抗Fas配体抗体和CTLA4 Ig诱导同种胰岛移植耐受

我们通过应用抗ＦａｓＬ抗体及ＣＴ ＬＡ4Ｉｇ ,探讨其在同种胰岛移植耐受中的作用 ,现将结果报道如下。一、材料和方法采用Ｗｉｓｔａｒ大鼠作为供体 ,ＳＤ大鼠为受体。抗ＦａｓＬ抗体及ＣＴＬＡ4Ｉｇ剂量相同 ,移植前给药 1次 ,剂量 2 0 0μｇ/ｋｇ体重 ,移植次日起持续 7ｄ给药 ,阴茎背静脉或尾静脉注入 ,剂量 10 0μｇ/ｋｇ体重。受体ＳＤ大鼠随机分为 4组 :(1)无任何处理组 (ｎ=6 ) ,即移植前后未给予特殊处理 ;(2 )抗ＦａｓＬ抗体(ＳａｎｔａＣｒｕｚＢｉｏｔｅｃｈｎｏｌｏｇｙ公司 )处理组(ｎ =5 ) ;(3)ＣＴＬＡ4Ｉｇ处理组(ｎ =6 )…     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

丙酮酸对选择性单胚胎移植胚胎筛选中的价值

目的：通过检测胚胎培养液中丙酮酸的含量,评估其预测选择性单胚胎移植妊娠成功率的能力。方法选择到本院不孕中心就诊患者的第3天胚胎培养液,用拉曼光谱技术检测其丙酮酸含量,使用受试工作者曲线下面积评估丙酮酸对胚胎移植妊娠成功率的预测能力。结果妊娠组和非妊娠组第3天培养液中丙酮酸与白蛋白拉曼散射强度比值分别为0.0090（0.0070、0.0189）和0.0238（0.0183、0.0325）,差异有统计学意义;丙酮酸结合生态学评分预测妊娠成功的 ROC 曲线下面积为0.846,95％ CI：0.775～0.916,可较好地估计单胚胎移植妊娠率。结论在临床选择优质胚胎时,可考虑使用拉曼光谱法检测胚胎培养液中丙酮酸的含量,以提高选择性单胚胎移植的妊娠成功率。     

PGT周期中嵌合体胚胎移植的妊娠结局分析

目的 分析在辅助生殖的胚胎植入前遗传学检测(PGT)周期中,移植嵌合体胚胎的妊娠结局,初步探讨嵌合体胚胎的移植价值.方法 选择2017年4月-2020年10月广东省妇幼保健院生殖医学中心25个嵌合体胚胎移植周期作为研究组,根据研究组患者的一般临床资料按照1∶4匹配97个整倍体胚胎移植周期作为对照组,比较分析其移植后的妊...     

一例胃低分化腺癌合并同时性多发性结直肠腺癌的MDT诊治

多学科综合治疗协作组（multi－disciplinary team,MDT）诊治模式符合精准医学和个体化治疗的准则,目前逐渐成为一种主流模式。这一模式能够弥补不同学科对疾病认识上的不足,提高医疗质量,并且能使患者利益最大化。本文总结本院诊治的1例罕见胃低分化腺癌合并同时性多发性结直肠腺癌患者的资料,通过治疗过程中多次MDT讨论,制定适合该患者的最佳诊断和治疗方案,体现出MDT诊治的优势,最终使患者获益。     

MBBS留学生外科学教学初步探讨

文章以MBBS留学生外科学教学实践为基础进行探索,着重从学生特点、教材建设、教师队伍建设、教学模式、教学质量评估等方面探讨如何提高留学生临床医学教学质量,为留学生医学教育的可持续发展提供参考。     

