支气管肺癌脑转移并脑出血高渗性昏迷个案报告

本报道了一例外藉海员，航行中七天来发生头痛、腰病、失语、右侧上下肢瘫痪等脑血管意外症状，经颅脑CT检查证实为左侧丘脑区出血。抢救过程中曾先后发生周围循环衰竭、高渗性昏述、左侧自发性气胸肺不张等严重并发症，经复查颅脑CT、胸部CT及纤维支气管镜检查最后确诊为支气管肺癌脑转移并发脑出血。     

美国加州大学医学院住院医师培养情况借鉴

美国在住院医师培养方面取得了巨大的成就，已成为公认的住院医师规范化培养的典范。在我国，探索和尝试新的培养合格临床医生的机制，是关系到我国临床医疗水平的首要环节，也是医学继续教育中的重点和难点。结合我国的具体国情，可借鉴美国住院医师培养的相关经验开展工作，尽快缩短与国外的差距。通过总结我国自己的经验和借鉴他山之石，找出存在的问题，保留行之有效的培养制度，去掉形式化的指标和方法，为我国的住院医师培养探索出切实可行的新途径。     

Effects of α1-adrenergic receptor on the proliferation of cholangiocarcinoma cells

Objective To investigate the correlation between α1-adrenergic receptor and the pathological behavior of cholangiocarcinoma, and the effects of norepinephrine (NE) on the proliferation of cholangiocarcinoma cell line QBC939. Methods Thirty-six samples of cholangiocarcinoma were resected in Southwest Hospital from August 2002 to March 2008. The expression of α1-adrenergic receptor in the 36 samples of cholangiocarcinoma tissue and 4 samples of normal bile duct tissue were detected by SABC technique. The proliferation of cholangio-carcinoma cell line QBC939 was detected after processing the cells with NE, phentolamine and prazosin. All the data were analyzed by chi-square test. Results The high positive expression rate of α1-adrenergic receptor was 68% (17/25) in patients with lymph node metastasis, which was significantly higher than 9% (1/11) in patients without lymph node metastasis (χ2=10.604, P<0.05). The high positive expression rate of α1-adrenergic receptor was 85% (11/13) in patients with middle and low positioned cholangiocarcinoma, which was significantly higher than 30% (7/23) in patients with hilar cholangiocarcinoma (χ2=9.753, P<0.05). NE promoted the proliferation of cholangiocarcinoma cell line QBC939 by stimulating the expression of α1-adrenergic receptor, and in a concentration-dependent manner. The proliferative effect was weakened as time passed by, and it was eliminated by phentolamine and prazosin. Conclusions The expression of α1-adrenergic receptor is diverse due to lymph node metastasis and the location of the tumor, α1-adrenergic receptor with high expression may play an important role in the proliferation and metastasis of cholangiocarcinoma.     

汗管角化病的Ar^＋激光治疗

汗管角化病的Ａｒ＋激光治疗物理学教研室卢雁王岚于新陈永朴哈尔滨第四医院海军汗管角化病是一种少见的皮肤病，遗传性很明显，常有家族史，好发于面部和四肢，严重影响患者的美容，给患者精神上、心理上带来很大影响，目前在临床上无良好的治疗方法。３年来我们采用Ａｒ...     

完全腹腔镜脾切除贲门周围血管离断术121例临床研究

目的探讨全腹腔镜下脾切除贲门周围血管离断术(LSPD)治疗肝硬化门静脉高压症(PH)的可行性、有效性和安全性。 方法回顾分析2014年1月至2017年12月完成的LSPD 121例临床资料。 结果115例顺利完成,6例中转开腹(5.2%),手术时间95～325 min,平均162 min;术中出血100～1 600 ml,平均285 ml;术后住院时间6～20 d,平均8.6 d。术后腹腔出血3例,2例出血量较大再次开腹手术止血,1例经保守治疗出血控制。术后轻度腹水9例,胸腔积液7例,胰腺假性囊肿1例,肺部感染2例,无围手术期死亡。术后随访3～50个月,门静脉系血栓形成13例(11.3%),反复腹水4例(3.5%)。消化道再出血4例(3.5%),1例经胃镜下止血治愈,1例行TIPS出血停止,另2例失血性休克抢救无效死亡。1例术后2年肝功能衰竭死亡。其余患者均生存。 结论LSPD是一种安全、有效的治疗治疗肝硬化PH的微创手术方法。     

上海市卢湾区垃圾分类回收工作现状及前景

从源头减量和过程减量2个方面介绍了上海市卢湾区垃圾分类及资源化利用现状,探讨了卢湾区实施垃圾分类的创新经验和存在的问题,并对推进垃圾分类工作提出了建议.