脑梗死后远隔部位小脑皮层Nogo-A蛋白表达

目的探讨大鼠脑缺血后不同时间轴突生长抑制因子Nogo-A在远隔部位小脑皮质的动态表达。方法 60只大鼠随机分为假手术组(n=30只)和大脑中动脉闭塞组(n=30只),每组分为1、3、5、7和10 d五个不同的亚组;采用改良的ZeaLonga法制备大鼠大脑中动脉闭塞模型;HE染色观察小脑皮质组织形态学改变;免疫组化染色检测小脑皮质Nogo-A蛋白的表达。结果 Nogo-A蛋白免疫反应性细胞广泛分布于小脑皮层少突胶质细胞(OLG)构成的髓鞘区域,主要位于OLG(胞体小、胞浆少和突起少)的细胞浆,并于脑缺血后第5 d、7 d和10 d较假手术组明显增高(P<0.05),第1 d和3 d无统计学差异(P>0.05)。结论大鼠大脑中动脉闭塞后远隔部位小脑皮层Nogo-A主要由OLG表达且呈动态变化。     

骨盆肿瘤切除后带血管蒂股骨上段翻转重建髋关节的解剖学研究

目的 探讨骨盆肿瘤切除后带血管蒂股骨上段翻转重建髋关节的可行性.方法 1)选取10具骨盆标本,测量骨盆重建所需股骨截骨长度,并测量50例股骨干标本滋养孔位置,将截骨长度与滋养孔位置进行比较,确定股骨干滋养动脉在截骨长度内能否得到保留.2)对34具尸体标本髂内动脉和股深动脉主要分支的分布、外径、长度以及臀上、下动脉起始处至耻骨联合下缘距离进行解剖学观测,比较供、受区血管长度和外径,确定合适的吻合血管. 结果 1)股骨近端第1滋养孔和第2滋养孔均在截骨范围外,不能作为移植骨的供血管.2)臀上动脉出孔处分别与旋股内、外动脉起始端吻合后总长度比臀上动脉起始处到耻骨联合下缘分别长出1.74～2.23 cm和2.39～2.57 cm;臀下动脉出孔处分别与旋股内、外动脉起始端吻合后总长度比臀下动脉起始处到耻骨联合下缘分别长5.87～6.44 cm和6.51～6.83 cm,能够满足吻合需要,且血管吻合后张力不大.臀上、下动脉出梨状肌孔处、旋股内、外动脉起始处外径相仿,P＜0.05,差异没有显著性.结论 骨盆肿瘤尤其是髋臼部位肿瘤切除后利用带血管蒂自体股骨上段翻转移位重建骨盆环、再造髋臼在解剖学上是可行的.     

食管癌螺旋CT灌注成像与肿瘤血管生成的相关性研究

目的探讨食管癌螺旋CT灌注成像与肿瘤血管生成的相关性。资料与方法对50例食管癌患者行多排螺旋CT灌注扫描,分析食管癌CT灌注成像参数血容量(BV)、血流量(BF)、平均通过时间(MTT)、表面通透性(PS)与微血管密度(MVD)及血管内皮生长因子(VEGF)表达之间的关系。结果 50例食管癌中,VEGF阳性表达率为62%(31/50),阴性表达率为38%(19/50),MVD值在两组间的差异具有统计学意义(P<0.05);BF值与MVD呈正相关(P<0.05),BV及PS值与MVD呈显著性正相关(P<0.01),MTT值与MVD无相关性(P>0.05);PS值与VEGF表达呈正相关(P<0.05),BF、BV及MTT与VEGF表达无相关性(P>0.05)。结论食管癌CT灌注成像能够在一定程度上反映活体的肿瘤血管生成状况。     

