增强现实辅助电磁导航下的内镜逆行胰胆管造影胆管插管定位技术模型研究

背景 内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术者时常会面临选择性肝内胆管超选困难的问题,且反复尝试插管大大增加了术后并发症的发生率.近年来,增强现实(augmented reality,AR)辅助电磁导航已成为微创手术的重要辅助工具.目的 探讨增强现实辅助电磁导航引导ERCP胆管插管在3D打印胆道模型中的定位精度.方法 将1例肝内外胆管扩张患者腹部CT图像中的胆道进行三维重建,将结果通过3D打印生成一个1:1.36的胆道树脂模型.在胆道模型内嵌入标记物作为导航精度测量的"靶点",并固定在人体腹部体模中.在体模基底和皮肤表面分别贴上配准标志物和标记物.对体模行CT平扫,得到体模的标准三维图形文件(STL).在乳头括约肌切开刀通道内部安装一个电磁传感器,用于追踪其在模型中的位置,并使用图像叠加构建一个增强现实导航平台.通过术前CT扫描获得体模配准标志物和标记物的图像坐标,实验中再获取其磁场坐标,完成术前、术中配准和增强现实精度分析.结果 在体模上行ERCP胆管插管,在AR辅助电磁导航下乳头括约肌切开刀被准确引导进入左右肝管,导航精度误差为(0.949±0.033)mm,可达到临床应用的要求.结论 模型实验证实了AR辅助电磁导航ERCP胆管插管的可行性,为其进一步在临床应用奠定了基础.     

3315例精神病人的社区防治护理

目的探讨精神病人社区防治护理方法,促使社区精神病人尽快康复,重返社会。方法采取防治结合,配合各种各样的社区康复护理。结果经过一年多的社区防治护理后,3315例患者中,好转2486例,显好率达75%。同时资助927位特困患者每月的药品费用,实施了23位患者的“解锁工程”。结论住院化管理不是精神病人康复的唯一方法,应积极推广“开放式、社会化、综合性”的社区防治护理。     

Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years’ experience of 635 cases

Background Gastric varices (GV) are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate (BC), the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years’ practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients.Methods From January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The “sandwich method” and the “modified sandwich method” were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up.Results A total of 635 GV cases treated with endoscopic injection using BC were collected, most of them (90.2%) suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions (95.2%). Complications occurred in 32 cases (5.2%), including hemorrhage due to early expulsion of tissue glue (3.1%), septicemia (1%) and ectopic thrombosis (0.5%), such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance (76.9%), collapse (17.3%) or remnants (5.8%) of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding (8.0%) and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1, 2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively. Conclusions Endoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized oil.     

内镜超声引导下胃肠吻合术的临床应用与研究进展

近年来,内镜超声引导下胃肠吻合术（EUS-GE）作为一项创新技术,在治疗良恶性胃流出道梗阻(GOO)、输入袢综合征等方面展现出了良好的安全性和有效性。同时,多篇研究表明该技术同传统外科手术、内镜下腔内支架置入相比,具有创伤小、复发率低等优势。作为一项尖端的新型内镜介入技术,EUS-GE已逐渐成为学术热点,受到了越来越多国内外学者的关注。本文主要报道EUS-GE的临床应用和研究进展。     

接合物蛋白CrkⅠ在卵巢癌恶性潜能中的作用

目的 证实接合物蛋白CrkⅠ在卵巢癌恶性潜能中的作用.方法 采用Western blot法检测卵巢癌组织、卵巢良性肿瘤组织、正常卵巢组织中Crk和Dock180蛋白的表达;用免疫沉淀法检测3种卵巢癌细胞株中Crk与Dock180蛋白的内源性结合;用小干扰RNA敲低SKOV3细胞中内源性的Crk,检测Crk表达缺失性细胞Crk蛋白表达水平、Rac1酶活性和侵袭力的变化.结果 Dock180与CrkⅠ的表达强度呈现明显的一致性,卵巢癌组织中二者的表达均显著高于卵巢良性肿瘤组织和正常卵巢组织(P<0.05);而在卵巢良性肿瘤组织与正常卵巢组织之间未发现明显差异(P>0.05).3个卵巢癌细胞株中Dock180主要表现出与CrkⅠ的内源性结合.和对照相比,敲低Crk基因的细胞表现出侵袭能力和Rac1酶活性明显下降(P<0.05),而敲低CrkⅠ的细胞和同时敲低CrkⅠ和CrkⅡ的细胞相比无明显差异(P>0.05).结论 卵巢癌的恶性生物学行为与Crk/Dock180/Rac1信号通路相关,其中CrkⅠ在卵巢癌中扮演着主要角色.     

