全肺切除术治疗肺癌的临床分析

目的 :探讨全肺切除术和经心包内处理血管的全肺切除术治疗肺癌的效果。方法 :对 74例Ⅱb～Ⅲb期肺癌患者行全肺切除术 ,其中 32例在肺癌的全肺切除术中进行了心包内处理血管 ,其余 4 2例行标准全肺切除术。结果 :心包内处理血管组与标准切除组术后各有 1例并发脓胸 ,其中心包内处理血管组的并发脓胸者死亡。术后两组分别随访 2 2例和 31例 ,5年生存率分别为 18.1%和 16 .1%。经心包内处理血管的全肺切除与标准全肺切除术患者 5年生存率和术后并发症发生率差异均无显著性 (P =1.0 0 0和P >0 .0 5 )。结论 :全肺切除术中力争达到根治 ,经心包内处理血管技术的应用 ,对于提高患者的生存率、改善晚期肺癌的生活质量是有价值的     

Improved documentation of wound care with a structured encounter form in the pediatric emergency department.

OBJECTIVE: Accurate and complete documentation may enhance reimbursement and compliance with financial intermediary regulations, protect against litigation, and improve patient care. We measured the effect of introduction of a structured encounter form on the completeness of documentation of pediatric wound management in a teaching hospital. METHODS: The Children's Hospital Emergency Department introduced a structured encounter form for use in the documentation of wound care in place of the existing free-text dictation method. Attending physicians and trainees, all unaware of the study, had the option of using the form in place of free-text dictation for patients with lacerations requiring closure. We abstracted 100 consecutive free-text dictations from patients treated before the form's introduction. Following a 3-month run-in period, we abstracted 100 consecutive structured wound records. We compared the 2 chart types for completeness of documentation based on 20 predetermined criteria relevant to pediatric wound care. RESULTS: Overall completeness of documentation improved with structured forms (80% vs 68% for free text, P < .001), with significant improvements in 6 of 20 individual criteria. Trainees demonstrated improvement in documentation with the structured form, with the greatest improvements among senior-level residents. Documentation of the general physical examination worsened with structured charting. DISCUSSION: In an academic pediatric emergency department, the use of a structured complaint-specific form improved overall completeness of wound-care documentation. Structured encounter forms may provide for more standardized documentation for a variety of pediatric chief complaints, thereby facilitating communication and ultimately transition to template-driven systems in anticipation of an electronic medical record.     

噪声对人体心血管系统影响的动态观察

目的对长期接触噪声与心血管的关系作初步相关分析,并提出预防策略。方法以某厂221例噪声超过85分贝的作业场所职工列为暴露组,85分贝以下的行政、机关、科室及其他车间320例作业者列为非暴露组。对两组听力及心电图进行长期跟踪观察。结果长期接触噪声作业者,心电图指数明显高于非暴露组,两组比较差异有显著性(P<0.05),随着工龄年份的增加,心血管损害有增加趋势。结论证实噪声对心血管损害有一定相关性,为预防噪声提供依据,并提出可行性预防建议。     

Comparison of redox and D29 phage methods for detection of isoniazid and rifampicin resistance in Mycobacterium tuberculosis

Rapid, accurate and inexpensive methods are essential to detect drug-resistant Mycobacterium tuberculosis and allow timely application of effective treatment and precautions to prevent transmission. The proportion method, the MTT and Alamar Blue redox methods, and the D29 mycobacteriophage assay, were compared for their ability to detect resistance to isoniazid and rifampicin. When tested against a panel of known M. tuberculosis strains, the redox methods and the D29 assay showed good sensitivity and specificity compared to the proportion method, suggesting that they could be useful alternatives for identifying multidrug resistance in M. tuberculosis.     

Analysis of the inflammatory response in endovascular treatment of aortic aneurysms.

OBJECTIVE: The objective of this study is to evaluate the inflammatory response caused by endovascular stents in the treatment of aortic aneurysms. METHODS: Twenty-five patients underwent endovascular stent treatment from March through December 2005. The evolution of mediators (sedimentation velocity, C reactive protein, interleukin-6, interleukin-8, tumor necrosis factor-alpha, intercellular adhesion molecule-1, l-selectin), inflammatory cells (leukocytes, lymphocytes, platelets), serum creatinine and body temperature within preoperative period and in the following postoperative periods--1, 6, 24 and 48 h, 7 days, 1-3 months, was analyzed. In order to achieve statistic significance, Friedman test and Wilcoxon test were used, with index of significance of 5% (p<0.05). RESULTS: Peak values of sedimentation velocity, C reactive protein and interleukin-6 were observed at 7 days (p<0.0001), 48 h (p<0.0001) and 24h (p<0.0001), respectively. Tumor necrosis factor-alpha and interleukin-8 did not show statistically significant variability during the entire follow-up. In terms of intercellular adhesion molecule-1 and l-selectin, their expressive values were found in late phase of follow-up, although without statistical significance. Elevation of leukocytes count occurred in premature phase of follow-up (p<0.0001), while lymphocyte and platelet count occurred in a late phase of follow-up (p<0.0001). Serum levels of creatinine did not show significant variability during follow-up. The period between 24 and 48 h corresponded to major frequency for fever (p<0.0001). CONCLUSION: Individual mediators analysis and inflammatory cells demonstrated variability of their values during postoperative follow-up. This could help in the analysis of the inflammatory response evolution caused by endovascular stent treatment for aortic aneurysms in premature and late phases after implantation of the vascular prosthesis.     

