儿童专科医院日间手术标准化管理

目的探索儿童专科医院日间手术标准化管理实施的方法和效果。方法在上海儿童医学中心设计应用小儿日间手术操作标准并评估相关资料,包括实施病种、人数、疗效及满意度等。结果在2007年11月至2008年12月期间,参加日间手术人数达2091人。经过测评,患儿家长对日间手术总体满意,其中对手术的安全性和手术疗效很满意,相关医护人员的满意度有所提高。结论儿童专科医院开展日间手术具有显著的优点,不但可以节约巨大的医疗资源,也符合当前医疗改革的目标。标准化的运作是提高日间手术内涵质量、保证医疗安全、获得社会满意的重要手段。     

Central modulation of pain

It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for "top-down" modulatory circuits that profoundly change the sensory experience of pain.     

The role of hypofractionation radiotherapy for diffuse intrinsic brainstem glioma in children： a pilot study

PURPOSE： Most children with a diffuse intrinsic brainstem glioma will die within 1 year after diagnosis. To reduce patient burden, we investigated the feasibility of a radical hypofractionation radiotherapy schedule, given over 3 weeks, as an alternative to the standard regimen （30 fractions over 6 weeks）. METHODS AND MATERIALS： Nine children, ages 3-13, were treated by 13 fractions of 3 Gy （n = 8） or 6 fractions of 5.5 Gy （n = 1） given over 3 weeks. All patients had symptoms for ≤3 months and ≥2 signs of the neurologic triad （long tract signs, ataxia, cranial nerve deficit）. Bilateral involvement of the pons （n = 8）, encasement of the basilar artery （n = 7） and extension into the eerebellar peduncle （n = 6） was visible on magnetic resonance imaging.     

Axillary nodal metastasis and resection margins as predictors of Loco Regional Recurrence in Breast Cancer Patients

BackgroundSurgical resection margins (RM), axillary nodal involvement and lymph node ratio (LNR) determine loco-regional control (LRC) in breast cancer management. Late presentation precludes breast conservation therefore surgical option is usually mastectomy and adjuvant chemoradiation minimize loco-regional recurrence (LRR).ObjectiveWe investigated the prognostic role of lymph nodes positive for malignancy (pN), LNR and RM on LRR of breast cancer in a tertiary hospital in Ibadan, Nigeria.MethodsLongitudinal cohort study of 225 females with breast carcinoma managed and followed up for 5-years with end point of LRR or not. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with LRR. The receiver-operator curve was plotted to determine the proportion of metastatic lymph nodes which predicted LRR.ResultsNinety-nine percent had modified radical mastectomy and 163 (72.4%) had negative resection margins. A mean of 11 axillary lymph nodes were harvested at surgery. The age, positive resection margin and number of harvested nodes with malignant cells are associated with LRR. The overall 5-year LRR rate was 16%.ConclusionLRR is dependent on lymph node involvement as well as and tumor aggressiveness.     

RAR-β2 基因在乳腺肿瘤组织中的表达及意义*

目的:检测视黄酸受体β 2（RAR-β 2）基因在不同乳腺肿瘤组织中的表达,探讨RAR-β 2 基因与乳腺肿瘤的关系,分析其在乳腺癌发生、发展中的作用。方法:免疫组织化学法检测乳腺浸润性癌、导管上皮重度不典型增生、腺纤维瘤各40例及20例正常乳腺组织中RAR-β 2 的表达情况。RT-PCR 法检测乳腺浸润性癌、导管上皮重度不典型增生、腺纤维瘤及正常乳腺组织各20例RAR-β 2 的表达水平。结果:免疫组化结果显示,RAR-β 2 阳性表达主要位于细胞核,RAR-β 2 蛋白在乳腺浸润癌组织中阳性表达率（30.0%）明显低于正常乳腺组织（95.0%）,χ2=26.30,P<0.05。RAR-β 2 蛋白在乳腺重度不典型增生组织中阳性表达率（17.5%）低于乳腺癌组织,但差异无统计学意义（P>0.05）。 在乳腺浸润性癌组织中,RAR-β 2 表达与患者年龄、肿瘤大小、临床分期、腋下淋巴结转移状况、组织学分级、病理学类型以及ER、PR表达状况无相关性（P 均>0.05）。 随访结果显示,28例RAR-β 2 阴性乳腺癌患者中3 例发生内脏转移,而12例RAR-β 2 阳性患者仅1 例发生骨转移。RT-PCR 结果显示,RAR-β 2 在乳腺癌、导管上皮重度不典型增生、腺纤维瘤及正常乳腺组织中阳性表达率分别为25.0%（5/20）、35.0%（7/20）、85.0%（17/20）和100%（20/20）,乳腺癌组织RAR-β 2 mRNA 明显低于正常乳腺组织（χ2=30.43,P<0.001）。 结论:RAR-β 2 可能在乳腺癌的发生过程中发挥抑制作用,并且可能在乳腺癌发生的早期发挥作用。      

血小板活化、炎症反应与冠心病的关系

目的：通过比较冠心病（CAD）患与健康正常人血小板表面膜蛋白颗粒（GMP－140）,假血友病因子（vWF),血浆C－反应蛋白（CRP）浓度的变化,探讨血小板活化,炎症反应在CAD发病中所起的作用。方法：对25例急性心肌梗死（AMI）和38例不稳定型心绞痛（UAP）患进行血浆GMP－140,vWF,CRP测定。结果：AMI和UAP患血浆GMP－140,vWF,CRP明显升高,GMP－140,vWF,CRP与AMI和心绞痛缺血面积呈正相关,结论：血小板活化,炎症反应参与CAD的发病,血小板活化与炎症反应的程度可判断预后。     

Ion Channels and Migraine

Migraine is one of the most common neurological disorders. Despite its prevalence, the basic physiology of the molecules and mechanisms that contribute to migraine headache is still poorly understood, making the discovery of more effective treatments extremely difficult. The consistent presence of head‐specific pain during migraine suggests an important role for activation of the peripheral nociceptors localized to the head. Accordingly, this review will cover the current understanding of the biological mechanisms leading to episodic activation and sensitization of the trigeminovascular pain pathway, focusing on recent advances regarding activation and modulation of ion channels.     

Myocardial Coagulation by Intraoperative Nd:YAG Laser Ablation and Its Dependence on Blood Perfusion

To investigate whether the efficacy of intraoperative laser ablation therapy is affected by myocardial blood perfusion, we irradiated 11 canine hearts through the epicardium with a Nd:YAG laser (10, 20. and 30 J/mm²) using air as the medium. Compared coagulated myocardial depth, width, and volume obtained in the red beating heart was compared with those in the white nonbeating heart infused with CC saline (cardioplegic model) via the coronary artery. Histologically, the macro- and microscopical findings were very similar. At each level of energy, the width and volume of red myocardium coagulated were significantly larger than those of white myocardium (P < 0.01). At 30 J/mn², the depth of coagulation of red myocardium was significantly larger than that of white myocardium (P < 0.01). The coagulated volume of the white myocardium was about 60% of that of the red myocardium. NdiYAG laser energy was absorbed by blood (red color = hemoglobin), and more energy was transferred in the higher temperature myocardium. During intraoperative Nd:YAG laser ablation, the presence of blood perfusion in cardiac tissue is thought to be an important factor affecting safe irradiation.