腰升静脉狭窄致椎管内静脉高压综合征

目的：探讨腰升静脉狭窄致椎管内静脉高压综合征的临床特点及诊治方法。方法：3例患者经选择性脊髓血管造影及经股静脉插管到腰升静脉造影证实狭窄部位后,用MAGIC－B1微导管插入静脉狭窄处,反复充盈不可脱球囊扩张,消除静脉狭窄,恢复腰升静脉的正常血液回流,解除椎管内静脉高压。结果：3例患者经上述治疗后随访1至2年,2例痊愈,1例症状减轻。结论：腰升静脉狭窄是椎管内静脉高压综合征的病因之一,治疗应首选腔内血管扩张成形术。     

食管癌围手术期死亡原因分析

目的探讨食管癌围手术期死亡原因及影响因素。方法总结1970年-2004年1858例食管癌手术患者临床资料,选择17个可能影响围手术期死亡的因素,应用Cox回归模型进行多因素分析。结果1858例食管癌手术患者围手术期死亡36例(1.94%)。呼吸系统并发症是引起围手术期死亡最常见的原因(41.7%)。Cox模型多因素分析显示严重吞咽困难、长期重度吸烟史、手术时间和手术年代是影响食管癌围手术期死亡的独立因素(P<0.05)。结论加强营养、改善肺功能、缩短手术时间是降低食管癌围手术期死亡率的重要方法。     

腹腔镜辅助结肠次全切除经肛门取出标本治疗慢传输型便秘

目的：探讨腹腔镜辅助结肠次全切除、经肛门取出标本治疗慢传输型便秘的临床应用价值。方法回顾性分析2013年2-11月间行腹腔镜辅助结肠次全切除、经肛门取出标本并进行升结肠直肠吻合术的8例慢传输型便秘患者的临床资料。采用Wexner便秘与失禁评分来评估术后便秘情况,采用胃肠生活质量评分来评估术后生活质量。结果全组患者手术完成顺利,无肠瘘、盆腔感染、吻合口狭窄、术后肠梗阻和肛门失禁等并发症发生。手术时间（287．6±21．5） min,术中出血量（109．7±41．1） ml,术后肛门排气时间（2．5±0．9） d。患者术后便秘症状评分为4.7±1.9,较术前的15.1±2.8明显降低（P＜0．05）。术后胃肠生活质量评分为97．3±15．7,较术前的71．5±14．7明显提高（P＜0．05）;术后Wexner便秘与失禁评分为8．8±3．7,较术前20．4±5．7明显降低（P＜0．05）。结论腹腔镜辅助结肠次全切除、经肛门取出标本并进行升结肠直肠吻合术治疗慢传输型便秘,近期疗效满意,生活质量改善明显。     

接纳承诺疗法对口腔癌复发患者癌症复发恐惧的影响

目的探讨接纳承诺疗法降低口腔癌复发患者癌症复发恐惧情绪的效果。方法将63例口腔癌复发患者按照住院时间分为对照组32例和干预组31例。对照组接受常规护理,干预组在对照组的基础上以接纳承诺疗法为理论基础,构建并给予口腔癌复发患者癌症复发恐惧的接纳承诺疗法干预方案。结果干预后,干预组恐惧疾病进展简化量表、接纳与行动问卷、焦虑自评量表得分显著低于对照组(均P0.01)。结论应用接纳承诺疗法干预方案有利于降低口腔癌复发患者癌症复发恐惧情绪。     

The Impact of Internal or External Transanastomotic Pancreatic Duct Stents Following Pancreaticojejunostomy. Which One Is Better? A Meta-analysis

Background

The use of pancreatic duct stent to improve postoperative outcomes of pancreatic anastomosis remains a matter of debate, and the value of stenting when performing anastomosis for normal pancreas (soft and duct less than 3 mm) needs further study. The aim of the present meta-analysis was to evaluate the perioperative outcomes of patients with stenting during pancreatic anastomosis and compare the effect of external stent with that of internal stent indirectly.

