电子胃镜下微波与探条扩张联合治疗重度食管贲门狭窄24例

目的：探讨内镜下微波与探条扩张联合治疗重度食管贲门狭窄的临床疗效。方法：内镜直视下对24例重度食管贲门部狭窄患者，采用微波烧灼扩大狭窄口后再进行探条扩张治疗。术后定期随访和检查，观察患者临床症状缓解与复发以及内镜检查结果。结果：24例重度食管贲门狭窄患者经内镜微波与探条扩张联合治疗后，吞咽困难症状明显缓解，梗阻解除；显效16例，占66．7％。有效8例，占33.3％，总有效率为100％．治疗后均出现不同程度的黏膜撕裂、擦伤和渗血，未发生呕血、穿孔、食管气管瘘等严重的并发症。术后随访1mo无病例复发；随访2mo。有2例因食管异物再次梗阻，经取异物及再次微波与扩张联合治疗后成功解除；随访3mo，有5例出现不同程度的吞咽困难症状。结论：内镜下微波与探条扩张联合治疗重度食管贲门狭窄是一种简便易行．临床近期疗效确实可靠的治疗方法。但对癌性狭窄疗效难以持久。     

食管贲门及直肠狭窄的内镜下扩张治疗体会

目的：探讨内镜下应用气囊扩张器或聚乙烯探条扩张器治疗食管贲门部狭窄138例及7例直肠狭窄的应用体会和临床疗效分析。方法：应用气囊扩张器，在内镜直视下对120例食管贲门部狭窄病人进行了249次扩张治疗；并对7例直肠术后吻合口狭窄病人进行了17次扩张治疗；应用探条扩张器对18例食管狭窄病人进行了35次扩张治疗。扩张前常规先行内镜检查，明确狭窄的部位、特点和病因，选择直径适悬空的扩张器。结果：扩张后食管狭窄137例、直肠狭窄6例效果均很显著，该组食管狭窄117例、直肠5例首次扩张后内镜即可顺利通过，既直径大于1．0cm，20例经几次扩张后内镜可以通过，扩张后当日既可进普食。为巩固疗效，患者应进行多次扩张，扩张2、3次为佳。顽固性食管狭窄2例扩张3次后效果不佳置入一食道支架，2个月后取出，胃镜可通过。结论：采用气囊或探条扩张器对良性食管及直肠狭窄扩张是在内镜直视下进行，能准确放置扩张器，其成功率高，疗效显著。     

内镜下扩张治疗食管及贲门狭窄的疗效观察

目的 探讨内镜扩张治疗食管及贲门的良(恶)性狭窄的临床疗效.方法 术前进行内镜及食管吞钡X线检查,了解狭窄的位置、形态、管腔直径大小以及有无新生物等情况,采用内镜下球囊扩张、探条扩张、支架置入及热凝治疗等综合措施治疗76例食管及贲门的良(恶)性狭窄.结果 单纯行球囊扩张治疗68例,球囊扩张并探条扩张1例,球囊扩张并支架置入4例,球囊扩张并热凝治疗3例,术后均有不同程度的效果.结论 内镜扩张治疗食管及贲门的良(恶)性狭窄是一种简便有效的方法.     

内镜下球囊扩张治疗幽门管瘢痕性狭窄28例分析

目的探讨内镜下球囊扩张治疗幽门管瘢痕性狭窄的临床疗效。方法幽门管瘢痕性狭窄28例，内镜下找到幽门管狭窄处，选择适当的球囊扩张器，使充水的球囊骑跨于狭窄处，维持扩张15min退管。结果内镜下球囊扩张治疗幽门管狭窄28例，总有效率96．4％。结论内镜下球囊扩张治疗幽门管瘢痕狭窄定位准确，操作便捷。效果好。     

球囊导管扩张治疗贲门失弛缓症

目的：探讨球囊导管治疗责门失弛缓症的A-法与疗效。方法：在X线透视下，应用球囊时30例责门失弛缓症惠者进行扩张治疗，将食管导丝经口腔置入至狭窄段以远，跟进直径30-40mm球囊至责门狭窄部，注入稀释造影荆将球囊充盈至中间凹陷部完全消失，持续扩张5～10min后松压，间隔5min，再加压重复扩张3～5次。结皋：30例中1次扩张治愈28例，占93．3％，2例扩张2次治愈。术后随访1～2年，吞咽困难缓解率100％，无1例复发。结论；疗效确切，操作简单．安全，费用较低，值得临床推广应用。     

