托出式胰后入路脾门淋巴结清扫在腹腔镜胃癌根治术中的临床应用

目的探讨经腹腔镜胰后入路脾托出式脾门淋巴结清扫术在近端胃癌根治术中应用的可行性、安全性,并初步分析其解剖特点。方法采用回顾性队列研究方法,收集2014年6月至2017年1月宜宾市第二人民医院收治的84例进展期近端胃癌患者的临床资料。其中44例为观察组,采用经腹腔镜托出式胰后入路法;40例为对照组,采用经腹腔镜左侧入路法。所有手术均由同一团队完成。观察并比较2组患者手术情况、术后情况、随访情况。结果 84例患者均顺利完成根治性全胃切除术(D2根治术),成功保留脾,完成第10组淋巴结清扫,未中转开腹。观察组与对照组术中出血量分别为(107.9±52.9)m L和(153.1±72.2)m L,手术时间分别为(228.8±27.7)min和(244.7±31.3)min,第10组淋巴结清扫数量分别为(5.0±2.2)枚和(2.9±1.3)枚。2组术中出血量、手术时间、第10组淋巴结清扫数量比较差异有统计学意义(P0.05)。观察组与对照组术后首次下床活动时间分别为(1.6±0.4)d和(1.5±0.4)d,术后肛门排气时间分别为(2.9±0.8)d和(2.6±0.5)d,术后住院时间分别为(7.5±1.4)d和(7.0±1.3)d。观察组术后发生并发症4例,对照组术后发生并发症5例,均经非手术治疗痊愈。2组术后首次下床时间、肛门排气时间、术后住院时间、并发症发生率比较差异无统计学意义(P0.05)。84例患者中共82例获得随访,随访时间为6~36个月,中位随访时间为15.5个月,随访中2组分别有1例因癌性腹水死亡。结论经腹腔镜胰后入路脾托出式脾门淋巴结清扫术可行性较高,与常规腹腔镜左侧入路相比,能减少术中出血量,缩短手术时间,增加第10组淋巴结清扫率。     

改良左胸入路在Siewert Ⅰ、Ⅱ型胃食管连接部腺癌手术中的应用

目的 探讨改良左胸入路在Siewert Ⅰ、Ⅱ型胃食管连接部腺癌(EGJA)手术中的应用价值。方法 采用回顾性病例对照研究方法。收集2010年1月—2012年12月蚌埠医学院第一附属医院肿瘤外科手术治疗的83例Siewert Ⅰ、Ⅱ型EGJA 患者临床资料,其中男63例、女20例,年龄37~79岁。按手术入路的不同分组:65例为改良组,选择左胸第8、9肋间进胸,切口前方位于胸肋关节处,后方至正对肩胛骨下角处;18例为经腹组,取上腹正中切口,经腹入路手术。比较两组的手术时间、清扫淋巴结数量、纵隔淋巴结清扫比例和术后并发症等指标。结果 改良组和经腹组手术时间分别为(186.40±19.45)min和(172.67±21.73)min,清扫淋巴结分别为(16.55±2.42)枚和(12.06±2.88)枚,差异均有统计学意义(t=2.585、7.553,P值均＜0.05)。改良组和经腹组患者的纵隔淋巴结清扫率分别为100.00%(65/65)和1/18,差异有统计学意义(χ²=71.511,P＜0.01)。两组输血率、住院时间和并发症发生率比较,差异均无统计学意义(P值均＞0.05)。结论 改良左胸入路适用于Siewert Ⅰ、Ⅱ型EGJA的手术治疗,具有术野清晰、手术过程相对简便的优点,能满足胃周及下纵隔淋巴结清扫的需要。     

腹腔镜广泛宫旁切除术在意外发现宫颈癌治疗中的应用

目的 探讨意外发现的宫颈癌(UDCC)行腹腔镜下广泛宫旁切除+阴道上段切除+盆腔淋巴清扫术的安全性及可行性。方法 回顾性分析蚌埠医学院第一附属医院2017年2月—2018年3月收治的6例全子宫切除术(5例经腹手术、1例腹腔镜手术)术后UDCC患者的临床病理资料及随访资料。6例患者44~62岁,宫颈鳞癌5例、宫颈腺癌1例,临床分期ⅠB1期5例、ⅠB2期1例,均行腹腔镜下广泛宫旁切除+阴道上段切除+盆腔淋巴清扫术。观察患者两次手术间隔时间,再次腹腔镜下手术时间、术中出血量、手术并发症发生情况,术后留置尿管时间、残余尿量、住院时间,术后病理检查观察阴道壁、宫旁组织、卵巢有无累及、盆腔淋巴结转移情况。结果 6例患者两次手术间隔时间平均19.3 d。腹腔镜手术时间平均154.2 min,术中出血量平均116.7 mL,术后留置导尿管时间平均14.5 d,测定残余尿量平均88.3 mL,术后住院时间平均8.5 d。术中、术后无手术相关并发症发生。再次手术后病理检查提示:阴道壁、宫旁组织、卵巢未见癌累及,阴道切缘、宫旁切缘阴性;清扫盆腔淋巴结平均18.6枚,其中1例患者有2枚盆腔淋巴结转移,并伴有癌栓形成。6例患者术后随访14~27个月,期间未发现复发和远处转移。结论 UDCC临床少见,在掌握娴熟的手术技巧的基础上,行腹腔镜下广泛宫旁切除+阴道上段切除+盆腔淋巴清扫术治疗UDCC是安全、可行的。     

