腹腔镜解剖性肝Ⅶ段切除术的难点与应对策略

腹腔镜解剖性肝Ⅶ段切除术是被公认难度较大的肝段切除手术方式之一。肝Ⅶ段因其位置与解剖特点,行解剖性肝切除术时存在显露不佳、操作困难、肝蒂解剖复杂、切除平面难以确定和断肝容易出血等问题。笔者在行腹腔镜解剖性肝Ⅶ段切除术时病人常规采取左侧半卧位,将Trocar布局整体向右季肋区偏移,根据术前三维重建个体化选择适宜的肝Ⅶ段肝蒂解剖方式,由肝Ⅵ和Ⅶ段间平面开始离断肝脏,以垂直方向寻找和显露肝右静脉主干,然后以肝右静脉作为肝内路标指引肝实质离断。笔者临床经验表明:通过选择合适手术策略能有效降低腹腔镜解剖性肝Ⅶ段切除术难度、提高手术安全性和可控性,同时保证肿瘤根治性效果。     

浙江省男男性行为人群网络临时性伴的知情交友状况分析

目的 分析浙江省MSM网络临时性伴的HIV感染状况知情交友（知情交友）状况及相关因素,为干预措施制定提供参考依据。方法 2018年6-12月在杭州市、宁波市、温州市、台州市和绍兴市,由社会组织和自愿咨询与检测门诊招募符合研究对象标准的MSM,招募样本量为793人。采用自行设计问卷,采用面对面方式问卷调查,收集社会人口学特征、艾滋病知识、性行为、知情交友行为等信息。采用SPSS 20.0软件进行统计学分析。结果 在MSM 767人中,最近6个月发生网络临时性行为302人,发生网络型临时性行为、网络/场所混合型临时性行为者分别占62.6%（189/302）和37.4%（113/302）。在网络临时性伴的知情交友中,已告知、已询问和已知晓者分别占54.6%（165/302）、49.2%（146/297）和42.9%（82/191）,知晓网络临时性伴HIV阴性状况后坚持使用安全套者占75.8%（113/149）。多因素logistic回归分析结果显示,最近6个月网络临时性伴的知情交友中未询问的相关因素包括年龄25~34岁（aOR=2.17,95%CI：1.20~3.91）、最近6个月网络临时性伴数>2个（aOR=2.13,95%CI：1.27~3.57）、不认为网络临时性伴HIV感染风险较高（aOR=1.96,95%CI：1.14~3.35）、既往HIV检测数>1次（aOR=0.38,95%CI：0.22~0.66）。结论 浙江省MSM网络临时性伴的知情交友的意愿较高,但知情交友行为及知晓对方HIV检测结果的比例较低,针对MSM的网络临时性伴较多、认为网络临时性伴感染风险低和HIV检测次数较少者,需加强健康教育和促进知情交友的行为干预。     

"健康中国"战略下临床医学专业本科生职业医学教育的实践与探索

临床医学专业学生是职业病的诊断、治疗、康复和预防的未来主干力量,因而在"健康中国"战略下采用多元化教学方式培养学生解决问题的能力,提高临床医学生学习职业医学的积极性,推进职业医学专业人才队伍建设,对维护全体劳动者身体健康、促进经济社会协同发展具有重要意义。     

Nacre surface transformation to hydroxyapatite in a phosphate buffer solution

Nacre, also known as mother-of-pearl, constitutes the inner layer of mollusc shells. Nacre is a natural composite material consisting mostly of calcium carbonate in the aragonite crystal form and some organic matter. Previous studies have shown that geological aragonite, coral and nacre can convert hydrothermally to hydroxyapatite (HAP) in phosphate solution by a solid-state topotactic ion-exchange reaction. This conversion typically occurs within the range of 140-260 degrees C, although higher temperatures are possible. In this work, we have found that nacre can transform to HAP in a phosphate buffer solution at room temperature via a surface reaction. The morphology of the nacre-transformed HAP surface was investigated by scanning electron microscopy (SEM). The HAP surfaces were characterized by X-ray photoelectron spectroscopy (XPS) and secondary ion mass spectroscopy (SIMS). A layer covered with packed particles was found in contrast to the tablet structure typical of nacre surfaces. XPS and SIMS indicated that the mineral phase of the nacre surface had converted from an aragonite phase to an HAP phase. Fourier transform infrared spectroscopy (FTIR) showed that phosphate (PO(4)) bands appeared after nacre was soaked in a phosphate buffer and the intensity of the PO(4) bands increased with exposure time. The FTIR was consistent with XPS and SIMS results. We suggest that this surface reaction occurs by a dissolution-precipitation mechanism. Calcium ions are released from the nacre surface, react with phosphate ions in the buffer solution, and then precipitate as HAP on the nacre surface.     

Relationship between a novel human cytotoxin (factor 2) produced by a B cell line (Karpas 160) and phorbol-myristate-acetate-associated cytotoxicity.