内镜扩张、微波加局部注药联合治疗重度癌性食管狭窄

目的：探讨经内镜扩张，微波加局部注药联合治疗重度癌性食管狭窄的应用价值。方法：首先经胃镜活检孔插入导丝后对食管狭窄部行Savary-Gilliard探条扩张术，再插入微波天线对狭窄段进行微波凝固治疗，最后用胃镜注射针对狭窄段多点注射化疗药物，结果：42例治疗均一次成功，治疗成功率100％，其中显效54．8％（23／42），良效33．3％（14／42），有效11．9％（5／42），总有效率100％，未见食管穿孔等严重并发症，结论：该综合疗法可达到即刻解除食管梗阻症状，明显延长再次发生进食受限时间，疗效明显优于任何单一疗法，是基层医院较易开展的治疗重度癌性食管狭窄的有效方法。     

内镜直视下球囊扩张治疗贲门失弛缓症

目的：探讨内镜直视下球囊扩张治疗贲门失弛缓症的疗效。方法：内镜直视下应用食管球囊扩张器对失弛缓贲门进行扩张，术后定期随访，经内镜和上消化道钡餐检查，对症状缓解或复发与否进行评价。结果：38例中重度贲门失弛缓症状消失，经1-3次扩张治疗，吞咽困难症状消失，缓解率依次为42．11％(16/38)、90．91％(20/22)、100.00％(2／2)。有贲门粘膜撕裂、渗血者76．32％(29／38)，但无大出血及穿孔等并发症。每0．5、1、2、3年各随访一次，平均1．8年，复发率依次5．26％(2／38)、10．53％(4／38)、15．79％(6/38)、16．67％(5/30)(P＞0．05)。0．5年内出现反酸，烧心者为3l.58％(12／38)，经内镜诊断为轻度反流性食管炎21．05％(8／38)，以后随访中未发现。结论；内镜立视下球囊扩张治疗贲门失弛缓症近期疗效肯定，远期疗效满意，是一种比较安全的治疗方法。     

内镜下切开术联合探条扩张治疗食管良性难治性狭窄的研究

目的探讨内镜下切开术联合探条扩张治疗食管良性难治性狭窄的疗效。方法选取反复探条扩张疗效不佳的17例吻合口狭窄患者,进行内镜下切开术联合探条扩张治疗,观察症状改善情况,吻合口直径变化,再狭窄间隔时间。结果所有患者均成功进行了内镜下切开联合探条扩张治疗,较单纯扩张治疗相比,患者吞咽困难症状明显改善,吻合口扩大(P0.05),平均缓解时间延长(P0.05)。结论内镜下切开术联合探条扩张治疗食管良性难治性狭窄是安全、有效的。     

内镜下探条加球囊扩张联合质子泵抑制剂治疗十二指肠溃疡瘢痕狭窄的效果观察与护理

目的研究十二指肠溃疡瘢痕性狭窄病人治疗及护理方法。方法23例十二指肠溃疡瘢痕性狭窄病人在内镜引导下行特制沙氏探条及球囊扩张治疗。结果23例病人治疗后复查内镜均能顺利通过原狭窄部位到达十二指肠降部,随访6—24个月,症状缓解率为81．25％～95．65％,无严重并发症发生。结论内镜引导下特制是治疗十二指肠溃疡瘢痕狭窄的有效方法。而术前禁食、术中护士娴熟的配合及术后饮食控制、做好并发症护理是沙氏探条及气囊扩张治疗成功的重要措施,坚持服用质子泵抑制剂对于防止十二指肠溃疡瘢痕狭窄复发十分重要。     

