注射人绒毛膜促性腺激素与否对体外受精周期中改行未成熟卵体外培养结局的影响

目的探讨不育患者在常规体外受精一胚胎移植（IVF-ET）周期中改行未成熟卵体外培养（IVM）,取卵前注射人绒毛膜促性腺激素（hCG）与否对其实验室及临床结局的影响。方法回顾分析2008年1月至2010年11月在温州医学院附属第一医院生殖医学中心行常规IVF治疗的138个周期,在促排卵5～7d后,双侧卵泡数目≥20个,或用药8～13d后,卵泡发育缓慢且两侧卵泡数目≥15个,最大卵泡直径平均≤12mm,根据患者意愿,停药改行IVM治疗,其中63个周期在取卵前12h注射hCG（A组）,75个周期未注射hCG（B组）。比较两组的实验室及临床结局。结果A组的卵成熟率（64．56％）显著高于B组（56．3％）,但是平均获卵数（8．42±0．52）个低于B组（11．32±0．82）个,差异均有统计学意义（P〈0．05）。两组的受精率、卵裂率、移植率、临床妊娠率、流产率,多胎妊娠率比较均无统计学差异（P〉0．05）。结论常规IVF周期改行IVM后可以获得良好的妊娠结局,取卵前注射hCG虽然可以提高卵子的成熟率,但并不能提高妊娠结局。     

小切口辅助腹腔镜巨大腹壁切口疝修补术的探讨

目的总结小切口辅助腹腔镜巨大切口疝修补术的经验。方法 2008年6月-2009年12月,采用小切口辅助腹腔镜修补巨大切口疝15例,疝环（12.3±3.4）cm,采用小切口切除疝囊并进行腹壁塑形。结果 15例均顺利完成手术,手术时间100-150 min,（123.3±15.9）min。小切口长度5-8 cm,（6.0±0.9）cm。术中发现隐匿疝6例,一并予以修补。浆液肿1例。术后住院时间4-8 d,（5.3±1.2）d。1例术后疼痛持续〉3个月,无切口感染和肠道及腹腔脏器损伤。全组随访12-30个月,（19.9±4.7）月,无复发。结论小切口辅助腹腔镜修补巨大切口疝是一种安全可靠的手术方法,术后并发症少,达到了腹壁塑形的效果。     

临床护理工作中实施连续排班模式的效果观察

目的:探讨尝试连续排班模式(APN排班)改革护理排班方式,全面提高临床护理质量,实现优质护理服务.方法:改革原有传统护理排班方式,通过设立APN班,制定各班次的工作流程与质量标准,应用于临床护理工作.比较实施前后患者服务满意率、护理质量、护理职业满意率.结果:通过实施该项改革尝试,患者对护理工作满意率,病人基础护理合格率、病房管理合格率有显著性差异(P＜0.05).结论:APN连续排班模式有助干科学管理人力资源,为患者提供安全、高效的护理服务,满足患者、护士的需求话应新的医学模式需求.     

Fas及Caspase家族在泡球蚴感染宿主肝脏中的表达及其意义

目的 探讨细胞凋亡信号分子Fas及Caspase家族在肝泡球蚴病宿主中的表达及意义.方法 16例配对泡型包虫患者(AE)肝脏标本,16只雌性BALB/C小鼠.分析肝脏标本中肝细胞病理变化、凋亡及Fas、Caspase-3、Caspase-8和Caspase-9的表达.结果 AE患者病灶周围肝细胞水肿,汇管区周围纤维化,肝细胞造型坏死;病灶周围肝细胞发生显著凋亡[(74.0±15.0)％比(4.2±3.3)％],Fas[ (71.3±19.0)％比(5.2±1.6)％]、Caspase-3[ (39.4±18.3)％比(3.3±2.9)％]、Caspase-8[ (37.6±3.5)％比(4.0±1.8)％]和Caspase-9[ (24.7±13.8)％比(2.0±1.4)％]高表达(P＜0.05).泡球蚴感染小鼠病灶处可见囊泡,肝组织纤维化严重;肝细胞发生显著凋亡[(37.5±5.2)％比(13.9±2.7)％],Fas[ (48.3±6.2)％比(4.6±1.2)％]、Caspase-3[(29.7±6.3)％比(5.2±1.9)％]、Caspase-8[ (23.1±2.9)％比(3.5±1.4)％]和Caspase-9[( 16.7±3.2)％比(2.3±1.1)％]高表达(P＜0.05).结论 泡球蚴感染引起宿主肝细胞凋亡,提示Fas及Caspase家族介导的细胞凋亡信号通路可能参与了泡球蚴所致肝损伤进程.     

