切开复位内固定治疗移位的跟骨关节内骨折

目的探讨切开复位跟骨钢板内固定治疗跟骨关节内骨折的效果。方法自2001年8月至2003年4月,采用切开复位内固定治疗移位的跟骨关节内骨折34例35足。所有骨折均采用Sanders分型,应用广泛外侧入路,AO跟骨钢板内固定。对有选择的病例进行了植骨。应用影像学检查和美国足踝协会的后足评分系统进行结果评价,患者全部获得随访。平均随访时间18.3个月(12～32个月)。结果共完整随访Ⅱ型骨折30足,Ⅲ型骨折5足。术前平均Bhler角是5.6°,随访时平均Bhler角是28.2°。X线测量表明在单侧跟骨骨折患者跟骨高度恢复为健侧的97.7%。80%的患者取得关节面的解剖复位或近解剖复位。平均评分在SandersⅡ型骨折为88分,Ⅲ型骨折为79分。优良率在SandersⅡ型骨折为83%,Ⅲ型骨折为60%。总的优良率为79%。结论对于SandersⅡ型和Ⅲ型骨折患者采用切开复位内固定治疗,效果较好。     

腹腔镜下行肾血管平滑肌脂肪瘤剜除术治疗10例

目的探讨不阻断。肾蒂腹腔镜下行肿瘤剜除术治疗较小。肾血管平滑肌脂肪瘤（RAML）的应用效果。方法采用腹腔镜经腹腔途径在不阻断肾蒂情况下对10例较小RAML（肿瘤直径〈4cm）行肿瘤剜除术,并观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果10例手术全部获得成功,平均手术时间为90min,平均出血量80ml,平均术后住院时间为7d,手术效果好,无并发症,随访3—19个月,未见肿瘤转移或复发。结论该术式肿瘤切除精确彻底,创伤小,出血少,恢复快。     

手术护理记录单电子模板的设计与应用

利用医院和手术部的计算机网络,以"海泰临床信息系统"软件为平台,在护理电子病历模块中创建手术护理记录电子模板,以此书写、打印手术护理记录单,为手术室提供了一个方便、简捷的工作平台,提高了工作效率和质量,实现了手术护理的标准化、规范化、信息化管理.     

护士择业意愿与角色认知及应对方式的相关性

目的 探讨护士择业意愿与角色认知、应对方式的相关性,为构建稳定的护理队伍提供管理决策依据.方法 采用择业方式、角色认知及应对方式问卷对733名临床护士进行调查.结果 76.13%护士自愿选择护理职业,81.31%表示将一直从事护理职业,64.94%表示有职业规划;护士的择业意愿不同,其角色认知及应对方式比较,差异有统计学意义(均P<0.01);角色认知与积极应对呈正相关,与消极应对呈负相关(均P<0.01).结论 护士对职业的情感尚有待强化,其总体角色认知处于中等稍偏上,面对压力时多采用积极的应对方式.护理管理者应从各个方面培养护士对职业的情感与角色认知,从而有利于其采取积极的应对方式.     

前路减压与植骨内固定治疗胸腰椎骨折伴截瘫

目的探讨胸腰段脊柱骨折伴脊髓损伤前路伤椎大部切除减压、植骨融合、钢板内固定的手术方式与效果。方法41例胸腰段骨折伴脊髓损伤患者均行前路椎管减压、植骨融合及钢板内固定。对神经功能恢复情况、局部脊柱的稳定性进行分析。结果41例均获随访,时间6个月～4.5年,平均（30±7.8）个月,椎体间均获骨性融合,时间4～8个月。神经功能Frankel分级：A级7例恢复至B级5例,2例无恢复;B级15例恢复至C级10例、D级4例,1例无恢复;C级10例恢复至D级9例,1例无恢复;D级7例恢复至E级;E级2例无变化,无并发症发生。结论胸腰段脊柱骨折伴神经损伤,前入路手术直视下减压彻底,神经功能恢复好,Ⅰ期植骨融合内固定前路重建脊柱稳定性好,疗效满意。     

应用输尿管镜放置双J管早期治疗输尿管阴道瘘

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.     

FasL基因表达对缺氧状态下直肠癌细胞增殖凋亡的影响

Objective To elucidate the effect of FasL gene expression on the proliferation and apoptosis of hypoxic rectal carcinoma cells. Methods The normoxic expression level of FasL in HR-8348 subtype cells (HR-8348B, HR-8348L, HR-8348F and HR-8348As) with different invasive power were verified by Western blot. Hypoxia models for HR-8348B, HR-8348L, HR-8348F and HR-8348As were constructed with chemical modeling, then the FasL levels in all groups at 12 h after hypoxia were quantitated by Western blot. Distribution of different cell life cycles was determined with flow cytometry. Cell reproductive activities were detected with MTT method, and cell apoptesis was assessed with TUNEL. Results FasL protein was pigmentized at the position of 40 000 by Western blot, and the expression level of FasL was significantly higher in HR-8348F cells than those in HR-8348B, HR-8348L and HR-8348As cells(F=361.149, P<0.01) in normoxia. At 12 h after hypoxia, the FasL level was also significantly higher in HR-8348F cells than those in other groups (F=278.766, P<0.01), but was not markedly different as compared to themselves in normoxia (t=1.762, P>0.05). The proliferation index was significantly higher in HR-8348F (60.43±3.72) than those in HR-8348B (40.01±3.30), HR-8348L (41.30±4.06) and HR-8348As cells (35.87±4.39), respectively (F=39.477, P<0.01). However, both inhibition rate of proliferation and apoptotic index were remarkably lower in HR-8348F (17.30±1.98 and 13.10±1.04) than those in HR-834B (33.70±4.33 and 21.60±1.31), HR-8348L (34.20±3.92 and 20.10±1.15), and HR-8348As (38.00±4.55 and 23.90±1.23), respectively (F=28.811 and 76.462, respectively, P<0.01). Conclusion The expression enhancement of intracellular FasL in rectal carcinoma in hypoxia can lead to accelerated proliferation and reduced apeptosis of cells, which will promote tumor cells to adapt microenvironmental hypoxia.     

