颈胸腹3切口治疗中晚期高位食管癌124例临床研究

为扩大中晚期高位食管癌手术适应证，提高远期效果，采用右进胸全食管切除、胸骨后全胃代食管、颈部食管（咽）胃吻合重建（简称本组或三野手术）。与同期左胸左颈手术组对照（简称对照组或二野手术），并经统计学处理。结果：右进胸７３例，肿瘤切除完成三野手术７０例，切除率９５．９％（７０／７３），术后并发症４例（５．７％），死亡１例（１．４％），近期治愈率９８．６％（６９／７０）。远期随访１、３、５、１０ａ存活率分别为８９．８％（６２／６９）、５８．９（４１／６９）、５５％（３８／６９）、２０％（１４／６９）。对照组６２例，肿瘤切除完成二野手术５４例，切除率８７．１％（５４／６２），术后并发症８例（１４．８％），死亡２例（３．７％）。远期随访１、３、５、１０ａ存活率分别为７７．７％（４０／５２）、５０．０％（２６／５２）、３４．６％（１８／５２）、１１．０％（６／５２）。两组差异显著（Ｐ＜０．０１）。表明：右进胸三野手术肿瘤切除率高，开胸时间短，对心肺功能干扰小，术后并发症少，淋巴结清扫彻底且安全，远期效果较二野手术好。     

新辅助化疗同时化疗及高剂量放疗治疗食管鳞癌的Ⅱ期临床试验

目的：评价新辅助化疗同时化疗及高剂量放疗（新辅助治疗方案）治疗食管鳞癌的疗效。方法：选择４５例肿瘤病期为Ｔ１～４Ｎ０～１Ｍ０的食管鳞癌患者（男３４例、女１１例）,中位年龄６１岁（３８～７７岁）。入组标准：≥１８岁,ＥＣＯＧ状态０～２级,血清肌酐≤１．５ｍｇ％,血清肌酐清除率≥６５ｃｃ／ｍｉｎ。新辅助治疗方案：病人接受三个周期５－氟脲嘧啶／顺铂（５－ＦＵ／ＣＤＤＰ）治疗后加两个周期５－ＦＵ／ＣＤＤＰ治疗并同时放射治疗。化疗以４周为一个周期。前三个周期,第１～５天给５－ＦＵ１０００ｍｇ／（ｍ２·２４…     

吸入不同浓度和时间七氟醚对阿曲库铵肌松效应的影响

目的：研究吸入不同浓度和时间七氟醚对阿曲库铵肌松效应的影响。方法：５０例ＡＳＡⅠⅡ级,头、颈和面部择期手术病人,年龄１８～６４岁,根据吸入七氟醚的浓度和时间随机分为五组：Ｉ组５０％Ｎ２Ｏ１５ｍｉｎ,Ⅱ组、Ⅲ组１％七氟醚５０％Ｎ２Ｏ１５ｍｉｎ、３０ｍｉｎ,Ⅳ组、Ⅴ组１．５％七氟醚５０％Ｎ２Ｏ１５ｍｉｎ、３０ｍｉｎ。用加速度仪以四个成串刺激（ＴＯＦ）监测静注阿曲库铵０．５ｍｇ／ｋｇ后的神经肌肉功能。结果：阿曲库铵的起效时间各组间有显著性差异（Ｆ＝４．１４,Ｐ＜０．０１）,Ｖ组（１．４８±０．４３ｍｉｎ）短于Ｉ组（２．２７±０．７３ｍｉｎ）和Ⅱ组（２．２８±０．３８ｍｉｎ）（Ｐ＜０．０５）。临床维持时间、２５％与７５％恢复时间,Ⅲ、Ⅳ组长于Ｉ组（Ｐ＜０．０５）,Ⅴ组也长于Ⅰ、Ⅱ组（Ｐ＜０．０５）。恢复指数,ＩＶ组（１６．６０±３．６３ｍｉｎ）和Ｖ组（１８．５３±５．２８ｍｉｎ）显著长于Ｉ组（１１．２２±３．４９ｍｉｎ）（Ｐ＜０．０５）。结论：七氟醚能明显增强阿曲库铵的肌松效应,且随着吸入浓度的增加及持续时间的延长,可使阿曲库铵的起效时间缩短,作用维持与恢复时间延长     

