胃癌切除术中、术后亚甲蓝染色检测前哨淋巴结

目的探讨胃癌前哨淋巴结(SLN)定位技术的可行性,并比较术中、术后不同方法定位SLN技术的利弊。方法使用亚甲蓝染料,对68例胃癌D2根治术标本分组进行术中、术后SLN定位。结果术中SLN的阳性判断值、阴性判断值、敏感性和特异性分别为100%(8/8)、91.7%(22/24)、80.0(8/10)和100%(22/22);术后SLN的阳性判断值、阴性判断值、敏感性和特异性分别为100%(10/10)、98.9%(22/23)、90.9(10/11)和100%(22/22)。结论胃癌SLN定位技术是可行的,对提高胃癌临床病理分期的精确性有一定价值。     

房室结逆向传导电生理特点的观察

目的研究房室结逆向传导的电生理特点。方法分析在我院行电生理检查和／或射频消融的成年患者中电生理资料比较完整的300例患者的房室结逆传电生理特点。结果射频消融术后有161例（54％）有房室结逆传。有逆传患者的前传功能要好于无逆传的患者，对于术后存在室房逆传的患者，逆传功能均明显差于前传功能。射频消融术后有28例（17％）经房室结逆传最早激动冠状静脉窦口，其逆传功能较最早激动希氏束电图的病例相比要差，而两者的前传功能差异无统计学意义。结论射频消融术后54％的患者存在房室结逆传，可能是正常人群中室房逆传的真实反映。有室房逆传患者的房室结前传功能优于无室房逆传者，也优于其本身的逆传功能。房室结逆传冲动进入心房可能存在两条不同的通路。     

眼轴线后部眶容积增大与眼球内陷比值的测定研究

目的:通过测量眼眶爆裂性骨折伴有眼眶扩大患者的后部眼眶容积、观察眼球内陷出现的时间及程度,研究后部眶容积扩大与眼球内陷的关系比值,为病情预测和眶内填充手术提供比较精确的参考数据。方法:将96例患者按发病时间分为早期病例组(60例、受伤时间1周以内)和晚期病例组(36例、受伤时间3个月以上),早期组除进行后部眼眶容积测量外,分别于1周、2周、3周测定眼球突出度(相差>1mm为阳性),记录眼球内陷出现时间,用卡方检验进行统计学分析;晚期组测量后部眶容积增大值和眼球内陷量,对其相关性采用Pearson统计方法进行统计学分析,并得出回归方程及相关系数。结果:早期组60例患者中,(58.33%)例患者在1周内出现眼球内陷,4(880%)例在2周内出现内陷,3周时有5(388.33%)例呈现出内陷;2周时出现眼球内陷的例数与1周时有显著性差异(χ2=62.484,P<0.001),2周时出现眼球内陷例数与3周时无差异(χ2=1.563,P>0.05),1周时出现眼球内陷例数与3周时有显著差异(χ2=76.885,P<0.001),后部眶容积增大与眼球内陷的比值约为1.0,两者之间呈正相关(r=0.994,P<0.001),即后部眶容积每增加1ml,产生1.0mm的眼球内陷。结论:眼球内陷通常于伤后2周～3周出现,3个月时趋向稳定;后部眶容积增大与眼球内陷产生比值为1.0,呈正相关;后部眶容积扩大与眼球内陷比值可预测发生眼球内陷的可能性和程度,为手术矫正眼球内陷提供可靠、精确的参考,具有十分重要的临床指导意义。     

Immediate versus delayed chemotherapy in patients with asymptomatic incurable metastatic cancer

Aim: To examine the evidence of benefit in initiating immediate chemotherapy in patients with newly diagnosed asymptomatic metastatic incurable cancer, compared with delaying chemotherapy until symptomatic progression. Methods: Through an extensive review of published reports, we examined the biological, clinical, psychological and ethical background of the issue and reported on the available clinical trial evidence in a variety of tumor types. Results: Only a limited number of clinical trials have directly examined the role of immediate versus delayed chemotherapy in patients with incurable asymptomatic metastatic cancer. Small studies in mesothelioma, colorectal cancer, breast cancer, myeloma, and low‐grade lymphoma suggest no survival benefit for the immediate initiation of chemotherapy. However, there was no evidence in other tumor types. Conclusion: The appropriate timing of chemotherapy initiation in an asymptomatic patient with metastatic cancer remains a substantial question in oncology. Many factors are likely to impact on the decision. However, little if any evidence demonstrates a clear advantage in the immediate initiation of chemotherapy in this setting.     

