胃癌根治术后非计划再次手术的原因和危险因素分析

目的通过对病例资料的回顾性研究分析胃癌根治术后非计划再次手术的原因和危险因素。方法回顾性分析2012年1月至2017年12月在南京大学医学院附属鼓楼医院行胃癌根治术(包括开腹和腹腔镜)的病人资料,纳入标准:(1)年龄18～80岁;(2)胃镜病理明确诊断胃癌;(3)接受D2胃癌根治术(包括开腹和腹腔镜手术)。排除标准:(1)胃癌术中行联合脏器切除术;(2)残胃癌行胃癌根治术。共统计胃癌手术病人3 213例,其中接受非计划再次手术病人37例。按照性别、年龄进行1∶2配对,以胃癌术后未接受再次手术的病人为对照组,开展回顾性配对研究,查找非计划再次手术的原因,同时分析导致发生非计划再次手术的危险因素。结果术后行非计划再次手术的中位时间为1d(0～9d),开腹术后31例,腹腔镜术后6例。手术原因包括:腹腔出血(23例,62.2%);吻合口出血(3例,8.1%);吻合口漏(3例,8.1%);切口裂开(2例);肠梗阻(2例);十二指肠残端漏(1例);急性胆囊炎(1例);脾梗死(1例);切口感染(1例)。单因素分析结果显示,非计划再次手术组与对照组的病人在术中出血量(P=0.014)、第一助手资格(P=0.042)方面差异有统计学意义,手术时间、主刀医生资格、手术开始时间、术中输血、手术方式、手术部位等方面差异无统计学意义。多因素Logistic回归分析显示:术中出血量≥200ml是非计划再次手术的独立危险因素(OR=1.827,95%CI:1.034,3.026,P=0.024)。结论腹腔出血是胃癌根治术后非计划再次手术的最常见原因,术中出血量≥200ml是非计划再次手术的独立危险因素。     

介入再生医学中干细胞治疗研究进展

介入再生医学(IRM)是一门通过影像引导微创手术与干细胞的局部递送实现受损器官修复和再生的交叉学科。近年来,基于干细胞的再生治疗已在多项疾病的临床试验中显示出应用前景,然而,通过静脉输入的干细胞会大量聚集于肺和网状内皮系统中,仅有少量细胞能够到达靶组织,使干细胞的临床应用效果难以实现,局部靶向递送是一种有效解决方案。IRM旨在通过经血管内注射、腔内注射或直接注射,将干细胞靶向递送到目标组织器官,提高干细胞再生治疗的功效。综述了再生治疗中常用的干细胞来源、干细胞靶向递送涉及的疾病类型、递送途径和作用机制,展示了IRM中干细胞治疗的研究进展和发展趋势,并对IRM的应用前景及其转化所面临的挑战进行展望和总结。     

应用八髎穴药物注射并膀胱功能训练改善脊髓损伤膀胱功能障碍的效果

目的:脊髓损伤膀胱功能障碍患者采用八穴药物注射配合膀胱功能训练与单纯膀胱功能训练进行疗效对比观察。方法:选择2001-10/2004-03在广州工伤康复医院住院的脊髓损伤膀胱功能障碍患者24例,随机分为两组,治疗组12例,对照组12例。治疗组采用膀胱功能训练配合八穴药物注射疗法。①八穴药物注射:将维生素B1200mg+维生素B12500μg+生理盐水3～5mL,注入上穴,次穴,中穴,下穴,每穴位注入2～2.5mL,1次/d,两侧穴位每天交替注射,10d为1个疗程,平均治疗2～4个疗程,每疗程间隔3～5d。②膀胱功能训练的方法:限制饮水量,24h总入水量控制在2500mL左右;依据残余尿量多少进行间歇导尿。③对照组仅行上述膀胱功能训练方法。④膀胱功能评定以自主性排尿节律,勿需导尿管排尿,残余尿量<100mL为显效;导尿次数减少,残余尿量100～150mL为有效;无明显改善为无效。结果:按意向处理分析,24例患者均进入结果分析。治疗组显效5例,有效5例,无效2例。对照组显效2例,有效2例,无效8例。治疗组总有效率显著高于对照组犤83%(10/12),33%(4/10),χ2=4.29,P<0.05犦。结论:采用八穴药物注射配合膀胱功能训练治疗脊髓损伤膀胱功能障碍患者,比单纯的膀胱功能训练方法疗效显著。说明八穴药物注射后,发挥了穴位和药物的综合治疗作用,能有效的改善脊髓损伤后的膀胱功能。     

