头皮淋巴管的解剖及其临床意义

通过对７８侧胎儿尸体头皮淋巴管进行显微解剖及透明法研究，对头皮淋巴管形态、数目及其归宿提出了若干新观点，提示要注意前囟与颅脑无骨膜相隔的特殊性，为临床头皮炎症蔓延和肿瘤转移的诊治提供了解剖学基础。     

纵行神经束内电极与周围神经生物相容性的实验研究

目的　研究纵行神经束内电极长期植入家兔坐骨神经神经束中的生物相容性 ,并探讨应用纵行神经束内电极记录的周围神经束的信号对电子假手控制的可能性。方法　将纵行神经束内电极长期植入 12只新西兰大白兔坐骨神经的神经束内 ,分别作为记录和刺激电极 ,通过经颅刺激系统 ,在术后不同时间记录运动诱发电位 (MEP)和皮层体感诱发电位 (CSEP) ,观察电极长期植入神经束内所记录到的信号的变化 ;术后 6个月信号记录结束后 ,取电极植入处的神经束进行组织学检查 ,了解电极对神经束的影响。然后 ,将纵行神经束内电极植入一名前臂残肢志愿受试者残肢的三条主要神经的神经束中 ,记录志愿受试者在意识控制中完成不同手的动作时的信号 ,并将其应用于电子假肢的实时控制。结果　不同时间记录的MEP和CSEP潜伏期间的差异均具有显著性意义 (方差分析 ,均P <0 .0 0 1)。经组间比较 ,MEP和CSEP的潜伏期在术后 1个月内无明显变化 ,以后明显延长 ,但 3个月以后趋于稳定 ;不同时间记录的MEP峰间波幅间的差异有显著意义 (方差分析 ,P <0 0 0 1)。经组间比较 ,在术后 1个月内变化不明显 ,以后明显降低 ,3个月后又趋于平稳。不同时间记录的CSEP峰间波幅虽然随时间延长有下降的趋势 ,但其间的差异无显著意义 (方差分析 ,P >0 0     

Translumbar retroperitoneal endoscopy: an alternative in the follow-up and management of drained infected pancreatic necrosis

BACKGROUND: The follow-up of drained infected pancreatic necrosis (IPN) is usually done with data on the patient's clinical evolution and information obtained from serial helical computed tomographic scans. Management often requires necrosectomies and periodic debridements. HYPOTHESIS: Translumbar retroperitoneal endoscopy is effective in the management of drained IPN. DESIGN: A prospective observational study. SETTING: University tertiary care hospital. PATIENTS: A series of 11 consecutive patients with drained IPN undergoing postoperative follow-up with translumbar retroperitoneal endoscopy. INTERVENTIONS: Initially, the IPN was drained via the posterior extraperitoneal translumbar approach; then, a superficial necrosectomy was performed during the same surgical intervention by flushing and endoscopic aspiration; and, finally, a lavage and drainage system was fitted. In the immediate postoperative period, for management of the IPN, we removed the drainage tube and inserted a flexible endoscope as far as the pancreatic area to eliminate the infected necrotic material by flushing and aspiration. MAIN OUTCOME MEASURES: In these patients, we studied control of the infection of the pancreatic area, quantification variables of the necrosectomy, technique-related morbidity and mortality, and the need for subsequent operations. RESULTS: The 11 patients studied showed good results regarding the control and complete elimination of the infected necrosis. There was no technique-related morbidity or mortality or need for subsequent operations. CONCLUSION: Translumbar retroperitoneal endoscopy allows exploration of the retroperitoneal space under direct visual guidance, facilitates lavage and aspiration, avoids subsequent surgical operations for debridement, decreases the need for repeated computed tomographic scans to evaluate the evolution of the IPN, and has no added morbidity or mortality.     

肝尾状叶原发性肝细胞肝癌的外科治疗

目的 探讨尾状叶原发性肝癌手术切除的方式及其影响。方法 自1995年至2003年,对39例尾状叶原发性肝癌进行了手术切除,其中单独尾状叶切除19例,联合切除20例。并对两组病例中可能影响术后肝功能的指标进行了比较。结果 39例患者均被成功切除肿瘤,1例于术后30d因肾功能衰竭死亡,3例并发胸腔积液,4例并发腹水,1例并发胆漏,其余病例均顺利恢复。术后30例获得随访,1年、3年、5年生存率分别为53％、50％、39％。结论 尾状叶切除是治疗原发于尾状叶肝癌的有效手段,若肿瘤原发于肝尾状叶而又无其他肝叶侵犯时,单独尾状叶切除该是外科治疗的最佳选择。     

清扫术中保留与不保留副神经对患者术后生活质量的影响

目的 探讨颈淋巴清扫术中保留与不保留副神经对患者术后生活质量的影响.方法 以综合生活质量评定问卷和颈清扫手术功能调查表研究了山东大学齐鲁医院54例行颈清扫术的下咽癌患者的生活质量,比较保留与不保留副神经对患者生活质量影响的差别.结果 保留副神经组的生活质量评分除认知、住房、社区服务、生活环境等因子及物质生活维度之间与不保留副神经组差异无显著性意义(P＞0.05);在生活质量其他方面,均显著高于不保留副神经组(P＜0.05);颈清扫手术功能调查表保留副神经组显著好于不保留副神经组(P＜0.05).结论 保留副神经的颈清扫术对患者的功能损伤小,保留副神经的患者生活质量明显优于不保留副神经的患者.     

