CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

营养不良-炎症-动脉粥样硬化综合征与终末期肾脏病

心血管疾病(CVD)目前仍是终末期肾脏病(ESRD)透析患者的主要并发症及死亡原因之一,动脉粥样硬化性心血管病(ACVD)是其重要组成部分。最近Hou等[1]开展的中国透析协作研究(CCSD)发现我国2 388名成年透析人群中57%出现CVD,22.7%出现缺血性心脏病。早在1999年Stenvikel等[2~4]通过对109例ESRD患者调查发现营养不良、炎症、动脉粥样硬化三者之间有着紧密的联系:炎症与营养不良可互为因果,     

齐拉西酮和奥氮平对双相I型患者疗效和不良反应的比较

目的比较两种非典型抗精神病药物(齐拉西酮和奥氮平)对双相I型躁狂发作患者的疗效和不良反应。方法对符合DSM-Ⅳ诊断标准的双相障碍I型躁狂发作的120例住院患者,随机进入奥氮平组和齐拉西酮组治疗,评定治疗第4、8、12周末两组的疗效和不良反应的情况。结果在治疗第4周末,躁狂量表总分、临床总体印象量表的疗效因子、疗效指数因子方面的比较,奥氮平的疗效要优于齐拉西酮组;不良反应量表中思睡因子分的比较中,奥氮平组的思睡因子分明显高于齐拉西酮组(P<0.05);在治疗第8周末,两组的疗效因子分比较,奥氮平疗效仍优于齐拉西酮组;在不良反应方面,奥氮平组的思睡因子分、体重增加因子分、血清总胆固醇水平、低密度脂蛋白胆固醇水平、体重质量指数要显著高于齐拉西酮组(P<0.05);在治疗第12周末,两组的疗效因子分比较差异无统计学意义;在不良反应方面,两组比较差异有统计学意义,奥氮平组的思睡因子分、体重增加因子分、糖化血清蛋白水平、血清总胆固醇水平、低密度脂蛋白胆固醇水平、体重质量指数、腰围要显著高于齐拉西酮组,而震颤因子分、失眠因子分两组间差异无统计学意义(P>0.05)。结论在双相I型躁狂发作患者的治疗方面,奥氮平早期显示出疗效优于齐拉西酮,但随着疗程的继续,奥氮平和齐拉西酮的疗效趋于相当,但奥氮平远期带来的糖脂代谢和过度镇静的不良反应远高于齐拉西酮,不容忽视。     

胶原蛋白海绵用于下颌阻生牙拔除术的效果分析

目的:探讨在下颌阻生牙拔除术后应用胶原蛋白海绵的临床效果。方法:选取2016年11月—2017年11月在天津市口腔医院行下颌阻生牙拔除术的患者150例,随机分为常规组和胶原蛋白海绵组。胶原蛋白海绵组患者进行下颌阻生牙拔除术后在拔牙窝内填入胶原蛋白海绵,常规组患者则只进行常规拔牙处置,比较2组患者拔牙后的相关情况。采用SPSS 20.0软件包对数据进行统计学处理。结果:胶原蛋白海绵组患者拔牙后30 min内拔牙窝出血率显著低于常规组（P<0.05）,拔牙后第1天和第3天疼痛程度评分显著低于常规组（P<0.05）,拔牙后干槽症和其他并发症的发生率显著低于常规组（P<0.05）。结论:在下颌阻生牙拔除术后应用胶原蛋白海绵,不仅可以有效减少术后出血量,而且可以有效降低术后干槽症和其他并发症的发生率,值得推广应用。     

新型脓毒症分类方法在临床中的应用价值

目的：探讨新型脓毒症分类方法在临床中的应用价值。方法根据高乳酸盐血症（乳酸＞4 mmol／L）与持续低血压建立新的脓毒症分类方法：重症脓毒症、隐匿性休克、血管麻痹性休克、低氧合性休克,并比较4组患者住院死亡率。结果重症脓毒症组病死率最低（5.56％）,低氧合性休克组病死率最高（43.59％）,差异有统计学意义（P＜0.05）;隐匿性休克组与血管麻痹性休克组病死率差异无统计学意义（19.23％vs 25％,P＞0.05）。结论根据低血压、高乳酸盐血症建立新型脓毒症分类方法,该分类方法对于判断患者预后具有重要价值。     

家兔胰岛的分离纯化研究

目的探讨家兔胰岛分离、纯化的方法及其计数和活性的测定。方法选用日本大耳自家兔。予V型胶原酶于38℃内水浴外消化。采用Ficoll 400不连续密度梯度离心法对胰岛进行纯化,并对获得的胰岛进行DTZ染色计数。同时计算胰岛当量（IEQ）数。予台盼蓝染色法分析胰岛活性。结果DTZ染色纯化前每只家兔胰腺收获胰岛细胞数为15046±2733。IEQ数为：4635±554;化后胰岛数量为：5300±609,IEQ数为：1213±218;胰岛细胞活率〉90％,胰岛纯度为〉60％。结论家兔胰腺消化分离后得到胰岛的数量和IEQ均较多,且动物来源广泛、实验成本较低,预示其在胰岛移植中可作为胰岛来源。     

电子邮件心理咨询在大学生中的应用

电子邮件心理咨询（E-mail therapy）指的是以网络电子邮件为媒介,运用各种心理咨询的理论和方法,帮助当事人以恰当的方式解决其心理问题的过程.     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

阿司匹林及其他抗血小板药物在冠脉搭桥手术中的应用

阿司匹林因具有抑制冠脉搭桥手术以后静脉桥的闭塞的临床效能,故能延长心肌梗死后的无意外事件生存期.但有个别随机临床试验认为,体外循环下行冠脉搭桥手术的患者术前服用阿司匹林,增加术后出血及输血,这就形成了所谓的＂阿司匹林矛盾＂.对于很多抗血小板药物来说也有类似两难的选择.本文就阿司匹林类药物在冠脉搭桥手术中的应用作一.     

丹参素治疗肝纤维化及其作用机制研究

目的 研究丹参素对大鼠免疫性肝纤维化的治疗作用及其怍用机制。 方法 用猪血清制作大鼠肝纤维化动物模型,自第8周起给予丹参素组大鼠腹腔注射丹参素300 mg·kg-1·d-1,同时给予模型对照组和正常对照组相同体积的双蒸水腹腔注射。第12周动物实验结束时,除留取一只模型组大鼠用原位循环灌流法提取肝星状细胞(HSC)外,其余大鼠全部处死提取血清检测透明质酸(HA)以及取肝脏标本切片做HE、VG染色。以MTT法观察不同浓度丹参素对HSC的增殖抑制作用,用流式细胞仪分析丹参素作用后HSC所处周期。 结果 丹参素干预组HA为(231.4±41.1)ng/ml,模型组(398.7±54.5)ng/ml,F=154.796,P<0.05。HE及VG染色示丹参素干预组肝纤维化程度明显轻于模型组;细胞试验表明50、100、200 mg/L丹参素对HSC作用后的MTT值(A值)分别为1.60×102±8.17×10-4、1.10×10-2±1.41×10-3和6.75×10-3±3.30×10-3,细胞对照组A值为7.18×10-2±1.71×10-3,F=1154.221,P<0.05。 结论丹参素对大鼠免疫性肝纤维化有明显的防治怍用。其主要机制为丹参素对HSC明显的增殖抑制作用。