急性胆源性胰腺炎手术治疗探讨——附96例报告

目的 探讨急性胆源性胰腺炎手术时机的选择。方法 回顾性分析1999-2004年收治的急性胆源性胰腺炎96例患者的临床资料。结果 59例急性非梗阻性胆源性胰腺炎中，48例经非手术治疗症状缓解后1-2周内延期手术；11例急诊手术，1例死亡。37例急性梗阻性胆源性胰腺炎先经非手术治疗，18例在24-48h后症状不缓解行急诊手术，19例在症状缓解后1—2周内行延期手术，均获治愈。结论 急性非梗阻性胆源性胰腺炎早期应选择非手术治疗，症状缓解后延期手术。急性梗阻性胆源性胰腺炎在非手术治疗24h-48h症状不缓解则急诊手术。     

Systematic and differential myelination of axon collaterals in the mammalian auditory brainstem

A brainstem circuit for encoding the spatial location of sounds involves neurons in the cochlear nucleus that project to medial superior olivary (MSO) neurons on both sides of the brain via a single bifurcating axon. Neurons in MSO act as coincidence detectors, responding optimally when signals from the two ears arrive within a few microseconds. To achieve this, transmission of signals along the contralateral collateral must be faster than transmission of the same signals along the ipsilateral collateral. We demonstrate that this is achieved by differential regulation of myelination and axon caliber along the ipsilateral and contralateral branches of single axons; ipsilateral axon branches have shorter internode lengths and smaller caliber than contralateral branches. The myelination difference is established prior to the onset of hearing. We conclude that this differential myelination and axon caliber requires local interactions between axon collaterals and surrounding oligodendrocytes on the two sides of the brainstem. GLIA 2016;64:487–494     

The importance of correctly timing cancer immunotherapy

Introduction: The treatment options for cancer—surgery, radiotherapy and chemotherapy—are now supplemented with immunotherapy. Previously underappreciated but now gaining strong interest are the immune modulatory properties of the three conventional modalities. Moreover, there is a better understanding of the needs and potential of the different immune therapeutic platforms. Key to improved treatment will be the combinations of modalities that complete each other’s shortcomings.

Area covered: Tumor-specific T-cells are required for optimal immunotherapy. In this review, the authors focus on the correct timing of different types of chemotherapeutic agents or immune modulators and immunotherapeutic drugs, not only for the activation and expansion of tumor-specific T-cells but also to support and enhance their anti-tumor efficacy.

Expert opinion: At an early phase of disease, clinical success can be obtained using single treatment modalities but at later disease stages, combinations of several modalities are required. The gain in success is determined by a thorough understanding of the direct and indirect immune effects of the modalities used. Profound knowledge of these effects requires optimal tuning of immunomonitoring. This will guide the appropriate combination of treatments and allow for correct sequencing the order and interval of the different therapeutic modalities.     

服药时间对结肠镜检查肠道准备效果的影响

目的探讨行结肠镜检查时服药时间对肠道准备效果的影响。方法选取行结肠镜检查的200例患者,分为两组,A组:5:00~7:00,B组:10:00~12:00,于肠镜检查前4 h口服复方聚乙二醇电解质散(PGEP)(恒康正清)139.12 g(2 000 ml)作为清肠剂,内镜医师行Boston肠道准备量表(BBPS)和肠腔内气泡评分,记录患者肠道准备时间,问卷调查患者对肠道准备的耐受性,记录肠道准备过程中的不良反应。结果所有患者均完成肠道准备及全结肠镜检查。A组BBPS总分明显高于B组(P0.05),A组肠腔内气泡评分明显低于B组(P0.05),A组肠道准备时间少于B组(P0.05),A组耐受性高于B组(P0.05),A组不良反应明显低于B组(P0.05)。结论 5:00~7:00服用PGEP行结肠镜检查肠道准备时间短、效果好,方便患者就医,能减少患者空腹等待及不适(头晕、饥饿感)等潜在风险,增加其依从性和耐受性,使肠镜检查顺利进行。     

去骨瓣减压手术治疗恶性大脑中动脉脑梗死的手术时机探讨

目的观察分析选择合适的手术时机在去骨瓣减压手术治疗恶性大脑中动脉脑梗死中的临床疗效。方法选择于2008年3月至2012年4月在我院接受治疗的82例恶性大脑中动脉脑梗死患者作为研究对象,随机分成对照组和观察组各41例,对照组患者在脑疝后进行手术治疗,观察组患者在脑疝前进行手术治疗,治疗后比较两组患者6个月后的病死率和功能恢复状况。结果观察组患者的病死率较低,且显著低于对照组,两组比较差异具有统计学意义(P<0.05);观察组患者手术后的功能恢复症状也显著优于对照组,两组比较差异具有统计学意义(P<0.05)。结论选择合适的手术时机对于去骨瓣减压手术治疗恶性大脑中动脉脑梗死尤为重要;研究发现脑疝前就立即进行手术治疗能够有效减少恶性大脑中动脉脑梗死治疗过程中的病死率,同时有助于患者术后功能的恢复,具有十分重要的临床意义。     

