Attractin蛋白在不同病理分型无精子症患者睾丸组织中的表达

目的探讨Attractin蛋白在不同生精功能状态的人睾丸组织中的表达情况。方法对31例无精子症患者进行睾丸组织病理检查诊断,根据病理形态的不同分为:唯支持细胞综合征型(n=4),生精功能低下型(n=12),生精阻滞型(n=5),生精功能基本正常型(n=10)。选择上述各型结构完整的睾丸组织,分别应用免疫组化法(SP)观察Attractin蛋白在不同生精功能状态的睾丸组织中的表达。结果各组睾丸组织内均存在Attractin蛋白的表达,其分布特点为:睾丸生精小管和间质细胞、管周肌样细胞、支持细胞上均有Attractin蛋白的表达,主要表达于胞膜和胞质,胞膜表达强于胞质。Leydig细胞、Sertoli细胞、精原细胞、精母细胞及精子细胞均为阳性表达,呈棕黄色着染。Attractin的表达与生精功能有关,正常组表达明显高于其它组,唯支组表达明显低于其他组。结论 Attractin蛋白与男性生殖密切相关,但其具体作用环节尚有待进一步研究。     

学校与医院“定岗双元”合作培养护理专业人才的课程构建

目的通过改革护理专业学校与医院"定岗双元"合作培养护理人才的课程构建,向社会输送优秀护士,为医院专科护士的培养打下基础。方法学校与医院签订合作协议,双方在专业论证、承担临床课程教学、实训基地建设、课程构建、学生就业等方面广泛合作,构建的课程体系分为通识教育课程模块、专业基础课程模块、专业主干课程模块、专业方向课程模块和实践课程模块5大模块。并对2008～2011级护理专业"定岗双元"的学生实施院校合作培养。结果学生对教师课堂教学组织、教学效果、结合临床与大纲、拓展前沿知识的评分为(7.92±1.45)～(8.97±1.69)分,为较好水平;2008级学生均通过2011年的全国护士执业资格考试,毕业后全部被医院录用。用人单位对毕业学生留院临床工作的综合评价良好。结论院校"定岗双元"合作培养的课程构建使学生、学院和医院多方受益。"定岗双元"教学课程改革能构建就业导向型课程体系,将教学质量的测评与国家、行业标准相衔接。     

后腹腔镜肾部分切除术中免打结分层缝合法修补肾脏组织缺损的临床应用研究

目的:探讨后腹腔镜肾部分切除术中免打结分层缝合法修补肾脏组织缺损的临床可行性和安全性。方法:2008年12月～2010年12月,对167例肿瘤直径<4cm的肾肿瘤患者行后腹腔镜肾部分切除术。术中采用免打结技术分别缝合肾脏髓质和全层的分层缝合法修补肾脏组织缺损。观察肾脏热缺血时间、手术时间、术中出血量、术后住院天数、围手术期和近期并发症以及手术效果。结果:167例手术全部获得成功,无中转开放手术;术中平均肾脏热缺血时间(20.5±3.5)min,平均手术时间(62.1±10.6)min,术中出血量中位数30ml(10～220ml),无术中输血病例,术中肾脏组织冷冻病例检查3例,均为阴性,术后病理检查肾细胞癌肿瘤切缘均为阴性。术后住院时间中位数7d(5～13d),2例患者住院期间肾脏创面出血,予高选择性肾动脉栓塞后出血停止;术后无尿瘘病例。围手术期无死亡病例及二次手术切除肾脏病例。158例患者随访12～36个月,肾细胞癌患者均未见局部复发及远处转移,9例失访。结论:对于肿瘤直径<4cm的选择性肾肿瘤病例,后腹腔镜肾部分切除术中肾脏组织免打结缺损分层缝合法安全、有效,具有较好的临床可行性。     

口服普萘洛尔治疗婴幼儿血管瘤的临床研究

目的:观察口服普萘洛尔治疗婴幼儿血管瘤的疗效。方法:2009年1月～2011年6月,笔者采用口服普萘洛尔治疗11例婴幼儿血管瘤,2mg/kg/天,分2次口服,3个月为1个疗程。如观察瘤体有复发表现,则重复1个疗程,至患儿1岁停药。结果:口服普萘洛尔后1周,瘤体颜色开始变淡、萎缩变软。治疗3个月后,大部分瘤体明显萎缩。至1岁时,瘤体基本消退,表面遗留毛细血管扩张。部分患儿出现心率减慢和腹泻,均在停药1周后恢复,继续治疗。结论:口服小剂量普萘洛尔治疗婴幼儿血管瘤具有良好疗效。     

Pyruvate Effects on Red Blood Cells During In Vitro Cardiopulmonary Bypass With Dogs’ Blood