Residual fraction as a parameter to predict bladder outlet obstruction in men with lower urinary tract symptoms

Objectives:   To determine whether noninvasive tests including the residual fraction are reliable for the diagnosis of bladder outlet obstruction (BOO).
Methods:   A total of 212 men (median age 68, range 44–89 years) were included in the present study. The median serum prostate-specific antigen level and prostate volume were 1.3 ng/mL (range 0.2 to 9.4) and 37.9 mL (range 11.3 to 148.0), respectively.
Results:   Among the variables analyzed in the multivariate model, the likelihood of BOO varied by the total prostate volume, with a 3.6-fold higher odds for ≥40 mL than for <40 mL (odds ratio [OR], 3.616; 95% confidence interval [CI], 1.217–10.749; P  = 0.021). In the same model, a low maximal flow rate (Qmax) (OR, 2.840; 95% CI, 1.260–6.401; P  = 0.012) and high residual fraction (OR, 7.103; 95% CI, 1.924–26.225; P  = 0.003) were associated with an increased likelihood of BOO. The sensitivity and specificity for predicting BOO using a total prostate volume of 40 mL or greater were 73.7% and 65.2%, respectively. Using a Qmax cut-off of 12 mL/s or less for predicting BOO, the sensitivity and specificity were 77.2% and 54.2%, respectively. Prediction of the BOO by the residual fraction only had a sensitivity and specificity, for a residual fraction of less than 20%, of 75.4% and 67.7%, respectively.
Conclusions:   The presence or absence of BOO might be predicted using non-invasive methods. The residual fraction may help with patient management by better predicting the likely patient classification from pressure-flow studies.     

疏血通对肢体动静脉内瘘的保护应用

目的：探讨疏血通注射液促进肢体动静脉内瘘（AVF）术后成熟的疗效及治疗AVF血栓性阻塞的效果。方法：用疏血通注射液和香丹注射液于AVF手术后预防性治疗各50例,用疏血通注射液和尿激酶治疗AVF阻塞各20例,每日1次,7d为1疗程;对比AVF成熟情况、复通效果、透析时能达到的最大血流量及用药前后血液流变学改变。结果：疏血通促进AVF成熟良好率显著高于香丹（χ^2=4.336,P〈0.05）。疏血通与尿激酶对内瘘部分阻塞的复通效果相当,但对完全阻塞无效。疏血通和尿激酶治疗后血浆黏度值和纤维蛋白原均显著下降（P〈0.01）;而香丹注射液虽能改善血浆黏度值和红细胞聚集指数,但对纤维蛋白原无影响（P〉0.05）。结论：疏血通注射液能更好地促进肢体动静脉内瘘术后血管通路成熟,并能替代出血风险较大的尿激酶治疗AVF血栓形成致血管部分阻塞,可作为维护HD血管通路的常规治疗用药。     

利用shotgun蛋白组学策略鉴定健康生育男性精浆蛋白质

目的:鉴定正常生育男性的精浆蛋白质。方法:3例正常健康已生育的自愿者精液标本通过Percoll分离获取精浆,等量混合后在SDS-PAGE上进行分离,切胶取条带进行胶内酶解,抽提肽段后利用shotgun蛋白组学策略鉴定蛋白质。结果:正常生育男性精浆鉴定出331种蛋白质,相对分子质量范围8000～572068,等电点范围4.36～11.05;这些蛋白质按功能和生物进程归类,大致有51个(15.4%)运输蛋白质,11个(3.32%)细胞运动蛋白,63个(19.03%)信号转导蛋白质,147个(44.4%)蛋白酶及38个(11.5%)酶调节蛋白质,21个(6.3%)细胞凋亡蛋白,12个(3.62%)结构和支撑蛋白质,59个(17.8%)分子功能未知蛋白质。结论:shotgun蛋白组学策略是鉴定蛋白质的一个较好的方法。膜联蛋白及相关蛋白、Ras相关蛋白Rab是鉴定到的信号转导蛋白中的主要成员,因此推测钙离子和G蛋白信号通路是精子胞外信号传递到胞内的最重要途径,但是这些蛋白间的相互作用还不清楚。另外,精浆中鉴定到了大量的酶类,可能与维持精子活力和代谢有密切关系。