直肠癌全直肠系膜切除术后直肠阴道瘘原因与防治

本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离．以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口，以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗，即肠内营养，阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗，大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。     

一种可生物降解温度敏感型聚乙二醇-聚己内酯-聚乙二醇水凝胶的合成和表征

合成了一系列分子量较低的聚乙二醇．聚己内酯-聚乙二醇（Poly（ethylene glycol）-Polycaprolactone-Poly（ethylene glycol），PEG-PCL—PEG）三嵌段共聚物。分别采用FTIR和1H—NMR对其结构进行了表征。所合成的PEG-PCL-PEG共聚物具有良好的水溶性，当水溶液浓度高于临界凝胶浓度（Critical gel concentration，CGC）时，随着温度的变化聚合物水溶液会呈现特有的凝胶-溶胶转变。研究了共聚物亲水疏水链段的比例和长度，以及热历史等对凝胶-溶胶转变行为的影响。通过调节上述条件，可以在一定程度上拓宽凝胶-溶胶转变温度范围，有助于PEG—PCL-PEG水凝胶在可注射药物控制释放系统等方面的应用。     

不同年龄组儿童甲状腺测量值及其变化的研究

调查了90具童尸用状腺的基本形态,可分四型。其中以甲状腺由两侧叶及峡部组成者为最多,占50.22%。测量了甲状腺各部的长、宽、厚。分年龄组进行了数据的统计学处理,并计算出儿童与成人甲状腺各部相应值的百分比。结果显示:小儿甲状腺侧叶的长度和宽度在幼儿期(1—3岁)就已发育近成人的一半。随着年龄的增长,甲状腺各部的均值逐渐增加。除各部的宽度以及锥体叶的长度外,各相邻两组间同项均数的比较,经双侧T检验发现差异具有高度显著性(P<0.01)。     

Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea

STUDY OBJECTIVE: To determine whether mucosal sensory dysfunction is present at multiple upper-airway sites in patients with obstructive sleep apnea (OSA). DESIGN: Physiologic testing of consecutive patients with OSA and nonsnoring controls. SETTING: University hospital sleep center. PARTICIPANTS: Thirty-nine subjects with OSA and 17 controls. INTERVENTIONS: Endoscopic testing was used to determine sensory detection thresholds for air-pressure pulses delivered to the oropharynx, velopharynx, hypopharynx, and larynx (aryepiglottic eminence). The air-pulse stimulus intensity required to elicit the protective laryngeal adductor reflex was also determined. MEASUREMENTS AND RESULTS: There was a significant impairment in sensory detection threshold for OSA versus control subjects in the oropharynx, as previously described by ourselves using other techniques, as well as at the velopharynx (median 11 mm Hg [confidence interval 9-11] for subjects with OSA vs 8 mm Hg [confidence interval 4-11] for controls, P = .03) and, at the larynx, 4 mm Hg [confidence interval 2-9] for subjects with OSA vs 2 mm Hg [confidence interval 2-3] for controls, P < .001). The threshold stimulus intensity for the laryngeal adductor reflex was also significantly higher for OSA subjects. For OSA patients with abnormal laryngeal sensation (61% of OSA subjects), there were significant correlations between laryngeal sensory values and measures of apnea severity, including apnea-hypopnea index (r = 0.82, P < .001) and nadir SaO2 (r = -0.48, P < .05). CONCLUSION: Mucosal sensory function is impaired at multiple upper-airway sites in OSA.     

腕关节关节囊内韧带的解剖观察及其创伤学意义

本文描绘了腕关节关节囊内韧带的解剖,其中首次描述了中腕关节的韧带连结,即大、小多角骨,头状骨至舟状骨的韧带和钩骨至三角骨的韧带.本文还论述了与这些韧带连结方式密切相关的腕骨生理运动特点及维持腕关节稳定性的因素.文章还讨论了与腕关节关节囊内韧带有关的腕部创伤学特点.     

