前列腺癌机器人手术的“是是非非”

无论是开放手术、腹腔镜手术,还是机器人手术,因前列腺的解剖结构是不变的,前列腺癌根治术的目标也是不变的(通过手术手段,切除包括精囊、部分输精管在内的全部前列腺组织,部分患者需行淋巴结清扫),所以,手术的切除范围和适应证都是一样的,区别只是外科医生所采用的工具不同而已。     

口腔颌面部间隙感染病原菌分布及耐药性分析北大核心CSCD

目的分析口腔颌面部间隙感染病原菌分布特点及耐药性。方法回顾性分析患者的病例资料、感染源及感染部位。抽取脓液或分泌物并进行细菌分离、培养、鉴定。采用K-B纸片扩散法进行药敏分析。对病例的性别、年龄、职业、入院前病程、糖尿病、累及间隙数量、白细胞计数值进行对比,分析发生并发症的影响因素。结果本研究86例口腔颌面部间隙感染患者,69.77%有明确牙痛史,17.44%患糖尿病,39.53%患者于发病7 d内就诊,15.12%患者白细胞计数≥15×10^(9)/L,56.98%患者出现蜂窝状炎症。以牙源性为主要感染来源,占比72.09%。牙源性口腔颌面部间隙感染患者中,主要病因为智齿冠周炎。口腔颌面部间隙感染患者主要为多间隙感染,占比54.65%。下颌下间隙感染为单间隙与多间隙感染患者主要感染部位。送检标本细菌检出率为75.58%,共检出病原菌112株,48.22%为需氧-厌氧混合菌。需氧菌主要为金黄色葡萄球菌,厌氧菌主要为普氏菌,需氧-厌氧混合菌主要为草绿色链球菌。牙源性感染患者检出病原菌共68株。金黄色葡萄球菌对头孢呋辛的耐药率为59.09%,草绿色链球菌对克林霉素的耐药率分别为63.64%,两者对万古霉素、利奈唑胺的敏感性均为100.00%。普氏菌对克林霉素的耐药率分别为55.55%,对奥硝唑的敏感性为100.00%。通过治疗后,31.40%患者出现并发症,主要为上呼吸道阻塞。对比未发生并发症的病例与发生并发症病例的临床资料发现,年龄≥60岁、农民、入院前病程≥7 d、糖尿病、多间隙感染、白细胞计数≥15×10^(9)/L是预后发生并发症的影响因素。结论通过分析口腔颌面部间隙感染临床特点、致病原因、病原菌分布特点、耐药性、预后并发症影响因素,对口腔颌面部间隙感染患者的临床抗生素使用及手术治疗具有指导意义。     

虾青素在小鼠肾脏缺血再灌注损伤方面的保护作用

目的:探讨虾青素(ATX)在小鼠肾脏缺血再灌注(IR)损伤方面的保护作用。方法:将雄性ICR小鼠随机分为4组:假手术组1(Sham)、假手术组2(Sham+ATX)、手术组1(IR)、手术组2(IR+ATX)。用灌胃法分别管饲等量ATX(5 mg·kg-1·d-1)和橄榄油2周,左肾蒂夹闭50 min诱导IR损伤。收集24 h后血清标本及肾脏组织。比较各组间血尿素氮(BUN)、血肌酐(Cr),肾组织超氧化物歧化酶(SOD)、脂质过氧化产物丙二醇(MDA)含量及肾脏的组织病理学评分。结果:IR+ATX组血清BUN、Cr较IR组显著下降(P<0.05),SOD较IR组明显升高(P<0.05),MDA较IR组明显降低(P<0.05);肾脏组织病理学评分IR+ATX组较IR组显著降低(P<0.05)。结论:ATX对肾功能及肾脏组织具有保护作用。     

新型冠状病毒肺炎疫情防控时期主动脉急症患者诊治的建议

近期新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情爆发,恰逢主动脉急症高发的冬春时节,而主动脉急症大多起病急骤,病情危重,死亡率高,需紧急处理。在国家"重大突发公共卫生事件一级响应机制"之下,疫期主动脉急症患者的诊疗需制订全新的流程。如何在这一特殊时期增强医护人员的防护和正确救治意识,既让主动脉急症患者获得及时、有效的治疗,又能避免救治期间可能发生的院内疫情传播,是急诊科、心外科、血管外科等相关学科当前面临的重大课题。本文呼吁各医疗单位在严格遵守政府和医院感控部门规章制度的基础上开展医疗实践,在"疫情防控为重,严防院内感染,确诊COVID-19患者首选保守"的前提下,提倡"择期手术适当推迟,限期手术术前隔离排查,急诊手术严格防护"的诊治原则,同时针对COVID-19疫期主动脉急症患者的急诊科接诊、病房收治、术前准备、术中防护、术后处理等方面提出了建议。     

