Sequential defunctionalization followed by thyroxine supple- mentation as preoperative preparation of hyperthyroid patients undergoing thyroidectomy

Background Preparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment “sequential thyroid defunctionalization followed by thyroxine supplementation.”
Methods Four hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with “sequential thyroid defunctionalization followed by thyroxine supplementation”. Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications.
Results Compared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group （（326±163） ml in the control group; （196±57） ml in subgroup A; （230±71） ml in subgroup B; （240±80） ml in subgroup C; and （312±97） ml in subgroup D）. The postoperative complication rate of the experimental group was 8.64% （21/243） whereas that of the control group was 17.54% （40/228）.
Conclusions Sequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in     

Effect of endoscopic retrograde cholangiopancreatography combined with laparoscopy and choledochoscopy on the treatment of Mirizzi syndrome

Background Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic （Calot＇s） triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome. Methods Fifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography （ERCP）, laparoscopy, and choledochoscopy （tripartite approach group）; type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy （routine approach group）; type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups. Results All patients were successfully cured in surgical operation. The operation time was （49.7±27.5） minutes, blood loss during operation was （21.1±15.9） ml, initiation of intake time of food was （6.3±2.7） hours, postoperative complications were with two cases （7%, 2/27）, and hospital stay was （6.7±1.8） days in the tripartite approach group. In the routine approach group, the operation time was （85.1±20.3） minutes, blood loss during operation was （150.3±20.5） ml, initiation of intake time of food was （36.6±10.3） hours, postoperative complications were with three cases （11%, 3/27）, and hospital stay was （10.9±3.4） days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups （P 〈0.05）. Conclusions ERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.     

Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis: a Comparison of Anterior and Posterior Approaches

Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis. Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior （group A） or posterior （group B） correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed. Results Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery （P〈0.05）, with an average correction rate of 75.2% and 88.2%, respectively. Upon final follow-up, the coronal Cobb angles of the two groups were 18.9°± 11.1 ° and 7.7°±5.6°, respectively, with an average correction loss of 6.8°±6.5° and 2.7°±3.3°, respectively. The coronal Cobb angle after operation and at final follow-up, and the correction rate were significantly better in group B than those in group A （P〈0.05）, while the coronal Cobb angle loss in group A was greater than that in group B （P〈0.05）. The disc wedging before operation, after operation, and at final follow-up were 3.2°±3.0° 5.7°±3.0% and 8.6°±4.4° in group A, and 2.4°±3.2° , 3.3°± 3.4°, and 3.7°± 3.6° in group B, respectively. Postoperative disc wedging was significantly larger compared with preoperative measurements in group A （P〈0.05）, but not in group B （P〉0.05）. The difference between disc wedging at final follow-up and that after surgery was significant in group A （P〈0.05）, but not in group B （P〉0.05）. Between the two groups, group A had larger disc angles after operation and at final follow-up （P〈0.05）, and a greater loss of disc angle （P〈0.05）. Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.     

附加钢板在治疗股骨干骨折髓内钉固定后肥大性骨不连中的应用：与更换钢板的比较

Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.     

Effect of preoperative limited fluid resuscitation to the patients with traumatic shock

Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.     

Small incision combined with laparoscopy for ureteropelvic junction obstruction: comparison with retroperitoneal laparoscopic pyeloplasty

Background Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction （UP J） obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.
Methods Sixty-four patients with primary UPJ obstruction underwent pyeloplasty： 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoDerative, postoperative and follow-up conditions of patients were compared between the two groups.
Results Preoperative data were comparable in the patients of the two groups. The operative time was shorter （60.9 minutes vs 157.7 minutes, P 〈0.0001） and the complication rate was lower （9.4% vs 31.3%, P 〈0,05） in the open assisted group than in the laparoscopic group. The estimated blood loss （42.3 ml vs 47.8 ml）, time to have normal diet （37.6 hours vs 33.8 hours）, and hospital stay （6.7 days vs 6.2 days） were equivalent, The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group. Conclusions The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.     

Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation

Background Laparoscopic splenectomy （LS） is currently the standard approach for resection of a normal-sized spleen. However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging （CDFI） in splenic vessel anatomy and evaluated its value for LS.
Methods Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size （CDFI group）. In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed （non-CDFI group）. Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student＇s ttest.
Results All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the constituent ratios of the parameters by CDFI and those by intraoperative telerecording in the CDFI group （χ^2=0.383, 1.072, 0.119, P=0.536, 0.784, 0.730）. However, statistically significant differences were observed in the operative time （（158.70±42.51） minutes vs （200.65±47.89） minutes, P=0.003）, intraoperative blood loss （（55.87±17.36） ml vs （101.83±62.21） ml, P=0.001）, and recovery time of gastrointestinal function （（24.39±8.88） hours vs （30.60±9.45） hours, P=0.024） between the groups. Conclusions The individual operative route and schedule can be successfully determined on the basis of various kinds of reproducible anatomic frameworks of the spleen provided by preoperative CDFI. This technique facilitates the surgical procedure, shortens the operative time, reduces intraoperative blood loss and decreases the risk of LS in splenomegaly cases.     

Clinical assessment for three routes of hysterectomy

Background Hysterectomy is a very common surgery in gynecology. Ideal surgery for hysterectomy is microinvasive with few complications. There are three major routes of hysterectomy that are currently used. The aim of this study was to identify the differences of peri-operative outcome among the patients who underwent the three different approaches.
Methods One hundred and one women undergoing hysterectomy for myoma had the procedure performed by laparoscopic assisted vaginal hysterectomy （LAVH）, total vaginal hysterectomy （TVH） or total abdominal hysterectomy （TAH） in a randomized study. We compared the course of peri-operative and post-operative outcome for the three different approaches. Results were evaluated by linear regression analysis, Fisher＇s exact test and Student＇s t test for independent samples.
Results The operation time among the three procedures was not significantly different （P 〉0.05）. The amount of blood loss in the TVH group was less than in the LAVH and TAH groups （P 〈0.05）. The pain score 3 hours after operation in the LAVH group was significantly lower than in the TAH and TVH groups （P 〈0.001）. The pain scores in the LAVH and TVH groups were lower than in the TAH group at 24 and 48 hours after operation （P 〈0.01）. The women who underwent LAVH and TVH had a shorter hospitalization stay （P 〈0.001）. The highest body temperature after operation in the TAH group was higher than that in LAVH and TVH groups （P 〈0.001）.
Conclusions LAVH and TVH are better procedures for women requiring hysterectomy. The peri-operative and post-operative courses of TVH are better than LAVH, excluding the pain score 3 hours after operation. Vaginal hysterectomy is the most cost-effective approach but the final choice for the route of hysterectomy can depend on many factors such as gynecological disease, patients＇ health status and experiences of the gynecologist.     

Determination of drug concentration in aqueous humor of cataract patients administered gatifloxacin ophthalmic gel

Background Ophthalmic gel has been developed to increase the drug concentration in aqueous humor and to retard the loss of drug from the conjunctival sac.The research was to compare the drug concentration in aqueous humor of cataract patients administered 0.3% gatifloxacin ophthalmic gel with that in patients administered 0.3% gatifloxacin ophthalmic solution.Methods Ninety-six patients with cataract （96 eyes） were randomly assigned to 8 groups.The patients in groups 1-4received topical gatifloxacin 0.3% ophthalmic gel and those in groups 5-8 received gatifloxacin 0.3% ophthalmic solution.The dose regimen was 1 drop, 4 times a day for 3 consecutive days prior to cataract surgery.On the day of surgery, 1drop was applied at 15, 30, 60 or 120 minutes before commencement of cataract surgery in groups 1 and 5, groups 2 and 6, goups 3 and 7, and groups 4 and 8, respectively.Aqueous humor was extracted during the cataract surgery for the analysis of gatifloxacin concentration..Results The concentrations of gatifloxacin in aqueous humor were （0.24±0.25） μg/ml, （1.11±0.74） μg/ml, （2.32±2.01）μg/ml and （1.85±1.14） μg/ml in groups 1 to 4, and （0.16±0.25） μg/ml, （0.31±0.24） μg/ml, （0.75±0.28） μg/ml and （0.33±0.22） μg/ml in groups 5 to 8, respectively.Patients receiving gatifloxacin ophthalmic gel showed greater mean values of gatifloxacin concentration in aqueous humor than those receiving gatifloxacin solution, and such differences were significant with P 〈0.05 for all comparisons except that between groups 1 and 5.Conclusion Topical gatifloxacin ophthalmic gel can attain significantly greater drug concentrations in human aqueous humor than gatifloxacin ophthalmic solution.     

