直肠癌患者根治性前切除术后复发转移的单因素和多因素分析

目的探讨直肠癌患者根治性前切除术后复发转移的相关临床病理因素。方法应用单因素和多因素分析方法,回顾性分析1990年至1999年262例直肠癌根治性前切除术患者的临床病理因素。结果单因素分析显示,Dukes分期、淋巴结转移、肿瘤部位、分化程度、远切缘长度与直肠癌前切除术后复发转移有关,肿瘤部位、远切缘长度与局部复发有关。多因素分析显示,分化程度和远切缘长度是影响术后复发转移的预后因素,远切缘长度是影响术后局部复发的预后因素。结论肿瘤分化程度和远切缘长度是影响直肠癌患者根治性前切除术后复发转移的重要预后因素,肿瘤远切缘短的患者术后局部复发的风险增大。     

硫喷妥钠对人心房肌细胞瞬间外向钾电流的影响

目的 观察硫喷妥钠对人心肌细胞瞬间外向钾通道电流(Itol)的影响,探讨其对心肌抑制作用中可能的电生理改变作用。方法采用急性分离的人心房肌细胞,应用膜片钳全细胞技术记录不同浓度的硫喷妥钠[30μmol/L(T1组)、100μmol/L(T2组)、300μmol/L(T3组)]对细胞膜瞬间外向钾电流的影响。结果 T1组硫喷妥钠在 30～ 60 mV有抑制Itol的趋势,其中,在 50 mv和 60 mv有明显抑制作用(n=21,P<0.05);T2组和T3组硫喷妥钠分别在测试电位 30～ 60mv(n=19)和 20- 60 mV(n=17)时,对Itol有明显抑制作用(P<0.05);并且在膜电位去极化至 60 mV时,三组浓度(30μmol/L、100 μmol/L、300μmol/L)的硫喷妥钠对电流的抑制率分别为10.7±3.3、21.3±3.8和(49.3±4.8)％,不同浓度效应间差异具有显著性(P<0.05),且抑制程度与浓度呈正相关(r=0.943,P<0.05)。电流-电压曲线基本形态无显著变化。结论 临床相关及其高于临床浓度的硫喷妥钠对人心房肌细胞Itol有明显而直接的抑制作用,且具有浓度依赖性,提示这种改变与硫喷妥钠的心肌抑制作用中的负性变时性作用有关。     

脾切除治疗特发性血小板减少性紫癜202例

目的评价特发性血小板减少性紫癜脾切除治疗的远期疗效 ,探讨围手术期的特殊处理。方法对 1 974年 1月至 2 0 0 1年 6月脾切除治疗特发性血小板减少性紫癜 2 0 2例的临床资料进行回顾性分析 ,依临床症状改善情况分为有效组和无效组。结果术后并发症 1 8例 (8 9% ) ,远期随访 1 89例 ,有效组 1 5 9例 ,(其中显效 96例 ,良好 6 3例 ) ,无效组 30例 ,远期死亡 6例 (3 2 % )。术后血小板上升速度 1周内≥ 1 0 0× 1 0 9/L者共 1 1 8例 ,有效组 1 1 0例 ,占有效组 6 9 2 % ,无效组 8例 ,占无效组 2 6 7% (χ2 =1 9 4 5 ,P <0 0 1 ) ;术后血小板上升峰值≥ 2 0 0× 1 0 9/L者 5 6例 ,有效组 5 4例 ,占有效组 34 0 % ,无效组 2例 ,占无效组 6 7% (χ2 =9 0 3,P <0 0 1 )。脾脏病理定量检查与术后远期疗效相关。结论　术后 1周内血小板≥ 1 0 0× 1 0 9/L或血小板峰值≥ 2 0 0× 1 0 9/L者均预示脾切除远期疗效良好     

Adventitial Myofibroblasts Play no Major Role in Neointima Formation After Angioplasty

Abstract

Objective—Myofibroblasts migrating from adventitia have been suggested to constitute a majority of neointimal cells after angioplasty. We sought to examine this hypothesis by use of smoothelin, which is a marker for the quiescent smooth muscle cell (SMC) phenotype while not expressed by myofibroblasts. Design—Balloon angioplasty was performed in left iliac arteries of 25 rabbits that were killed after 3-56 days. Arterial cross-sections were immunostained for (X-actin (general marker), smoothelin (quiescent SMC phenotype), and Ki-67 (proliferative phenotype).

