超声造影剂肝渡越时间对肝良恶性病变诊断的临床意义

目的探讨超声造影剂肝渡越时间(hepatic transit time,HTT)对肝良恶性病灶鉴别诊断的临床意义。方法良性病灶组包括22例局灶性脂肪肝和50例血管瘤;恶性病灶组包括26例原发性肝癌,16例转移性肝癌。经肘静脉弹丸注射超声造影剂声诺维,计算超声造影剂HTT。结果良性病灶HTT值波动范围大,其HTT范围6~17 s,平均(10.5±2.3)s。恶性病灶HTT均不大于10 s,HTT范围3~10 s,平均(6.0±1.9)s。以HTT<10 s作为恶性的诊断标准,其敏感性为95.0%,特异性为50.0%,阳性预测值为52.6%,阴性预测值为94.7%。结论超声造影剂HTT在肝良恶性病变中的价值主要在于对恶性病灶的排除诊断,不适合进行病灶恶性的确切诊断。     

门静脉高压症介入治疗前后血流动力学变化分析

目的探讨肝炎后门静脉高压症的多重介入治疗方法的可行性.方法分析22例部分脾动脉栓塞术和12例行经颈内静脉肝内门体分流术并胃冠状静脉栓塞术患者的彩色多普勒检查资料.结果经颈内静脉肝内门体分流术并胃冠状静脉栓塞术后脾静脉、门静脉管径缩小(P<0.05),门静脉、脾静脉流速流量明显增加,呈高动力状态.部分脾动脉栓塞术后脾静脉、门静脉平均血流速度降低(P<0.05),血流量明显减少(P<0.01).结论经颈内静脉肝内门体分流术并胃冠状静脉栓塞术若与部分脾动脉栓塞术联合运用可缓解门脉系循环高动力状态、降低门静脉压力.     

高频超声结合增强型能量多普勒成像评价Ⅱ型糖尿病患者指尖微血管变化的应用研究

目的寻找Ⅱ型糖尿病患者并发末梢微血管病变的早期证据，为临床提供有效的观察方法和指标。方法应用高频超声结合增强型能量多普勒显像（e-Flow）观察30例Ⅱ型糖尿病患者右手中指末节指腹和甲床内微血管床的分布特征、走行和数量，并计算指腹动脉和甲床动脉的收缩期峰值速度（PSV）、舒张期峰值速度（EDV）以及血管阻力（RI）参数。观察结果与32例年龄、性别相匹配的健康成人对照。结果①正常人中指末节指腹的血管供应丰富，e-Flow清晰显示手指的两支掌侧固有动脉及发出的分支，呈网状分布于整个指腹。血管形态勾勒清晰，走行正常，可追踪全程；甲床内微血管呈纵行分布，末梢可见横行吻合支，血管网清晰，血供丰富。②糖尿病患者中指的末节指腹血管网显示欠丰富，仅可显示一或两支固有动脉分支或仅见零星点条状血流，血管走行迂曲断续，与正常人差异有统计学意义（P〈0．05）；甲床内微血管，尤其是远端血管显示不良，仅见零星点条状血流，与正常人差异有统计学意义（P〈0．05）；糖尿病合并症者的指端微血管异常较单纯糖尿病患者为甚。③与正常人比较，糖尿病患者的指腹动脉、甲床动脉PSV、EDV测值稍减低（P〈0．05～0．09），RI相应升高（P〈0．05）。结论E-Flow结合传统彩色多普勒血流成像技术可敏感、准确地反映糖尿病患者的指端微血管分布减少，血管阻力增高，为临床早期诊断糖尿病微血管病变和评价治疗效果提供了新手段。     

