Silk-elastinlike protein polymers for matrix-mediated cancer gene therapy

Silk-elastinlike protein polymers (SELPs) are recombinant polymers designed from silk fibroin and mammalian elastin amino acid repeats. These are versatile materials that have been examined as controlled release systems for intratumoral gene delivery. SELP hydrogels comprise monodisperse and tunable polymers that have the capability to control and localize the release and expression of plasmid DNA and viruses. This article reviews recent developments in the synthesis and characterization of SELP hydrogels and their use for matrix-mediated gene delivery.     

大黄(庶虫)虫丸对非胰岛素依赖型Ⅳ期糖尿病肾病患者Ⅷ因子相关抗原及纤维蛋白原的影响

目的:探讨大黄(庶虫)虫丸对非胰岛素依赖型Ⅳ期糖尿病肾病(DN)患者Ⅷ因子相关抗原(vWF:Ag)、纤维蛋白原(Fbg)的治疗作用。方法:选择Ⅳ期DN患者60例,用自动凝血机检测vWF:Ag、Fbg的变化,并随机分为治疗组和对照组。治疗组用大黄(庶虫)虫丸,对照组用潘生丁干预治疗,观察大黄(庶虫)虫丸对Ⅳ期DN患者vWF:Ag、Fbg的影响。结果:Ⅳ期DN患者血vWF:Ag、Fbg含量显著增高,与正常对照组比较有极显著差异(P<0.01)。用大黄(庶虫)虫丸治疗后,vWF:Ag、Fbg浓度显著降低(P<0.05或P<0.01),明显优于潘生丁组。结论:大黄(庶虫)虫丸能显著降低Ⅳ期DN患者血vWF:Ag、Fbg含量,改善高凝状态。     

大黄对糖尿病大鼠血管病变保护机制的实验研究

目的:探讨大黄对糖尿病血管病变的保护机制。方法:制备糖尿病大鼠模型,并给予大黄干预,8周后,取血测定一氧化氮(NO)及内皮素-1(ET-1)。取胸主动脉环观察不同累积浓度的乙酰胆碱(Ach)对去甲肾上腺素(NE)引起的血管收缩的抑制率。另留取一段胸主动脉制备病理切片,SP法免疫组化染色,观察细胞间黏附分子-1(ICAM-1)及血管细胞间黏附分子-1(VCAM-1)的阳性表达。结果:大黄组与模型组相比能明显抑制升高的血浆ET-1(P<0.05);升高NO的水平(P<0.05);但均达不到正常组的水平(P<0.05)。模型组血管环对NE的收缩反应明显强于正常对照组及大黄组(P<0.05),且大黄组对NE的收缩反应亦强于正常对照组(P<0.05)。在相同Ach浓度下,模型组及大黄组胸主动脉环对Ach的舒张作用明显弱于正常组(P<0.05),而大黄组强于模型组(P<0.05)。大黄组能明显抑制糖尿病大鼠胸主动脉ICAM-1及VCAM-1表达(P<0.05)。结论:大黄具有降低大鼠ET-1及升高NO的作用,能够保护糖尿病大鼠内皮依赖的血管舒张功能,且能够抑制ICAM-1及VCAM-1的表达,具有抗动脉硬化作用。     

达芬奇机器人手术对手术患者医院感染及相关因素的影响——7种手术病例对照研究

目的 了解达芬奇机器人手术对手术患者医院感染及相关因素的影响，为掌握达芬奇机器人手术感染情况及防控提供依据。方法 选取某院2016年5月— 2018年10月进行达芬奇机器人手术病例，从中筛选出7种手术共839例患者作为病例组，选出同时期符合纳入标准的传统方式手术病例作为对照组（891例），进行回顾性病例对照分析。结果 泌尿外科手术占达芬奇机器人手术总量的74.26%，普通外科手术占20.50%，心胸外科手术占5.24%。直肠癌根治术病例组医院感染例次率、手术部位感染率、住院日数、抗菌药物使用日数、留置导尿管日数均低于对照组；房间隔缺损修补术病例组住院日数、留置导尿管日数均低于对照组；肾部分切除术病例组留置导尿管日数低于对照组，差异均有统计学意义（均P<0.05）。病例组住院总费用和手术费用均高于对照组，差异有统计学意义（均P<0.01）。结论 与传统手术方式比较，达芬奇机器人手术不会额外增加医院感染发病率，部分手术中可减少医院感染的发生。     

Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer

AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eight studies matched the selection criteria and r...     