Results—Adventitial cells became transiently actinpositive (myofibroblasts) but did not express smoothelin at any time point. In media, angioplasty induced transient proliferation and coinciding transient decrease in smoothelin expression. Neointimal cells, present 7 days after angioplasty, were initially proliferating and smoothelin-negative but changed to non-proliferating, smoothelin-positive cells after 56 days where 82 ± 10% of cells stained positive for smoothelin. This phenotypic modulation of medial and intimal cells began in media and moved gradually towards the lumen.

Conclusion—At late follow-up, the majority of intimal cells are smoothelin-positive indicating that adventitial myofibroblasts play no major role for neointima formation.     

Intramural injection with botulinum toxin significantly elongates the pig esophagus

Background/Purpose

Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch.

Methods

Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device.

Results

The mean esophageal elongation was 84% (range 83–101) in the BTX-A-group and 65% (50–78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001).

Conclusion

Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.     

格特隐球菌vgⅡ基因型的快速鉴定和序列分型研究

目的 建立一种核糖体基因内间隔区(igs)的特异性pcr扩增和序列分析方法,用于快速鉴定格特隐球菌vgⅡ基因型及其亚型.方法 选取新型和格特隐球菌核糖体igs区中可变度最高的1区为靶点,经clustalx 2多重比对后,设计特异性扩增格特隐球菌vgⅡ基因型的引物用于pcr分析.通过扩增新型和格特隐球菌其余基因型以及其他致病酵母菌来评价引物的特异性,并对阳性扩增片段(vgⅡ基因型)进行测序和序列分型研究.结果 基于核糖体igs区的特异pcr引物扩增所有受试格特隐球菌vgⅡ基因型菌株均为阳性,而新型和格特隐球菌其余基因型以及其他致病酵母菌均为阴性.序列分型显示,在扩增片段的72、79和104 bp处存在3个多态性位点,可用于区分vgⅡ基因型中的不同亚型.结论 该研究建立的特异性pcr扩增方法可快速、准确地鉴定格特隐球菌vgⅡ基因型,对扩增片段的序列分型可初步筛查高致病性的vgⅡa亚型. abstract： objective to establish a pcr method for rapid identification and sequence typing of vg Ⅱ allele of the intergenic spacer region (igs) of cryptococcus gattii.methods since igs1 was of high sequence variation,multiple alignments were conducted by clustalx 2 in igs1 of cryptococcus gattii and cryptococcus neoformans,and then primer sets specific to genotype vg Ⅱ was designed for pcr analysis.the specificity of the primer pair was detected by amplification of the other genotypes in cryptococcus gattii,cryptococcus neoformans,and other pathogenic yeasts.the amplified fragments from vg Ⅱ genotype were sequenced and subtyped.results using the pcr analysis developed in this study,all vg Ⅱ genotype strains tested were amplified,whereas no amplification was obtained from other genotypes or yeast species involved herein.three polymorphic nucleotide sites at 72,79 and 104 bp in the fragment amplified could be used to distinguish sub-genotypes within vg Ⅱ genotype.conclusions the pcr analysis developed in this study can be used for rapid identification of genotype vg Ⅱ of cryptococcus gattii.the sequence typing based on the amplified fragment from igs1 may be performed for screening the highly virulent sub-genotype vgⅡ a.     

呼和浩特市2019年风疹流行病学特征分析

目的：了解呼和浩特市风疹流行现状,为制定本市风疹预防控制措施和疫苗免疫策略提供科学依据。方法：运用描述性流行病学研究方法对疾病监测麻疹专报系统收集的2019年呼和浩特市风疹疫情资料进行分析。结果：2019年通过麻疹专报全年共报告风疹确诊病例170例,风疹报告发病率为5.67/10 万。其中,最小发病年龄1岁,最大发病年龄32岁,发病年龄主要集中在12～23岁,占总病例数的的89.4%。发病高峰集中在4-6月份,占总病例数的86.4%。结论：呼和浩特市风疹疫情形势较为严峻,应在做好风疹成分疫苗常规免疫的同时加强大中专入学新生风疹成份疫苗的补种和大中专院校的传染病管理。     

The value of frozen section analysis of the sentinel lymph node in clinically N0 squamous cell carcinoma of the oral cavity and oropharynx.

