视网膜裂孔的早期诊断与治疗

目的:探讨视网膜裂孔早期的临床表现与早期诊断及其治疗。方法:2007-05/2009-08对门诊检查出视网膜周边区存在裂孔的患者用氩激光行早期环绕光凝裂孔,视网膜光凝患者19例21眼,随访观察疗效。结果:术后随诊2wk～6mo。分析裂孔成因、大小及形态对疗效的影响,其中1例再行巩膜外冷凝+巩膜外垫压术,均无视网膜脱离发生。结论:早期发现,早期诊断视网膜裂孔非常重要,选择性行视网膜光凝安全,有效。     

调强适形放疗在乳腺癌保乳术后应用的系统评价

Objective

The aim of this study was to assess the long-term effect of breast conservation with breast intensity-modulated radiotherapy (IMRT) for early-stage breast cancers.

Methods

Pub Med, EMBASE, Cochrane Library, Chinese Biomedical Literature Database were searched to identify relevant original published trails, and the references of eligible studies were manually screened. Randomized controlled trails reported in any language, comparing breast IMRT with conventional radiotherapy (RT) in patients with early-stage breast cancer were eligible for inclusion. Two investigators independently assessed the quality of included trials and extracted data. The RevMan 5.0 software was used for statistical analysis.

Results

Four trials involving 1440 patients were included. The results showed that in the IMRT group, the occurrence of acute moist dermatitis, the edema of the mammary gland and the occurrence of hyperpigmentation were lower than those of RT group, the pooled risk ratio value and 95% confidence interval were 0.28 (0.17–0.48), 0.03 (0.00–0.21) and 0.06 (0.02–0.15) respectively. The use of IMRT did not correlate with pain and quality of life, but the presence of moist desquamation did significantly correlate with pain and reduced quality of life.

Conclusion

The currently available evidence showed that IMRT significantly reduces the occurrence of moist acute dermatitis anywhere in the breast and alleviates the suffering of patients and improves the quality of life of patients. Future large-scale, high-quality, double-blind trials are needed.     

Clinical Experience of Lobectomy With Pulmonary Artery Reconstruction for Central Non–Small-Cell Lung Cancer

BackgroundIn patients with central lung cancer, lobectomy can be achieved without pneumonectomy by surgical reconstruction of the pulmonary artery (PA). Herein, we report our clinical experience of 34 patients who had lobectomy with PA reconstruction, including perioperative administration, morbidity, mortality, and long-term survival.Patients and MethodsThe clinical records of 34 patients who received lobectomy with PA reconstruction in our department between August 2003 and September 2005 were reviewed.ResultsIn our series, PA reconstruction with end-to-end anastomosis was performed in 18 patients (52.9%). Seven patients (20.6%) required partial PA reconstruction with autologous pericardium patch. Five patients (14.7%) with a lower lobe tumor required PA reconstruction with artery flap. The perioperative mortality was 2.9%, and 1 patient died on postoperative day 13 because of severe bronchopleural fistula. Another 2 patients had acute respiratory distress syndrome (ARDS) and required reintubation in our Intensive Care Unit. The overall Kaplan-Meier 3-year and 5-year survival rates were 46% and 37%, respectively. As compared with the stage III patients, stage I patients had significantly greater 5-year survival (80% vs. 11%; P = .005). Patients with pN0 disease also had greater 5-year survival than patients with pN2-3 disease (71% vs. 9%; P = .004).ConclusionIn our department, PA reconstruction has been more frequently and actively performed for patients with central lung cancer, especially for some patients with a lower lobe tumor. Although the morbidity and mortality is acceptable, surgeons should be more attentive to lethal postoperative complications such as ARDS induced by lung ischemia-reperfusion injury.     

