小切口化学性胆囊切除临床应用

目的：总结临床上行小切口化学性胆囊切除的经验。方法：通过对23例胆囊结石患采用右上腹3～5cm斜切口．在切口加用冷光源探头作照明，充分显露胆囊三角，直视下寻找胆囊管，用钛夹钳施钛夹来闭塞胆囊管，取尽胆囊结石及胆汁并向胆囊腔灌注硬化剂无水乙醇(≥99．5％)，反复3次，硬化剂共灌注20min，胆囊底开放，放置胆囊窝引流管。结果：在灌注硬化剂时可见胆囊黏膜脱落、坏死，2周内胆囊明显萎缩，纤维组织开始形成，10周左右胆囊全部被纤维组织所代替，全部萎缩完全，23例胆囊全部化学性切除成功，除2例术后出现腹痛外，余未发现有并发症发生。结论：硬化剂灌注最佳时间为20min，硬化剂灌注要反复多次，小切口化学性胆囊切除是一种安全、可行的微创手术。     

大肠埃希菌和肺炎克雷伯菌中质粒介导的喹喏酮类耐药研究

目的:研究国内11家医院分离大肠埃希菌(ECO)和肺炎克雷伯菌(KPN)中质粒介导的喹喏酮类耐药。方法:收集北京大学第三医院无重复临床分离产超广谱β-内酰胺酶(ESBL s)的ECO和KPN共84株,另10家医院相应菌株共155株,北京协和医院对头孢西丁不敏感的ECO和KPN共25株。采用琼脂稀释法测定抗生素最低抑菌浓度M IC;接合实验判断该基因位置和移动性;聚和酶链反应(PCR)及其产物测序确定基因型。结果:北医三院84株菌中1株KPN(编号24)阳性,ECO的发生率是0;余10家医院155株产ESBL s菌株中没有阳性结果;协和医院25个临床株中3株KPN(编号P 3、P 6、P 10)阳性。这4株菌只有P 6接合试验阳性,相应接合子qnr-PCR阳性。环丙沙星C IP对该菌的M IC是0.5μg/m l,对该接合子的M IC是1μg/m l,而对受体菌EC 600的M IC是0.125μg/m l。对24号标本和P 6标本及其接合子进行测序证实:二者的qnr↑序列和AY 878718(qnrA)100%同源,并且qnr基因的上游都有ORF 513存在。结论:北医三院和北京协和医院分类株中存在质粒介导的喹喏酮类耐药基因qnr,其他医院分离株本次研究中未发现该基因。     

开胸手术围术期多模式镇痛的临床研究

目的：探讨围术期多模式镇痛与传统术后镇痛方法用于开胸手术的镇痛效果及副作用.方法：36例择期行开胸肺叶切除术的病人,随机分为2组：A组（多模式镇痛组）于麻醉诱导前10分钟静注曲马多1.5 mg/kg,诱导时开始经静脉舒芬太尼病人自控镇痛（PCIA）,并于切皮前进行一次罗哌卡因肋间神经阻滞;B组于麻醉诱导时静脉注射舒芬太尼0.4 μg/kg,并于术后开始PCIA.分别于术后各时间点观察病人的VAS评分、镇静与舒适状态评分、镇痛药的使用剂量、PCA的按压次数、生命体征及副作用,并记录排气时间、计算PCA按压次数比及舒芬太尼使用量.结果：（1）与B组比较,A组静止及活动状态时的VAS评分、舒芬太尼用量、PCA按压次数明显下降,舒适状态评分明显升高,PCA按压次数比上升（P＜0.05）;（2）两组病人术后生命体征,镇静评分,排气时间,恶心、呕吐、皮肤瘙痒、胸闷等副作用的发生率无明显差异（P＞0.05）.结论：开胸手术围术期多模式镇痛的效果优于传统术后镇痛方法.     

N-末端脑钠肽在心源性与气道炎性疾病致呼吸困难鉴别诊断中的价值

目的 探讨脑利钠肽N端前体肽(Nt-proBNP)在呼吸困难患者中的水平变化及其临床意义.方法 用放射免疫法(RIA)分别测定健康人18名及46例呼吸困难患者的血浆Nt-proBNP水平,其中心源性呼吸困难组(CDG)25名和气道炎性疾病组(AIDG)21名,并检测心脏超声、血气分析等指标,然后分别检测其与Nt-proBNP相关性.结果 CDG组和 AIDG组血浆Nt-proBNP显著高于正常对照组P＜0.01;CDG组血浆Nt-proBNP显著高于AIDG 组,P＜0.01;左室射血分数与Nt-BNP呈负相关(r＝-0.662,P=0.000);左室舒张末内径与Nt-BNP呈正相关(r＝0.633,P＝0.000);左房前后径与Nt-BNP呈正相关(r＝0.491,P＝0.000).在AIDG患者中Nt-proBNP水平在氧分压正常组、轻度低氧血症组、中度低氧血症组、重度低氧血症组为逐渐升高,组间比较无统计学差异.结论 血浆Nt-proBNP对心源性与气道炎性疾病致呼吸困难有鉴别诊断价值.由于这种标志物在急性不稳定心衰病人明显增高,有希望成为评价心功能的重要补充指标,成为一项常规检查.     

