输尿管镜钬激光碎石术和后腹腔镜输尿管切开取石术治疗输尿管上段结石的临床疗效比较

目的:比较输尿管镜钬激光碎石术(USL)和后腹腔镜输尿管切开取石术(RLU)治疗输尿管上段结石的疗效,探讨治疗输尿管上段结石的最佳方法.方法:回顾性分析115例输尿管上段结石患者临床资料,其中71例采用输尿管镜术治疗,44例采用后腹腔镜术治疗,比较两种手术方法的临床治疗效果.结果:后腹腔镜组的手术成功率(97.7％)明显高于输尿管镜组(83.1％)(P＜0.05).输尿管镜组和后腹腔镜组手术时间分别为(43.2± 14.7)min和(79.6± 24.1)min,术中出血量分别为(3.1±0.8)ml和(36.4± 3.7)ml,术后住院天数分别为(3.3±2.1)d和(6.7±1.3)d,差异均具有显著统计学意义(P＜0.01),输尿管镜组均优于后腹腔镜组.输尿管镜组手术后并发症6例,后腹腔镜组5例,两组并发症的发生率比较差异无统计学意义(P＞0.05).术后1个月复查腹部X线平片(KUB),输尿管镜组17例有结石残留,后腹腔镜组均无结石残留,输尿管镜组的结石残留率明显高于腹腔镜组(P＜0.01).结论:输尿管上段结石采用输尿管镜钬激光碎石术和后腹腔镜输尿管切开取石术治疗各有其优缺点.RLU具有安全、高效、创伤小、并发症少、结石清除率高的优点;而USL相对具有出血少、手术时间及住院时间短等优点,但手术成功率和结石清石率低,需其他辅助方式治疗结石.因此,泌尿外科医师应根据结石大小、位置、有无炎性息肉包裹、梗阻程度、肾积水量等术前检查结果及所拥有的设备与技术熟练程度选择最合适的治疗方法.     

盐酸利多卡因凝胶在老年男性患者导尿中的应用研究

目的:评价盐酸利多卡因凝胶在老年男性患者导尿中的应用价值,增加新的临床导尿辅助方法,方便临床操作,减轻患者痛苦,提高临床导尿成功率,减少相关并发症.方法:将2012年1月～2012年12月期间我科需要留置导尿的146例次老年男性患者随机分为常规导尿组(对照组)及盐酸利多卡因预处理组(实验组),比较两组之间患者的耐受情况,一次插管成功率及相关并发症发生率,并做统计学分析.结果:实验组患者对导尿的耐受程度显著高于对照组(P＜0.05);实验组一次性插管成功率为100％,显著高于对照组(83.6％),P＜O.05;而相关并发症显著少于对照组(P＜0.05).结论:盐酸利多卡因凝胶在老年患者的导尿术中作用明显,对老年男性患者导尿前用盐酸利多卡因做预处理可显著减轻患者痛苦,提高一次置管成功率,减少相关并发症发生,值得临床推广.     

三种输尿管镜治疗输尿管上段结石的疗效比较

目的:比较半硬性输尿管镜、输尿管软镜、孙氏末段可弯输尿管镜治疗输尿管上段结石的临床疗效,为临床上治疗方式的选择提供参考。方法:回顾性分析2015年8月到2017年12月间于上海市第十人民医院泌尿外科因输尿管上段结石行输尿管镜下钬激光治疗的515例患者的临床资料。按照所用输尿管镜类型分为3组:硬镜组(给予半硬性输尿管镜治疗)297例,软镜组172例(给予输尿管软镜治疗),孙氏镜组(给予孙氏末段可弯输尿管镜治疗)46例。比较三组的手术时间、一期清石率、术后住院时间及术中、术后并发症。结果:硬镜组、软镜组、孙氏镜组清石率分别为81.5%、94.2%、95.7%,其中软镜组、孙氏镜组清石率显著高于硬镜组(P0.05)。硬镜组、软镜组、孙氏镜组术中并发症发生率分别为18.9%、5.8%、4.3%,其中硬镜组术中并发症发生率显著高于软镜组和孙氏镜组(P0.05),三组术后并发症发生率整体比较差异无统计学意义(P0.05)。硬镜组、软镜组、孙氏镜组平均手术时间分别为(28.6±6.2)min、(49.4±12.4)min、(26.1±6.5)min,软镜组平均手术时间显著高于硬镜组及孙氏镜组,差异有统计学意义(均P0.05)。硬镜组、软镜组、孙氏镜组平均住院时间分别为(5.4±3.2)d、(6.7±5.7)d、(5.0±2.5)d,软镜组住院时间显著高于硬镜组和孙氏镜组,差异有统计学意义(均P0.05)。结论:软镜清石效果和手术安全性较硬镜更有优势,但手术耗时长,患者术后住院时间长。孙氏镜有望成为治疗输尿管上段结石的更佳选择。     

