B组 (缺血组)、C 组 (KATP开放剂处理组)及D组 (KATP开放剂和阻断剂处理组)。用线栓法制备大鼠大脑中动脉缺血(middle cerebral artery occlusion,MCAO)模型,用DNA断端末端标记法(terminal-deoxynucleotidytransferase-mediated dUTP-biotin nick end labeling,TUNEL)检测神经元凋亡,用原位杂交方法检测caspase-3、caspase-8及caspase-9 mRNA的表达。结果 (1) C组12 h、24 h、48 h、72 h 时间点的凋亡细胞数较 B、D 组显著减少(P<0.05 或 P<0.01) ;B 组和 D组之间无显著性差异(P>0.05)。(2) C 组 caspase-3 mRNA 和 caspase-8 mRNA 在各时间点及 caspase-9 mRNA 在 12 h、24 h、48 h、72h 时间点的表达显著少于B组和D组(P<0.01或P<0.05),B组和D组之间无显著性差异(P>0.05)。结论 KATP通道开放剂能显著减少大鼠脑缺血再灌注后的细胞凋亡及caspase-3、caspase-8及caspase-9 mRNA的表达。KATP通道开放剂可能通过抑制线粒体通路和死亡受体通路降低神经元凋亡,保护缺血再灌注损伤后的脑组织。     

克罗恩病并发肠瘘的诊断与治疗

目的探讨克罗恩病(CD)并发肠瘘的诊断与治疗方法。方法对1978至2004年收治的62例CD并发肠瘘患者的临床资料进行分析。结果本组肠外瘘68例次,其中多发瘘6例次;肠内瘘8例次。肠瘘以末端回肠瘘(27例次)和回结肠吻合口瘘(21例次)为主。手术方式主要为回结肠吻合口拆除重建(26例次)和回盲部切除回结肠吻合(14例次)。首次肠瘘、术后服用免疫药物者复发率15.4%,明显低于未服药患者(34.8%);复发时间为(40±17)个月,明显长于不服药组的(8±3)个月;两组比较,P<0.01。结论CD合并的肠瘘以肠外瘘为主。主要手术方法为瘘口切除与肠吻合术。术后应用免疫抑制药物可降低CD合并肠瘘的复发率。     

Remote-controlled catheter ablation of accessory pathways: results from the magnetic laboratory.

AIMS: This study evaluates feasibility, safety, and efficacy of magnetic remote-controlled accessory pathway (AP) ablation. METHODS AND RESULTS: The novel magnetic navigation system (MNS) (Niobe, Stereotaxis) creates a steerable magnetic field (0.08 T) controlling the distal magnetic tip of an ablation catheter. In conjunction with a catheter advancer system (Cardiodrive, Stereotaxis) remote catheter ablation is enabled. Conventional electrophysiology study identified AP conduction in 59 patients (37 males, 36+/-14 years, 60 APs). First generation 1-magnet tip (1-M) (group I, n=18), second generation bipolar 3-magnet tip (3-M) (group II, n=27), and third generation quadripolar 3-magnet tip catheters (3-M quad.) (group III, n=14) were used for magnetic remote-controlled ablation. Successful AP ablation was achieved in 67% (group I), 85% (group II), and 92% (group III). A significant decrease of median [IQR: Q1-Q3] fluoroscopy time and dosage was observed: 21.2 [12.1-33.8] min, 1110 [395-3234] microGym2 (group I); 6.5 [4.4-15.4] min, 290 [129-489] microGym2 (group II), and 4.9 [3.4-8.0] min, 129 [74-270] microGym2 (group III). Mean procedure time (217+/-67 min; 182+/-68 min, and 172+/-90 min) significantly decreased in group III. Median number [Q1-Q3] of radiofrequency current applications in groups I, II, and III was 4 [2-9], 4 [2-6], and 2 [2-4], respectively. No complications occurred. CONCLUSION: Remote AP ablation is safe and feasible using the novel MNS. Introduction of the 3-magnet quadripolar ablation catheter significantly improved the efficacy of the procedure.     

Hepatic UDP-glucose 13C isotopomers from [U-13C]glucose: a simple analysis by 13C NMR of urinary menthol glucuronide.

Menthol glucuronide was isolated from the urine of a healthy 70-kg female subject following ingestion of 400 mg of peppermint oil and 6 g of 99% [U-(13)C]glucose. Glucuronide (13)C-excess enrichment levels were 4-6% and thus provided high signal-to-noise ratios (SNRs) for confident assignment of (13)C-(13)C spin-coupled multiplet components within each (13)C resonance by (13)C NMR. The [U-(13)C]glucuronide isotopomer derived via direct pathway conversion of [U-(13)C]glucose to [U-(13)C]UDP-glucose was resolved from [1,2,3-(13)C(3)]- and [1,2-(13)C(2)]glucuronide isotopomers derived via Cori cycle or indirect pathway metabolism of [U-(13)C]glucose. In a second study, a group of four overnight-fasted patients (63 +/- 10 kg) with severe heart failure were given peppermint oil and infused with [U-(13)C]glucose for 4 hr (14 mg/kg prime, 0.12 mg/kg/min constant infusion) resulting in a steady-state plasma [U-(13)C]glucose enrichment of 4.6% +/- 0.6%. Menthol glucuronide was harvested and glucuronide (13)C-isotopomers were analyzed by (13)C NMR. [U-(13)C]glucuronide enrichment was 0.6% +/- 0.1%, and the sum of [1,2,3-(13)C(3)] and [1,2-(13)C(2)]glucuronide enrichments was 0.9% +/- 0.2%. From these data, flux of plasma glucose to hepatic UDPG was estimated to be 15% +/- 4% that of endogenous glucose production (EGP), and the Cori cycle accounted for at least 32% +/- 10% of GP.     

The 12‐Lead ECG in Patients with Mahaim Fibers

The aim of this review article is to discuss the electrocardiographic presentation of the so called variants of pre‐excitation (“Mahaim fibers”) during sinus rhythm and tachycardia.