扁平足X线片测量法与比值法、三线法的比较

目的:应用X线法测量足弓,并与足印比值法和三线法的方法比较,为扁平足提供新的测量方法。方法:以足印比值法选择Ⅰ～Ⅳ型分布相对均匀的48人共96支足印,通过X线片测量,再与两种足印法进行评定。结果:X线片测量显示,内、外侧纵弓角对照比值法Ⅰ～Ⅳ型和三线法正常、轻、中、重顺序依次增加,舟骨结节距离依上述顺序而递次减小;比值法、三线法测出扁平足发生率分别为42．7%、43．6%,其中轻型比例分别为43．9%、50．0%,中型比例为31．75%、42．9%,重型比例分别为24．4%、7．1%。结论:两种足印测量方法与X线片测量结果之间密切相关,但在扁平足分型比例上存在差异。     

化学致剂马桑内酯导致大鼠海马神经细胞内Ca~(2 )升高

于培养的新生大鼠海马神经细胞,应用ｆｕｒａ２ 荧光检测技术,观察了致疒间剂马桑内酯对单个海马神经细胞内钙离子浓度（［Ｃａ２＋ ］ｉ）的影响。培养液内马桑内酯浓度达１０－ ８ｍ ｏｌ／Ｌ时可引起［Ｃａ２＋ ］ｉ增加,［Ｃａ２＋ ］ｉ随给药浓度的提高而升高。马桑内酯浓度达５×１０－ ８ｍ ｏｌ／Ｌ时,［Ｃａ２＋ ］ｉ维持于稳定的高水平上。当胞外无Ｃａ２＋时,马桑内酯仍可引起［Ｃａ２＋ ］ｉ的升高;Ｌ型钙通道阻断剂ｖｅｒａｐａｍ ｉｌ不能阻断马桑内酯的上述作用。结果提示,海马神经细胞在致疒间剂作用下,发生Ｃａ２＋ 内流及胞内钙池释放现象。     

微创技术在腹腔镜胆囊切除术后黄疸诊治中的应用

目的：探讨微创技术在腹腔镜胆囊切除术（LC）后黄疸的诊断与治疗中的作用。方法：在微创观念指导下，对LC术后出现黄疸的患者运用内镜逆行胰胆管造影（ERCP）和内镜括约肌切开（EST）等微创技术进行诊断与治疗。结果：我院1998年8月至2001年5月间共行3160例LC手术，术后出现黄疸者5例，均先接受B超、ERCP检查，提示胆总管结石与胆总管末端狭窄，3例EST取石一次成功，1例首次EST取石失败后予保守治疗5天后再行ERCP与碎石治疗成功，1例因结石较多较大行开腹胆总管探查术。结论：对LC术后黄疸，在B超等检查排除明显胆道损伤和胆漏后，胆总管结石应首先考虑。ERCP可进一步明确诊断，EST取石或碎石这一微创技术治疗胆道细小结石伴有胆总管末端炎性狭窄引起的梗阻效果良好。     

Astragaloside IV attenuates renal tubulointerstitial fibrosis by inhibiting p38 MAPK signaling

Objective To investigate the effect of astragaloside IV (AS-IV) on renal tubulointerstitial fibrosis and its regulation on p38 MAPK signaling. Methods In vivo, UUO model with renal tubulointerstitial injury was constructed. Mice in AS-IV group were orally administrated AS-IV 20 mg•kg-1•d-1 for 7 days after operation, and mice in other groups were administrated the equal volume vehicle. Bilateral kidneys were collected in 7 and 14 days after operation. Transverse kidney slices were stained with Masson trichrome to evaluate the severity of renal tubule injury. In vitro, normal human renal tubular epithelial cells (HK-2) were stimulated with recombinant TGF-β1 (10 ng/ml) and simultaneously treated with different concentrations of AS-IV (0, 50, 100, 200 μg/ml) for 24 h. SB203580 (10 μmol/L) was also ultilized to pre-treat HK-2 cells for 1 h to inhibit phosphorylation of p38 MAPK signaling. The expression of FN, Col IV, and α-SMA were investigated by western blotting and real-time PCR. The expression of p-p38 MAPKs were also observed by Western Blotting. Results Astragaloside IV morphologically ameliorated renal tubulointerstitial fibrosis. The proteins and mRNA expression of FN, Col IV, α-SMA, and TGF-β1 were also increased significantly in UUO kidney tissues (all P＜0.05), which could be reversed by AS-IV administration (all P＜0.05). In vitro, the expression of FN, Col IV, and α-SMA were up-regulated by TGF-β1 after stimulating for 24 h (all P＜0.05), which were decreased by AS-IV. The inhibition effect on FN and α-SMA were similar between AS-IV and MAPK inhibitor SB203580. AS-IV inhibited p-p38 MAPK signals both in vivo and in vitro. Conclusions AS-IV could attenuate renal tubulointerstitial fibrosis induced by UUO and TGF-β1 through reducing FN、Col IV、α-SMA expression in renal tubular cells. The mechanism of AS-IV protective effect might be associated with inhibition of p38 MAPK phosphorylation.     

