肾上腺意外瘤中亚临床库欣患者的转归

目的 探讨肾上腺意外瘤中亚临床库欣综合征患者的临床转归.方法 随访我院诊治的37例亚临床库欣患者的临床和实验室检查资料.结果 本组随访亚临床库欣患者中8.11%(3/37)发展为临床显性库欣.患者有代谢综合征的临床症状,在随访1 ～ 3年后出现显性库欣综合征的典型临床症状,血尿皮质醇升高,2 mg和8 mg地塞米松抑制试验不能抑制,患者行肾上腺腺瘤摘除术后临床症状改善,糖皮质激素水平降低.结论 亚临床库欣患者有部分可发展成为临床显性库欣,对肾上腺意外瘤患者应仔细行生化指标和激素水平检查,明确其功能,一经确诊为亚临床库欣,应积极手术.     

军队医院信息系统规范建设与功能拓展

本文着重探讨军队医院信息系统规范化建设的必要性及建设目标和功能拓展的方向。     

长期服抗精神病药病人的隐性运动障碍

目的：评估抗精神病药对迟发性运动障碍（ＴＤ）的掩盖,即隐性运动障碍（ｃｏｖｅｒｔ ｄｙｓｋｉｎｅ－ｓｉａ）状况。方法应用Ｓｉｍｐｓｏｎ运动障碍评分表评定ＴＤ。入组的６９例病人有２３例病人完成了减药之前、停药三周后和再服药四个月后的ＴＤ评定,６９例次检查都给于隶像,并且两个评定者按照录像独立评定ＴＤ是否存在,评定ＴＤ的一致性良好（ＩＣＣ＝０．７５）。结果完成整个调查的２３例病人中,减药前ＴＤ出现率为     

清热抗感冲剂对小鼠IL-2水平影响的实验研究

目的:通过检测清热抗感冲剂对实验性免疫低下小鼠及正常小鼠血清IL-2水平的影响,探讨该冲剂对免疫功能的调节作用.方法:选取昆明种小鼠100只,雌雄各半,其中50只腹腔注射环磷酰胺3mg/0.2mL/只,每天给药1次,连续7天,造成免疫低下小鼠,然后随机分为模型组、中药对照组(银翘解毒片组)、西药对照组(γ-干扰素组)、小剂量组、大剂量组;其余50只随机分为正常空白对照组(即生理盐水组)、中药对照组、西药对照组、小剂量组、大剂量组.上述各组连续用药3天后,处死,采血,离心取血清,采用放免γ测量仪检测IL-2含量.结果:清热抗感冲剂能显著提高正常小鼠和注射环磷酰胺引起的免疫低下小鼠血清中IL-2生成水平(统计学处理P＜0.01).结论:清热抗感冲剂对小鼠的细胞免疫功能有明显的增强作用.     

Vascular endothelial growth factor gene polymorphisms and risk of primary lung cancer.

Angiogenesis is an essential process in the development, growth, and metastasis of malignant tumors including lung cancer. DNA sequence variations in the vascular endothelial growth factor (VEGF) gene may lead to altered VEGF production and/or activity, thereby causing interindividual differences in the susceptibility to lung cancer via their actions on the pathways of tumor angiogenesis. To test this hypothesis, we investigated the potential association between three VEGF polymorphisms (-460T > C, +405C > G, and 936C > T)/haplotypes and the risk of lung cancer in a Korean population. VEGF genotypes were determined in 432 lung cancer patients and 432 healthy controls that were frequency matched for age and sex. VEGF haplotypes were predicted using Bayesian algorithm in the phase program. Compared with the combined +405 CC and CG genotype, the +405 GG genotype found associated with a significantly decreased risk of small cell carcinoma [SCC; adjusted odds ratio (OR), 0.36; 95% confidence interval (95% CI), 0.17-0.78]. The 936 CT genotype and the combined 936 CT and TT genotype were also associated with a significantly decreased risk of SCC compared with the 936 CC genotype (adjusted OR, 0.47; 95% CI, 0.26-0.85 and adjusted OR, 0.44; 95% CI, 0.24-0.80, respectively). Haplotype CGT was associated with a significantly decreased risk of SCC (adjusted OR, 0.39; 95% CI, 0.18-0.87), whereas haplotype TCC conferred a significantly increased risk of SCC (adjusted OR, 1.63; 95% CI, 1.14-2.33). None of the VEGF polymorphisms studied significantly influenced the susceptibility to lung cancer except SCC. However, haplotypes TCT and TGT were significantly associated with the risk of overall lung cancer, respectively (adjusted OR, 0.38; 95% CI, 0.25-0.60 and adjusted OR, 3.94; 95% CI, 2.00-7.76, respectively). These effects of haplotypes TCT and TGT on lung cancer risk were observed in three major histologic types of lung cancer. These results suggest that the VEGF gene may be contribute to an inherited predisposition to lung cancer.     

