手术示教系统的细节设计

手术示教系统已是一个较为成熟的教学系统,本文将根据现时流行的几种设计方案进行分析,并对设计过程和选材中遇到的一些细节问题提出一些意见.     

c-myc mRNA在成釉细胞瘤中的表达

目的:研究成釉细胞瘤(AB)和牙源性角化囊肿(OKC)中c-mycmRNA的表达,探讨c-myc在AB和OKC中的发生、发展及其生物学意义。方法:使用原位杂交法检测54例AB、16例OKC和7例口腔正常黏膜(NOM)组织中c-mycmRNA的表达,并将AB按原发、复发、恶变分组,结果使用χ2检验进行统计分析。结果:AB、OKC及NOM组织中c-mycmRNA的阳性表达率分别为81.5%(44/54)、75.0%(12/16)和14.3%(1/7),3组比较有显著性差异(χ2=15.488,P<0.05)。原发组AB中c-mycmRNA的阳性表达率为71.0%,复发组为94.7%,恶变组为100.0%,伴随原发、复发、恶变,差异有显著性(χ2=16.912,P﹤0.05)。结论:c-myc表达在AB的发生、发展中有重要作用;c-mycmRNA的表达与AB的临床生物学行为有关,伴随其生物学行为变化,c-mycmRNA表达增强;提示c-myc有可能成为评价预后的有效指标。     

18例青年人肺癌的CT表现与临床分析

目的：对青年人肺癌18例的CT表现与临床分析。方法：收集我院近5年肿瘤科、呼吸内科及门诊就诊的肺癌325例,经CT检查结合临床表现进行诊断、治疗和分析。结果：18例从起病到确诊时间为2 w至半年不等,平均2个月;其中,中央型肺癌10例,周围型肺癌8例。结论：近年来青年人肺癌发生率有上升趋势、应对青年人群定期体检,争取早诊断早治疗以提高青年人肺癌治疗效果。     

前列腺癌新辅助治疗临床分析（附32例报告）

目的 总结32例前列腺癌患者新辅助治疗（NHT）的作用。方法 32例前列腺癌患者中药物去势17例，手术去势15例，并联合抗雄激素治疗3个月，统计NHT前后前列腺癌体积、肿瘤大小、PSA、FSH、LH和睾酮水平变化。结果 2组NHT后前列腺体积明显变小、肿瘤变小、变软，甚至消失，PSA和睾酮明显下降，药物去势组睾酮水平在耻骨后前列腺癌根治术（RRP）术后2～3个月可恢复正常，而手术去势组RRP术后睾酮呈持续低水平。结论 NHT可明显缩小前列腺体积，降低PSA，有利于手术操作。药物去势对内分泌影响是可逆的，而手术去势内分泌改变不可逆。     

Association of the GNAS1 gene variant with hypertension is dependent on alcohol consumption.

The beta-adrenoceptor (beta-AR)-stimulatory guanine nucleotide-binding (Gs) protein system has been shown to play important roles in the cardiovascular system. The gene encoding the alpha-subunit of Gs proteins (GNAS1) is a candidate genetic determinant for hypertension. Because alcohol consumption is known to affect blood pressure partly through the beta-AR-Gs protein system, we examined the possible interaction between GNAS1 T393C polymorphism and drinking status in the association with hypertension in the present study. As a result, a non-significant but reasonable trend supporting the presence of an interaction was shown (p = 0.076). In line with this trend, the T393C polymorphism significantly interacted with drinking status in the association with systolic blood pressure (p = 0.028). Moreover, supporting the presence of an interaction, T allele carriers consistently had a higher probability of hypertension, higher systolic blood pressure, and higher diastolic blood pressure than CC homozygotes in non-drinkers and light drinkers. In contrast, CC homozygotes consistently had a higher probability of hypertension, higher systolic blood pressure, and higher diastolic blood pressure than T allele carriers in moderate to heavy drinkers. The present study also showed a significant interaction between the T393C polymorphism and drinking status in the association with pulse pressure (p = 0.026), reflected by a significant association between the T393C polymorphism and pulse pressure in moderate to heavy drinkers (p = 0.026). These findings may be helpful in conducting further molecular and biological studies on the relationship among the effects of alcohol, the beta-AR-Gs protein system, and hypertension.     

Using rare earth element tracers and neutron activation analysis to study rill erosion process.

