非体外循环下小儿腔肺吻合术疗效分析

为总结体外循环与非体外循环的两组病例行双向腔肺吻合(M．Glenn)术后的转归，以客观评价小儿施行非体外循环腔肺吻合术的可行性，将2000年5月--2002年11月行单纯M．Glenn术的32例患儿(年龄0．33--ll岁，体重6—32kg)分为两组，A组(n＝16)为体外循环组，B组(n＝16)为非体外循环组。所有病例监测术后1、6、12、24、48h氧合指数(OI)；测定人ICU即刻(T1)、呼吸机撤离前、后(T2和T3)3个时间点的中心静脉压(CVP)、跨肺压(TPG)、跨脑压(TCP)；记录两组病例手术时间(OT)、术后并发症、术后12h用血球量、呼吸机使用时间(VT)、ICU滞留时间(IT)以及住院费用。结果显示，B组术后OI均高于A组，尤其在术后lh和6h，OI分别为A组的1．4倍和1．3倍，差异有非常显著性(P＜0．01)。尽管撤机前B组CVP为A组的1．3倍(P＜0．05)，TCP明显低于A组，但撤机后两组差异无显著性。两组VT、IT差异虽无显著性(P＞0．05)，但B组术后12h用血球量、并发症明显降低，住院开支亦较A组节省了约30％(P＜0．05)。提示非体外循环技术应用于小儿双向腔肺吻合术是可行且有利的。     

Population-based case-control study of CYP11A gene polymorphism and breast cancer risk.

The CYP11A gene encodes the cholesterol side-chain cleavage enzyme (P450scc) that catalyzes the first and rate-limiting step for the biosynthesis of sex hormones. A pentanucleotide repeat [(TAAAA)n] polymorphism in the 5' of the CYP11A gene has been reported to be related to the risk of polycystic ovary syndrome, an inherited endocrine disorder characterized by hyperandrogenemia. We investigated the association of this polymorphism with breast cancer risk in a population-based case-control study conducted among Chinese women in Shanghai. Genotype assays were completed for 1015 incident breast cancer cases and 1082 community controls. Three common alleles with 4, 6, or 8 TAAAA repeats were identified in the study population. The frequency of the 8 repeat allele was more common in cases (12.6%) than controls (8.5%) (odds ratio = 1.6, 95% confidence interval = 1.3-1.9; P < 0.0001). Compared to subjects who did not carry this allele, adjusted odds ratios were 1.5 (95% confidence interval = 1.2-1.9) and 2.9 (1.3-6.7) (P for trend, <0.001), respectively, for those who carried one and two copies of this allele. This positive association was observed in both pre- and postmenopausal women and all strata defined by major breast cancer risk factors, including years of menstruation, body mass index, and waist-to-hip ratio. The results from this study indicate that the TAAAA repeat polymorphism near the promoter region of the CYP11A gene may be an important susceptibility factor for breast cancer risk.     

Surgery for cervical spinal cord compression in patients with multiple sclerosis

OBJECTIVE: The goal of this study was to investigate the clinical and paraclinical features, treatment, and outcomes of patients with multiple sclerosis (MS) and coexisting spinal cord compression secondary to either cervical spondylosis or cervical disc disease. Patients with MS commonly experience neurological disabilities that present as myelopathy associated with bladder dysfunction. For some patients with MS, however, this neurological deterioration may result from coexisting spinal cord compression attributable to either spondylosis or a herniated disc. Overlapping symptoms of the two conditions do not allow clear clinical determination of the underlying cause of worsening. METHODS: Patients with MS who underwent cervical decompression surgery were selected. Medical records were retrospectively reviewed, to collect data on their pre- and postoperative clinical courses. RESULTS: Nine women and five men with definite MS were selected for cervical decompression surgery to treat neurological deterioration considered to be at least partially attributable to spinal cord compression. The most common symptoms were progressive myelopathy (n = 13), neck pain (n = 11), and cervical radiculopathy (n = 10). Bladder dysfunction was notably absent among these patients with MS with moderate disabilities. Surgical intervention was frequently delayed because the neurological deterioration was initially thought to be attributable to MS. The majority of patients experienced either improvement or stabilization of their preoperative symptoms in the immediate postoperative period; three subjects (21%) maintained this improvement after a mean follow-up period of 3.8 years. No MS relapses, permanent neurological worsening, or serious complications resulting from surgery or general anesthesia were noted. CONCLUSION: Carefully selected patients with MS and cervical spinal cord compression secondary to either spondylosis or disc disease may benefit from surgical decompression, with minimal associated morbidity. Clinical features (especially neck pain and cervical radiculopathy) and magnetic resonance imaging may assist clinicians in differentiating between the two conditions and may guide appropriate treatment without undue delay.     