High-resolution and accelerated multi-parametric mapping with automated characterization of vessel disease using intravascular MRI

Background

Atherosclerosis is prevalent in cardiovascular disease, but present imaging modalities have limited capabilities for characterizing lesion stage, progression and response to intervention. This study tests whether intravascular magnetic resonance imaging (IVMRI) measures of relaxation times (T₁, T₂) and proton density (PD) in a clinical 3 Tesla scanner could characterize vessel disease, and evaluates a practical strategy for accelerated quantification.

Methods

IVMRI was performed in fresh human artery segments and swine vessels in vivo, using fast multi-parametric sequences, 1–2 mm diameter loopless antennae and 200–300 μm resolution. T₁, T₂ and PD data were used to train a machine learning classifier (support vector machine, SVM) to automatically classify normal vessel, and early or advanced disease, using histology for validation. Disease identification using the SVM was tested with receiver operating characteristic curves. To expedite acquisition of T₁, T₂ and PD data for vessel characterization, the linear algebraic method (‘SLAM’) was modified to accommodate the antenna’s highly-nonuniform sensitivity, and used to provide average T₁, T₂ and PD measurements from compartments of normal and pathological tissue segmented from high-resolution images at acceleration factors of R ≤ 18-fold. The results were validated using compartment-average measures derived from the high-resolution scans.

Results

The SVM accurately classified ~80% of samples into the three disease classes. The ‘area-under-the-curve’ was 0.96 for detecting disease in 248 samples, with T₁ providing the best discrimination. SLAM T₁, T₂ and PD measures for R ≤ 10 were indistinguishable from the true means of segmented tissue compartments.

Conclusion

High-resolution IVMRI measures of T₁, T₂ and PD with a trained SVM can automatically classify normal, early and advanced atherosclerosis with high sensitivity and specificity. Replacing relaxometric MRI with SLAM yields good estimates of T₁, T₂ and PD an order-of-magnitude faster to facilitate IVMRI-based characterization of vessel disease.

     

培哚普利对老年高血压患者颈动脉内-中膜厚度及血管内皮依赖性舒张功能的影响

目的探讨培哚普利对老年高血压患者内皮功能的影响及其机制。方法选择老年高血压患者100例,随机分为培哚普利治疗组(P组,n=50)和安慰剂组(C组,n=50);另选50例健康体检者为血压正常对照组(N组,n=50),应用无创超声检查技术,观察治疗前、后的颈动脉内中膜厚度及肱动脉内皮依赖性舒张功能的变化。结果培哚普利治疗组治疗后颈动脉内中膜厚度明显减少,肱动脉内皮依赖性舒张功能明显改善。结论培哚普利可明显改善老年高血压患者内皮功能,具有抗动脉粥样硬化的作用。     

Luminal NaCl delivery regulates basolateral PGE2 release from macula densa cells

Macula densa (MD) cells express COX-2 and COX-2-derived PGs appear to signal the release of renin from the renal juxtaglomerular apparatus, especially during volume depletion. However, the synthetic machinery and identity of the specific prostanoid released from intact MD cells remains uncertain. In the present studies, a novel biosensor tool was engineered to directly determine whether MD cells release PGE2 in response to low luminal NaCl concentration ([NaCl]L). HEK293 cells were transfected with the Ca2+-coupled E-prostanoid receptor EP1 (HEK/EP1) and loaded with fura-2. HEK/EP1 cells produced a significant elevation in intracellular [Ca2+] ([Ca2+]i) by 29.6 +/- 12.8 nM (n = 6) when positioned at the basolateral surface of isolated perfused MD cells and [NaCl]L was reduced from 150 mM to zero. HEK/EP1 [Ca2+]i responses were observed mainly in preparations from rabbits on a low-salt diet and were completely inhibited by either a selective COX-2 inhibitor or an EP1 antagonist, and also by 100 microM luminal furosemide. Also, 20-mM graduated reductions in [NaCl]L between 80 and 0 mM caused step-by-step increases in HEK/EP1 [Ca2+]i. Low-salt diet greatly increased the expression of both COX-2 and microsome-associated PGE synthase (mPGES) in the MD. These studies provide the first direct evidence that intact MD cells synthesize and release PGE2 during reduced luminal salt content and suggest that this response is important in the control of renin release and renal vascular resistance during salt deprivation.     

