胰管空肠连续吻合联合肠腔外引流预防胰十二指肠切除术后胰瘘

目的 对胰十二指肠切除术的胰肠吻合缝合技术和置管引流方法进行改进,以防止胰瘘的发生.方法 对2004年6月至2007年9月138例胰十二指肠切除术患者的胰肠吻合采用降落伞式胰管空肠连续吻合和吻合口下方肠腔减压外引流的临床资料进行回顾性分析.结果 降落伞式胰管空肠连续吻合时间平均11min,手术时间明显缩短,全部病例均未出现胰肠吻合口漏,术中出血平均353±61ml,平均住院日19.2d.6例患者出现肺部感染,3例上消化道出血考虑为应激性溃疡,2例患者出现胃排空障碍,均保守治疗痊愈,无手术死亡.结论 降落伞式胰管空肠连续吻合和吻合口局部肠腔减压外引流,操作简便、省时、并发症少,是胰肠吻合术的一种有效改进.     

环氧合酶-2抑制剂对白血病细胞HL-60的化疗增敏作用及机制

 目的　观察环氧合酶-2（COX-2）抑制剂塞来昔布对白血病细胞株HL-60的化疗增敏作用,并对其机制进行初步探讨。方法　MTT法评估塞来昔布、多柔比星及二者联合对HL-60细胞的生长抑制效应;流式细胞术（FCM）检测细胞的凋亡;反转录聚合酶链反应（RT-PCR）检测Survivin基因的表达;Western blotting检测Survivin蛋白的表达。结果　多柔比星联合塞来昔布5和10 μmol／L对HL-60细胞的半数抑制浓度（IC50）分别为0.25及0.16 μg／ml,明显低于多柔比星单用的IC50（0.48 μg／ml）;多柔比星0.10 μg／ml联合10 μmol／L塞来昔布下调Survivin基因mRNA及蛋白的表达;联合塞来昔布5和10 μmol／L的凋亡率[分别为（13.07±1.66）%及（22.36±1.84）%]较多柔比星0.10 μg／ml单用[（5.72±1.25）%]明显增加（P＜0.01）。结论　COX-2抑制剂塞来昔布对白血病细胞株HL-60具有明显的化疗增敏作用,其初步机制涉及下调Survivin的表达,增加细胞凋亡。     

军队医院非现役文职人员考评体系构建及应用

本文讨论了军队非现役文职人员考评体系的基本原则和方法,对文职人员考评指标及权重进行了研究,构建了文职人员考评体系,并对其应用情况进行了探讨。     

Spontaneous hemorrhagic Descemet membrane detachment causing pupillary block

Purpose. To present a unique case of a 65-year-old man using warfarin who presented with acute unilateral loss of vision due to hemorrhagic Descemet membrane detachment (DMD) with pupillary block and elevated intraocular pressure and its subsequent treatment and challenges. Method. Case report. Results. Clinical examination showed a visual acuity of finger counting, central DMD with near contact to the iris and premembrane hemorrhage, an intraocular pressure (IOP) of 19 mmHg, and normal pupillary reaction. An International Normalized Ratio (INR) of 4.9 was treated with dose reduction and vitamin K. Twelve hours later the patient re-presented with an acute increase in pain and an IOP of 78 mmHg with pupillary block and iris bombé. YAG-laser membranotomy, anterior chamber paracentesis, and maximal topical and systemic therapy were unsuccessful in reducing the IOP. Surgical management, including irrigation and aspiration of blood, led to a normalization of the IOP. Descemet stripping automated endothelial keratoplasty (DSAEK) resulted in a visual acuity of 0.3. Deep stromal/pre-Descemet membrane neovascularization was found bilaterally, suspicious for a previous interstitial keratitis. Conclusions. The previously unreported complication of pupillary block following a pre-Descemet membrane hemorrhage was treated successfully for the first reported time, in a 2-step DSAEK. This indicates that DSAEK could be considered as a treatment option for DMD, especially in traumatic circumstances.     

大鼠急性肺栓塞血清差异表达蛋白的研究

目的研究急性肺栓塞（APE）大鼠血清和正常大鼠血清的差异蛋白表达变化。方法采用血栓颈静脉注入法制备大鼠APE模型,采用双向电泳技术找出差异蛋白,用MALDI-TOF技术和生物信息学技术鉴定差异蛋白,并对部分差异表达蛋白采用Western-blot技术作进一步验证。结果大鼠血清蛋白的2-DE胶银染可分离出1 400多个点,考染可达到1 200个点以上。经图像分析得到的24个差异表达蛋白中有12个蛋白得到鉴定。对部分差异蛋白采用Western-blot方法在蛋白水平的验证结果与2-DE结果基本相符。结论采用比较蛋白质组学的方法可以发现APE大鼠血清中的差异表达蛋白,这些差异表达蛋白分子将为我们寻找新的APE血清学标志物提供重要的线索和依据。     

急性阑尾炎切除术后细菌培养和药敏试验的临床研究

目的：探索急性阑尾炎的主要致病菌和敏感药物。方法：急性阑尾炎切除术后细菌培养和药敏试验。结果：阑尾感染主要以厌氧菌和需氧菌混合感染为主，其中厌氧菌检出率为81％，先锋霉素V、丁胺卡那霉素、甲硝唑有效率86％，青霉素、丁胺卡那霉素、甲硝唑有效率85．5％，丁胺卡那霉素、甲硝唑有效率85％。结论：抗生素以丁胺卡那霉素加甲硝唑联合应用最合理。     

大鼠异位辅助性肝移植肝的形态及功能变化

目的 :观察大鼠异位辅助性肝移植后的自体肝及辅助肝 (两肝 )的形态及功能改变。　方法 :建立大鼠异位辅助性肝移植模型 ,行 (血流动力学 )核素显像、电镜观察及光镜检测 ,评价术后大鼠生存以及移植肝功能状况。　结果 :大鼠异位辅助性肝移植模型切实可行 ,手术成功率较高 (93.3% )。术后 1周存活率达 80 % ,并能长期存活(>3个月 )。术后行相关检查 ,表明供肝随移植时间延长逐渐萎缩 ,功能逐渐丧失 ,4 5天后已基本无功能。　结论 :异位辅助性肝移植中 ,两肝共存时 ,自体肝的功能基本不受影响 ,随着移植时间延长 ,辅助肝逐渐萎缩。     

Donor corneas for transplantation: a scanning electron microscopic study of the epithelium

PURPOSE: Donor corneas are processed in eye banks and used for transplantation as a standard routine. The maximum time limit post-mortem for harvesting donor tissue varies greatly between eye banks. This study aimed to examine the corneal epithelium for structural changes post-mortem. METHODS: A total of 51 corneas harvested between 14 and 163 hours post-mortem were examined using scanning electron and light microscopy. RESULTS: Cell loss occurred through desquamation of flat superficial cells during the first days. In corneas with a post-mortem time of more than 2-3 days, large superficial cell sheets and deeper cells detached, starting centrally. Deep peripheral cells remained. The loss of the superficial cells revealed the 3-dimensional structure of the epithelium and the membrane characteristics of deeper cells. CONCLUSION: The longer the time post-mortem, the greater the epithelial cell loss. However, a rim of peripheral cells remained, even after 7 days. The superficial cell layer showed signs of strong lateral attachment and broke up in a sheet-like fashion. The intercellular adhesion between deeper cells and adhesion between the basal cells and the basement membrane appeared to be weak post-mortem. The cell membrane structures of the remaining cells were surprisingly well retained. The clinical implication of the study is discussed.