再论大柴胡汤证之归属

大柴胡汤证不是少阳阳明合病，而是小柴胡汤证由气分向血分发展的必然阶段，病势有深浅之分，病位却不是由少阳及于阳明．而是由气郁发畏为气滞热郁血瘀。“心下急”、“郁郁微烦”为其辨证眼目。     

津力达口服液对2型糖尿病患者胰岛素敏感性的影响

目的 观察津力达口服液对2型糖尿病患者胰岛素敏感性的影响。方法 70例2型糖尿病患者随机分为治疗组和对照组,治疗组40例,予津力达口服液20ml,每日3次;对照组30例,予渴乐宁胶囊4粒,每日3次,2组疗程均为8周,治疗前后进行标准馒头餐试验,并计算外周胰岛素敏感性指数。结果 2组治疗后空腹血糖和餐后2h血糖均明显下降,血清胰岛素和C-肽浓度无变化,而胰岛素敏感性指数明显改善。结论 津力达口服液可通过提高2型糖尿病患者外周胰岛同素敏感性,消除胰岛素抵抗,降低血糖。     

Robotic surgery update

Background Minimally invasive surgical techniques have revolutionized the field of surgery. Telesurgical manipulators (robots) and new information technologies strive to improve upon currently available minimally invasive techniques and create new possibilities.Methods A retrospective review of all robotic cases at a single academic medical center from August 2000 until November 2002 was conducted. A comprehensive literature evaluation on robotic surgical technology was also performed.Results Robotic technology is safely and effectively being applied at our institution. Robotic and information technologies have improved upon minimally invasive surgical techniques and created new opportunities not attainable in open surgery.Conclusions Robotic technology offers many benefits over traditional minimal access techniques and has been proven safe and effective. Further research is needed to better define the optimal application of this technology. Credentialing and educational requirements also need to be delineated.     

Installation of telerobotic surgery and initial experience with telerobotic radical prostatectomy

OBJECTIVE: To assess the ability of untrained laparoscopic surgeons to learn and implement laparoscopic telerobotic radical prostatectomy (TRP) using the daVinci Surgical System (Intuitive Surgical, CA), and assess the education, safety and efficacy issues when instituting this system. PATIENTS AND METHODS: Between December 2003 and October 2004, 122 consecutive TRPs were performed by two surgeons for clinically localized prostate cancer. The individual robotic surgeon was assisted at the bedside by another surgeon. The TRP was performed robotically by the surgeon at the remote console unit. Perioperative data and pathological results were recorded. The two surgeons spent 1 week in a skills laboratory using a porcine model of laparoscopic TRP, and then cadaveric robotic prostatectomy. The first six cases were mentored by an experienced telerobotic surgeon. RESULTS: The TRP was conducted by two surgeons with no previous laparoscopic experience. There were no conversions to open surgery. Assessing the complications, postoperative continence, operating time and transfusion rates showed equivalent efficacy and safety to open and pure laparoscopic methods. CONCLUSION: TRP represents a novel computer-based surgical approach to prostate cancer, which offers the benefits of minimally invasive surgery without the extensive experience associated with the laparoscopic method. It remains to be seen whether the robotic approach can deliver better outcomes in continence and potency over time.     

明代六部综合性医书的传日及其影响

明代传日医书众多,以《医书大全》、《南北经验医方大成》、《玉机微义》、《医学正传》、《医学入门》、《万病回春》等综合性医书,传播最快,影响最大。它们促进了16世纪以降日本开始对中国医籍的大量翻刻;为日本当时医师培养提供了便捷教本;丰富了道三学派的理论与实践,从而为日本医学中兴增添了砖瓦。