Skin cancers and precancerous lesions in Parkinson's disease patients.

Our objective was to evaluate the frequency of neoplastic and preneoplastic skin lesions in Parkinson's disease (PD) patients when compared with an aged-matched population. We performed a cross-sectional survey in PD patients and in an age-matched control group. Patients and controls were examined by a movement disorder specialist and a dermatologist. 150 PD patients and 146 controls were included. Thirty-five PD patients (23.3%) presented skin lesions that could be classified as neoplastic or preneoplastic vs. 20 subjects in the control group (13.7%) (OR 95%, CI 1.92 [1.05, 3.51]). However, this difference lost statistical significance when adjusted for gender (recruitment of controls was matched just for age with an over representation of males in the PD group). Twenty-nine PD patients (19%) presented actinic keratosis and basal cell carcinoma was diagnosed in 4 patients (3%). Although nonconclusive, our results are in agreement with previous studies suggesting an increased risk of skin cancer in PD patients. The frequency of actinic keratosis in PD patients and the associated risk to develop melanoma recommends its screening in future epidemiological studies.     

Amyloid fibril formation by human stefin B: influence of pH and TFE on fibril growth and morphology.

As shown before, human stefin B (cystatin B) populates two partly unfolded species, a native-like state at pH 4.8 and a structured molten globule state at pH 3.3 (high ionic strength), from each of which amyloid fibrils grow. Here, we show that the fibrils obtained at pH 3.3 differ from those at pH 4.8 and that those obtained at pH 3.3 (protofibrils) do not transform readily to mature fibrils. In addition we show that amorphous aggregates are also a source of fibrils. The kinetics of amyloid fibril formation at different trifluoroethanol (TFE) concentrations were measured. TFE accelerates fibril growth at predenaturational concentrations of the alcohol. At concentrations higher than 10%, the fibrillar yield decreases proportionately as the population of an all alpha-helical, denatured form of the protein increases. At an optimum TFE concentration, the lag and the growth phases are observed, similarly to some other amyloidogenic proteins. Morphology of the protein species at the beginning and the end of the reactions was observed using atomic force microscopy and transmission electron microscopy. Final fibril morphologies differ depending on solvent conditions.     

乳腺病变X线立体定位钢丝置入移位的分析

目的分析乳腺立体定位下钢丝置入移位的表现、原因、处理方法，提高术前定位的准确性。方法行立体定位置入钢丝患者79例，96个病变，发生钢丝移位13例。结果立体定位中发生钢丝移位5例，原因分别来自于患者和操作医师；立体定位完成后钢丝移位5例，原因是局麻注射药物过多，导致乳腺Z轴的深度与计算机提示的实际深度不符合、放置定位针的方法不正确、拔出钢丝外套针套时疏忽钢丝是否已锚定病变。处理方法：可按照钢丝提示位置向病变方向移位2cm以内进行手术，重新放置第2根钢丝，将双J型钢丝收入针套并取出体外，重新定位。手术中钢丝脱出2例，因术后过分提拉钢丝所致，放射科医师放置钢丝后应向外科医师准确描述深度、方向，并从距离钢丝头端距离皮肤最近处取切口手术。术后标本未见钙化1例，与钙化位于手术电刀破坏的腺体内有关，可扩大范围切除并短期复查，证实钙化是否完整切除。结论正确认识乳腺X线立体定位下钢丝移位的表现，熟练掌握其处理方法，可提高对不可触及的乳腺病变的定位准确性，正确引导外科手术。     

注射自体成纤维细胞除皱的临床应用

目的观察体外培养的自体成纤维细胞注射的面部除皱临床效果,探讨其在面部年轻化治疗中的意义。方法取10例睑袋及上睑松弛手术切除的皮肤行体外培养,细胞数量扩增至108后注射入面部不同治疗部位皮肤的真皮深层,共注射3次,每次间隔2周。结果10例随访6~12月,各例皱纹均得到明显改善,未出现免疫排斥、肉芽肿等并发症。结论应用培养的自体成纤维细胞注射去除面部浅表皱纹,治疗过程简便、创伤微小、安全、效果确实,是一种较好地填充除皱方法。由于尚缺乏更长期的随访结果,远期疗效还有待进一步观察。