经液囊空肠导管灌注中药治疗急性胰腺炎45例疗效观察

目的　观察采用液囊空肠导管中西医结合治疗胰腺炎的临床疗效。方法　将 90例急性胰腺炎病人随机分为治疗组和对照组各 4 5例 ,两组均采用胃肠减压、禁食、抗感染、抑制胰腺分泌、防止脏器功能衰竭、维持水电解质平衡及对症治疗。治疗组胃肠减压采用液囊空肠导管 ,早期自空肠管输入清胰汤或大承气汤及空肠管喂饲肠内营养治疗。结果　治疗组 :治愈率 71 % ,总有效率97.8%。对照组 :治愈率 4 0 % ,总有效率 81 .2 %。两组总有效率比较差别有显著性意义。在肠功能恢复 ,体重的减轻及治疗经费上亦有统计学意义。结论　采用液囊空肠导管中西医结合治疗急性胰腺炎 ,对维持肠屏障功能 ,早期肠内营养及明显提高总有效率有积极作用     

自制L型骨块复位器在治疗胸腰椎爆裂性骨折致骨块椎管内占位的应用

目的探讨自制L型骨块复位器在治疗胸腰椎爆裂性骨折致骨块椎管内占位中的应用方法。方法对24例胸腰椎爆裂性骨折患者,先用AF系统撑开恢复损伤节段的高度,再采用自制L型骨块打入复位器,使突出骨块复位,行AF系统骨折固定。结果24例均获随访,平均14（12-24）月。疗效评价：优20例,良1例,差3例,优良率为87.5%。术后1年Frankel分级：A级3例,为术前A级T12骨折者,余21例均可下地步行,其中1例术前B级的T12骨折患者出现痉挛步态,经锻炼后逐渐缓解。24例均于术后1年取出内固定。结论对胸腰椎爆裂性骨折致骨块椎管内占位患者,应用自制L型骨块复位器复位疗效好,安全可靠,可操作性强,值得推广。     

胰腺实性假乳头状瘤的CT及MRI表现

目的探讨胰腺实性假乳头状瘤（SPTP）的CT及MRI表现。方法回顾性收集、分析9例经病理证实的胰腺实性假乳头状瘤的CT及MRI表现,分析肿瘤的位置、大小、边缘、密度及增强特征。结果9例均为女性,3例位于胰头,1例位于胰颈,5例位于胰体尾部,肿瘤体积较大,边界清楚,直径6～11cm,均表现为囊实性肿块,囊性、实性成分比例各有不同,以实性成分较多,4例伴有钙化,增强扫描时,肿瘤实性成分及包膜呈渐进性、填充式强化,囊性部分无强化,9例均不伴有胆管扩张,1例伴有轻度胰管扩张。结论胰腺实性假乳头状瘤的CT及MRI表现具有～定的特征性。     

输尿管软镜联合硬镜治疗女性肾盂结石30例报告

目的：评价输尿管软镜联合硬镜治疗女性肾盂结石患者的安全性、有效性及优越性。方法：2012年6月～2013年4月采用输球管软镜联合硬镜治疗女性肾高结行（结石直径〉2cm而≤3cm）患者30例。结果：27例一期碎石成功．一次性碎石率为90％;3例二期碎石成功。无输尿管穿孔、脓肾等严重并发症发生。手术时间54～76min．平均58min。术后住院时间2～5d,平均3．8d。留营双J管2～3脚后拔除。结论：输尿管软镜联合硬镜治疗女性肾孟结石（结石直径≥2cm而≤3cm）是安全、高效的,同时具有创伤小、并发症少的优点,值得在临床上进一步推广使用。     

急性胆囊炎320例腹腔镜手术时机的评价与操作体会

目的　对急性胆囊炎腹腔镜手术时机进行评价 ,并总结手术操作体会。方法　将 32 0例急性胆囊炎患者分 3组施行LC。结果　早期手术组 16 4例 ,中转手术 8例 (0 .5 % ) ;限期手术组 5 1例 ,中转手术 7例 (13.7% ) ;择期手术组 10 5例 ,中转手术 5例 (0 .5 % )。平均手术时间分别为早期组4 6min、限期组 89min及择期组 35min ,平均住院时间分别为 5 .4d、13.6d及 8.7d。本组患者均痊愈出院。结论　急性胆囊炎在发病早期是行LC的理想时机 ;Calot三角的良好显露、正确处理胆囊管和胆囊动脉是LC成功的关键 ;正确对待中转手术和掌握中转手术的指征是LC的安全保证措施     

Expression and significance of PTEN,hypoxia-inducible factor-1 alpha in colorectal adenoma and adenocarcinoma

