ENDOSCOPIC MUCOSAL RESECTION AND SUBMUCOSAL DISSECTION METHOD FOR LARGE COLORECTAL TUMORS

The goal of endoscopic mucosal resection (EMR) is to allow the endoscopist to obtain tissue or resect lesions not previously amenable to standard biopsy or excisional techniques and to remove malignant lesions without open surgery. In this article, we describe the results of conventional EMR and EMR using an insulation‐tipped (IT) electrosurgical knife (submucosal dissection method) for large colorectal mucosal neoplasms and discuss the problems and future prospects of these procedures. At present, conventional EMR is much more feasible than EMR using IT‐knife from the perspectives of time, money, complication, and organ preservation. However, larger lesions tend to be resected in a piecemeal fashion; and it is difficult to confirm whether EMR has been complete. For accurate histopathological assessment of the resected specimen en bloc EMR is desirable although further experience is needed to establish its safety and efficacy. Further improvements of in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms.     

STANDARD IMAGING TECHNIQUES OF ENDOSCOPIC ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION USING A CURVED LINEAR ARRAY ECHOENDOSCOPE

Standard imaging techniques using a curved linear array echoendocope are summarized to facilitate the attainment of expertise in endoscopic ultrasonography and endoscopic ultrasound‐guided fine needle aspiration, and to promote the widespread use of this diagnostic and therapeutic tool. Typical images of the mediastinal organs, the bilio‐pancreatic systems and neighboring organs by scanning from the esophagus, stomach, duodenal bulb, and descending portion of the duodenum, are shown in a sequential manner. The basic techniques of endoscopic ultrasound‐guided fine needle aspiration are also presented.     

Progressive peri‐implantitis. Incidence and prediction of peri‐implant attachment loss.

The aim of this prospective study was to characterize an implant patient population exhibiting clinical signs of peri‐implantitis and to determine subsequently the incidence of progressive attachment loss. The predictive values of diagnostic parameters were evaluated. 25 patients with 54 endosseous implants that had been loaded for 41±15 months were included in the study. Clinical parameters included the assessment of plaque, bleeding on probing, probing depth, attachment levels, and Periotest® values. Probing measurements were performed in duplicate by means of a controlled force electronic probe (Periprobem). Peri‐implant crevicular fluid samples were collected and assayed for neutral proteolytic enzyme (NPE) activity (Periocheck®). Analysis of duplicate baseline probing data revealed a high degree of reproducibility (mean difference: 0.1±0.3mm). A minimum threshold of 1.0mm (>3×S.D.) loss of probing attachment was chosen to classify a site as positive for breakdown. Alternatively, the tolerance method was employed to identify sites with progressive attachment loss. After 6 months, irrespective of the analytical method, 6 percent of all sites (in 19% of the implants) and 28% of the patients had experienced further per attachment loss. There were significant differences ( p <0.05) in mean plaque (73% vs. 45%) and NPE (36% vs. 12%) scores between patients with progressive peri‐implantitis and those with stable peri‐implant conditions. Both bleeding on probing and the NPE‐test were characterized by high negative predictive values, and thus negative scores can serve as indicators for stable peri‐implant conditions. For monitoring peri‐implant health during recall visits, attachment level recordings with a controlled force electronic probe in conjunction with enzymatic diagnostic tests of the host response can be recommended.     

CT对眼球异物的诊断及定位

本文比较了11例眼球异物CT与X线影像，并经手术摘出异物证实，CT眼球异物检出及定位准确性均优于X线，尤其对球壁异物的定位，而且能显示断层眼球壁轮廓，具有直观效果，CT异物影像比异物明显扩大，应警惕CT伪影可能使球壁异物定位发生误差，CT目前尚不能完全取代眼球异物常规X线检查。     

有抑郁症史者想象力的研究

实验组为45名缓解的内源性抑郁症患(男25例,女20例)。对照组为15名缓解的双相障碍患者(男8例,女7例),71名正常人(男41例,女30例)。利用作者建立的想象结局法发现:实验组想象力总分显著低于正常人组,特别是当涉及不愉快事件的测题时,单项分亦显著低于正常人。双相障碍组总分亦显著低于正常人。实验组有关性内容的比率得分显著低于正常人。     

