湖南省郴州市一起新型冠状病毒肺炎聚集性疫情流行病学调查

目的 通过分析郴州市一起新冠肺炎聚集性疫情相关病例发病确诊过程,探讨新冠病例早发现、早报告以及病例诊断和隔离观察解除的策略依据。 方法 对该起新冠肺炎聚集性疫情的病例和密切接触者进行现场流行病学调查,描述性分析流行病学史、临床和实验室资料。 结果 利用大数据比对监测,在转送监测对象至集中场所隔离医学观察时发现了新冠肺炎确诊病例何某华,由此发现一起新冠肺炎家庭聚集性疫情,何某的5名密切接触者中有3人发病确诊（包含1名重症病例）,其中重症病例黄某第7次新型冠状病毒核酸检测阳性进而确诊,密切接触者中胡某有流行病学史、血常规白细胞下降和肺炎影像学改变,但是5次咽拭子核酸检测阴性,未确诊。 结论 大数据比对监测对发现传染病有积极作用;早期对有流行病学史人员单独隔离医学观察对防止聚集性疫情发生有重要意义;将2次核酸检测阴性作为新冠肺炎病例的排除标准和将核酸检测阳性作为确诊新冠肺炎病例的必备条件,值得探讨,这都可能放走传染源,导致新冠肺炎传播。     

拱桥弹性钢板椎弓根固定器的研制与临床应用

目的:探讨自行研制的椎弓根系统固定器的性能及临床效果。方法:对拱桥式弹性钢板椎弓根固定器(archbridgetypeelasticpediclefixationsystem,ABPF)进行生物力学实验与临床应用分析。结果:ABPF在应变、应力、位移、强度、刚度方面性能良好。应用ABPF治疗胸腰椎骨折57例,53例平均随访26个月,术前椎体前高度平均54郾36%,术后2周98郾5%,术后26个月97%。未发生弯钉、断钉。结论:ABPF利用拱形钢板和钉板角能对脊柱骨折产生过伸折顶复位与纵向撑开复位。术后对脊柱骨折产生持续向前的推力与弹性固定,可防止后凸畸形复发和椎体高度丢失。     

中老年男性血清催乳素水平与良性前列腺增生的关系

目的　探讨中老年男性血清催乳素 (PRL)和睾酮 (T)的变化 ,研究PRL与良性前列腺增生的关系。　方法　将 84例健康中老年男性分为 4个年龄组 ,测定血清PRL和T水平 ,分析不同年龄组的数值变化。采用B超测定其中 38例的前列腺体积 ,与PRL进行相关性分析。　结果　 5 0、6 0、70和 80岁年龄组的T水平分别为 (2 5 .92± 2 .5 4)、(2 1.0 0± 1.92 )、(18.37± 2 .49)和 (14.75±2 .38)nmol/L ,不同年龄组之间T水平比较 ,差别有显著性意义 (F =3.44 ,P <0 .0 5 ) ;PRL水平分别为 (1.11± 0 .16 )、(0 .96± 0 .2 0 )、(0 .99± 0 .18)和 (0 .91± 0 .2 9)nmol/L ,组间比较差别无显著性意义(F =0 .12 ,P >0 .0 5 ) ;PRL水平与前列腺体积无显著相关性 (r =0 .2 5 ,P >0 .0 5 )。　结论　PRL通过雄激素在前列腺的生长过程中产生作用 ,但中老年男性雄激素水平不断降低 ,削弱了PRL在前列腺增生中的作用。     

腹腔镜在妇科良性肿瘤中的应用

目的 :总结腹腔镜手术治疗卵巢良性肿瘤的经验。方法 :随机将有手术指征的卵巢良性肿瘤患者 6 0例分为 2组 ,腹腔镜组和手术组各 30例。对两组患者的手术时间 ,术中出血量 ,术后发热率 ,胃肠功能恢复时间 ,开始下床活动时间 ,住院时间 ,使用镇痛剂的百分率 ,及 2组患者术前、术后 2 4hWBC计数 ,CRP水平进行比较分析。结果 :2组患者手术时间 ,术前 2 4hWBC计数 ,及术前 2 4hCRP水平差异无显著性 (P >0 0 5 ) ;术中出血量 ,胃肠功能恢复时间 ,下床活动时间 ,住院时间 ,应用镇痛剂的百分率 ,术后发热率以及术后CRP水平差异均有显著性 (P <0 .0 5 )。结论 :腹腔镜手术用于妇科良性肿瘤 ,具有出血少 ,侵袭性小 ,不干扰腹腔内环境 ,术后发热率低 ,恢复快 ,住院时间短等优点     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

