肝脏恶性肿瘤682例手术治疗分析

目的　探讨影响肝脏恶性肿瘤患者手术治疗后长期生存的因素。方法　回顾性分析1989年 1月至 2 0 0 3年 1月施行外科手术治疗的 6 82例肝脏恶性肿瘤患者的临床资料。结果　小肝癌 (直径 <5cm ,n =2 96 )患者术后 3年、5年生存率分别为 (6 1 2 5± 4 4 1) %和 (5 3 84± 5 6 8) % ,巨大肝癌 (直径 >10cm ,n =14 5 )患者术后 3年、5年生存率分别为 (45 90± 6 98) %和 (30 2 1±10 2 3) % ;肿瘤单发患者 (n =4 0 3)术后 3年、5年生存率分别为 (6 1 86± 3 6 9) %和 (5 5 4 0±4 91) % ,肿瘤多发 (2个或 2个以上 )患者 (n =2 4 6 )术后 3年、5年生存率分别为 (38 31± 4 97) %和(2 8 0 1± 6 31) % ;术前肝功能Child分期为Ⅰ期的患者 (n =397)术后 3年、5年生存率分别为 (6 0 6 8± 3 6 8) %和 (5 0 99± 5 10 ) % ,Ⅱ期或Ⅱ期以上的患者 (n =2 85 )术后 3年、5年生存率则为 (43 0 1±5 33) %和 (36 39± 7 5 8) % ;行局部或一段切除的患者 (n =2 98)术后 3年、5年生存率分别为 (6 8 6 5± 4 95 ) %和 (6 5 38± 5 6 9) % ,行两段或两段以上及半肝切除的患者 (n =32 4 )术后 3年、5年生存率分别为 (49 88± 4 13) %和 (37 98± 5 70 ) %。结论　小肝癌     

隔室推药子宫输卵管造影的临床应用

目的探讨隔室手推造影剂子宫输卵管造影的应用价值。方法将12F硅胶球囊导管插入子宫腔，注入2-3mL生理盐水充盈球囊，使球囊堵塞子宫颈内口。延长管与球囊导管和注射器相接，用适当的压力推注造影剂，在电视监视下，确定导管位置良好且嵌塞后，逐渐加压，在子宫腔输卵管逐步充盈时，实时摄片。遇输卵管阻塞时，加压推注，能使轻度粘连阻塞的输卵管再通，发现逆流立即停止推药。结果本组检查2300例，一次造影成功2116例（92％）；二次造影成功115例（5％）；改用子宫颈塞法手推造影69例（3％）。造影示子宫输卵管正常483例（2l％），子宫病变207例（9％），输卵管病变1610例（70％），其中，463例（28．7％）阻塞的输卵管再通。患者无须在放射科插管，医师、患者受照辐射量少，推注压力能灵活调节，未出现严重的并发症。结论该法简便、经济实用、安全、推注压力可调节，图像清晰、隔室推药，辐射剂量小，对轻度粘连阻塞的输卵管有再通作用，值得推广应用。     

圆柱型Halbach永磁魔环研究进展

受局部饱和和局部退磁效应的影响以及磁材料性能的限制,永磁体的气隙磁场一般难以达到4T。Halbach永磁魔环结构磁材料利用效率高,且能够产生比剩磁更高的静磁场,因而近年来在磁共振成像领域得到了广泛关注。本文针对Halbach永磁魔环的构成形式,介绍了永磁魔环、阵列永磁魔环、永磁双魔环和单边永磁魔环的研究现状,分析了这些魔环结构由于永磁磁块形状、尺寸,永磁材料受温度变化影响,和加工工艺等因素引起的磁场均匀性较差等主要问题,并对圆柱型Halbach永磁魔环在NMR、MRI和便携式分析仪器等方面的应用进行了展望。     

