国产注射用盐酸瑞芬太尼有效性和安全性的评价

目的 采用随机、对照、双盲、多中心的Ⅱ期临床试验,评价国产注射用盐酸瑞芬太尼的有效性和安全性。方法201名受试者分成两组:对照组使用静脉芬太尼(2.5μkg诱导,0.03μg·kg-1·min-1维持)复合吸入66％氧化亚氮麻醉,试验组使用静脉瑞芬太尼(2μg/kg诱导,0.2μ·kg-1·min-1维持)复合吸入66％氧化亚氮麻醉。药物有效性的观察指标有:手术刺激时的应激反应,如血压、心率、流泪、麻醉质量。安全性的观察指标有:血压和心率、麻黄碱、阿托品、纳洛酮、乌拉地尔的使用量、手术失血量、心电图变化、术前和术后48 h内血中ALT、AST、肌酐、尿素氮、停止麻醉到可以拔除气管导管的时间、拔除气管导管前的PETCO2或PaCO2、停止麻醉(关闭氧化亚氮)后呼唤名字可以睁眼时间、术后送往麻醉恢复室或ICU情况以及不良事件。结果 瑞芬太尼与芬太尼在本试验剂量下,药效作用相似,但镇痛作用瑞芬太尼强于芬太尼,停止输注后其作用消退快于芬太尼。结论 国产瑞芬太尼用于全麻可产生良好的镇痛作用,且具有与芬太尼相同的安全性。     

Skp2、p27kip1蛋白在结直肠癌中的表达及其意义

目的 探讨Skp2蛋白在结直肠癌发生、发展中的作用及其与p27kip1蛋白表达的关系.方法 应用免疫组织化学法结合计算机图像分析检测结直肠癌(80例)、腺瘤(20例)、正常组织(20例)中Skp2蛋白和p27kip1蛋白的表达.结果 由正常结直肠黏膜、腺瘤到癌,Skp2阳性表达率为0%、55%、93.8%,呈上升趋势(P＜0.01);p27kip1阳性表达率为100%、95%、87.5%,呈下降趋势(P＜0.05).结直肠癌中Skp2表达与p27kip1表达呈负相关(r=-0.311,P＜0.01).Skp2蛋白在癌组织中的表达与结直肠癌的分化程度、淋巴转移有关(P＜0.05).结论 结直肠癌skp2蛋白过表达与p27kip1蛋白降解有关,Skp2蛋白过表达可能是结直肠癌发生、发展的原因之一.     

经典式原位肝移植术弃用静脉转流的经验总结

目的：观察经典式原位肝移植术不作静脉转流的效果,分析不转流对术后胃肠道及肾脏功能的影响。方法：总结自１９９９年来我所４５例经典式原位肝移植术弃用静脉转流的经验。结果：４５例术中无肝期时间平均为５４．５ｍｉｎ,术后与不转流相关的胃肠道和肾功能明显损害的并发症有４例：３例术后近期发生急性肾功能衰竭,２例经血透后恢复,１例死亡;另１例于术后１．５月发生急性坏死性胰腺炎。结论：若无肝期控制在１ｈ内,经典式原位肝移植不作转流,并不显著增加胃肠道和肾脏功能损害等并发症,且有缩短手术时间和节省费用等优点。     

基于模糊理论的酵母发酵动力学模型

在模糊理论基础上,提出了一种描述菌体生长的模糊动力学模型,将专家对发酵过程的定性经验描述和精确的数学模型联系起来.模型分析发现,对数期隶属度函数就是菌体的相对比生长速率,从而提供了一种划分菌体发酵阶段的方法.最后针对酵母发酵过程,精确地确定了划分对数生长期的开始时间和结束时间.     

