中国北方汉族男子fms样酪氨酸激酶基因多态性与高住高练低训敏感性的关联性研究

目的:探讨fms样酪氨酸激酶(Flt-1)基因多态性与低氧训练敏感性的关联性。方法:选取70名中国北方平原地区汉族男子进行4周高住高练低训(HiHiLo),方案为每日在低氧环境(O2浓度为14.5%～14.8%,大约相当于海拔3000米)中休息10h,每周进行3次75%VO2max低氧训练(O2浓度为15.4%,大约相当于海拔2500米),其余时间在常氧下训练。测试其HiHiLo前后的VO2max及训练期间的血象指标。用PCR-RFLP法分析Flt-1基因SNP/A193019G多态性。结果:(1)4周HiHiLo后,AA基因型VO2max增加幅度高于AG基因型57.54%,但无显著性差异。(2)在HiHiLo期间(除第23天外),AA基因型Hb的变化幅度始终高于AG基因型,但无显著性差异。结果提示,与AG基因型者相比,AA基因型者可能有对低氧训练更敏感的趋势。     

改良的Madigan前列腺切除术

目的　对Madigan前列腺切除术 (MPC术 )进行改良 ,提高手术疗效。　方法　对 52例前列腺增生 (BPH)患者行MPC术 ,并进行手术改良。包括 :(1)显露膀胱颈及尿道起始部以避免或减少尿道损伤 ;(2 )联合膀胱顶部小切口以治疗中叶增生显著和 (或 )合并膀胱病变的BPH。结果　尿道完整或基本完整者 48例 ,术中出血较少 ,平均手术时间 12 0min。其中 3 5例获随访 ,随访时间 1～ 12个月 ,术后平均最大尿流率 18 9ml/s;8例患者手术前后行排尿期膀胱尿道造影 ,证实术后前列腺部尿道及膀胱颈完整 ,尿道较术前明显增宽。　结论　改良的MPC术减少了尿道损伤的发生 ,扩大了MPC术的适应证 ,手术操作简便、并发症少 ,疗效确切     

4例口服复方避孕药致假性库欣综合征病例分析

目的：研究我院收治的4例口服复方避孕药（oral contraceptive pills,OCPs）后致假性库欣综合征病例的临床特征以及复习OCPs影响皮质醇测定的相关文献。方法：回顾性分析4例因月经稀发服用OCPs的育龄期女性患者的临床特点。应用等倍稀释的方法测定OCPs与血总皮质醇之间的交叉反应,并复习相关文献。结果：4例患者在服用OCPs期间均发现血总皮质醇的升高。3例患者均在停用OCPs之后血总皮质醇降至正常。予等倍稀释的方法,在OCPs溶液中测定血总皮质醇,交叉反应小。文献中报道OCPs可能从以下两方面导致假性库欣综合征：OCPs中的雌激素增加皮质醇结合球蛋白的合成而引起血总皮质醇的升高;OCPs可能通过直接刺激下丘脑-垂体-肾上腺轴使血总皮质醇生成增多。结论：OCPs可通过多种机制导致假性库欣综合征,临床上需结合患者的临床表现、体格检查以及其他的实验室结果与库欣综合征进行鉴别,以免误诊、误治。     

咪唑安定靶控输注时镇静深度的预测

目的　探讨咪唑安定 (MDZ)靶控输注镇静时目标血药浓度、效应室浓度与脑电指标双频指数 (BIS)、95 %边缘频率 (95 %SEF)预测镇静深度的临床价值及MDZ在区域麻醉靶控输注镇静中的适宜目标浓度。方法　选择ASAⅠ～Ⅱ级的择期手术患者 14例 ,以血药浓度作为靶控输注目标浓度。第一阶段靶浓度为 5 0ng/ml,继以 5 0ng/ml浓度梯度递增 ,每一阶段维持 15分钟 ,至镇静评分 (OAA/S评分法 )达 1分后停药 ,观察并双盲记录目标血药浓度、效应室浓度、BIS、95 %SEF、血液动力学和镇静评分各指标至患者清醒 ,用Spearman’s等级相关进行相关分析。 结果　镇静起效期(0AA/S5～ 1)OAA/S与BIS、95 %SEF、目标血药浓度、效应室浓度的相关系数分别为r =0 735、0 4 15、- 0 4 87和 - 0 6 89(P值均 <0 0 0 1)。镇静恢复期 (0AA/S1～ 5)分别为r =0 6 14、0 2 94、-0 5 5 1和 - 0 4 97(P值均 <0 0 1)。不同镇静评分时各指标变化有显著差异。血液动力学指标未见与镇静评分相关。结论　MDZ靶控输注镇静时 ,目标血药浓度、效应室浓度、BIS和 95 %SEF均可用于镇静深度的预测 ,镇静评分与BIS相关最好 ,镇静深度宜维持在OAA/S评分 2～ 3分 ,目标血药浓度 10 0ng/ml左右 ,BIS在 77～ 81之间。     

腹腔镜阑尾切除术1261例报告

目的 :总结腹腔镜阑尾切除术的经验。方法 :回顾分析行腹腔镜阑尾切除术 12 6 1例的临床资料。结果 :12 6 1例中 ,12 4 9例在腹腔镜下完成阑尾切除术 ,2例行阑尾周围脓肿引流术 ,10例为阑尾根部穿孔或腹膜后阑尾中转剖腹手术。 1例术后出血而再手术 ,戳孔感染 4例 ,无因肠瘘、肠粘连、肠梗阻而再手术者。结论 :腹腔镜阑尾切除术要正确处理系膜并将阑尾移出腹腔 ,可降低切口感染、肠粘连、肠梗阻的发生率 ,此术式尤其适用于肥胖 ,小儿及化脓坏疽性阑尾炎患者     

急诊门奇断流术30例临床分析

目的 探讨门脉高压症并发上消化道大出血的抢救措施。方法 回顾分析30例患者的围手术期资料。结果 止血率100%，无死亡率，5年生存率81%。结论 急诊门奇断流术可抢救部分上消化道大出血患者的生命，合理选择相关手术适应症，掌握手术时机，确切断流，注重围手术期处理是取得良好效果的关键。     

New surgical technique of left ventricular free wall rupture: double patch sealing method.

