数据库建设第五部分：结直肠癌的肿瘤特征——模块的设计（一）

目的对华西肠癌数据库(DACCA)中结直肠癌的肿瘤特征模块的构成、定义及解读进行阐述。方法采用文字描述的形式。结果在华西DACCA中,选择作为结直肠癌的肿瘤特征模块的项目包括:癌前病变、癌家族、肿瘤部位、缘距、肿瘤形态、大小、方位、发生、分化、肿瘤病理性质、Ki67、梗阻、套叠、穿孔、疼痛、水肿、出血,本研究中对其中癌前病变、癌家族、肿瘤部位及缘距的具体定义、癌前病变的分类、肿瘤部位划分、癌家族的填写形式以及这些项目的标签与结构化、纠错与更新以及在对DACCA中的数据进行分析时如何使用这些肿瘤特征的方式进行了详细阐述。结论通过对目前华西DACCA中已有的结直肠癌的肿瘤特征模块中的一部分项目(余下部分项目在后期相应章节内容中描述)进行了详细描述及规范,为结直肠癌的规范化治疗提供参考依据,同时为想做结直肠癌数据库建设的同行们提供经验。     

腹腔镜在6月龄以内新生儿和婴儿疾病诊断和治疗中的应用(附297例报告)

目的 探讨腹腔镜技术在新生儿和小婴儿疾病诊断和治疗中的安全性及可行性. 方法 2001年1月～2007年5月,我们对297例新生儿及小婴儿进行腹腔镜手术治疗.年龄生后2小时～6个月,其中先天性肥厚性幽门狭窄80例,梗阻性黄疸67例,腹股沟斜疝35例,胆道闭锁31例,中高位肛门闭锁21例,胆汁黏稠21例,先天性膈疝7例,空肠闭锁7例,胆总管囊肿6例,先天性巨结肠5例,十二指肠膜式狭窄5例,肾积水3例,食管裂孔疝2例,食管闭锁2例,肠旋转不良2例,小肠梗阻1例,肠套叠1例,先天性肌性斜颈1例. 结果 诊断性手术胆道造影术67例;操作简单的中小手术如幽门环肌切开术80例,疝囊高位结扎术35例,胆道冲洗术21例,十二指肠膜式狭窄手术5例,肠旋转不良Ladd手术2例,肠套叠复位术1例,肠粘连松解术1例,胸锁乳突肌松解术1例;复杂性大手术如肝门空肠吻合术31例,肛门成形术21例,膈疝修补术7例,肠闭锁肠切除吻合术7例,肝管空肠吻合术6例,长段型巨结肠根治术5例,肾盂成形术3例,食管闭锁2例,食管裂孔疝胃底折叠术2例.无术中大出血、无术中及术后需要输血者、意外损伤及围手术期死亡病例.腹腔镜下完成手术294例,3例胆道闭锁因术中肝门渗血中转开腹手术.术后随访2个月～6年,无明显远近期并发症发生. 结论 腹腔镜技术是诊断、治疗新生儿和小婴儿疾病的安全、可靠的方法,具有创伤小,恢复快,美容效果满意等优势.     

Trials and tribulations of multicenter studies

Multicenter studies in Pediatric Nephrology have been acknowledged in recent years as an important mechanism for studying renal disease in children. The purpose of this review is to describe some of the experiences of the Southwest Pediatric Nephrology Study Group (SPNSG) in order to assist others in developing their own multicenter studies. The importance of protocol development, including adequate attention to study design, data management, and data analysis, is emphasized. Mechanisms for facilitating the frequency and productivity of study group meetings that are so essential for the success of multicenter studies, are described in some detail. The need and some of the methods for achieving ongoing collaboration within a climate of critical peer review are also discussed. Controversial issues such as authorship and the question of institutional credit for involvement in multicenter studies are discussed in brief. Finally, some of the features of the SPNSG that have permitted us to meintain a relatively high rate of productivity are described. The two most important of these, ongoing commitment to the group and willingness to collaborate across differences of opinion, are stressed throughout the review.SPNSG centers Baylor College of Medicine, Houston, Tex.; Baylor University Medical Center, Dallas, Tex.; Cook-Fort Worth Children's Medical Center, Fort Worth, Tex., Louisiana State University, New Orleans, La.; Texas A and M University, Temple, Tex.; Tulane University Medical Center, New Orleans, La.; University of Alabama at Birmingham, Birmingham, Ala.; University of Arkansas, Little Rock, Ark.; University of Colorado, Denver, Colo.; Oklahoma University Health Science Center, Oklahoma City, Okla.; University of Tennessee, Memphis, Tenn.; University of Texas Health Science Center, San Antonio, Tex.; University of Texas Medical Branch, Galveston, Tex.; University of Texas Medical School, Houston, Tex.; University of Texas Southwestern Medical Center, Dallas, Tex.; University of Utah, Salt$Lake City, Utah     

