Prospective Study of Gastric Outlet Obstruction in Unresectable Periampullary Adenocarcinoma

Controversy persists regarding the role of prophylactic gastrojejunostomy in patients with unresectable periampullary adenocarcinoma. In review of the retrospective series, presence of gastric outlet obstruction (GOO) has been claimed to be a bad prognostic sign. This prospective study aimed to clarify the necessity of routine prophylactic gastrojejunostomy in patients with unresectable periampullary adenocarcinoma. The incidence and prognostic significance of GOO were also evaluated. Sixty-six patients with unresectable periampullary adenocarcinoma were enrolled. They were divided into 2 groups to receive either a single biliary bypass or a double bypass (concomitant gastric and biliary bypasses) if they had GOO. The single bypass group was followed up to assess the incidence of GOO and subsequent need of a gastric bypass. Prognostic factors were evaluated by univariate and multivariate analyses. Forty-four (67%) of the overall 66 patients presented with GOO at the time of diagnosis. There was no statistical difference regarding the morbidity and mortality between the 2 groups, except longer (7 days) hospital stay in the double bypass group. Seven (31.8%) of the 22 patients in the single bypass group subsequently developed GOO an average of 6.2 ± 1.0 months after their initial biliary bypass. By univariate analysis, significant prognostic factors for unresectable periampullary adenocarcinoma were: GOO (p= 0.0379), pancreatic head origin (p= 0.0146 by univariate analysis), and distant metastasis (p < 0.0001). After multivariate analysis, only pancreatic head origin and distant metastasis remained significant independent factors of poor prognosis. In conclusion, gastrojejunostomy should be performed prophylactically in addition to a biliary bypass in patients with unresectable periampullary adenocarcinoma. The presence of GOO is not an independent factor of poor prognosis, but a reflection of the aggressive biologic behavior of pancreatic head adenocarcinoma.     

Time-dependent astroglial changes after gamma knife radiosurgery in the rat forebrain

OBJECTIVE: Using an experimental rat model and a clinically relevant treatment dose, we performed gamma knife radiosurgery to define the hyperacute radiation effects in normal rat forebrain, the time dependence of the astrocytic reaction, and the participation of astrocytes in the healing process after single-dose gamma radiation injuries. METHODS: Seventy-one rats underwent radiosurgical treatment (4-mm collimator) of the caudate-putamen nucleus (single-fraction maximal dose of 100 Gy) and were killed at times ranging from 3 hours to 90 days. Serial cryostat brain sections were processed with the immunohistochemical avidin-biotin complex technique, using anti-glial fibrillary acidic protein as the primary antibody (to identify astrocytes). RESULTS: Vascular changes, including endothelial hyperplasia and vessel wall thickening, were identified as the earliest postradiation manifestations and continued throughout the observation period. Astrocytes reacted to the radiation injury with hyperplasia and hypertrophy. At earlier time points (3-24 h), proliferation was the predominant reaction. The expression of glial fibrillary acidic protein in the proliferating and hypertrophic astrocytes formed an initial peak in the adjacent corpus callosum 3 days after radiosurgery and peaked within the target site between 14 and 30 days. Astrocytic proliferation and hypertrophy were also observed in distant cortices (frontal, parietal, insular, and piriform cortices) and in the hippocampus. No necrosis was observed less than 30 days after irradiation. By Day 90, necrotic lesions with a mean diameter of 4 mm were identified, with glial scar at their peripheries. Astrocytic morphological features varied according to the distance from the necrosis. The irradiated side contained more glial fibrillary acidic protein-containing cells than did the nonirradiated contralateral side. CONCLUSION: During the early phase after radiation, vasculopathy was the first morphological change and may serve as the initiating factor for subsequent changes. Reactive astrocytes appeared not only at the target site but also in the surrounding regions; the severity of injury was determined by the distance from the target.     

Trace Metals' abnormalities in hemodialysis patients: relationship with medications

A multicenter collaborative study was performed to investigate the prevalence of abnormal blood contents of 6 trace metals, copper (Cu), zinc (Zn), aluminum (Al), lead (Pb), cadmium (Cd), and mercury (Hg), in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3, Ca acetate, Al containing phosphate-binding agents, 1,25-dihydroxy vitD3, 1-hydroxy vitD3, and erythropoietin (EPO), as well as hematocrit level, by chi-square statistics. From 6 medical centers in Taiwan, we included 456 patients in maintenance HD for more than 4 months for this study, and they had continued the previously mentioned medications for at least 3 months. Blood samples were collected before initiating HD, and atomic absorption spectrophotometry was used to measure plasma levels of Cu, Zn, and Al as well as whole blood levels of Pb, Cd, and Hg. Three hundred seventy-five (78%) of the HD patients had low plasma Zn levels, that is, <800 microg/L, and the mean (+/-SD) concentration was 705.8 (+/-128.23) microg/L in all subjects. One hundred forty-one (31%) of the HD patients had high plasma Al, that is, >50 microg/L, and the mean (+/-SD) was 44.30 (+/-28.28) microg/L in all subjects. Three hundred thirty-three (73%) of the dialysis patients had high Cd levels, that is, >2.5 microg/L, and the mean (+/-SD) was 3.32 (+/-1.49) microg/L in all subjects. The majority of HD patients had normal blood levels of Cu, PB, and Hg. Only 21 (4. 6%), 5 (1.1%), and 3 (0.06%) patients had elevated blood levels of Cu, Pb, and Hg, respectively. Their mean (+/-SD) blood concentration of Cu, Pb, and Hg were 1,049.78 (+/-233.25) microg/L, 7.45 (+/-3.95) microg/dL, and 3.17 (+/-25.56) microg/L, respectively. Three patients had elevated plasma Hg concentrations, that is, 546, 12.6, and 24.0 microg/L, respectively. In the 152 normal healthy age and sex matched control group, the blood levels of Al, Cd, and Pb were all significantly lower than the HD patients. However, the levels of Cu and Zn were higher in the control group. The Hg level was not significantly different in both groups. There was no statistical difference between patients with normal and abnormal blood levels of trace metals in various medications except Al containing phosphate binder. The Al containing phosphate binder users had significantly higher plasma Al levels (54.71 +/- 26.70 versus 41.15 +/- 28.03 microg/L, p < 0.001) and hematocrit levels (29.61 +/- 4.61 versus 27. 81 +/- 3.91, p < 0.0005). There was no statistical correlation between erythropoietin (EPO) dose and hematocrit level in these patients. In conclusion, the blood level of trace metals of these HD patients except Al was not related to their medications. However, caution must be exercised in interpreting this result as dose and duration of medication; efficiency of HD and water treatment may play an important role. Otherwise, environmental factors, diet, and the aging process may contribute to the trace metal burden in uremia. Thus, Zn and Cu are abundant in seafood, and Cd is abundant in contaminated plants such as rice.     