螺旋CT动脉早期扫描在肝脏实性占位鉴别诊断中的价值

目的　探讨螺旋 CT动脉早期扫描对肝实性占位鉴别诊断的价值 ,并分析典型 CT表现。方法　 89例 89个肝实性占位 ,除血管瘤外均经手术病理证实。其中原发性肝癌 2 2例 ,转移性肝癌 17例 ,血管瘤 2 5例 ,局灶性结节增生 13例 ,腺瘤 5例 ,血管平滑肌脂肪瘤 7例。首先分析动脉早期扫描是否有助于提高诊断准确率 ,然后分析各种占位在动脉早期的特征形态学表现。结果　动脉早期扫描能显著提高诊断准确率 (77/ 89,86 .5 % Vs 5 7/ 89,6 4 .0 % ,P<0 .0 1)。尤其是原发性肝癌 (19/ 2 2 Vs11/ 2 2 ,P<0 .0 1)和局灶性结节增生 (11/ 13Vs 5 / 13,P<0 .0 5 )。动脉早期的特征性表现对鉴别诊断有帮助 :明显一致强化(FNH ,腺瘤 ) ,中央粗大滋养血管 (FNH ) ,中央放射疤痕 (FNH ) ,不均匀强化 (HCC) ,周边点簇强化 (血管瘤 ) ,脂肪成分(AML )。结论　肝实性占位在动脉早期的特征性表现对鉴别诊断有重大价值     

Once‐Daily Prolonged‐Release Tacrolimus (ADVAGRAF) Versus Twice‐Daily Tacrolimus (PROGRAF) in Liver Transplantation

The efficacy and safety of dual‐therapy regimens of twice‐daily tacrolimus (BID; Prograf) and once‐daily tacrolimus (QD; Advagraf) administered with steroids, without antibody induction, were compared in a multicenter, 1:1‐randomized, two‐arm, parallel‐group study in 475 primary liver transplant recipients. A double‐blind, double‐dummy 24‐week period was followed by an open extension to 12 months posttransplant. The primary endpoint, event rate of biopsy‐proven acute rejection (BPAR) at 24 weeks, was 33.7% for tacrolimus BID versus 36.3% for tacrolimus QD (Per‐protocol set; p = 0.512; treatment difference 2.6%, 95% confidence interval ?7.3%, 12.4%), falling within the predefined 15% noninferiority margin. At 12 months, BPAR episodes requiring treatment were similar for tacrolimus BID and QD (28.1% and 24.7%). Twelve‐month patient and graft survival was 90.8% and 85.6% for tacrolimus BID and 89.2% and 85.3% for tacrolimus QD. Adverse event (AE) profiles were similar for both tacrolimus BID and QD with comparable incidences of AEs and serious AEs. Tacrolimus QD was well tolerated with similar efficacy and safety profiles to tacrolimus BID.     

考虑血液灌注温度依赖特性的相变生物传热分析

目的 基于温度依赖型血液灌注率,分析生物组织在体表冷刀作用下的降温冻结及相应的复温过程。方法 依据经典Pennes生物传热方程。用变时间步长的隐式有限差分法,通过循环迭代逼近来求解。结果 数值计算得到体表冷刀温度固定（-196℃及-30℃）和体表冷刀降温速度恒定（8.95℃/min)两种情况下不同血液灌注率（血液灌注率为常数,零、随温度变化及平均血液灌注率）对生物组织降温及相变过程的温度影响,瞬态降温速度分布及复温的温度响应。结论 血液灌注率的温度依赖模型较传统平均血液灌注率模型更接近活体组织的实际血液灌注率,而基于两者的相变分析差别显著。因此低温外科手术中精确温度预示应采用前者,本文结果对其有积极的参考价值。     

Evaluation of free-breathing three-dimensional magnetic resonance coronary angiography with hybrid ordered phase encoding (HOPE) for the detection of proximal coronary artery stenosis.

We evaluated free-breathing, prospective navigator-gated, three-dimensional (3D) magnetic resonance coronary angiography (MRCA) with hybrid ordered phase-encoding (HOPE), in the detection of proximal coronary artery stenosis. The coronary arteries were imaged in 46 patients undergoing cardiac catheterization. The mean scan time was 48 minutes. The mean arterial length (mm) visualized was left main stem (LMS) 11.7 (SD 4.5), left anterior descending (LAD) 30.1 (SD 11.1), circumflex (LCx) 15.5 (SD 8.6), and right (RCA) 56.2 (SD 20.8). Twenty-three patients had coronary artery disease with 47 significant stenoses on cardiac catheterization. All LMS were normal on both catheterization and MRCA. MRCA sensitivity was highest for the LAD (89% CI 65%-99%) and RCA (76% CI 50%-93%), but lower for the LCx (50% CI 21%-79%). Specificity ranged from 72%-100%. Improvements in image quality, length of vessel seen, and specific imaging of the LCx are required for MRCA to become an alternative to cardiac catheterization.     