微创经皮锁定钢板内固定治疗胫腓骨骨折疗效评价简

目的探讨微创经皮锁定钢板内固定治疗胫腓骨骨折的疗效。方法将2004年1月至2012年3月所收治的胫腓骨骨折患者分为两组,治疗组105例,其中男62例,女43例,年龄11～80岁,平均39．5岁,胫骨上段及平台骨折35例,中段骨折30例,下段及远端骨折40例,粉碎性骨折85例,简单骨折20例;对照组99例,其中男58例,女41例,年龄10～78岁,平均38．8岁,胫骨上段及平台骨折34例,中段骨折28例,下段及远端骨折37例,粉碎性骨折78例,简单骨折21例。治疗组采用微创经皮锁定钢板内固定治疗,对照组采用切开复位普通钢板或锁定钢板内固定治疗,比较两组患者手术时间、手术切口长度、骨折愈合时间、切口一期缝合率、并发症、踝关节功能优良率、膝关节功能优良率。结果两组患者手术切口长度、手术时间、骨折愈合时间、切口一期缝合率、皮肤坏死率、总并发症例数差异均有统计学意义,但踝关节功能优良率、膝关节功能优良率差异无统计学意义。结论微创经皮锁定钢板内固定是治疗胫腓骨骨折的有效方法,具有创伤小、骨折愈合时间缩短、皮肤坏死率低等优点。     

微创治疗颧弓颧骨骨折与常规方法的比较

目的:探讨应用微创复位以及常规开放复位的方法对颧弓颧骨骨折病患进行治疗,研究微创治疗颧弓颧骨骨折治疗效果。方法:选取2007年01月～2011年12月到本院进行颧弓颧骨骨折治疗的80例病患为主要的研究对象,均为治疗组,采用回顾性分析方法,将同期80例应用传统治疗方法的患者分为对照组,在治疗组采取微创复位治疗方法对颧弓颧骨骨折病患进行治疗,在对照组采取常规开放复位的方法对颧弓颧骨骨折病患进行治疗,研究治疗前后张口受限情况、骨折对位情况、术后不良反应情况、骨折解剖位愈合情况、面部对称情况、治疗有效率、感觉神经恢复情况、病患满意度情况、治疗费用以及恢复时间等指标。结果:两组研究治疗前后张口受限情况、骨折对位情况以及治疗费用,无显著性差异;两组术后不良反应情况、骨折解剖位愈合情况、面部对称情况、治疗有效率、感觉神经恢复情况、病患满意度情况以及恢复时间等指标,存在显著性差异,有统计学意义。结论:应用微创治疗颧弓颧骨骨折与常规方法的比较,创伤更小,术后不易复发,恢复情况较好,总体效果更加显著,极具安全性,有较高的推广价值。     

The stressful kiss: A biopsychosocial evaluation of the origins,evolution, and societal significance of vampirism

First, the stress relevance of vampirism is discussed, and the current vampire craze is considered along with a rationale for the scientific investigation of vampirism. Second, the origins of vampirism are examined. Third, the origin of Dracula is presented. Fourth, cinematic portrayals of Dracula and other vampires are given. Fifth, methods of prevention of vampire formation are considered. Sixth, a typical vampire is examined. Seventh, creation of vampires is explored. Eighth, destruction of vampires is considered. Ninth, historical vampires are examined. Tenth, current vampires are discussed. Eleventh, the sociological, physiological, and stress--related reasons for vampirism are explored. Twelfth, the anatomical, physiological, and stress-related aspects of love, vampire, and lethal biting are considered. Forensic methods of bite detection are then examined. Afterwards, the sociological, physiological, and psychological aspects of vampirism are evaluated. Finally, the dangers of vampirism are detailed.     

Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties.

