手术结及打结方法的规范与进展

打结是手术的最基本技术之一，主要包括结扎打结（结扎血管、胆管、淋巴管等）、固定打结（固定引流管、引流条等）及缝合打结。手术不论大小都不能不做许多重复的打结动作，学习手术技术正是从学打结、练打结开始的。由于打结的操作太习以为常，许多手术医生对打结不够重视，对各种手术结并没有一个全面的了解和认识，甚至每日都在重复着不规范的打结操作。手术打结操作是否正确、熟练程度如何等不仅体现了手术医生的基本素质，而且直接关系到手术的效果，甚至关系到病人的安危。     

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.     

Angiopoietin1/Tie2 and VEGF/Flk1 induced by MSC treatment amplifies angiogenesis and vascular stabilization after stroke.

Bone marrow stromal cells (MSCs) increase vascular endothelial growth factor (VEGF) expression and promote angiogenesis after stroke. Angiopoietin-1 (Ang1) and its receptor Tie2 mediate vascular integrity and angiogenesis as does VEGF and its receptors. In this study, we tested whether MSC treatment of stroke increases Ang1/Tie2 expression, and whether Ang1/Tie2 with VEGF/ vascular endothelial growth factor receptor 2 (VEGFR2) (Flk1), in combination, induced by MSCs enhances angiogenesis and vascular integrity. Male Wistar rats were subjected to middle cerebral artery occlusion (MCAo) and treated with or without MSCs. Marrow stromal cell treatment significantly decreased blood-brain barrier (BBB) leakage and increased Ang1, Tie2, and occludin (a tight junction protein) expression in the ischemic border compared with MCAo control. To further test the mechanisms of MSC-induced angiogenesis and vascular stabilization, cocultures of MSCs with mouse brain endothelial cells (MBECs) or astrocytes were performed. Supernatant derived from MSCs cocultured with MBECs significantly increased MBEC expression of Ang1/Tie2 and Flk1 compared with MBEC alone. Marrow stromal cells cocultured with astrocytes also significantly increased astrocyte VEGF and Ang1/Tie2 expression compared with astrocyte culture alone. Conditioned media from MSCs alone, and media from cocultures of MSCs with astrocytes or MBECs, all significantly increased capillary tube-like formation of MBEC compared with control Dulbecco's modified Eagle's medium media. Inhibition of Flk1 and/or Ang1 significantly decreased MSC-induced MBEC tube formation. Knockdown of Tie2 expression in MBECs significantly inhibited MSC-induced tube formation. Our data indicate MSC treatment of stroke promotes angiogenesis and vascular stabilization, which is at least partially mediated by VEGF/Flk1 and Ang1/Tie2.     

EEG source imaging: correlating source locations and extents with electrocorticography and surgical resections in epilepsy patients.

SUMMARY: It is desirable to estimate epileptogenic zones with both location and extent information from noninvasive EEG. In the present study, the authors use a subspace source localization method (FINE), combined with a local thresholding technique, to achieve such tasks. The performance of this method was evaluated in interictal spikes from three pediatric patients with medically intractable partial epilepsy. The thresholded subspace correlation, which is obtained from FINE scanning, is a favorable marker, which implies the extents of current sources associated with epileptic activities. The findings were validated by comparing the results with invasive electrocorticographic (ECoG) recordings of interictal spike activity. The surgical resections in these three patients correlated well with the epileptogenic zones identified from both EEG sources and ECoG potential distributions. The value of the proposed noninvasive technique for estimating epileptiform activity was supported by satisfactory surgery outcomes.     

改良W形回肠代膀胱术的疗效观察(附36例报告)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。     

论“恐伤”心理的基因定势表达

本文在基因定势表达研究概况基础上，列举0MIM上部分与恐惧等心理因素定势的基因与疾病，进而探讨心理、基因定势表达与精神病的关系。     

多分类有序反应变量logistic回归应用条件的检验

目的 对多分类有序反应变量logistic回归的应用条件寻求科学合理的检验方法。方法 使用卡方分布的理论，SAS软件及抽样调查方法。结果 设计出多分类有序反应变量logistic回归应用条件的卡方检验方法，推导出反应变量取各水平的概率计算公式及卡方检验中理论值、自由度的计算公式，并在作者主持的国家医师资格临床实践技能考试研究中取得了成功效果。结论 多分类有序反应变量logistic回归得到完善和补充，具有较大的理论和实际意义。     

水泥型羟基磷灰石人工骨的制备及性能分析

Objective: To prepare hydroxyapatite cement (or calcium phosphate cement,CPC) and analyze its capability. Methods: Tetracalcium phospluge (TTCP ) was prepared by the method of high heat. TTCP reacted with in simulated body situation and produced CPC. Its capability was analyzed by scanning electron microscopy ( SEM), X-ray diffraction( XRD). Its density, absorbing water coefficient, macroporosity and compressive strength were measured also. Results: The main element of CPC is hydroxyapatile (HA), its microstructure comprised of petal crys-tals. The diameter of micropore was 4-10μm, density was 1. 922 g/cm^3, macroporosity was 29. 777%, absorbing coefficient was 15. 503%, compressive strength was 42.70 Mpa. Conclusion: This CPC has three-dimensional spatial structure, its strength meets the need of cancellous bone grafting.     

Nicastrin基因新选择性剪接与阿尔茨海默病的相关性研究

目的 探讨Nicastrin基因转录产物的选择性剪接与阿尔茨海默病的相关性.方法 通过使用RT-PCR法分别在病理确诊的10例AD患者与13例非AD对照中检测了海马区Nicastrin基因转录产物的选择性剪接,同时PCR-RFLP法进行apoE基因分型,对比分析Nicastrin基因、apoE基因与AD的相关性.结果 我们发现Nicastrin基因上的一个新的选择性剪接转录产物-NCSTN△E16,该转录产物导致其跨膜结构域上游71个氨基酸缺失,在apoEε4携带者伴外显子16缺失阳性组中AD患病率明显增加,但这一相关性没有统计学意义.结论 Nicastrin基因转录产物的选择性剪接-NCSTN△E16与AD没有明显相关性.