TWINFIX TI QUICK-T锚钉治疗跟腱止点撕脱的临床研究

目的应用TWINFIX TI QUICK-T治疗跟腱止点撕脱伤,评价其疗效,为临床治疗提供参考。方法 2007年9月至2010年5月采用TWINFIX TI QUICK-T锚钉治疗跟腱止点撕脱伤16例,男10例,女6例;平均44.7岁。左侧7例,右侧9例。按AOFAS踝与后足功能评分标准评价疗效。结果随访6～24个月,平均13个月。术后无一例出现缝线裂开、切口感染、主要血管及神经损伤、内固定失效等并发症,术后恢复正常解剖关系及外观,踝关节功能恢复满意。本组16例,优12例,良2例,可2例,优良率87.5%。结论利用TWINFIX TI QUICK-T锚钉治疗跟腱止点撕脱是一种合理有效的方法,这种技术不仅能有效地对抗小腿三头肌的牵拉,还有利于术后踝关节早期功能锻炼及更好地恢复功能。     

腹腔镜巨脾切除术9例报告

随着外科观念的改变和腹腔镜技术的成熟与完善,腹腔镜脾脏切除术已逐渐成为外科常规治疗术式。因门脉高压症巨脾、脾功能亢进造成全血减少,脾周围血管增粗、扭曲、数量增多,同时巨脾造成了手术视野狭窄,手术风险明显增加,在腹腔镜下手术操作较困难。因此,常被视为腹腔镜脾切除术相对禁忌证。我院2009年3月～2010年7月成功开展完全腹腔镜巨脾切除术9例,现报道如下。     

转化生长因子-β1及凋亡相关因子在泡球蚴感染宿主病灶旁免疫细胞中的表达及其意义

目的 探讨泡球蚴感染宿主病灶旁免疫细胞中转化生长因子-β1(TGF-β1)、凋亡及相关因子Caspase-3的变化及其意义.方法 8例配对泡型包虫患者和泡球蚴感染小鼠均采用苏木素-伊红(HE)染色观察病理变化,免疫组织化学技术检测病灶旁免疫细胞TGF-β1以及凋亡相关因子Caspase-3的表达与分布,原位末端标记技术(TUNEL)检测病灶旁免疫细胞凋亡.结果 泡型包虫患者及泡球蚴感染小鼠病灶旁及汇管区均有大量炎性细胞灶性浸润,TGF-β1(P＜0.01)和凋亡相关因子Caspase-3(P＜0.01)高表达,TUNEL结果表明病灶旁免疫细胞发生凋亡,与对照比较差异有统计学意义(P＜0.01).结论 泡球蚴在感染宿主过程中可能通过引起宿主TGF-β1高表达,造成免疫细胞发生凋亡而达到逃避宿主免疫反应长期寄生的目的.

Abstract：

Objective To explore the expression of transforming growth factor-pi (TGF-β1 ) and Caspase-3 in immune cells adjacent to Echinococcus multilocularis (Em) invasion. Methods In 8 paired alveolar echinococcoisis (AE) patients and Em infected mice, pathological changes were observed by Hematoxylin and Eosin (HE) staining. The expression of TGF-β1 and Caspase-3 in immune cells was detected by using immunohistochmistry, and the apoptosis of the immune cells was assayed by TUNEL. Results As compared with the lesion and the distant, TGF-β1 expressed mainly around granuloma,showed significant difference: AE leision and distant tissue ( P ＜ 0. 01) , acompanied with the high expression of Caspase-3 in immune cells ( P ＜ 0. 01). The immune cells showed significant apoptosis ( P ＜ 0. 01). The results of Em mouse model were consistent with AE patients. Conclusion TGF-β1 may play an important role in immune cell apoptosis during Em Evasion.     

