目的 探讨动力髋螺钉(dynamic hip screws,DHS)内固定与股骨近端解剖钢板在不同类型股骨粗隆间骨折中的应用价值。方法 研究对象取自于我院2013年11月—2014年11月收治的76例不同类型股骨粗隆间骨折患者,按随机数字表法分为对照组与观察组。对照组采用DHS内固定治疗;观察组用股骨近端解剖钢板治疗。统计两组患者手术时间等手术指标,记录并发症发生情况,随访6个月调查患者骨折愈合优良率。结果 观察组手术时间、术中出血量及术中输血量[(83.6±13.8)min、(236.5±27.3)mL和(208.3±86.6)mL]均优于对照组(P<0.05);较对照组,观察组术后并发症发生率13.2%低,骨折愈合优良率81.5%高,两组比较差异有统计学意义(P<0.05)。结论 为确保获得理想治疗效果,临床应结合股骨粗隆间骨折患者的骨折类型选择合适方法。股骨近端解剖钢板手术时间短、术中出血量少,术后并发症发生率低,优势更明显。

目的 构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型。方法 采用低浓度加量持续诱导法,诱导吉西他滨耐药乳腺癌细胞4T1耐药株,命名为4T1/Gem;CCK-8法测定4T1与4T1/Gem细胞的增殖抑制率,计算耐药指数; Western blot法检测细胞P-gp蛋白表达;B超引导下注射4T1/Gem细胞悬液诱导裸鼠肝脏成瘤;HE染色观察肿瘤组织病理情况,免疫组化法检测瘤组织ER、PR、HER2、Ki-67和P-gp蛋白的表达。结果 经过14个月的诱导成功建立4T1/Gem细胞株,可在含40 μg/mL的Gem培养液中稳定生长。4T1/Gem细胞耐药指数为4T1细胞的788.547倍。与亲代相比,4T1/Gem处于G1期和G2期的细胞增加,S期细胞减少;上调P-gp蛋白的表达。4T1/Gem细胞成功建立裸鼠乳腺癌肝转移模型,瘤组织中ER、PR、HER2蛋白阴性表达,Ki-67阳性10％和P-gp蛋白阳性表达。结论 成功构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型,为开发治疗乳腺癌肝转移化疗耐药的药物提供实验基础。

Objective To construct a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem) and establish a nude mouse model of breast cancer with hepatic metastatic. Methods A gemcitabine-resistant variant of the breast cancer 4T1 cell line was induced by gradually increasing the concentration of gemcitabine; this variant is referred to in this study as 4T1/Gem. The proliferation suppression rates of 4T1 and 4T1/Gem cells were determined by using the CCK-8 essay to evaluate the drug resistance indices of the cell lines. Western blot analysis was used to detect P-gp protein expression. Under ultrasonography, a 4T1/Gem cell suspension was injected into nude mice to induce liver tumors. H&E staining was used to observe tumor pathology, and immunohistochemistry was used to detect the expression of ER, PR, HER-2, Ki-67, and P-gp. Results After 14 months of induction, a 4T1/Gem cell line is established successfully. The cell line can grow stably in culture liquid containing 40 μg/ml gemcitabine. The drug resistance index of 4T1/Gem is 788.547. Compared with the 4T1 cell line, the 4T1/Gem cell line can upregulate P-gp protein expression and successfully establish a nude mouse model of breast cancer with hepatic metastatic. ER, PR, and HER-2 proteins exhibit negative expression in the tumor tissue. The positive expression of P-gp and 10% of Ki-67 proteins is also observed. Conclusion This study successfully constructs a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem)and establishes a nude mouse model of breast cancer with hepatic metastatic, thereby providing an experimental basis for developing and treating a drug-resistant variant of breast cancer.