OBJECTIVE: To determine the feasibility and accuracy of fine-sectioned frozen-section analysis of the sentinel lymph node (SLN) in cN0 oral cavity and oropharynx squamous cell carcinoma. STUDY DESIGN: Thirty-one patients were included and underwent lymphoscintigraphy a day before surgery and marking of the SLN. Intraoperatively, the SLNs were identified using a gamma probe, excised, and analyzed using fine-sectioned frozen section. The remaining SLN tissue was fixed in formalin for further staining and immunohistochemical analysis. An elective neck dissection was performed in all patients and all excised lymph nodes were examined for metastatic disease. RESULTS: SLNs were identified preoperatively by lymphoscintigraphy as well as by gamma probe intraoperatively in all patients. A total of 82 sentinel lymph nodes were excised and analyzed by fine-sectioned frozen section. Micrometastases were found in 16 out of the 82 SLNs, upstaging 14 out of 31 patients (45%) from cN0 to pN+. Furthermore, a total of 1295 lymph nodes from the neck dissection specimens were analyzed, confirming only one more metastatic disease. Sensitivity and negative predictive value of SLN biopsy were 93% and 94% respectively for frozen section analysis. CONCLUSION: Our study shows that SLN biopsy in cN0 neck of patients with oral cavity and oropharyngeal carcinoma is both feasible and accurate. Provided that larger studies confirm our results, an elective neck dissection may become unnecessary if fine-sectioned frozen-section analysis of the SLN shows no nodal metastases in patients with cN0 oral cavity and oropharynx carcinoma.     

踝关节慢性前外侧不稳的手术治疗

目的: 探讨治疗踝关节慢性前外侧不稳定 (踝关节外侧不稳定合并距下关节不稳定) 的合理而有效的手术方式。方法: 自 1999 ~2003年, 应用Chrisman Snook术式, 以腓骨短肌腱前半部分重建距腓前韧带、跟腓韧带和距跟外侧韧带,治疗踝关节慢性前外侧不稳 8例患者,共 13例关节。结果: 术后随诊 6个月~5年, 平均 19个月。术后所有踝关节均达到功能稳定, 关节活动度基本恢复正常, 没有复发性踝关节不稳发生。以Good评级标准作为疗效评价, 10例关节 (77% ) 为优, 2例关节 (15% ) 为良, 1例关节为中 (7% ), 优良率达 92%。结论: Chrisman Snook术式重建了距腓前韧带、跟腓韧带和距跟外侧韧带, 有效地矫正了踝关节外侧不稳定和距下关节不稳定, 是治疗踝关节慢性前外侧严重不稳定的合理而有效的治疗方法。     

Continued stabilization of Triathlon cemented TKA: A randomized RSA study concentrating especially on continuous migration

Background and purpose — There is a general call for phased introduction of new implants, and one step in the introduction is an early evaluation of micromotion. We compared the micromotion in the Triathlon and its predecessor, the Duracon total knee prosthesis, concentrating especially on continuous migration over 5 years of follow-up. Patients and methods — 60 patients were randomized to receive either a cemented Triathlon total knee prosthesis or a cemented Duracon total knee prosthesis. 3-D tibial component migration was measured by radiostereometric analysis (RSA) at 3 months and at 1, 2, and 5 years. Results — There was no statistically significant difference in maximum total point motion (MTPM) between the 2 groups (p = 0.1). The mean MTPM at 5 years for the Duracon was 1.10 (SD 1.21) mm and for the Triathlon it was 0.66 (SD 0.38) mm. The numbers of continuously migrating prostheses were similar in the groups at the fifth year of follow-up; 6 of 21 prostheses in the Duracon group and 3 of 21 in the Triathlon group had migrated more than 0.3?mm between the second year and the fifth year of follow-up (p = 0.2). Interpretation — The Triathlon has a micromotion pattern similar to that of the Duracon total knee system at both short-term and medium-term follow-up, and may therefore, over time, show the same good long-term mechanical stability.