针刺外手三里治疗上肢痿废78例

目的探讨针刺外手三里对中风后上肢痿废病人的上肢神经功能的影响。方法采用针刺外手三里(治疗组)与采用常规针刺穴位(对照组),10d为1个疗程。评定两组治疗前后神经功能缺损积分及临床疗效。结果治疗组经治疗后总有效率96.15%,疗效明显优于对照组的86.48%(P<0.05),神经功能缺损积分改善优于对照组。结论针刺外手三里可改善病人的上肢功能,提高病人的生存质量。

老农老外手拉手 沙镇崛起食品城

听说鲁西南的菏泽市沙土镇新堀起一座由老农和“老外”合力筑起的“农”字号食品城。记者慕名前往。 通往食品城的公路上,拖拉机、地排车满装着白菜、甘蓝、萝卜等,黑压压挤满路面。隆冬季节,这么多蔬菜从何而来?食品城能吃得下、吐得出?置身车流之中,记者倍感吃惊。 “到了!”一座新兴城市果真兀立在眼前。只见高楼林立,现代建筑配以重檐碧瓦,既古朴端庄又具时代气息。东西。

Latex法测定血浆D二聚体的临床应用研究

血浆D二聚体(D—DIMER)是交联纤维蛋白在纤溶酶作用下产生的一种特异性的降解产物,正常人血浆中此降解产物甚微(【200ng/ml),仅当纤溶作用增加时,血浆中才会出现大量的D—DIMER。本文应用Latex法测定正常人群和心脑疾病患者血浆中的D—DIMER的含量。

凭仗君扶大雅轮——从樊榭集外书札一通之考证论厉鹗在雍、乾诗坛的地位

从厉鹗集外一通书札作年之考证入手,以雍正一朝十三年风波迭起的政治局势及相关案狱为背景,勾勒出天津水西庄查氏与扬州小玲珑山馆马氏在“盛世”的雷霆风雨中聚合江浙才杰之士的人文态势及生成之内因,进而透过对野逸诗人群体性与动态性的把握,凸显厉鹗在雍、乾之际文坛的地位,为廓清樊榭在文学史中的面目做准备。

Comparative study on the efficacy of transoral robotic surgery and non-robotic surgery for tongue base tumors

Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.

浅谈悬挑式外脚手架搭设技术

近年来,随着经济的快速发展,建筑领域有了更大的发展空间,高层、超高层不断涌现,悬挑式外脚手架的应用也日益广泛。本文结合北流精通·财富广场的工程实例,探讨了悬挑式外脚手架搭设技术。

Surgical Significance of the Aortic Root and its Neighbouring Structure Relationships

Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal adult were studied. The dimensions of four levels inaortic root were measured and the relationships between the aortic sinues and its neighbouringstructure were observed. Results: The dimensions of four levels in aortic root obtained as follows;Sinus > STJ1 > STJ0 > Base (P < 0.05) . The dimensions of the aortic valve leaflets were measured.The right coronary leaflet was larger than those of the left coronary and noncor-onary leaflets .But there was no statistical signiftcane (P > 0.05) . The relationships between the middle axis ofthe anterior valve of the bicuspid valve and the aortic sinuses were examined. The middle axis ofthe anterior valve in 26 specimens (86.6%) located between the left coronary sinus and thenoncoronary sinus . The relationship between the aortic prominence of the right atrium and theaortic sinuses was examined. The aortic prominence was formed from noncoronary sinus in 22 specimens(73.3%) . The relationship between the middle point of the right and left pulmonary valves and theaortic sinuses was examined. The middle point of the right and left pulmonary valves in 24 specimens(80%) was faced to the point between the right and left aortic sinuses . Conclusion: The dimensionof the four levels in aortic root is as follows, sinus > STJ1 > STJ0 > Base (P < 0.05) . There wasno statistical significance in the size of the three aortic valve leaflets (P > 0.05).