经内镜球囊"双向控制"法扩张治疗贲门失弛缓症

目的 探讨经内镜球囊“双向控制”法扩张治疗贲门失弛缓症的疗效和安全性。方法 选择Boston专用贡门扩张球囊（直径35mm），采用病人感觉和内镜观察相结合的“双向控制”法扩张，术后定期随访和检查，观察患者临床症状缓解与复发、内镜和X线钡餐检查结果。结果 56例患者治疗后症状都得到缓解，术中有贲门黏膜撕裂、擦伤、渗血等，未发生穿孔、呕血或黑便。术后随访6-54个月，平均31个月，总有效率98．2％（55／56），其中显效率83．9％（47／56），有效率14．3％（8／56）；复发率1，8％（1／56）。此外出现反酸、烧心2例（3,6％）。结论 经内镜球囊“双向控制”法扩张是治疗贲门失弛缓症安全、有效的方法。     

洁尔阴含漱预防化疗所致口腔溃疡的效果观察

目的:观察洁尔阴含漱预防口腔溃疡的临床效果.方法:接受化疗的乳腺癌患者50例应用洁尔阴含漱预防口腔溃疡,并与同期住院的50例进行对照.结果:观察组口腔溃疡发生率为40%,以Ⅰ～Ⅱ度为主,无Ⅲ～Ⅳ度;口腔溃疡发生率明显低于对照组(P＜0.05).结论:洁尔阴舍漱预防化疗所致口腔溃疡有较好的效果.     

子宫肌瘤腹腔镜剥除与开腹剥除的配对研究

目的对比研究腹腔镜与开腹行子宫肌瘤剔除的优点和风险。方法收集2002年5月～2004年5月间48例子宫肌瘤(浆膜下或肌壁间)手术病人。所有病人分成腹腔镜组和开腹组,测定两组的手术时间、手术出血量、术后最高体温、体温恢复正常天数、下床活动时间、肛门排气时间、住院天数、术后用镇痛药与否、术后3d白细胞分类及计数正常与否、术后有无并发症,并进行1∶1的配对研究。结果两组病人无手术并发症,腹腔镜组无中转开腹手术。腹腔镜组手术出血量、术后体温恢复时间、下床活动时间、肛门排气时间、住院天数、镇痛药使用率和血常规正常时间较开腹组少;但手术时间较长,考虑与手术操作熟练程度有关。结论腹腔镜下子宫肌瘤剔除术是一种安全有效的手术方法,较开腹手术损伤小、出血少、恢复快。     

Modulation of emotion by cognition and cognition by emotion

In this study, we examined the impact of goal-directed processing on the response to emotional pictures and the impact of emotional pictures on goal-directed processing. Subjects (N=22) viewed neutral or emotional pictures in the presence or absence of a demanding cognitive task. Goal-directed processing disrupted the BOLD response to emotional pictures. In particular, the BOLD response within bilateral amygdala and inferior frontal gyrus decreased during concurrent task performance. Moreover, the presence of both positive and negative distractors disrupted task performance, with reaction times increasing for emotional relative to neutral distractors. Moreover, in line with the suggestion of the importance of lateral frontal regions in emotional regulation [Ochsner, K. N., Ray, R. D., Cooper, J. C., Robertson, E. R., Chopra, S., Gabrieli, J. D., et al. (2004). For better or for worse: neural systems supporting the cognitive down-and up-regulation of negative emotion. NeuroImage, 23(2), 483-499], connectivity analysis revealed positive connectivity between lateral superior frontal cortex and regions of middle frontal cortex previously implicated in emotional suppression [Beauregard, M., Levesque, J., and Bourgouin, P. (2001). Neural correlates of conscious self-regulation of emotion. J. Neurosci., 21 (18), RC165.; Levesque, J., Eugene, F., Joanette, Y., Paquette, V., Mensour, B., Beaudoin, G., et al. (2003). Neural circuitry underlying voluntary suppression of sadness. Biol. Psychiatry, 53 (6), 502-510.; Ohira, H., Nomura, M., Ichikawa, N., Isowa, T., Iidaka, T., Sato, A., et al. (2006). Association of neural and physiological responses during voluntary emotion suppression. NeuroImage, 29 (3), 721-733] and negative connectivity with bilateral amygdala. These data suggest that processes involved in emotional regulation are recruited during task performance in the context of emotional distractors.     

