医械时代

曾几何时,一个小药箱,一个听诊器,就是一个医生的全部家当。但今天这也许意味着医疗事故官司和失去患者信任度的双重危险。在科学日益昌明的现在,医者和患者都越来越仰仗更昂贵、更先进的仪器,而在这现象之后,是各种医疗仪器设备的迅速普及,是诊疗过程的快速、高效和缜密,是更多科技新发明对人体的近距离关照,当然随之衍生出来的,还有过度医疗服务的不当取利,和种种难见阳光的幕后交易。     

经尿道等离子双极汽化电切(TUPKVP)治疗前列腺增生症580例

目的:探讨经尿道等离子前列腺双极汽化电切术(TUPKVP)治疗前列腺增生的效果。方法:回顾性分析580例良性前列腺增生(BPH)患者行TUPKVP的临床资料。结果:中转开放手术2例,切除前列腺组织10~80 g,平均32.5 g。手术时间25~150 min,平均60 min,术中输血10例,无电切综合征(TURS)发生。术后随访2~36个月,患者最大尿流率升高,IPSS症状评分值降低,排尿通畅,疗效好,并发症少。结论:TUPKVP出血少,手术安全,疗效确切,是治疗前列腺增生的有效方法。     

微波对超低温细胞复温的可行性研究和若干问题的探讨

采用微波炉中的谐振场和外辐射天线的平面波对冻存在－１９６℃的活细胞进行复温试验。结果表明：谐振场加温迅速但极不均匀，造成细胞大量死亡。平面电磁波微波泄漏大，效率低，加温时间过长，不能应用。本文阐述了微波对超低温细胞复温的可能性和现有微波仪不宜进行细胞复温的原因，并提出改进设计的建议。     

Possible contribution of follicular interleukin-1beta to nitric oxide generation in human pre-ovulatory follicles

The aim of this study was to investigate the relationships between follicular nitric oxide (NO) metabolite concentrations and several related variables, with special reference to follicular interleukin- 1beta (IL-1beta). The follicular fluid from the leading and secondary follicles was collected individually from 20 women undergoing in-vitro fertilization (IVF) treatment, and the concentrations of nitrite (NO2-) and nitrate (NO3-) were determined fluorometrically using 2,3- diaminonaphthalene. Both follicular nitrite (r = 0.42, P < 0.01) and nitrate (r = 0.49, P < 0.001) were found to be significantly correlated with follicular IL-1beta concentrations. There were also significant positive correlations between follicular nitrate and the number of oocytes retrieved (P < 0.01) and serum oestradiol concentration on the day of human chorionic gonadotrophin (HCG) administration (P < 0.05). When follicular cells were incubated in vitro with 10 ng/ml of IL-1beta for 24 h, nitrate generation was significantly (P < 0.01) elevated compared with the control. In conclusion, our study demonstrates that follicular IL-1beta and the number of developing follicles are significant variables that affect follicular NO concentrations, and points to the possible contribution of IL-1beta to NO generation in human preovulatory follicles.      

Lack of correlation between expression of Epstein-Barr virus (EBV) latent membrane protein and bcl-2 oncoprotein in vivo.

AIMS--To evaluate whether there is any correlation between the expression of Epstein-Barr virus (EBV) latent membrane protein (LMP) and oncoprotein bcl-2 in the lymph node biopsy specimens of a Chinese patient with EBV-related reactive lymphoproliferation who later developed T cell lymphoma after a short period of time. METHODS--Immunohistochemistry, with a standard alkaline phosphatase antialkaline phosphatase (APAAP) method and New Fuchsin as a chromogen, was used for single staining of bcl-2 or LMP. Double immunostaining combining APAAP and indirect immunofluorescence was performed for dual labelling of LMP and bcl-2. RESULTS--bcl-2 was expressed in 10-30% of cells in the first lymph node biopsy specimen (EBV-associated lymphoproliferative disorder) and 30-50% of cells in the second lymph node biopsy specimen (T cell lymphoma). LMP was expressed in the first biopsy specimen but not in the second. Double immunostaining results showed that around 78% of LMP positive cells were bcl-2 negative and 94% bcl-2 positive cells were LMP negative. Among the very small fraction of LMP and bcl-2 double positive cells, the intensity of bcl-2 staining was heterogeneous and was not always stronger than that observed in LMP negative bcl-2 positive cells. CONCLUSIONS--The expression of bcl-2 protein is independent of LMP protein status in vivo. Several mechanisms may be involved in EBV associated lymphomagenesis, and bcl-2 induction may occur independently of LMP expression.     

The influence of normal human ageing on automatic movements

There is evidence that aged normal subjects have more difficulty in achieving automaticity than young subjects. The underlying central neural mechanism for this phenomenon is unclear. In the present study, functional magnetic resonance imaging (fMRI) was used to investigate the effect of normal ageing on automaticity. Aged healthy subjects were asked to practice self-initiated, self-paced, memorized sequential finger movements with different complexity until they could perform the tasks automatically. Automaticity was evaluated by having subjects perform a secondary task simultaneously with the sequential movements. Although it took more time, most aged subjects eventually performed the tasks automatically at the same level as the young subjects. Functional MRI results showed that, for both groups, sequential movements activated similar brain regions before and after automaticity was achieved. No additional activity was observed in the automatic condition. While performing automatic movements, aged subjects had greater activity in the bilateral anterior lobe of cerebellum, premotor area, parietal cortex, left prefrontal cortex, anterior cingulate, caudate nucleus and thalamus, and recruited more areas, including the pre-supplementary motor area and the bilateral posterior lobe of cerebellum, compared to young subjects. These results indicate that most healthy aged subjects can perform some complex motor tasks automatically. However, aged subjects appear to require more brain activity to perform automatically at the same level as young subjects. This appears to be the main reason why aged subjects have more difficulty in achieving automaticity.     

肿瘤光动力治疗中组织氧含量的动态模型研究

目的：分析肿瘤光动力治疗中的组织氧含量的变化规律，研究影响肿瘤光动力治疗效果的与氧相关的因素,探讨改进光动力治疗的途径。方法：建立肿瘤光动力治疗中氧含量的动态模型，并采用Crank—Nicolson离散方法解析该模型，在时间域和空间域上，分析光动力过程中肿瘤氧含量的动态变化过程，研究光照的光功率密度、肿瘤初始氧含量等因素对光动力疗效的影响，并比较间断光照和连续光照两种方式的不同疗效。结果：肿瘤氧含量随着治疗时间和离血管的距离呈衰减趋势，光动力反应只发生在血管附近的有限区域，且区域大小与初始氧含量密切相关．在较高的初始氧含量下，更大区域的氧含量因为处于阈值Cth以上，所以能发生光动力反应。当采用较低的光功率密度光照治疗时,肿瘤氧含量衰减比高功率密度下慢；当采用间断光照进行光动力治疗时，在治疗黑暗期肿瘤氧含量能得到回升．有利于光照期的治疗。结论：初始氧含量较高的情况下治疗效果更好；在较低的光功率密度下，光动力反应较难进行，但是有利于保护肿瘤供氧源的工作。在较低的初始氧含量下，间断光照方式的疗效要比连续光照要好。