An Analysis of Prospective Outcome of Re-resection for Recurrent Live Cancer and Extrahepatic Metastases,a Follow-up of 267\Cass

Objective To evaluate the prospective outcome and summarize experience in re-resection for recurrent liver cancer and extrahepatic metastases. Methods The clinical data of 267 patients with recurrent primary liver cancer (PLC) after re-resection from January 1960 to July 2000 were retrospectively analyzed. Re-hepatectomy was performed on 205 cases, resection of extrahepatic metastases on 51 cases and combined resection of recurrent liver cancer and extrahepatic metastases on 11 cases. The clinico-pathologic features, operation type and survival were compared. Results The types of liver re-resection included left lateral lobectomy in 11.2% of patients, hemihepatetomy and extended hemi-hepatectomy in 4.4%, local radical resection in 68.3%, other subsegmentectomy in 17.1%. The peak recurrence rate (64.4%) occurred at 1–2 years. The overall 1-, 3, 5- and 10-year survival rates after second resection were 81.0%, 40.3%, 19.4% and 9.0% respectively, while they were 77.5%, 29.8%, 13.2% and 6.61% respectively after the third resection. The median survival time was 44 months. The re-resection with extrahepatic metastases also provided the possibility of longer survival. Conclusion The results suggest that subsegmentectomy and local excision is appropriate for the hepatic repeat resection. The peak recurrence may be correlated with portal thrombus and operative factor. The re-resection can be indicated not only in intrahepatic recurrent metastases but also in extrahepatic metastases in selected patients. Re-resection has become the treatment of choice for recurrence of PLC, as neither chemotherapy nor other nonsurgical therapies can achieve such favorable results. Key words prospective outcome - re-resection - primary liver cancer - recurrence - extrahepatic metastases

朱二相亲

母 朱二,朱二,哪去啦?您说说,这一大清早,又把我鞋拿去玩了,我咋养这么一个缺德鬼呀,朱二朱二。 朱 (唱歌上)…… 母 呆着,我说,你怎么又把我鞋拿走玩去啦? 朱 我学唱歌呢! 母 哟,我儿子学唱歌呢,唱啥歌,唱给妈听听。 朱 我唱啦!我爷的儿子是我爸。

第二产程剖宫产术巧取胎头40例临床应用

目的:探讨第二产程剖宫产术胎头深嵌宫腔外手推胎头出盆腔后取头法的优势。方法:选择第二产程必须进行剖宫产病例80例,随机分为观察组和对照组。分析两组的子宫切口裂伤、术中出血、新生儿窒息、手术时间、术后病率情况。结果:宫腔外手推胎头出盆腔后取头法,明显优于常规手法,比较差异有显著性(P<0.05)。结论:第二产程剖宫产术宫腔外手推胎头出盆腔后取头法,能减少子宫切口裂伤、术中出血、新生儿窒息及术后病率,缩短手术时间,无新生儿产伤,方法简单、易学。

Current surgical treatment for bile duct cancer

Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy （PD）, plus extrahepatic bile duct resection and regional lyrnphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD （hepatopancreatoduodenectomy） has been applied to selected patients with widespread tumors. Preoperative biliary drainage （BD） followed by portal vein embolization （PVE） enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis

This article is to offer a concise review on the use of cytoreductive surgery （CRS） plus intraperitoneal hyperthermic chemotherapy （IPHC） for the treatment of peritoneal carcinomatosis （PC）. Traditionally, PC was treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 too. With the establishment of several phase Ⅱ studies, a new trend has been developed toward the use of CRS plus IPHC as a standard method for treating selected patients with PC, in whom sufficient cytoreduction could be achieved. In spite of the need for more high quality phase Ⅲ studies, there is now a consensus among many surgical oncology experts throughout the world about the use of this new treatment strategy as standard care for colorectal cancer patients with PC. This review summarizes the current status and possible progress in future.

Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer

AIM: To give the evidence for rationalizing surgical therapy for early gastric cancer with different lymph node status. METHODS: A series of 322 early gastric cancer patients who underwent gastrectomy with more than 15 lymph nodes retrieved were reviewed in this study. The rate of lymph node metastasis was calculated. Univariate and multivariate analyses were performed to evaluate the independent factors for predicting lymph node metastasis. RESULTS: No metastasis was detected in No.5, 6 lymph nodes (LN) during proximal gastric cancer total gastrectomy, and in No.10, 11p, 11d during for combined resection of spleen and splenic artery and in No.15 LN during combined resection of transverse colon mesentery. No.11p, 12a, 14v LN were proved negative for metastasis. The global metastastic rate was 14.6% for LN, 5.9% for mucosa, and 22.4% for submucosa carcinoma, respectively. The metastasis in group Ⅱ?was almost limited in No.7, 8a LN. Multivariate analysis identified that the depth of invasion, histological type and lymphatic invasion were independent risk factors for LN metastasis. No metastasis from distal cancer (≤ 1.0 cm in diameter) was detected in group Ⅱ?LN. The metastasis rate increased significantly when the diameter exceeded 3.0 cm. All tumors (≤ 1.0 cm in diameter) with LN metastasis and mucosa invasion showed a depressed macroscopic type, and all protruded carcinomas were > 3.0 cm in diameter. CONCLUSION: Segmental/subtotal gastrectomy plus D1/D1 + No.7 should be performed for carcinoma (≤ 1.0 cm in diameter, protruded type and mucosa invasion).Subtotal gastrectomy plus D2 or D1 + No.7, 8a, 9 is the most rational operation, whereas No.11p, 12a, 14v lymphadenectomy should not be recommended routinely for poorly differentiated and depressed type of submucosa carcinoma (> 3.0 cm in diameter). Total gastrectomy should not be performed in proximal, so does combined resection or D2+/D3 lymphadenectomy.

Surgical treatment for rectal cancer:An international perspective on what the medical gastroenterologist needs to know

Rectal cancer accounts for one third of all colorectal cancers.The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening,improved diagnostic tests,improved standardized surgical technique,improved medical support,neoadjuvant chemotherapies and radiation treatment or combinations of these.Because of complex treatment algorithms,use of multidisciplinary teams in the management of rectal cancer patients has also been popularized.Medical gastroenterologists performing colonoscopies are frequently the first health care provider to raise the suspicion of a rectal cancer.Although the diagnosis depends on histological confirmation,the endoscopic presentation is almost diagnostic in many cases.In order to meet the patient's immediate needs for information,it is important that the endoscopist has knowledge about the investigations and treatment options that will be required for their patient.The aim of this paper is to describe the modern preoperative investigations and operative procedures commonly offered to rectal cancer patients taking into account perspectives of three colorectal surgeons,practicing in the USA,Europe and Asia.

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

AIM: To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. METHODS: Thirty-four patients (15 males, 19 females) with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma. RESULTS: The pathological T stage of the tumors was: pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was: pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70% (27 out of 34). The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29% (24 out of 34). The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases usingphased-array MRI gave an accuracy of 74.50% (21 out of 34). The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47% (18 out of 34) was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively. CONCLUSION: ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion (T stage) and has same value in detecting lymph node metastases (N stage) as compared to ERUS.

Pediatric liver transplantation

In previous decades,pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality.Graft and patient survival have continued to improve as a result of improvements in medical,surgical and anesthetic management,organ availability,immunosuppression,and identification and treatment of postoperative complications.The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients.Newer immunosuppression regimens,including induction therapy,have had a significant impact on graft and patient survival.Future developments of pediatric liver transplantation will deal with long-term followup,with prevention of immunosuppression-related complications and promotion of as normal growth as possible.This review describes the state-of-the-art in pediatric liver transplantation.

Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

AIM:To evaluate the effects of preoperative immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention.In addition,effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups.The immunonutrition group received a combination of arginine,fatty acids and nucleotides.The second and third group received normal nutrition and standard enteral nutrition,respectively.Nutrition protocols were administered for 7 d prior to the operation.Nutritional parameters,in particular prealbumin levels and lymphocyte subpopulations(CD4+,CD8+,CD16+/56+,and CD69 cells)were evaluated before and after the nutrition protocols.Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed thestudy,16 received immunonutrition,13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group,but this parameter was improved after the nutritional protocol only in the immunonutrition group(13.64±8.83 vs 15.98±8.66,P=0.037).Groups were similar in terms of CD4+,CD16+/56,and CD69+prior to the nutritional protocol;whereas CD8+was higher in the standard nutrition group compared to the immunonutrition group.After nutritional protocols,none of the groups had an increase in their lymphocyte subpopulations.Also,groups did not differ in terms of postoperative complications and postoperative durations of hospital stay. CONCLUSION:Preoperative immunonutrition provided a significant increase in prealbumin levels,while it did not significantly alter T lymphocyte subpopulation counts,the rate of postoperative complications and the duration of hospital stay.

Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder

AIM:To investigate the preoperative factors that can predict neoplastic polypoid lesions of the gallbladder(PLGs) as well as malignant PLGs.METHODS:A retrospective analysis was conducted on the 210 consecutively enrolled patients who underwent cholecystectomy due to a PLG larger than 10 mm,as was determined by preoperative trans-abdominal ultrasonography or endoscopic ultrasonography.We ana-lyzed the medical,laboratory,radiologic data and the pathologic results.RESULTS:In 210 cases,146 had non-neoplastic polyps(69.5%) and 64 cases were neoplastic polyps(30.5%).An older age(≥ 65 years),the presence of diabetes mellitus(DM) and the size of polyp(≥ 15 mm) were revealed to be independent predictive variables for neoplastic polyps with odd ratios(OR) of 2.27(P = 0.044),2.64(P = 0.021) and 4.94(P < 0.01),respectively.Among the neoplastic PLGs,an older age(≥ 65 years),the presence of DM and polyp size(≥ 15 mm) were associated with malignancy with ORs of 4.97(P = 0.005),6.13(P = 0.001) and 20.55(P < 0.001),respectively.CONCLUSION:Among patients with PLGs larger than 10 mm in size,higher risk groups such as elderly patients more than 65 years old,those with DM or a large polyp size(≥ 15 mm) should be managed by cholecystectomy.

Surgical outcome of adenosquamous carcinoma of the pancreas

Adenosquamous carcinoma is rare,accounting for 3%-4% of all pancreatic carcinoma cases. These tumors are characterized by the presence of variable proportions of mucin-producing glandular elements and squamous components,the latter of which should account for at least 30% of the tumor tissue. Recently,several reports have described cases of adenosquamous carcinoma of the pancreas. However,as the number of patients who undergo resection at a single institute is limited,large studies describing the clinicopathological features,therapeutic management,and surgical outcome for adenosquamous carcinoma of the pancreas are lacking. We performed a literature review of English articles retrieved from Medline using the keywords 'pancreas' and 'adenosquamous carcinoma'. Additional articles were obtained from references within the papers identif ied by the Medline search. Our subsequent review of the literature revealed that optimal adjuvant chemotherapy and/or radiotherapy regimens for adenosquamous carcinoma of the pancreas have not been established,and that curative surgical resection offers the only chance for long-term survival. Unfortunately,the prognosis of the 39 patients who underwent pancreatic resection for adenosquamous carcinoma was very poor,with a 3-year overall survival rate of 14.0% and a median survival time of 6.8 mo. Since the postoperative prognosis of adenosquamous carcinoma of the pancreas is currently worse than that of pancreatic adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques should be investigated as they may prove indispensible to the improvement of surgical outcomes.