阻断子宫动脉的腹腔镜筋膜内子宫切除术60例报告

目的探讨阻断子宫动脉的腹腔镜筋膜内子宫切除术(c lassic intrafasc ial supracervical hysterectomy,C ISH)的临床应用价值。方法子宫良性疾病60例在腹腔镜下分离出子宫动脉后钛夹夹闭,阻断子宫动脉后行筋膜内子宫切除术。结果手术均获成功,无中转开腹,无手术并发症。手术时间72~186 m in,(91.4±26.3)m in;术中出血量50~150 m l,(76.5±20.6)m l;术后肠功能恢复时间18~30 h;(22.7±5.8)h;24 h引流液50~160 m l,(80.5±31.8)m l。术后2例体温38.5℃,术后病率3.3%(2/60)。术后住院4~7 d。60例随访6~18个月,(10.6±4.2)月,3例在1~3个月阴道点滴出血,经抗感染、止血等治疗5~7 d治愈。结论阻断子宫动脉的腹腔镜筋膜内子宫切除术是C ISH的技术改进,并发症少,安全,效果好,值得临床推广。     

Phenolic glycosides with antioxidant activity from the stem bark of Populus davidiana

Phytochemical study on the EtOAc-soluble fraction of the stem bark of Populus davidiana resulted in the isolation of 10 phenolic glycosides (1-10), which were identified on the basis of physicochemical and spectroscopic analyses. Among these, three new compounds, populosides A-C (1-3), were determined to be 2-coumaroylmethyl-4-hydroxyphenyl-beta-D-glucopyranoside, 2-coumaroylmethylphenyl-beta-D-glucopyranoside, and 2-feruoylmethylphenyl-beta-D-glucopyranoside, respectively. Compounds 1-10 were tested for their radical scavenging activity against an azo radical, ABTS*+. Of these, populosides A-C (1-3), populoside (4), grandidentatin (8), salireposide (9), and coumaroyl-beta-D-glucoside (10) exhibited antioxidant activity in this assay.     

Lesion patterns and mechanism of cerebral infarction caused by severe atherosclerotic intracranial internal carotid artery stenosis

The hippocampus is believed to have close relationship with many cerebral cortexes and constitute memory network to modulate and facilitate communication, which makes it especially interesting and meaningful in the study of functional connectivity in mild cognitive impairment (MCI). However, functional connectivity between the hippocampus and other brain regions remains unclear in MCI. Furthermore, the longitudinal changes of the hippocampal connectivity have not been reported. In the study, resting state functional MRI (fMRI) was used to examine changes in hippocampal connectivity comparing 14 patients and 14 healthy age-matched controls. We found that functional connectivity between the hippocampus and a set of regions was disrupted in MCI, these regions are: the right frontal lobe, the bilateral temporal lobe and the right insular. While, the left posterior cingulate cortex, precuneus, hippocampus, caudate and right occipital gyrus showed increased connectivity to the hippocampus in MCI. Additionally, we traced the seven MCI patients and compared the hippocampal connectivity in initial stage and 3 years later stage. Several regions presented decreased connectivity to the hippocampus after 3 years. Finally, the hippocampal connectivity with some regions showed significant correlation with the cognitive performance of patients. Based on these findings, the decreased hippocampal connectivity might indicate reduced integrity of hippocampal cortical memory network in MCI. In addition, the increased hippocampal connectivity suggested compensation for the loss of memory function. With the development of the disease, the hippocampal connectivity may lose some compensation and add some more disruption due to the pathological changes.     

Magnetic stimulation of carotid sinus as a treatment for hypertension

Previously, we reported that magnetic stimulation of carotid sinus (MSCS) could lower arterial pressure in rabbits. In this randomized, sham‐controlled pilot study, we evaluated the effects of MSCS on blood pressure in pre‐hypertensive and hypertensive subjects. A total of 15 subjects with blood pressure higher than 130/80 mm Hg were randomized to receive sham or 1Hz MSCS. The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MAP) during treatment were compared between groups. The heart rate variability (HRV) and baroreflex sensitivity (BRS) before, during, and after treatments were analyzed. Reduction of SBP was significantly greater in subjects with MSCS than those with sham stimulation (6.6 ± 0.4 vs −2.5 ± 0.4 mm Hg, P < 0.001). Reduction of DBP was significantly greater in subjects with MSCS than those with sham stimulation (1.2 ± 0.2 vs −2.8 ± 0.2 mm Hg, P < 0.001). Reduction of MAP was significantly greater in subjects with MSCS than those with sham stimulation (1.4 ± 0.3 mm Hg vs −4.0 ± 0.3 mm Hg, P < 0.001). Reduction of HR was significantly greater in subjects with MSCS than those with sham stimulation (0.5 ± 0.5 vs −1.9 ± 0.3 beats/min, P = 0.002). BRS increased from 6.85 ± 0.77 to 8.79 ± 0.95 ms/mm Hg after MSCS compared with that at baseline (P = 0.027). Thus, MSCS can lower blood pressure and heart rate in pre‐hypertensive and hypertensive subject, warranting further study for establishing MSCS as a treatment for hypertension.     

