免喷涂金属质感改性塑料成型工艺优化

针对金属质感免喷涂改性塑料在实际应用过程中常存在的熔接线及流痕问题,从注塑工艺角度对免喷涂金属质感改性塑料表观缺陷进行了优化验证研究。结果表明,提升注塑温度、降低注塑速度对流痕和熔接线有改善作用,但同时要兼顾低速注塑条件下易出现的欠注风险,对于复杂结构制件要注重分段多级注塑的验证;提高模具温度可以大大减弱流痕和熔接线,其中模具急冷急热技术是较好的改善手段;对于孔洞结构,常规的加工工艺改善措施对流痕及熔接线只有一定的缓解作用,无法根除,而模内切技术以其独特的加工过程,能实现孔洞结构流痕和熔接线的完美消除,是孔洞结构缺陷解决的有力方案;应尽量减少模具浇口的数量,如果无法规避,应根据制件结构适当调整浇口排布,通过顺序进胶方式将流痕和熔接线规避或是赶至制件非外观面。

内质网应激在趋化素诱导成骨细胞代谢过程中的作用机制

观察趋化素诱导成骨细胞代谢过程中的影响,探讨内质网应激反应在此过程中的机制。将成骨细胞随机分组,给予不同浓度的趋化素(Chemerin)进行诱导,观察成骨细胞活力变化;ELISA法测定细胞趋化蛋白1(MCP-1)、E选择素(E-selection)变化;Western blot法检测成骨细胞黏附分子1(ICAM-1)、需肌醇跨膜激酶/核酸内切酶1(inositol-requiring transmembrane kinase/endonuclease 1,IRE1)、葡萄糖调节蛋白78(Glucose-regulated protein 78,GRP78)的表达情况。通过研究发现Chemerin对成骨细胞活力未见明显影响;与正常对照组相比,Chemerin呈浓度依赖性上调MCP-1、E-selection、ICAM-1等炎症因子的表达(P<0.05),上调内质网应激反应相关指标IRE1、GRP78的表达(P<0.05);其中,1×10-5mol/L组Chemerin作用最为显著。研究结果表明趋化素可诱导成骨细胞的凋亡过程,在成骨细胞的代谢中发挥重要作用,此过程可能和内质网应激反应相关。

Endoscopic resection of superficial gastrointestinal tumors

Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

Endoscopic mucosal resection in the upper gastrointestinal tract

Endoscopic mucosal resection （EMR） is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett＇s esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett＇s esophagus.

Endoscopic mucosal resection of early gastric cancer: Experiences in Korea

Endoscopic mucosal resection （EMR） has been established as one of the treatment options for early gastric cancer （EGC）. However, there are many uncertain areas such as indications of EIR, best treatment methods, management of complications and follow-up methods after the procedure. Host studies on this topic have been carried out by researchers in Japan. In Korea, gastric cancer is the most common malignant disease, and the second leading cause of cancer death. In these days, EIR for EGC is widely performed in many centers in Korea. In this review, we will provide an overview of the bechniques and outcomes of EIR in Korea.

THROMBOENDARTERECTOMY FOR CHRONIC PULMONARY THROMBOEMBOLISM

Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterec- tomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. Results Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. Conclusion Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.

Treatment of over 20 mm gastric cancer by endoscopic submucosal dissection using an insulation-tipped diathermic knife

AIM： To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife （IT-ESD） for the treatment of patients with over 20 mm early gastric cancer （EGC）. METHODS： A total of 112 patients with over 10 mm EGC were treated with IT-ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 5 year period from January 2002 to December 2006, including 40 patients with over 20 mm EGC. We compared patient backgrounds, the one-piece resection rate, complete resection （CR） rate, operation time, bleeding rate, perforation rate between patients with over 20 mm EGC [over 20 mm group （21-40 ram）] and the remaining patients （under 20 mm group）. RESULTS： We found no significant difference in the rate of underlying cardiopulmonary disease （over 20 mm group vs under 20 mm group, 5.0% vs 5.6%）, one- piece resection rate （95% vs 96%）, CR rate （85% vs 89%）, operation time （72.3 rain vs 66.5 rain）, bleeding rate （50 vs 4.2%）, and perforation rate （0% vs 1.4%） between the 2 groups. Three patients in each group had submucosal invasion and two in each groups underwent additional surgery. CONCLUSION： There was no significant difference in the outcome resulting from IT-ESD between the 2 groups. Our study proves that IT-ESD is a feasible treatment for patients with over 20 mm mucosal gastric cancer although the long-term outcome should be evaluated in the future.

