Reversal of fulminant hepatic failure using an extracorporeal liver assist device.

Liver transplantation is currently the only effective therapy for patients with fulminant hepatic failure. The availability of an artificial liver could bridge these patients through the relatively brief crisis period and allow their own livers to regenerate, providing a more favorable outcome and sparing the trauma and expense of transplant. We have developed a device consisting of a highly differentiated human liver cell line cultured in a hollow fiber cartridge. This device is capable of supporting dogs with acetaminophen-induced fulminant hepatic failure for a period long enough for their own livers to resume function. Even though liver function tests such as albumin and prothrombin time became extremely abnormal during the course of the experiment, the dogs did not become encephalopathic. Two of the three treated animals recovered sufficient liver function after 42 to 48 hr of treatment that they could be disconnected from the device, and they survived the experiment. Histological results and serum ALT levels suggest that the device affected the course of the disease in two animals, allowing recovery of hepatocytes that would otherwise have lysed. In the third animal, regenerative nodules demonstrated that, even in the presence of severe liver injury, the device was capable of supporting total liver function.     

血清睾酮与妊高征发病相关性研究

目的:测定妊高征患者血清睾酮水平并探讨其临床意义。方法:采用放射免疫分析法测定妊高征患者30例、正常孕妇20例血清及其新生儿脐血睾酮水平。结果:妊高征患者血清睾酮水平(0.153±0.078nmol/L)明显高于正常孕妇组(0.023±0.015nmol/L),有显著性差异(P<0.001)。妊高征组脐血睾酮水平(0.052±0.041nmol/L)低于正常孕妇组(0.119±0.059nmol/L),有显著性差异(P<0.05),两组睾酮水平与新生儿性别无关(P>0.05)。结论:孕妇血清睾酮在妊高征的病理生理中起调节或加强作用。     

达菲林在体外受精-胚胎移植中的应用

目的:观察达菲林在体外受精-胚胎移植中的疗效。方法:根据112例不孕患者用药前窦卵泡的数目采用不同剂量的达菲林降调节,常规超促排卵至卵泡成熟后,经阴道B超引导下取卵,行实验室体外培养受精,优质胚胎移植。结果:3组获卵数、获得的Ⅰ级胚胎数、胚胎移植后临床妊娠率、卵巢过度刺激综合征发生率等均无明显差异,受精率皆在70％以上,卵裂率在93％以上。结论:不同剂量的达菲林降调节均可获得高质量的卵子,且是一种肌肉注射缓释剂,易被患者接受。     

Diffusion‐Weighted MRI in Creutzfeldt‐Jakob Disease: A Better Diagnostic Marker Than CSF Protein 14‐3‐3?

Two middle-aged patients presented with rapidly progressive dementia and ataxia, nonspecific electroencephalography findings, and negative cerebrospinal fluid (CSF) protein 14-3-3. Both patients underwent brain magnetic resonance imaging (MRI) scans that demonstrated abnormalities on diffusion-weighted imaging (DWI) sequences, and both were later confirmed to have Creutzfeldt-Jakob disease. (CJD) by tissue examination. Because a recent position paper from the American Academy of Neurology characterized CSF protein 14-3-3 as a gold standard for clinically diagnosing CJD, the authors reviewed studies of CJD in which DWI-MRI imaging and CSF protein 14-3-3 studies were both performed. Among 19 reported cases of CJD with DWI-MRI lesions, CSF protein 14-3-3 was negative in 6 cases and positive in 2 others. The authors' findings suggest that multifocal cortical and subcortical hyperintensities confined to gray matter regions in DWI-MRI may be a more useful noninvasive diagnostic marker for CJD than CSF protein 14-3-3. These observations provide a compelling rationale for a prospective comparative study.     

腹腔镜手术治疗嵌顿性胆囊结石的经验

目的探讨嵌顿性胆囊结石行腹腔镜胆囊切除术（LC）的经验。方法回顾性分析我院1998年1月至2004年12月期间用LC治疗嵌顿性胆囊结石365例的临床资料。结果358例成功施行LC，7例中转开腹，2例术后发生胆瘘，无胃肠道、胆管损伤等并发症，无死亡病例，全部患者均痊愈出院。结论随着腹腔镜技术日臻完善，嵌顿性胆囊结石选择LC，一次性切除病灶，术后恢复快，并发症少。     

抗氧化性维生素与男性生殖

生殖系统内过多的活性氧 (ROS)产生可导致精子膜脂质过氧化损伤 ,而抗氧化性维生素对于清除ROS 避免精子脂质过氧化损伤具有一定保护作用。本文就抗氧化性维生素在男性生殖中的作用及其在男性不育治疗等方面进行了综述     

The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy.