BACKGROUND: Total hip arthroplasty is a commonly performed procedure in the United States and Canada that is associated with a definite risk of postoperative infection. Moreover, diagnosing an infection after total hip arthroplasty can present a challenge as there are no preoperative tests that are consistently sensitive and specific for infection in patients who need a revision arthroplasty. The present prospective study was performed to evaluate a variety of investigations for the diagnosis of infection at the site of a previous arthroplasty in order to determine if any combination of diagnostic studies could be used to determine which patients are at risk for a postoperative wound infection. METHODS: We prospectively analyzed the preoperative and intraoperative investigations used for the diagnosis of infection in 178 patients who had a total of 202 revision hip replacements. Clinical data were collected preoperatively. Investigations to determine the presence or absence of infection included a white blood-cell count, measurement of the erythrocyte sedimentation rate, measurement of the level of C-reactive protein, preoperative aspiration of the joint, intraoperative gram-staining and culture of periprosthetic tissue, a white blood-cell count in synovial fluid, and examination of intraoperative frozen sections. Frozen sections were analyzed in a blinded fashion without knowledge of clinical or laboratory data. Patients receiving antibiotics at the time of aspiration or collection of specimens for intraoperative culture were excluded from the analysis of those investigations, regardless of the results of the cultures. A positive result (suggestive of infection) was clearly defined for each of the investigations. RESULTS: Thirty-five hips (17 percent) were determined to be infected on the basis of clinical findings and positive results, according to the defined criteria, of investigations. With inflammatory conditions excluded, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.82, 0.85, 0.58, and 0.95, respectively, for the erythrocyte sedimentation rate and 0.96, 0.92, 0.74, and 0.99, respectively, for the level of C-reactive protein. All patients who had a periprosthetic infection had an elevated erythrocyte sedimentation rate or level of C-reactive protein, but not always both. When patients who were receiving antibiotics were excluded, the results of aspiration of the joint were 0.86 for sensitivity, 0.94 for specificity, 0.67 for the positive predictive value, and 0.98 for the negative predictive value. Intraoperative studies revealed sensitivities, specificities, positive predictive values, and negative predictive values of 0.19, 0.98, 0.63, and 0.89, respectively, for gram-staining of specimens of the most inflamed-appearing tissue; 0.36, 0.99, 0.91, and 0.90, respectively, for the white bloodcell count in synovial fluid; and 0.89, 0.85, 0.52, and 0.98, respectively, for a neutrophil count in synovial fluid of more than 80 percent. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.80, 0.94, 0.74, and 0.96, respectively, for the frozen sections and 0.94, 0.97, 0.77, and 0.99, respectively, for the intraoperative cultures. CONCLUSIONS: The combination of a normal erythrocyte sedimentation rate and C-reactive protein level is reliable for predicting the absence of infection. Aspiration should be used when the erythrocyte sedimentation rate or the C-reactive protein level is elevated or when a clinical suspicion of infection remains. We found the gram stain to be unreliable. Examination of intraoperative frozen sections is useful in equivocal cases or when hematological markers may be falsely elevated because of an inflammatory or other condition.     

影响神经源性膀胱排尿报警装置的主要因素

目的研究神经源性膀胱排尿报警装置的主要影响因素，为产品设计及临床应用提供参考。方法采用厚3mm／n、直径10mm／n的铁氧体永磁铁和直径分别为10、15、20mm／n的钕铁硼永磁铁，模拟腹壁厚度为2、3、4、5、6、7、8、9cm，永磁铁位置设定为0、1、2、3、4、5、6、7、8、9、10、11、12cm，测试腹壁厚度、永磁铁位置及其类型对神经源性膀胱排尿报警装置的影响。模拟腹壁厚度为2、3、4、5cm，永磁铁位置为2、3、4、5、6、7、8、9、10cm，测试地磁场对神经源性膀胱排尿报警装置的影响。结果报警仪指针角度与铁氧体永磁铁位置仅在腹壁厚度为2cm时成正相关（r=0．632，P〈0．05），而在3～9cm时无相关性（P〉0．05）。报警仪指针角度与钕铁硼永磁铁位置成正相关（r〉0．622，P〈0，05），且随永磁铁直径增大而增强，随腹壁增厚而减弱。地磁场的影响与人体朝向、永磁铁位置和腹壁厚度相关。结论影响神经源性膀胱排尿报警装置的主要因素包括永磁铁磁性和位置、腹壁厚度和地磁场，这些主要影响因素的合理配置可优化装置性能。     