核仁组成区嗜银蛋白和肾肿瘤临床关系的研究

目的：探讨核仁组成区嗜银蛋白（ＡｇＮＯＲ）和肾肿瘤的分类、临床分期的关系。方法：用胶体银技术对１１６例肾肿瘤和１１例正常肾组织进行ＡｇＮＯＲ计数并进行分析。结果：ＡｇＮＯＲ计数在肾盂癌、肾细胞癌和Ｗｉｌｍ氏瘤中分别为５．２３±１．４、４．１２±１．２和３．９８±０．９；肾错钩瘤和正常肾组织分别为１．８６±０．９和１．６３±０．７；ＡｇＮＯＲ计数在肾脏良恶性肿瘤之间差异非常显著（Ｐ＜０．０１），肾细胞癌临床Ⅰ、Ⅱ、Ⅲ和Ⅳ期ＡｇＮＯＲ数目分别为３．６５±０．３、４．０２±０．５、４．６２±０．３和４．５８±０．４。结论：ＡｇＮＯＲ计数随肾细胞癌的临床分期升高而增加，可作为鉴别肾脏良恶性肿瘤的重要参考指标     

高海拔地区急性呼吸窘迫综合征的诊治

目的：探讨高海拔地区急性呼吸窘迫综合征（ＡＲＤＳ）的诊治特点。方法：３０例急性呼吸窘迫综合征,其中多器官功能衰竭１１例,除１例为心、肺、脑、肾、肝、胃多器官功能衰竭外,其他多为并发心功能衰竭,本组ＰａＯ２／ＦｉＯ２４０～３００,ＰａＯ２４０～３００,ＰａＯ２４．８～８ｋＰａ,ＰＣＯ２３．３３～１０．６ｋＰａ,Ｓａｏ２０．４～０．８５,ＣＶＰ０．５～１．９６ｋＰａ。单独应用ＨＦＶ治疗２例,ＩＰＰＶ治     

超声诊断脾脓肿的价值

资料：超声检查脾脓肿３例均为女性，年龄分别为２７、２９及３４岁，起病分别为脾动脉栓塞术（简称脾栓术、以下同）后左上腹疼痛伴发热４天、４月及２２天，体温３８．０～３９．５℃。查体：脾肋下８．０ｃｍ至平脐。超声检查：术前肋间／肋下脾脏大小分别为８．０ｃｍ×３．５ｃｍ／未探及，１１．８ｃｍ×５．９ｃｍ／１．５ｃｍ×２．０ｃｍ，及１１．０ｃｍ×５．２ｃｍ／３．０ｃｍ×２．０ｃｍ，脾区回声均匀，起病后次日复查，胁间脾脏大小分别为１１．６ｃｍ×５．５０ｃｍ、１５ｃｍ×８．０ｃｍ及１４．０ｃｍ×６．５ｃｍ，脾…     

MRI对良恶性椎体疾病的鉴别诊断

目的：提出良恶性椎体疾病的鉴别要点。材料和方法：本组１０６例，其中４０例恶性椎体病变和６６例良性椎体病变，经病理、临床及随访证实。设备采用美国ＧＥ公司１．５Ｔｓｉｇｎａ成像仪。常规行自旋回波Ｔ１加权，快速自旋回波Ｔ２加权，梯度回波Ｔ２＊加权，矩阵２５６×１９２，层厚４．０ｍｍ，间隔１．０ｍｍ。结果：晕征（３０％）、靶征（２７．５％）Ｔ１ＷＩ椎间盘信号增高（７．５％）、跳跃征（４０％）、椎弓根破坏（８０％）、椎旁软组织肿物（４０％），常见于恶性椎体病变。Ｔ１ＷＩ椎体信号增高（４．５５％）、平行于终板的带状异常信号（１２．１２％）、椎体碎裂并椎间盘突出（或脱出）（１９．７１％）、椎间盘破坏（２１．２１％）、椎间隙变窄（３３．３３％）、常见于良性椎体病变。椎基底静脉消失征不能作为鉴别诊断的要点。结论：磁共振椎体成像征象多。ＭＲＩ用于鉴别良恶性椎体疾病具有重要作用。     

