卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

谷氨酰胺转移酶对大豆分离蛋白成膜性能的影响

研究了谷氨酰胺转移酶（TGase）对大豆蛋白膜特性的影响。研究表明：在成膜溶液中加入TGase（4U／g）可以使膜的抗拉强度增加16．79，6，表面疏水性增加39．2％，同时也明显降低了膜的断裂伸长率、水分含量、总可溶性物质量及透光率，但是对水蒸气转移速率几无影响。扫描电镜（SEM）显示，酶法交联膜的表面比对照膜略为粗糙，断面却更为均匀致密。SDS-PAGE分析表明，TGase催化SPI产生了共价交联。     

Smart Prep技术在肾动脉CTA中的临床应用

目的:探讨Smart Prep技术在肾动脉多层螺旋CT血管造影中的应用。方法:20例行同层动态增强扫描,通过时间-密度曲线获得肾动脉的有效浓度阈值。65例行肾动脉CTA造影,经肘静脉团注370mgI/ml优维显1.5ml/kg后,应用Smart Prep软件实时监控靶血管浓度,当感兴趣区对比剂浓度达有效浓度阈值时触发增强扫描完成数据采集,重组和重建图像显示肾动脉。结果:65例肾动脉CTA造影均获成功,58例(89.2%)增强时相处于最佳扫描时期。增强扫描的延迟时间15~38s不等,个体差异明显,而肾动脉CT值持续位于有效浓度阈值(100HU)以上。结论:Smart Prep技术实时监控肾动脉对比剂浓度变化并及时触发增强扫描,它不受个体差异影响即可确保增强扫描的实施,优于小剂量试验。     

米索前列醇预防剖宫产后出血344例临床观察

目的:观察米索前列醇预防剖宫产手术后出血的临床效果。方法:随机将有剖宫产手术指征的344例孕妇分为3组,分别为在胎儿娩出后给予米索前列醇200mg舌下含化(A组)、缩宫素静脉滴注及子宫肌层注射(B组)和对照组(C组,不给予任何药物),观察产后不同时间的出血量。结果:产后出血量及出血发生率A、B组均明显少于C组(P<0·05)。结论:米索前列醇对分娩后子宫具有较好的收缩作用,且给药方便、安全性较好。     

机械通气治疗小儿急性肺损伤

目的：探讨小儿急性肺损伤(ALI)的临床治疗。方法：对本院综合ICU1998年4月至2002年4月发生的22例小儿ALI的临床治疗情况进行回顾性分析。结果：本组22例小儿ALI采用呼吸末正压机械通气(PEEP)联合大剂量甲基强的松龙冲击治疗，有效率为86．36％；3例死亡，死亡率为13．64％，死于多器官功能不全综合征(MODS)。结论：机械通气治疗小儿ALI应选择最佳PEEP，动态监测动脉血气指标和X线胸片，在综合治疗基础上加用大剂量甲基强的松龙冲击治疗能收到较好的疗效。     

肾损伤的治疗进展

轻度、中度的肾损伤可行保守治疗。严重的肾损伤出血应首选超选择性肾动脉栓塞术,因该技术定位准确,止血迅速,创伤小,恢复快,并发症少,能最大限度地保护肾脏功能,是一种安全可靠治疗肾损伤出血的有效方法。     

脐动脉血PCT、CRP检测在早产儿早期感染中的作用

目的:为进一步提高早产儿重症感染的早期诊断率探讨一种快速、可靠的方法。方法:用LUMITestPCT方法检测我院出生的有感染可能的早产儿的脐动脉血清降钙素原(PCT)。同时检测脐动脉血C反应蛋白(CRP);由新生儿专业的医师对其病情进行观察,在不知道PCT值时做出病情的临床诊断,52例病例分为:重症感染组(n=28)和对照组(n=24)。进行回顾性对比分析。结果:早期开始的早产儿感染与CRP、PCT浓度在出生时的增加相关,差异有极显著性(P<0.001);脐动脉血中,PCT浓度的增加与CRP水平变化呈正相关(r=0.88)。PCT的敏感性(96.4%)和特异性(95.8%)均高于CRP(敏感性75%,特异性91.6%)。结论:PCT可作为早产儿早期感染的早期、快速检测指标,与CRP相比,PCT敏感性、特异性均高。本研究方法对早产儿无创伤。     

苯并[a]芘对内皮细胞HSF1与HSE结合特性分析

目的研究苯并[a]芘（BaP）作用下热休克转录因子1（HSF1）与热休克元件（HSE）结合特性，分析BaP对热应激蛋白70（HSP70）的表达的影响。方法取对数生长期的猪主动脉内皮细胞传代培养，分别以不同浓度的BaP染毒（0、0．1、0．5、1、5、10μmol／L）24h，提取细胞核蛋白，用凝胶阻滞电泳实验（EMSA）检测结合率。结果低（0．1μM）、中剂量（0．5，1μM）BaP可使HSF1-HSE结合率上升，高剂量（5，10μM）BaP使HSF1-HSE结合率明显降低。结论BaP可改变细胞HSF1-HSE结合能力，低、中剂量的BaP使HSF1-HSE结合率升高，提示可促进HSP70表达，高浓度BaP可抑制HSP70的表达。     

五味子低温水提取物HPLC特征图谱的研究

目的 建立HPLC法测定五味子低温水提取物有效成分含量的方法.方法 用外标法测定五味子醇甲的含量.色谱柱Kromasil C18柱(250 mm×4.6 mm,5 μm),流动相为乙腈-水系统(梯度洗脱),流速1.00 mL/min,柱温30℃,流速1.0 mL/min,检测波长240 nm.结果 五味子醇甲的线性范围为5.0-200.0 μg/mL;r=0.999 9:平均加样回收率为101.27%(RSD为1.97%;n=6).结论 该测定方法简便可靠,专属性强,重现性好,可为五味子制剂的质控标准提供参考依据.     

V型斜视伴原发性下斜肌功能过强的治疗

目的 探讨Ⅴ型斜视伴原发性下斜肌功能过强的治疗效果。方法根据手术方式将49例Ⅴ型斜视伴下斜肌功能过强惠者分为四组，分别采用水平肌加强减弱术不联合下斜肌切断减弱术（Ⅰ组）、联合单侧下斜肌切断减弱术（Ⅱ组）、联合双侧下斜肌对等切断减弱术（Ⅲ组）及联合双侧下斜肌不对等切断并部分切除减弱术（Ⅳ组）治疗Ⅴ型斜视。结果Ⅴ型斜视伴原发性下斜肌功能过强采用四种方式治疗后，眼位正位，下斜肌功能亢进改善＋～＋＋，双侧下斜肌功能对等，术前术后原在位度数和上下注视25。斜视角之差的差异有非常显著性（P〈0．001）。结论根据单侧或双侧下斜肌功能过强的具体情况来选择不同的手术方式治疗Ⅴ型斜视伴原发性下斜肌功能过强，眼位矫正满意，同时手术方式简单、安全有效。