丁基苯酞对血管性痴呆大鼠的保护作用

目的研究丁基苯酞（buty lphthalide,DBT）对血管性痴呆大鼠学习记忆、核因子-κB（nuclear factor-κB,NF-κB）及环氧合酶-2（cyclooxygenase-2,COX-2）的影响,探讨DBT对血管性痴呆的干预疗效。方法大鼠随机分为假手术组（SOG）、模型组（MG）、丁基苯酞大剂量治疗组（DBT1）、丁基苯酞小剂量治疗组（DBT2）、丁基苯酞预防组（DBT3）,用药1月,采用HE染色,观察海马CA1区锥体细胞的改变,免疫组化方法检测海马CA1区NF-κBp65、COX-2蛋白的表达。结果与模型组比较,DBT不同剂量治疗1月后,学习记忆能力改善,海马CA1区神经元变性、坏死不同程度减轻;NF-κBp65、COX-2阳性细胞数表达减少（P〈0.01）,且不同剂量组间亦有差异（P〈0.01）。结论丁基苯酞改善实验大鼠的学习记忆能力,减少实验大鼠海马CA1区神经细胞的丢失,降低血管性痴呆大鼠海马CA1区NF-κB、COX-2表达,可能具有预防和治疗血管性痴呆的作用。     

日本血吸虫抗体检测试剂盒（IHA 法）参考品的制备及标定

目的 建立日本血吸虫抗体检测试剂盒（IHA 法）参考品的制备方法。方法 采用33.3%的饱和硫酸铵提取日本血吸虫抗体IgG γ球蛋白,经过离子交换剂DEAE 层析过滤后,用Lowry 法测定蛋白浓度。标定和验证合格后制成冻干阳性标准参考品。采取健康试验兔血清经处理、标定后冻干作为阴性标准参考品。用阴、阳性同批号冻干参考品各100 份,分别在1、3、5、7、9、11、13、15、17、19、21、24月后,用ELISA 和IHA 测定冻干参考品实验室保存条件下的稳定性。结果 冻干参考品经过ELISA 和IHA 两种免疫学方法检测其效价符合要求,其阳性符合率和阴性符合率均为100%,各时间点测定均符合要求。结论 本方法制备的阴性和阳性血清冻干品可以作为日本血吸虫抗体检测试剂盒（IHA 法）的参考品,其冻干品稳定性满足试剂盒保存两年的要求。     

犬肺动脉支架置入的实验研究

目的通过支架置入的成功率及生物相容性的实验动物研究,对肺动脉支架置入的可行性进行评价。 方法成年杂种犬8只,随机分为2组,每组4只。全麻下采用介入技术在其右肺下叶动脉置入Cook Zliver 635自膨式血管支架。实验组1术前2天～术后12周使用抗凝药,实验组2术前2天～术后6周使用抗凝药。所有动物,术前及术后即刻、术后6周、12周行DSA检查;术后6周、12周行CT肺动脉造影;术前及术后6周、12周进行肺动脉压力、潮气量及血气分析测定,12周时将动物处死取标本。评价支架置入过程、术后影像学表现、标本的组织病理学改变,对技术成功率、支架内皮覆盖、支架置入后狭窄率和潮气量、血气分析等参数进行统计学处理。采用SPSS 13. 0软件包进行分析,测最数据采用配对t检验及Friedman检验方法进行分析。 结果8只实验动物均顺利置入血管支架于右肺动脉内,支架释放过程顺利,支架膨胀良好、位置满意。术后影像学检查8只动物支架均未见狭窄、移位、变形、断裂等改变,但CT肺动脉造影显示其中2例支架近端未能完全贴紧血管壁。肺动脉压、潮气量、血气分析检查未发现显著改变。4例支架完全内皮化,4例支架未能完全内皮化(所有未完全内皮化的支架皆为远端内皮化,近端未内皮化,1例内皮化约30%、2例内皮化约50%、1例内皮化约70%),支架远端较近端更易形成内皮化,内皮化程度与实验组无关。被支架覆盖开口的分支血管皆未堵塞,血管内皮绕过血管分支开口处生长。 结论自膨式血管支架可以顺利置入犬肺动脉,对呼吸功能、右心功能无显著影响。肺动脉的血管支架置入是安全可行的。     