孤立性肺结节的危险因素

目的 通过临床资料与孤立性肺结节(SPN)相关的单因素和多因素分析,评估其对SPN良、恶性判断的影响.方法 2000年1月至2009年7月经手术切除明确病理诊断的孤立性肺结节病人390例,其中男212例,女178例.年龄17～86岁,平均(57.1±14.8)岁.结节最大径0.2～3.0 cm,平均(2.02±0.78)cm.分别收集以下资料(1)年龄、性别、病程、症状、吸烟史及吸烟量、既往肿瘤史、肿瘤家族史;(2)影像学检查资料:肿瘤部位、肿瘤最大径、有无钙化、毛刺、分叶、胸膜牵拉征、界限清楚、血管集束征、纵隔淋巴结肿大;(3)术中探查结果:与胸壁有无粘连、有无胸膜皱缩征、有无胸腔积液.结果 肿瘤剜除术20例,楔形切除153例,肺叶切除217例.术后病理为良性病变130例,其中结核瘤49例,错构瘤33例,炎性假瘤27例,硬化性血管瘤9例,霉菌球3例,肺囊肿2例,淋巴组织增生2例,支气管扩张2例,动静脉瘘1例,间质性肺炎1例,神经纤维瘤1例;恶性病变260例,其中腺癌164例,鳞癌40例,肺泡细胞癌23例,肺转移癌20例,小细胞癌9例,类癌4例.单因素及逻辑回归分析显示,病人年龄、肿瘤最大径、伴有钙化、边界清楚及胸膜皱缩在良、恶性病变中的数据差异有统计学意义.而病人性别、吸烟史及吸烟量、术前有无症状、影像学检查有无分叶、毛刺、胸膜牵拉征、纵隔淋巴结肿大及术中探查有无胸腔积液在良、恶性肿瘤病人中的数据差异无统计学意义.结论 病人年龄、肿瘤最大径、伴有钙化及胸膜皱缩,对判断肺结节的良、恶性有显著意义.     

断指再植术后血管危象的多因素分析

目的分析影响断指再植术后发生血管危象的危险因素,为早期发现和及时防治血管危象的发生提供理论依据,从而减少断指再植术后血管危象的发生,提高断指再植的成活率。方法回顾性分析712指断指再植的病例,将患者性别、年龄、指别、伤因、断指缺血时间、离断平面、是否完全离断、动脉修复情况、静脉修复情况共九个因素分别与是否发生血管危象进行单因素分析和亚变量多因素Logistic回归分析,探讨断指再植术后发生血管危象的独立预测因素。结果712指断指再植术后共有132指发生血管危象,其中静脉危象44指,动脉危象88指,危象发生率为18．5％。单因素分析结果表明:性别、年龄、指别、伤因、离断平面、是否完全离断、动脉修复情况、静脉修复情况对血管危象的发生均有影响。二分类亚变量Logistic多因素分析表明,性别、年龄、伤因、离断平面、是否完全离断、动脉修复情况是断指再植术后发生血管危象的独立的预测因素。结论性别、年龄、伤因、离断平面、是否完全离断、动脉修复情况是断指再植术后发生血管危象的独立的预测因素。对于发生血管危象机率高的患者术中要精细操作,术后密切观察,预防断指再植术后血管危象的发生。     

骨康方君臣佐使药治疗骨质疏松药理机制探讨

目的 基于网络药理学分析骨康方中药治疗骨质疏松(OP)的具体作用机制及其作用靶点、通路的异同。方法 首先通过数据库以及文献检索分别筛选出骨康方中君臣佐使各药的主要活性成分及其作用靶点;同时利用网络数据库得到OP相关的靶点;通过Venny 2.1分别筛选出君臣佐使-OP的交集靶点;然后通过STRING和Cytoscape软件分别构建骨康方中君臣佐使-OP交集靶点的蛋白相互作用(PPI)网络并筛选出关键靶点;最后通过DAVID数据库分别对君臣佐使-OP的关键靶点进行KEGG通路分析,并使用Venny 2.1对KEGG结果进行交集。结果 经交集筛选后获得君臣佐使-OP的关键靶点,其中君药有6个、臣药有30个、佐药有31个和使药有30个,KEGG通路富集结果显示有9条君臣佐使各药关键靶点的共同通路、7条君药所特有的通路、2条臣药特有通路和1条使药特有通路,而佐药无特有的通路。结论 骨康方中君臣佐使各药有共同的调节通路,可能通过MAPK通路治疗OP,同时也有各自特殊的调节机制,发挥独特作用。     

