外科决定

In managing their patients,surgeons have to make clinical decisions.Looking back,some decisions are correct,while others are incorrect.Does making a wrong clinical decision by a surgeon constitute prof...     

Emerging Energy Sources for Catheter Ablation of Atrial Fibrillation

Catheter-based ablation techniques have been increasingly used as a curative therapy for treating atrial fibrillation (AF). Currently, radiofrequency (RF) energy is the most widely accepted and used method for catheter ablation of AF. However, RF ablation has potential disadvantages, including endocardial disruption, charring, platelet activation, pulmonary vein stenosis, and thrombus formation, and has limited efficacy in performing atrial linear ablation. As a result, new alterative energy sources have been explored for AF ablation. These new technologies, including cryoablation, microwave, ultrasound, and laser have different potential advantages over RF, but all of them have limited clinical experiences. Furthermore, the emergence of these new ablation energy sources should be paralleled with development of new ablation catheters, mapping and imaging tools to improve the successful rate of AF ablation. In the future, conventional RF ablation will remain the standard approach for AF, but some of these energies may be used in combination at specific sites for safety reasons, such as the use of cryoablation inside PVs or the use of microwave to create long atrial linear ablation more effectively.     

Innate immunity and systemic lupus erythematosus

Innate immunity is the first‐line host defence against pathogens and damaged host cells, and the major cellular components are phagocytes such as monocytes/macrophages, polymorphonuclear cells and dendritic cells. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the loss of tolerance to self‐antigens, the source of which has been suggested to be apoptotic cells. In this article, we will review studies on apoptosis in SLE and discuss the contribution of innate immunity abnormalities in the development of this condition.     

Benign recurrent intrahepatic cholestasis in a Chinese girl

A 15 year old Chinese girl presented with features of benign recurrent intrahepatic cholestasis, confirmed by liver biopsies performed during attack and remission. Her only younger brother also has features of this syndrome. Serial biochemistry monitoring during a recent attack demonstrated that a rise in the serum bile acids preceded the clinical onset of symptoms and the rise in serum bilirubin and ductal enzymes by 8 weeks. Whether this earlier rise in serum bile acids is related to the pathogenetic mechanism of this syndrome remains to be elucidated.     

机器人经腹腔镜行前列腺根治性切除术60例的初步结果

目的评价机器人经腹腔镜行前列腺根治性切除术的可行性和效果。方法利用da Vinci机器人外科手术系统对60例局限性前列腺癌患者施行机器人经腹腔镜行前列腺根治性切除术。患者年龄53～75岁，平均63．7岁；Gleason评分5～9，平均6；术前前列腺特异性抗原(PSA)5．5～38．3ng／ml，平均9．4ng／ml。结果术前机器人准备时间平均28(10～90)min，手术平均时间200(95～330)min。术中平均失血量355(50—1200)ml，输血7例(12％)。术后平均1d恢复正常饮食。术后平均导尿管留置时间7d，平均住院时间3d。1例发生吻合口漏尿者紧急手术探查和重新吻合，1例因膀胱颈挛缩行经尿道膀胱颈切开，1例因严重尿路感染行静脉输入抗生素。30例术前有性生活的患者术后6个月内自动恢复或经PDE5抑制剂或PGEl药物治疗后恢复性功能。术后3个月随访38例，完全控尿21例(55％)，轻度尿失禁9例(24％)，中度尿失禁8例(21％)。随访至术后6个月24例，完全控尿17例(71％)，轻度尿失禁4例(17％)，中度尿失禁3例(12％)。结论机器人经腹腔镜前列腺根治性切除术术中失血少、术后患者疼痛小、恢复快、住院时间短，使盆腔内难以进行的腹腔镜手术变得简单、方便，更加灵巧和准确。     

A pseudopeptide incorporating the tetrahydrophthalazine nucleus,a constrained Aza analog of phenylalanine

Replacement of the α-carbon with a nitrogen in α-amino acids gives rise to azaamino acids. Most examples of azaamino acids that have been incorporated into peptides are linear analogs, in which conformational effects are restricted to the immediate vicinity of the urea bond. In contrast to the linear azaamino acids, the heterocyclic analogs might be expected to exhibit stronger conformational preferences, but examples of this class of azaamino acids are very limited. We synthesized tetrahydrophthalazine (THPhth) as a constrained phenylalanine analog and elaborated it into the model pseudotripeptide N-{([N-alanyl]-1,2,3,4-tetrahydro-2-phthalazinyl)carbonyl)}-L-alanine (1). As shown by NMR studies, tetrahydrophthalazine 1A has a secondary structure in which ψTHPhth is fixed at 16–18° and there are two equal populations of cis and trans amide bonds from the N-terminal alanine. © Munksgaard 1996.