尼氏小体染色方法的改进及其在神经病理学研究中的应用

组织或细胞的染色在病理学诊断、科学研究和教学工作中,都具有非常重要的意义和使用价值。组织切片染色的质量好坏对于医学诊断,科研和教学至关重要。为了更好的研究神经组织,使医学诊断、科研和教学工作更为方便,本文对Toluidine Blue(甲苯胺蓝)染色方法做了一些改进。在传统的甲苯胺蓝染色过程中,仅考虑对细胞核和尼氏小体进行染色,未考虑细胞浆和其他细胞器:而改进后的甲苯胺蓝染色方法在甲苯股蓝染色后用伊红再染色,既考虑对细胞核和尼氏小体进行染色,也对细胞浆进行了染色。结果显示传统的Toluidine Blue染色结果光镜下观察,细胞核和尼氏小体都可见,即尼氏小体为深蓝色,细胞核为蓝色,染色背景为淡蓝色;改进后的染色结果光镜下观察,尼氏小体为紫蓝色,细胞核为蓝色,染色背景为粉红色。可见,改进后的染色方法染出的组织切片比传统的要清晰、美观。随着科学技术的飞速发展,病理学的研究也随之发展,病理技术势必进一步提高,来适应科技的进步和医学的发展。改进的尼氏小体染色法能够使脑组织切片更清楚观察,更有利于医学工作者对神经组织及尼氏小体的研究。     

A One–Step, Operator–Independent Method for Isolating Islets of Langerhans from the Porcine Pancreas

Abstract: Large–scale isolation of islets of Langerhans is one of the major obstacles in islet transplantation. Until now, isolation methods relied on enzymatic digestion, the duration of which relies on a decision dictated by the operator's experience. This approach has always hindered development of an automated method. The aim of this study was to develop a one–step method based on complete digestion of the pancreas. The original aspect of the technique (derived from the Ricordi method) is use of the University of Wisconsin (UW) solution in the digestion medium and a continuous flow collagenase processing circuit with local cooling and rewarming to allow tissue digestion to proceed at 37°C while settling of the cell suspension takes place at 4°C. A stopcock system permits the alternate use of two settling chambers so that while one is in the circuit, the other can be removed for cen–trifugation, resuspension of the crude islet preparation in collagenase in free UW solution, and further purification in a density gradient system. Ten experiments were performed, and 545, 750 ± 48, 670 purified pig islets were obtained per totally digested pancreas. Histological studies showed cell integrity. Insulin secretion in response to double glucose stimulation under perfusion conditions demonstrated the functional viability of the isolated islets. In conclusion, this one–step method makes it possible to obtain a high number of viable islets of Langerhans in the absence of any decision by an operator, and it should therefore provide basis for an automated method.     

"提高意识"活动在大学英语精读课中的体现 --对医学护理专业学生精读课改革的重新思考

语法翻译教学法多年来一直主宰着大学英语精读课的教学。随着中国经济突飞猛进的发展,各行各业的人们与国外同行交流的机会和要求也随之增加。面对社会发展而带来的这种变化,显然,古老传统的教学方法已不能适应。通过具体详尽的理论分析,对语法翻译教学法提出了自己的看法。     

膳食纤维分析方法的简化

对ＳｅｌｖｅｎｄｒａｎＲＲ等人的冷中性洗涤剂纤维提取分析法（ＣＮＤＦ）进行简化，改变了各溶剂的处理时间，省去了湿球研磨与超声波处理步骤。将原法中ＳＬＳ－ＰＡＷ－ＤＷＳＯ处理时间１５ｈ，３０ｍｉｎ和１６ｈ分别延长为２２ｈ，４０ｍｉｎ与２２ｈ，化学分析与透射电镜观察结果表明，简化法对膳食纤维的提取分析效果与原推荐法相同，更加方便与实用。     

Efficacy of ivermectin for chronic strongyloidiasis: two single doses given 2 weeks apart

We assessed the efficacy and adverse effects of ivermectin for the treatment of chronic strongyloidiasis. Fifty patients were treated with a single dose of ivermectin at approximately 200 μg/kg, and the dose was repeated 2 weeks later. The eradication rate was 96% (48 of 50 patients) at 2 weeks after the first dose and 98% at 2 weeks after the second dose (49 of 50 patients). In the latter cases, no recurrence was noted at the end of the 4-month post-treatment follow-up period. The gastrointestinal symptoms observed most frequently before the treatment were borborygmus, constipation, and diarrhea. These symptoms improved in the majority of patients after the treatment. Side effects, including nausea and vomiting, occurred in 1 patient (2%), but these were mild and transient. Although abnormal values in laboratory tests were observed in 4 patients (8%), they were mild, and no particular clinical care was required. Thus, ivermectin showed an excellent antihelminthic effect, with little toxicity. Our results indicate that a regimen of two single doses of 200 μg/kg ivermectin, given 2 weeks apart, is clinically suitable for the treatment of chronic strongyloidiasis. Received: April 25, 2001 / Accepted: November 16, 2001