Intestinal endometriosis-A rare cause of colonic perforation

Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected.Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection.Articles were searched for in Medline,Pubmed,and the Cochrane Control Trial Registry,among other sources. RESULTS:An initial search identified 2620 reference articles,from which 429 relevant articles were selected and reviewed.Data was extracted from 25 studies(n =5221)which met the inclusion criteria.All the studies used snares to perform EMR.Pooled proportion of en-bloc resections using a random effect model was 62.85%(95%CI:51.50-73.52).The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66%(95%CI:47.14-69.71).With higher patient load(>200 patients),this complete cure en-bloc resection rate improves from 44.19%(95%CI: 24.31-65.09)to 69.17%(95%CI:51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.

Endoscopic Mucosal Resection

Endoscopic mucosal resection is indicated in limited esophageal carcinomas with in?ltration of the mucosa. As submucosal cancer is combined with a rate of lymph node metastasis in up to 30% mucosectomy is not the procedure of choice. The main techniques of endoscopic mucosal resection are the “suck and cut” technique using a cap on the endoscope or a ligation device to create a pseudocroup of the carcinoma. Submucosal injection of saline or other solutions is recommended prior to diathermic mucosectomy in order to reduce the risk of perforation or haemorrhage. The long term results of endoscopic mucosal resection show tumor speci?c 5 year survival rates of about 97% especially if the indication is restricted to m1 and m2 mucosal carcinomas.

Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma

The standard treatment of endometrial cancer or atypical hyperplasia is surgical removal of the uterus and ovaries. In early stage disease this has an excellent chance of cure but results in infertility. Although the majority of patients are postmenopausal an increasing number of patients with atypical hyperplasia or endometrial cancer are presenting with a desire to retain their fertile potential. In the last 8 years a number of studies have been published involving 403 patients with endometrial cancer and 151 patients with Atypical hyperplasia treated with high dose progestagens. The response rate is 76.2% and 85.6% respectively with endometrial cancer having a recurrence rate of 40.6%. There is a 26% recurrence rate in atypical hyperplasia. Overall 26.3% of those wishing to conceive had a live baby. Although concerns exist about the risks of medical treatment, those that fail this treatment do not appear to have a significantly poorer prognosis although 20 patients(3.6%) had either ovarian cancer or metastatic disease discovered during treatment or follow up.

Usefulness of magnifying endoscopy in post-endoscopic resection scar for early gastric neoplasm:A prospective short-term follow-up endoscopy study

AIM： To investigate the relationship between postendoscopic resection （ER） scars on magnifying endoscopy （ME） and the pathological diagnosis in order to validate the clinical significance of ME. METHODS： From January, 2007 to June, 2008, 124 patients with 129 post-ER scar lesions were enrolled. Mucosal pit patterns on ME were compared with conventional endoscopy （CE） findings and histological results obtained from targeted biopsies. RESULTS： CE findings showed nodular scars （53/129）, erythematous scars （85/129）, and ulcerative scars （4/129）. The post-ER scars were classified into four pit patterns of sulci and ridges on ME： （ Ⅰ ） 47 round; （Ⅱ） 54 short rod or tubular; （Ⅲ） 19 branched or gyrus-like;and （Ⅳ） 9 destroyed pits. Sensitivity and specificity were 88.9% and 62.5%, respectively, by the presence of nodularity on CE. Erythematous lesions were high sensitivity （100%）, but specificity was as low as 36.7%. The range of the positive predictive va ue （PPV） on CE was as low as 10.6%-25%. Nine type N pit patterns were diagnosed as tumor lesions, and 120 cases of type Ⅰ-Ⅲ pit patterns revealed non-neoplastic lesions. Thus, the sensitivity, specificity, and the PPV of ME were 100%. CONCLUSION： ME findings can detect the presence of tumor in post-ER scar lesions, and make evident the biopsy target site in short-term follow-up. Further large-scale and long-term studies are needed to determine whether ME can replace endoscopic biopsy.

Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection

Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.

ABDOMINAL SCAR ENDOMETRIOSIS:REPORT OF 28 CASES

Twenty-eight cases of abdominal scar endometriosis from Janurary, 1980 to December, 1993 are reported. Of these patients, twenty-four underwent term cesarean section, and four underwent a midtrimester abortion by abdominal hysterotomy, The majority of patients manifested symptoms 1 year after the operation. The most common was a painful mass of scar tissue that became swollen and tender during menstruation. The pathogenesis, diagnosis and treatment are discussed. In correlation with the pathological findings, the effects of drug therapy are evaluated. It was found that surgical excision is the best method of treatment.

Efficacy of Spinal Pia Mater Incision and Laminoplasty Combined with Internal Fixation for Old Spinal Cord Injury

Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods From March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of preand postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale. The improvement rate of JOA score at the indicated time was recorded. Results Postoperative Frankel classification rating of 16 patients improved obviously. JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9±2.3, 8.5±1.6, 8.9±2.1, and 12.4±2.5, respectively, and significantly increased compared with that prior to surgery (5.5±0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period. Conclusion It is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.

Corneal relaxing incision combined with phacoemulsification and IOL implantation

Objective: To analyze the effectiveness and safety of corneal relaxing incisions (CRI) in correcting keratometric astigmatism during cataract surgery. Methods: A prospective study of two groups: control group and treatment group. A treatment group included 25 eyes of 25 patients who had combined clear corneal phacoemulsification, IOL implantation and CRI. A control group included 25 eyes of 25 patients who had clear corneal phacoemulsification and IOL implantation.Postoperative keratometric astigmatism was measured at 1 week, 1 month, 3 months and 6 months. Results: CRI signifi-cantly decreased keratometric astigmatism in patients with preexisting astigmatism compared with astigmatic changes in the control group. In eyes with CRI, the mean keratometric astigmatism was 0.29±0.17 D(range 0 to 0.5 D) at 1 week, 0.41±0.21 D (range 0 to 0.82 D) at 1 month, respectively reduced by 2.42 D and 2.30 D at 1 week and 1 month postoperatively (P=0.000, P=0.000), and postoperative astigmatism was stable until 6 months follow-up. The keratometric astigmatism of all patients decreased to less than 1.00 D postoperatively. Conclusions: CRI is a practical, simple, safe and effective method to reduce preexisting astigmatism during cataract surgery. A modified nomogram is proposed. The long-term effect of CRI should be investigated.

Advances and progress of endarterectomy in the treatment of carotid stenosis

Carotid stenosis, one of the risk factors that tend to result in cerebral ischernia, infarction as well as ischemic manifestations. CEA （carotid endarterectomy）, was initially designed delicately to excise of the thickened, atheromatous tunica intima from the focal stenosis segment, which therefore has been acknowledged as an efficacious way in the management of the prophylaxis of cerebral ischemia. Deruing 1990＇s, carotid endarterectomy （CEA） has matured to a widely performed, standard intervention with well defined successive steps. In the recent years, appearance of angloplasty, stenting, and distal protection procedures provides competitive alternatives to classical endarterectomy. However, long-term benefits of carotid angioplasty should be confirmed by larger, randomized, comparative clinical trials.

