MANAGEMENT TO PREVENT BLEEDING DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING THE FLUSH KNIFE FOR GASTRIC TUMORS

The gastric vasculature responsible for intraoperative bleeding in endosocpic submucosal dissection (ESD) is the ramified vascular network occupying the middle of the submucosal layer and large vessels penetrating the muscle layer. Appropriate management for these vessels must be addressed. The trimming of the ramified vascular network can be safely performed with coagulation mode following shallow mucosal cutting. A large penetrating vessel usually requires precoagulation prior to dissection. These procedures are effectively performed with the water jet short needle knife (Flush knife).     

The effect of central corneal thickness on estimates of the anterior chamber depth

Background: The slitlamp can be used to estimate the anterior chamber depth (ACD). The length of a slit object is increased until the corneal and iris/lens images appear to just touch. Multiplying the just‐touching‐slit‐length (JTSL) by a conversion factor gives an estimate of the ACD as measured by ultrasonography. The purpose of this study was to determine if central corneal thickness (CCT) affects the accuracy of this technique. Methods: The ACD of 50 subjects was measured by A‐scan ultrasonography and estimated by the slitlamp technique. CCT was measured by ultrasonic pachometry. The refractive error was determined subjectively. Results: The average ultrasonographic ACD for all subjects was 3.32 ± 0.65 mm. The average JTSL was 2.46 ± 0.38 mm. The conversion ratio between the ultrasonographic ACD and the average JTSL was 1.35. The predicted ACD using the regression equation of JTSL on the ultrasound anterior chamber depth (USACD) was 3.32 ± 0.54 mm. The corresponding value using the regression equation of JTSL and CCT on USACD was exactly the same, that is, 3.32 ± 0.54 mm. Conclusion: Incorporation of CCT into a regression equation does not improve the accuracy of the Smith technique.     

双频谱指数在心脏瓣膜置换术中的观察

目的应用脑电双频谱指数(BIS)监测常规经验麻醉下瓣膜置换术病人的麻醉深度(意识水平),观察BIS在伤害性刺激时的变化.方法选择30例瓣膜置换术病人,采用芬太尼、咪唑安定、哌库溴铵及心血管活性药物对病人实施麻醉;术中监测并有专人分别记录入室(基础值)、诱导后、插管后、切皮后、锯胸骨时、缝胸骨时及术毕BIS和MAP,HR各参数值,观察不同阶段各参数的变化.结果诱导后各参数均明显降低,虽然切皮后、锯胸骨及缝胸骨等强刺激后MAP和HR未见统计学意义的显著改变,但BIS却显著增高(P＜0.01);全部病人锯胸骨时BIS均在60(67.28±8.97)以上,缝胸骨时63(68.46±8.70)以上,而无1例低于50者.结论该组瓣膜置换术病人麻醉偏浅,尤以锯胸骨、缝胸骨及术毕等时段为甚,表现为BIS值偏高,有知晓发生;知晓可发生在临床认为满意的麻醉中;应用BIS监测,可更加合理地评价麻醉深度.     

Probe tine diameter and probing depth

The aim of this study was to assess the effect of difference in tine diameter on probing pocket depth measurement. 2 sets of tines with Williams markings at 1, 2, 3, 5, 7, 8, 9 and 10 mm, and with a "round" tip, diameter 0.5 mm, were compared. One set was described as parallel-sided, the other as tapered. The parallel-sided tine was almost parallel from the 10 mm marking to the tip (tip diameter mean = 0.46 mm, 95% C.I. 0.456-0.464), while the corresponding diameter for the tapered tine varied (tip diameter mean = 0.48 mm, 95% C.I. 0.473-0.489). Calibration markings appeared highly consistent with the expected value to within 0.01 mm. The tines were mounted in Brodontic handles at 0.25 N. Examiner probing repeatability yielded kappa 0.86 for "parallel-sided" and 0.81 for "tapered" tines in vivo. 412 approximal pockets were assessed in 53 patients with routine chronic adult periodontitis, mean age 42.1 years. Each site had a probing depth of greater than or equal to 5 mm, PlI less than or equal to 1, GI less than or equal to 1, PBI less than or equal to 1. Each site was probed 2x with a 15-min interval. At the first 251 sites, the parallel-sided tine was used initially, and the tapered at the remaining 161 sites. Results indicated a highly significant tendency for the parallel-sided tine to yield a deeper reading when a difference occurred. These findings indicate that with adequate training providing high examiner repeatability, one source of error in probing data can be minimised.     

Curing efficiency and ocular hazards of dental photopolymerization sources

The spectral distributions of a range of dental photocuring sources were measured at the exit window and at a distance of 10 cm. The former enabled the evaluation of a newly proposed photocuring efficiency index which correlates well with the depth of cure of the photopolymerized resins, thus providing a basis for the comparison of different photocuring sources. The spectral irradiante of the sources obeyed the inversesquare law, allowing a comparison with the ACGIH threshold limit values. According to these criteria, no ocular hazard is posed to the patient or clinician by u.v.-A or u.v.-B radiation nor to the patient by the visible light when momentarily exposed to the sources. Similarly the ACGIH criterion indicates that the clinician does not risk chorioretinal injury provided the exposure is restricted to less than 140 s in a 3 h period.     