Endovascular stenting for atherosclerotic subclavian artery stenosis in patients with other craniocervical artery stenosis

Atherosclerotic subclavian artery stenosis (SAS) accompanied with other craniocervical artery stenosis (OCAS) is not uncommon in practice. We sought to investigate the safety and efficacy of endovascular stenting for SAS in patients with OCAS. Between January 2004 and February 2012, 71 consecutive atherosclerotic SAS patients who underwent primary stenting in our medical center were included. The enrolled patients were divided into combined-SAS group (n = 51) and solitary-SAS group (n = 20) depending on the presence or absence of OCAS. Data of demographics, procedure, and the followed-up were retrieved and analyzed. The technical success rate was 95.8 %; the clinical success rate was 90.1 %. There was no catheter-related major stroke or death. The immediate outcomes had no statistical difference between groups. During a mean of 27 ± 20 months (range 2–88 months) followed-up, 7(10.3 %) restenosis and 12(17.6 %) clinical events were identified. The primary patency rate was 95.3, 84.9 and 84.9 % at 12, 24 months, and final followed-up respectively, which had no statistical difference between groups (odds ratio (OR), 2.60; 95 % confidence interval (CI), 0.54–12.53; P = 0.232). The overall clinical event-free survival rate was 93.5, 86.2 and 54.6 %, respectively, where the result of combined-SAS group was inferior to that of the solitary-SAS group (OR, 3.34; 95 % CI, 1.02–11.00; P = 0.047). Endovascular stenting was safe and feasible for atherosclerotic SAS in patients with OCAS, although the combined OCAS may have a significant influence on the long-term outcome. Further studies are warrant to investigate the effects of revascularization for multiple craniocervical artery stenoses on the cerebral hemodynamics and long-term outcomes.     

Influence of Vessel Size and Tortuosity on In-stent Restenosis After Stent Implantation in the Vertebral Artery Ostium

Purpose  

Percutaneous transluminal angioplasty and stenting is emerging as an alternative for treating atherosclerotic stenosis in the vertebral artery ostium. However, in-stent restenosis (ISR) still remains a critical issue to be addressed. Little is known about the relationship between anatomic characteristics of the artery and ISR after stent implantation. In this study, we have evaluated influential factors for ISR in a cohort of the patients with stenting in the vertebral artery ostium.     

现时生存分析方法的应用实践与评价

目的利用林州市肿瘤登记处的资料,应用现时生存分析方法计算食管癌、胃癌的5年相对生存率,并与传统的队列方法比较,评价现时生存分析方法在预测癌症患者长期生存率时的应用价值。方法分别利用队列、完全生存分析和现时生存分析方法计算食管癌、胃癌的5年相对生存率,与随访5年后得到的实际生存率进行比较,以三种方法计算的数据与实际值的绝对差值平方评估差异的大小。结果应用队列、完全生存分析和现时生存分析方法计算林州市食管癌的5年相对生存率分别为28.00%、32.08%、36.67%,胃癌23.19%、29.03%、33.98%,食管癌和胃癌的实际5年相对生存率分别为36.82%和34.04%。三种方法计算的结果与实际生存率差异的平方分别是196、48、0。结论现时生存分析方法得到的5年相对生存率与实际值最为接近,能及时地反映现时癌症诊治的水平与效果,可以作为评估癌症长期生存指标的一种统计方法。     

猪小肠黏膜下层脱细胞修复补片修复手部软组织缺损的效果分析

目的 对比应用新型再生可降解生物材料猪小肠黏膜下层脱细胞修复补片(SIS)与植皮术在修复手部软组织缺损的治疗效果.方法 2017年12月至2018年12月,共收治手部软组织缺损36例,根据缺损面积与治疗方法分为两组:补片组21例,软组织缺损面积2.0 cm×1.5 cm^9.0 cm×3.5 cm,平均5.3 cm×2.1 cm,采用SIS治疗;植皮组15例,软组织缺损面积9.0 cm×4.0 cm^16.0 cm×9.0 cm,平均12.0 cm×8.5 cm,采用中厚皮片植皮治疗.观察两组治疗方法促进软组织缺损愈合的效果,记录术后14 d、21 d、28 d、3个月创面区愈合情况,并随访评估创面区愈合后的外观、色泽、弹性、感觉恢复与部分肌腱外露的治疗效果.结果 本组36例均获随访,随访时间3~10个月,平均5个月.两组创面均完全愈合,外观、色泽接近,皮肤弹性及感觉均恢复良好.补片组感觉恢复优14例(66.6%),良5例(23.8%),差2例(9.6%);植皮组感觉恢复优9例(60.0%),良4例(26.0%),差2例(14.0%).创面愈合效果补片组优14例,良5例,差2例;植皮组愈合优9例,良4例,差2例.结论 SIS能快速、有效的刺激机体再生出表皮组织,并且新生的表皮经过生长与周围皮肤颜色无明显差异,无明显瘢痕增生,是一种手部小面积浅表软组织缺损的理想修复材料.