AIM: To investigate the expression and significance of PTEN,hypoxia-inducible factor-1 alpha (HIF-1α), and targeting gene VEGF during colorectal carciogenesis.METHODS: Total 71 cases colorectal neoplasms (9 cases of colorectal adenoma and 62 colorectal adenocarcinoma)were formalin fixed and paraffin-embedded, and all specimens were evaluated for PTEN mRNA, HIF-1α mRNA and VEGF protein expression. PTEN mRNA, HIF-1α mRNA were detected by in situ hybridization. VEGF protein was identified by citrate-microwave SP immunohistochemical method.RESULTS: There were significant differences in PTEN, HIF1α and VEGF expression between colorectal adenomas and colorectal adenocarcinoma (P＜0.05). The level of PTEN expression decreased as the pathologic stage increased.Conversely, HIF-1α and VEGF expression increased with the Dukes stage as follows: stage A (0.1029±0.0457:0.1207± 0.0436), stage B (0.1656±0.0329: 0.1572±0.0514),and stage C+D (0.2335±0.0748: 0.2219±0.0803). For PTEN expression, there was a significant difference among Dukes stage A, B, and C+D, and the level of PTEN expression was found to be significant higher in Dukes stage A or B than that of Dukes stage C or D. For HIF-1α expression,there was a significant difference between Dukes stage A and B, and the level of HIF-1α expression was found to be significantly higher in Dukes stage C+D than that of Dukes stage A or B. The VEGF expression had similar results as HIF-1α expression. In colorectal adenocarcinoma,decreased levels of PTEN were significantly associated with increased expression of HIF-1α mRNA (r=-0.36, P＜0.05)and VEGF protein (r=-0.48, P＜0.05) respectively. The levels of HIF-1 were positively correlated with VEGF expression (r=0.71, P＜0.01).CONCLUSION: Loss of PTEN expression and increased levels of HIF-1α and VEGF may play an important role in carcinogenesis and progression of colorectal adenocarcinoma.     

Modulation of liver oxidant-antioxidant system by ischemic preconditioning during ischemia／reperfusion injury in rats

AIM: To investigate effects of ischemic pre-conditioning on the liver endogenous oxidant-antioxidant system during ischemia/reperfusion injury. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into sham-operated (Sham), ischemia/ reperfusion (I/R), ischemic pre-conditioning plus ischemia/ reperfusion (IPC) groups. Serum ALT, AST and hyaluronic acid levels were assayed and pathologic alterations observed. Liver malondialdehyde (MDA) contents, endogenous antioxidant enzymes, superoxidase dismutase (SOD), catalase (CAT), gultathionine peroxidase (GSH-Px) activities, neutrophils accumulation marker, myeloperoxidase (MPO) activities were measured respectively. RESULTS: Compared with I/R group, sinusoidal endothelial cells as well as hepatocytes damages, as assessed biochemically and histochemically, were improved significantly in IPC group; neutrophils infiltration was also markedly reduced. In IPC group, liver peroxidation, as measured by MDA contents, was significantly decreased when compared with I/R group; endogenous antioxidant enzymes, SOD, CAT and GSH-Px activities were markedly higher than that in I/R group. CONCLUSION: Ischemic pre-conditioning exerts protective effects on both hepatic sinusoidal endothelial cells and hepatocytes during liver I/R injury. Its mechanisms may involve dimunition of neutrophils infiltration and modulation of the imbalance of endogenous oxidant-antioxidant system in the organism.     

关节镜下应用微骨折方法修复关节软骨缺损的实验研究及临床初步应用

目的探讨应用微骨折技术对全层关节软骨缺损修复的效果。方法20只大白兔随机分为两组,在其右股骨内髁先建立全层软骨缺损模型,实验组进行微骨折处理,对照组则不予特殊处理。分别在4周和8周各处死10只实验兔,作大体观察、病理学检查和修复组织厚度测量。临床上对68例全层关节软骨缺损进行随机分组：实验组35例,关节清理后应用微骨折技术进行处理;对照组33例,仅作关节清理术。结果对照组只有肉芽组织和瘢痕组织生长,仅边缘有少量软骨组织生长,实验组在4周时大部分为软骨组织生长,8周已全部被软骨组织修复。术后平均随访8．6个月,Lysholm评分实验组明显优于对照组。结论微骨折技术是一种有效的修复全层关节软骨缺损方法。     

氟西汀治疗酒依赖的临床研究

目的 研究氟西汀在酒依赖临床治疗中的疗效。方法 用氟西汀分别对酒依赖组（1）和酒依赖组（2）（HAMD量表评分〉20分组和≤20分组）进行12周随访治疗,用安慰剂对酒依赖组（3）（HAMD量表评分≤20分）进行12周随访治疗;对酒依赖复发率进行评定。结果 酒依赖组（1）和酒依赖组（2）复发率分别为21．88％和38．71％有显著差异（P〈0．05）。结论 氟西汀在酒依赖临床治疗中对酒依赖伴抑郁者有更好的治疗效果。     

社区老年人心理健康状况调查分析

目的了解黄石市老年人的心理健康状况,为社区老年人心理健康保健提供科学参考依据。方法采用症状自评量表(SCL-90)〔1〕,测定60岁以上老年人515人,并将结果与常模因子比较。结果老年人SCL-90总分、总均分数高于常模,P<0.05,提示社区老年人总体心理健康水平偏低。60岁年龄组SCL-90躯体化、焦虑、恐惧因子P<0.01,抑郁因子P<0.05;70岁年龄组躯体化因子P<0.01;80岁年龄组精神病性因子P<0.05,提示60~岁年龄组心理压力较大,心理健康水平较低,其它各因子与常模相当,无统计学意义。有配偶组SCL-90躯体化、焦虑、恐惧、精神病性因子P<0.01,抑郁因子P<0.05;分居组焦虑、恐惧因子P<0.01,抑郁、敌对、偏执、精神病性因子P<0.05;丧偶组躯体化、焦虑、恐惧因子P<0.05;提示有配偶组、分居组、丧偶组老年人存在不同程度的心理问题。有配偶组、分居组、丧偶组其它因子与离异组、未婚组各因子与常模相当,无统计学意义。结论社区老年人文化素质低,经济负担重,体弱多病,心理健康总体水平偏低,需要全社会关注。