一氧化氮合酶对精索静脉曲张患者精子功能的影响

为探讨一氧化氮、一氧化氮合酶对精索静脉曲张（VC）患者精子功能的影响,本文测定15例VC不育患者外周静脉血清、精索静脉血清和精浆中一氧化氮（NO）及一氧化氮合酶（NOS）,并与12例有生育能力的对照组进行了对比研究。结果显示VC组精索静脉血清和精浆中NO含量及NOS活性,不仅高于其外周静脉血清（P＜0．01）,而且高于对照组（P＜0．01）,但两组外周静脉血清中两项指标无显著性差异（P＞0．05）。提示VC时可能是由于曲张精索静脉血和精浆中NOS的产生增加导致精子生成障碍或（和）精子活力下降,从而导致不育症。     

坚持化学烧伤研究特色立足临床技术创新

北京军区解放军第二五一医院是一家开展床位1300张的三级甲等医院,拥有1个国家医院运行机制研究基地、3个全军专科中心,其中全军烧伤中心为医院首家成立者.     

Incidence and risk factors for low trauma fractures in men with prostate cancer

BACKGROUND: Men with prostate cancer on androgen deprivation therapy (ADT) are at increased risk of bone loss. The present study sought to determine the incidence of low trauma fracture in men with prostate cancer (PC), and to characterize the association between potential risk factors and fracture risk in these men. METHODS: In the prospective, population-based Dubbo Osteoporosis Epidemiology Study, 43 men aged 60+ years reported a history of prostate cancer; among whom, 22 men received ADT, and 21 men did not. Low-trauma fractures were ascertained between 1989 and 2004. Bone mineral density at the femoral neck (FNBMD), postural instability and lifestyle factors were obtained at baseline. RESULTS: Men with prostate cancer had significantly higher lumbar spine BMD than those without cancer (p=0.013). During the follow-up period, 15 men with prostate cancer had sustained a fracture, yielding the age-adjusted incidence of fracture among this group was 31.6 per 1000 person-years, which was greater than those without cancer (22.1 per 1000 person-years). The age-adjusted incidence of fracture was more pronounced among those with prostate cancer on ADT (40.2 per 1000 person-years). After adjusting for age, the increase in fracture risk among prostate cancer patients was associated with lower femoral neck BMD (hazard ratio [HR] per SD=1.8, 95% CI: 1.0-3.4) and increased rate of bone loss (HR 2.3, 1.2-4.6). CONCLUSIONS: Men with prostate cancer, particularly those treated with ADT, had an increased fracture risk. Although the average BMD in men with prostate cancer was higher than men without cancer, a low BMD prior to treatment or increased rate of bone loss after initiating ADT treatment was each a significant predictor of fracture in these.     

胆囊癌与mdr1基因的临床相关性研究

目的　研究多药耐药基因mdr1编码P 糖蛋白 (Pgp)和mRNA在原发性胆囊癌组织中的表达 ,分析其临床意义。方法　采用S P免疫组织化学方法和原位多聚酶链反应 (PCR)对 53例未化疗原发性胆囊癌和 1 2例胆囊炎存档石蜡包埋切片组织中Pgp、mdrlmRNA的表达进行检测。结果　 53例胆囊癌、1 2例胆囊炎组织中Pgp和mdrlmRNA阳性表达率分别为 60 .38%、71 .69%和 2 5 .0 0 %、33 .33 %。两组mdrl基因表达差异有显著性 (P <0 .0 5)。胆囊癌组织中的Pgp和mdrlmRNA阳性率在胆囊癌Nevin分期Ⅰ、Ⅱ、Ⅲ期中为 69.44%和 83 .33 % ,Ⅳ、Ⅴ期为41 .1 8%和 47.0 6 % ;高、中分化为 69.2 3 %和 79.49% ,低、未分化为 35 .71 %和 50 .0 0 %。胆囊癌Nevin分期Ⅰ～Ⅲ和高中分化mdrl基因表达明显高于Nevin分期Ⅳ、Ⅴ及低未分化胆囊癌组织 (P<0 .0 5)。结论　胆囊癌多药耐药性与其内源性耐药密切相关 ,检测mdrl基因为逆转耐药提供依据。mdrl基因表达与胆囊癌部分生物学特性相关 ,mdrl基因可能参与癌肿的发生 ,mdrl基因有望作为胆囊癌独立预后的生物学指标     