腹腔镜下胃癌根治术对胃癌患者临床应激指标及术后并发症的影响

目的探讨腹腔镜手术对胃癌患者临床应激指标及术后并发症的影响。方法将2015年1月至2017年1月在我院普外科手术治疗的96例胃癌患者按照手术方式不同分为腹腔镜组和开腹组,各48例;对比2组患者手术时间、出血量、清扫淋巴结数目、术后住院时间、肛门排气时间、术后6个月并发症情况;应用酶联免疫吸附法(ELISA)检测并比较术前及术后1 d外周血白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的水平。结果腹腔镜组患者的出血量、住院时间、术后肛门排气时间均优于开腹组,手术时间长于开腹组、清扫淋巴结数目少于开腹组,2组比较差异有极显著性统计学意义(P0.01);术后1 d腹腔镜组患者的WBC、CRP、TNF-α、IL-6低于开腹组,差异有统计学意义(P0.05);腹腔镜组术后6个月并发症发生率为22.8%,低于开腹组的54.7%,2组比较差异有统计学意义(P0.05)。结论与传统开腹手术相比,腹腔镜下胃癌根治术在减少住院时间及术中失血量的同时,还能降低应激反应、减少术后并发症发生率。     

腹腔镜胃癌D2根治术和开腹胃癌D2根治术中患者炎症反应比较

目的：比较腹腔镜胃癌D2根治术和开腹胃癌D2根治术对患者炎症因子的影响。方法：选取96例胃癌患者随机分为腹腔镜组和开腹组,腹腔镜组采用腹腔镜胃癌D2根治术治疗,开腹组采用开腹D2根治术治疗,比较两组术前及术后CRP、IL-6、TNF-α及IL-10水平。结果：腹腔镜组术中出血量明显少于开腹组,手术时间、术后排气时间及术后下床活动时间少于开腹组,差异比较有统计学意义(P<0.05);两组术后1 d CRP、IL-6、TNF-α及IL-10水平较术前明显升高,差异比较有统计学意义(P<0.05);腹腔镜组术后CRP、IL-6、TNF-α水平明显低于开腹组,IL-10水平高于开腹组,差异比较有统计学意义(P<0.05)。结论：腹腔镜胃癌D2根治术较开腹胃癌D2根治术炎症反应轻,创伤小,可在临床上推广。     

腹腔镜与开腹胃癌切除的疗效比较

目的:比较腹腔镜手术与传统开腹手术治疗胃癌的效果。方法:回顾腹腔镜胃癌根治术与传统开腹胃癌根治术的病历资料,通过手术时间、术中出血量、淋巴结清除数目,胃肠道功能恢复时间和术后住院时间,分析腹腔镜胃癌根治术与传统开腹胃癌根治术的疗效。结果:腹腔镜组术中出血量指标优于传统开腹组,而腹腔镜组手术时间长于传统开腹组。淋巴结清除数目两组没有显著性差别。腹腔镜组的胃肠道功能恢复时间和术后住院时间短于传统开腹组。结论:腹腔镜胃癌切除术在技术上是可行和安全的,而且具有微创、术后康复快等优点。     

盆腔淋巴结计数的应用解剖学研究及其临床意义

目的 探讨根治性膀胱全切术中盆腔不同清扫范围内淋巴结的清扫数目作为衡量盆腔淋巴结清扫(PLND)手术质量标准的可行性。方法 在19具成人尸体标本上模拟行超扩大PLND术,并将范围分为标准、扩大、超扩大3级及10个解剖区域,对每个区域淋巴结分别清扫及计数。计算超扩大、扩大和标准清扫解剖区域之内清除的淋巴结总数目及其变异系数(CV)。结果 超扩大PLND术产生的淋巴结数目29~72个,平均(46.1±12.5)个;扩大清扫为23~69个,平均(41.3±10.8)个;标准清扫为18~39个,平均(28.9±7.2)个;CV分别为27.2%、26.2%与25.1%。结论 盆腔各解剖区域淋巴结数目存在较大的个体差异。在根治性膀胱切除术中,应用最低淋巴结计数作为衡量PLND手术质量标准的合理性和可行性需进一步探讨。     

