动静脉结合给药的FLEEOX方案对以淋巴结转移为主晚期胃癌的新辅助化疗

动静脉结合给药的FLEEOX新辅助化疗对于以淋巴结转移为主的晚期胃癌具有较好的疗效,动静脉不同的给药途径是提高胃癌新辅助化疗疗效的一种办法.     

32例腔镜下乳腺癌腋窝淋巴结清扫术临床分析

目的 探讨腔镜下乳腺癌腋窝淋巴结清扫手术方法、可行性及临床效果.方法 回顾性分析32例乳腺癌腔镜下腋窝淋巴结清扫手术(腔镜组)的临床资料,并与46例同期临床分期类似而行传统腋窝淋巴结清扫(传统组)资料比较.结果 两组均为Ⅰ～Ⅱ期乳腺癌.腔镜组无中转开放手术,未发生大出血、皮下气肿、脂肪栓塞等并发症.腔镜组淋巴结数目(15.5枚)、平均手术时间(80min)与传统组比较差异均无统计学意义.但缩短了引流时间(3～5d)、减少了出血量(380ml)和术后并发症发生率(仅1例).结论 在选择性乳腺癌患者行腔镜下腋窝淋巴结清扫术能够达到传统腋窝淋巴清扫治疗效果,可在保证腋窝淋巴结清扫质量的同时降低手术并发症发生率,达到了生理、心理的微创化,提高了患者的生活质量.腔镜下腋窝淋巴结清扫术是可行的.     

甲状腺术中喉返神经解剖显露的临床意义

目的 探讨甲状腺术中喉返神经(RLN)的解剖特点及探查方法,以减少神经损伤.方法 回顾性分析327例甲状腺手术的临床资料.常规显露RLN 242例(293条),不显露RLN 85例,并对RLN解剖特点、损伤情况和预防进行分析.结果 显露RLN者暂时性损伤率为1.65%(4/242),无永久性损伤;未显露者暂时性损伤率为8.23%(7/85),永久性损损伤率为2.35%(2/85),两组暂时性损伤率之间和永久性损伤率之间差异均有统计学意义(P＜0.05).67.23%(197/293)的RLN在入喉前分为前后两支,61.09%(179/293)的RLN位于甲状腺下动脉的深面,31.39%(92/293)位于动脉的浅面,4.09%(12/293)穿行于动脉的分叉处,4.13%(10/293)与动脉无关,"非返性喉下神经"的发生率为0.68%(2/293).结论 RLN的行程过程中解剖关系较为复杂,甲状腺手术中有计划地显露RLN可以预防其损伤.     

慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

杭州地区2例甲型H1N1流感患者抵触心理的疏导

甲型H1N1流感是由变异后的甲型H1N1流感病毒引起的急性呼吸道传染病。2009年5月30日，杭州市第六人民医院收治浙江省首例甲型H1N1流感患者，6月14日收治第2例。由于是浙江省较早发现的甲型H1N1流感患者，受到相关媒体高度关注。2例患者在隔离期间均出现极强的抵触心理，不配合隔离及医护治疗，但经护理人员积极、耐心的心理疏导后，不良情绪有所改善，主动配合检查，接受治疗，一周后顺利出院。     

腹腔内促纤维增生性小圆细胞肿瘤CT表现与组织病理学对照分析

目的初步探讨腹腔内促纤维增生性小圆细胞肿瘤的CT表现,并与组织病理学进行对照分析。方法搜集4例经手术病理及免疫组化证实的腹腔内促纤维增生性小圆细胞肿瘤,均行螺旋CT平扫及动态增强扫描,回顾性分析其CT表现,并与手术病理对照。结果 4例腹腔内促纤维增生性小圆细胞肿瘤,均表现为腹腔、盆腔多发无明确器官来源的软组织肿块.CT平扫密度不均匀,增强扫描表现为轻中度不均匀强化,并以边缘强化为主,2例肿瘤内多发斑点状钙化.3例腹膜多发种植转移.3例肝脏转移,3例腹膜后多发淋巴结转移,2例少量腹腔积液。结论腹腔内促纤维增生性小圆细胞肿瘤CT平扫及增强扫描有一定特征性,男性青少年出现腹盆腔多发无明确器官来源的软组织肿块,应考虑到本病的可能。     