硝酸甘油注射液稳定性研究

目的通过考察不同pH值的无水乙醇对硝酸甘油注射液稳定性的影响,筛选出最适于硝酸甘油注射液生产的无水乙醇。方法用高温加热破坏试验及长期试验的方法研究硝酸甘油注射液的稳定性,考察指标pH值和含量。结论碱性杂质含量低的无水乙醇配制的硝酸甘油注射液稳定性最好,适于硝酸甘油注射液的生产。     

基于UHPLC-QqQ-MS的四逆散水提液中16种主要化学成分的定量研究

目的 建立同时测定四逆散水提液中16种化学成分含量的方法。方法 应用UHPLC-QqQ-MS技术,采用负离子模式进行扫描,以MRM配对离子方式进行定量。结果 柴胡皂苷A、柴胡皂苷B₂、柴胡皂苷C、柴胡皂苷D、橙皮素、儿茶素、甘草苷、甘草酸、甘草素、绿原酸、没食子酸、芍药苷、芍药内酯苷、异甘草素、异绿原酸A、橙皮苷在负离子模式下响应良好。结论 本实验所建立的同时测定四逆散水提液中16种化学成分含量的分析方法专属性强、快速、灵敏且准确可靠,在完成含量测定的同时又可以准确给出化合物质量数信息,从而达到成分鉴别的效果,该方法可以为四逆散水提液的全面质量控制提供技术支持。      

胸主动脉腔内修复术采用裙边型烟囱支架（Longuette™）的PATENCY临床试验研究结果

背景与目的 烟囱技术是胸主动脉腔内修复术（TEVAR）中重建左锁骨下动脉（LSA）的方法,Ⅰa型内漏是其主要并发症。裙边型烟囱支架（Longuette?）专为烟囱技术设计,用于重建LSA时降低Ⅰa型内漏。为评估Longuette?烟囱支架联合TEVAR治疗累及LSA的Stanford B型主动脉夹层（TBAD）的疗效,笔者开展了前瞻性、多中心临床试验（PATENCY临床试验）。本研究总结PATENCY临床试验的1年结果和经验。方法 2018年10月—2022年3月,全国26家血管外科中心参与PATENCY临床试验,共纳入150例符合标准的TBAD患者。所有患者均在TEVAR术中采用Longuette?烟囱支架重建LSA。评估患者围手术期和术后12个月的临床效果和不良事件,并分析患者术后1年累积生存率、LSA通畅率和无内漏率。结果 患者年龄30~77岁,平均（54.48±11.12）岁,138例（92.0%）患者合并高血压病;急性、亚急性和慢性TBAD分别占74.7%,17.3%和8.0%。124例（82.7%）患者采用全身麻醉。手术成功率为99.33%（149/150）,手术时间（91.67±41.47）min,X线暴露时间（31.36±16.71）min,手术出血量为（71.55±60.40）mL。围手术期内漏发生率为5.33%（8/150）,包括Ⅰ型6例、Ⅱ型1例、Ⅳ型1例;1例（0.67%）患者发生Longuette?烟囱支架急性闭塞,再次实施腔内手术后恢复通畅;1例（0.67%）患者术后发生急性脑梗死;2例（1.33%）患者术后发生逆撕的Stanford A型主动脉夹层,其中1例术后3周死亡。术后30 d死亡2例（1.33%）。142例患者进行了密切随访,随访时间为11.67（5~16）个月。无主动脉支架和Longuette?烟囱支架移位。2例Ⅰ型内漏患者分别于术后6个月和1年进行了再次介入栓塞手术治疗,术后1年随访仍有6例患者有轻微的内漏持续存在,患者TBAD假腔保持稳定,无明显症状,均予以保守治疗。Longuette?烟囱支架内狭窄和闭塞分别发生1例和2例,逆撕的Stanford A型主动脉夹层患者1例,假腔增大,患者均无明显症状,予以保守治疗。无发生脑卒中、截瘫、左上肢缺血等并发症。术后12个月累积生存率、LSA通畅率、无内漏率分别为97.96%、97.96%和91.91%。结论 采用Longuette?烟囱支架在TBAD腔内治疗中重建LSA简便、安全、有效,其能够有效降低围手术期Ⅰa型内漏的发生率,为微创治疗主动脉弓部病变提供新的治疗方式。     

Malignant transformation of nevus sebaceous to basal-cell carcinoma: Case series,literature review,and management algorithm

Nevus sebaceous (NS) is a common congenital hamartoma of the skin composed predominantly of sebaceous glands. Although most NS are benign skin tumors, malignant transformations have been reported. There is still controversy about the lifetime risk of malignant degeneration and precise surgical criteria. This study reports cases of malignant degeneration and suggests a surgical treatment algorithm. The medical records of patients with basal-cell carcinoma (BCC) arising from NS between January 2001 and January 2021 were retrospectively reviewed. Patient demographics including lesion location, and tumor size were investigated. The symptoms, histological findings before and after excision, complications, and recurrence during 2-year follow-up periods were investigated. Ten patients were identified with BCC arising from NS lesions. All patients were female and the mean age was 52.11 years. All patients complained of sudden morphological changes, the most common type being rapid color changes. Two cases had histological findings that showed a miss-match between punch biopsy and excisional biopsy results. No recurrence was detected 2 years after surgeries in any patients. Cases after third stage, especially in over 40 years who report morphologic changes, should undergo total surgical excision as the first approach, with strong suspicion of malignant degeneration.     

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.