微创远端胃癌手术结合D2淋巴结清扫治疗胃癌的临床疗效分析

目的探讨微创远端胃癌手术结合D2淋巴结清扫治疗胃癌的临床疗效。方法选择我院2010年9月至2012年9月收治的胃癌手术患者95例,剔除2例腹腔中转开腹患者共计纳入93例作为研究对象。按照手术方式的不同将93例患者分为观察组43例和对照组50例。观察组采用微创远端胃癌手术结合D2淋巴结清扫,对照组采用开腹手术结合D2淋巴结清扫。比较2组患者术中出血量、下床活动时间、手术时间、住院时间、淋巴结清扫数目、术后并发症发生情况,及随访1年、3年和5年复发转移和死亡情况。结果观察组术中出血量少于对照组,下床活动时间早于对照组,住院时间短于对照组,2组比较差异有统计学意义(P0.05);而2组手术时间比较差异无统计学意义(P0.05)。2组清扫第一站淋巴结数、第二站淋巴结数和清扫淋巴结总数比较差异无统计学意义(P0.05)。观察组术后并发症发生率(6.98%)低于对照组(22.00%),2组比较差异有统计学意义(P0.05)。2组患者随访1年、3年和5年复发转移率和病死率均较低,差异无统计学意义(P0.05)。结论微创远端胃癌手术结合D2淋巴结清扫对胃癌患者临床疗效显著,术中出血量少,术后恢复快,并发症少,且远期随访复发转移和死亡少。     

腹腔镜与传统开腹手术治疗直肠癌疗效的比较

目的:通过传统开腹手术对照,研究腹腔镜治疗胃癌的效果。方法:2013年5月至2015年5月我院86例直肠癌患者随机分成腹腔镜组和传统开腹组,分别进行腹腔镜和传统开腹手术治疗。观察手术时间、出血量、切除肠管长度、清扫淋巴结数量、术后胃肠功能恢复时间、住院时间和并发症。结果:腹腔镜组术中出血量少于传统开腹组,而腹腔镜组手术时间明显长于传统开腹组;腹腔镜组的胃肠道功能恢复时间和术后住院时间短于传统开腹组;腹腔镜组和传统开腹组的术后并发症分别为14.0%和23.3%(P0.05)。腹腔镜组和传统开腹组淋巴结清除数目和肠管切除长度没有显著性差别。结论:腹腔镜直肠根治术治疗直肠癌的疗效确切,与传统手术方式相比,术后并发症及恢复等方面有明显的优势。     

预防性颈中央区淋巴结清扫对cN0期甲状腺乳头状癌疗效的Meta分析

目的 探讨预防性颈中央区淋巴结清扫术(PCND)在cN0期甲状腺乳头状癌(PTC)患者手术治疗中的临床应用价值。方法 分别以“甲状腺乳头状癌、预防性颈中央区淋巴结清扫、复发、并发症”和“papillary thyroid carcinoma、prophylactic central neck dissection/prophylactic central cervical lymph node dissection、recurrence、complication”为中英文检索词,检索PubMed、EMbase、The Cochrane Library、CNKI、万方数据库、中国生物医学文献数据库,限定文献发表年限为2007—2017年,纳入比较单纯行甲状腺乳头状癌原发灶手术治疗(对照组)和同时加行预防性颈中央区淋巴结清扫(观察组)临床疗效的队列研究,由两名研究者独立筛选文献与提取数据,并进行质量评价。计数资料采用优势比(OR)及95%可信区间(CI)表示。采用I²进行异质性分析。结果 共纳入符合筛选标准的文献10篇,均为回顾性队列研究,共3 383个研究对象,其中对照组1 797例,观察组1 586例。Meta分析结果显示:观察组与对照组局部复发率之间的差异无统计学意义(OR=0.97,95%CI 0.63～1.50, P=0.90)。与对照组相比,观察组术后暂时性低钙血症(OR=2.20,95%CI 1.81～2.68, P＜0.000 01)、永久性低钙血症(OR=3.02,95%CI 1.97～4.61,P＜0.000 01)、暂时性喉返神经损伤(OR=1.58,95%CI 1.06～2.34, P=0.02)、永久性喉返神经损伤(OR=1.90,95%CI 1.10～3.58, P=0.05)的发生率均增高,且差异均有统计学意义。结论 对于cN0期PTC患者,在原发灶手术治疗的同时行PCND并不能降低肿瘤的局部复发率,但却能明显增加手术并发症风险;因此,不推荐临床常规实施该术式。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.