论中职生职业生涯规划课程的现状和对策

职业生涯规划课程对帮助中职生树立正确的职业意识起到了积极的促进作用,针对职业生涯规划教学出现的具体问题,提出指导中职生制订职业生涯规划的对策：把职业意识的培养贯穿在中等职业教育教学体系之中;指导学生参与社会实践活动和社团活动,使学生了解自己的个性和就业形势,增强自信和对社会的了解;教师积极参与职业实践调研,开展德育活动实践,探究职业生涯规划课的教学新模式。     

超声检查对腹部实质性脏器损伤的诊断价值

目的评价超声检查对腹部实质性脏器损伤的诊断价值。方法将150例腹部实质性脏器损伤患者的超声检查结果与手术、病理结果进行对照分析。结果超声检查对腹部实质性脏器损伤诊断的敏感性95.2%、特异性92.3%、假阳性率4.8%、假阴性率7.7%、诊断准确性94.7%。结论超声检查对腹部实质性脏器损伤的诊断具有较高的准确性和可靠性,它是腹部实质性脏器损伤检查诊断的一种首选、简便及有效的方法。     

腹腔镜在胰腺肿瘤诊断和分期中的价值

目的:总结胰腺肿瘤剖腹手术前先行腹腔镜探查的价值。方法:对12例经B超和CT诊断或怀疑为胰腺肿瘤的病人,在剖腹手术前先行腹腔镜探查,其中2例联合使用腹腔镜超声检查(LUS)。结果:1例CT诊断疑为胰头肿瘤伴少量腹水者,腹腔镜明确为原发性腹膜炎,作冲洗引流而愈。2例影像学检查见胰体尾增厚,怀疑胰腺肿瘤者,腹腔镜检查未见明显异常,再作LUS检查,1例为胰腺囊肿,另1例未见异常。9例腹腔镜检查确诊为胰腺恶性肿瘤病人中,3例明确已有远处转移,从而避免了开腹;另6例腹腔镜探查提示可以切除,结果其中1例由于肠系膜血管被肿瘤包绕而无法切除,余5例(5/9=55.6%)进行了根治性切除。腹腔镜探查在评估胰腺癌不可切除性的敏感性为75%,特异性为100%,阳性预测值为100%,阴性预测值为83.3%。结论:腹腔镜探查可发现影像学检查不能发现的腹膜转移,结合腹腔镜超声检查可提高胰腺肿瘤诊断、分期的准确性,使部分病人避免了不必要的剖腹手术。     

LC在65岁以上老年病人中的应用

目的　探讨老年胆囊疾病患者行腹腔镜胆囊切除术 (L aparoscopic cholecystectom y,L C)的安全性 ,并总结有关经验。方法　回顾性分析邵逸夫医院 2 0 0 0年连续施行 L C的 1 5 32例病人 ,对比分析老年组 (≥ 6 5 y,n=1 96 )与非老年组 (<6 5y,n=1 336 )的病程、合并症、手术时间、术后并发症等临床资料。结果　老年组的病程明显长于非老年组 (P<0 .0 5 ) ,老年组伴有心电图异常及合并症的比例高于非老年组 (P<0 .0 5 ) ,老年组病例中萎缩性胆囊炎及伴有胆囊颈部结石嵌顿者比例高于非老年组 (P<0 .0 5 ) ,两组的中转开腹率分别为 8.6 7%及 3.0 7% (P<0 .0 5 ) ,并发症发生率分别为 2 .0 4 %及 1 .5 7% (P>0 .0 5 ) ,平均总住院时间分别为 5 .4 6 d及 4 .1 4 d(P<0 .0 5 ) ,平均术后住院时间分别为 2 .6 3d及 1 .96 d(P<0 .0 5 ) ,全组病例均治愈出院。结论　虽然老年胆囊疾病患者合并症多 ,胆囊病变重 ,手术风险及手术难度更高 ,但只要正确掌握老年人 L C的适应证 ,积极进行合理的围手术期处理 ,加强术中及术后的监测 ,老年人行 L C的安全性与非老年人相近     

Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway

Background and Aim: Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. Methods: Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied. Results: All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53–126 days after TAE in five patients and 74 days after EVL in one patient. Conclusions: When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.