Oxygen-dependent up-regulation of mucoid exopolysaccharide (alginate) production in Pseudomonas aeruginosa.

We previously showed substantial differences in Pseudomonas aeruginosa exopolysaccharide production in vitro at oxygen tensions reflective of the right versus left cardiac circuits in vivo (40 versus 80 mm Hg, respectively; A. S. Bayer, T. O'Brien, D. C. Norman, and C. C. Nast, J. Antimicrob. Chemother. 23:21-35, 1989). However, those studies did not specifically confirm this exopolysaccharide to be the characteristic P. aeruginosa mucoid alginate seen in patients with cystic fibrosis. With a murine monoclonal antibody prepared against P. aeruginosa alginate, strongly positive immunofluorescence (IF) staining of a nonmucoid P. aeruginosa strain (PA-96) was seen after its exposure in vitro to oxygen tensions (pO2) of approximately 80 mm Hg; the intensity of the IF staining under these conditions was similar to that observed with a phenotypically mucoid P. aeruginosa strain (C1712M) from a cystic fibrosis patient. In contrast, the same nonmucoid strain (PA-96), after exposure to pO2 of approximately 40 mm Hg, showed little IF staining for alginate. Following enzyme treatment with alginase, PA-96 cells previously exposed to the higher pO2 and exhibiting enhanced alginate production, as determined by IF staining, now showed no IF staining. Moreover, treatment of the oxygen-up-regulated PA-96 cells with alginase released amounts of unsaturated alginate breakdown products (uronic acids) quantitatively similar to those released by typically mucoid strains treated with the same enzyme. These data indicated that the P. aeruginosa exopolysaccharide in our studies was, indeed, mucoid alginate and that variations in oxygen tensions represent one of the trigger mechanisms for the up-regulation of mucoid exopolysaccharide production.     

维拉帕米对失血性休克犬心脏的保护作用及机制

杂种犬１１只，由股动脉放血使平均动脉压（ＭＡＰ）维持在６．０ｋＰａ９０ｍｉｎ后回输全部血液，继续观察１５０ｍｉｎ。在休克３０ｍｉｎ后，对照组和维拉帕米处理组（Ｖｅｒ组）分别静脉滴注生理盐水和Ｖｅｒ溶液［（１０μｇ／ｋｇ·ｍｉｎ）１５ｍｉｎ］，液体总量为３ｍｌ／ｋｇ。对照组犬在失血后心率（ＨＲ）加快，左室ｄｐ／ｄｔｍａｘ显著降低，回输血液后ＭＡＰ虽有回升，但仍低于基础值，左室ｄｐ／ｄｔｍａｘ无明显改善；Ｖｅｒ使休克犬ＨＲ减慢，血液回输后ＭＡＰ缓慢恢复至基础值，左室ｄｐ／ｄｔｍａｘ显著高于对照组；电镜观察可见对照组心肌肌原纤维和线粒体等有明显的损伤，而Ｖｅｒ组心肌超微结构基本正常。结果还显示：Ｖｅｒ组犬心肌中丙二醛含量、黄嘌呤氧化酶活性低于对照组，而超氧化物歧化酶活性高于对照组。结果表明：Ｖｅｒ对失血性休克犬的心脏具有保护作用，其机制可能与其阻滞膜Ｃａ２＋内流、抑制脂质过氧化有关。     

脑室注射促甲状腺素释放激素对电针镇痛及脑内亮氨酸脑啡肽含量的影响

实验用大鼠76只,用辐射热-甩尾法测痛,以电针后痛阈变化的百分率评价镇痛效应;用放射免疫分析法测定脑内L-Enk含量。发现脑室注入三肽-促甲状腺素释放激素(TRH)后,能显著降低电针镇痛效果;提高丘脑内L-Enk含量,但痛阈与脑内L-Enk含量的变化无相关关系。本文证明,TRH在电针镇痛过程中是对抗作用。已知针刺镇痛与脑内多种神经质和肽类有关,在不利于针刺镇痛的因素中,TRH是新添的“一员”。