Effect of chronic intermittent hypoxia on the expression of Nip3, cell apoptosis, β-amyloid protein deposit in mice brain cortex

Background Chronic intermittent hypoxia （CIH） is the most important pathophysiologic feature of sleep apnea syndrome （SAS）. To explore the relationship between SAS and dementia, the effects of CIH on the expression of Nip3, neuron apoptosis and β-amyloid protein deposit in the brain cortex of the frontal lobe of mice were evaluated in this study.
Methods Thirty male ICRmice＇were divided into four groups： control group （A, n=-10, sham hypoxia/reoxygenation）, 2 weeks CIH group （B, n=5）, 4 weeks CIH group （C, n=-5）, and 8 weeks CIH group （D, n=10）. The ICR mice were placed in a chamber and exposed to intermittent hypoxia （oxygen concentration changed periodically from （21.72±0.55）% to （6.84±0.47）% every two minutes, eight hours per day）. Neuron apoptosis of the cortex of the frontal lobe was detected by means of terminal deoxy-nucleotidyl transferase-mediated in situ end labeling （TUNEL）. Immunohistochemical staining was performed for measuring expression of Nip3 and β-amyloid protein. The ultrastructure of neurons was observed under a transmission electron microscope.
Results TUNEL positive neurons in each square millimeter in the cortex of the frontal lobe were categorized by median or Riinto group A （1, 5.5）, group B （133, 13）, group C （252, 21）, and group D （318, 24）. There were significant differences among the above four groups （P=0.000）. The significance test was performed between the control group and each CIH group respectively： group A and B （P 〉0.05）; group A and C （P 〈0.01）; and group A and D （P 〈0.005）. The number of apoptotic neurons kept increasing in the ICR mice under CIH condition, and reached the peak in the group D, but there was no significant difference between groups B and C, between groups B and D, and between groups C and D. Nip3 positive neurons in each square millimeter in the cortex of the frontal lobe in each group were calculated by median or Ri as follows： group A （2, 5.5）, group B （117, 13）, group C （227, 26.2）, and group D（479, 21.4）. There were significant differences among the four groups （P=0.000）. The statistical test was performed between the control group and each CIH group respectively： groups A and B （P 〉0.05）; groups A and C （P〈0.005）; and groups A and D （P 〈0.005）. There was no significant difference between groups B and C, groups B and D, and groups C and D. The expression of Nip3 was closely correlated with neuron apoptosis in the brain （P 〈0.05）. The expression of β-amyloid protein in the brain of mice was negative in all CIH groups and the control group. Ultrastructure observation showed karyopyknosis of nucleus, swelling of chondriosomes, deposit of lipofuscins and degeneration of neural sheath in all CIH groups but not in the control group. Conclusion The results of this study indicate that CIH could up-regulate the expression of Nip3, and result in neuron apoptosis and ultrastructural changes in neurons of the frontal cortex.     