目的 探讨彩色多普勒超声在无精子症患者睾丸穿刺活检中的应用价值。方法 回顾性分析2012年11月—2015年2月在我科诊断为无精子症的53例患者的病例资料。所有患者进行常规阴囊超声检查,采用频谱多普勒检测睾丸动脉(TA)、睾丸内动脉(ITA)的收缩期最大速度(PSV)、舒张末期速度(EDV)和阻力指数(RI)。采用彩色多普勒超声观察睾丸内的血管分布及其数目,并进行半定量评分。所有患者进行睾丸穿刺活检并进行Johnsen评分。结果 47例患者诊断为梗阻性无精子症(OA),6例患者诊断为非梗阻性无精子症(NOA)。0A组睾丸的平均体积(15.3±3.6) mL,NOA组睾丸的平均体积(7.1±2.8) mL,差异有统计学意义(P＜0.01);OA组与NOA组患者睾丸的血流参数(PSV、EDV、RI) 结果有统计学意义(P＜0.05);OA组与NOA组睾丸内血管半定量分级有的差异,其差异有统计学意义(P＜0.01)。结论 彩色多普勒超声检查对睾丸生精功能有很好的预测作用,可作为鉴别OA患者和NOA患者的指标。

Objective To explore the application value of color Doppler ultrasound in patients with azoospermia who underwent testicular needle biopsy. Methods Retrospective analysed the clinical data of 53 cases patients with azoospermia from 2012 November to 2015 February in our department.All patients underwent routine scrotal ultrasonography, to detecte the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) of testicular artery (TA)and intratesticular artery (ITA)with spectral Doppler ultrasound. Color Doppler ultrasound was used to observe the distribution and the number of blood vessels in the testicle, and semi quantitative score. All patients underwent testicular biopsy and Johnsen score. Results 47 patients were diagnosed as obstructive azoospermia(OA), 6 patients were diagnosed as non obstructive azoospermia(NOA). The average volume of testis was (15.3±3.6)mL in 0A group. The average volume of testis was (7.1±2.8) mL in N0A group.There was significant difference (P<0.01). The blood flow parameters(PSV, EDV, RI) results between OA group and NOA group have obvious difference,the difference was statistically significant (P<0.05). The semi quantitative classification of testicular vessels between OA group and NOA group have obvious difference,the difference was statistically significant (P< 0.01). Conclusion Color Doppler ultrasound is a good predictor of testicular spermatogenic function, can be used as the identification index of patients with OA and patients with NOA.

目的 为避免和减少颈部手术对喉返神经损伤,本文利用尸体解剖探讨喉返神经走向与分布以及与周围组织的相关性。方法 将20具用甲醛固定的成年尸体标本喉返神经(40侧)及其分支解剖;肉眼观察其与甲状腺、甲状腺下动脉和Berry's韧带相关性;测量喉返神经入喉点与甲状软骨下角的距离,以及甲状软骨下角至锁骨中点与胸骨柄上端的距离。结果 喉返神经与甲状腺下动脉交叉比例为96%,交叉点在甲状腺下极平面之上占88%,喉返神经位于甲状腺下动脉及其分支的前方与后方分别为22%与50%,经过Berry's韧带后方占95%,喉返神经入喉点至甲状软骨下角的距离(8.2±2.5)mm。结论 喉返神经与甲状腺下动脉和甲状腺韧带关系复杂,甲状软骨下角可作为喉返神经定位标志。

Objective In an attempt to reduce the risk of intraoperative recurrent laryngeal nerve (RLN) damage, human autopsy was conducted to determine the distribution of RLN and its relationship with surroundings. Methods With the naked eye observation, 20 formalin-fixed adult cadavers were examined. The relationships between RLN and inferior thyroid artery and inferior horn of thyroid cartilage were defined. Both the distance between entering point and inferior horn of thyroid cartilage and the distance between inferior horn of thyroid cartilage and middle point of clavicle bone or upper margin of stern were measured. Results The proportion of cases for recurrent laryngeal nerves intercrossed with inferior thyroid artery and for the crossing above the plane of inferior pole was respectively 88% and 96%. Therecurrent laryngeal never in front and rear of the inferi of thyroid artery and its branches were 22% and 50%,respectivdly.Most cases of RLN were behind Berry s suspensory ligament (95%). The distance between entering point of recurrent laryngeal nerve and inferior horn of thyroid cartilage was 8.2±2.5mm. Conclusion The results suggested that the correlation between RLN and its surrounding tissues is very complicated. The inferior horn of thyroid cartilage may be a useful marker for RLN.