轮廓线切口入路行唇裂术后畸形整复术

目的 探寻一种功能和外观满意，要后上唇不再遗留或减少手术瘢痕的唇裂术后畸形整复方法。方法 采用复唇沟、唇红缘等轮廓线切口入路，于皮下进行唇裂术后畸形功能性整复。结果 应用该法行手术15例，其中双侧唇裂术后畸形4例，单侧唇裂术后11例，经6个月至2年随访，功能、外观均达到满意的效果。结论 该法一改传统的唇裂术后畸形整复方法，彩和轮廓线切口入路，术后手术瘢痕不明显；皮下充分松解，使原手术瘢痕明显淡化、平整；口轮匝肌从其不正常的附着处分离，恢复肌肉正常走向和功能，重建口轮匝肌环；调整鼻翼软骨、重塑鼻翼软骨，使唇裂鼻恢复正常。从而使患者的诸多畸形在功能和外观上均获得满意的效果。     

粉防己碱对瘢痕成纤维细胞活性功能的影响

目的　观察粉防己碱对体外培养的巨噬细胞介质介导瘢痕成纤维细胞活性功能的调控作用 ,并探讨其在瘢痕防治中的意义。方法　取 5例手术切除的人增生性瘢痕组织标本行瘢痕成纤维细胞体外培养 ,于传代培养至第 4代的成纤维细胞 (5× 10 4)中分组加入巨噬细胞介质、粉防己碱继续培养 ,然后分别用3 H TdR和3 H 脯氨酸脉冲标记 ,放射性核素液闪烁仪定量检测各组3 H TdR和3 H 脯氨酸掺入值。并采用三维培养方法测定体外模拟瘢痕样组织的收缩指数变化。结果　粉防己碱 3mg/L不抑制细胞DNA合成时 ,即可明显减少瘢痕成纤维细胞 3 H 脯氨酸掺入值 ,由对照组的 94 5± 191减少至6 82± 2 0 5 (P <0 .0 5 ) ;并能显著降低巨噬细胞介质介导的瘢痕成纤维细胞3 H TdR掺入值和3 H 脯氨酸掺入值 ,由单纯介质组的 2 75 6± 2 4 4、1384± 2 93分别降低至 194 8± 2 82、10 34± 14 2 (均P <0 .0 1)。粉防己碱 1mg/L即可降低体外瘢痕样组织的收缩指数 (P <0 .0 1)。结论　粉防己碱对体外培养的巨噬细胞介质介导瘢痕成纤维细胞增殖、胶原合成以及收缩三方面具有抑制效应 ,可望在增生性瘢痕的防治中发挥重要作用。     

肝细胞癌合并肝硬化患者肝切除联合脾切除的临床意义探讨

目的探讨肝细胞癌合并肝硬化患者肝癌切除时联合脾切除的临床意义。方法将我科收治肝癌合并肝硬化患者分成 2组 ,即切脾组 (11例 )和保脾组 (15例 ) ,比较 2组患者手术前后肝功能与血象改变。结果切脾组术后 14d白细胞和血小板计数分别为 (8 9± 1 6 )× 10 9/L、(310±32 )× 10 9/L ,明显高于保脾组 (3 7± 1 4 )× 10 9/L和 (10 4± 4 1)× 10 9/L(P <0 0 1)。术后第 7天切脾组血清总胆红素为 (2 4± 7) μmol/L ,低于不切脾组 (37± 13) μmol/L ,P <0 0 5。 2组间术后并发症发生率差异无显著意义。结论肝细胞癌合并肝硬化患者肝癌切除时联合脾切除提高白细胞和血小板计数 ,减轻术后肝脏胆红素代谢负担 ,但术后并发症发生率并未明显增加     