芦黄颗粒对实验性动脉粥样硬化家兔C反应蛋白和白细胞介素-6水平的影响

目的:观察中药复方芦黄颗粒对实验性家兔动脉粥样硬化(AS)炎性细胞因子水平的影响,探讨该方防治AS的机制.方法:40只新西兰白兔随机分为5组:假手术组、模型组、血脂康对照组、芦黄颗粒高剂量组、芦黄颗粒低剂量组.采用高脂饲料喂饲及动脉内膜球囊损伤法建立兔AS模型,制模成功后给予相应的药物8周,分别测定各组C反应蛋白(CRP)和白细胞介素-6(IL-6)的浓度.结果:与假手术组比较,模型组CRP和IL-6均明显升高(P<0.01和P<0.05),芦黄颗粒高剂量组血清CRP和IL-6水平均明显低于模型组(P<0.05和P<0.01),与血脂康对照组比较差异无显著性.芦黄颗粒低剂量组CRP水平与模型组比较差异无显著性.结论:芦黄颗粒可能通过抗炎机制,发挥抑制AS的作用.     

2例原发性小肠淋巴管扩张症患儿的护理

探讨原发性小肠淋巴管扩张症惠儿的护理.对2例原发性小肠淋巴管扩张症的忘儿采取以中链三酰甘油酯饮食为主导的肠内营养支持和以静脉高营养为主的肠外营养支持;正确应用谷氨酰胺和重组人生长激素促进肠功能康复和蛋白质合成;积极做好护忘沟通,提高患几和家长的就医依从性;同时做好健康教育和出院随访等有针对性护理.2例原发性小肠淋巴管扩张症忘儿水肿基本消退,低蛋白血症得以纠正,未发生严重的并发症,长期随访怠儿的生长发育情况良好.     

基于“魂魄飞扬”的多梦症病机探讨

多梦症是指睡眠不实,睡眠中梦境纷纭不休,醒后神疲乏力、头昏的一种病症。根据多梦症的临床表现,结合古代医籍,笔者提出"魂魄飞扬"是多梦症的发病机制,认为因脏腑虚损或邪气侵扰而出现魂不定、魄不平,发病为"多梦症",据此提出"定魂平魄"的治疗法则,临证治疗时根据患者病因病症灵活用药,可平肝定魂、益肺平魄,使得魂定于肝,魄平于肺。     

神经细胞黏附分子L1在先天性巨结肠中的表达

目的：研究L1型神经细胞黏附分子（LICAM）基因在先天性巨结肠不同肠段的表达。方法：分别取16例先天性巨结肠惠儿狭窄段和正常段平滑肌组织，经处理后提取总RNA，应用逆转录多聚酶链反应（RT-PCR）扩增目的基因和看家基因片段，观察狭窄段和正常段的LICAM基因的表达，并与看家基因（β-aetin）在狭窄段和正常段的表迭作对比。结果：16例患者正常段LICAM和β-actin均有明显的表达，狭窄段β-actin亦有明显的表达，但LICAM均无表迭或弱表达。结论：先天性巨结肠患者狭窄段LICAM减少的原因可能是LICAM的mRNA的减少或缺如，并进一步引起病变段运动障碍和巨结肠发生。     

Clinical prognostic factors associated with outcome in patients with renal cell cancer with prior tyrosine kinase inhibitors or immunotherapy treated with everolimus

BackgroundThe mTOR inhibitor, everolimus, is approved for the treatment of metastatic renal cell carcinoma (RCC). However, prognostic models are needed to determine the patients who would most benefit from this therapy. We have developed a model based on clinical parameters and patient stratification into risk groups to predict patients with RCC who will derive the most benefit from treatment with everolimus.MethodsWe assessed retrospective data on 57 patients with RCC who received everolimus after previous treatment with immunotherapy or tyrosine kinase inhibitors to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). In the original phase II study, patients received 10 mg of everolimus daily without interruption and were assessed every other week for the first 8 weeks on therapy and every 4 weeks thereafter. Kaplan-Meier analysis was used to calculate OS and PFS. Univariate and multivariate analyses were constructed using the Cox proportional hazards model and a stepwise procedure to validate the data.ResultsWe grouped patients according to risk: 0 prognostic factors indicated favorable risk, 1 to 2 factors intermediate risk, and≥3 factors poor risk. We found notable differences in median OS (29.6 mo for favorable risk, 14.3 mo for intermediate risk, and 7.2 mo for poor risk). Three risk factors (prior radiation treatment, no lung metastasis present at the start of treatment, and lymphocytes<25 cells/µl) in the multivariate analysis were found to be associated with PFS, and 4 risk factors were found to be associated with OS (bone metastasis at start of treatment, LDH>1.5×upper limit of normal, alkaline phosphatase>120 U/l, and lymphocytes<25 cells/µl).ConclusionsOur prognostic model includes 3 readily available clinical parameters for PFS and 4 readily available clinical parameters for OS to help stratify patients into poor, intermediate, and favorable prognosis groups for the treatment of everolimus in clear cell RCC. These intriguing results warrant further study in a larger patient population to validate the findings.     

Multi-label classification of retinal lesions in diabetic retinopathy for automatic analysis of fundus fluorescein angiography based on deep learning

Graefe's Archive for Clinical and Experimental Ophthalmology - To automatically detect and classify the lesions of diabetic retinopathy (DR) in fundus fluorescein angiography (FFA) images using...