Attempted Salvage Resection for Recurrent Gastric or Gastroesophageal Cancer

The purpose of this study was to determine the outcome of surgery for patients with recurrent gastric or gastroesophageal cancer. We queried records from 7,459 patients who presented with gastric or gastroesophageal cancer to our institution from 1973 through 2005 to identify those for whom resection of recurrent disease had been attempted. We assessed the associations between various clinicopathologic factors and resectability with logistic regression analysis and between clinicopathologic factors and overall survival (OS) with the Cox proportional hazards model. Sixty patients underwent attempted resection for recurrent cancer. In 31 cases (52%), recurrent disease proved unresectable at laparotomy. Factors associated with the ability to undergo re-resection included neoadjuvant treatment prior to initial resection [odds ratio (OR) 12.2, 95% confidence interval (CI) 1.9–75.6] and having an isolated local recurrence (OR 5.1, 95% CI 1.3–20.5). Of the 29 patients who underwent re-resection, 14 required adjacent organ resection, and 6 required interposition grafting. Three- and 5-year OS rates for all 60 patients were 21% and 12%, respectively; median follow-up time was 23 months. Median OS for patients undergoing resection was 25.8 months (95% CI 17.1–49.8) versus 6.0 months (95% CI 4.0–10.5) for unresectable patients (P < 0.001). Initial tumor location at the gastroesophageal junction was associated with diminished OS [hazard ratio (HR) 2.8, 95% CI 1.2–6.5] and ability to undergo resection of recurrence was associated with improved OS (HR 0.2, 95% CI 0.1–0.6). We conclude that surgical resection of select patients with recurrent gastric or gastroesophageal cancer can result in improved OS but often requires adjacent organ resection or interposition graft placement.     

Clinical and radiographic reports following cervical arthroplasty: a 24-month follow-up

We reviewed patients with cervical disc prosthesis replacement for single-level cervical disc disease to evaluate its clinical effect and maintenance of cervical spine motion. Fifteen patients underwent Bryan artificial cervical disc replacement and were followed-up for at least 24 months. No neurological or vascular complications were observed during or after operation. JOA, VAS, and NDI scores showed statistical significant improvement in our follow-up. The procedure achieved an 87% (13/15) satisfactory rate at 24-month evaluations according to Odom's criteria. The range of motion (ROM) of the cervical spine, treated segment, adjacent segment, and functional spinal unit (FSU) decreased at early follow-up, but they recovered to the preoperative level at 12- and 24-month follow-up. Also, preoperative lordosis of the cervical spine and FSU were not only maintained but also even improved during the 24-month follow-up. No obvious degeneration of adjacent discs were found at MRI. There were no cases of prosthesis subsidence or extrusion. The cervical disc prosthesis showed a good clinical outcome; it also restored ROM of the cervical spine and reestablished cervical curvature in our 24-month follow-up. But to be sure of its long term effect, a longer follow-up is needed.     

保留股骨颈全髋关节置换的手术体会

目的探讨保留股骨颈的全髋关节置换在临床应用中的手术体会。方法2002年1月至2007年2月,12例13侧因各种原因需行全髋关节置换者接受了保留股骨颈的全髋关节置换,采用Gibson切口,在头下位置将股骨头截断,保留完整的股骨颈。选择合适的外杯,55°外翻角装入。内杯为超高分子聚乙烯,超半径设计保持外翻45°。术前、术后及随访中对患者髋关节功能进行Harris评分,随访时摄X线片以了解假体的位置、松动情况及异位骨化。结果全部患者获得1～4年的随访,13侧人工髋关节临床效果良好。人工髋关节的活动及功能良好,髋关节的Harris评分由术前的平均50分提高到末次随访时的平均91分;影像学检查显示人工髋关节位置良好,假体无松动和下沉。结论保留股骨颈的全髋关节置换术对因各种原因需行全髋关节置换者,是一种良好的选择,主要适用于无骨质疏松且股骨颈完整者。     

农村和城市糖尿病患者对糖尿病足相关知识的认知比较

目的了解农村和城市糖尿病（DM）患者对DM足相关知识认知及自护状况,为加强农村DM患者的健康教育提供参考。方法应用自行设计的问卷对住院治疗的农村（80例）和城市（80例）DM患者DM足相关知识、DM足危险因素、足部护理情况进行调查。结果5．0％～71．3％农村患者了解DM足相关知识,7．5％～90．0％患者至少存在一种DM足危险因素,76．2％～100％患者未实施足部护理;农村患者对DM足相关知识的认知和足部自我护理实施情况显著低于城市患者（P〈0．05,P％0．01）。结论农村DM患者对DM足危险因素认知水平明显低下,需在农村人群中普及DM知识并加以强化,提高其对DM认知,重视足部护理,降低DM足发生率,提高其生活质量。     