腹腔镜手术治疗结肠癌的临床应用

目的:探讨腹腔镜手术治疗结肠癌的临床效果.方法:选取我院结肠癌患者44例,随机分为观察组和对照组,各22例,观察组行腹腔镜手术,对照组行开腹手术,比较两组的治疗效果和安全性.结果:两组患者的手术时间差异无统计学意义(P＞0.05),观察组的术中出血量明显少于对照组,差异有统计学意义(P＜o.05),观察组术后排气时间、术后疼痛时间和住院时间均比对照组更短,差异有统计学意义(P＜0.05).观察组和对照组并发症发生率分别为9.09％和22.73％,差异有统计学意义(P＜0.05).两组患者3年内局部复发、远处转移、种植转移和总生存率差异均无统计学意义(P＜0.05).结论:腹腔镜手术治疗结肠癌有效、安全,具有创伤小,恢复快,并发症少等优点,适合临床广泛应用.     

商环在糖尿病患者包皮环切术中的疗效观察

目的:评估商环在糖尿病患者包皮环切术中的临床疗效及其安全性.方法:选择54例拟行包皮环切术的糖尿病合并包茎的患者,其中26例采用传统包皮环切术(对照组),28例采用商环包皮环切术(商环组),分析和比较两组患者的手术时间、术中出血量、术后疼痛程度、术后恢复时间和术后感染的发生率.结果:对照组与商环组患者的手术时间分别为(28±7)和(9±2)分钟(P＜0.05),术中出血量分别为(6.2±2.0)和(0.4±0.5)ml(P＜0.05),术后疼痛视觉模拟评分分别为(5.3±1.5)和(3.9±1.3)分(P＜0.05),术后恢复时间分别为(12±4)和(19±5)天(P＜0.05),术后感染率分别为7.7％和10.7％(P＞0.05).与传统组相比,商环组患者的手术时间显著缩短,术中出血显著减少,术后疼痛显著减轻,术后恢复时间显著延长,但术后感染率无明显增加.结论:对糖尿病患者采用商环行包皮环切术,手术时间短、出血少,疼痛轻,术后恢复时间较长但护理方便,术后感染率无明显增加,是一项便捷、安全、有效的手术方式.     

内、外侧肱骨远端解剖钢板手术治疗肱骨髁上及髁间粉碎性骨折

目的:探讨内、外侧远端解剖钢板手术治疗肱骨髁上及髁间粉碎性骨折临床效果及安全性.方法:选取我院骨科2009年3月-2012年5月收肱骨髁上及髁间粉碎性骨折患者80例,采用随机数字表法分为Y型钢板组和双钢板组,每组各40例;分别采用Y型钢板内固定治疗和内外远端解剖钢板内固定治疗;比较两组患者术后临床改善优良率及术后并发症发生情况等.结果:Y型钢板组和双钢板组患者临床改善优良率分别为80.0％,100.0％;双钢板组患者临床改善优良率明显优于Y型钢板组,组间比较差异显著(P＜0.05);同时Y型钢板组和双钢板组患者术后不良并发症发生率分别为22.5％,5.0％;双钢板组患者术后并发症发生率明显低于Y型钢板组,组间比较差异显著(P＜0.05).结论:相较于Y型钢板,内、外侧肱骨远端解剖钢板手术治疗肱骨髁上及髁间粉碎性骨折临床效果确切,能够有效缓解疼痛,改善肘关节活动范围,同时术后并发症风险降低,具有较高临床应用价值.     

术前肠外营养对有营养风险的肝胆管结石病患者预后的影响

目的:研究术前预防性营养支持对有营养风险的肝胆管结石病病患者术后的影响,为临床上合理应用营养支持提供临床指导.方法:依据入选及排除标准选取我院共60例肝胆管结石病病患者做研究对象,采用术前肠外营养进行营养支持(为实验组);与同期进行手术治疗的60例肠内营养肝胆管结石病痛患者做对照组,观察两组术前、术后肝功能指标变化,血清白蛋白、前白蛋白变化,并发症发生率、死亡率情况,并进行对比分析.结果:两组术后2d AST、ALT、TBIL指标明显高于术前,差异明显有统计学意义(P＜0.05).两组间AST、ALT、TBIL、DBIL术前、术后2d比较无明显差异,无统计学意义(P＜0.05);术后8d对照组明显低于实验组(P＜0.05).两组术后ld血清白蛋白(ALB)、前白蛋白(PAB)均较术前显著下降(P＜0.05);两组术后8d血清白蛋白(ALB)、前白蛋白(PAB)均有明显增高,差异明显有统计学意义(P＜0.05).两组并发症发生率比较差异明显,有统计学意义(P＜0.05).结论:对于有营养风险的肝胆管结石病病患者采取恰当预防性的营养支持,有降低手术对肝功能的影响、减少不良并发症发生率、降低死亡率的明显效果.     

