董建华的脾胃学术思想

系统地整理、研究了董建华的脾胃学术思想。在治法上强调治胃病用通降法，在病机上认为脾胃虚寒学说固然有重要的价值，但目前应着力研究胃热学说；注重疏肝气以调脾胃气机，用药忌壅补，轻灵流畅为其用药特点。     

A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence

Background

The aim of this study was to determine the effect of anatomic resection (AR) versus non-anatomic resection (NAR) on recurrence rates in patients with hepatocellular carcinoma (HCC).

老年心血管病患者白内障围手术期安全性分析

目的:对老年心血管疾病患者行白内障围手术安全性分析.方法:对近2008-10/2010-09在我科住院拟行白内障手术的74例74眼老年心血管疾病患者的相关临床资料行回顾性分析.结果:老年心血管疾病患者4例4眼因术前评估发现手术禁忌证、无法耐受手术而未行白内障手术;其余70例70眼均在心电监护和持续低流量吸氧下安全行白内障手术,5例5眼白内障现代囊外摘出联合人工晶状体植入术,65例65眼白内障超声乳化摘除联合人工晶体植入术.有3例患者术前安装临时起搏器.术后随访1mo,术后最佳矫正视力<0.05者1例1眼(1.4%);0.05~者4例4眼(5 7%),≥0.3者65例65眼(92.9%).术中均无严重全身和局部并发症发生,达到预期效果.结论:老年心血管疾病患者施行白内障摘除联合人工晶状体植入术应做好术前评估与术前准备,严格掌握手术适应证和手术禁忌证,术中应用心电监护提高手术安全性.     

Clinical Course of Renal Disease in Recipients of Liver Transplant Who Required Peritransplant Dialysis

PurposeRenal dysfunction is a common complication and one of the factors that affects the outcomes of liver transplantation (LT). The aim of this study was to review the clinical course of recipients of LT who needed peritransplant dialysis at our center.MethodsWe compared the clinical demographics, morbidity, and mortality between patients who required and those who did not require peritransplant dialysis among 26 recipients of LT from May 2015 to February 2018 at our center.ResultsAmong the recipients, 9 had pretransplant or posttransplant dialysis and 17 did not. The patients who underwent dialysis had a higher pretransplant Model for End-Stage Liver Disease score (42 vs 13; P < .001), older donor age (41 vs 24 years; P < .001), and longer post-LT hospital stay (37 vs 20 days; P < .001). However, there was no significant difference in the serum creatinine level between the 2 groups (1.36 vs 0.93 mg/dL; P = .187) at 2 weeks (1.10 vs 0.96 mg/dL; P = .341), 1 month (1.06 vs 0.86 mg/dL; P = .105), and 3 months after LT (0.92 vs 0.94 vs 0.89 mg/dL; P = .825). Mortality was higher in the peritransplant dialysis group (P = .043). The pre-LT dialysis duration was significantly related to post-LT dialysis (P = .028) and mortality (P = .011).ConclusionsThe pre-LT dialysis duration is considered an important factor in the survival and recovery of kidney function after LT. Therefore, if the patient has started dialysis, it may be beneficial to proceed to LT as soon as possible.     

贵州省六种少数民族公众科学素养现状及对策

目的：了解贵州省布依族、苗族、侗族、水族、瑶族和毛南族6种少数民族公众科学素养状况，提出对策研究。方法：采用国际通用的社会学、人类学和统计学方法分层整群抽样方法和中国科协制定的科学素养测试体系和问卷模式，对布依族、苗族、侗族、水族、瑶族和毛南族6种少数民族18～69岁成年人进行抽样调查。结果：贵州省少数民族公众具备基本科学素养的比例为0．13％，其中水族0．5％，苗族0．3％，布依族、侗族、瑶族和毛南族均为零。结论：贵州省6种少数民族公众科学素养低下，应引起政府和科技、科普等有关部门高度重视，采取形式多样的针对性措施，提高贵州省少数民族公众的科学素养能力。     

广西侗族人多瘤病毒感染率的调查研究

目的了解广西侗族健康人多瘤病毒(BKV)的感染情况,为防治BKV相关性肾病(BKVN)提供理论依据。方法采集广西侗族健康人外周血标本300份,提取淋巴细胞基因组DNA,用巢式PCR方法扩增BKV的保守区编码序列,统计分析不同年龄、性别组BKV-DNA检出率。结果300份广西侗族健康人BKV-DNA检出率为60.67%,不同性别组、年龄组之间差异无统计学意义(P>0.05)。结论BKV在广西侗族健康人中感染率较高,并进一步证实了外周血淋巴细胞(PBLs)是BKV在体内的潜伏细胞及传播载体,应加强对BKV条件致病性的认识。     