BACKGROUND AND PURPOSE: The potential risk of prolongation of treatment time in cervical cancer has been reported for many low-dose rate (LDR) studies, with an estimated loss of local control ranging from 0.3 to 1.6% per day of treatment prolongation. Since the treatment schedule for fractionated high-dose rate intracavitary brachytherapy (HDRICB) is not directly comparable with that for low-dose rate studies, this report aims to evaluate the adverse effect of treatment prolongation specifically for cervical cancer treated with HDRICB. MATERIAL AND METHODS: From September 1992 to December 1997, 257 patients diagnosed with uterine cervical cancer (35 Ib, 26 IIa, 122 IIb, 10 IIIa, 57 IIIb, 7 IVa), who underwent external radiotherapy combined with between two and four courses of HDRICB and a minimum of 3 years of follow-up (median 57 months), were analyzed. Treatment consisted of irradiation of the whole pelvis with 44-45 Gy consisting of 22-25 fractions by 5 weeks, with the dose boosted to 54-58 Gy (with central shielding) for patients diagnosed as FIGO stage IIb-IVa bilateral parametrial disease. HDRICB was performed using an Ir-192 remote afterloading technique at 1-week intervals. The standard prescribed dose for each course of HDRICB was 7.2 Gy to point A for three insertions (before July 1995), or 6.0 Gy to point A for four insertions (after July 1995). Total prescribed point A doses (external beam radiotherapy+HDRICB) ranged from 58 to 71.6 Gy (median, 65.6 Gy) for stage IB-IIA, while analogous dosage for larger lesions (stage IIb-IVa) ranged from 59 to 75.6 Gy (median, 65.6 Gy). Kaplan-Meier and multivariate analyses were used to test the effect of treatment time on pelvic control rate (PCR) and cause-specific survival (CSS) at 5 years. RESULTS: Median treatment time was 63 days. For all stages of disease, the 5-year CSS and PCR were significantly different comparing treatment times of less than and greater than or equal to 63 days [83% and 65% (P=0.004], 93% and 83% (P=0.02), respectively]. These associations were also significant for stage Ib/IIa [97% and 79% (P=0.01), and 100% and 87% (P=0.02), respectively), but not for stage IIb [75% and 72% (P=0.79), and 93% and 87% (P=0.83), respectively] or stage III [66% and 49% (P=0.2), and 83% and 72% (P=0.21), respectively]. Multivariate analysis identified three prognostic factors for CSS, stage (P<0.001), tumor response to external RT (P=0.001), and overall treatment time (OTT; P=0.006). Prognostic factors for pelvic failure were stage (P<0.001), tumor response to external RT (P=0.001), and OTT (P=0.03). Prolongation of treatment time resulted in a daily decrease in pelvic control rate of 0.67% overall, and 0.43% for stage Ib-IIa, 0.57% for stage IIb, and 0.73% for stage III patients. CONCLUSION: Analysis of the data from the current study demonstrates that the adverse effect of treatment prolongation was observed later in the treatment course for the high-dose rate (HDR) series compared to the LDR analog, however, treatment-time prolongation still negatively influenced the cause-specific survival and pelvic control rate for both dosage groups.     

革兰阴性病原菌耐药性变化的分析

目的：了解革兰阴性病原菌耐药水平的变化趋势。方法：对我院1998～2004年从各类临床标本分离出的革兰阴性病原菌的药敏试验结果进行统计分析。结果：病原菌对亚胺培南的总体敏感率始终保持在较高水平,以下依次为头孢他啶(69%)、阿米卡星(66%)和环丙沙星(66%),但是铜绿假单胞菌和不动杆菌对常用抗生素的敏感率呈下降趋势。大肠杆菌、肺炎克雷伯菌和阴沟肠杆菌对亚胺培南的敏感率始终维持很高水平,但对其它各类药物的敏感率大多呈现明显的下降趋势,或维持在较低水平。结论：革兰阴性病原菌耐药水平有增高的趋势。亚胺培南可作为重症患者经验用药的首选药物之一,慎重使用第3代头孢菌素,并尽量避免经验用药。     

低铁与低热量饮食延缓糖尿病肾病的进展

目的探讨低铁与低热量饮食是否能延缓糖尿病肾病的进展。方法以168例Ⅱ型糖尿病肾病患者为研究对象,随机分为两组,对照组予以常规治疗,治疗组在进行同样常规治疗的同时,予低铁、低热量饮食。结果平均随访37±22个月,治疗组患者血清铁水平显著降低,与对照组比较,有显著差异(P<0.01);治疗组血清肌酐189±78μmmol/L,对照组257±115μmmol/L,两组比较,有显著差异(P<0.01)。治疗组有6例患者达到终止随访目标,血红蛋白低于80g/L和或红细胞压积<33%,需进行促红素治疗,占17.6%;对照组有10例达到终止目标,占35.7%,两组比较,有显著差异(P<0.01)。结论低铁饮食治疗能显著降低糖尿病肾病患者铁负荷,配合低热量饮食治疗,能明显延缓糖尿病肾病的进展。     

单丝聚丙烯合成非吸收齿状线在美容整形应用中并发症的防治及应用改进

目的探讨单丝聚丙烯合成非吸收齿状线在美容整形中的并发症产生的原因及应用方法及技术的改进。方法对近两年的单丝聚丙烯合成非吸收齿状线在美容整形中的应用进行总结与分析。结果改进应用方法后，并发症明显减少，效果加强。结论单丝聚丙烯合成非吸收齿状线在美容整形中应用得当，可减少并发症、取得显著效果。