单孔腹腔镜下子宫内膜癌分期手术的临床报告

目的探索单孔腹腔镜下子宫内膜癌分期手术（LESSstagingoperationofendometrialcarcinoma）的可行性,以拓展单孔腹腔镜在妇科手术领域的应用。方法北京协和医院妇科自2013年3月至2013年8月,共完成单孔腹腔镜下子宫内膜癌分期手术3例,无并发症发生,无失访病例,随访时间42d至6个月。手术技巧的改良主要是所有操作均在单孔腹腔镜下完成,包括全子宫切除、双侧附件切除、盆腔淋巴结切除,手术操作以传统腹腔镜器械配合特殊单孔腹腔镜器械,电凝及切割组织采用智能能量器械来完成。结果3例子宫重量110—230g,平均155g,术后病理证实切除盆腔淋巴结数量14～26个,平均20．6个,手术时间145～169min,平均156-3min,术中出血量100～200ml,平均150ml,术后疼痛VAS评分2～5分,平均4分,术后肠道功能恢复时间8～24h,平均14h,术后住院日3～5d,平均4d,术中后均未发生并发症,随访时间14d至6个月,术后随诊所有患者均无明显自觉症状,二便如常,阴道分泌物正常,脐部伤口愈合良好,脐部伤口愈合为隐蔽伤口,未见明显瘢痕,3例患者阴道残端伤口均愈合良好。结论单孔腹腔镜手术是安全、有效完成子宫内膜癌分期手术的一种可行手术方式,但需要进一步的前瞻性、随机更多样本的研究评估。     

50例舒缓患者音乐疗法生活质量影响观察

目的：探讨音乐疗法对临终患者生活质量的影响。方法：选择舒缓疗护病房100例患者,实验组和对照组各50例。对照组给予常规治疗及护理,实验组增加音乐疗法干预,每次30 min,1次/d。结果：两组患者心率、疼痛指标和远期生活质量比较差异有统计学意义（P＜0.05）;两组患者呼吸和血压指标差异无统计学意义。结论：音乐疗法能缓解舒缓患者疼痛症状,提高生活质量。     

奥沙普秦分散片有关物质方法的研究

目的:确定奥沙普秦分散片有关物质的检查方法,通过有关物质检查方法控制药品的质量。方法:采用HPLC法,以十八烷基硅烷键合硅胶为填充剂;以乙腈-水(用磷酸调pH值为2.5)(50:50)为流动相;检测波长为254nm;流速1.0mL/min;进样量20μL,进行有关物质测定。结果:本品的的理论塔板数按奥沙普秦计算均不低于2000。结论:该方法操作简便,结果准确,可用于奥沙普秦分散片有关物质的检查。     

SHR3824, a novel selective inhibitor of renal sodium glucose cotransporter 2, exhibits antidiabetic efficacy in rodent models

Aim： The sodium glucose cotransporter 2 （SGLT2） plays an Jmportant role in renal glucose reabsorption, thus serves as a new target for the treatment of diabetes. The purpose of this study was to evaluate SHR3824 as a novel selective SGLT2 inhibitor and to characterize its in vivo effects on glucose homeostasis. The effects of chronic administration of SHR3824 on peripheral insulin sensitivity and pancreatic !5-cell function were also investigated. Methods： The in vitro potency and selectivity of SHR3824 were assessed in HEK293 cells transfected with human SGLT2 or SGLTI. Acute and multi-dose studies were performed on ICR mice, GK rats and db/db mice to assess the ability of SHR3824 to enhance urinary glucose excretion and improve blood glucose levels. 2-Deoxyglucose uptake and insulin immunohistochemical staining were performed in the soleus muscle and pancreas, respectively, of db/db mice. A selective SGLT2 inhibitor BMS512148 （dapagliflozin） was taken as positive control. Results： SHR3824 potently inhibited human SGLT2 in vitro, but exerted much weak inhibition on human SGLT1 （the IC50 values of SHR3824 against human SGLT2 and SGLT1 were 2.38 and 4324 nmol/L, respectively）. Acute oral administration of SHR3824 （0.3, 1.0, 3.0 mg/kg） dose-dependently improved glucose tolerance in ICR mice, and reduced hyperglycemia by increasing urinary glucose excretion in GK rats and db/db mice. Chronic oral administration of SHR3824 （0.3, 1.0, 3.0 mg·kg·d-1） dose-dependently reduced blood glucose and HbAlc levels in GK rats and db/db mice, and significantly increased insulin-stimulated glucose uptake in the soleus muscles and enhanced insulin staining in the islet cells of db/db mice. Conclusion： SHR3824 is a potent and selective SGLT2 inhibitor and exhibits antidiabetic efficacy in several rodent models, suggesting its potential as a new therapeutic agent for the treatment of type 2 diabetes.     