双J管在上尿路梗阻性疾病中的应用(附64例报告)

目的:探讨双J管在上尿路梗阻性疾病中应用疗效及并发症防治.方法:对64例复杂性肾结石、输尿管结石、肾孟榆尿管连接部狭窄者在上尿路应用双J管进行内支架和内引流,并随访观察.结果:1例双J管自动脱落,1例因异物排斥反应提前拔管.无明显腰痛酸胀及膀胱刺激症状,手术病人无切口感染和尿漏,无1例双J管堵塞、滞留.置管3月后,患者肾脏功能与形态均有明显改善或恢复正常.结论:双J管在上尿路疾病中疗效肯定,并发症少,易于掌握,可缩短住院时间,值得推广应用.     

快速流程管理对老年直肠癌术后康复的影响

目的:探讨快速流程管理对老年直肠癌术后康复的影响.方法:选择40例患者,随机分为两组,观察组实施快速流程管理,主要分为7个步骤,对照组则实施常规管理,比较两组患者术后康复指标:胃管拔除时间、进流质时间、进普食时间以及尿管拔除时间等,比统计两组发生的并发症情况.结果:观察组胃管拔除时间快于对照组(P＜0.05),进流质时间快于对照组(P＜0.05),进普食时间快于对照组(P＜0.05),尿管拔除时间快于对照组(P＜0.05),两组患者发生吻合口瘘的比率差异无统计学意义(P＞0.05),发生吻合口出血的比率差异无统计学意义(P＞0.05),发生肺部感染的比率差异无统计学意义(P＞0.05),发生发热的比率差异无统计学意义(P＞0.05).结论:对老年直肠癌术后实施快速流程管理,能有效促进患者术后恢复,且并不增加术后并发症,是一种安全有效的方法.     

经咬肌颌后路治疗髁突中低位骨折的疗效分析

目的:研究观察经咬肌颌后路对髁突中低位骨折的临床疗效分析.方法:将我院从2008年1月至2012年1月收治的200例髁突中低位骨折患者按随机数表法均分为实验组100例(采用经咬肌颌后路进行治疗),对照组100例(采用耳颞部入路治疗).随访跟踪1年,观察统计骨折恢复情况和治疗疗效及并发症.结果:实验组手术时间、住院时间、术后并发症发生率均低于对照组,组间差异在住院时间和术后并发症上有统计学差异(P＜0.05);实验组总有效率达90.0％,对照组为74.0％,组间差异有统计学意义(P＜0.05);实验组复诊率为19.4％,低于对照组26.1％,满意度78.5％,高于对照组66.3％,后遗症发生少于对照组,组间差异有统计学意义(P＜0.05).结论:经咬肌颌后路能有效治疗髁突中低位骨折,疗效值得肯定.     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Photoregulation of seed germination of wild-type and of an aurea-mutant of tomato

Seed germination of an aurea mutant of tomato ( Lycopersicon esculentum Mill.) is promoted by continuous irradiation with red, far-red or long-wavelength far-red (758 nm) light as well as by cyclic irradiations (5 min red or 5 min far-red/25 min darkness). Far-red light applied immediately after each red does not change the germination behaviour. Seed germination of the isogenic wild-type, cv. UC-105, is promoted by continuous and cyclic red light while it is inhibited by continuous and cyclic far-red light and by continious 758 nm irradiation. Far-red irradiation reverses almost completely the promoting effect of red light. The promoting effect (in the aurea mutant) and the inhibitory effect (in the wild-type) of continuous far-red light do not show photon fluence rate dependency above 20 nmol m⁻² s⁻¹. It is concluded that phytochrome controls tomato seed germination throgh low energy responses in both the wild type and the au mutant. The promoting effect of continuous and cyclic far-red light in the au mutant can be attributed to a greater sensitivity to P_fr.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

Interconnection of parameters of regulation system of lipid peroxidation and of morphophysiological parameters of mouse liver

A complex analysis of seasonal fluctuations of the mean group parameters of the system of regulation of lipid peroxidation has been performed in liver of Balb/c mice. Association of lipid characteristics and morphophysiological parameters is studied in the Balb/c mouse liver. An inter-connection is revealed between the liver index and the amount of lysoforms of phospholipids, the scale and character of the interconnection differing essentially depending on proportion of phos-phatidylcholine in mouse liver phospholipids.     