Spatially averaged soil erosion data provide little information on the process of rill erosion. The dynamically varied data on the temporal and spatial distributions in the rill erosion process are needed to better understand the erosion process and reveal its innate characteristics. The objectives of this study were to examine the feasibility and effectiveness of rare earth element (REE) tracers and the neutron activation analysis (NAA) method on the study of the rill erosion process and to reveal quantitatively the relationships and characteristics of temporal and spatial distributions of sediment yield in rill erosion. Four REEs were used to study the changeable process of rill erosion at 4 slope positions. Four water inflow rates were applied to a 0.3 x 5 m soil bed at 3 slopes of 10.5%, 15.8% and 21.2% in scouring experiments. All of the runoff was collected in the experiment. Each sample was air-dried and well mixed. Then 20 g of each sample was sieved through 100-mesh and about a 50 mg sample was weighed for analysis of the four elemental compositions by NAA. Results indicate that the REE tracers and NAA method can be used to not only quantitatively determine soil erosion amounts on different slope segments, but also to reveal the changeable process of rill erosion amount. All of the relative errors of the experimental results were less than 25%, which is considered satisfactory on the study of rill erosion process.     

Abdominal nontuberculous mycobacterial infection in a university hospital in Taiwan from 1997 to 2003.

BACKGROUND/PURPOSE: Abdominal nontuberculous mycobacterial infection is a rare condition. Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis is the most common manifestation of infection due to nontuberculous mycobacteria (NTM). There are limited data on the clinical manifestations of nontuberculous mycobacterial infection. This study investigated the diagnostic features, clinical presentation, mycobacteriology, treatment and outcome of all abdominal NTM infections treated over a 7-year period at a major teaching hospital in Taiwan. METHODS: The medical records of all patients with a diagnosis of abdominal NTM infection from January 1997 through to December 2003 were retrospectively reviewed. RESULTS: All 11 patients with abdominal NTM infections identified during the 7-year period were included. Among these patients, six were male and five were female, with a mean age of 64.5 years. The disease manifested as peritonitis (9 patients, 82%), splenic abscess (1, 9%), or perirenal abscess (1, 9%). Most patients (73%) had underlying malignancy, most often hepatoma (45%). Immunocompromised status (liver cirrhosis, malignancy, acquired immunodeficiency syndrome) was noted in 10 patients (91%). None of our patients who developed NTM peritonitis had received CAPD. The peritoneal fluid appearance varied considerably, with no particular predominance of clear, turbid, bloody, or chylous findings. Rapidly growing mycobacteria were the major etiology (46%) of abdominal NTM infection, and Mycobacterium abscessus played a major role (27%). Overall, eight patients died, and only one patient survived longer than 1 year. Seven patients (64%) died before diagnosis. CONCLUSION: Abdominal NTM infection is frequently overlooked because of its rarity and nonspecific symptoms, with consequent delays in diagnosis and treatment. In immunocompromised patients with ascites from any cause (liver cirrhosis, malignant ascites, etc.), NTM peritonitis should be considered early in the differential diagnosis of symptoms including fever, abdominal pain and weight loss. The poor prognosis of abdominal NTM infection appears to be related to the severity of underlying conditions, most often malignancy.     

Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.     

结直肠de novo癌的研究概况

近年来，随着内镜技术的发展，已能发现越来越多的微小和早期结直肠病变。部分报道曾描述了一种微小而极具侵袭性的结直肠癌，因其缺乏起源于腺瘤的证据，被称为“de novo癌（de novo carcinoma）”。这类肿瘤由于挑战了经典的腺瘤癌变途径而引起众多争议，但由于其所显示的独特生物学特性，也得到了各国学者的充分重视。本文将对de novo癌的概念、争议及其临床、分子生物学水平的特点进行初步概述。     

慢性多发性肌炎临床及病理分析

目的探讨慢性多发性肌炎的发病机制、临床和病理特征。方法回顾性分析95例慢性多发性肌炎患者临床表现、肌酶学和肌电图检查结果,总结肌肉病理学特征。结果慢性多发性肌炎以四肢近端肌无力、肌萎缩为主要表现,血清酶谱轻-中度增高,肌电图以肌源性损害为主,病理改变为灶性坏死、炎性细胞浸润与再生肌纤维共存。结论临床特点结合病理学检查有助于慢性多发性肌炎的诊断,多数患者激素治疗有效。