dentification of DW532 as a novel anti-tumor agent targeting both kinases and tubulin

Aim： 7,8-Dihydroxy-4-（3-hydroxy-4-methoxyphenyl）-2H-chromen-2-one （DW532） is one of simplified analogues of hematoxylin that has shown broad-spectrum inhibition on tyrosine kinases and in vitro anti-cancer activities. The aim of this study was to identify DW532 as a agent targeting both kinases and tubulin, and to investigate its anti-cancer and anti-angiogenesis activities. Methods： In vitro tyrosine kinases activity was examined with ELISA, and tyrosine kinases activity in cells was evaluated with Western blot analysis. Tubulin turbidity assay, surface plasmon resonance and immunofluorescence technique were used to characterize the tubulin inhibitory activity. Cell proliferation was examined with SRB assay, and cell apoptosis and cell cycle distribution were analyzed with Annexin-V/PI staining and flow cytometry. Tube formation, aortic ring and chick chorioallantoic membrane assays were used to evaluate the anti-angiogenesis efficacy. Results： DW532 inhibited EGFR and VEGFR2 in vitro kinase activity （the ICso values were 4.9 and 5.5 pmol/L, respectively）, and suppressed their downstream signaling. DW532 dose-dependently inhibited tubulin polymerization via direct binding to tubulin, thus disrupting the mitotic spindle assembly and leading to abnormal cell division. In a panel of human cancer cells, DW532 （1 and 10 pmol/L） induced G2/M phase arrest and cell apoptosis, which subsequently resulted in cytotoxicity. Knockdown of BubR1 or Mpsl, the two core proteins of the spindle assembly checkpoint dramatically decreased DW532-induced cell cycle arrest in MDA-MB-468 cells. Moreover, treatment with DW532 potently and dose-dependently suppressed angiogenesis in vitro and in vivo. Conclusion： DW532 is a dual inhibitor against tubulin and tyrosine kinases, and deserves further development as a novel anti-cancer agent.     

老年股骨粗隆间骨折髓内和髓外固定治疗显性及隐性失血量的初步分析

目的：对采取髓内固定和髓外固定两种内固定方法治疗老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,以探讨对术后隐性失血量的影响。方法回顾性分析2010年1月1日～2013年12月31日间采用髓内内固定手术治疗的64例及采用髓外内固定手术治疗的87例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时评估围手术期的显性、隐性失血情况。结果采用髓内固定治疗的患者平均术中失血（65.7±3.4） ml;术后平均显性失血量为（70.4±4.6）ml,平均隐性失血量为（431.6±17.8）ml。采用髓外固定治疗的患者平均术中失血量为（94.5±7.4）ml;术后平均显性失血量为（80.4±4.7）ml,平均隐性失血量为（298.4±5.3）ml。骨折髓外固定出血量均多于髓内固定（P＜0.01）,但髓内固定术后隐性出血量及总体出血量均多于髓外固定（P＜0.01）。结论髓内固定和髓外固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,但髓内固定术后隐性出血量更多,需引起重视。     

股骨转子周围骨折并股骨中上段骨折的手术治疗

[目的]探讨应用股骨近端髓内钉配合有限切开复位钛捆绑带内固定治疗股骨转子周围骨折并股骨中上段骨折的手术方法和疗效。[方法]对2002年1月～2006年10月收治的21例股骨转子周围骨折并股骨中上段骨折的病人，均采用股骨近端髓内钉固定或配合行有限切开复位钛捆绑带内固定技术治疗。[结果]21例病人全部获得9个月～5年的随访，平均13个月，所有病例均达临床骨性愈合，未出现内固定物折断、松动、脱出等情况。患肢髋膝关节功能均恢复良好。[结论]根据病人的年龄和骨折的类型，采用股骨近端髓内钉或配合行有限切开复位钛捆绑带内固定技术是一种良好的内固定方式，具有创伤小、操作简便易行、固定牢固可靠、利于骨折愈合等优点，良好的保留了患肢的功能。技术的主要关键是在微创的前提下达到解剖复位。