Evaluation of the Heart Truth Professional Education Campaign on Provider Knowledge of Women and Heart Disease

BackgroundThe Heart Truth Professional Education Campaign was developed to facilitate education of health care providers in evidence-based strategies to prevent cardiovascular disease (CVD) in women.MethodsAs part of the 3-year campaign, lectures based on the American Heart Association's evidence-based guidelines for CVD prevention in women were presented by local speakers to healthcare providers and students in three high-risk states: Delaware, Ohio, and New York. Participants' responses to pretest and posttest questions about CVD in women are presented. We performed t-test and multivariable linear regression to assess the influence of provider characteristics on baseline knowledge and knowledge change after the lecture.ResultsBetween 2008 and 2011, 2,995 healthcare providers, students, and other participants completed the baseline assessment. Knowledge scores at baseline were highest for physicians, with obstetrician/gynecologists scoring lowest (63%) and cardiologists highest (76%). Nurses had intermediate total knowledge (56%) and students had the lowest total knowledge (49%) at baseline. Pre- and post-lecture assessments were completed by 1,893 (63%) of attendees. Scores were significantly higher after the educational lecture (p ≤ .001), with greater increase for those with lower baseline scores. Baseline knowledge of the use of statins, hormone therapy, and antioxidants, as well as approaches to smoking cessation and treatment of hypertension, differed by provider type.ConclusionTailoring of lectures for non-physician audiences may be beneficial given differences in baseline knowledge. More emphasis is needed on statin use for all providers and on smoking cessation and treatment of hypertension for nurses, students, and other healthcare professionals.     

Preparation of Nanoparticles by Solvent Displacement Using a Novel Recirculation System

Submicron colloidal suspensions of poly(ε-caprolactone) (PCL) were prepared by the solvent displacement method, using either the conventional form or a new recirculation device. In the latter case, a process that allows the recirculation of the aqueous phase into a device, providing a continuous flow, is proposed. The influence of the organic solution injection rate and polymer concentration on mean particle size and process yield were studied for both methods. The recirculation rate was also analyzed for the recirculation system. Nanoparticles (NPs) showed mean sizes that ranged from 156 to 381. The smallest particles were obtained when recirculation rate, injection rate and polymer concentration were maximized but at the expense of the yield. The only acceptable yields (83–96%) were obtained at the lowest PCL concentration (2.5% w/v). ANOVA tests (α = 0.05) showed that the variables implicated in the recirculation system significantly affected the mean particle size and the process yield. The entrapment efficiencies of NPs prepared by the conventional method were not significantly different (α = 0.05) from those obtained by the recirculation system.     

Inhibition of 3-Hydroxy-3-Methylglutaryl–Coenzyme A Reductase and Application of Statins as a Novel Effective Therapeutic Approach against Acanthamoeba Infections

Acanthamoeba is an opportunistic pathogen in humans, whose infections most commonly manifest as Acanthamoeba keratitis or, more rarely, granulomatous amoebic encephalitis. Although there are many therapeutic options for the treatment of Acanthamoeba, they are generally lengthy and/or have limited efficacy. Therefore, there is a requirement for the identification, validation, and development of novel therapeutic targets against these pathogens. Recently, RNA interference (RNAi) has been widely used for these validation purposes and has proven to be a powerful tool for Acanthamoeba therapeutics. Ergosterol is one of the major sterols in the membrane of Acanthamoeba. 3-Hydroxy-3-methylglutaryl–coenzyme A (HMG-CoA) reductase is an enzyme that catalyzes the conversion of HMG-CoA to mevalonate, one of the precursors for the production of cholesterol in humans and ergosterol in plants, fungi, and protozoa. Statins are compounds which inhibit this enzyme and so are promising as chemotherapeutics. In order to validate whether this enzyme could be an interesting therapeutic target in Acanthamoeba, small interfering RNAs (siRNAs) against HMG-CoA were developed and used to evaluate the effects induced by the inhibition of Acanthamoeba HMG-CoA. It was found that HMG-CoA is a potential drug target in these pathogenic free-living amoebae, and various statins were evaluated in vitro against three clinical strains of Acanthamoeba by using a colorimetric assay, showing important activities against the tested strains. We conclude that the targeting of HMG-CoA and Acanthamoeba treatment using statins is a novel powerful treatment option against Acanthamoeba species in human disease.     

基于晶闸管导通角控制的脉宽调制旋转阳极控制技术的设计与实验

针对X线检查大型医疗设备整机价格昂贵、维保费用高、生命周期短、场地要求严苛等问题,研究一种能够应用于教学示教及技能培训、故障演练测试的教学器具,结合旋转阳极电路的基本功能要素,涵盖高压启动、低压维持、延时保护、运转检测等基本流程,结果表明,该装置能够准确地演练实际工作环境,起到培育医疗设备维修人员检修旋转阳极时所需要的实际技能的作用,降低了实际教学成本,满足了工位数需求,增加了实践动手训练机会,提升了技能培训效果。