Methods

A systematic literature search (EMBASE, MEDLINE, PubMed, The Cochrane Library, and Web of Science) was performed to identify studies evaluating external stent or internal stent. Included literature was assessed and extracted by two independent reviewers. A meta-analysis including comparative studies providing data on patients with and without external stenting or internal stenting during pancreaticojejunostomy anastomosis was performed.

Results

Thirteen articles including 1,867 patients were identified for inclusion: five randomized controlled trials study and eight observational clinical studies. Meta-analyses revealed that use of external stent was associated with a significantly decreased risk for pancreatic fistula in total (odds ratio (OR) 0.47; 95 % confidence interval (CI) 0.31–0.71; P?=?0.0004; I ²?=?3 %), pancreatic fistula in normal pancreas(OR 0.5; 95 % CI 0.30–0.82; P?=?0.007; I ²?=?5 %), and overall morbidity(OR 0.64; 95 % CI 0.45–0.90; P?=?0.01; I ²?=?0 %); however, the meta-analysis showed that there were no significant differences between internal stenting and non-stenting groups as regards perioperative outcomes and that in fact it may increase pancreatic fistula rate in normal pancreas(OR 1.97; 95 % CI 1.05–3.69; P?=?0.03; I ²?=?0 %).

Conclusions

The results of this analysis demonstrate a trend toward reduced pancreatic fistula with the use of external pancreatic stents in pancreaticojejunostomy. An internal stent does not impact development of fistula and that in fact it was not useful in a soft pancreas. Our conclusion may be limited to stenting during the duct-to-mucosa pancreaticojejunostomy anastomosis, and the value of stenting during invagination anastomosis needs further study.     

胆管癌组织中凋亡基因Fas、FasL的表达及其意义

目的 探讨胆管癌组织中凋亡基因Fas、FasL的蛋白表达及其与胆管癌的发生、发展及预后判断的关系.方法 :应用免疫组化S-P法检测22例胆管癌组织及10例先天性胆管囊肿组织中Fas、FasL的表达.结果 :胆管癌Fas蛋白表达率为45.45%(10/22),显著低于对照组90%(9/10)(P<0.05);而FasL蛋白表达率为72.73%(16/22),显著高于对照组(P<0.05).淋巴结或远处转移的患者中Fas表达率明显下降(P<0.05);FasL阳性表达主要集中在TNM分期Ⅲ~Ⅳ期、有淋巴结或远处转移的患者中(P<0.05).Fas、FasL表达无显著相关性.FasL阳性而Fas阴性的患者累积生存率高于其他患者(P<0.05).结论 :胆管癌细胞中存在Fas表达下调而FasL表达上调现象,并与临床分期及是否转移密切相关.Fas、FasL基因异常表达是反映胆管癌恶性行为及判断预后的有用指标.     

Spatiotemporal Dynamics of Covert Attention With Different Degrees of Central Visual Field Defects: An ERP and sLORETA Study

PurposeThe present study aimed to investigate the spatiotemporal dynamics of covert attention by simulating different degrees of central visual field defects in healthy subjects.MethodsAn electroencephalogram (EEG) was recorded while 40 normal-sighted subjects performed a target discrimination task. Target stimuli simulated different defect degrees of the central visual field by artificially central scotomas (5, 10, 20, and 30 degrees of visual angle) masked on the center of black-and-white checkerboards. Event-related potentials (ERPs) and standardized low-resolution brain electromagnetic tomography (sLORETA) based on ERPs were analyzed.ResultsERP results indicated that during early perceptual processes, compared with 5-degree and 10-degree defects, N1 amplitudes of 20-degree and 30-degree defects decreased, whereas P2 amplitudes significantly reduced in 30-degree defects. During later discrimination and decision processing, N2 amplitudes gradually increased from 5-degree to 30-degree defects, whereas P3 amplitudes gradually decreased. Source localization indicated that 5-degree and 10-degree defects had stronger activations than 20-degree and 30-degree defects from the occipital cortex to the ventral stream and dorsal streams. Especially, 30-degree defects primarily recruited additional activations in the ventrolateral prefrontal cortex and ventral stream and later caused the disconnection of dorsolateral prefrontal-posterior parietal cortices in the dorsal stream.ConclusionsDifferent degrees of central visual field defects differed in distinct spatiotemporal characteristics at multiple stages of covert attention, from top-down forward feedback and attentional allocation to executive controls through ventral and dorsal processing streams, suggesting that the combination of ERP and source localization can reveal the spatiotemporal control capacity of the cortex on central visual field defects.     