微型钛板置入颈椎管成形与单开门椎管扩大治疗脊髓型颈椎病的对比

背景：郑州大学第一附属医院骨科近年开展一项微创微型钛板置入颈椎管成形治疗脊髓型颈椎病,在保留颈椎重要结构的基础上对颈椎病实现脊髓减压。 目的：对比分析微创微型钛板置入颈椎管成形与颈后路单开门椎管扩大成形对脊髓型颈椎病的治疗效果。 方法：将78例脊髓型颈椎病患者随机分成2组,分别采用微创微型钛板置入颈椎管成形与颈后路单开门椎管扩大成形治疗。 结果与结论：治疗后随访3-36个月。末次随访患者日本骨科学会(JOA)评分优良率两组差异无显著性意义(P > 0.05)。治疗后轴性症状明显率微创颈椎管成形组明显低于单开门组(P < 0.05),颈曲指数丢失值微创颈椎管成形组显著低于单开门组(P < 0.05)。微创颈椎管成形组末次随访1例患者2枚钛钉轻微松动,患者无异常症状。单开门组治疗中6例开门时出现铰链侧断裂,将断裂椎板切除,脊髓表面覆盖人工硬脊膜加以保护。结果表明,微创颈椎管成形组与单开门组相比在脊髓功能恢复方面疗效无差别,但治疗后并发症远低于单开门组。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

骨髓间充质干细胞中软骨调节素Ⅰ的稳定上调表达

背景：软骨调节素Ⅰ是一种糖蛋白,主要在软骨中表达,而在骨髓间充质干细胞中少量表达。结合课题组的前期研究,推断软骨调节素Ⅰ在诱导骨髓间充质干细胞向软骨细胞分化过程中可能会起促进作用。 目的：构建软骨调节素Ⅰ表达载体,使其在大鼠骨髓间充质干细胞中稳定上调表达。 方法：在大鼠软骨组织中获取软骨调节素Ⅰ目的基因,使用pcDNA3.1(+)质粒表达载体构建pcDNA3.1(+)/ChM-I表达载体。密度梯度离心法和贴壁培养法获得大鼠骨髓间充质干细胞。用脂质体法将构建的pcDNA3.1(+)/ChM-I表达载体转染大鼠骨髓间充质干细胞,使用G418稳定筛选转染细胞,用RT-PCR 及Western blot 检测软骨调节素Ⅰ在细胞株内的表达。 结果与结论：对阳性克隆的双酶切鉴定及测序和分析对比,结果显示与软骨调节素Ⅰ基因长度相符并且序列无误,且读码框正确。RT-PCR及western blot检测结果显示,软骨调节素Ⅰ的mRNA及蛋白在骨髓间充质干细胞中稳定的高表达。实验成功构建了pcDNA3.1(+)/ChM-I表达载体,并成功将其转染到大鼠骨髓间充质干细胞中,最终使软骨调节素Ⅰ在大鼠骨髓间充质干细胞中稳定上调表达。     

唇腭裂患儿父母生活质量及其影响因素研究

目的 了解唇腭裂患儿父母生活质量现状,确认其影响因素,为改善唇腭裂患儿父母生活质量提供理论依据。方法 选取行一期唇腭裂畸形整复手术患儿的家长143例作为病例组,109例正常成年人作为对照组,2组均接受一般情况问卷、生活质量综合评定问卷（GQOLI-74）、社会支持评定量表（SSRS）的测评。对2组的结果进行统计分析,并对可能影响生活质量的各因素进行多元线性逐步回归分析。结果 1）病例组生活质量总分、心理功能维度、社会功能维度、物质生活维度得分均低于对照组（P＜0.05）。2）病例组社会支持总分、主观支持维度和社会支持利用度维度得分均低于对照组（P＜0.05）。3）病例组社会支持总分、客观支持维度得分、主观支持维度得分与其生活质量总分及各维度得分均成正相关。4）影响病例组生活质量的相关因素为社会支持和人均月收入。结论 唇腭裂患儿父母生活质量及社会支持情况偏低,应给予其更多的支持与帮助,提高其生活质量。