保留肾单位手术治疗早期小肾癌21例临床分析

OBJECTIVE: To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma. METHODS: Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T(1), 4 in stage T(2), and 1 in stage T(3). Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection. RESULTS: All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients. CONCLUSION: As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T(1) and T(2) stages of localized unilateral tumor with normal contralateral kidney.     

腹腔镜胆囊切除术胆管损伤及术后胆漏的临床分析

目的 分析腹腔镜胆囊切除术后胆漏及胆管损伤的原因、治疗方法及预后。方法 总结1999年1月～2005年7月7例腹腔镜术后胆漏及胆管损伤的患者，进行回顾性分析。结果 7例患者中2例迷走胆管漏，1例经腹腔引流后治愈，1例经B超引导穿刺引流后治愈；胆囊管残端漏1例，再次手术缝扎，胆总管探查取石放置T型管引流后治愈，肝总管损伤漏2例，1例用3-0可吸收线间断缝合，放置腹腔引流治愈，1例剖腹手术修补漏口，放置T型管支撑6个月；胆总管横断2例剖腹行胆总管端端吻合放置T管支撑6-7个月。术后随访1～3年，均恢复良好。结论 腹腔镜胆囊切除术后的胆漏及胆管损伤，应及时发现，正确处理。     

长期培养的大鼠原代肝细胞功能和形态学观察

目的：研究大鼠原代肝细胞长期体外培养后功能和形态的变化。 方法： 采用两步胶原酶原位灌流法分离大鼠肝细胞，并用Percoll分离液进行密度梯度离心进一步纯化肝细胞，采用0.4%台盼蓝染色观察细胞活力。然后将细胞接种于HepatoZYME-SFM培养基中培养，定期收集肝细胞培养液上清检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶（AST）、白蛋白、尿素氮的水平。采用乙氧基试卤灵O-脱乙基酶活性（EROD）方法检测肝细胞P450的CYPⅠA1功能。 结果： 新鲜分离的大鼠肝细胞总数（2-3）×108cells/whole liver，Percoll分离液纯化后活力和纯度在90%以上。HepatoZYME-SFM培养下肝细胞生长良好并保持正常形态。AST、ALT水平在培养3 d后下降显著，6-9 d后趋于相对稳定的低水平。白蛋白的分泌功能、尿素合成能力在18 d内维持在较高水平。可在3-6 d检测到CYPⅠA1酶活性。 结论： Percoll液纯化新分离肝细胞可提高其活率和纯度，HepatoZYME-SFM培养条件下肝细胞可有效保持良好形态结构和一定的生物合成代谢能力，适合肝细胞的体外长期培养和功能研究。     

胃食管反流病的流行病学研究和危险因素分析

胃食管反流病(Gastroesophageal reflux disease,GERD)系指胃内容物反流入食管,引起不适症状和(或)并发症的一种疾病.GERD可分为非糜烂性反流病(non-erosive reflux disease,NERD)、糜烂性食管炎(erosive esophagitis,EE)和BaiTett食管(Barrett's esophagus,BE)3种类型.     

热敏灸治疗膝关节骨性关节炎35例临床观察

目的：观察热敏灸治疗膝关节骨性关节炎（KOA）的临床疗效。方法：选取KOA患者68例，随机分为热敏灸组和常规针刺组，分别用热敏灸和常规针刺治疗，每天1次，每周5次，总共治疗15次。治疗前后应用Lysholm膝关节量表进行评分。结果：2组治疗后总积分均明显升高，与治疗前比较，差异有非常显著性意义（P〈0．01），热敏灸组改善优于常规针刺组（P〈0．01）。治疗后2组各症状积分均改善，热敏灸组不稳、肿胀症状积分明显升高，与常规针刺组治疗后比较，差异有显著性或非常显著性意义（P〈0．05，P〈0．01）。总有效率热敏灸组为94．29％，常规针刺组为87．88％，2组比较，差异有非常显著性意义（P〈0．01）。结论：热敏灸治疗KOA具有确切的临床疗效。     

两性霉素B微乳的制备及体外经皮渗透研究

 目的制备水包油型两性霉素B微乳,并对其进行体外经皮渗透性能考察。方法用相转变温度法制备两性霉素B微乳,用光散射粒度仪测定微乳的粒径,电子透射电镜观察微乳的形态。用药物渗透扩散仪进行两性霉素B透皮吸收研究,高效液相色谱法测定两性霉素B含量。结果用相转变温度法制备了Tween80和异丙醇重量比为1∶1,IPM和混合表面活性剂之比为1∶9,水含量64.6%,载药量为0.247%的两性霉素B微乳。所制微乳符合微乳特征,调节pH值有助于两性霉素B由分散介质向微乳表面转移。水性月桂氮酮对两性霉素B的促渗效果最好,pH值为5.12,月桂氮酮浓度为1%时,两性霉素B微乳经离体兔皮的JS为4.627μg·cm^-2·h^-1,经离体大鼠皮肤的JS为4.484μg·cm^-2·h^-1。结论开发微乳透皮给药制剂有望提高两性霉素B的疗效,降低其毒副作用。     

Effects of early reperfusion on the mechanical and biochemical characteristics of ischemic myocardium

Coronary reperfusion of ischemic myocardium may be beneficial but is highly dependent upon occlusion and reperfusion times. To study the effects of early reperfusion on ischemic myocardium, 24 open chest pigs underwent coronary occlusion; one group was occluded for 40 min, and the other was occluded for 30 min followed by 10 min of reperfusion. Left ventricular wall thickness during systole and diastole was determined by ultrasound. Mitochondrial energy production and calcium content were evaluated from ischemic and nonischemic areas. Results showed: There was an absence of systolic thickness, a slight decrease of diastolic thickness from baseline, and a decrease in energy production in the ischemic myocardium. Reperfusion resulted in a diverse pattern of systolic and diastolic wall thickness in the ischemic area and a variable Ca2+ accumulation and mitochondrial ATP production. The variability of myocardial Ca2+ accumulation in the ischemic reperfused group correlated inversely with mitochondrial ATP production (r = -0.94) and directly with diastolic wall thickness (r = 0.65). Similarly, calcium accumulation, ATP production, and diastolic wall thickness correlated with mean blood pressure during reperfusion. These results suggest that many factors including individual characteristics of the animal and experimental conditions such as the level of blood pressure and the degree of calcium accumulation may determine outcome of reperfusion even in as brief a period as 10 min.     

Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Patient Outcomes

OBJECTIVE: To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF. STUDY DESIGN: Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources. DATA COLLECTION: Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use. PRINCIPAL FINDINGS: Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p< or =.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p< or =.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes. CONCLUSIONS: This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.     

浮膝损伤的手术治疗

目的 探讨手术治疗浮膝损伤的疗效.方法 将13例浮膝损伤,按Fraser分型方法分为4型.Ⅰ型7例,Ⅱa型3例,Ⅱb型2例,Ⅱc型1例.所有病人均行手术复位固定,术后早期功能锻炼.结果 术后随访1～3年.疗效评定采用Karlstrom和Olerud标准.优8例,良2例,可1例,差2例.结论 对浮膝损伤的手术治疗,视全身及局部情况选择适当的内固定或外固定器,其中交锁髓内钉内固定效果好.