Krukenberg瘤27例临床特点和预后分析

目的研究Krukenberg肿瘤的临床病理特点,分析影响其预后的因素,探讨改善预后的方法.方法回顾性分析我院从1996年1月至2008年8月收治的27例Krukenberg肿瘤患者的临床资料.结果 Krukenberg肿瘤中位发病年龄为34岁.15例检测消化肿瘤五项（CEA、AFP、CA125、CA19-9、鳞癌抗原）,其中肿瘤标记物有阳性者8例（53.3%）.原发肿瘤来源于胃14例,结直肠癌11例,阑尾者1例,未确定原发灶者1例.16例（59.3%）为双侧卵巢转移,11例（40.7%）为单侧卵巢转移.25例有完整生存资料,生存期最长46个月,中位生存期 11.7个月.单因素分析结果显示年龄以及治疗方案均为影响预后的主要因素（χ2=11.450,P＜0.05）,手术联合化疗能改善生存（P＜0.05,β=-3.294）,而原发肿瘤的直径、部位、浸润深度、淋巴转移以及卵巢转移瘤的肿瘤大小、部位、分化程度等因素并非影响生存的预后因素.结论 Krukenberg瘤多出现于原发病灶初次手术2年内,手术联合化疗为首选治疗方式,50岁以上的患者预后较佳.建议原发胃肠道恶性肿瘤术后,随访必须包括卵巢相关检查.     

快速康复外科促进术后胰岛素敏感性的恢复

Background  Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.

Methods  Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively.

Results  Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.

Conclusion  Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

     

影响宫腔内人工授精妊娠率的临床及精液因素分析

目的探讨促排卵方案、子宫内膜因素、处理后前向运动精子总数和活动率、受精次数对人工授精妊娠率的影响。方法回顾性分析本中心2009-2010年收治的677对病人促排卵方案,子宫内膜类型及厚度,受精次数,将前向运动精子总数分为7组,即A:(4～9)×106,B:(10～12)×106,C:(13～15)×106,D:(16～20)×106,E:(21～25)×106,F:(26～30)×106,G:>30×106,分别比较各组患者年龄、不孕年限、活动率对临床妊娠率的影响。结果 677个周期共获得88例生化妊娠,79例临床妊娠,平均生化妊娠率为13.15%,临床妊娠率为11.81%。促排卵方案以HMG组最好,子宫内膜类型为三线征及内膜厚度大于8mm是妊娠达到10%以上的必要条件。双次人工授精妊娠率(15.27%)明显高于单次(7.57%)。各活动精子数量组妊娠率分别为0、14.37%、11.92%、15.09%、8.33%、20.34%、6.06%,A组临床妊娠率最低,与其余组比较差异有统计学意义,F组活动率和妊娠率最高,与其余组比较差异有统计学意义。结论促排卵方案以HMG组最好;三线征子宫内膜且厚度大于8mm、(26～30)×106精子密度和84%以上的活动率是获得高妊娠率的先决条件;双次人工授精优于单次。     

生物补片在疝与腹壁外科的临床应用进展

目前人工合成补片在疝与腹壁外科中应用广泛,并取得良好的效果,但是合成补片具有难以避免的缺点,如补片感染、慢性疼痛、肠粘连、甚至肠瘘等,一旦补片感染则需要移除补片。此外,因合成补片可能增加手术部位感染的概率,故目前不推荐其应用于存在明确污染或感染部位的手术中。生物补片正是针对人工合成补片存在的缺陷而研发出来,它具有耐感染性好、良好组织相容性、完全可吸收等优势。研究证明生物补片可以安全应用于潜在污染或感染部位的疝修补术中。目前生物补片已应用于各种腹壁疝以及腹壁肿瘤、感染或创伤后的腹壁重建等手术中。然而,现阶段有关生物补片的循证医学证据等级较低,不同研究报道生物补片的应用效果差异较大,尚无共识形成,故针对生物补片的临床应用尚需要持谨慎态度。我们期待前瞻性的临床研究来进一步论证生物补片的长期疗效。本文针对生物补片临床应用现状和进展进行简要综述。