小儿先天性胆管扩张症的诊治：附44例报告

背景与目的:先天性胆管扩张症(CBD)是小儿较常见的胆道畸形,可发生于肝内和肝外胆管的任何部位。随着时间的推移,患者易并发胆道结石、胰腺炎、胆管癌、复发性胆管炎、门静脉高压症、自发性囊肿破裂等严重并发症。CBD常伴有胰胆管合流异常(PBM),且临床症状不典型,部分急性发作患者腹腔粘连严重,手术难度大且术后并发症多,因此其诊断与治疗对小儿外科医生带来了巨大挑战。本研究总结分析小儿CBD的诊治经验,以期为临床工作提供参考。方法:回顾性分析中南大学湘雅医院2010年6月-2017年8月间收治的44例CBD患儿的临床资料。结果:44例患儿中女38例,男6例,男女比1:6.3;发病年龄为2~161个月,中位发病年龄为63个月。主要临床症状为腹痛30例(68.1%)、皮肤巩膜黄染20例(45.5%)、恶心呕吐7例(15.9%)。37例行彩超检查,30例(81.1%)考虑为CBD;32例行CT检查,29例(90.6%)考虑诊断为CBD;20例行磁共振胰胆管成像(MRCP)检查,20例(100.0%)均考虑诊断为CBD,其中18例(90.0%)伴有PBM。按Todani分型:I型34例(77.3%),IVA型10例(32.7%);按董氏分型:C1型26例(59.1%),C2型8例(18.2%),D1型8例(18.2%),D2型2例(4.5%)。一期行胆囊切除+胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术的29例患儿术中出血(80.0±25.0)mL,无并发症发生,术后住院(8.0±1.6)d;行胆囊切除+胆总管囊肿切除+左半肝切除+右肝管空肠Roux-en-Y吻合术的1例术中出血150.0 mL,术后住院10 d;一期行胆总管囊肿切开T管引流术,3个月后行二期胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术的6例患儿术中出血(500.0±125.0)mL,术后住院(11.0±4.2)d;1例行胆总管空肠端侧吻合术患儿术中出血200.0 mL,术后出现吻合口瘘,术后住院24 d,6个月后行二期手术,术中失血200.0 mL,术后住院7 d;7例未行手术治疗,其中4例为IVA型。40例获随访20~110个月(中位随访时间60个月),其中35例行手术治疗患儿均恢复良好,5例未行手术治疗患儿中3例(60.0%)症状反复发作,1例因反复发作胆管炎死亡。结论:MRCP诊断CBD的准确率高,且能显示有无PBM及PBM类型,术中可根据MRCP显示的胰胆管汇合部位而避免损伤胰管并完全切除病变胆管,可作为诊断CBD的首选方法;董氏分型有助于手术方式的选择,为部分IVA型患者提供合理的手术方式。     

Combination of the Centre for International Blood and Marrow Transplant Registry Risk Score and the Global Severity Score Enhances Prognostic Risk Stratification in Patients Receiving Frontline Therapy for Chronic Graft-versus-Host Disease

The Centre for International Blood and Marrow Transplant Registry (CIBMTR) score has been shown to be prognostic for overall survival (OS) and nonrelapse mortality (NRM) but has been shown in several single-center studies to classify a large proportion of patients with chronic graft-versus-host disease (cGVHD) in the lower risk groups (RG1 to RG2), thereby limiting its prognostic utility for those patients. We evaluate the CIBMTR score, the Global Severity Score (GSS), and a novel risk score developed to improve on the limitations of the CIBMTR with respect to clinically relevant outcomes, including failure-free survival (FFS), in patients receiving frontline systemic treatment for cGVHD. We identified 277 patients between 2002 and 2012 at the Princess Margaret Cancer Centre in Toronto, Canada, who developed cGVHD and were treated with at least 1 line of systemic therapy. cGVHD was graded by GSS, and patients were stratified by CIBMTR. We evaluated OS, NRM, relapse, and FFS within GSS grade groups, as well as CIBMTR RGs, and used a novel prognostic risk score. The median FFS duration was 164 days in the severe GSS group versus 238 days in the moderate-grade group and 304 days in mild-grade group (P= .001). The median FFS duration was 501 days in CIBMTR RG1 versus 291 days in RG2 and 166 days in RG3 to RG6 (P = .003). A novel risk score combining the GSS and CIBMTR scores was prognostic of OS, NRM, and FFS and was able to subdivide patients with cGVHD in CIBMTR RG1 to RG2 into distinct prognostic risk categories. The CIBMTR risk score and the GSS are well correlated with FFS, OS, and NRM following frontline systemic treatment for cGVHD. A new risk score model combining the CIBMTR risk score and the GSS could enhance risk stratification in the lower CIBMTR risk groups.     

三金穴放血结合腹针治疗膝关节骨性关节炎临床观察

目的:观察董氏奇穴"三金穴"放血结合腹针治疗膝骨性关节炎的临床疗效。方法:96例分为两组治疗组48例用"三金穴"放血结合腹针治疗;对照组48例单用腹针疗法治疗,共治疗4周。结果:总有效率治疗组95.83%、对照组87.50%,两组比较有统计学差异(P<0.05)。治疗后WOMAC总分治疗组优于对照组(P<0.05)。缓解疼痛时间治疗组短于对照组(P<0.05)。缓解僵硬时间治疗组与对照组相当。结论:董氏奇穴"三金穴"放血结合腹针可有效缓解膝关节骨性关节炎症状,降低WOMAC评分、缓解疼痛。     

湘西侗族、苗族青年手的形态学研究

目的了解湘西侗族、苗族18²5岁青年人手的形态学参数,为手外科损伤修复、机械装备、工具制造及手套设计提供形态学基础,丰富形态学资料。方法对400例在校大学生的左、右手进行16项活体测量,并对获取的资料进行统计学分析。结果同民族、不同性别间男、女生手长、手指长、手掌宽、手最大宽存在差异,且与其他地区比较手指长度有差异。但在同性别、不同民族间手的形态学参数无差异。结论湘西青年人的手短小,有地区差异。