关节周围注射混合药物在全膝关节置换术围手术期多模式镇痛方案中的疗效评估

目的运用随机对照的前瞻性方法观察关节周围注射混合药物在全膝关节置换术（TKA）酮手术期多模式镇痛方案中的的止痛效果。方法60例单侧TKA患者随机分为研究组30例和对照组30例。所有患者术前24小时及术后第2天给予塞来昔布（西乐葆）200mg每天2次（术后6小时400mg口服）、氨酚曲马多（及通安）1片每天3次口服,连续使用5d;研究组患者术中膝关节周围注射镇痛药物（10g／L罗哌卡因20ml,吗啡10mg,复方倍他米松（得宝松）1ml,生理盐水80ml）,对照组患者没有运用关节周围注射药物。术后首次哌替啶注射6h后视患者疼痛情况再给予相同剂量注射1次。术前、术后分别记录静止与活动视觉模拟疼痛评分和膝关节活动度。结果58例患者进入统计学分析,其中对照组有2例在术后麻醉师给行静脉镇痛。（1）视觉模拟疼痛评分：研究组术后6、12、24、36、48h静止、运动视觉模拟疼痛评分低于对照组（P均〈0．01）,两组术后72h静止和运动视觉模拟疼痛评分间的差异无统计学意义（P〉0．05）;（2）膝关节活动度：研究组术后第1、2、3天膝关节活动度高于对照组（P均〈0．01）,两组术后第1、2周膝关节活动度间的差异无统计学意义;（3）并发症：两组术后没有发现任何因为注射而引起的伤口感染、延期愈合及组织坏死等并发症。结论TKA术中应用关节周围注射镇痛药物在可以在多模式镇痛方案中起一定作用：减少术后早期静止和活动状态疼痛评分、改善术后早期关节活动度。     

基质金属蛋白酶血清含量与膀胱移行细胞癌浸润转移的关系

目的探讨基质金属蛋白酶-2（MMP-2）和基质金属蛋白酶-9（MMP-9）的血清含量与膀胱移行细胞癌侵袭转移的关系。方法采用酶联免疫吸附试验（ELISA）对46例膀胱移行细胞癌患者血清中的MMP-2及MMP-9进行测定,并与18例正常血清进行对照分析。结果膀胱移行细胞癌患者同正常对照组比较,血清中MMP-2和MMP-9含量均显著增高（P〈0.000）,血清中MMP-2和MMP-9含量随着临床分期的升高均有显著性增高（P〈0.0000）,膀胱癌组织学Ⅱ、Ⅲ级患者血清中MMP-2和MMP-9含量明显高于I级（P〈0.0000）,但两者间比较无显著性差异（P〉0.05）。站论MMPs与膀胱移行细胞癌的发生、发展及侵袭转移密切相关,MMPs血清学测定可作为判断膀胱肿瘤预后的指标之一。     

表没食子儿茶素没食子酸酯对高糖环境下体外小鼠足细胞活性氧的影响

目的　观察不同浓度表没食子儿茶素没食子酸酯（EGCG）对高糖造成氧化应激状态下体外小鼠足细胞损害的作用并探讨其机制。 方法　以高糖（25 mmol/L）培养的小鼠足细胞为研究对象,维生素E培养为对照。首先以MTT法检测细胞活力,再在激光共聚焦显微镜下以CM-H2DCFDA荧光探针观察不同浓度EGCG（0.2、10、100 μmol/L）刺激足细胞6、12、24 h后活性氧（ROS）生成,并以流式细胞仪定量分析ROS平均荧光强度。RT-PCR法检测足细胞内ROS产生的主要通路NADPH氧化酶各亚基mRNA（ph22phox、p47phox、p67phox）的表达。 结果　高糖刺激下6 h,足细胞ROS生成显著增加（P < 0.01）。正常糖组和甘露醇组培养12 h ROS生成无显著增加（P > 0.05）。EGCG 0.2 μmol/L作用6 h可显著降低高糖环境下体外小鼠足细胞ROS水平（P < 0.01）。与高糖组比较,EGCG（100 μmol/L）显著减少NADPH氧化酶亚基p22phox和p67phox mRNA表达（均P < 0.05）。与维生素Ｅ组比较,EGCG（0.2 μmol/L）和维生素E（0.2 mmol/L）协同作用组显著减少p47phox mRNA表达（P < 0.05）。 结论　EGCG能缓解高糖环境下体外足细胞氧化应激状态,对高糖培养下足细胞有保护作用。     