HPLC测定消食止泻散中橙皮苷的含量

目的　建立消食止泻散中橙皮苷的含量测定方法。方法　超声提取 ,HPL C测定消食止泻散中橙皮苷的含量。 C1 8柱 ,乙腈 -水 -磷酸 (180∶ 82 0∶ 0 .1)为流动相 ,检测波长为 2 83nm,柱温 :2 8℃。结果　橙皮苷含量测定的线性范围为 0 .197μg～ 1.182μg,r=0 .9999,n=6 ,平均加样回收率为 99.8 ,RSD为 1.3%。结论　本方法准确 ,简便 ,快速 ,可用于消食止泻散的质量控制。     

CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines.

BACKGROUND AND PURPOSE: The appropriate application of 3-D CRT and IMRT for HNSCC requires a standardization of the procedures for the delineation of the target volumes. Over the past few years, two proposals--the so-called Brussels guidelines from Grégoire et al., and the so-called Rotterdam guidelines from Nowak et al.--emerged from the literature for the delineation of the neck node levels. Detailed examination of these proposals however revealed some important discrepancies. MATERIALS AND METHODS: Within this framework, the Brussels and Rotterdam groups decided to review their guidelines and derive a common set of recommendations for delineation of neck node levels. This proposal was then discussed with representatives of major cooperative groups in Europe (DAHANCA, EORTC, GORTEC) and in North America (NCIC, RTOG), which, after some additional refinements, have endorsed them. The objective of the present article is to present the consensus guidelines for the delineation of the node levels in the node-negative neck. RESULTS AND CONCLUSIONS: First a short discussion of the discrepancies between the previous Brussels and the Rotterdam guidelines is presented. The general philosophy of the consensus guidelines and the methodology used to resolve the various discrepancies are then described. The consensus proposal is then presented and representative CTVs that are consistent with these guidelines are illustrated on CT sections. Last, the limitations of the consensus guidelines are discussed and some concerns about the direct applications of these guidelines to the node-positive neck and the post-operative neck are described.     

肾上腺素诱导兔血小板聚集的实践与理论探讨

目的创建以Ａｄｒ诱导兔血小板聚集的方法，并对受体分子特性作初步探讨。方法以高Ｋ＋缓冲液等取代兔ＰＲＰ中血浆，以Ａｄｒ诱导聚集，以Ａｐｙｒ证实结果。结果兔血小板悬浮于高Ｋ＋缓冲液时Ａｄｒ能单独诱导真正的聚集。结论由此推测血小板膜上α２肾上腺素受体分子可能为由两种亚单位组成：促聚亚单位和辅助亚单位。人辅助亚单位当Ａｄｒ浓度高达聚集阈值以上时可被激活，与促聚亚单位结合为活性的二聚体，与Ａｄｒ进一步结合发生聚集作用。兔辅助亚单位则还需要高Ｋ＋方能被激活     

氯硝安定与安定溶液直肠给药用于惊厥急救的对照研究

目的以安定为对照，探讨氯硝安定溶液直肠给药对惊厥急救的实用价值。方法在２８例儿童中对比观察直肠注入氯硝安定与安定溶液的吸收速度和对脑电活动的影响，并比较两药对大鼠实验性惊厥的疗效。结果氯硝安定与安定溶液均能从直肠迅速吸收，皆于用药５分钟后达有效血浓度，分别于３～８分钟及２～８分钟对脑电活动产生显著影响，明显抑制癫痫样波发放，使美解眠诱发的惊厥致死率从对照组的７０％降为０。结论氯硝安定与安定溶液直肠给药，均能作为小儿惊厥抢救的有效措施。     

喉腔及喉咽部平滑肌肉瘤3例报告

为了解发生于喉腔及喉咽部的平滑肌肉瘤的临床特点，报告１例喉咽部平滑肌肉瘤和２例喉腔平滑肌肉瘤患者早期症状都不明显，且无特异性，临床表现与该部常见鳞癌极为相似，术前明确诊断有一定困难。