男性肾透明细胞癌性染色体数目异常及其临床意义

目的:探讨性染色体数目异常与男性肾透明细胞癌病理分级及临床分期之间的关系。方法:将20例男性肾透明细胞癌按照病理分级和临床分期分组,并选择5例正常肾组织作为阴性对照,用荧光原位杂交技术分析各例肿瘤细胞及对应癌旁细胞性染色体数目变异情况。以性染色体的获得和缺失为变异指标,分析其和肾癌病理分级及临床分期之间的关系。结果:肾癌细胞中性染色体获得显著高于癌旁及正常组织中的细胞(P0.05);低分化组中肿瘤细胞性染色体获得高于高分化组(P0.05);进展性肾癌较局灶性肾癌更易发生性染色体获得(P0.05)。结论:男性肾透明细胞癌细胞性染色体的获得与肿瘤病理分级和临床分期有相关性。     

经腹膜外腹腔镜前列腺癌根治术（附7例报告）

目的：探讨经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效.方法：对7例局限性前列腺癌患者实施经腹膜外前列腺癌根治术.结果：7例手术均成功完成,手术时间145～250 min,平均175 min.估计术中出血量200～600 ml,平均300 ml,其中3例患者输400 ml红细胞悬液,术中无腹膜破裂、直肠输尿管损伤、膀胱损伤等病例;术后病理均报告切缘阴性,无淋巴结转移,留置导尿14～23天,平均18.2天;术后1～3天肠道功能恢复,平均1.6天.术后发牛尿漏2例,6天后尿漏消失.随访3～10个月,平均6个月,术后拔除尿管出现轻度尿失禁3例（43%）,1周内完全恢复尿控率71.4%（5/7）,第1、3、6个月完全恢复控尿率分别为71.4%（5/7）、85.7%（6/7）、100%（7/7）,术后3个月检查血清PSA＜0.2 μg/L,随访期间末出现生化复发.结论：腹腔镜下腹膜外途径前列腺癌根治术创伤小、并发症少、恢复快,是局限性前列腺癌安全有效的外科治疗方法.     

Patency of sequential and individual saphenous vein grafts after off-pump coronary artery bypass grafting

Abstract Background: The impact of the grafting techniques (individual or sequential grafts) on the graft patency of off‐pump coronary artery bypass grafting (OPCAB) has not been reported. The mid‐term patency rates for individual and sequential saphenous vein grafts (SVGs) as coronary bypass conduits of OPCAB were compared. Methods: A total of 714 distal coronary anastomoses on 448 SVGs were assessed using a 64‐multislice computed tomography in 398 patients at an average of 26.4 ± 23.6 months (three months to five years) after an OPCAB procedure. The blood flow of grafts in the proximal segment of individual and sequential SVGs was also compared. Results: The overall patency of sequential SVGs (95.9%) was significantly superior to individual ones (90.6%, p = 0.022). The anastomoses on the sequential conduits had better patency (95.1% vs. 90.1%, p = 0.013). The patency of side‐to‐side anastomoses (97%) was better than that of end‐to‐side anastomoses (93.1%) and also better than that of the individual end‐to‐side anastomoses (90.1%, p = 0.002, p = 0.041). No significant difference was observed between the two approaches in regard to the three major coronary systems; however, anastomoses on sequential grafts had superior patency to those on individual grafts in the right coronary system (p = 0.008). The blood flows of double and triple sequential SVGs were significantly higher than those of individual ones (p < 0.001, p = 0.048, respectively). Conclusions: The mid‐term patency of a sequential SVG conduit after OPCAB is excellent and generally superior to that of an individual one. (J Card Surg 2010;25:633‐637)     