组织因子小干扰RNA壳聚糖纳米粒的制备及其特征

目的 探讨壳聚糖-组织因子小干扰RNA(TFsiRNA)纳米粒制备方法并研究其特性.方法 采用三聚磷酸钠(TPP)离子胶凝法分别制备包封型和吸附型壳聚糖-TPP-TFsiRNA纳米粒.检测纳米粒平均粒径和Zeta电位、载药率,并分析血清稳定性、体外生物活性及其细胞毒性.结果 两种纳米粒粒径均小于550 nm,粒径大小主要取决于壳聚糖类型、分子量及其浓度.酸碱度、壳聚糖TPP质量比也影响粒径大小.包封型纳米粒siRNA载药率为100%.壳聚糖-TPP-TFsiRNA纳米粒中的siRNA在5%血清中孵育24 h开始降解,60 h完全降解;50%血清孵育6 h保持完整,48 h完全降解.结论 壳聚糖纳米粒可能成为有效的siRNA转运载体.     

慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

组织工程心脏瓣膜的种子细胞

应用计算机检索Pubmed数据库1995—01／2008—01期间和CNKI、维普数据库2001-01／2008—01期间与组织工程心脏瓣膜种子细胞相关的44篇资料显示：l临床应用的机械瓣和生物瓣存在一些缺点，而组织工程心脏瓣膜优点包括无需抗凝治疗、抗感染、有活力、具有生长和修复能力，具有很好的前景。组织工程心脏瓣膜种子细胞可来源于：血管、骨髓、血液、脐带、绒毛膜和胚胎干细胞等，这些细胞具有相应特异的细胞表型，并适合产生用作组织工程的细胞外基质。组织工程心脏瓣膜研究已经取得了相当大的进展和令人鼓舞的成绩，但有许多技术问题和临床实际问题尚待解决和克服。要想组织工程心脏瓣膜成功应用于临床，需要更深入的研究：比如可降解多聚物支架材料特性、干细胞分化、尽量发挥自体细胞功能、使用无创技术评价瓣膜生长和重构的速度及质量等，这样就会催生更新进的技术应用于体内安全性实验以及临床前期研究。     

去端肽胶原介导小干扰RNA抑制大鼠静脉移植物内膜增生

Objective To evaluate the efficacy of using small interfering RNA targeting TF as a therapy for vein graft failure. Methods External jugular vein to carotid artery interposition vein grafts, which were applied to a low flow condition, were made in 120 Sprague-Dawley rats weighing 260 to 300 g. These rats were randomly divided into 4 groups, 30 rats each group. Group A was atelocollagen-TF Stealth<'TM> Select RNAi group. Group B was atelocollagen-TF Stealth<'TM> RNAi group. Group C was atelocollagen group. Group D was control group. Small interfering RNA mixed with atelocollagen was administrated to the external wall of grafted veins. The TF protein expression of vein gratis was analyzed by Western blot at 1, 3, 7, 14, and 28 d postoperatively, and by immunochemistry at 3 d postoperatively. The proliferation index was determined at 14 d postoperatively. Neointimal hyperplasia was evaluated at 28 d postoperatively. BLOCK-iTTM fluorescent oligo was used to confirm its stability and successful transfer into the vein graft wall at 3 and 7 d postoperatively for another group (n = 12). Results Fluorescence of BLOCK-iT<'TM> fluorescent align could be detected in the graft wall even at 7 d postoperatively. Knockdown of the TF expression was achieved by perivascular application of siRNA using atelocollagen. Compared with control group, the intima thickness at 28 d after grafting was significantly reduced (P ＜ 0.05). This phenomenon was preceded by significant reduction of cell proliferation in siRNA-treated grafts at 14 d postoperatively (P ＜0.05). Conclusion The expression of TF in vein grafts can be effectively inhibited by specific siRNAs using a atelocoilagen-based nonviral delivery approach/n vivo, so that the neointimal thickening can be prevented.     

婴幼儿法洛四联症1期根治术时机选择

目的:评价婴幼儿法洛四联症(TOF)早期根治术后效果。方法:2002年1月至2006年6月,我科共手术治疗<36个月婴幼儿TOF 87例,年龄(2~36)个月,平均(17.2±5.6)个月:<6个月14例(16.1%)、7~12个月34例(39.1%)、13~36个月39例(44.8%)。比较不同年龄组手术病死率、围手术期处理、术后并发症及随访结果。结果:2例(2.3%)死于术后低心排出量综合征,1例(1.2%)死于术后心律失常。不同年龄组术后并发症差异无统计学意义。术后6个月以下患儿更多需要升压药维持,但术后呼吸机通气时间、ICU停留时间、住院时间差异无统计学意义。回访时间2.0~6.0年,平均(3.5±1.6)年,56例(66.7%)例患儿存在不同程度肺动脉瓣反流,2例(2.3%)残余右心室流出道梗阻,3例(3.4%)室缺残余分流再次手术矫治。结论:对<6个月婴儿TOF一期根治手术病死率和术后并发症低,手术年龄不影响术后效果。