HBV感染与结直肠癌肝转移关系的Metα分析

目的初步探讨HBV感染与结直肠癌肝转移的关系。方法检索1990年1月至2011年12月PubMed、Cochrane图书馆、万方数据库、CNKI数据库收录的已发表文献,并辅以文献追溯、手工检索等方法收集相关杂志及会议论文中未发表的文献。采用表格提取文献资料,将样本中结直肠癌患者按照是否感染HBV分为感染组和对照组（未感染HBV患者）,并对肝转移发生率进行分析。应用ReviewManager5．0软件进行Meta分析。采用,检测各研究的异质性,／2〉50％提示纳入的研究之间异质性强,则采用随机效应模型;反之使用固定效应模型。以效应量标准误的倒数为纵坐标,以效应量的对数为横坐标绘制散点图,评估潜在的发表偏倚。计数资料采用优势比（on）以及95％可信区间（95％ci）表示。结果检索到相关文献共56篇,其中符合纳入标准的中文文献11篇,结直肠癌患者共计5622例,其中感染组患者924例,对照组患者4698例,各文献研究结果的异质性检验差异无统计学意义（I2=0,df=10,P〉0．05）;采用固定效应模型进行合并,并进一步分析结果表明：感染组结直肠癌患者肝转移发生率为10．61％（98／924）,对照组为23．84％（1120／4698）,两组肝转移发生率比较,差异有统计学意义（合并OR=0．35,P〈0．05）。散点图显示文献不存在明显发表偏倚。结论感染HBV的结肠癌患者具有较低肝转移发生率。     

NNMT在肾透明细胞癌的表达及对肾癌细胞侵袭能力的影响

目的:研究NNMT在肾透明细胞癌中的表达情况及对肾癌细胞侵袭能力的影响。方法:采用RT-PCR和Western blot方法检测正常肾小管上皮细胞株HKC、肾癌细胞株786-O及30例肾透明细胞癌组织、相应癌旁组织中NNMT的mRNA和蛋白的表达水平,并分析NNMT的mRNA水平与临床病理参数的关系。化学合成针对NNMT特异的siRNA序列,应用脂质体Lipofectamine 2000将其转染进786-O细胞中,利用RT-PCR和Western blot法检测NNMT在786-O细胞中的表达水平,用Transwell小室法检测肾癌细胞786-O侵袭能力的变化。结果:NNMT在肾癌细胞786-O中的mRNA和蛋白表达水平显著高于正常肾小管上皮细胞株HKC(P<0.001);肾透明细胞癌组织和对应的癌旁组织中NNMT的mRNA相对表达量分别为(1.582±0.2145)、(0.1269±0.04279),两组比较P<0.001。NNMT的mRNA水平与肿瘤大小、临床分期有关(P<0.05);Tran-swell法检测结果显示降低NNMT的表达后786-O细胞的侵袭能力明显下降。结论:NNMT在肾透明细胞癌组织和细胞中表达升高,可能在肾癌发生、发展过程中发挥重要作用。     

经腹腹腔镜膀胱外乳头式输尿管膀胱再植术治疗输尿管开口异位1O例报告

目的：探讨输尿管开15异位患者经腹腹腔镜膀胱外乳头式输尿管膀胱再植术的可行性和临床效果。方法：对10例输尿管开口异位患者均采用经腹腹腔镜膀胱外乳头式输尿管膀胱再植术。全麻,仰卧位患侧抬高,建立腹腔镜工作通道（经肚脐5mmTrocar,经腹直肌外侧缘左侧5mm／10mmTrocar,右侧12mmTrocar）,充分游离患侧扩张输尿管,注意保护同侧正常输尿管,于靠近膀胱处离断异位开口输尿管,自同侧Trocar切口拉出腹壁,体外裁剪输尿管至大致正常直径,5／0可吸收线缝合输尿管管壁,末端制成乳头状,置入双J管后回纳腹腔;于膀胱底部后壁做全层切口,将输尿管末端乳头及双J管插入膀胱内,使用5／0可吸收线于膀胱全层与输尿管浆肌层间断吻合6～8针,吻合结束后膀胱注水测试有无漏尿,放置引流管及尿管。结果：10例手术均获成功,手术耗时90～160min,术中出血30～50ml,术后4～6天拔引流管,7～10天拔除尿管,术后1个月拔除双J管。术后随访1～11个月阴道无漏尿,尿常规正常,B超示肾积水减轻或消失。结论：重复肾输尿管开口异位患者经腹腹腔镜膀胱外乳头式输尿管膀胱再植是可行性的,临床效果等同于开放手术,且具有创伤小、恢复快、手术瘢痕基本不可见的优点。     

减少新生儿静脉输液外渗的护理干预

目的 探讨减少新生儿静脉输液外渗的有效方法.方法 将需要实施静脉输液的80例新生儿随机分为观察组和对照组各40例.对照组按常规行静脉输液,观察组实施静脉输液护理干预,包括建立团队,将不同药物发生外渗后的处理方法编印成册,合理安排药物输注顺序等.结果 观察组一次穿刺成功率显著高于对照组,血管外渗发生率显著低于对照组（P＜0.05,P＜0.01）.结论 通过强化责任,依靠团队,确定目标,分析外渗影响因素,可有效减少新生儿静脉输液外渗.     