胸腔镜联合腹腔镜食管癌根治术学习曲线研究

目的评估胸腔镜联合腹腔镜食管癌根治术不同阶段的手术效果,探讨开展胸腔镜联合腹腔镜食管癌根治术的学习曲线。方法回顾性分析2009年4月—2011年1月由同一组医师完成的50例胸腔镜联合腹腔镜食管癌根治术。按手术先后次序分5组(A～E组),每组10例;比较各组手术时间、术中出血量、淋巴结清扫数目、手术并发症及术后住院时间,分析不同阶段的手术效果。结果 5组患者在年龄、性别、浸润深度、肿瘤直径、清扫淋巴结数目和手术并发症等方面差异均无统计学意义(P>0.05)。手术时间A组(424±68)min、B组(348±70)min、C组(275±63)min、D组(279±64)min、E组(245±51)min,差异有统计学意义(P<0.05);术中出血量和术后住院时间5组间差异均有统计学意义(P<0.05)。结论胸腔镜联合腹腔镜食管癌根治术的学习曲线大约为20例。     

腹腔镜辅助下阴式子宫切除术临床效果分析

目的探讨腹腔镜辅助下阴式子宫切除术（LAVH）的临床应用价值。方法对121例需行子宫全切术的患者,按入院先后随机分为两组：A组（LAVH组）61例,B组（TVH组）60例。A组行LAVH,B组行单纯阴式子宫全切术（TVH）。分别对两组的临床疗效（手术时间、术中出血量、术后肛门排气时间、术后住院时间、术后阴道残端感染率）进行观察。结果手术时间：A组[（125±27）min]较B组[（130±22）min]无明显延长（P〉0.05）;术中出血量：A组[（121±70）]ml较B组[（141±73）]ml明显减少（P〈0.05）;肛门排气时间：A组[（26.2±7.3）]h较B组[（49.6±13.4）h]明显缩短（P〈0.05）;住院时间：A组[（5±1）d]明显短于B组[（6±3）]d（P〈0.05）。阴道残端感染率：A组（1.6%）明显少于B组（8.33%）,有统计学意义（P〈0.05）。结论 LAVH明显优于单纯TVH,是一种较为理想的手术方法,值得临床推广应用。     

0.5％罗哌卡因重比重液在剖宫产手术的剂量选择

目的 探讨腰硬联合麻醉下0.5％罗哌卡因重比重液用于剖宫产手术的合适剂量.方法 100例产妇随机分成A、B、C、D、E五组,A组剂量为1.5ml,B、C、D、E四组剂量依次递加0.3ml,分别观察记录各组麻醉效果和麻醉不良反应.结果 A组与其余四组比较麻醉平面达到手术要求明显偏少(P＜0.01),E组与其余四组比较麻醉效果好,但随着剂量的增加不良反应也明显增加(P＜0.01).B、C、D三组与A组比较麻醉效果好,与E组比较不良反应少.结论 0.5％罗哌卡因重比重液用于剖宫产手术的剂量为(2.1±0.3)ml.     

脑室预注射Wortmannin对沙土鼠海马缺血耐受的影响

目的：探讨磷脂酰肌醇-3(羟基)激酶(PI-3K)与沙土鼠海马缺血耐受的关系。方法：沙土鼠24只，随机分为A(2min缺血组)、B(5min缺血组)、C(2min缺血 5min缺血组)、D(假手术组)、E(脑室预注射PBS组)、F(脑室预注射Wortmannin组)6组。每组4只。TUNEL法检测海马CA1区锥体细胞凋亡。结果：B组锥体细胞凋亡数较A、C、E3组显著增多，F组凋亡细胞数较C组明显增多。D组未见明显凋亡细胞。结论：脑室预注射Wortmannin可抑制海马CA1区的缺血耐受现象，PI-3K可能参与介导了沙土鼠海马缺血耐受。     

