嗜铬细胞瘤患者围手术期处理的改进

目的：探讨提高嗜铬细胞瘤患者围手术期安全性的措施。方法：对15例嗜铬细胞瘤患者、术前采用选择性α1受体阻滞剂多沙唑嗪控释片(可多华)控制高血压；11例患者采用3D DCEMRA进行肿瘤定位；术中均采用联合高容量血液稀释(AHH)和术中患者自体血回输纠正血容量。结果：除1例持续性高血压患者需联合钙离子拮抗剂和ACEI药物降压外．其余患者血压控制均为满意；根据3D DCEMRA定位选择手术径路者均顺利完成手术；AHH联合术中自体血回输使14例患者避免了异体输血。结论：本文围手术期处理改进．可多华可明显减少药物的不良反应；采用3D DCEMRA进行肿瘤定位，可增加手术安全性；AHH联合术中自体血回输可减少医疗成本和异体输血，以及由此而引起的并发症。     

350例膝关节镜检查分析

自1981年以来进行了350例膝关节镜检查。明确诊断340例(97.1%),纠正诊断52例(14.7%),补充诊断47例(13.4%)。关节镜检查不仅有助于确定临床诊断,而且提高了手术的准确性。     

椎弓根螺钉内固定及植骨融合治疗退行性腰椎滑脱的临床疗效评价

目的　评价腰椎管减压、后外侧植骨和椎弓根螺钉内固定治疗退行性腰椎滑脱的临床疗效。方法　 1993年 1月～ 2 0 0 2年 9月对 74例腰椎退行性滑脱的患者行腰椎管减压、后外侧植骨和椎弓根螺钉内固定 ,采用的椎弓根内固定技术包括Dick 8例、Steffee 10例、RF 9例、Socon 2 5例、Tenor 2 0例、Moss Miami 2例。滑脱水平在L4的患者有 4 4例、L3 有 9例、L5有 16例 ,两节水平的滑脱有 5例。Ⅰ°滑脱 37例 ,Ⅱ°31例 ,Ⅲ°6例。患者平均年龄为 5 3.6岁 (30～ 79岁 )。根据手术前、后日本骨科协会 (TDA)评分评价临床症状改善的程度。结果　平均随访时间为 4 4个月 (12～ 10 4个月 ) ,所有患者最后随访的JOA评分中客观症状为 (6 .7± 1.0 )分 ,临床体征为 (4 .7± 1.1)分 ,日常活动为 (11.8± 1.9)分 ,总评分为 (2 3.0± 2 .5 )分。手术前、后的JOA评分比较 ,术后主观症状改善 70 % ,临床体征改善 6 8% ,日常活动改善 77%。根据患者的年龄分为A组 (30～ 39岁 )、B组 (4 0～ 4 9岁 )、C组 (5 0～ 5 9岁 )、D组 (≥ 6 0岁 ) ,以JOA的评分结果 >2 5分定为满意 ,A、B、C、D组的满意率分别为91%、75 %、6 9%、6 1%。结论　椎板减压、后外侧植骨融合和椎弓根螺钉内固定是治疗不稳定腰椎滑脱的一种有效方法 ,临床疗效     

Comparative Study of Gemcitabine Plus Cisplatin and Gemcitabine Plus Fluorouracil in the Treatment of Advanced Pancreatic Cancer