Clinical and experimental effects of informational stress

Under certain conditions, information may become stressful. In the initial stages of our research we found that informational stress can result in fatigue, anxiety, sleeplessness, and excitability. Later we found further symptoms, such as tachycardia, palpitations, chest pain, abdominal pain, increase or decrease of appetite, diarrhoea or constipation, muscle cramps, back pain, headache, tremor, dizziness, diaphoresis, tics, and so on. Some of these symptoms might be the result of cathecholamine increased secretion, others of a decrease of endogenous opioids. Because in the initial stage of stress analgesia may occur, we studied the clinical and experimental evolution of the pain threshold and its clinical manifestations. We found that after the initial analgesia, there follows a stage of hyperalgesia; the symptoms of this stage very much resemble those of the opioid abstinence syndrome. The evolution of this syndrome is enhanced by naloxone, an opioid antagonist, and it is attenuated by clonidine and propranolol, used in the treatment of opioid abstinence syndrome. Thus we demonstrated that in the latter stage of stress, there is diminished secretion of endogenous opioids and an acute tolerance to them.     

长链非编码RNA MEG3靶向下调miR-21对IL-1β诱导的软骨细胞凋亡及炎症反应的影响

目的探究长链非编码RNA母系表达基因3(MEG3)靶向miR-21的作用对白细胞介素1β(IL-1β)诱导的软骨细胞凋亡及炎症反应的影响及其作用机制。方法将细胞分为cTRL组、IL-1β组、LV-MEG3组、miR-21 mimic组和LV-MEG3+mimic组,用IL-1β处理软骨细胞后,加入对应的慢病毒或miRNA mimic处理细胞。RT-PCR检测MEG3、miR-21、基质金属蛋白酶13(MMP-13)、II型胶原蛋白(Collagen II)、聚蛋白聚糖(Aggrecan)基因表达水平,Hoechst检测细胞凋亡,Western blot检测活化半胱天冬酶3(cl-Caspase-3)、cl-Caspase-9、MMP-13、Collagen II、Aggrecan蛋白表达水平和p65、信号传导及转录激活因子3(STAT3)磷酸化比率,试剂盒检测丙二醛(MDA)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)、谷胱甘肽(GSH)、肿瘤坏死因子α(TNF-α)、IL-6、IL-10水平,免疫荧光检测p65的核定位情况。结果与cTRL组比较,IL-1β组miR-21表达,细胞凋亡率,MMP-13基因表达,cl-Caspase-3、cl-Caspase-9、MMP-13蛋白表达,MDA、LDH、TNF-α、IL-6水平,p65和STAT3磷酸化比率,p65核内信号水平升高,MEG3表达,Collagen II、Aggrecan基因和蛋白表达,SOD、GSH、IL-10水平降低;与IL-1β组比较,LV-MEG3组miR-21表达,细胞凋亡率,MMP-13基因表达,cl-Caspase-3、cl-Caspase-9、MMP-13蛋白表达,MDA、LDH、TNF-α、IL-6水平,p65和STAT3磷酸化比率,p65核内信号水平降低,MEG3表达水平,Collagen II、Aggrecan基因和蛋白表达水平,SOD、GSH、IL-10水平升高;miR-21 mimic组各项检测指标的变化与LV-MEG3组相反;与miR-21 mimic组比较,LV-MEG3+mimic组miR-21表达,细胞凋亡率,MMP-13基因表达,MMP-13、cl-Caspase-3、cl-Caspase-9蛋白表达,MDA、LDH、TNF-α、IL-6水平,p65和STAT3磷酸化比率,p65核内信号水平降低,MEG3表达水平,Collagen II、Aggrecan基因和蛋白表达,SOD、GSH、IL-10水平升高。结论MEG3可下调miR-21表达,从而抑制IL-1β诱导的软骨细胞凋亡,缓解炎症反应,其作用机制可能与抑制NF-κB信号通路激活有关。     

