不同镇痛方法对胆囊切除术病人糖代谢和康复的影响

目的　观察比较多途径和单一方式镇痛方法对胆囊切除手术病人糖代谢和术后康复的影响。方法　 40例择期在硬膜外阻滞下行胆囊切除术的病人 ,随机分为多途径组 1(M1)、多途径组 2 (M2 )、对照组 1(C1)和对照组 2 (C2 )。C1组于术前从硬膜外腔给予吗啡 1mg +新斯的明 1mg。C2 组术后仅肌注哌替啶镇痛。M1和M2 组在C1基础上于术前至术后 2天口服双氯芬酸 ,M2 组于术毕在切口处采用 0 5 %布比卡因喷洒。结果　M1和M2 组血糖 (Glu)变化平稳。C1组血糖于术后第 1天上升 (P <0 0 5 ) ,C2 组血糖值则从术中至术后第 3天均明显上升 (P <0 0 5或P <0 0 1)。术后第 1天 ,四组胰岛素 (Ins)水平均明显上升 (P <0 0 5或P <0 0 1)。C1和C2 组胰岛素上升幅度明显高于M1和M2 组 (P <0 0 5 )。至术后第 3天 ,M1和M2 组胰岛素水平均恢复至正常水平 (P >0 0 5 ) ,而C1和C2 组胰岛素值仍高于麻醉前值 (P <0 0 5或P <0 0 1)。血浆皮质醇 (Cor)浓度均于术中 6 0分钟时明显上升 (P <0 0 1) ,与M1和M2 组相比 ,升高幅度以C1和C2 组显著 (P <0 0 5 )。IL 6水平在各组未见显著性改变 (P >0 0 5 )。结论　多途径镇痛方法对术后糖代谢和康复的影响小于单一途径镇痛术     

胆囊癌中基质金属蛋白酶-9、粘附分子CD44变构体6表达及其临床意义

目的 研究胆囊癌中基质金属蛋白酶-9（MMP-9），粘附分子CD44变构体6（CD44v6)的表达情况及其临床意义。方法 应用免疫组织化学Env ision二步法测定46例胆囊癌（GBC）和12例慢性结石性胆囊炎中MMP-9，CD44v6表达。结果 MMP-9，CD44v6在胆囊癌组织中阳性表达率分别为78.26%,71.74%,MMP-9,CD44v6表达与胆囊癌分化程度，临床分期，淋巴结转移，术后生存率有关。结论 检测MMP-9，CD44v6的表达有望成为判断胆囊癌淋巴结转移，病变发展以及评估预后的客观指标。     

Studies on the integration of hepatitis B virus DNA sequence in human sperm chromosomes

Aim: To study the integration of hepatitis B virus (HBV) DNA into sperm chromosomes in hepatitis B patients and the features of its integration. Methods: Sperm chromosomes of 14 subjects (5 healthy controls and 9 HB patients, including 1 acute hepatitis B, 2 chronic active hepatitis B, 4 chronic persistent hepatitis B, 2 HBsAg chronic carriers with no clinical symptoms) were prepared using interspecific in vitro fertilization between zona-free hamster oocytes and human spermatozoa. Fluorescence in situ hybridization (FISH) to sperm chromosome spreads was carried out with biotin-labeled full length HBV DNA probe to detect the specific HBV DNA sequences in the sperm chromosomes. Results: Specific fluorescent signal spots for HBV DNA were seen in sperm chromosomes of one patient with chronic persistent hepatitis B. In 9(9/42) sperm chromosome complements containing fluorescent signal spots, one presented 5 obvious FISH spots and the others 2 to 4 signals. The fluorescence intensity showed significant diffe     

盐酸氨基葡萄糖治疗骨性关节炎有效性与安全性评价

目的 评价盐酸氨基葡萄糖胶囊治疗骨性关节炎的有效性和安全性。方法 多中心、随机、阳性药物对照研究。143例膝和髋骨关节炎患者被随机分为两组,盐酸氨基葡萄糖研究组1桫次,每日2次;硫酸氨基葡萄糖对照组2桫次,每日3次,疗程均为6周。结果 治疗6周后,盐酸氨基葡萄糖在改善行走疼痛、夜间静息痛、晨僵几方面优于硫酸氨基葡萄糖,差异有统计学意义（P〈0．05）。总有效率评价显示盐酸氨基葡萄糖有效率为75．4％,硫酸氨基葡萄糖为60．6％,两组间差异无统计学意义,提示两种氨基葡萄糖治疗骨关节炎疗效相当。盐酸氨基葡萄糖组发生不良反应3例,硫酸氨基葡萄糖组2例,均较轻微,无严重不良事件发生。结论盐酸氨基葡萄糖胶囊治疗骨关节炎安全、有效,与硫酸氨基葡萄糖疗效相当。     

3.0T术中磁共振成像导航在神经外科手术应用的初步经验

目的 探讨3.0 T术中磁共振成像(iMRI)导航在神经外科手术应用的临床价值.方法 回顾性分析2010年9月至2011年3月,在具备诊断和手术功能的"3.0 T iMRI数字一体化神经外科手术中心"施行的各类颅脑手术122例,包括临床资料、iMRI实时影像导航对手术进程和手术结果的影响等.结果 122例患者手术室内扫描2～4次,平均2.6次.各种扫描图像质量皆优良.iMRI技术使脑胶质瘤(60例)手术全切除率从71.7%提高到90.0%,患者的近期致残率为6.7%,远期致残率3.3%.iMRI技术使垂体大腺瘤(29例)手术全切除率从75.9%提高到93.1%.未发生与应用iMRI数字一体化神经外科手术有关的并发症(如感染等).同期完成2500余人次MRI诊断性检查.结论 3.0 T iMRI神经导航的应用,为脑胶质瘤与垂体大腺瘤手术进程的实时引导、切除范围的精确判断以及脑功能与代谢信息的定量分析提供了客观依据,真正实现了脑肿瘤的最大程度安全切除.

