翅果油树休眠芽和种子的试管萌发

目的：为了扩大珍稀濒危植物翅果油树组织培养的取材范围和研究其种子休眠的原因。方法：以翅果油树一年生枝条的休眠芽（分别于10,11,12,1,2,3,月份取材）和当年生种子为材料,采用MS为基本培养基,附加6－BA,NAA,GA3等外源激素进行试管苗萌发研究。结果：1．休眠芽的萌发率表现为从秋季到冬季逐渐下降和从冬季到春季逐渐提高的规律性变化。其中以3月份取材最佳,休眠芽可萌发为小苗。2．对种子进行试管内和试管外萌发研究,表明翅果油树种子休眠的原因有：中果皮坚硬,种皮革质化,透水透气性差,中果皮和种皮内有抑制物质存在;种仁营养丰富,易引起土壤,空气中微生物的繁殖而烂种;此外,裸露的种仁在试管中的萌发率高达70％,可发育为无菌苗。结论：3月份取材的休眠芽和种仁无菌萌发的实生苗可为组织培养提供新的材料来源。     

Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

BackgroundPatients undergoing esophagectomy often receive jejunostomy tubes (j-tubes) for nutritional supplementation. We hypothesized that j-tubes are associated with increased post-esophagectomy readmissions.Study designWe identified esophagectomies for malignancy with (EWJ) or without (EWOJ) j-tubes using the 2010–2015 Nationwide Readmissions Database. Outcomes include readmission, inpatient mortality, and complications. Outcomes were compared before and after propensity score matching (PSM).ResultsOf 22,429 patients undergoing esophagectomy, 16,829 (75.0%) received j-tubes. Patients were similar in age and gender but EWJ were more likely to receive chemotherapy (24.2% vs. 15.1%, p < 0.01). EWJ was associated with decreased 180-day inpatient mortality (HR 0.72 [0.52–0.99]) but not with higher readmissions at 30- (15.2% vs. 14.0%, p = 0.16; HR 0.9 [0.77–1.05]) or 180 days (25.2% vs. 24.3%, p = 0.37; HR 0.94 [0.79–1.10]) or increased complications (p = 0.37). These results were confirmed in the PSM cohort.ConclusionJ-tubes placed in the setting of esophagectomy do not increase inpatient readmissions or mortality.     

胆总管探查内置自行脱落J管一期缝合与T管引流治疗胆总管结石的临床分析

目的 比较腹腔镜胆总管探查放置自行脱落J管一期缝合与T管引流的临床疗效,探讨胆总管一期缝合放置自行脱落J管引流的可行性。方法 回顾性分析2019年3月至2020年10月西安交通大学附属咸阳市中心医院肝胆外科156例行腹腔镜下胆囊切除联合胆总管探查患者的临床资料。按手术方式分为自行脱落J管组（n=80）和T管引流组（n=76）,比较两组患者基线资料、术中术后情况及并发症等。结果 两组手术总时间、术中出血量、术后并发症情况无统计学差异（P＞0.05）。自行脱落J管组较T管引流组术后下床活动时间[（18.2±7.2）h vs（22.1±8.3）h,t=3.139,P=0.002]、术后排气时间[（1.7±0.9）d vs（2.1±1.3）d,t=2.244,P=0.026]、补液总量[（5 634.1±432.8）mL vs（6 351.4±547.9）mL,t=13.56,P＜0.001]、拔管时间[（8.7±3.3）d vs（47.1±13.0）d,t=14.966,P＜0.001]、住院时间[（7.9±2.8）d vs（9.4±3.3）d,t=3.067,P=0.003]、住院总费用[（15 489.2±2 217.1）元 vs（18 136.4±2 251.3）元,t=7.398,P＜0.001]差异有统计学意义。结论 严格掌握手术适应证前提下,自行脱落J管引流扩大了胆总管一期缝合适应证,安全有效,相比T管引流具有加速康复、减少住院费用、缩短住院时间等优势。     

Guidelines for gastrostomy tube placement and enteral nutrition in patients with severe,refractory hypoglycemia after gastric bypass