儿童孤独症康复因素分析

目的:探讨儿童孤独症康复的相关因素。资料来源:应用计算机检索Medline1990-01/1998-12有关儿童孤独症的文献,检索词为“autism,rehabilitation,therapy”,限定语言种类为Eng-lish;同时应用计算机检索www.cnki.net(中国知网)电子期刊全文数据库1990-01/2005-11有关儿童孤独症的文献,检索词为“孤独症,康复,治疗”,限定语言种类为中文。资料选择:对资料进行初审,选择有关儿童孤独症的病因、临床表现、早期诊断、康复治疗及康复治疗影响因素等方面的文献,排除重复性研究。资料提炼:收集到符合要求的文献41篇,排除19篇重复性研究,22篇符合纳入标准,被选为参考文献。资料综合:通过检索发现,单独研究儿童孤独症康复因素的文献较少,因此对儿童孤独症的病因、临床表现、诊断、康复及其相关影响因素进行综合分析。影响儿童孤独症康复治疗的因素包括以下几点:①孤独症患儿的智力水平。②孤独症患儿的语言发育水平。③社会、家庭的支持及患儿父母的文化素质。④孤独症患儿的其他并发症。结论:儿童孤独症的康复是多角度、多层次的,与患儿疾病本身的严重程度、病因及并发症是否及时控制有关,早期预防、早期诊断与治疗是孤独症患儿康复的关键。特别需要注意的是治疗或教育要注重个体化。     

高强度超声对乳腺癌微血管破坏作用的病理观察

目的 观察高强度聚焦超声（HIFU）对乳腺癌组织及其滋养血管的破坏作用。方法 对23例HIFU治疗患者每例3张连续的切片分别进行HE染色、内皮细胞生物素标记的荆豆凝集素（UEA I）染色光镜观察，第3张用电镜检查，观察HIFU对乳腺癌营养血管破坏的情况。 结果 HFIU治疗后，HE染色显示肿瘤营养血管和肿瘤组织发生凝固性坏死，UEAI染色为阴性，透射电镜见乳腺癌HIFU治疗后即刻血管内皮细胞破坏，血管内血栓形成。 结论 HIFU使乳腺癌组织及其滋养血管完全破坏，阻止血管再生和癌组织无序增殖，从而有可能治愈乳腺癌。     

血小板活化因子受体拮抗剂的神经保护作用

目的:探讨血小板活化因子(platelet-activatingfactor,PAF)所致的神经元损伤是否通过PAF受体而起作用,PAF受体拮抗剂对神经元损伤是否具有保护作用。方法:实验于2003-05/2004-05在南京大学医学院附属鼓楼医院神经科研究室和美国约翰霍普金斯大学Dr.Tao实验室完成。使用原代野生型小鼠皮质神经元细胞培养系统;不同剂量PAF处理神经元细胞24h,并经PAF拮抗剂5μmol/LBN52021预处理;碘化物/钙黄绿素染色检测细胞凋亡,MTT法测定神经元生存能力。结果:0.3和0.6μmol/LPAF明显增加神经元细胞死亡率,0.01和0.10μmol/L增加死亡率不明显;PAF受体拮抗剂5μmol/LBN52021明显地抑制0.3μmol/LPAF所致的神经毒性。结论:PAF介导的神经元损伤是通过其受体而作用的,PAF受体拮抗剂对神经元损伤具有保护作用。     

急诊科开展健康教育的尝试

对急诊科病人及陪护者进行健康教育，采用“整、分、合”及“文、声、形”的方式，提高了病人及陪护者的自护能力，收到了良好的效果