49例造影剂副反应及急救体会

讨论了影像造影剂使用过程中副反应的发生率、发生原因、急救方法和预防措施。     

熟地黄药效物质基础研究进展

熟地黄为玄参科植物地黄Rehmannia glutinosa新鲜或干燥块根的炮制加工品,具有补血滋阴、益精填髓等功效。熟地黄是中药“滋阴”作用最具代表的药味之一,也被称之为“至阴之药”。熟地黄配伍相关经典方剂被广泛应用于治疗肝肾阴虚导致的各种临床疾病,包括糖尿病相关疾病、神经系统疾病、骨关节炎相关疾病、妇科相关疾病等。基于近年来发表的文献,对熟地黄化学成分、活性成分的药理作用、方剂配伍条件下的药效物质的基础研究进展进行综述,以期为熟地黄的深入研究提供参考。     

基于HS-GC-IMS技术分析六神曲炮制前后（炒、焦）挥发性物质的变化

目的 分析六神曲Massa Medicata Fermentata炮制前后（炒、焦）的挥发性有机物特征及其变化规律。方法 采用顶空-气相色谱-离子迁移质谱（headspace-gas chromatography-ion migration mass spectrometry,HS-GC-IMS）测定六神曲生品、炒品和焦品的挥发性有机物,构建HS-GC-IMS指纹图谱,采用VOCal软件对检测到的成分进行定性和定量分析,运用主成分分析（principal component analysis,PCA）、偏最小二乘-判别分析（partial least squares-discriminant analysis,PLS-DA）、t检验等对样品进行差异性分析。结果 基于HS-GC-IMS技术从六神曲生品、炒品和焦品中共获得了80种挥发性有机物,定性鉴别出60种;构建了六神曲生品、炒品和焦品的HS-GC-IMS指纹图谱,通过PCA、PLS-DA、t检验等分析方法可将三者进行区分,己醛-D(hexanal-D)、乙醇（ethanol）2种物质可作为六神曲生品的特征性成分;丁醛（butanal）...     

腹腔镜胰腺外科手术缝合技术与缝合材料选择中国专家共识（2021版）

正胰十二指肠切除术(pancreaticoduodenectomy,PD)及胰体尾切除术(distal pancreatectomy, DP)作为治疗壶腹周围及胰体尾肿瘤的经典术式,具有手术难度大、技术要求高及术后并发症多等特点,是腹部外科极具代表性及挑战性的术式之一。随着手术理念、技术及缝合材料的更新、进步与优化,PD术后围手术期死亡率已降至3%以下,但术后并发症特别是胰瘘的发生率仍高达10%～30%。     

ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

目的 比较不同栓塞材料的门静脉栓塞术（PVE）与联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）对剩余肝体积（FLR）增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法 采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌（HCC）或肝内胆管癌（ICC）病人,将其分为4组：ALPPS组及分别采用氰基丙烯酸正丁酯（NBCA）、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果 各组的手术切除例数及二期手术切除率分别为：ALPPS组38例（99.4%）,NBCA组32例（76.2%）,明胶海绵组20例（60.6%）,微球组10例（83.3%）。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 mL/d和 8.5 mL/d,均高于明胶海绵组（3.7 mL/d）。结论 采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。     

Use of a new mixture for embolization of intracranial vascular malformations

Summary The internal carotid artery system in swine has a special anatomic configuration similar to a brain arterial-arterial malformation. The internal carotid artery breaks up into a multitude of fine channels (rete mirabile) situated at the base of the skull on the side of the hypophysis. This anatomic arterial model was used to analyze acute and chronic angiographic and histological changes after occlusion of the rete mirabile with I) avitene, II) avitene, and 50% ethanol, III) avitene, 30% ethanol and Polyvinyl alcohol, IV) avitene 50% ethanol and Polyvinyl alcohol, V) IBCA and VI) silk. Histopathological changes observed in the rete mirabile six weeks following occlusion demonstrated that a mixture of avitene, 30% ethanol and Polyvinyl alcohol and IBCA produced the best anatomic results. Embolization with avitene, PVA and ethanol induced a more bland histological reaction than the one observed with IBCA. Preliminary clinical experience with this mixture is reassuring in those cases in which the AVM was surgically resected. The partially thrombosed AVM was easily depressed and compressed by the neurosurgeon allowing for satisfactory hemostasis in and around the nidus of the AVM.This paper was presented in part at the International Symposium on Cerebral Stroke, Sendai, Japan, 1987     