腹部及盆腔孤立性纤维瘤的CT诊断

目的探讨腹部及盆腔孤立性纤维瘤(SFT)的CT征象,进一步提高对本病的认识。方法回顾性分析11例经手术病理证实的腹部及盆腔孤立性纤维瘤的CT表现。结果 11患者中,6例发生于腹部,5例发生于盆腔,肿瘤大小在4.6cm×4.0cm×3.0cm～10cm×14cm×21.3cm之间,9例病变呈类椭圆形,2例呈不规则形,10例病变边缘清楚,1例病变边缘不清,其中2例盆腔肿瘤带蒂。CT平扫4例呈均匀稍低密度,7例呈等低混杂密度,其中2例病变内见点状钙化影,增强扫描3例病变呈明显均匀强化,8例呈不均匀性强化,其中3例患者在中度及明显强化肿块内见散在轻度强化斑片状及纵形索条状影,5例病变在动脉期呈轻度-明显不均匀强化,门脉期肿块实质部分进一步强化,内见线条状、斑片状及片状无强化区,肿块内及周围见增粗、迂曲血管影。结论腹部及盆腔孤立性纤维瘤的CT表现有一定的特征性,但最后确诊仍需结合病理学及免疫组织化学。     

Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: analysis of the lateral meniscus

Purpose

To evaluate whether medial open wedge high tibial osteotomy (HTO) results in structural and biochemical changes in the lateral meniscus in adult sheep.

Methods

Three experimental groups with biplanar osteotomies of the right proximal tibiae were tested: (a) closing wedge HTO resulting in 4.5° of tibial varus, (b) open wedge HTO resulting in 4.5° of tibial valgus (standard correction) and (c) open wedge HTO resulting in 9.5° of valgus (overcorrection), each of which was compared to the contralateral knees with normal limb axes. After 6 months, the lateral menisci were macroscopically and microscopically evaluated. The proteoglycan and DNA contents of the red–red and white–white zones of the anterior, middle and posterior third were determined.

Results

Semiquantitative macroscopic and microscopic grading revealed no structural differences between groups. The red–red zone of the middle third of the lateral menisci of animals that underwent overcorrection exhibited a significant 0.7-fold decrease in mean DNA contents compared with the control knee without HTO (P = 0.012). Comparative estimation of the DNA and proteoglycan contents and proteoglycan/DNA ratios of all other parts and zones of the lateral menisci did not reveal significant differences between groups.

Conclusion

Open wedge HTO does not lead to significant macroscopic and microscopic structural changes in the lateral meniscus after 6 months in vivo. Overcorrection significantly decreases the proliferative activity of the cells in the red–red zone of the middle third in the sheep model.     

脊髓损伤后急性期醛糖还原酶的表达变化

目的研究醛糖还原酶(AR)在脊髓损伤(SCI)组织中的表达特点,并探索其与SCI的相关性,以期为脊髓损伤修复提供新的干预靶点及治疗途径。方法健康成年SD大鼠150只,用随机数字法分为3组:假手术对照组(Sham组,n=50只),脊髓损伤组(SCI组,n=50只),脊髓损伤+醛糖还原酶抑制剂(唐林,即依帕司他)干预组(ARI组,n=50只)。sham组只做T9、T10椎板切除术,SCI组和ARI组采用改良Allen法制备大鼠脊髓损伤模型。将大鼠分别于术后第3、12、24、48、72h处死切取以受伤节段为中心约8mm长的脊髓组织,行苏木精-伊红(HE)染色观察局部炎症反应,并用免疫组化、双抗体夹心法、逆转录-聚合酶链反应(RT-PCR)和蛋白免疫印迹(Western-Blot)检测AR表达。结果在各组术后的相应时间点,SCI组和ARI组可见到醛糖还原酶在神经元、星形胶质细胞内均有较明显分布;SCI组AR含量明显高于Sham组和ARI组(P<0.05);SCI组醛糖还原酶mRNA表达明显高于Sham组和ARI组(P<0.05)。结论脊髓损伤后AR表达增高,其含量变化与脊髓损伤程度有一定的相关性。     

密闭环境中悬浮颗粒物上附着微生物的检测

目的 分析检测密闭环境中县浮颗粒物上附着微生物的种类及数量。为航天器舱内大气污染的控制和监测提供参数依据。方法 依据Ｕ．Ｓ．Ａ ＥＰＡ ＩＰ－１０方法,在密闭环境中用大流量冲击式采样器分３级连续采样,颗粒物的空气动力学直径（ＡＤ）分别为：１００μｍ≥ＡＤ〉１０μｍ、１０μｍ≥ＡＤ〉２μｍ及ＡＤ≤２μｍ。选择室外较洁净空气以同样方法采样作为对照。对采集的颗粒物精密称量。分别培养颗粒物上的吸附微生物,