Objective To compare the efficacy and toxicity of gemcitabine plus cisplatin and gemcitabine plus fluorouracil in the treatment of advanced pancreatic cancer. Methods Sixty patients with advanced pancreatic cancer were randomly divided into a GP group (gemcitabine + cisplatin, 30 cases) and a GF group (gemcitabine + fluorouracil, 30 cases). All patients were treated with gemcitabine at a dose of 1,000mg/m² (diluted in 100ml saline solution over 30 min) once a week for 3 consecutive weeks. The GP Group was followed by 40mg cisplatin via intravenous drip on days 15,16,17. Group GF was followed by 500mg/m²5-Fu (diluted in 5% glucose-saline (GS) 500ml, intravenously, over 6 hr) every day for five subsequent days. Results In the GP group, eight cases (32.0%) were PR and MR, the median survival time was 8.7 months, the Clinical Beneficial Rate (CBR) was 57.7%, and the CA19-9 decreased by over 50% in 13 cases (48.1%). In the GF group, 11 cases (45.8%) were PR and MR, the survival time was 10.1 months, the CBR was 82.1%, and CA19-9 decreased by over 50% in 15 cases(53.6%). There was a significant difference in the CBR between the two groups (P<0.05). The main toxicities in both groups were leucopenia and thrombocytopenia with no significant difference. Conclusions The treatment given to either the GP or GF group is a feasible and well-tolerated chemotherapy regimen for treating advanced pancreatic cancer with improved therapeutic efficacy and few side effects. The median survival period is long and the CBR is high, especially with the GF regimen.     

Experimental-Numerical Study on the Flexural Ultimate Capacity of Prestressed Concrete Box Girders Subjected to Collision

Precise evaluation for flexural ultimate capacity of bridges which are subjected to the collision of over-height trucks is essential for making decisions on corresponding maintenance, strengthening or replacement. When the span of a cross-line continuous bridge with a double-box girder was hit by an overly high vehicle, the concrete floor of one girder was severely damaged, and part of the prestressed strands and reinforcements in the girder were broken. After the double-box girder was removed and separated into two single box girders, the ultimate flexural capacity of both box girders was studied by destructive tests, and a comparison was made between the damaged and undamaged girders. Moreover, finite element analysis was conducted to simulate the failure process. The results show that the flexural bearing capacity of the damaged box girder decreased by 33%, but it was still 1.07 times greater than the design bearing capacity, which basically meets the design requirements. Also, the damaged box girder showed a desirable serviceable limit state for three-axle vehicles and five-axle vehicles, but showed an undesirable serviceable limit state for six-axle vehicles. This study shows that repairing or strengthening the damaged span may be better than demolishing and rebuilding the whole superstructure bridge.     

急性冠状动脉综合征患者血清白细胞介素-10、18及肿瘤坏死因子α水平及其临床意义

目的:评价血清白细胞介素(IL)-18、肿瘤坏死因子α(TNF-α)和IL-10水平与急性冠状动脉综合征(ACS)的关系及其临床意义。方法:冠心病(CHD)患者91例,分为ACS组、稳定型心绞痛(SAP)组;非CHD患者55例作为对照组,采用ELISA法测定血清IL-18、TNF-α和IL-10浓度并分析。结果:CHD患者血清IL-18和TNF-α水平明显高于对照组(P<0.01),而血清IL-10明显低于对照组(P<0.01);与SAP组相比,ACS组血清IL-18和TNF-α水平明显升高(P<0.01),而血清IL-10水平则显著降低(P<0.01)。且随着冠状动脉狭窄程度的增加,IL-18的水平逐渐增高。结论:IL-18、TNF-α和IL-10可以反映动脉粥样硬化斑块的严重程度和稳定状态,可作为监测病情的临床生化指标。     

三苯氧胺逆转过表达BCRP的JAR/VP16细胞对VP16的耐药性

目的 探讨三苯氧胺(TAM)对过表达乳腺癌耐药蛋白(BCRP)的JAR/VP16细胞的逆转耐药作用.方法 在人绒癌细胞株JAR和对VP16耐药的JAR/VP16细胞株中以MTT法比较单药VP16组、TAM组及两药联合组的药物毒性,并运用流式细胞术以hochest 33342和PI双染观察两株细胞在加与不加TAM时的胞内荧光值强度.以RT-PCR和Western blot方法在mRNA水平和蛋白水平观察TAM、VP16及两药联用时BCRP表达水平.结果 JAR/VP16细胞株与JAR细胞相比,BCRP的表达量上调;TAM能显著增加VP16的抗肿瘤作用,与VP16单药组相比,联合用药组的细胞抑制率增加(P＜0.05);TAM可下调BCRP的表达.结论 BCRP的过表达可能导致了JAR/VP16细胞对VP16的耐药,而TAM可通过下调BCRP的表达及抑制BCRP的功能,从而逆转这种耐药.     