c-erbB-2、VEGF和组织蛋白酶D在胃癌中的表达及其相关性

目的：探讨癌基因c-erbB-2、血管内皮生长因子（VEGF）和组织蛋白酶D（Cath-D)在胃癌中的表达及其与胃癌生物学行为的关系。方法：采用免疫组织化学（S－P）法，检测了102例胃癌手术标本中c-erbB-2、VEGF及Cath-D的表达，同时观察了网状纤维分布与c-erbB-2、Cath-D之间的关系，并将检测结果与跟踪随访资料进行了综合分析。结果：102例胃癌组织中c-erbB-2表达阳性率为38.24%（39／102），与胃癌浸润深度（P＜0.05）、淋巴结转移（P＜0.05）密切相关；VEGF表达阳性率为50％（51／102），与胃癌浸润深度（P＜0.01）、生长方式（P＜0.01）、淋巴结转移（P＜0.01）密切相关；Cath-D表达阳性率为81.37%(83/102)，与胃癌浸润深度（P＜0.05）、生长方式（P＜0.05）、淋巴结转移（P＜0.05）及脉管内有无癌栓（P＜0.05）有关。对生存期分析显示：Cath-D、VEGF、c-erbB-2阳性患者预后差，5年生存率低于阴性表达患者。结论：c-erbB-2、VEGF及Cath-D与胃癌的生长、浸润、转移、预后有密切关系，可作为判断胃癌生物学行为和预后的重要指标。     

可切削渗透陶瓷玻璃料对不同堆积密度氧化铝基体的渗透

探讨了可切削渗透陶瓷 (Infiltration of Machinable- infiltrated- ceramic,MIC)渗透玻璃在不同堆积密度氧化铝基体中的渗透情况及渗透后复合体的颜色表达。在 110 0℃保温 2 h,将玻璃渗透到不同堆积密度的氧化铝基体中 ,分别测得其渗透深度和颜色参数。扫描电镜观察玻璃—氧化铝复合体断面。玻璃渗透深度的平方与氧化铝堆积密度有直线负相关关系 ,最小渗透深度为 3.0 92 m m。复合体的颜色系数与氧化铝堆积密度无相关性。渗透复合体在断裂过程中可见 :裂纹偏转、晶体拔出和穿晶断裂。本实验证实 MIC渗透玻璃的渗透性能达到临床要求。渗透后的复合体颜色稳定 ,强度可靠     

Fine particulate matter exposure during pregnancy and infancy and incident asthma

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麻醉深度监护仪对老年腹部手术全麻质量的影响

目的:研究Narcotrend(NT)麻醉深度监护仪对老年腹部手术患者全麻质量的影响。方法:选取医院收治的150例择期行腹部手术老年患者,按照抽签方式将其随机分为观察组和对照组,每组75例。两组手术均采取全身麻醉,对照组凭借临床经验及患者身体指征对麻醉药用量进行调整,观察组在NT麻醉深度监护仪指导下调整麻醉用量,比较两组围手术期麻醉时间、苏醒时间、定向力恢复时间、重症监护病房停留时间及麻醉药使用情况;比较两组患者麻醉前(T₀)、麻醉30 min后(T₁)及手术结束时(T₂)的心率(HR)、平均动脉压(MAP)和NT麻醉监护仪麻醉深度指数(NTI);比较两组手术后Ricker镇静-躁动(SAS)评分、Ramsay镇静(RSS)评分、简易智能量表(MMSE)评分及疼痛视觉模拟(VAS)评分;比较两组患者术后并发症发生率。结果:观察组术后苏醒时间、定向力恢复时间低于对照组,差异有统计学意义(t=2.806,t=2.476;P<0.05);麻醉药依托咪酯和舒芬太尼的使用量显著低于对照组,差异有统计学意义(t=8.349,t=2.158;P<0.05);两组HR、MAP的组内比较T₁>T₂>T₀,NTI的组内比较T₀>T₂>T₁,差异有统计学意义(F=205.467,F=36.545,F=111.677,F=156.932,F=57.659,F=869.035;P<0.05);观察组NTI在T₁、T₂时组间比较显著低于对照组,差异有统计学意义(t=14.265,t=9.347;P<0.05);两组术后SAS评分、RSS评分、VAS评分及PSQI评分差异均无统计学意义,观察组MMSE评分显著高于对照组,差异有统计学意义(t=7.992,P<0.05);观察组术后并发症总发生率为10.67%,显著低于对照组(25.33%),两组比较差异有统计学意义(x²=5.465;P<0.05)。结论:NT麻醉深度监护仪指导下调整麻醉药用量可减少老年患者术后苏醒时间,加快患者定向力恢复,且能减少术后并发症发生,有较高的临床应用价值。     

DCC基因蛋白在大肠癌中的表达及意义

目的探讨DCC基因在大肠癌中的蛋白表达及其生物学行为的关系.方法应用免疫组化方法检测46例大肠癌及相应癌旁正常组织和41例正常人大肠组织的DCC基因蛋白表达.结果正常大肠粘膜组织全部表达,大肠癌组织部分表达,阳性率为28%(13/46),两组差异显著(P＜0.01),且与肿瘤浸润转移(Dukes分期)及分化程度有明显相关(P＜0.05),5例伴肝转移组织全部表达缺失.结论DCC基因与大肠癌的发生发展有关,与其浸润转移(Dukes分期)呈负性相关.DCC基因蛋白表达可作为形态学之外判断大肠癌生物学行为的一种指标.