经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果

目的 总结多中心应用食管超声引导、经胸微创小切口、非体外循环(CPB)下封堵室间隔缺损(VSD)的临床经验和近、中期随访结果.方法 432例病儿,男235例,女197例;年龄3个月～15岁,平均(3.2±1.9)岁;体重4.0～26.0 kg,平均(13.3±5.6)kg.膜周部VSD 351例,嵴上或嵴内型VSD 57例,肌部VSD 24例(17例多发VSD).VSD直径3～12 mm,平均(5.3±1.6)mm.膜周部VSD,经剑突下或胸骨下端3～4 cm小切口进胸;嵴内或嵴上VSD,经胸骨左缘第3肋间2～3 cm小横切口进胸.暴露右心室表面,在食管超声引导和实时监测下,穿刺右心室游离壁,导引钢丝经右心室腔穿过VSD到达左心室腔,沿导引钢丝导入输送鞘管建立轨道.通过输送鞘管直接将封堵器安放在VSD部位.经食管超声多切面反复评估封堵器的位置和与周边组织的关系,若无异常情况即可释放封堵器.结果 432例中417例封堵成功(96.5%),15例(3.5%)术中改为常规CPB手术.封堵成功者中,选用对称伞238例(57.1%),偏心伞179例(42.9%).13例(3.1%)发生新的微量至轻度三尖瓣反流,11例(2.6%)术后发生不完全右束支传导阻滞,3例(0.7%)术后发生一过性完全性房室传导阻滞.术后383例(91.8%)病儿在2 h内拔除气管插管,3～5天出院.术后416例(96.2%,416/432例)随访12～38个月,平均(19.3±11.6)个月,无近、中期死亡.1例术后6个月发生完全性房室传导阻滞.其余无明显异常.结论 应用食管超声引导、经胸微创非CPB下封堵VSD技术,是一种相对简单有效的治疗方法,近、中期临床结果满意,但远期结果需要进一步观察.

Abstract：

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.     

细胞分裂周期蛋白42mRNA和蛋白在食管鳞癌中的表达及其病理生物学意义

目的 探讨细胞分裂周期蛋白42(Cdc42)在食管鳞状细胞癌(ESCC)中的表达及其与临床病理参数间的关系.方法 应用实时荧光定量-聚合酶链反应(qRT-PCR)、蛋白免疫印迹和免疫组织化学方法,从mRNA和蛋白两个水平检测ESCC中Cdc42的表达,并分析其与临床病理参数的关系.结果 22对新鲜ESCC与癌旁正常组织中,Cdc42 mRNA在ESCC中的表达量(0.21±0.14)显著高于其在癌旁正常组织中(0.16±0.12)的表达(P＜0.05);Cdc42蛋白在ESCC中的表达量(0.83±0.35)高于其在癌旁正常组织中(0.75±0.24)的表达;在175对ESCC中,Cdc42蛋白的阳性表达率为73.7%(129/175),高于其在配对的癌旁正常组织中的表达62.9%(110/175,P＜0.05).此外,Cdc42的表达与ESCC患者的年龄、淋巴结转移及分化程度明显相关(P＜0.05).结论 Cdc42可能参与ESCC发生及转移的过程.

Abstract：

Objective To explore the expression of cell division cycle 42 (Cdc42) in human esophageal squamous cell carcinoma (ESCC) and investigate the association between Cdc42 and clinicopathological parameters. Methods The expression levels of Cdc42 mRNA and protein in ESCC and corresponding adjacent normal tissues were detected by real-time fluorescent quantitative polymerase chain reaction ( qRT-PCR), Western blotting and immunohistochemistry, respectively. The correlations between Cdc42 expression and clinicopathological parameters were analyzed. Results The expression of Cdc42 mRNA was significantly higher in ESCC tissues (0. 21 ± 0. 14 ) than that in corresponding controls (0. 16 ±0. 12) (t test,P ＜0. 05). The protein expression of Cdc42 was significantly higher in ESCC tissues (0. 83 ± 0. 35 ) than that in corresponding controls ( 0. 75 ± 0. 24). Immunohistochemistry revealed that 73.7% (129/175) of the ESCC samples had higher expression of Cdc42 protein than the corresponding controls[62. 9% (110/175) (χ2 test, P ＜ 0. 05 )]. Cdc42 expression level was correlated with age,lymphoid node metastasis and differentiation ( P all ＜ 0. 05 ), but not with the clinicopathological features,such as gender, ethnicity and macroscopical types (P ＞ 0. 05 ). Conclusion The higher expression of Cdc42 played a certain role in the carcinogenesis and metastasis of ESCC.     

肝脏血管周上皮样细胞瘤1例报告

病人女性,35岁,因体检发现右肝肿物半年于2010-01-18入院。病人无任何临床症状、相关既往史及阳性体征。血尿便常规、血生化、肿瘤标记物等检查均无异常。肝炎标志物提示乙肝病毒表面抗原(+)。MRI检查肝右后叶上段见一25mm×35mm×35mm大小长T1长T2信