目的 观察喉罩通气下全凭七氟醚吸入麻醉在妇科宫腔镜手术中的应用价值。方法 60例拟行妇科宫腔镜手术的患者随机分为七氟醚和丙泊酚组,每组30例,记录不同时间点两组患者的平均动脉压(MAP),脉搏血氧饱和度(SpO₂)、苏醒时间以及术后恶心,呕吐、躁动的发生率。结果 A组患者血流动力学指标波动较少,苏醒时间A组明显短于B组,差异有显著性(P<0.05)。两组患者诱导后MAP,HR均较诱导前显著下降(P<0.05)。B组患者术中MAP,HR值显著低于A组(P<0.05),拔除喉罩即刻两组MAP,HR差异无显著性(P>0.05)。结论 喉罩下全凭七氟醚吸入麻醉对患者的血流动力学的影响较小,适用于妇科宫腔镜手术。

Objective To observe the effect of laryngeal mask airway(LMA) combined with sevoflurane inhalation anaesthesia in gynecological hysteroscopy operation. Methods Sixty patients, classified from ASAⅠtoⅡscheduled for hysteroscopic operation were randomly divided into sevoflurane inhalation anesthesia group (group A) and propofol intravenous anesthesia group(group B).The mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), recovery time and the incidence of nausea, vomiting and recovery time were recorded at different time points of the two groups. Results The hemodynamic index of the patient in the group A fluctuated seldom,and the recovery time was significantly shorter than that in the B group, and the differences were significant (P<0.05).The MAP and the HR were all decreased after anesthesia induction compared with those of before in both groups (P<0.05).The MAP and the HR in the group B was significantly lower than that in the group A (P<0.05), there were no significant differences in MAP and HR between the two groups of patients with laryngeal mask airway removal. Conclusion Small hemodynamic influence is taken with the technique of laryngeal mask airway(LMA) combined with sevoflurane inhalation anesthesia. It is suitable for gynecological hysteroscopic operation.

目的 对中医治未病在社区孕妇孕期保健应用中效果进行探讨。方法 选取符合条件的300名社区孕妇,随机分为对照组和干预组,对照组不采取干预措施,干预组依据孕妇的中医体质判定表实施相应的中医干预方法,持续二个月,并对两组孕妇进行随访。对比分析两组孕妇的分娩和产后情况。结果 干预组孕妇自然分娩95例,剖宫产55例,自然分娩率高于对照组孕妇,差异有统计学意义(P<0.05);干预组新生儿巨大儿的发生率为6.7%,低于对照组的16.7%,差异有统计学意义(P<0.05);此外,干预组孕妇先兆流产、早产、妊娠期高血压和妊娠期糖尿病的发生例数低于对照组孕妇(P<0.05)。结论 应用中医治未病思想指导孕期保健,有助于减少孕产妇并发症和巨大儿发生率,保证母儿健康。

目的 研究分析甲强龙静脉注射对老年腹部全麻术患者血流动力学和呼吸动力学的影响。方法 选取2014年3月—2015年3月拟于我院行腹部全麻手术的老年患者76例,随机分为实验组和对照组,每组38例,均对其行全身麻醉。两组病人麻醉诱导用药咪达唑仑0.05 mg/kg,速眠安0.15 mg/kg,乙咪酯 0.2 mg/kg,气管插管后连接麻醉呼吸机。麻醉维持咪达唑仑和速眠安各0.05 mg/kg,给予实验组静脉注射甲强龙1 mL(40 mg),对照组静脉注射生理盐水1 mL。记录两组患者给药前(T₁)、给药后10 min(T₂)、20 min(T₃)、30 min(T₄)、40 min(T₅)的气道峰压(Ppeak)、气道平台压(Pplat)、肺的顺应性(Compl)、气道阻力(Raw)等呼吸动力学参数值。以及两组患者给药前20 min(T₀)和T₁～T₃患者的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)等血流动力学参数值,并于以上各时间点采取两组患者静脉血测定其血浆中cAMP和cGMP含量。观察比较两组患者各时间点的数据变化以及拔管后10 min(T₆),15 min(T₇)和35 min(T₈)的RAMSAY镇静评分和RASS评分。结果 实验组在T₂～T₅时Compl明显增高,而同期Ppeak、Pplat、Raw则降低(P＜0.05)。与对照组相比较,实验组在T₀到T₄的SBP、DBP、MAP和HR无差异,且各时间点的数值低于同期对照组。两组患者在T₀和T₃cAMP和cGMP含量比较无差异,实验组cAMP和cGMP含量在T₁和T₂时低于对照组,两组患者在T₈时的Ramsay评分和RASS评分比较差异无统计意义,但实验组患者在T₆和T₇时的镇静评分高于对照组(P＜0.05),而同一时间点的RASS躁动——镇静量表评分则低于对照组(P＜0.05)。结论 甲强龙静脉注射能稳定老年腹部全麻术患者的血流动力学和呼吸动力学,抑制手术过程中的应激反应,改善苏醒质量和镇静效果,值得临床上推广使用。