Magnetic resonance flow measurements in real time: comparison with a standard gradient-echo technique

Ultrafast gradient systems and hybrid imaging sequences offer the opportunity to acquire phase contrast flow data in real time. In a 1.5-Tesla magnetic resonance (MR)-tomograph, peak velocity and volume flow were assessed in 36 large vessels (aorta) and 33 medium-sized vessels (carotid and iliac artery) using a real-time (segmented k-space turbo gradient-echo planar imaging sequence) in comparison with a gradient-echo technique. With the real-time technique, the matrix was reduced from 116 to 64, and temporal resolution changed from 30 msec to 124 msec. Measurements of peak velocity correlated in large (r = 0.88) and medium-sized vessels (r = 0.81). Volume flow measurements correlated in large vessels (r = 0.87), however, a poor correlation (r = 0.64) was found in medium-sized vessels. Thus, scan time can be significantly reduced and images acquired without electrocardiogram (ECG)-triggering. Flow volume can only be determined in large vessels with sufficient accuracy, mainly due to reduced spatial resolution in smaller vessels.     

Preliminary study of the anatomy of the venous drainage of the intrahepatic and extrahepatic bile ducts and its relevance to the practice of hepatobiliary surgery

Background : Although there have been many studies of the arterial supply of the biliary system, attempts to study the corresponding venous drainage have been few and all have been incomplete. The purpose of the present investigation is to describe the anatomy of the venous drainage of both the intrahepatic and extrahepatic bile ducts and to determine its relevance to hepatobiliary surgery. Methods : The intrahepatic and extrahepatic venous drainage of the bile ducts was investigated in seven specimens by injecting a solution of 10% gelatin coloured with Alcian blue into the portal vein or the superior mesenteric vein to outline the venous drainage. The specimens were dissected under loop magnification and representative drawings were obtained. Results : The surface of the intrahepatic and extrahepatic bile ducts was covered by a fine venous plexus. On the surface of the supraduodenal common hepatic duct and common bile duct the venous plexus drained laterally into marginal veins, usually two in number and known as the 3 o’clock and 9 o’clock marginal veins. Inferiorly the marginal veins and the venous plexus communicated with the pancreaticoduodenal venous plexus, which in its turn drained into the posterosuperior pancreaticoduodenal vein, a branch of the superior mesenteric vein. Superiorly the marginal veins divided into a number of branches. Some branches followed the left and right hepatic ducts into the liver, communicating with the venous plexus and the adjacent branches of the portal vein. Other branches of variable size entered either segment IV or the caudate lobe or process via the hilar venous plexus. A most important finding was that even after dividing the bile duct and all communicating veins at the upper border of the duodenum, the venous plexus and the marginal veins filled normally to the level of transection. This occurred almost certainly by retrograde filling from above. Conclusion : The satisfactory results of end‐to‐end anastomosis in whole liver transplantation depends partly on the presence of adequate venous drainage. This has been amply demonstrated by the injection studies. This would indicate that the poor results of end‐to‐end repair of the bile duct after surgical trauma results from other factors such as poor technique, devascularization of the cut ends due to trauma, and carrying out the anastomosis under tension. After resection of the hilum for cholangiocarcinoma the venous drainage of the left and right hepatic ducts and their branches depends mainly on the communications between the venous plexus on the ducts and the adjacent branches of the portal vein, even at a lobular or sinusoidal level. The satisfactory results obtained after anastomosis of the left and right hepatic ducts or their branches to a Roux loop of jejunum attest to this. This applies also to the transplantation of segments II and III in paediatric patients from related adult donors and in patients receiving split liver transplants. Finally, the venous drainage at the bifurcation of the common hepatic duct has been shown to enter the caudate lobe and segment IV directly. This suggests that a hilar cholangiocarcinoma may metastasize to these segments, and perhaps partly explain the significantly better long‐term results when the caudate lobe and segment IV are resected en bloc with the cholangiocarcinoma as part of modern radical surgery for this condition.