T1G3期膀胱肿瘤经尿道二次电切的临床疗效分析

目的探讨二次经尿道膀胱肿瘤电切术（TURBT）治疗T1G3期膀胱肿瘤患者的临床疗效。方法回顾分析2005年1月至2011年12月在我院初次行TURBT治疗病理诊断为T1G3期膀胱肿瘤、并规律进行丝裂霉素膀胱灌注的49例患者资料。其中行二次TURBT治疗的患者19例（观察组）,未行二次电切的患者30例（对照组）。观察两组间肿瘤复发率差异、残余肿瘤存在与否,以及肿瘤病理分期、分级的变化。结果二次电切后发现5例（26．3％）有残余肿瘤,3例（15．9％）有肿瘤分期的升高,其中1例改行根治性膀胱切除术。随访8～18个月（平均15个月）,观察组有3例（15．9％）肿瘤复发,对照组13例（43．3％）肿瘤复发。结论二次TURBT可切除残存肿瘤,更准确了解肿瘤分期情况,是确定患者是否应行根治性膀胱切除的重要依据,并可明显降低肿瘤的复发与进展。     

监测脑电双频谱指数预防全麻患者术中知晓的效果:meta分析

目的 采用meta分析评价脑电双频谱指数(BIS)监测用于预防全麻患者术中知晓的效果.方法 检索Cochrane Central Register of Controlled Trials (Central)、Pubmed、Medline、EMBASE等数据库有关BIS监测与未应用BIS监测全麻患者术中知晓效果的临床、随机、对照研究.应用Cochrane协作网系统评价法对纳入文献质量进行评价和资料提取,评价指标为术中知晓发生率.采用RevMan5.1软件进行meta分析.结果 共纳入5项研究,包括34181例患者,其中应用BIS监测患者17432例,术中知晓发生率0.132％;未应用BIS监测患者16749例,术中知晓发生率0.245％,BIS监测组与未应用BIS监测组术中知晓发生率比较差异无统计学意义(P＞0.05);根据麻醉方式不同进一步分析:在吸入麻醉中,应用BIS监测患者13288例,术中知晓发生率0.128％,未应用BIS监测患者13202例,术中知晓发生率0.113％,BIS监测组与未应用BIS监测组术中知晓发生率比较差异无统计学意义(P＞0.05);在全凭静脉麻醉中,应用BIS监测患者4144例,术中知晓发生率0.145％,未应用BIS监测患者3547例,术中知晓发生率0.733％,BIS监测组术中知晓发生率明显低于未应用BIS监测组(P＜0.01).结论 监测BIS可预防全凭静脉麻醉患者术中知晓的发生,但不能预防吸入麻醉患者术中知晓的发生.     

Autoantibodies Against Glomerular Mesangial Cells and Their Target Antigens in Lupus Nephritis

Mesangial proliferation and deposition of immunoglobulins and complement components within glomerular mesangium was one of the important pathological features of lupus nephritis. Autoantibodies against human mesangial cells could be detected in the sera of patients with IgA nephropathy (IgAN) and Henoch-Schöenlein nephritis. We speculated that autoantibodies against human glomerular mesangial cells might play a role in the development of lupus nephritis. Objective. To screen autoantibodies against human glomerular mesangial cells in sera from patients with lupus nephritis and to identify their target antigens. Methods. Sera were collected from 96 patients with lupus nephritis as well as 25 patients with IgAN and 20 patients with idiopathic membranous nephropathy (IMN). Cell lysates of in vitro cultured human glomerular mesangial cells were used as antigens in Western-blot analysis to detect autoantibodies against human mesangial cells in sera from patients with lupus nephritis as well as IgAN and IMN. The clinical and pathological significance of the autoantibodies were further investigated. Results. Autoantibodies against human mesangial cells could be detected in 94/96 (97.9%) of the sera from patients with lupus nephritis in Western-blot analysis. Twelve protein bands could be blotted by the sera from patients with lupus nephritis. The prevalence of autoantibodies against human mesangial cells in IgAN was 14/25 (56.0%) and only seven protein bands could be blotted. Five autoantibodies (anti-18, 24, 36, 46, and 91 kD) could be detected only in sera from patients with lupus nephritis. In patients with lupus nephritis, some autoantibodies might have some relationship with gender, hematuria, ANA, anti-dsDNA or anti-ENA antibodies. Conclusions. There are autoantibodies directly against heterogeneous antigens of human glomerular mesangial cells in sera from patients with lupus nephritis, and some of them might be associated with different clinical manifestations.     

McGrath可视喉镜与Macintosh直接喉镜显露颈椎手术患者喉部结构的比较

目的 比较McGrath可视喉镜与Macintosh直接喉镜显露颈椎手术患者喉部结构的效果. 方法 50例颈椎手术患者采用随机数字表法随机分为McGrath组和Macintosh组,每组25例.麻醉诱导后,McGrath组先用Macintosh直接喉镜显露喉部结构并记录Cormack-Lehane分级(C/L分级),不插管,再改用McGrath可视喉镜显露喉部结构并插入气管导管.Macintosh组先用McGrath可视喉镜显露声门,再使用Macintosh直接喉镜显露喉部结构并插管.记录患者一般情况、气道评估指标(甲颏间距、张口度、Mallampati分级、颈部活动度)、喉镜显露C/L分级和插管并发症. 结果 两组间患者一般情况和气道评估指标差异无统计学意义(P＞0.05).McGrath可视喉镜的C/L分级(Ⅰ级∶Ⅱ级∶Ⅲ级为34∶14∶2)显著优于Macintosh直接喉镜(Ⅰ级∶Ⅱ级∶Ⅲ级为13∶32∶5,P＜0.01). 结论 McGrath可视喉镜对喉部结构的显露优于Macintosh直接喉镜,提示该可视喉镜有助于颈椎手术患者的气管插管处理.     

Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis

Background

Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes.

Methods

The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted.

Results

The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3 % in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups.

Conclusions

We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon’s preference.