激光诱导脉络膜视网膜吻合初步实验研究

目的 探讨不同激光能量诱导脉络膜视网膜静脉在家免视网膜分支静脉阻塞眼的吻合成功率及安全性。方法 通过光动力法建立 20只兔眼视网膜静脉阻塞模型,24h后以 50 m 光斑,0.1 s的氪红离子激光的不同能量(A组 800mW.B组 1000mW)诱导脉络膜视网膜静脉间的吻合。对侧无静脉阻塞眼以作对照。在实验1、2、4、6 周时进行眼底照相和荧光眼底血管造影检查,测定吻合成功率。结果 在建立 BRVO模型的 20只眼中。A组诱导成功率 30%,激光对周围组织损伤中等;B组诱导成功率 40%;但激光对周围组织的损伤重。在对照组眼中,1只眼形成脉络膜视网膜静脉吻合。A、B实验组与对照组相比,诱导成功率差异有非常显著性意义(P < 0.001);A、B组之间比较成功率差异没有显著性意义(P > 0.1)。结论 利用激光诱导脉络膜视网膜静脉吻合,在技术上可行,较为安全;但在提高成功率方面尚有待进一步研究。     

紫菀药材的高效液相色谱指纹图谱与定量分析

目的:建立紫菀药材的反相液相色谱定性和定量鉴别分析方法.方法:Ultrasphere ODS C18色谱柱(250mm ×4.6mm,5μm),流动相为甲醇-乙腈(1:2)-0.4%磷酸梯度洗脱,流速为1.0 mL/min,检测波长为360 nm,柱温为25℃.紫菀药材经80%甲醇超声处理,进行指纹图谱分析,并对紫菀药材中的主要成分槲皮素进行含量测定.结果:在该色谱条件下,6份不同紫菀药材的RP-HPLC指纹图谱中可检出10个共有峰作为定性鉴别;紫菀药材中槲皮素的含量在0.135%～0.246%之间.结论:本方法样品处理简便,准确性好,可用于紫菀药材的质量控制.     

排石灵片的制备和质量标准研究

目的：制备排石灵片并建立其质量控制方法。方法：以槲寄生、木通、泽泻、白茅根、车前子、牛膝、赤芍、延胡索、三棱、王不留行为主药制备排石灵片，用HPLC汉对芍药苷作含量测定，流动相为甲醇：水=28：72；流速：1．0mL．min^-1；紫外检测波长230nm；结果：芍药苷的平均回收率为98．4％，RSD为1．6％，且方法的稳定性与精密度实验的RSD均小于3％。结论：该制剂的制备工艺，质量可控且稳定。以XHPLC对气含量进行测定，方法简便、准确、重现性好。     

Clinical analysis of knee osteoarthritis treated mainly by acupuncture

目的:了解不同治疗方法对膝关节骨关节炎的临床治疗效果.方法:对148例患膝随机分为4组进行针灸、中药频谱照射法、综合法、西药内服治疗,观察其疗效.结果:4组总有效率分别为78.9%,72.7%,92.3%和78.9%,各组之间无差异(P＞0.05).综合组显效率优于其他各组(P＜0.05).结论:针灸、中药频谱照射对膝骨关节炎有一定疗效,综合法能协同两者作用,使疗效提高.     

Treatment of Acute Lumbar Sprain with Single Acupoint： A RCT

目的:评价单一穴位治疗急性腰扭伤的治疗效果.方法:根据统一的诊断标准,在多个临床中心进行随机对照研究.全部病例320例经随机数字表法分为针刺后溪穴观察组和针刺腰痛点对照组.对患者的疼痛程度分别由医师和患者进行评分.结果:治疗2个疗程后,观察组和对照组近期有效率分别为89.4%和82.5%,远期有效率分别为95.6%和93.5%.经Ridit分析,近期疗效差异有统计意义(P<0.05),远期疗效差异无统计意义(P>0.05).结论:针刺单一穴位治疗急性腰扭伤疗效确切,取穴简便,后溪穴疗效好于腰痛点.