不同低浓度罗哌卡因低位硬膜外镇痛对运动神经阻滞的临床观察

目的 观察不同低浓度罗哌卡因（ropivacaine,Rop）低位硬膜外镇痛对运动神经的阻滞作用。探讨罗哌卡因低位硬膜外镇痛的最佳药物浓度。方法 随机选择我院67例下腹部择期手术患者，术后随机分为5个治疗组（A、B、C、D、E）和一个对照组（F），3h后硬膜外腔用药。前5组使用不同浓度罗哌卡因（A：0.1%;B:0.15%;C:0.2%;D:0.25%;E:0.3%），F组使用0.9%生理盐水。注药前后20分钟分别观察、记录以下项目：1.视觉模拟评分（Visual analogue scale,VAS）；2.阻滞区运动神经反射；3. 下肢指令运动。结果 不同低浓度罗哌卡因均有程度不同的术后镇痛作用。对运动神经的阻滞作用A、B、C三组与对照组无显著性差异（P＞0.05），而D、E两组有显著性差异（P＜0.05）。结论 选择浓度为0.2%的罗哌卡因低位硬膜外镇痛既可以有效地发挥术后镇痛作用，又最大程度地减少了对运动神经的阻滞作用，有利患者术后恢复。     

ZD1839对小鼠宫颈癌细胞株U14移植瘤抑制作用的研究

[目的]观察ZD1839对小鼠宫颈癌U14的抗癌作用及对U14细胞凋亡的诱导作用,探讨ZD1839治疗宫颈癌的临床应用价值。[方法]建立615近交系小鼠宫颈癌U14移植瘤动物模型,随机分为4组(每组8只):A组为空白对照组,给予0.5 mL5%葡萄糖溶液灌胃,B、C、D组分别给予50、100、150 mg/(kg.d)剂量的ZD1839进行灌胃治疗。检测各组小鼠的瘤体直径、重量和抑瘤率;采用流式细胞术和TUNEL法检测瘤体的细胞凋亡率。[结果]①A、B、C、D组小鼠的瘤体直径逐渐变小,肿瘤重量逐渐减轻(A与B组比较P>0.05,C、D组与A、B组比较P<0.05);A、B、C、D组肿瘤抑制率分别为0、3.95%、24.86%、25.99%。②A、B、C、D组肿瘤细胞凋亡率:采用流式细胞术分别为(2.50±0.37)%、(3.52±0.32)%、(9.92±0.65)%、(15.69±0.70)%(C、D组与A、B组比较,C组与D组比较P<0.01);TUNEL法分别为(0.9±0.29)%、(2.87±0.73)%、(6.84±1.01)%、(11.77±1.24)%(B、C、D组与A组比较P<0.05,C、...     

奥曲肽局部应用对兔眼滤过手术疗效的影响

目的探讨奥曲肽(OCT)在兔眼滤过手术中的抗增殖效果及其不良反应,并与丝裂霉素C(MMC)比较。方法新西兰大白兔40只随机分成A、B、C、D、E 5组,每组8只。各组均行双眼标准小梁切除术。A组仅行标准小梁切除术。B组术中切小梁前用蘸有MMC 0.2 mg/ml的棉片巩膜瓣下作用5min。C组术中切小梁前用蘸有OCT0.1 mg/ml的棉片巩膜瓣下作用5min。D组术前3d OCT 0.1mg/ml点眼,每日4次。E组按C组、D组联合用药处理。术后3、7、14、28d时分别观察各组眼部情况、视觉电生理、滤过泡形态和眼压的变化。结果术后14d,与A组相比,B、C、D、E 4组的滤过泡有效率升高(P<0.05),而B、C、D、E 4组之间差异无统计学意义(P>0.05)。术后3d、7d及28d,5组之间差异无统计学意义(P>0.05)。与术前比较,各组术后眼压均显著下降(P<0.05),但各组间比较差异无统计学意义(P>0.05)。各组均未出现角膜、结膜以及视神经和视网膜功能的明显不良反应。结论 OCT在兔小梁切除术中巩膜瓣下应用以及术前3d点眼均能安全有效地提高滤过泡有效率,不良反应未见增加。     