Clinical Significance of Lymph Node Sampling in Endometrial Carcinoma

OBJECTIVE To study the clinical significance of pelvic and para-aortic lymph node sampling in endometrial carcinoma.METHODS Data were analyzed from 311 patients who received surgical treatment in our hospital during the period from January 1995 to December 2002.Among the patients,197 underwent lymph node sampling or lymph-adenectomy.The patients were divided into 2 groups based on the nature of their lymph node dissection,i.e.a)The sampling group included 114 patients with an extrafascial hysterectomy or modified radical hysterectomy plus pelvic or paraaortic lymph node sampling of the abdominal aorta;b)The dis-section group,included 83 patients with a radical or modified radical hyster-ectomy plus systemic pelvic lymph node clearance or paraaortic lymph node dissection of the abdominal aorta.RESULTS The median of the sampling sites for lymph node removal was 5 in the sampling group,and the median of the lymph nodes removed was 15 per case.Lymph node metastasis was found in 8 cases.In the dissection group,the median of the cases for lymph node removal was 8,and the me-dian of the lymph nodes removed was 27 per case.Lymph node metastasis was found in 6 cases.The 5-year survival rates were 90.2% and 90.9% in the 2 groups,respectively.CONCLUSION Lymph node sampling of endometrial cancer is a good way of precisely finding lymphatic metastases,and is suitable for surgical staging without causing immoderate surgical treatment and without affecting the survival rate.

Endoscopic Mucosal Resection of Mucosal Neoplasm Located on the Duodenal Bulb through Endoscope Retroflexion

OBJECTIVE To assess the results of endoscopic mucosal resection （EMR） of benign mucosal neoplasms located on the duodenal bulb using endoscope retroflexion. METHODS This study involved 14 patients with 16 mucosal neoplasms located on the duodenal bulb. The diameter of each neoplasm was less than 15 mm. After endoscope retroflexion within the duodenum for evaluation of the size, extent and depth of the tumor, EMR was attempted with endoscope retroflexion for removing the lesion in the duodenal bulb. The rate of endoscope retroflexion, the time required for endoscope retroflexion, median operation time, curative resection rate, en bloc resection rate, complication, and median follow-up period were evaluated. RESULTS Sixteen lesions in 14 patents （median age of 56 years, 5 female, 9 male） were removed through EMR. The mean size of the lesions resected was 6.9 mm （median size of 5.5 mm, range of 3-15 mm）. Post-EMR histologic examination revealed Brunner＇s gland hyperplasia in 6, gastric mucosal metaplasia in 5, adenoma in 1, chronic inflammation in 3, and benign lymphocytic hyperplasia in 1. The curative resection rate was 100% （16/16）, and the en bloc resection rate was 94% （15/16）, with EMR. One of the lesions was piecemeal removed through EMR for its large size （15 mm） and for its involving the area from the duodenal bulb to the pyloric ring. The success rate of endoscope retroflexion within the duodenum was 94% （15/16）. The time required for endoscope retroflexion was longer for the first 10 lesions （median time of 2 min, range of 1-2.5 min） than that for the last 5 lesions （median time of 1.5 min, range of 1-2 min）. The median follow-up period was 22 months （range of 4-48 months）. During the follow-up, no residual, no pyloric or duodenal stenosis was found in any of the patients after EMR. There was no severe hemorrhage, or perforations occurring. CONCLUSION EMR of mucosal neoplasm located on the duodenal bulb through endoscope retroflexion, which is a feasible and useful adjunctive procedure, appears to be a safe and effective technique.

本经取穴针刺法对肝阳上亢型无先兆偏头痛患者MME基因表达的影响

目的观察本经取穴针刺法调控肝阳上亢型无先兆偏头痛患者膜金属肽链内切酶(membrane metallo-endopeptidase,MME)基因的差异表达。方法将20例肝阳上亢型无先兆偏头痛患者随机分为经穴组(针刺患侧经穴)和非经非穴组(针刺患侧非经非穴),每组各10例,每天针刺1次,连续10天。利用基因芯片技术,获得两组的基因表达谱,并对其进行Gene Ontology(GO)分析。结果与本组治疗前比较,经穴组治疗后MME基因表达量下降(P=0.0023),该基因富集于β-淀粉样蛋白代谢过程(beta-amyloid metabolic process,P=3.16E-05)以及肽代谢过程(peptide metabolic process,P=0.009612),该基因在非经非穴组治疗后各样本中未见表达。结论本经取穴对肝阳上亢型无先兆偏头痛的效应可能通过对MME基因的调控实现。