青春期己烯雌酚暴露对大鼠睾丸发育及功能的影响

目的 探讨青春期己烯雌酚(diethylstilbestrol,DES)暴露对SD(Sprague-Dawley)大鼠睾丸发育及功能的影响.方法 35日龄雄性SD大鼠90只,随机分为DES 0.01、0.1、1.0、10.0 μg·kg-1·d-14个实验组和1个对照组(编码为Bda、BDb、BDc、BDd和BC组,每组18只).于青春期,即出生后第36天(postnatal day 36,PND 36)至PND 49,实验组每日皮下注射相应剂量的DES,共14 d,对照组仅注射溶媒.于青春期晚期(PND 50)、性成熟后(PND 64)和成年期(PND 130)分3批(每批6只)处死各组大鼠取材,测定睾丸重量,观察比较睾丸组织形态学变化,分析PND 130大鼠附睾尾精子质量.结果 PND 50时,BC、Bda、BDb、BDc和BDd组单侧睾丸重量分别为(1.26±0.13)、(1.23±0.20)、(0.99±0.15)、(0.85±0.23)和(0.60±0.04)g,其中BDb、BDc和BDd组均较BC组减轻(P＜0.05);与BC组比较,BDb组仅有少数生精小管生精上皮中的细胞数目稍减少,BDc和BDd组生精小管发育较差、生精上皮中细胞数目减少、精子发生阻滞、间质细胞发育幼稚,其程度随DES暴露剂量增加而加重.PND 64时,BC、Bda、BDb、BDc和BDd组单侧睾丸重量分别为(1.54±0.14)、(1.55±0.17)、(1.52±0.11)、(1.37±0.14)和(0.88±0.15)g,其中BDc和BDd组均较BC组减轻(P＜0.05);BDc和BDd组睾丸组织形态学改变与PND 50时类似,但较PND 50时有所改善.PND 130时,各实验组与对照组比较,单侧睾丸重量差异无统计学意义(P＞0.05),睾丸组织形态学改变未见明显差异;BC、Bda、BDb、BDc和BDd组大鼠附睾尾精子密度分别为(71.00±14.85)、(69.00±23.98)、(67.00±13.52)、(31.67±12.94)和(18.83±6.68)×106/ml,其中BDc和BDd组精子密度均较BC组明显降低(P＜0.01);与BC组比较,BDd组精子活动率下降(P＜0.01),BDb、BDc和BDd组A级精子比例降低(P＜0.05),BDd组B级精子比例降低(P＜0.01).结论 青春期小剂量DES(0.01μg·kg-1·d-1×14 d)暴露对SD大鼠睾丸发育及功能无明显影响,大剂量DES(1.0～10.0 μg·kg-1·d-1×14 d)暴露对大鼠睾丸发育及功能具有明显的近期(PND 50和PND 64)和较远期(PND 130)毒性作用,该毒性作用随DES暴露剂量增加而加重,随鼠龄增长而逐渐减退,其机制可能与间质细胞和支持细胞的发育及功能受损密切相关.     

塞来昔布对骨科围手术期镇痛的疗效评估

[目的]观察塞来昔布(西乐葆)对骨科围手术期患者术后镇痛的疗效及安全性。[方法]选择2004~2005年住院手术患者,共64例,随机分组,分别给予西乐葆或镇痛泵进行术后镇痛。西乐葆给药时间:一般于手术前8~12 h,即患者手术禁食前首次给药,手术后6 h患者可进食后再次给药,手术后3~5 d按手术大小及患者疼痛程度决定停药时间。给药剂量:西乐葆首次服用400 mg,大手术可加大剂量。观察患者疼痛VAS评分、药物不良反应及患者满意度。[结果]西乐葆的术后镇痛效果与镇痛泵相似,但发生不良反应比及患者总体满意度优于镇痛泵。[结论]西乐葆对手术后镇痛具有满意的疗效及安全性,适合于骨科围手术期术后镇痛。