不同手术方式治疗Ⅱ型剖宫产瘢痕妊娠临床效果比较

目的 比较不同手术方式治疗Ⅱ型剖宫产瘢痕妊娠(CSP)患者的临床效果及其对预后的影响。方法 选择南京医科大学附属泰州人民医院妇产科2016年6月至2019年8月收治的124例Ⅱ型CSP患者为研究对象。根据所采用的手术方式将124例患者分为A组(n=77)、B组(n=20)、C组(n=8)、D组(n=13)、E组(n=6),其中A组患者行宫腔镜瘢痕妊娠病灶清除术,B组患者行腹腔镜瘢痕妊娠病灶切除+修补术,C组患者行阴式子宫瘢痕妊娠病灶清除+修补术,D组患者于子宫动脉栓塞术(UAE)后行宫腔镜手术,E组患者于UAE后行腹腔镜手术。分别观察5组患者的手术时间、术中出血量、术后血红蛋白下降值、术后人绒毛膜促性腺激素(HCG)下降率、HCG降至正常时间、术后月经来潮时间、住院时间、术中及术后2周内不良反应;术后随访36～48个月,观察5组有妊娠需求的CSP患者的自然妊娠、流产、再发CSP及分娩情况。结果 A组、B组、C组、D组和E组患者的手术成功率分别为84.41%(65/77)、65.00%(13/20)、87.50%(7/8)、100.00%(13/13)、100.00%(6/6),5组患者...     

不同预充气量及自动调节充气量时置入Supreme喉罩难易比较

目的比较不同预充气量及自动调节充气量时的Supreme喉罩（SLMA）置入难易程度。方法 180例ASAⅠ或Ⅱ级妇科、乳腺、四肢及胆囊择期手术患者全麻下置入4号SLMA,按通气罩预充气量不同及自动调节充气量（简称自动）时,采用随机数字表法均分为0 ml组（A组）、5 ml组（B组）、10 ml组（C组）、15 ml组（D组）、20 ml组（E组）、自动组（F组）,记录SLMA置入次数、置入时间及难易程度评分。结果在多组间比较中,置入评分为1分的患者C组和F组多于A及E组（P〈0.05）;4分的患者C组和F组小于A及E组（P〈0.05）;3分的F组明显少于其他组（P〈0.05）。置入时间C组和F组明显少于其他组（P〈0.05）。结论 SLMA预充气量为10 ml时及自动调节充气量时置入时间更短,置入更容易。     

含缓释生物活性因子的组织工程骨异位成骨

目的研究含重组人骨形态发生蛋白/转移生长因子-β(recombinanthumanbonemorphogeneticprotein/transforminggrowthfactor-β,rhBMP/TGF-β)和WO-1两种生物活性因子的缓释体构建组织工程骨的异位成骨能力。方法以猪部分脱钙骨为支架材料,用真空负压吸附法将rhBMP/TGF-β和WO-1分别涂层在支架材料上,然后再用聚乳酸(polylacticacid,PLA)涂层,制成缓释体。设计单纯材料组(A组),单纯材料复合成骨细胞(B组),含rhBMP/TGF-β为缓释体1(C组)、C组复合成骨细胞(D组)、含WO-1为缓释体2(E组)、E组复合成骨细胞(F组)6组,分别植入36只新西兰兔双后肢,每组6只。术后2、4、6、8周进行组织学、组织化学及生物化学检测,并进行统计学处理。结果在观察时限内,A组无成骨现象,B、D、F组成骨评分显著优于C、E组(P<0.05),C、E组的成骨活动明显延迟,D、F组成骨的质和量较B组提前2周,较C、E组提前4周。C、E组间差异无显著性。新增钙含量B、D、F组显著优于A、C、E组(P<0.05);A、C、E组钙含量递减幅度逐渐减少。结论含生物活性因子1、2的两种缓释体异位诱导成骨出现时间较复合成骨细胞后的成骨活性显著延迟,单纯材料无异位成骨能力。