磁共振扩散张量成像(DTI)在诊断中枢神经系统疾病中的应用

目的评价磁共振扩散张量成像(DTI)在诊断中枢系统疾病中的用途。方法 86例临床证实的中枢神经系统疾病患者包括超急性及急性期脑梗死40例,脑肿瘤32例,脑白质疏松7例,多发性硬化4例,脑中毒3例以及作为正常对照的健康志愿者9例均经常规磁共振序列和DWI、DTI检查,对患侧和健侧大脑白质纤维束感兴趣区各向异性分数(FA)值进行定量分析,获得方向编码彩色(DEC)图和黑白各向异性(FA)图,扩散张量纤维束成像(DTI)显示脑白质纤维束走形方向、损伤、受压、移位等情况。结果健康组不同部位的脑白质的FA值不同,但大脑半球两侧的FA值差异无统计学意义。超急性(发病后小于6 h)脑梗死区白质FA值与对侧相比轻度增高或降低,急性期(发病后6～72 h)脑梗死区白质FA值显著减低,FA图为低信号,健侧脑白质为高信号,均有明显差别。良恶性脑肿瘤FA值仅在瘤周水肿区的比较中有统计学差异,FA图肿瘤实质为稍低信号,中心坏死及周围水肿表现为低信号。脑白质病变和正常对照组感兴趣区测量FA值,病变区FA值降低,两组差异有统计学意义。结论 DTI可无创且清晰地显示白质纤维束走行方向及分布情况,对诊断中枢神经系统病变有重要用途。     

儿童蓝色橡皮泡样痣综合征一例

患者,女,12岁,间断性黑便12年.大便3～4次/d,为咖啡色或黑色稀软便.一直口服药物纠正"贫血".2岁时因"口腔舌下血管瘤"接受手术治疗,3岁时因左手拇指指间关节处"蓝色样血管瘤"接受手术治疗.     

肝移植后受者真菌感染的易感因素分析

肝移植为治疗终末期肝病的有效手段.肝移植受者术后常继发真菌感染,其发生率为4%～48%,而病死率则高达50%～80%[1].探讨其易感因素,对真菌感染的预防及早期诊断,对提高疗效具有重要意义.     

肝切除术前肝脏储备功能评估的专家共识(2011版)

肝脏外科已走进了精准外科时代.精准肝脏外科在追求彻底清除目标病灶的同时,确保剩余肝脏解剖结构完整和功能性体积最大化,并最大限度控制手术出血和全身性创伤侵袭,最终使手术患者获得最佳康复效果[1-2].     

肝癌切除围手术期肝脏功能的保护

Liver cancer is a common malignancy.Its incidence ranks sixth among malignant tumors,and it is the third most common cause of cancer death worldwide.Extended hepatectomy,hepatectomy following chemotherapy and repeat or staged hepatectomy are being widely used to prolong the survival time of patients with hepatic neoplasms.Although advances in perioperative management and operative techniques have improved the safety and extended the indications for hepatectomy over the past 2 decades,postoperative hepatic failure is still a severe complication which causes perioperative mortality.In this review,current advances in preoperative evaluation of the condition of patients,precise hepatectomy,postoperative assessment of the hepatic function and therapeutic strategies for postoperative hepatic failure are introduced.     