Wedge-Shaped Excision and Modified Vertical Mattress Suture Fully Buried in a Multilayered and Tensioned Wound Closure

Background  A successful deep multilayered wound suture should provide a firm tension-relieving closure, good wound-edge eversion, hemostasis, and minimal intradermal extraneous materials. However, this is not always achieved with a single standard technique. The authors describe their modification of a wound closure method that can rapidly and reliably achieve these results. Methods  A wedge-shaped excision was adopted to obtain a trapezoid pattern transect, after which a modified fully buried vertical mattress suture technique was used to close the wound. These techniques were compared with the standard excision and suture techniques used for the same patient at different times after surgery. Results  The wedge-shaped excision can facilitate good wound-edge eversion, and the modified fully buried vertical mattress suture can provide firm tension relief and optimal apposition. Compared with conventional excision and suture techniques, the described techniques brought about a better outcome in terms of hypertrophic scar prevention. Conclusion  The described modified technique seems to be more efficient than conventional procedures used to prevent hypertrophic scar formation.     

内皮抑素在大鼠腹膜的表达及其与腹膜血管新生的关系

目的 研究大鼠腹膜血管内皮抑素（endostatin, ES）基因及蛋白表达与腹膜血管新生的关系。 方法 32只雄性SD大鼠,按随机数字表法分为正常组、肾衰竭非透析组（非腹透组）、1.5%腹膜透析组（1.5% PD组）、4.25%腹膜透析组（4.25% PD组）,每组8只。PD组经规律PD 28 d后,取各组大鼠新鲜腹膜组织,用RT-PCR检测ES mRNA表达;用组织免疫组化染色检测ES蛋白表达;以CD34染色观察腹膜组织毛细血管密度（MVD）。 结果 各组均有ES mRNA表达,正常组为0.47±0.05;非腹透组为0.45±0.04;1.5% PD组为0.46±0.04;4.25% PD组为0.47±0.03;各组表达差异无统计学意义。正常组ES蛋白表达积分0分;非腹透组积分2分;1.5%PD组积分4分;4.25%PD组呈高表达,积分9分。正常组MVD为3.13±1.13;非腹透组为5.13±1.14;1.5%PD组为9.00±1.51;4.25%PD组为10.75±1.83;组间差异均有统计学意义（P < 0.05）。 结论 尿毒症状态和非生理性腹透液刺激可使大鼠腹膜组织ES蛋白表达升高,其在长期透析所致腹膜组织毛细血管生成增多中可能发挥一定的作用。     

前列腺癌和良性前列腺增生组织中M3受体表达及意义

目的 探讨前列腺组织中胆碱能毒蕈碱受体M3亚型表达在前列腺肿瘤发生发展中的作用.方法 收集正常前列腺、良性前列腺增生、前列腺癌组织标本各36例.应用RT-PCR方法分别测定标本组织中M3受体、血管内皮生长因子(VEGF)的表达情况;蛋白质印迹与免疫组织化学染色方法测定各组标本中M3、VEGF、人白细胞分化抗原34(CD34)的蛋白表达.图像分析系统检测数据,以相对表达强度(目的 物质表达强度/β-actin表达强度)作为统计学分析参数.数据统计分析 计数资料采用方差分析,分类变量资料采用χ2检验,相关性分析采用Pearson方法.结果 前列腺癌组织标本M3受体基因相对表达强度0.8354±0.1897、VEGF基因表达0.7824±0.2047,明显高于良性前列腺增生组织(0.6735±0.1603、0.6021±0.1637)和正常前列腺组织(0.5425±0.1629、0.3436±0.1581),组间差异有统计学意义(P<0.001),3种组织中M3受体与VEGF基因表达呈直线正相关关系(r=0.4999,P<0.001).前列腺癌组织标本M3受体蛋白表达0.4777±0.1638、VEGF蛋白表达0.5718±0.2245,明显高于良性前列腺增生组织(0.3655±0.1474、0.4342±0.1538)和正常前列腺组织(0.2659±0.1076、0.3380±0.1527),组间差异有统计学意义(P<0.05).结论 M3受体表达与前列腺肿瘤的发生发展有关.