Characters and influential factors of vascular remolding after native arteriovenous fistula

Objective To finding out the characters of vascular remolding after the establishment of native arteriovenous fistula on the wrist, and exploring the influential factors.MethodsDoppler ultrasound was used to monitor the diameter of cephalic vein, brachial artery, radial artery and ulnar artery at the time before the surgery and one day, one week, two weeks, four weeks and eight weeks after the surgery respectively. The tendency of the diameter change was analyzed. ResultsTwenty eight patients completed the whole monitor session, in which eleven were female. The average age of those patients was (53.68 ± 2.61) years old. Twelve of them were diabetic nephropathy. The diameters of all vessel were increased more rapidly at the first day than any other days after surgery(all P＜0.01). The patients were divided into two groups depending on whether diabetic nephropathy. No significant difference was found between the two groups on the tendency of diameter change in cephalic vein and brachial artery (all P ﹥ 0.05). However, the tendency of diameter change in radial artery and ulnar artery was statistically significant difference between the two groups (all P＜0.05). ConclusionsCephalic vein, brachial artery, radial artery and ulnar artery are all apparently dilated on the first day after the surgery. The vascular dilation and diameter increasing become much slower after the period, the diameter tend to be stable. The primary diseases may affect the tendency of the diameter change in radial artery as well as ulnar artery.     

胸腔腹膜后联合入路行肾动脉上型腹主动脉瘤手术的配合

对6例肾动脉上型腹主动脉瘤患者在全身麻醉下经胸腔腹膜后联合入行手术动脉瘤切除加人工血管重建术,手术效果满意,患者均存活至今。提出巡回护士做好充分的物品准备,为患者安置好上半身45°侧卧位,阻断动脉瘤远、近端前进行全身肝素化,术中密切观察生命体征;器械护士备好阻断钳、血管缝合线、人造血管,术中及时传递手术器械是手术配合的要点。     

阴茎拉直衡量去皮法在成人包皮环切术中的应用探讨

目的:研究寻找一种在包皮环切术中衡量去皮适度的最佳方法。方法:对2010年4月~2014年5月收治的220例成人包皮过长患者分别采用传统的包皮环切术及阴茎拉直衡量去皮法包皮环切术。术后观察对比阴茎外观、水肿、伤口恢复、功能及勃起疼痛情况。结果:阴茎拉直衡量去皮法包皮环切术患者术后水肿、外形及勃起疼痛明显好于传统包皮环切术。结论:阴茎拉直衡量去皮法包皮环切术是一种简单、有效的术中衡量包皮去皮量多少的较理想方法,值得临床推广。     

The role of urethral pressure profile on treating premature ejaculation by tamsulosin

Dear Editor,
I am Dr. Hui-Rong Chen, from the Department of Urology in Shanghai First People＇s Hospital at Shanghai Jiao Tong UnNersity, Shanghai, China. Premature ejaculation （PE） is a common sexual dysfunction, affecting approximately 20%-30% of sexually active men. According to intravaginal ejaculatory latency time （IELT） of l min, the incidence is approximately 1%-3%.1 PE is significantly associated with many personal and negative consequences, such as distress, frustration, and avoidance of sexual intimacy due to the inability of successful delayed ejaculation, α1-adrenergic blockers were effective in delaying ejaculation in approximately 50%-67% of the cases.2,3 Recently, abnormal ejaculation, an adverse infrequent side effect associated with the use of α1A-adrenergic blockers such as silodosin or tamsulosin, has drawn significant attention. Clinical studies suggested that this represents a relative anejaculation rather than a retrograde ejaculation. We present here the study to investigate the role of urethral pressure profile （UPP） on treating PE by tamsulosin.     

将案例教学嵌入BOPPPS模型的“制药工艺学”教学实践

目的:对案例教学嵌入BOPPPS模型的《制药工艺学》教学模式进行实践研究。方法:以浙江中医药大学制药工程专业2012级30人为对照组,2015级25人为观察组,从课堂效果、能力素养、考试成绩等方面进行评价。结果:新的教学模式有助于提高学生的学习兴趣、能力和素养,引导学生积极参与教学,显著提高其学习成绩。结论:将案例教学嵌入BOPPPS模型的教学模式能够促使学生参与教学,提高学习效果。     

亚低温对重型颅脑损伤患儿Ⅰ型及Ⅱ型辅助性T细胞平衡漂移的影响

大量基础和临床研究证明,亚低温疗法能显著改善颅脑损伤病人的预后,对于在小儿领域的应用以及对机体细胞免疫功能的影响方面,目前研究较少.本研究通过对采用亚低温治疗的脑损伤患儿伤后T辅助淋巴细胞亚群进行测定,旨在探讨亚低温对重型颅脑损伤患儿伤后细胞免疫功能的影响,为临床治疗应用提供理论及实践依据.     