The effects of glutamine of the maintenance of embryogenic cultures of Cryptomeria japonica

Summary Embryogenic tissues of sugi (Cryptomeria japonica) were induced on a modified Campbell and Durzan (CD) medium containing 1 μM 2,4-dichlorophenoxyacetic acid (2,4-D) and 600 mg l⁻¹ glutamine, and subcultured in the medium of the same composition for over 1 yr. This resulted in a mixed culture of embryogenic and non-embryogenic cells. When embryogenic cells were isolated and cultured independently, their capacity to form embryogenic aggregates was lost. Thus, the non-embryogenic cells present within a mixed culture system were essential to the formation of embryogenic aggregates. When embryogenic tissues were isolated and cultured independently on a high glutamine-containing (2400 mg l⁻¹) medium, dry weights and endogenous levels of glutamine increased, and the tissue could generate a large number of embryogenic aggregates. Amino acid analysis of embryogenic and non-embryogenic cells from the maintenance culture indicated a higher level of glutamine was present in the latter. The high endogenous level of glutamine in the non-embryogenic portion of mixed cell masses may be the supplier of glutamine for maintaining the embryogenic property of the tissues.     

Specificity of action of piperidylcholine derivatives as substrates of cholinesterases of various origin

The review deals with study of enzymologic properties of a novel highly specific acetylcholinesterase substrate, N-(β-acetoxyethyl) piperidinium iodomethylate (“piperidylcholine”), and its 30 derivatives that were tested as effectors of cholinesterases of mammals and various species of Pacific squids. It was proven for the first time that responsible for specificity of action was structure of cyclic ammonium grouping of the alcohol part of molecule of the ester substrate. Analysis of specificity is performed based on enzymatic hydrolysis parameters—activity of catalytic center of cholinesterases and bimolecular constant of the reaction rate that are determined at optimal and low substrate concentrations. Among the specially synthesized group of thioester compounds there is revealed one more highly specific acetylcholinesterase substrate—N-(β-acetoxyethyl) piperidinium.     

Physiological characteristics of various species of strains of carboxydobacteria

Seven strains of aerobic carbon monoxide-oxidizing bacteria (carboxydebacteria) when growing on CO as sole source of carbon and energy had doubling times which ranged from 12–42 h. The activity profiles obtained after discontinuous sucrose density gradient centrifugation indicated that the CO-oxidizing enzymes are soluble and the hydrogenases are membrane-bound in all strains examined. The CO-oxidizing enzymes of Pseudomonas carboxydohydrogena, Pseudomonas carboxydoflava, Comamonas compransoris, and the so far unidentified strains OM2, OM3, and OM4 had a molecular weight of 230,000; that of Achromobacter carboxydus amounted to 170,000. The molecular weights of the CO-oxidizing and H₂-oxidizing enzymes turned out to be identical. The cell sonicates were shown to catalyze the oxidation of both CO and H₂ with methylene blue, thionine, phenazine methosulfate, toluylene blue, dichlorophenolindophenol, cytochrome c or ferricyanide as electron acceptors. Methyl viologen, benzyl viologen, FAD⁺, FMN⁺, and NAD(P)⁺ were not reduced. The spectrum of electron acceptors was identical for all strains tested. Neither free formate, hydrogen nor oxygen gas were involved in the CO-oxidation reaction. Methylene blue was reduced by CO at a 1:1 molar ratio. The results indicate that CO-oxidation by carboxydobacteria is catalyzed by identical or similar enzymes and that the reaction obeys the equation CO+H₂OCO₂+2H⁺+2e^- as previously shown for Pseudomonas carboxydovorans.Dedicated to Otto Kandler remembering almost three decades of enjoyable cooperation     

Modulation of allostery of pyruvate kinase by shifting of an ensemble of microstates

Since the introduction of the concepts of allostery about four decades ago, much advancement has been made in elucidating the structure-function correlation in allostery. However, there are still a number of issues that remain unresolved. In this review we used mammalian pyruvate kinase (PK) as a model system to understand the role of protein dynamics in modulating cooperativity. PK has a triosephosphate isomerase (TIM)(α/β)₈ barrel structural motif. PK is an ideal system to address basic questions regarding regulatory mechanisms about this common (α/β)₈ structural motif. The simplest model accounting for all of the solution thermodynamic and kinetic data on ligand-enzyme interactions involves two conformational states, inactive E^T and active E^R. These conformational states are represented by domain movements. Further studies provide the first evidence for a differential effect of ligand binding on the dynamics of the structural elements, not major secondary structural changes. These data are consistent with our model that allosteric regulation of PK is the consequence of perturbation of the distribution of an ensemble of states in which the inactive E^T and active E^R represent the two extreme end states. Sequence differences and ligands can modulate the distribution of states leading to alterations of functions. The future work includes: defining the network of functionally connected residues; elucidating the chemical principles governing the sequence differences which affect functions; and probing the nature of mutations on the stability of the secondary structural elements, which in turn modulate allostery.