地塞米松抑制多核白细胞诱导的角膜基质细胞胶原降解

目的探讨地塞米松对多核白细胞诱导的角膜基质细胞胶原降解作用及机制。方法利用角膜基质细胞三维胶原凝胶培养模型，加入多核白细胞或其培养上清及不同浓度地塞米松，在MEM培养液中培养48h后，通过测定培养上清液中的羟脯氨酸（HYP）的量作为胶原降解的活性单位。免疫印记法分析MMP活性变化。结果在纤维蛋白溶酶原存在的情况下，多核白细胞单独无胶原降解作用，多核白细胞与角膜基质细胞混合培养，及多核白细胞培养上清均能增加角膜基质细胞胶原降解量，差异有显著性（P〈0．01）；多核白细胞培养上清能够刺激角膜基质细胞MMP-1和MMP-3释放，地塞米松依浓度依赖关系减少角膜基质细胞胶原降解量，差异有显著性（P〈0．01）。结论多核白细胞促进角膜基质细胞胶原降解，地塞米松具有抑制多核白细胞诱导的角膜基质细胞胶原降解的作用。     

鼻内镜手术治疗鼻窦炎鼻息肉87例分析

目的回顾分析鼻内镜手术治疗慢性鼻窦炎鼻息肉的疗效及影响因素。方法总结87例102侧慢性鼻窦炎鼻息肉患者使用鼻内镜手术治疗的疗效、并发症及围手术期治疗。结果该组病例治愈率67%,总有效率93%,无效7%。结论Ⅱ型3期及Ⅲ型患者疗效较差,说明病变程度和疗效有关。手术技巧的掌握及术中一并解决鼻中隔偏曲、下鼻甲肥大等鼻阻塞疾病可提高手术疗效。     

Hemolysis of erythrocytes by granulysin-derived peptides but not by granulysin

Granulysin, a 9-kDa protein localized in human cytolytic T lymphocytes and natural killer cell granules, is cytolytic against tumors and microbes but not against red blood cells. Synthetic peptides corresponding to the central region of granulysin recapitulate the lytic activity of the intact molecule, and some peptides cause hemolysis of red blood cells. Peptides in which cysteine residues were replaced by serine maintain their activity against microbes but lose activity against human cells, suggesting their potential as antibiotics. Studies were undertaken to determine the mechanism of resistance of red blood cells to granulysin and sensitivity to a subset of granulysin-derived peptides. Granulysin lyses immature reticulocytes, which have mitochondria, but not red blood cells. Granulysin lyses U937 cells but not U937 cells lacking mitochondrial DNA and a functional respiratory chain (U937rho(o) degrees cells), further demonstrating the requirement of intact mitochondria for granulysin-mediated death. Peptide G8, which corresponds to helix 2/loop 2/helix 3, lyses red blood cells, while peptide G9, which is identical except that the cysteine residues were replaced by serine, does not lyse red blood cells. Granulysin peptide-induced hemolysis is markedly inhibited by an anion transporter inhibitor and by Na(+), K(+), and Ca(2+) channel blockers but not by Na(+)/K(+) pump, cotransport, or Cl(-) channel blockers. Although recombinant granulysin and G9 peptide do not induce hemolysis, they both competitively inhibit G8-induced hemolysis. The finding that some derivatives of granulysin are hemolytic may have important implications for the design of granulysin-based antimicrobial therapeutics.     

The status of travel by severely handicapped patients by railroads

An essential prerequisite for integrating disabled persons is their mobility. The special transport approach, both in terms of handling capacity and cost involved, is increasingly turning out to be unable to achieve future-oriented solutions in this context. Disabled people wish to use the transport services available to the general public. They therefore demand public transportation policies to provide for their access to the mainstream system, ideally independent of outside assistance. Deutsche Bundesbahn, the German federal railways, in the field of tension between the need to orient its business policies on economic and financial considerations and disabled persons' demands that vehicles and premises be designed in a barrier-free manner, seeks to achieve solutions that are responsive to users' needs and at the same time economically justifiable. On account of the 19th century infrastructure legacy and a wide range of rolling stock in long- and short-distance rail travel, this can however be realized only step by step. The facilities offered to disabled people so far range from free use of short-distance trains to the accessibility-oriented design of coaches for the Intercity Express, the future of the railways in the European rapid transit network. The various services and facilities provided are hoped to foster disabled persons' decision in favour of the environmentally compatible rail mode of travelling.