异丙酚麻醉下行钳刮术82例临床观察

目的 :探讨异丙酚麻醉下行孕 10～ 13周钳刮术镇痛效果及安全性。方法 :应用异丙酚静脉给药麻醉后钳刮 (观察组 )。与无任何镇痛方法钳刮 (对照组 )。结果 :观察组与对照组在宫口松驰度 ,手术时间 ,出血量方面相比无明显差异 (P >0 .0 5 ) ,人工流产综合征发生率观察组 0 ,对照组 5 9%。结论 :异丙酚麻醉下行钳刮术能安全镇痛 ,避免人流综合征的发生     

β—环糊精／环氧氯丙烷水凝胶中水的存在状态及其溶胀特性

研究了β-环糊精／环氧氯丙烷水凝胶的合成工艺条件,发现该水凝胶透明性好,其干胶具有溶胀速度快的且在－40－200℃范围内不存在玻璃化转变,用DSC对β-环糊精／环氧氯丙烷水凝胶的溶胀过程及水在聚合物网络中的存在状态进行了研究,结果表明,该聚合物在溶胀过程中水首先分布于β-环糊精的外围亲水空间依次形成非冻结结结合水,可阈结结合水及游离水、其后水分布于β-环糊精内腔空间,当达到溶胀平均后,β-环糊精的内外空间都分布有水。     

蠕变局部损伤开裂的有限元模型

建立了蠕变局部损伤法模型,并给出单元进入损伤态的判据和失效的临界拉伸应变条件,局部蠕变损伤理论的实质就是试样是多种不同蠕变性能材料的统一,并由蠕变应力再分布得到证实,应用有限元对双缺口圆试样作了蠕变局部损伤分析,启裂时间和断裂蠕变应变值均与实验结果相吻合。     

Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases

ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions.     

煤的热解研究III.煤中官能团与热解生成物

借助化学分析和ＦＴＩＲ光谱分析对我国煤化程度不同的１８ 种煤中官能团的研究表明：煤中官能团含量与煤化程度有关;煤中羧基、羟基及醚键等其他含氧官能团的含量与热解生成物ＣＯ２、Ｈ２Ｏ 和ＣＯ 的产率有关,脂肪—ＣＨ 的含量与甲烷和焦油的产率相关联,芳香—ＣＨ 的含量与热解半焦产率有关。煤的热解生成物主要是煤中官能团的断裂所致。     

基因芯片对PMA激活的血管内皮细胞早期反应基因的研究

目的 :用基因芯片研究 PMA激活的血管内皮细胞的早期反应基因 (imm ediate early response gene,ERG)。方法 :以包含 40 96条人类基因的 DNA芯片检测血管内皮细胞受代谢增强剂 PMA(phorbol myristate acetate)激活后早期的基因表达谱 ,并从中筛查出 ERG。结果 :血管内皮细胞受 PMA作用 6 h后 ,17条基因上调 ,11条下调。数据处理聚类分析表明 17条上调基因中多数 (13/ 17)属蛋白质磷酸酶和转录调控因子基因 ,而下调基因中多数 (9/ 11)为细胞分裂相关基因。结论 :证明PMA激活的人血管内皮细胞早期反应基因主要是转录调控因子和蛋白质磷酸酶基因。     

睫状体冷冻术联合巩膜穿刺术治疗绝对期青光眼

目的评价睫状体冷冻术联合巩膜穿刺术在治疗绝对期青光眼中的应用。方法对绝对期青光眼４７眼施行睫状体冷冻术联合巩膜穿刺术,观察术后３ａ内眼压变化。结果全部病例术后高眼压症都获缓解,对术后早期眼压反弹,本术较单纯施行睫状体冷冻术者控制眼压疗效好（Ｐ＜０．０１）,且无副作用和并发症。结论睫状体冷冻术联合巩膜穿刺术是治疗绝对期青光眼更简便、安全、有效的手术选择。     

人眼眩光失能测定及其临床意义

目的:观察国产仪器测定眩光失能的性能与规律,并讨论其临床意义。方法:采用MGT—1多功能视觉眩光测试仪(海军医学研究所研制),按规定方法操作。测定正常人30名56眼(矫正视力全部≥1.0,晶体透明,无其他明显眼病),晶体混浊患者15人27眼。测定目标亮度及眩光亮度设置为中—中及弱—中两档分别模拟白天及夜间眩光失能。结果:中—中状态下,眩光失能值正常人均值为9.22%(全距0～31),低于晶体混浊者(24.05%,全距9～67),两者差异显著。正常眼在弱—中状态眩光失能值较中—中状态明显(均值20.12%,全距0～56)。不同频率条件对正常及晶体混浊眼眩光失能的影响不同,低频及中频较高频区的影响明显。结论:作为视功能评论指标,眩光失能检查是一种实用方法。在眼科临床及人体工效学上具有重要的意义。     

造血干细胞移植治疗原发性免疫缺陷病研究进展

原发性免疫缺陷病(PID)是一类遗传性全身免疫系统缺陷病,患儿通常很早发病,以反复致命的感染为主要表现.近年来对PID的认识从表型到基因型不断深入,对PID的治疗从有效的支持疗法缓解感染症状,到通过异基因造血干细胞移植治愈PID也有了长足的进步.目前基因治疗尚处于前期临床研究阶段.该文对异基因造血干细胞移植治疗PID的种类、干细胞来源、预处理方案及远期预后等方面进行综述.     

诱发型一氧化氮合酶在人类鼻黏膜上皮细胞中的表达

目的　探讨人类鼻黏膜上皮细胞应答炎性刺激因子白细胞介素 1 β(interleukin 1 β ,IL 1 β)和肿瘤坏死因子 (tumornecrosisfactor α ,TNF α) ,合成诱发型一氧化氮合酶 (induciblenitricoxidesynthase ,iNOS)的能力及其机制 ,以及类固醇药物对上皮细胞的影响。方法　将人类鼻黏膜上皮细胞(包括鼻息肉上皮细胞 ,下鼻甲上皮细胞 )进行无血清原代细胞培养 ,分别加入各种不同浓度的炎性刺激因子 (IL 1 β和TNF α)以及地塞米松 ,采用原位杂交的方法检测不同条件下iNOSmRNA的水平。结果　①不论用IL 1 β或是TNF α刺激 ,iNOSmRNA水平均随浓度的增加 ,时间的延长而增加 ,尤以鼻息肉上皮细胞明显。但当浓度到一定水平后 ,iNOSmRNA水平不再继续升高 ;②用IL 1 β +TNF α共同刺激 ,iNOSmRNA水平要高于单纯用其中的一种 (P <0 .0 1 ) ,同样鼻息肉上皮细胞iNOSmRNA水平要高于下鼻甲上皮细胞 ;③加入地塞米松后 ,被炎性因子诱发的iNOSmRNA升高的水平下降。当地塞米松浓度为 4 0ng/ml以上时 ,iNOSmRNA水平不再继续下降。 结论　①IL 1 β和TNF α上调人类鼻黏膜上皮细胞合成的iNOSmRNA水平 ,鼻息肉上皮细胞更为活跃。它的机制可能是通过核因子 κB途径 ;②地塞米松降低这种上调作用 ,它的机制可能是通过阻断核