丙酸睾丸酮联合hCG诱导OHSS倾向PCOS大鼠模型的建模与评价

目的:制备卵巢过度刺激综合征(OHSS)倾向多囊卵巢综合征(PCOS)大鼠模型,并对造模方法进行评价.方法:将SD雌性幼鼠60只分为实验组(48只)和空白对照组(12只).实验组大鼠予颈背部皮下注射丙酸睾丸酮+中性茶油进行PCOS造模,空白对照组注射中性茶油,连续20 d.造模成功的41只大鼠随机分为PCOS对照组10只、高剂量人绒毛膜促性腺激素(hCG)模型组(简称高hCG组)11只、中剂量hCG模型组(简称中hCG组)10只、低剂量hCG模型组(简称低hCG组)10只.高、中、低hCG组分别给予颈背部皮下注射高、中、低剂量hCG+0.9％氯化钠注射液干预,空白对照组和PCOS对照组注射0.9％氯化钠注射液,连续9 d.比较各组大鼠体质量、卵巢病理形态学改变、卵巢指数、卵巢最大横截面积、腹水评分、腹腔伊文思蓝(EB)含量、血清雌二醇(E2)水平.结果:模型组大鼠卵巢体积增大,卵巢指数降低,最大横截面积增大,卵巢出现多发性滤泡囊肿和黄体囊肿;E2水平升高;腹腔毛细血管通透性增加.与空白对照组相比,高hCG组各项指标差异均有统计学意义(P＜0.05);中hCG组除腹水评分外,其余各项指标差异均有统计学意义(P＜0.05);低hCG组除腹水评分、卵巢指数外,其余各项指标差异均有统计学意义(P＜0.05).与PCOS对照组相比,高、中hCG组大鼠卵巢指数、卵巢最大横截面积、腹腔EB含量、血清E2水平差异均有统计学意义(P＜0.05);低hCG组卵巢指数、卵巢最大横截面积、血清E2水平差异均有统计学意义(P＜0.05).结论:丙酸睾丸酮联合中剂量hCG可以诱导OHSS倾向PCOS大鼠模型,该模型的卵巢病理形态学改变、腹腔毛细血管通透性增加、血清E2水平明显升高,但未出现明显腹水,接近人类OHSS倾向PCOS患者的改变.     

非霍奇金淋巴瘤误诊分析

目的：吸取教训，总结经验，提高非霍奇金淋巴瘤(Non-Hodgkin's 1ymphoma，NHL)的诊断水平，降低误诊率。方法：收集1993年12月～2003年12月收治的55例NHL患者，对误诊的疾病、首诊的症状进行统计记录，对误诊原因进行归类总结，探索减少误诊的经验。结果：55例NHL患者首次确诊13例(23.6％)，误诊率高。结论：对NHL认识不足，看问题片面局限、缺乏全面分析，缺少耐心、不注意随访，活检取材部位不准确、检查技术落后，忽视全面检查是NHL误诊的主要原因。熟悉早期症状，掌握NHL的生物学行为，正确的活组织取材和免疫组化检查，充分利用各项检查可提高NHL的早期诊断率。     

MAGED1: molecular insights and clinical implications

The melanoma antigen (MAGE) protein family contains more than 25 members that share a conserved MAGE homology domain (MHD). Type I MAGE genes exhibit cancer/testis-specific expression patterns and antigenic properties which render them ideal candidates for cancer immunotherapies. Maged1, a type II MAGE gene, is ubiquitously expressed and has been previously shown to play an important role in neuronal apoptosis during development. Recent studies have expanded the functional tissues and processes in which Maged1 activity is important and uncovered interacting partners of MAGED1 protein, adding novel layers to Maged1 functions. Maged1 plays a role in anti-tumorigenesis in a variety of cell types, and the down-regulation of MAGED1 has been observed in tumor cells. Moreover, MAGED1 can interact with a specific group of nuclear members and regulate circadian clock functions. These newly identified functions will enrich the molecular and clinical studies of the MAGE family of proteins.     

制定循证指南的原则

各国都有自己的临床指南,用于规范医疗行为,中国亦在建立自已的临床指南.然而,从全世界多年的临床指南使用情况看,并未达到应有的指导效果.循证医学的发展,给指南的制定带来了根本性的转变,以证据为基础建立循证临床指南已在世界迅速兴起.作者根据苏格兰制定国家循证指南的经验,对循证指南的建立原则进行了探讨,以供国内同事参考.