失血性休克大鼠肠上皮细胞线粒体DNA腺苷三磷酸酶6,8基因表达及线粒体功能的改变

目的　探讨失血性休克大鼠肠上皮细胞线粒体DNAATPase 6 ,8基因表达及线粒体功能的改变 ,为阐述休克肠道靶学说和线粒体能量代谢提供分子生物学基础。　方法　 2 4只Wistar大鼠随机分为休克前组和休克 1,2 ,3,4 ,5h组。采用RT -PCR方法观察线粒体ATPase 6 ,8mRNA量的改变。用透射电镜观察、生物体视学测量线粒体形态 ,用Clark氧电极测线粒体呼吸功能。　结果　失血性休克 1,2h ,ATPase 6 ,8基因表达增强 ,以后渐减弱 ,至休克 5h表达最低 ,ATPase 6 ,8基因表达分别降为正常的 6 9.3%和 78.4 % (P <0 .0 1和P <0 .0 5 )。失血性休克 2h和5h ,线粒体平均截面积、长径、面密度、体密度均显著增加 (P <0 .0 1) ,休克 5h时分别为休克前的2 .0 ,1.4 5 ,1.4 7,2 .2 2倍。休克 5h ,线粒体比表面和数密度分别下降 32 %和 2 4 % (P <0 .0 1和P <0 .0 5 ) ,嵴和基质破坏明显。失血性休克后肠上皮细胞线粒体呼吸控制率和氧化磷酸化效率比休克前显著降低 (P <0 .0 1)。　结论　失血性休克时大鼠肠上皮细胞线粒体DNAATPase 6 ,8基因表达下调 ,线粒体呼吸功能出现障碍 ,线粒体超微结构发生了改变     

APTT测定值和APTT测定值比率的临床应用价值探讨

目的;探讨APIT测定值(秒)和APIT测定值比率中哪一种是更稳定、更可靠的临床应用指标。方法:将同一标本采用法国STA-Compat全自动血凝仪以及两种手工法同时测定,比较同组标本不同方法的APTT测定值(秒)和APTT测定值比率。结果:手工法(一)与法国STA-Compact全自动血凝仅比较,如APTT值以秒表示,对照组、口服抗凝剂组及肝病组病人同组标本不同方法之间存在显著性差异(P<0.01,P0.10,P>0.50,P>0.05);手工法(二)与法国STA-Compact全自动血凝仪在对照组、口服抗凝剂组及白血病组的比较中,也获得类似的结果。结论:将APTT测定值(秒)转化为病人与对照APTT测定值比率报告,使不同方法结果间更具可比性。在APTT报告的标准化方面,建议将APTT和APTT测定值比率同时报告。     

胸腔镜辅助小切口手术诊治肺周围型结节

目的探讨胸腔镜辅助小切口手术在诊断和治疗肺周围型结节病变中的临床应用价值。方法胸腔镜辅助小切口手术诊治肺周围型结节55例，其中单发结节54例，多发结节1例。肺楔形切除术23例；肺叶切除联合淋巴结清扫治疗原发性肺癌32例，采用常规开胸手术器械及胸腔镜用器械切除肺叶，自制淋巴结摘除钳完成淋巴结清扫。结果55例均在胸腔镜下完成手术。手术时间35～180min，平均109min，术中出血量50～400ml，平均122min。均未输血，1例术后漏气术后32d出院，1例切口延迟愈合，术后19d出院，余53例术后住院4～11d，平均8．3d。无严重并发症。术后病理：良性病变15例，原发性肺癌38例，非典型性腺瘤样增生1例，转移性肺癌1例。良性病变行肺楔形切除术，32例原发性肺癌行解剖学肺叶切除联合淋巴结清扫，4例肺癌胸膜广泛播散未手术处理，2例肺癌因肺功能差行姑息性肺楔形切除。结论胸腔镜辅助小切口手术有助于明确诊断肺周围型结节病变，治疗临床早期原发性肺癌的长期疗效有待随访观察。     

Signal-to-noise ratio effects in quantitative cerebral perfusion using dynamic susceptibility contrast agents.

Theoretical and simulation evidence is presented in support of the idea that the optimal manner of determining blood flow from MR perfusion studies is not necessarily obtained by setting experimental conditions to maximize either the arterial input or the measured tissue concentration level for a particular echo time (TE). The noise power in the contrast concentration curve is associated with its peak because of the nonlinear relationship between the contrast concentration and MR signal intensity curves. The optimum signal-to-noise ratio (SNR), SNR(C), for a particular contrast concentration curve can be obtained when the experimental concentration level and TE are adjusted to produce an MR intensity curve whose signal loss is 63% of the precontrast MR signal intensity. It is demonstrated that the stability of the singular valued decomposition (SVD) deconvolution approach to determine blood flow parameters is increased when the tissue curve maximum signal loss is in the range of 40-80%. The accuracy and stability of the SVD-determined blood flow parameters are affected by deviations from these optimum conditions in a manner that depends on the mean transit time (MTT) associated with the residue function. It is recommended that the experimental TE value be set so that neither the tissue nor the arterial curves are placed a region of rapidly deteriorating SNR(C).