人工全膝关节置换术后深部感染的治疗

目的探讨人工全膝关节置换术后深部感染的治疗方法和临床效果。方法1994～2003年对9例人工全膝关节置换术后深部感染患者分别采用抗生素治疗;关节镜下清创、灌洗;切开清创、灌洗;清创后一期假体再置换;清创后二期假体再置换等不同治疗方法。对以上治疗方法采用自身前后对照的方法进行回顾性分析,HSS膝评分标准评估临床治疗效果。结果3例抗生素治疗,2例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例关节镜下清创、灌洗治疗,1例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例清创后一期假体再置换治愈;2例清创后二期假体再置换治愈。9例均获随访,平均随访51.2个月,均无感染复发。HSS膝评分由38分(21～52分)增加至74分(53～85分),膝关节平均活动度由45°(20°～108°)增加至80°(60°～105°)。结论每一种治疗方法都有其适应证和优缺点,应根据具体病情选择合理治疗方法。关节镜下清创损伤小,可最大程度恢复关节功能,但其彻底性不如切开清创,二期假体再置换临床治疗效果可靠。     

Effects of low‐frequency pulsed electromagnetic fields on plateau frostbite healing in rats

Plateau frostbite (PF) treatments have remained a clinical challenge because this condition injures tissues in deep layers and affected tissues exhibit unique pathological characteristics. For instance, low‐frequency pulsed electromagnetic field (PEMF) can affect tissue restoration and penetrate tissues. Therefore, the effect of PEMF on PF healing should be investigated. This study aimed to evaluate the effects of low‐frequency PEMF on PF healing systematically. Ninety‐six Sprague‐Dawley rats were randomly and equally divided into three groups: normal control, partial thickness plateau frostbite (PTPF), and PTPF with low‐frequency PEMF exposure (PTPF + PEMF). PTPF wounds were induced in the dorsum of the rats. The PTPF + PEMF group was exposed to low‐frequency PEMF daily. During PF healing, wound microcirculation in each group was monitored through contrast ultrasonography. Wound appearance, histological observation, and wound tensile strength were also evaluated. Results showed that the rate of the microcirculation restoration of the PTPF + PEMF group was nearly 25% faster than that of the PTPF group, and wound appearance suggested that the healing of the PTPF group was slower than that of the PTPF + PEMF group. Histological observation revealed that PEMF accelerated the growth of different deep tissues, as confirmed by tensile strength examination. Low‐frequency PEMF could penetrate PF tissues, promote their restoration, and provide a beneficial effect on PF healing. Therefore, this technique may be a potential alternative to treat PF.     

Association of psychological and physiological measures of stress in health‐care professionals during an 8‐week mindfulness meditation program: mindfulness in practice

Work stress, burnout, and diminished empathy are prevalent issues for health‐care professionals. Mindfulness meditation (MM) is one commonly used strategy to manage stress. Measuring salivary cortisol allows for the assessment of serum cortisol level, a known stress level indicator. This study evaluated the association of subject‐reported stress symptoms and salivary cortisol in health‐care professionals, in an 8‐week MM program, with data collected prospectively at baseline and 8 weeks after program completion. Questionnaires [Profile of Mood States—Short Form (POMS‐SF), Maslach Burnout Inventory (MBI), and Interpersonal Reactivity Index (IRI)] measured mood, burnout and empathy. A paired t‐test between groups for pre/post‐salivary cortisol yielded no significant change. The POMS‐SF was most sensitive to change (mean increase 12.4; p = 0.020). Emotional exhaustion, measured in the MBI, was also affected by MM (mean decrease 4.54; p = 0.001). Changes in empathy may not have been captured due to either absence of effect of MM on empathy, subject number or scale sensitivity. Baseline and 8‐week correlations between salivary cortisol and survey results, and correlations between changes in these measures, were weak and not statistically significant. Nevertheless, psychometric results present a strong case for additional clinical trials of MM to reduce stress for health‐care professionals. Copyright © 2005 John Wiley & Sons, Ltd.