丹参酮ⅡA对K562细胞株的诱导分化

目的：了解丹参酮ⅡA（TanⅡA)对K562细胞株的生长影响及红系诱导分化作用，探讨其可能的作用机制，方法：细胞培养，形态观察和流式细胞术检测等。结果：TanⅡA对K562细胞有生长抑制作用，而适当浓度的TanⅡA可诱导K562细胞向红系分化。用0．5ug/ml的TanⅡA处理后，K562细胞的凋亡细胞增加，G0/G1，期细胞 堆积，c-myc,bcl-XL和H－ras的表达下降，p53和Rb的表达增加。结论：TanIIA对K562细胞有生长抑制及诱导红系分化的作用，同时伴有细胞的凋亡。     

基底节区脑出血血肿扩大预测模型的建立及手术时机研究

目的 探讨基底节区脑出血急性期血肿扩大的预测指标并确定最佳手术时机.方法 第一部分：回顾分析184例基底节区脑出血患者资料,采用Logistic回归分析建立影响血肿扩大的回归方程,运用多变量Logistic逐步回归分析方法对血肿密度是否均一、初始出血量及CT血管造影（CTA）“点征”与血肿扩大进行关联建立血肿扩大预测模型.第二部分：运用前期建立的血肿扩大预测模型,将30例存在血肿扩大风险并有手术指征的患者随机分为12h手术组和24 h手术组,比较不同时间窗手术患者术后再出血、病死率及近期预后的治疗效果.结果 初始出血量、血肿密度、血肿形态、入院时格拉斯哥昏迷评分（GCS）及CTA图像“点征”与血肿扩大有关（P＜0.05）;血肿量＞16 mL（OR =5.051,95％CI 1.314～21.355,P=0.0170）、血肿密度不均一（OR =7.805,95％CI 1.905～40.220,P=0.0021）且CTA图像存在“点征”（OR =8.764,95％CI 2.325～44.562,P=0.0006）则血肿扩大风险在60％左右;12h手术组格拉斯哥预后评分（GOS）和术后再出血方面较24h手术组差异有统计学意义（P＜ 0.05）,但两组患者在3个月病死率方面差异无统计学意义（P＞0.05）.结论 影响基底节区脑出血急性期血肿扩大的因素很多,基于血肿量、血肿密度及CTA“点征”的预测模型能够预测血肿扩大风险,早期手术能够改善患者早期预后.     

重组人表皮生长因子凝胶在肛裂术后应用的疗效观察

目的观察肛裂切除术后应用重组人表皮生长因子凝胶创面换药对肛门疼痛及创面愈合时间的影响。方法选择106例慢性肛裂患者,随机分为试验组及对照组各53例。试验组：肛裂术后创面在常规换药的基础上,应用重组人表皮生长因子凝胶涂抹创面;对照组：创面常规换药。分别观察肛裂术后2d、5d、8d创面换药时肛门疼痛情况及创面愈合时间。结果两组肛裂患者全部治愈,试验组较对照组术后2d[（4．58_＋0．60）VS．（5．00＋0．58）]、5d[（3．00±0．31）VS．（3．91±0．63）]、8d[（1．73＋0．20）VS．（3．12±0．50）]换药时疼痛VAS评分均明显下降,试验组较对照组创面愈合时间缩短5～7d,具有统计学意义（P〈0．01）。结论重组人表皮生长因子凝胶,在肛裂切除术后用于创面换药可以减轻患者肛门疼痛．缩短创面愈合时间。