河南省杞县60 Co卡源事件居民认知研究

目的 了解2009年6月河南省杞县利民辐照厂60Co卡源事件后,当地居民对核与辐射的知晓程度和对核能的接受性、对当地政府处理卡源事件的评价,以及对事件原因的分析.方法 2010年3月至4月,在杞县利民辐照厂10 km范围内,抽取5个乡镇的23个自然村和2所学校;在未受事件影响的135 km以外的辉县,选取3个乡镇的3个自然村和2所学校作为对照人群.对18岁以上的一般公众,意见代表(医生、教师、行政人员、官员、私营企业业主等)和学生(初三及高一),进行人户问卷调查.结果 本调查收回有效调查问卷1340份.两地居民对核与辐射的知晓程度都较低,杞县居民对核与辐射的知晓程度高于辉县.学生对核与辐射知识的知晓程度最高,意见代表次之,一般公众最低.男性、受教育程度较高者对核与辐射的知晓程度较高.40.0%以上的被调查者认为我国应当增加建设核电站,但仅一小部分被调查者支持在当地建设核电站,学生、受教育程度较高者更反对当地建设核电站.60%以上的一般公众和63.2%的意见代表"非常相信"或"比较相信"当地政府在"Co卡源事件中对他们的劝解.超过80%的受访者对当地政府在处理60Co卡源事件的能力持负面态度.与对政府官员的信任度评价相同,学生对当地政府的评价最低,意见代表次之,对政府的评价最高的为一般公众.60Co卡源事件导致大规模居民离家避险的主要原因有:谣言泛滥占67.2%、缺乏辐射知识占61.9%、随众效应占59.2%,以及政府未及时向群众公布事件真相占42.3%.结论 公众对核与辐射的了解较少.公众对当地政府的信任度比较高.但是对政府在处理60Co卡源事件中的表现不是很满意.学生的负面评价值得关注.

Abstract：

Objective To investigate radiation risk perception and nuclear acceptance after the 60Co stuck source incident in June 2009 in Qixian County,Henan Province.Methods From March to April 2010,23 hamlets and 2 schools from 5 towns in Qixian County were selected,while 3 hamlets and 2 schools from 3 towns were used as control in Huixian County,1 35 km away where no any impact of the incident was found.Face-to-face questionnaire survey was conducted among three groups including mass public,elite public(representatives of public opinion,such as physicians,teachers,govemmental officials,administrative personnel,private entrepreneurs),and middie school students(the third grade students in junior middle schools and the first grade students in senior middle schools).Results A total of 1 340 valid questionnaires were collected.The public knowledge levels about radiation and nuclear power were low among all groups in two areas and public knowledge levels in Qixian County were higher than those in Huixian County.In both areas.the knowledge levels of the students were higher tIIan those among the elite public,and that among the general public were the lowest.The knowledge levels of males and those with higher educational levels were higher than those of females and those with lower educational levels.More than 40.0% of the respondents supported the idea to build nuclear power plants in China.but only a small part of them supported to build nuclear power plants in their own areas.The percentages of opponents against local nuclear power plant construction were especially higher among the students and those with higher educational levels.More than 60% of the mass public and elite public believed the explanation of the government.More than 80% of the respondents held negative attitudes towards the performance of the Qixian County Government in dealing with this incident.The student gave the lowest evaluation of the credibility and the specific performance of the local government,whereas the elite public placed themselves between the students and the mass public.The reasons why the local people left their homes to evade risk included rumors(67.2%),lack of radiation knowledge(61.9%),group psychology(59.2%),and failure of the government to inform the truth to the public in time(42.3%).Conclusions The public still fails to know enough about radiation and nuclear power.Although they trust the government,they are dissatisfied with the performance of the local government in dealing with the incident.The negative evaluation of the students is worth concerning.     

腹腔镜联合药物治疗非破裂型输卵管妊娠观察

目的探讨腹腔镜保守性手术联合米非司酮及甲氨蝶呤治疗非破裂型输卵管妊娠的临床效果。方法米非司酮300mg1次顿服,MTX 50mg单次肌注后施行腹腔镜保守性手术设为研究组,单独施行腹腔镜保守性手术的患者设为对照组。结果研究组手术时间（56.0±12.0）min,术中出血量为（45.0±12.0）ml,术后血β-HCG降至正常平均时间（14.2±1.3）d;对照组手术时间（89.0±28.0）min,术中出血量（92.0±27.0）ml,术后血β-HCG降至正常平均时间（21.5±2.8）d,两组比较差异均有统计学意义（P〈0.01）。研究组输卵管通畅率明显高于对照组（P〈0.05）。结论腹腔镜保守性手术联合米非司酮及甲氨蝶呤治疗非破裂型输卵管妊娠疗效显著,无严重的不良反应,安全可靠。