目的 社区干预在颈动脉斑块伴脂代谢紊乱人群中的应用。方法 选取我院2012年3月—2014年3月186例颈动脉斑块伴脂代谢患者为研究对象,将患者抽签随机分为观察组与对照组,每组93例。对照组给予基础治疗及运动生活方式指导,观察组给予基础治疗以及强化社区健康管理综合干预,观察并记录两组Crouse积分,总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C )水平及遵医行为。结果 治疗1、2年后观察组颈动脉斑块积分(3.46±2.13)cm、(3.07±2.49)cm低于对照组(4.56±2.26)cm、(4.43±2.51)cm,两组差异有统计学意义(P＜0.05)。观察组治疗1年、2年后TC、TG、LDL-C水平低于对照组,HDL-C水平高于对照组,两组差异有统计学意义(P＜0.05)。观察组遵医行为优于对照组(P＜0.05)。结论 社区健康管理综合干预能显著提高患者遵医行为,改善生活方式,从而使血脂达到正常水平,延缓颈动脉斑块发展。

Objective To study the application of community intervention in population with carotid plaque complicated with dyslipidemia. Methods 186 cases of patients with carotid plaque complicated with dyslipidemia who were admitted in our hospital from March 2012 to March 2014 were selected as the study objects and were randomly divided into the observation group and the control group according to random sampling method, with 93 cases in each group. The control group was given basic treatment and guidance of exercise lifestyle. The observation group was given basic treatment and strengthened community health management integrated intervention. The crouse integral, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) levels and treatment compliance in the two groups were observed and recorded. Results After 1 and 2 years of treatment, the carotid artery plaque score in the observation group [(3.46±2.13) cm, (3.07±2.49) cm] was lower than that in the control group [(4.56± 2.26) cm, (4.43±2.51) cm](P<0.05). TC, TG and LDL-C levels in the observation group were lower than those in the control group while HDL-C level was higher than that in the control group (P<0.05). The treatment compliance in the observation group was significantly better than that in the control group (P<0.05). Conclusion Community health management integrated intervention can significantly improve the treatment compliance of patientsand their life style, so as to achieve the normal level of blood lipids and carotid plaque will be postponed.

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.

目的 探讨功能训练在Haglund病伴轻度认知障碍患者中的应用效果。方法 成立功能训练培训小组对46例关节镜Haglund病伴轻度认知障碍术患者实施功能训练,干预时间6个月。训练前后对患者Baird-Jackson踝关节评分、自我效能和临床疗效评估进行测评。结果 训练后,患者Baird-Jackson踝关节评分、自我效能优于训练前,临床疗效优良率升高,训练前后比较,差异均有统计学意义(P＜0.01)。结论 功能训练能促进关节镜Haglund病伴轻度认知障碍术患者踝关节功能康复和提高自我效能。

Objective To investigate the effects of application of functional training to Haglund disease patients with mild cognitive impairment. Methods The functional training group was built and gave functional training to 46 patients of Haglund disease with mild cognitive impairment. The period of intervention lasted 6 months. Before and after the training, We assessed patients in terms of scores of Baird-Jackson ankle joint, self-efficacy and clinical efficacy. Results After the training, scores of Baird-Jackson ankle joint and self-efficacy became higher and the excellent rate of clinical efficacy has risen. Compared with those before the training, the difference had statistic significance (P<0.01). Conclusion Functional training has a positive impact on the recovery of ankle joint function of Haglund disease patients with mild cognitive impairment and improve their self-efficacy.