肛门外括约肌的萎缩和缺损检查：三维肛门超声内镜与肛内磁共振成像检查的比较

目的：应用肛内磁共振成像检查肛门外括约肌萎缩的方法已经建立，但应用三维肛门超声内镜对这方面尚无明确研究。该研究目的是前瞻性比较三维肛门超声内镜与肛内磁共振成像对大便失禁患的肛门外括约肌萎缩和缺损进行检查的结果。此外，作还对肛门外括约肌厚度和长度的测量技术进行了比较。材料与方法：大便失禁患接受三维肛门超声内镜与肛内磁共振成像检查，并对肛门外括约肌的萎缩和缺损的肛内成像技术进行评估。三维肛门超声内镜对肛门外括约肌萎缩的评分依赖于肛门外括约肌与其反射系数的差别，而肛内磁共振成像对肛门外括约肌萎缩的评分则依赖于肌肉的数量和脂肪替代性萎缩的存在。萎缩评分分为无、中度和重度。三维肛门超声内镜通过高回波区定义缺损，肛内磁共振成像则通过括约肌环的不连续性和（或）瘢痕组织定义缺损。计算三维肛门超声内镜和肛内磁共振成像检查肛门外括约肌的萎缩和缺损的差异。此外，还比较了三维肛门超声内镜和肛内磁共振成像所测定的肛门外括约肌的厚度和长度。     

眼结核病

这个月Archives of Ophthalmology杂志参加了美国医师协会杂志关于结核病主题的刊物集。结核病依然是世界上死亡的主要感染病因，可以引起遍及全身及眼睛的多种疾病。全世界每年约有8百万新增结核病例，3百万人死于结核。有三分之一的世界人口曾被感染。感染的人口分布非常广泛，发展中国家的疾病负担最重。     

Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer

OBJECTIVE: To evaluate the quality of life (QoL) in patients undergoing anterior resection (AR) or abdominoperineal extirpation (APE) for rectal cancer in a sample of patients recruited from a field trial. SUMMARY BACKGROUND DATA: Abdominoperineal resection has been reported to put patients at higher risk of disruption to QoL than sphincter-preserving surgery. METHODS: Fifty patients treated with AR and 23 patients treated with APE were prospectively followed up. All patients were treated in curative attempt and were disease-free throughout the study. QoL was assessed before surgery and 6 to 9 and 12 to 15 months after surgery. RESULTS: Multivariate analysis of variance and subsequent post hoc comparisons revealed a main effect for time (role function, emotional function, body image, future perspective, and micturition-related problems) and group in favor of APE (sleeping problems, constipation, diarrhea), and a time-by-group interaction (role function). No significant results were obtained for the remaining scores, but patients undergoing APE consistently had more favorable QoL scores than those undergoing AR. Multivariate analysis and post hoc comparisons revealed a particularly poor QoL for patients undergoing low AR. They had a significantly lower total QoL, role function, social function, body image, and future perspective, and more gastrointestinal and defecation-related symptoms than patients undergoing high AR. CONCLUSION: Patients undergoing APE do not have a poorer QoL than patients undergoing AR. Patients undergoing low AR have a lower QoL than those undergoing APE. Attention should be paid to QoL concerns expressed by patients undergoing low AR.     

四项评分法对输卵管妊娠保守治疗效果的预测价值

目的:了解输卵管妊娠四项评分法对输卵管妊娠保守治疗效果的预测价值.方法:根据输卵管妊娠四项评分表并以Elito评分表作对照,对122例拟行保守治疗的输卵管妊娠进行评分,采用甲氨蝶呤联合米非司酮进行保守治疗并追踪治疗结局.结果:在122例中,保守治疗成功98例,失败24例,成功率80.3%.从ROC曲线得出8分值敏感度和特异度之和最大,是预测保守治疗失败的临界点,准确度为91.0%,阳性预测值达71.0%,四项评分法准确度显著高于Elito评分表(91.0%vs 84.4%,P<0.05).对保守治疗成功与失败两组进行比较,发现血清β-HCG>5000 U/L、孕酮(P)>47.55 nmol/L、阴道彩超血流呈半环～环状有统计学意义(P<0.01).结论:输卵管妊娠四项评分≥8分能有效预测输卵管妊娠保守治疗失败的病例.血清β-HCG>5000 U/L、P>47.55 nmoL/L、阴道彩超血流呈半环～环状是评估保守治疗失败的的重要指标.     