We found that 160b cells, a subclone of Karpas 160 human B cell line, spontaneously secreted a novel cytotoxin, factor 2 (F2). F2 was also extracted from the cells by 60% ammonium sulphate, 0.5% CHAPS and 0.28% Triton X-114. We were able to show that phorbol myristate acetate (PMA) greatly enhanced the production of F2, and PMA may also account for part of the putative F2 cytotoxic activity to K562 cells in crude preparations. We compared the cytotoxic effect of F2 with PMA-associated F2-like cytotoxicity to K562 cells as well as the adequacy of our schemes to purified F2 with regard to its separation from PMA. We found that it was possible to separate PMA from F2 preparations by gel filtration and Rotofor preparative isoelectric focusing. The fate of PMA was also monitored with 3H-PMA and chromatographic profiles of 3H-PMA were studied using DE52 and gel filtration chromatography. We were able to establish that less than 2.9% of the cytotoxicity to K562 was due to PMA. We also found that the radioactive peaks and cytotoxicity peaks to K562 were not well correlated, indicating that the cytotoxicity was not mainly due to remaining PMA. Activated charcoal removed virtually all F2 and PMA but not tumour necrosis factor activity. Our results also showed that cytotoxicity to K562 resulting from F2 or PMA-associated proteins had different physicochemical properties, indicating that they are different molecular entities. These findings are consistent with the earlier observation that 160 cells produce F2 spontaneously and that PMA can amplify its production significantly.     

Relationship between HLA-DRB1 and DQ alleles and the genetic susceptibility to type 1 diabetes

Objective　To study the relationship between human leukocyte antigen (HLA)-DRB1 and DQ alleles and the genetic susceptibility of type 1 diabetes in North Chinese children. Methods　Polymerase chain reaction (PCR) techniques were used to amplify the second exon of DRB1 and DQ alleles, after which sequence specific olignucleotide probe (SSOP) dot blot hybridization techniques were used to analyze the amplified products. Results　DRB1*0301, DQA1*0301, DQB1*0201 alleles and DRB1*0301-DQA1*0501-DQB1*0201 haplotype were significantly increased in patients, while DQA1*0103 and DQB1*0601 alleles were significantly increased in controls. The distribution of DR4 and DR9 haplotypes in patients and controls were not significantly different, but DR3/DR4 and DR4/DR9 heterozygotes were significantly increased in patients. Conclusions　DRB1*0301, DQA1*0301 and DQB1*0201 confer susceptibility while DQA1*0103 and DQB1*0601 confer protection to type 1 diabetes. DRB1*0301-DQA1*0501-DQB1*0201 haplotype offers a predisposition to type 1 diabetes in North Chinese. Although the distribution of DR4 and DR9 in patients and controls had no significant difference, DR3/DR4 and DR3/DR9 heterozygotes were significantly increased in patients, showing that the susceptive effects of DR3 and DR4 or DR4 and DR9 haplotypes could be added up.     

nm23-H1基因在人贲门癌中的表达

目的 :检测转移抑制基因 nm2 3- H1在贲门癌中的表达 ,探讨其与贲门癌生物学特性和其他病理学指标的关系。方法 :应用免疫组化染色技术对 2 8例贲门癌组织中的 nm2 3- H1进行检测并与正常组织对照。结果 :贲门癌及其相应的正常组织中 nm2 3- H1蛋白表达率分别为 67.9%和71 .4% ,两者间无显著性差异 ( P<0 .0 5)。 nm2 3- H1蛋白在贲门癌中的表达 ,随肿瘤浸润程度的增加而表达下降 ( P>0 .0 5) ;在淋巴结转移阳性组贲门癌中 ,表达阳性率为 46.2 % ,而淋巴结转移阴性组为 92 .8% ,两者差异显著 ( P<0 .0 5)。结论 :nm2 3- H1蛋白表达在肿瘤分化程度高组与低组之间 ,无显著性差异。     

Graves 与ABO血型的关联分析

目的：探讨Graves病(GD)与ABO血型的相关性。方法：采用玻片凝集法鉴定我院汉族GD患者215例ABO血型分布并进行疾病与血型的关联分析。结果：GD患者血型分布特征为O＞B＞A＞AB。发病相对危险率(RR),O型RR＞2,其他血型均RR＜1;A/O、B/O、AB/O均RR＜1(P＜0.01～0.0001)。结论：GD的发生可能与ABO血型有关。     

结核分支杆菌耐多药株katG突变SSCP技术检测的研究

目的 建立并评价ＰＣＲ－ＳＳＣＰ检测结核分支杆菌耐药性基因突变的方法。方法 根据ｋａｔＧ基因易变区设计一对引物,ＰＣＲ扩增,产物经沸点断裂成单链,经ＳＤＳ－ＰＡＧＥ,比较电泳的位置。结果 ＰＣＲ检测结核菌ＤＮＡ的灵敏度达到１００个细菌／ｍｌ,与其它细菌和其他分支杆菌无交叉反应。３０株敏感株和Ｈ３７Ｒｖ的ＰＣＲ产物经ＳＳＣＰ检测正常,２０株耐异烟肼结核菌中,１９株的ＰＣＲ产物ＳＳＣＰ检测游异常电泳带