We experienced two cases of left ventricular free wall rupture (LVFWR) following acute myocardial infarction (AMI). Case 1, with the blowout type of LVFWR was initially closed by direct suture, followed by hemostasis using a double patch sealing method (DPS) by which the tear was doubly sealed with large and small bovine pericardium patches to which GRF glue was applied. Case 2 with the oozing type of LVFWR was treated only using DPS. Complete hemostasis was achieved in both cases, and aneurysmal dilatation or constrictive heart failure were not detected by postoperative left ventriculography. Therefore, DPS may be useful for treating LVFWR following AMI.     

单孔腹腔镜下大圆针体外二次缝合法治疗小儿腹股沟斜疝的疗效分析

目的探讨应用单孔腹腔镜下大圆针体外二次缝合法治疗小儿腹股沟斜疝的疗效。 方法2016年8月至2017年6月,南方医科大学附属何贤纪念医院收治且由同一手术团队治疗的小儿腹股沟斜疝患者共400例,均采用腹腔镜手术,分为观察组和对照组,其中观察组应用大圆针体外二次缝合法治疗小儿腹股沟斜疝208例,对照组应用大圆针及Endoclose腹壁缝合器治疗小儿腹股沟斜疝192例。回顾分析2组不同方法在手术时间、住院时间、住院费用、是否需要增加辅助钳、术中血管损伤、术后并发症及复发情况等。 结果2组患儿均顺利完成腹腔镜下疝囊高位结扎术,观察组和对照组在住院费用[单侧：（6.29±0.32）千元比（7.40±0.53）千元,双侧（8.85±0.65）千元比（9.60±0.38）千元]、是否需要增加辅助钳（106/208比48/192）方面比较,差异均有统计学意义（P均<0.05）;而手术时间、住院时间、术中血管损伤、术后并发症及复发情况差异无统计学意义（P均>0.05）。 结论单孔腹腔镜下大圆针体外二次缝合法行疝囊高位结扎术,操作简单、方便;无需"疝针"或腹壁缝合器即能完成手术,费用更低;而且该技术微创、安全,具有一定的临床推广价值。     

The Effect of a PEEK Material‐Based External Fixator in the Treatment of Distal Radius Fractures with Non‐Transarticular External Fixation

ObjectiveTo explore the effect of a PEEK material‐based external fixator in the treatment of distal radius fractures with non‐transarticular external fixation.MethodsThere were 48 patients in this prospective comparative study. They were divided into two groups according to the materials used: the PEEK group and the titanium group. Wrist dorsiflexion, palmar flexion, pronation, supination, radial deviation, ulnar deviation, grip strength of the palm on the affected side, kneading force, Visual Analogue Scale/Score (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, operation time, frequency of fluoroscopy procedures, and X‐ray results were compared between the two groups. Functional recovery was evaluated at the last follow‐up according to the wrist joint evaluation criteria.ResultsThe baseline data were comparable between the two groups, and no significant differences were found in age, sex, fracture types (P > 0.05). There was no significant difference between the two groups in the results of DASH, grip strength, and recovery of pinch force and wrist function (dorsiflexion, clavicle, ulnar deviation, deviation, pronation, and supination) (P > 0.05). Normal limb function was achieved in the two groups of patients at an average of 6 weeks after surgery, and there was no significant difference in X‐ray examination radial height (10.60 ± 1.59 vs 11.00 ± 1.53, P = 0.687), radial inclination (1.11 ± 0.24 vs 1.12 ± 0.24, P = 0.798), volar tilt (10.33 ± 2.13 vs 10.00 ± 2.08, P = 0.660), ulnar variance (20.87 ± 3.00 vs 20.38 ± 3.04, P = 0.748), and step‐off persistence (1.73 ± 0.69 vs 1.68 ± 0.72, P = 0.425) between the two groups (P > 0.05). However, the operation time (54.80 ± 12.20 vs 85.23 ± 15.14, P = 0.033) and number of fluoroscopy procedures (36.93 ± 6.89 vs 64.77 ± 9.74, P = 0.000) in the PEEK group were significantly reduced compared with those in the titanium group.ConclusionCompared with the traditional titanium external fixator, the PEEK composite external fixator has advantages, such as a shorter operation time and fewer fluoroscopy procedures when used to treat different types of distal radius fracture.     

胃泌素和胆囊收缩素对胆管癌细胞浸润和转移的影响

目的观察胃泌素(gastrin)及胆囊收缩素(CCK)对胆管癌细胞浸润转移的影响。方法用Transwell小室分析胃泌素及胆囊收缩素对胆管癌细胞浸润转移能力的影响。并用RT-PCR及Western blot分析经胃泌素及胆囊收缩素刺激后,胆管癌细胞QBC939浸润转移相关分子基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)的表达。结果经胃泌素及CCK作用后,胆管癌细胞浸润转移能力明显增强,可能与浸润转移相关分子MMP-2、MMP-9表达增多有关。而其受体抑制剂丙谷胺(proglumid)可抑制该作用。结论胃泌素和胆囊收缩素可促进胆管癌细胞浸润和转移,而丙谷胺可抑制该作用。