鼻阻塞的主观评价与客观鼻测量的相关性研究

目的探讨鼻阻塞时检查者和患者的主观评价与客观鼻测量之间是否有相关性。方法检查者和患者均采用视觉模拟量表（visualanalogscale，VAS）对鼻阻塞程度进行评价。客观鼻测量采用主动后鼻测压仪和鼻声反射测量仪进行。以配对t检验分析检查者的临床评价和患者VAS均数的差异，以Spearman等级相关分析评价客观鼻测量结果单侧鼻气流阻力与单侧鼻道容积、单侧鼻腔最小横截面积的关系，以及检查者的临床评价、患者VAS与上述客观鼻测量结果的相关性。结果本组病例经统计学分析，316例患者中，减充血前后单侧鼻气流阻力与单侧鼻道容积、单侧鼻腔最小横截面积间呈负相关（r值分别为-0．430、-0．554、-0．373、-0．600，P值均〈0．001）。减充血前后，检查者的临床评价与患者VAS均数呈正相关，差异均有统计学意义（r值分别为0．630、0．526，P值均〈0．001），二者均与鼻气流阻力有一定的正相关关系（减充血前：检查者的临床评价与鼻气流阻力r=0．530，P=0．000，患者VAS与鼻气流阻力r=0．351，P=0．000；减充血后：检查者的临床评价与鼻气流阻力r=0．452，P=0．000，患者VAS与鼻气流阻力r=0．216，P=0．000），与鼻道容积和鼻腔最小横截面积均有一定的负相关关系（减充血前：检查者的临床评价与鼻道容积r=-0．411，P=0．000，患者VAS与鼻道容积r=-0．325，P=0．000，检查者的临床评价与鼻腔最小横截面积r=-0．507，P=0．000，患者VAS与鼻腔最小横截面积r=-0．384，P=0．000；减充血后：检查者的临床评价与鼻道容积r=-0．391，P=0．000，患者VAS与鼻道容积r=-0．209，P=0．000，检查者的临床评价与鼻腔最小横截面积r=-0．471，P=0．000，患者VAS与鼻腔最小横截面积r=-0．286，P=0．000）。检查者的临床评价与客观鼻测量参数的相关系数大于患者VAS与客观鼻测量参数的相关系数。结论鼻阻力测压与鼻声反射测量的结果有一定的相关性。检查者的临床评价与患者VAS存在一定的正相关关系。两者均与客观鼻测量参数存在一定的直线相关关系。     

晚期妊娠与围绝经期盆底松弛患者子宫主骶韧带Ⅲ型胶原含量的变化

目的:探讨妊娠晚期和围绝经期盆底松弛患者子宫主骶韧带的组织学改变及胶原含量变化与盆底松弛发生的关系。方法:以10例妊娠晚期因产科严重并发症而行全子宫切除术者为晚孕组,14例行全子宫切除术为围绝经期盆底松弛组,14例无盆底松弛因妇科疾病而行全子宫切除术者为同龄对照组。每例取主韧带及骶韧带组织经病理切片,经Masson染色,观察其组织学特征,并用免疫组化方法检测其Ⅲ型胶原含量。结果:晚孕组、围绝经期盆底松弛组主韧带Ⅲ型胶原阳性单位分别为10.29±1.56、9.62±2.43,与对照组的17.68±3.95比较,P<0.01,差异有意义。骶韧带Ⅲ型胶原阳性单位分别为12.88±3.21、10.34±3.62,与对照组的19.29±4.57比较,P<0.01,差异有意义。结论:①晚期妊娠所致盆底松弛与围绝经期盆底松弛的共同特征之一是Ⅲ型胶原含量减少;②妊娠所致盆底损伤、胶原结构代谢改变和胶原排列稀疏,提示胶原的分解增强可能是妊娠晚期盆底松弛发生的原因,也是导致产后盆底松弛及尿失禁的因素之一。     

慢性乙肝病毒感染的诊断和治疗研究动向—与中国学者学术探讨之我见

The infection and its management A high proportion of hepatitis B virus (HBV) infections, which lead to chronicity rather than being resolved, are infections occuring at birth or early childhood[1]. Despite successful vaccination programs, the number of chronic carriers increases worldwide. Hepatocellular carcinoma (HCC) develops late in the course of a chronic infection, with its concomitant overall decrease in viral replication. However, stages associated with a particularly high risk to develop cancer are not described to this date. A still attractive model for the progression of infection points to a persistence of hepatocytes that contain chromosomally integrated, as well as free viral DNA, over hepatocytes containing only free replicating DNA[2]. Specifically, it is suggested that the process of integration depends on structural differences of replication complexes, whereby newly-synthesized viral DNA is rendered accessible to nucleases. Apart from integrated viral DNA, thus far identified only in tissue material, a marker characteristic of a chronic infection is still lacking. Stages of cryptic replicative or non-replicative HBV infection have been described[3], and are thought to represent either late stages of a chronic infection or cases of infection that has resolved without a preceding phase of chronicity[4].     

白三烯对马杉氏肾炎中肾小球细胞增殖的作用

大鼠马杉氏肾炎也称为肾毒性血清性肾炎（ＮＳＧＮ），其发病早期肾小球合成的白三烯（ＬＴ）升高，伴有肾小球增殖性核抗原（ＰＣＮＡ）（＋）细胞及肾小球增殖活性（ＧＰＡ）的增加。用花生四烯酸５－脂氧化酶抑制剂治疗ＮＳＧＮ大鼠，可抑制肾小球ＬＴＢ４的合成及ＰＣＮＡ（＋）细胞、ＧＰＡ的升高。用Ｘ线照射去除外周血白细胞也可抑制ＰＣＮＡ（＋）细胞及ＧＰＡ的升高。已知在ＮＳＧＮ中肾小球合成的ＬＴ来源于浸润的白细胞［１］，本研究证实肾小球白细胞衍生的ＬＴ促进ＮＳＧＮ的肾小球细胞增殖。     

超声刀在实验性腹腔镜肝叶切除术中的应用

超声刀在实验性腹腔镜肝叶切除术中的应用宗明吴孟超Ｐ．ＫｕｊａｔｈＨ．Ｐ．Ｂｒｕｃｈ我们使用ＳｏｎｏｃａＩ型超声刀（ＳｏｅｒｉｎｇＧｍｂＨ）对１０头猪施行了１９次腹腔镜下肝叶切除术，其中肝左内叶１０例，肝左外叶２例，肝右内叶５例，肝右外叶２例。手术技术...