卵圆细胞参与实验性肝癌形成过程的研究

目的探讨卵圆细胞在肝组织内的起源及其与原发性肝细胞肝癌的关系。方法清洁型SD大鼠60只,随机分为正常组(20只)和实验组(40只),各组于开始制造肝癌模型后的不同时段取肝组织标本进行常规病理和C-kit、PCNA免疫组化检测。结果正常组大鼠肝脏表面光滑,组织学形态正常,偶见C-kit和PCNA阳性细胞;实验组于肝脏染毒的第2周,首先于汇管区发现卵圆细胞沿胆管上皮依次排列增生,这些卵圆细胞呈C-kit和PCNA阳性表达。随着染毒加重,卵圆细胞以汇管区为中心向肝小叶穿插生长。肝癌形成时,癌结节内外均见有卵圆细胞聚集,此期c-kit阳性细胞仍以汇管区为主,而PCNA阳性细胞遍布癌结节内外。结论卵圆细胞起源于汇管区的胆管上皮;卵圆细胞与肝癌的发生密切相关。     

淫羊藿次苷Ⅱ对大鼠阴茎海绵体压力、平均动脉血压的影响及其作用机制的研究

目的 淫羊藿次苷Ⅱ是淫羊藿中提取分离的单体,为了解淫羊藿次苷Ⅱ对阴茎性功能障碍(ED)的疗效,通过体内试验观察其对阴茎海绵体压力和平均动脉血压的影响及作用机制.方法 麻醉下游离大鼠左侧颈总动脉和左侧阴茎海绵体,允别插管与电生理仪连接;游离左侧海绵体神经(CN),采用电生理仪刺激器连接双极电极刺激;检测不同浓度的淫羊藿次苷Ⅱ在刺激CN后对阴茎海绵体压力(ICP)和平均动脉血压(MAP)影响,淫羊藿苷、西地那非、罂粟碱作为对照组.同时观察可溶性环鸟苷酸(sGC)抑制剂H-[1,2,4]噁二唑[4,3.A]喹喔啉(ODQ)、一氧化氮合酶(NOS)抑制剂N~ω硝基-L-精氨酸(LNNA)及一氧化氮生成抑制剂亚甲蓝(methylene blue,MB)对淫羊藿次苷Ⅱ(10~(-4)mol/L)诱发ICP/MAP变化的影响.结果 4组药物均剂量依赖性显著提高ICP(P<0.01),淫羊藿次苷Ⅱ、淫羊藿苷和西地那非对MAP无显著影响(P>0.05),而罂粟碱浓度达10~(-4)mol/L后,即可显著降低MAP(P<0.01).在受试浓度下,LNNA、MB和ODQ可显著抑制淫羊藿次苷Ⅱ诱发的ICP变化(P<0.01),对两地那非诱发的ICP变化无影响(P>0.05).结论 淫羊藿次苷Ⅱ和淫羊藿苷呈剂量依赖性地提高大鼠阴茎勃起功能(ICP),淫羊藿次苷Ⅱ效价强度为淫羊藿苷的2.44倍,对平均动脉血压没有显著影响,其机制可能与增强阴茎海绵体NO-cGMP通路的活性有关.     

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。