补肾化瘀祛痰方治疗多囊卵巢综合征的临床研究

目的了解补肾化瘀祛痰方治疗多囊卵巢综合征的临床疗效及可能的作用机制。方法以补肾化瘀祛痰中药为主的水煎内服方及外敷方（必要时联合西药二甲双胍）治疗多囊卵巢综合征46例,连续治疗6个月为1个疗程;观察治疗前后临床症状和体征（肥胖、多毛、痤疮及黑棘皮症评分）、血清激素水平及胰岛素释放试验的变化情况。结果治疗后患者多毛、痤疮、黑棘皮症评分值及肥胖评分值与治疗前比较均明显下降（P〈0．01,P〈0．05）;血清睾酮（T）水平较治疗前显著降低（P〈0．05）;胰岛素试验中空腹胰岛素值与治疗前比较下降（P〈0．01）,糖负荷后30min、60min胰岛素值及胰岛素曲线下面积（IAUC）与治疗前比较亦有明显下降（P〈0．05）。结论以补肾化瘀祛痰方可以显著改善多囊卵巢综合征患者的症状和体征,改善患者的卵巢功能。     

DNA interactions of new cytotoxic tetrafunctional dinuclear platinum complex trans,trans-[{PtCl2(NH3)}2(piperazine)

A new tetrafunctional dinuclear platinum complex trans,trans-[{PtCl2(NH3)}2(piperazine)] with sterically rigid linking group was designed, synthesized and characterized. In this novel molecule, the DNA-binding features of two classes of the platinum compounds with proven antitumor activity are combined, namely trans oriented bifunctional mononuclear platinum complexes with a heterocyclic ligand and polynuclear platinum complexes. DNA-binding mode of this new complex was analyzed by various methods of molecular biology and biophysics. The complex coordinates DNA in a unique way and interstrand and intrastrand cross-links are the predominant lesions formed in DNA in cell-free media and in absence of proteins. An intriguing aspect of trans,trans-[{PtCl2(NH3)}2(piperazine)] is that, using a semi-rigid linker, interstrand cross-linking is diminished relative to other dinuclear platinum complexes with flexible linking groups and lesions that span several base pairs, such as tri- and tetrafunctional adducts, become unlikely. In addition, in contrast to the inability of trans,trans-[{PtCl2(NH3)}2(piperazine)] to cross-link two DNA duplexes, the results of the present work convincingly demonstrate that this dinuclear platinum complex forms specific DNA lesions which can efficiently cross-link proteins to DNA. The results substantiate the view that trans,trans-[{PtCl2(NH3)}2(piperazine)] or its analogues could be used as a tool for studies of DNA properties and their interactions or as a potential antitumor agent. The latter view is also corroborated by the observation that trans,trans-[{PtCl2(NH3)}2(piperazine)] is a more effective cytotoxic agent than cisplatin against human tumor ovarian cell lines.     

Flow-related techniques for preoperative goal-directed fluid optimization

Background. Improved postoperative outcome has been demonstratedby perioperative maximization of cardiac stroke volume (SV)with fluid challenges, so-called goal-directed therapy. OesophagealDoppler (OD) has been the most common technique for goal-directedtherapy, but other flow-related techniques and parameters areavailable and they are potentially easier to apply in clinicalpractice. The objective of this investigation was thereforeto use OD for preoperative SV maximization and compare the findingswith a Modelflow determined SV, with an OD estimated correctedflow time (FTc), with central venous oxygenation () and with muscle and brain oxygenation assessedwith near infrared spectroscopy (NIRS). Methods. Twelve patients scheduled for radical prostatectomywere anaesthetized before optimization of SV estimated by OD.A fluid challenge of 200 ml colloid was provided and repeatedif at least a 10% increment in OD SV was obtained. Values werecompared with simultaneously measured values of Modelflow SV,FTc, and muscle and cerebral oxygenation estimated by NIRS. Results. Based upon OD assessment, optimization of SV was achievedafter the administration of 400–800 ml (mean 483 ml) ofcolloid. The hypothetical volumes administered for optimizationbased upon Modelflow and differed from OD in 10 and 11 patients, respectively. Changes in FTcand NIRS were inconsistent with OD guided optimization. Conclusion. Preoperative SV optimization guided by OD for goal-directedtherapy is preferable compared with Modelflow SV, FTc, NIRSand until outcome studies for the latter are available.     

Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis

Transatlantic cancer survival comparisons are scarce and involve mostly aggregate European data from the late 1980s. We compare the levels of cancer patient survival achieved in Germany and the United States (US) by the beginning of the 21st century, using data from the Cancer Registry of Saarland/Germany and the SEER Program of the US. Age-adjusted 5- and 10-year relative survival for 23 common forms of cancer derived by period analysis for the 2000-2002 period were calculated, with additional detailed age- and stage-specific analyses for cancers with the highest incidence. Among the 23 cancer sites, 5 (10) year relative survival was significantly higher for 1 (2) and 8 (5) cancers in Germany and the US, respectively. In Germany, survival was significantly higher for patients with stomach cancer, whereas survival was higher in the US for patients with breast, cervical, prostate, colorectal and oral cavity cancer. Among the most common cancers, age-specific survival differences were particularly pronounced for older patients with breast, colorectal and prostate cancer. Survival advantages of breast cancer patients in the US were mainly due to more favorable stage distributions. This comprehensive survival comparison between Germany and the US suggests that although survival was similar for the majority of the compared cancer sites, long-term prognosis of patients continues to be better in the US for many of the most common forms of cancer. Among these, differences between patients with breast and prostate cancer are probably due to more intensive screening activities.     

乳腺癌病人围术期心理神经免疫学研究进展

介绍了围术期乳腺癌病人免疫功能的改变,阐述了围术期心理干预可提高乳腺癌病人心理健康水平及免疫功能.     

某院外科系统1073例I类切口手术围术期预防性应用抗菌药物合理性分析

目的：了解某院外科系统I类切口手术围术期预防性应用抗菌药物情况，评价其合理性，为临床合理用药提供参考。方法：回顾性调查2011年1月——2012年4月某院1073例外科系统I类切1：7手术围术期抗菌药物使用情况，并参照卫生部《抗菌药物临床应用指导原则》、《卫生部办公厅关于抗茵药物临床应用管理有关问题的通知》及《卫生部办公厅关于做好全国抗茵药物临床应用专项整治活动的通知》进行合理性评价。结果：2011年月平均术前、术后均未预防性应用抗茵药物比例为7．56％，月平均预防性应用抗菌药物比例为92．46％；月平均术后用药时间为3．93d，月平均术前0．5～2h内给药率为94．23％；月平均24h内停药率为12．36％，月平均不合理使用抗菌药物比例为55．03％。2012年1—14月的月平均术前、术后均未预防性应用抗茵药物比例为55．71％，月平均预防性应用抗菌药物比例为44．28％；月平均术后用药时间为2．68d，月平均术前0．5～2h内给药率为75．22％；月平均24h内停药率为36．88％，月平均不合理使用抗茵药物比例为24．17％。结论：某院还未达到I类切口手术预防性应用抗菌药物比例不得超过30％这一指标，应加强合理用药水平，降低不合理使用抗菌药物的比例，提高24h内停用抗菌药物比例。     

腹腔镜与开放性肾上腺嗜铬细胞瘤切除术对呼吸与循环功能影响的比较

目的：观察比较腹腔镜手术与开放性手术切除肾上腺功能性嗜铬细胞瘤患者围手术期呼吸，循环功能变化的差异，为开展经腹腔和后腹腔腹腔镜手术治疗肾上腺嗜铬细胞瘤提供依据。方法：选择经腹腔及经后腹腔腹腔镜手术（A组）与开放性手术（B组）治疗的肾上腺嗜铬细胞瘤患者与各6例，分别于手术开始，充气后（B组为术中探要），分离肿瘤，肿瘤切除及术毕各10min时检测两组患者心率（HR），平均动脉压（MAP），中心静脉压（CVP），气道压（Paw)，每分通气量（V E），并抽血检测血气指标。结果：两组间PacO2差异有显著性意义（P＜0．05），在PH，PaO2,Paw,VE,HR,MASR,CVP指标上虽有一定差异，但差异无显著性意义（P＞0．05），结论：只要正确选择手术适应证经腹腔和后腹腔腹腔镜手术治疗肾上腺功能性嗜铬细胞瘤是可行的。     

高龄腹腔镜胆囊切除术围手术期安全性的探讨

目的:探讨高龄腹腔镜胆囊切除术围手术期的安全性。方法:本组1527例均经B超检查明确诊断,有合并病974例(63.8％),同一患者并存两种以上病症者421例。术前评估病人重要脏器功能,结合病史拟定出恰当的预防和治疗方案,待病情相对稳定再行LC。结果:顺利完成1510例(98.9％),中转开腹17例(1.1％),手术操作时间26min～3.5h,平均手术时间52min。术后并发症16例(1.05％),无术中胆管损伤及手术死亡。术后平均住院时间3.5d。结论:LC适应于老年胆石症患者。