To investigate the effects of pyruvate (Pyr) on adenosine triphosphate (ATP), endothelial nitric oxide synthase (eNOS), and nitric oxide (NO) in red blood cells (RBCs) during the cardiopulmonary bypass procedure (CPB), blood, 500 mL, was collected from each of 10 healthy dogs (weight 12–18 kg). The blood was divided into two parts (250 mL each) and randomly assigned into the control group (Group C, n = 10) or the Pyr group (Group P, n = 10). The blood was commingled with an equal volume of 0.9% NaCl and pyruvated isotonic solution (Pyr 50 mM) in the extracorporeal circuit in the two groups, respectively. The CPB procedure was fixed at 120 min, and the transferring flow was 4 L/min. Contents of ATP in RBCs, eNOS activities, and NO productions in plasma were measured before CPB and during CPB at 30, 60, 90, and 120 min in both groups. The ATP level, eNOS activity, and NO production were not different prior to CPB between the two groups. A decline of ATP levels was shown in both groups but remained significantly higher in Group P than in Group C at the same time points during in vitro CPB (P < 0.01). Values of eNOS and NO were significantly increased in Group C but markedly reduced in Group P during CPB, compared with pre‐CPB (P < 0.01). The CPB procedure significantly damaged dogs’ RBCs in the ATP level, eNOS activity, and NO production, in vitro, but Pyr effectively protected RBCs in these functions during CPB. Pyr would be clinically protective for RBCs during CPB.     

住院患者护理相关《国际功能、残疾和健康分类》类目的初步研究

目的初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架。方法从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性>80%的标准筛选类目;按临床实用性原则对咨询结果再次筛选。结果初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目。结论初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架。     

纳米炭与亚甲蓝在乳腺癌前哨淋巴结活检术中的对比研究

目的 探讨纳米炭混悬液在乳腺癌患者腋窝前哨淋巴结活检术中的示踪效果。方法 选取我院自2009年12月至2011年12月早期乳腺癌患者、无腋窝手术史143名随机分为两组,分别注射纳米炭混悬注射液和亚甲蓝,其中纳米炭组78例,亚甲蓝组65例。实施前哨淋巴结术后所有患者加行腋窝淋巴结清扫术,比较两组的检出率、假阴性率、准确性和灵敏度。结果 1）所有患者注射纳米炭混悬液前后均未出现过敏反应,生命体征无异常。2）纳米炭混悬液染色前哨淋巴结及淋巴道清晰。3）纳米炭组SLN检出率94.8%（74/78）,假阴性率6.5%（2/31）,灵敏度93.5%(29/31),准确性92.3%(72/78);亚甲蓝组SLN检出率83.1%（54/65）,假阴性率4.2%(1/24),灵敏度95.8%（23/24）,准确性81.5%（53/65）。纳米炭组检出率明显高于亚甲蓝组（P<0.05）,两组假阴性率、准确性和灵敏度差异无统计学意义（P>0.05）。 结论 1）纳米炭示踪效果稳定,能清晰黑染淋巴管、淋巴结;2）纳米炭混悬注射液与亚甲蓝相比,其在乳腺癌SLNB中可操作性强。     

环抱式接骨器治疗外伤性肋骨骨折45例分析

目的探讨环抱式接骨器治疗外伤性肋骨、胸骨骨折的价值。方法对我院2009年3月～2011年8月间收治的45例肋骨骨折病人进行回顾性分析。所有45例患者均接受Ni-Ti形状记忆合金环抱接骨器治疗。结果所有手术均一次成功完成且骨折断端得到解剖复位,患者胸部疼痛较术前明显缓解。手术时间约20～80min,平均住院时间短10d。未发生感染、骨折不愈、骨折错位或再次骨折等并发症。结论应用环抱式接骨器治疗外伤性胸骨、肋骨骨折是目前比较有效安全且创伤小的方法。     

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Purpose

The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach.

Methods

Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12–24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant–Murley shoulder score was used to evaluate function.

Results

No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15–25) weeks. In terms of function, the Constant–Murley score was 85.8 points on average (range, 67–100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients.

Conclusions

Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.     

Diagnosis and treatment of hepatic angiomyolipoma

Background

Hepatic angiomyolipoma (HAML) is a rare liver tumor. This paper summarized the clinical, radiological and pathological features of HAML.

Methods

Seventeen cases of HAML were analyzed retrospectively. All patients were subjected to surgical resection of tumor, one of which was performed emergency surgery because of hemorrhage of tumor.

Results

There are 13 females and 4 males, most of whom were asymptotic except 4 had minimal abdominal discomfort. US, CT and/or MRI were taken and corresponding data was comprehensively analyzed with other clinical signs and symptoms. Correct preoperative diagnosis was able to be achieved in 9 patients. Pathological analysis and immunohistochemistry of HMB-45 was used as final diagnosis. All patients were followed up and survived without recurrence.

Conclusions

Preoperative diagnosis of HAML can be benefited from comprehensive analysis of clinical manifestations. The malignant potential and fast growth of tumor suggested surgical removal of tumor while it was diagnosed.Key Words: Hepatic tumor, angiomyolipoma, diagnosis, surgery