Neural and vascular anatomy of the menisci of the human knee

STUDY DESIGN: Review of literature. OBJECTIVES: To review the general anatomy, vascular anatomy, healing potential, neural anatomy, and sensory functions of the menisci of the human knee. BACKGROUND: Recent research has revealed important roles and functions of the menisci of the human knee. METHODS AND MEASURES: A Medline search was performed using the following title and key words: menisci, meniscus, meniscal, vascular, blood, neural, nerve, anatomy, healing, sensory, mechanoreceptors, proprioception, nociceptors, surgery, meniscectomy, repair, and rehabilitation. The references from each article obtained were then reviewed in order to find additional articles not already located through the Medline search. RESULTS: In adults, the blood supply to the menisci of the knee reaches the outer 10% to 33% of the body of the menisci. This portion of the menisci is capable of inflammation, repair, and remodeling. Neural innervation with nociceptors and type I, II, and III mechanoreceptors reaches the outer 66% of the body of the menisci. The anterior and posterior horns of the menisci have a rich supply of both blood vessels and nerves. CONCLUSIONS: The menisci of the human knee are an important source of proprioceptive information regarding the position, direction, velocity, and acceleration and deceleration of the knee. Rehabilitation following injury or surgery to the menisci of the knee should, therefore, incorporate a proprioceptive retraining program that respects both the abilities and inabilities of different portions of the menisci to follow through with repair and remodeling.     

胆管癌光动力治疗临床应用技术规范专家共识

光动力治疗（PDT）是一种有效的肿瘤微创治疗手段,可联合胆管支架、胆道外引流、化疗等全身治疗方法治疗胆管癌,主要适用于不可手术切除胆管癌的治疗和术后肿瘤残留或局部复发的辅助性治疗,可有效控制肿瘤局部进展、解除胆道梗阻、改善患者生活质量、延长生存期,具有微创、精准及可重复等优点。目前用于胆管癌PDT的临床循证医学证据有限,缺乏临床诊疗技术规范和共识。中华医学会外科学分会外科手术学组、中华医学会外科学分会胆道外科学组及中国医师协会外科医师分会胆道外科医师委员会组织相关专家,对其适应证、禁忌证、技术操作规范、疗效评价及并发症处理等进行讨论,并达成共识,旨在为PDT在胆管癌治疗中的临床应用提供参考。     

基于 CiteSpace 可视化分析中医药治疗特应性皮炎的研究热点

目的 对中医药治疗特应性皮炎的相关文献进行计量与可视化分析,探讨其研究热点和发展趋 势,为其治疗提供一定参考。方法 以中国知网数据库（CNKI）为数据源检索2010年6月-2022年6月中医 药治疗特应性皮炎相关文献,利用CiteSpace 6.1.R2软件对关键词进行共现分析、聚类分析和突现分析,并 绘制相关图谱。结果 共纳入文献361篇,涉及的关键词有中药、儿童、龙牡汤、临床观察、辨证论治、临 床研究、针刺、生活质量、中医药、中医证型、中药药浴、中医。热点关键词为儿童、辨证论治、生活质 量、龙牡汤。聚类分析所产生的主要聚类有儿童、血虚风燥、龙牡汤、辨证分型、心火、生活质量等。突 现强度位于前3位的关键词为龙牡汤、针刺、中医药,其次分别为用药规律、辨证论治、中药、湿疮、血 虚风燥、健脾化湿等。结论 中医药治疗特应性皮炎的研究热点集中在儿童、血虚风燥、龙牡汤、辨证分 型、心火、生活质量等方面。     

影响胃癌患者术后生存因素的Cox回归分析

目的探讨胃癌临床病理特征及治疗方法对患者生存率的影响。方法以1994年4月至2005年8月手术治疗和病理确诊且随访资料完整的759例胃癌患者为对象,对其外科治疗结果进行回顾性分析,用KaplanMeier计算3年和5年生存率,用Logrank单因素比较和Cox回归多因素分析比较,分析影响胃癌患者术后生存率的因素。随访时间为4～131个月,平均(62.3±6.7)个月。结果单因素分析表明,患者的年龄、肿瘤部位、肿瘤直径、Borrmann分型、组织学类型、TNM分期、肿瘤浸润深度、淋巴结转移、肝转移、腹腔种植、术中输血、根治范围及清扫方法均为影响胃癌患者术后生存的影响因素。经Cox回归多因素分析发现,肿瘤部位、直径、浸润深度、术中输血、淋巴结清扫范围、淋巴结转移、清扫方法、肝转移、腹腔种植及TNM分期为影响患者术后生存的独立预后因素。结论影响胃癌患者术后生存的独立因素有肿瘤部位、大小、淋巴结转移、肿瘤浸润深度、腹腔种植、肝转移、病理分期,根治手术范围、淋巴结清扫技术及术中输血是影响患者术后生存率的重要因素。     