高血压脑出血180例的外科治疗探讨

目的探讨高血压脑出血的规范化外科治疗。方法回顾性分析2008年1月至2011年1月3年间重庆医科大学附属第一医院神经外科手术治疗180例高血压脑出血患者的临床资料。结果其中采用开颅血肿清除及去骨瓣减压术63例,小骨窗开颅血肿清除术48例,脑室穿刺外引流术42例,立体定向血肿穿刺碎吸引流术27例。所采用的术式与患者术前意识评分(GCS)、出血部位及出血量有显著相关性(P<0.05)。超早期(<7h)手术后再出血率为9.7%,早期(7～24h)和延迟期(>24h)手术未见再出血病例。术后追踪随访6个月,预后良好率达60.5%。结论采用个体化的治疗原则,采用恰当的术式及选择正确的手术时机能明显提高治愈率,降低病死率及致残率。     

脑挫伤早期神经细胞凋亡和Caspase-3表达变化的观察

目的观察脑挫伤后早期神经细胞凋亡和调节因子Caspase-3表达的时序及空间变化规律。方法采用TUNEL染色和免疫组化染色方法,结合图像分析技术,对不同损伤时间组人脑挫伤组织进行染色观察。结果①TUNEL染色和Caspase-3免疫组化染色的阳性细胞主要分布在挫伤区和挫伤半影区,与远隔部位和对照组脑组织的阴性染色有显著差异,P<0.05;②脑挫伤后48 h内,在挫伤半影区TUNEL染色的阳性率和阳性细胞IOD逐渐增加,各时间组之间有显著差异,P<0.05,两参数与损伤时间均呈线性关系,r分别为0.89和0.93;③Caspase-3阳性表达与神经细胞凋亡变化呈平行关系,两参数与损伤时间也呈线性关系,r分别为0.92和0.90。结论①人脑挫伤后48 h内神经细胞凋亡和Caspase-3阳性表达的阳性率、IOD增加与损伤时间之间呈线性关系,可作为损伤时间推断的新依据;②TUNEL和Caspase-3免疫组化染色阳性细胞主要分布在挫伤半影区和挫伤区都提示可以用于判断脑挫伤部位,尤其是对轻度脑损伤大体和HE染色形态改变不明显的脑挫伤更有意义。     

损伤控制性手术在严重肝外伤治疗中的应用分析

目的 探讨损伤控制性手术治疗严重肝外伤的临床价值.方法 将我科于2006年1月至2011年12月期间收治的严重肝外伤患者62例随机分为2组,观察组与对照组各31例,观察组患者接受损伤控制性手术治疗,对照组接受常规手术治疗.结果 （1）观察组的手术时间显著长于对照组,2组比较差异有统计学意义（P＜0.05）.（2）观察组的并发症发生率显著低于对照组,2组比较差异有统计学意义（P＜0.05）.（3）观察组的抢救成功率显著高于对照组,2组比较差异有统计学意义（P＜0.05）.结论 损伤控制性手术治疗严重肝外伤患者具有并发症发生率低、抢救成功率高等优点,因此损伤控制性手术这一外科理念值得在临床上推广.     

Effects of exercise training and a hypocaloric diet on female monozygotic twins in free-living conditions

This paper aims to examine the similarities in effects of exercise training and a hypocaloric diet within overweight female monozygotic twin pairs and to assess differences in twin partners' responses depending on the timing of exercise bouts and main meals. Six previously untrained twin pairs (aged 20-37 years, body fat 35.8 ± 6.3%) performed an identical exercise program (12 bouts endurance and 8 bouts resistance training) and took part in a nutrition counseling program for a period of 28 days. They pursued one identical goal: to lose body weight and fat. Each twin partner was randomly assigned to one of the two intervention groups: “exercise after dinner” (A) and “exercise before dinner” (B). Subjects followed a hypocaloric diet, supervised by a nutritionist, in free-living conditions. Reductions in body weight, waist and hip circumference, glucose tolerance, mean daily %fat intake, changes in morning resting energy rate and resting metabolic rate showed great variation between twin pairs, but only small variation within twin pairs. Thus, the genetic influence on the changes in most of the examined anthropometric and physiological variables was high. There was no influence of the specific timing on the dependent variables.     

高血压基底节区血肿术后肢瘫的针灸康复治疗时机选择

目的探讨针灸康复治疗在高血压基底节区血肿术后肢体瘫疾的时机选择。方法将高血压基底节区血肿术后肢体瘫痪患者随机分为3组：常规药物等对症治疗组,7～14d开始针灸康复治疗组,15—30d开始针灸康复治疗组,观察患者肢体瘫痪的恢复情况。结果3组互相之间比较差异有统计学意义CP〈0．01）,7—14d开始针灸康复治疗组明显优于15～30d开始针灸康复治疗组和常规药物等对症治疗组,15～30d开始针灸康复治疗组明显优于常规药物等对症治疗组。结论针灸康复治疗在高血压基底节区血肿术后肢瘫的治疗有明显疗效,而早期（7～14d）明显优于晚期（14d后）者。