膳食中油脂、锌、钙对非色素铁体外吸收的影响

本研究通过体外实验模拟胃肠道消化吸收过程，以蔬菜（小白菜）所含铁为非色素铁源，实验膳基本组成为小白菜，烹调油，食盐、水及外加的ＺｎＳＯ＿４、ＣａＣｌ＿２。观察膳食中不等量油脂和锌、钙对铁吸收的影响。结果表明：生菜组铁透过率为０．３４±０．０５％，１５克油组２．５０±０．１８％，３０克油组１．９８±０．１２％，５０克油组２．１８±０．３３％，１５克油＋水组０．３４±０．０７％，１５克油＋Ｚｎ组１．４８±０．１１％，１５克油＋Ｃａ组１．６４±０．１１％。结果提示：少量油脂有利于铁吸收，量大有抑制作用。膳食中Ｚｎ：Ｆｅ约为２．０时，明显抑制铁吸收，抑制率达６３％，Ｇａ：Ｆｅ约为２００时，也明显抑制铁吸收，抑制率达４９％。     

蒺藜总皂甙对TNF-α及IL-1β诱导内皮细胞粘附的抑制作用

目的：观察蒺藜总皂甙（ｇｒｏｓｓｓａｐｏｎｉｎｓｆｒｏｍ ＴｒｉｂｕｌｕｓｔｅｒｒｅｓｔｒｉｓＬ,ＧＳＴＴ） 对肿瘤坏死因子－ α（ＴＮＦ－ α） 、白细胞介素－１β（ＩＬ－１β） 诱导的培养新生牛脑微血管内皮细胞（ＣＭＥＣ） 粘附大鼠血单核细胞（ＭＮＣ） 及中性粒细胞（ＰＭＮ） 的影响。方法：用ＴＮＦ－α和ＩＬ－１β分别诱导传代的ＣＭＥＣ,计粘附ＭＮＣ及ＰＭＮ的细胞数,并计算粘附率。结果：ＣＭＥＣ 经ＴＮＦ－ α处理４ｈ 后,ＣＭＥＣ与ＭＮＣ及ＰＭＮ的粘附率,分别增加到３１．３±０．５％ 和３２．１±０．５％ （对照组分别为１２ ．５±０ ．２％ 和１３ ．８±０ ．４ ％） ,经ＩＬ－１β处理２ｈ 后,则分别为４４．５ ±１．０ ％ 和４４．８ ±０．７ ％ （ 对照组分别为１２ ．９ ±０．６ ％ 和１４．７ ±０．６％ ）。在ＴＮＦ－ α（ＩＬ－ １β） 处理前,用ＧＳＴＴ与ＣＭＥＣ共孵育,预处理２ｈ,则ＧＳＴＴ可剂量依赖性地抑制ＴＮＦ－ α和ＩＬ－ １β的作用。结论：ＧＳＴＴ可抑制ＣＭＥＣ 与ＰＭＮ及ＭＮＣ的粘附。     

复方蒿甲醚临床研究：选择剂量比例和治疗方案

目的：选择复方蒿甲醚的最佳剂量配比和治疗方案。方法与结果：蒿甲醚与本芴醇按１：６或１：５的剂量配比制成２种复方片剂，各治疗恶性疟２０例，均达临床治愈。观察２８ｄ，前者（１：６）无一复燃，治愈率１００％；后者（１：５）复燃４例，治愈率８０．０％。进而以１：６的片剂，设２ｄ４次，３ｄ３次和３ｄ４次给药３种疗法，比较其临床疗效，观察２８ｄ，治愈率分别为８０．０％，７２．７％和９５．９％，其中３ｄ４次疗法     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）