双能X线骨密度仪精密度和准确度的研究

目的：通过测量长、短期精密度和短期准确度对双能X线吸收法（ dual－energy X－ray absorptiometry ,DXA）骨密度仪进行质量控制。方法①长期精密度：对质量保证（Quality Assurance,QA）模块连续1年的测试数据进行统计分析,分别计算其高、中、低骨密度、均值骨密度、骨矿盐含量、投影面积的变异系数（ coefficient of variation ,CV）;②短期精密度：取连续25天的QA模块测试数据,计算高、中、低骨密度平均值和标准差（standard deviation,SD）,制作Shewhart质控图。另外选取30名志愿者,分别测量L1－4椎体,双侧股骨颈、大粗隆、Ward＇s三角、全髋关节的骨密度（bone mineral density,BMD）值,计算均方根变异系数（ root mean square of the CV ,RMS－CV）;③短期准确度：取连续25天的QA模块测试数据,计算高、中、低骨密度的准确度。结果①长期精密度：QA模块测量高、中、低骨密度、均值骨密度、骨矿盐含量、投影面积的CV分别为0．37％、0．37％、0．41％、0．43％、0．47％、0．12％;②短期精密度：连续25天QA模块测试数据均符合Shewhart 法则;30例受试者L1－4椎体,双侧股骨颈、大粗隆、Ward＇s 三角、全髋关节各测量部位的RMS－CV 分别为1．3％、0．8％、0．9％、1．2％、1．3％、1．5％、1．6％、0．6％、0．6％;③短期准确度：连续25天QA模块测试数据的高、中、低骨密度的准确度分别为－0．07％、0．10％、0．60％。结论进行长、短期精密度和准确度测试能反映双能X线吸收骨密度仪的一致性和可靠性,可有效提高骨质疏松的流行病学研究、诊断、治疗、药物试验研究的可信度。     

腹部腹腔镜手术后大块标本取出的切口并发症的多因素分析

目的：探讨腹部腹腔镜手术后大块标本取出的切口并发症的影响因素。方法按设定标准回顾分析我科2006年6月-2012年6月腹腔镜肝脏、脾脏及胃肠道切除术后大块标本取出切口位置、长度、并发症及美容效果。结果符合入选标准301例，其中肝切除56例，脾切除43例，胃切除66例，右半结肠切除35例，横结肠切除12例，左半结肠切除9例，乙状结肠切除25例，直肠切除55例。切口位置：上腹正中切口125例，下腹正中切口50例，脐周绕脐切口61例， Pfannenstiel切口39例，左下腹斜切口13例，左中腹经腹直肌切口9例，陈旧性切口4例。切口感染11例（11/301，3．6％），切口疝2例（2/301，0．7％）。单因素和logistic回归分析结果显示：切口位置（β＝0．596， P＝0．000）和合并症（β＝-4．526，P＝0．000）是切口并发症的危险因素。结论腹部腹腔镜手术后大块标本取出的切口应兼顾消化道重建需要、肿瘤标本完整性、美容、微创及减少并发症等因素进行选择设计，切口位置和合并症是切口感染和切口疝的危险因素。     

Systematic review of the efficacy of topical haemoglobin therapy for wound healing

Hypoxia is a common cause of poor wound healing, for which a variety of oxygen therapies have been developed. In order to overcome the limitations of traditional methods of treatment, namely the type of equipment, its setting, safety and cost, local haemoglobin therapy has been developed, although no reviews have so far been published. Here, we systematically review the current evidence to establish the efficacy, scope, adverse reactions, and required precautions of this new form of therapy. A search of the literature was conducted in the PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of science databases, with 17 studies meeting the eligibility criteria, comprising one animal model study and 16 clinical studies. Local haemoglobin therapy is able to safely and effectively promote the healing of a variety of wounds, especially those that are chronic and non‐healing. However, premature discontinuation of this treatment can result in impediment to wound healing and even deterioration of the wound. The distinct benefit of the elimination of slough and relief of pain suggests that this technique may represent a new generation of debridement technology. Furthermore, its ease of use and convenience enables patient self‐management, thereby greatly reducing health care costs.