国际专家组关于超声内镜引导下胰腺囊性肿瘤消融的立场声明

背景和目的最近,一些有关胰腺囊性肿瘤(pancreatic cystic neoplasms,PCNs)治疗的指南建议已经发表,但是超声内镜(endoscopic ultrasound,EUS)引导下PCNs消融的作用在这些指南中尚未明确。本文的目的是通过提出一系列临床问题并根据可获得的最佳科学证据提供答案来探讨围绕EUS引导下PCNs消融的问题。 方法我们从亚洲EUS学组和一个国际专家组中招募了一个EUS引导下PCNs消融专家小组。创建了一个临床问题列表,并将每个问题分配给一个成员以产生一个陈述。然后在2016年10月至2017年10月的三次互联网会议上讨论了这些陈述。之后相互协商对这些陈述进行修改,直到取得协商一致意见。之后,将完整的陈述总结集体发送给所有小组成员,以对陈述的强度进行投票,对陈述进行分类,对证据进行分级。 结果制定了关于EUS引导下PCNs的23个陈述。这些陈述涉及操作步骤、操作技术、操作前和操作后管理,并发症的管理以及手术中所需能力和培训。 结论在所有内镜学会中,本共识是关于EUS引导下PCNs消融的首篇共识。有兴趣进行这项技术的临床医生应参考这些共识,未来的研究应设法解决本共识中提出的重要问题。     

维生素C对失血性休克大鼠脏器功能的影响及机制研究

目的:探讨维生素C(Vit C)对失血性休克(hemorrhagic shock,HS)大鼠脏器功能的保护作用。方法:首先对16只雄性SD大鼠随机分为腹腔内注射生理盐水组(空白对照组,n=8)和Vit C组(V2 h组,100 mg/kg,n=8),用免疫组化方法检测空肠、肝脏、肺脏及肾脏中血红素加氧酶1(heme oxygenase-1,HO-1)的表达。其次,32只SD大鼠随机分为假手术组(n=8),休克模型组(HS 24 h组,n=8),休克加Vit C组(HSV 24 h组,HS+Vit C,n=8)和HO-1抑制组(HSVZ 24 h组,HS+Vit C+ZnPP,n=8)。HSV 24 h组在造模前30 min腹腔注射Vit C(100 mg/kg),HSVZ 24 h在HSV24 h处理方法的基础上腹腔注射HO-1抑制剂ZnPP(3 mg/kg),各组在造模后24 h取血清,检测器官功能指标丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、肌酐、乳酸脱氢酶及肌酸激酶的表达,取空肠、肝脏、肺脏及肾脏,制作病理切片并行HE染色,进行病理评分。结果:正常SD大鼠注射Vit C 2 h后,空肠、肝脏、肺脏及肾脏HO-1表达明显增高。与假手术组相比,失血性休克大鼠各个器官的组织病理损伤及评分和各器官功能指标均显著增高(P<0.05),预先给予VitC可显著减轻以上病理指标(P     

RESPONSE OF EARLY STAGE BULKY CERVICAL SQUAMOUS CARCINOMA TO PREOPERATIVE ADJUVANT CHEMOTHERAPY

Objective To investigate the potential role of preoperative adjuvant chemotherapy on early stage cervical squamous carcinoma with bulky tumor. Methods One hundred and forty-five patients with cervical squarnous cancer stages Ⅰb-Ⅱa were investigated, among which 17 patients with bulky tumors (≥4 cm) were managed by cisplatin-based chemotherapy for 1-2 courses followed by radical hysterectomy and pelvic lymphadenectomy (BC group). The change of tumor size, pelvic lymph nodes metastasis, cervical wall invasion, the involvement of surgical specimen margin, and the blood loss during operation were assessed after operation and compared with those in 51 patients with bulky tumors (BN group) and 77 patients with small local tumors (S group) who underwent surgery directly. Results (1) The tumor size of 17 patients in BC group were decreased in various degrees after chemotherapy, with 13 patients of clinical effectiveness (76.47%). And the responsiveness pertained to neither histological differentiation nor size of local tumors. (2) Post-operative histology has showed that patients in BC and BN group have higher incidence of lymph node metastasis and deep cervical infiltration (5/68 and 3/68, respectively) than in S group (1/77 and 1/77, respectively) while with no statistical significance. (3) Blood loss during operation in BC group was less than BN and S group. (4) Seventeen patients, including those underwent surgeries of vaginal prolongation and/or ovarian transposition, appeared disease-flee survival within the follow-up time. Conclusions Most of patients with bulky early stage cervical squamous carcinoma are sensitive to cisplatin-based chemotherapy, which could greatly reduce local tumor size and in turn facilitate the following operation by well controlling blood loss.     

CHANGES OF SOLUBLE FAS AND SOLUBLE FAS LIGAND IN SERUM AND PERITONEAL FLUID OF INFERTILE PATIENTS WITH ENDOMETRIOSIS

Objective To evaluate the relationship between levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in serum and peritoneal fluid of endometriosis-associated infertility.Methods The soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls. Results The sFasL levels were significantly higher in infertile patients with endometriosis (175.09 ±80.55 pg/mL in serum and 284.50 ± 152.38 pg/mL in peritoneal fluid) than those of infertile controls (88.47±43.55 pg/mL in serum and 17.30±9.62 pg/mL in peritoneal fluid) and fertile controls (16.13 ±11.75 pg/mL in serum and 8.84 ± 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis (828.60±429.65 pg/mL in serum and 349.61 ±288.89 pg/mL in peritoneal fluid) did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease (868.75 ± 570.48 pg/mL in serum and 181.76 ± 157.78 pg/mL in peritoneal fluid) and fertile control (822.26± 129.12 pg/mL in serum and 318.42 ± 145.16 pg/mL in peritoneal fluid). Conclusions Based upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.