氯化镧对烫伤鼠肠道细菌移位的防治研究

目的　探讨氯化镧对烫伤鼠肠道细菌移位的作用及其机制。　方法　SD大鼠分为正常对照组 (A)、烧伤对照组 (B)及烧伤治疗组 (C) ,每组 30只。采用PUC19质粒转染大肠杆菌示踪加限制性内切酶指纹图谱分析法 ,对肠道菌向肠系膜淋巴结 (MLN)及血液中的播散进行示踪及定量研究。　结果　阳性菌落经酶切图谱分析后 ,证实B、C组MLN匀浆及血液培养生长细菌与灌胃的细菌具有完全相同的酶切图谱 ;C组MLN菌量在伤后 3、5d低于B组 (P <0 .0 5 )。C组血细菌阳性率在伤后 3d低于B组 (P <0 .0 5 )。C组血ET、NO及NOS量在伤后 1、3、5d均低于B组 (P <0 0 1)。C组肠组织MDA量在伤后 1、3、5d低于B组 (P <0 .0 1) ,C组肠组织SOD量在伤后 1、3d高于B组 (P<0 .0 5 )。　结论　血和MLN培养出的细菌由肠道细菌移位而来 ;氯化镧能有效防治肠道细菌移位 ;氯化镧通过抗菌、降低血中的ET、抑制NOS的活性减少NO的生成、提高SOD的活性并使MDA的产生下降等途径减少肠道细菌移位。     

冠状动脉旁路移植术后旁路血管狭窄影响因素分析

目的总结冠状动脉旁路移植术(CABG)后旁路血管造影特点,分析相关因素对旁路血管通畅率的影响,并探讨提高旁路血管通畅率的方法。方法2004年4月至2006年4月间CABG术后平均间隔(46.4±39.1)个月,因心绞痛复发再入院行冠状动脉造影(CAG)病人149例,男120例;平均年龄(61.0±10.1)岁。共444支旁路血管,其中左乳内动脉(LIMA)131支,大隐静脉(SV)295支,左桡动脉(RA)15支,右乳内动脉(RIMA)3支。旁路血管造影完全闭塞或狭窄≥75%视为旁路血管病变。结果本组65.1%(97/149例)病人有旁路血管病变。31.1%(138/444支)旁路血管发生病变。LIMA闭塞5.3%(7/131支),狭窄(≥75%)6.9%(9/131支);SV旁路血管闭塞31.9%(94/295支),狭窄7.5%(22/295支);RA旁路血管闭塞33.3%(5/15支);RIMA旁路血管闭塞33.3%(1/3支)。LIMA旁路血管的通畅率明显优于SV。不同靶血管的SV旁路血管通畅率有明显差别。吻合口以远冠状动脉口径(runoff)≥2.0 mm的旁路血管通畅率明显高于<2.0mm者,尤其是SV旁路血管。近端冠状动脉狭窄程度对LIMA-前降支的通畅率影响明显,而对主动脉-SV-后降支通畅率影响不明显。序贯吻合及非体外循环CABG对旁路血管通畅率无明显影响。结论CABG术后旁路血管病变比较常见,是造成术后心绞痛复发的重要原因。不同旁路血管、不同靶血管、runoff大小、近端冠状动脉狭窄程度均明显影响旁路血管通畅率。手术技术不当是术后早期旁路血管病变的主要原因。改进手术技术,术后早期足量抗血小板药物及强化降脂治疗是提高旁路血管通畅率的关键。     

The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia

BACKGROUND/OBJECTIVE: For persons with spinal cord injury (SCI), severe bodily pain is related to a lower quality of life. However, the effect of pain from a specific body region on quality of life has yet to be determined. The shoulder joint is a common site of pain among persons with SCI. Therefore, our purpose was to identify the relationship of self-reported shoulder pain with quality of life, physical activity, and community activities in persons with paraplegia resulting from SCI. METHODS: Eighty participants with shoulder pain who propel a manual wheelchair (mean age: 44.7 years; mean duration of injury: 20 years; injury level T1-L2) completed the following questionnaires: Wheelchair User's Shoulder Pain Index, Subjective Quality of Life Scale, Physical Activity Scale for Individuals with Physical Disabilities, and Community Activities Checklist. Correlations between shoulder pain scores and quality of life, physical activity, and community activities were determined using Spearman's rho test. RESULTS: Shoulder pain intensity was inversely related to subjective quality of life (r(s) =-0.35; P= 0.002) and physical activity (r(s) = -0.42; P < 0.001). Shoulder pain intensity was not related to involvement in community activities (r(s) = -0.07; P = 0.526). CONCLUSIONS: Persons with SCI who reported lower subjective quality of life and physical activity scores experienced significantly higher levels of shoulder pain. However, shoulder pain intensity did not relate to involvement in general community activities. Attention to and interventions for shoulder pain in persons with SCI may improve their overall quality of life and physical activity.