BackgroundPostbariatric hypoglycemia (PBH) affects up to 38% of Roux-en-Y gastric bypass (RYGB) patients. Severe cases are refractory to diet and medications. Surgical treatments including bypass reversal and pancreatectomy are highly morbid and hypoglycemia often recurs. We have developed a highly effective method of treatment by which enteral nutrition administered through a gastrostomy (G) tube placed in the remnant stomach replaces oral diet: if done correctly this reverses hyperinsulinemia and hypoglycemia, yielding substantial health and quality of life benefits for severely affected patients.ObjectivesTo provide clinical guidelines for placement of a G-tube to treat postRYGB hypoglycemia, including candidate selection, preoperative evaluation, surgical considerations, and post-RYGB management.SettingStanford University Hospital and Clinics.MethodsBased on our relatively large experience with placing and managing G-tubes for PBH treatment, an interdisciplinary task force developed guidelines for practitioners.ResultsA team approach (endocrinologist, dietitian, surgeon, psychologist) is recommended. Appropriate candidates have a history of RYGB, severe hypoglycemia refractory to medical-nutrition therapy, and significantly affected quality of life. Preoperative requirements include education and expectation setting, determination of initial enteral feeding program, and establishing service with a home enteral provider. Close postoperative follow-up is needed to ensure success and may require adjustments in formula and mode/rate of delivery to optimize tolerance and meet nutritional goals. G-tube nutrition must fully replace oral nutrition to prevent hypoglycemia.ConclusionsG-tube placement in the remnant stomach represents a relatively well-tolerated and effective treatment for severe, refractory hypoglycemia after RYGB.     

Colon perforation caused by transanal decompression tube after laparoscopic low anterior resection: A case report

IntroductionThe effectiveness of transanal decompression tube (TDT) to prevent anastomotic leakage after rectal surgery has been widely accepted in recent years. However, a rare complication of intestinal perforation due to TDT has been also reported.Presentation of caseA 88-year-old woman underwent laparoscopic low anterior resection for rectal cancer. An abdominal drainage tube adjacent to the colorectal anastomosis and a TDT were placed. The patient experienced abdominal pain, nausea and elevated inflammatory markers on postoperative day 6. Enema and computed tomography demonstrated colonic perforation due to the TDT, and emergency laparotomy was performed. Perforation of the anterior sigmoid colon located at the proximal side of the colorectal anastomosis was seen, and the TDT was exposed to the abdominal cavity. Therefore, primary closure of the perforation site, peritoneal lavage, drainage tube placement and transverse colostomy was performed.DiscussionIn our case, TDT seemed to compress the anterior wall of the colon and lead to perforation. The looseness of the remaining oral intestinal tract depressed in the pelvis was compressed by the TDT.ConclusionTDTs should be very carefully placed to avoid complication. The length and looseness of the oral intestine and the relationship between the TDT to be inserted might be important.     

Pulse wave reflection at the collapsed segment of an artery in Riva-Rocci's method

Summary The contours of pressure and flow of a pulse wave arriving at the entrance of a collapsed segment of an elastic tube can be described by application of the basic laws of reflection. The collapsed segment acts like a valve. It is opened by the pressure of the pulse wave when the pressure within the tube becomes higher than the collapse pressure, i.e. the pressure exerted on the segment from outside. This opening of the collapsed segment suddenly changes the sign of the pulse wave reflection from positive to negative; thus a typical contour change of the pulse proximal to the segment is observed. The most obvious effect is a reduction of the pulse pressure. The extent of this reduction is a function of the collapse pressure.A typical example of this phenomenon can be observed in an artery proximal to the segment which is collapsed due to the pressure exerted by an inflated Riva-Rocci cuff. The effect is explained by the assumption that the sign of reflection changes when the pressure of the pulse wave crosses the level of the cuff pressure. This explanation is supported by the results of model experiments.     

尼古丁影响鼠胚神经管Nestin和S-100β表达

目的 探讨生殖致畸期宫内暴露尼古丁是否影响鼠胚神经管nestin和S—100g表达。方法 建立妊娠期宫内暴露尼古丁的大鼠模型，免疫组织化学法观察孕13d神经管顶板基板及16d鼠胚中缝组织分化程度的改变。结果 尼古丁组孕13d大鼠胚胎菱脑顶板未完全闭合，部分区域无神经上皮覆盖，nestin阳性神经上皮细胞数量明显比正常对照组少（P〈0．05），排列紊乱；孕16d鼠胚中缝处尼古丁组S-100β表达较对照组为弱（P〈0．05）；神经上皮细胞排列不规则，核仁不清晰，胞质内可见空泡，细胞间隙增宽。结论生殖致畸期内暴露尼古丁影响神经管菱脑区顶板、基板神经组织正常发育，延迟神经管闭合；延迟孕16d鼠胚中缝处神经组织的完全闭合。     

数字X射线成像中的摄像机技术比较

数字化已成为现代医学成像的主流，摄像机则是数字Ｘ射线成像设备中的核心技术，本文就上前在数字Ｘ射线成像系统中使用的两种摄像机技术－－摄像管及ＣＣＤ摄像机进行了讨论和比较，结果在未来主分辩力成像研究中ＣＣＤ优于摄像管。