牙龈成纤维细胞与牙周韧带细胞在二种玻璃离子水门汀上附着及增？…

目的 比较人类牙龈成纤维细胞（ＨＧＦ）与牙周韧带细胞（ＰＤＬＣ）在两种玻璃离子水门汀（ＧＩＣ）上的附着及增殖情况。方法 利用体外细胞培养技术及＾３Ｈ－ＴｄＲ掺入法检测ＨＧＦ及ＰＤＬＣ在两种ＧＩＣ上的附着及ＤＮＡ合成。结果 ＨＧＦ与ＰＤＬＣ在培养板上的附着及ＤＮＡ合成差异无显著性（Ｐ〉０．０５）,但ＨＧＦ在ＧＩＣ上的附着及ＤＮＡ合成明显强于ＰＤＬＣ（Ｐ〈０．０５）。结论 Ｋｅｔａｃ Ｆｉｌ和Ｆｕｊｉ     

弹性材料修复前牙缺失的临床探讨

目的 为探讨弹性材料在修复前牙缺失中的临床效果,进一步推广应用弹性材料在口腔修复美容中的价值。方法 利用美国Valpast公司研制的弹性材料,湖南长沙AULEN公司生产的隐形义齿机。选择前牙缺失患者216例,按临床要求制备基牙工作模型,制作蜡型装合,加热去腊后灌注弹性材料,冷却后取出铸件修整抛光。结果 216例患者修复298颗牙,两年后随访168例,优良者156例,占92．86％;一般者8例,占4．76％;较差者4例,占2．38％。结论 本方法修复前牙缺失与传统方法相比,无需金属卡环支架固位,具有美观、舒适、超薄、耐磨、制作快捷、简单等优点,是修复前牙缺失的理想材料及方法,值得临床推广应用。     

三维CT在颅底缺损重建中的作用

目的 用三维CT技术进行颅底重建手术的分析、设计、提高一期重建的成功率。方法 手术前联合采用三维CT、MRI或CT了解病变与颅底的关系,颅底缺损的大小、范围及所涉及的重要结构。根据不同情况设计相应手术方案,以自体骨、颞肌瓣和硅橡胶为修复材料。结果 10例中1例颅骨纤维结构不良者发生脑膜炎。3周后痊愈。余9例无类似或组织下垂、脑脊液鼻漏等并发症。结论 三维CT为分析颅底重建手术方案提供了立体分析资料,同时也为手术后评价颅底重建效果提供了直接的实体影像。     

Experimental study and clinical use of poly(vinyl acetate) emulsion as liquid embolisation material

A new material, an emulsion of poly(vinyl acetate) was experimentally developed and clinically used to overcome several disadvantages in currently used liquid embolisation materials. The emulsion microparticles, 0.3–0.7 m in size, possessed cationic charge on the surface and hence aggregated immediately on contact with fluids containing anions. This inert polymer has the advantage that it does not induce a deleterious reaction in living tissue. Moreover, its medium is water and it is not adhesive, like the cyanoacrylates. Several concentrations of emulsion were injected into the renal arteries of dogs. For the investigation of tissue reactions and the possibility of recanalisation, the emulsion was injected into rats both subcutaneously and into the renal arteries. The renal artery injections in dogs showed adequate radiopacity and consistent complete occlusion. The lower the concentration of the emulsion, the smaller the arteries which could be occluded. Even at very low concentrations, however, venous occlusion did not occur. Histological study of the embolised rat kidney revealed no detectable damage in the vessel wall and no recanalisation for up to 6 months. The subcutaneously injected PVAc emulsion elicited mononuclear cell infiltration and gradual centripetal fibrosis, without any deleterious effect on the surrounding tissue. A cerebral arteriovenous malformation (AVM) was embolised using the material. Histology of the resected nidus showed findings similar to those in the animal experiments.