Abstract：

Objective To report the preliminary experience in clinical application of 3.0 T intraoperative magnetic resonance imaging (iMRI) neuronavigation system in China. Methods From September 2010 to March 2011, a consecutive series of 122 patients with intracranial lesions underwent operations in guidance with 3.0 T iMRI. A retrospective analysis was conducted regarding clinical efficiency.Results Among 122 procedures, the numbers of intraoperative scanning were 2-4 times with an average of 2.6.The qualities of images were excellent. Due to the discovery and further possibility of resection of residual tumors, the ratio of gross total resection was increased from 71.7% to 90.0% in cerebral gliomas(n =60), while from 75.9% to 93.1% in macroadenomas (n =29).There were 6.7% of all patients occurred postoperative paralysis, but only 3.3% of patients had persistent paralysis at 1-2months follow-up.There was no iMRI-related adverse event occurred. During the same period, more than 2500 patients underwent diagnostic MRI scanning. Conclusions 3.0 T iMRI neuronavigation system provides high-quality intraoperative structural, functional and metabolic images for real time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.The system is cost-effective.     

不同染色方法对精子形态学分析结果的影响

目的 探讨不同染色方法 对精子形态学分析结果 的影响.方法 选取20例人精液样本,每例样本制作2张涂片,分别采用改良巴氏染色方法 和Diff-Quik快速染色法进行染色,每例样本剩余精液经生理盐水洗涤后再制作2张涂片,也分别用上述两种染色方法 进行染色.染色后的所有涂片在精子形态自动分析软件上进行分析.结果 未经洗涤的精液涂片经改良巴氏染色和Diff-Quik快速染色正常形态精子百分率分别为7%(95%CI,5%～9%)、9%(95%CI,6%～12%),两者差异无统计学意义.洗涤后改良巴氏法和Diff-Quik法评估的精子正常形态百分率有明显提高,并且Diff-Quik法评估的精子正常形态百分率(15%,95%CI12%～18%)显著高于改良巴氏法(10%,95%CI 9%～11%).结论 未经洗涤的精子涂片两种评估正常形态精子百分率差异无统计学意义;精子洗涤后涂片染色对计算机精子形态学自动分析结果 有显著影响,且Diff-Quik法提高效果更明显.     

Functional pectoralis minor muscle flap transplantation for reconstruction of thumb opposition: an anatomic study and clinical applications

In this report, we present the results of an anatomic study on the dimensions of the pectoralis minor muscle and its neurovascular supply in 10 adult human cadavers, in attempt to evaluate the feasibility of microsurgical transplantation of a part of the muscle for thumb opposition reconstruction. A series of five patients consequently underwent thenar reconstruction with the pectoralis minor muscle flap from December 2004 to October 2006. The transferred muscle was reinnervated with the third lumbrical branch of the ulnar nerve. Follow-up assessment showed that the patients recovered functional opposition of carpometacarpal joint with 24 degrees of pronation, and a muscle power with M4 to M5. All patients were satisfied with the appearance of reconstructed thenar eminence. We recommend this new technique for thenar and opposition reconstruction in patients who have severe loss of thenar muscles, injury to the median nerve, and wish to improve the appearance of thenar eminence.     

经椎板间隙术式摘除髓核65例报告

目的　探讨经椎板解剖间隙摘除L4 ,5、L5S1间盘髓核的可行性 ,以达到术后最大限度地保留腰椎后部结构 ,预防术后腰不稳和疤痕粘连、压迫的目的。方法　随机对 6 5例L4 ,5、L5S1单纯椎间盘突出的病人 ,经椎板解剖间隙行髓核摘除术。结果　术中摘除髓核 4～ 10 g ,平均 4 8g ,手术用时 1 5h以内 ,经 3～ 2 4个月的随访 ,优 6 0例 ,良 4例 ,可 1例 ,优良率98 46 %。结论　对单纯L4 ,5、L5S1椎间盘突出 ,经椎板解剖间隙能彻底地摘除髓核 ,椎板间隙作为一自然的间隙 ,能预防术后后方的疤痕粘连和压迫     

体外短波热疗联合前列腺灸及哈乐治疗非细菌性前列腺炎和前列腺痛疗效观察

目的 探讨慢性非细菌性前列腺炎（CNP）和前列腺痛（PD）的治疗方法。方法 应用体外短波热疗联合前列腺灸及α1A-肾上腺素能受体阻滞剂哈乐治疗CNP和PD患者26例，疗程8周。观察治疗前后前列腺炎症状评分（CPSI）与最大尿流率（MFR）变化。结果 有效率为80．8％。治疗前后CPSI和MFR均有显著改善（P〈0．05）。结论 体外短波热疗联合前列腺灸及哈乐治疗CNP和PD安全有效。