What is the best age to circumcise? A medical and ethical analysis

Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.     

早期乳腺癌保乳手术与改良根治手术的临床效果比较

目的：比较早期乳腺癌保乳手术与改良根治手术的临床效果,探讨治疗早期乳腺癌的最佳手术方案。方法：选择早期乳腺癌患者138例,根据自愿的原则,分为保乳组（Bcs）和根治组（MRS）,保乳组采取保乳手术方案,根治组采用改良根治手术方案,比较两组患者手术时间、术中出血量、切口长度、住院时间、术后并发症、美容效果满意率及患者预后情况。结果：两组患者手术时间、术中出血量、切口长度、住院时间、术后并发症、美容效果满意率比较,差异具有（高度）统计学意义（P〈0．01,P〈0．05）;术后12个月、18个月和24个月复发或死亡例数比较,差异无统计学意义（P〉0．05）。结论：早期乳腺癌患者外科手术治疗时,应首选保乳手术方式治疗。     

后腹腔镜保留肾单位手术术式对术肾肾功能的影响

目的：探讨后腹腔镜保留肾单位手术（LNSS）术式对术肾肾功能的影响。方法：2009年1月-2010年12月行经后腹膜途径腹腔镜保留肾单位手术例26。男16例,女10例。随访时间〉1年的有18例。年龄40-70岁。肾细胞癌23例,肾嫌色细胞癌2例,肾平滑肌瘤1例。肿瘤直径2.6-3.2cm,平均2.9cm。所有患者术中阻断肾动脉,剪刀切除肿瘤。术中肾动脉阻断时间20-30min,平均26.4分钟。分别于术前、术后2周、术后3月、术后1年测定双肾显像、血清肌酐、血清胱抑素。结果：18例患者术肾术前GFR及占总GFR的比例分别为53.2±7.8 ml/min和50.7±3.6%,术后两周GFR及占总GFR的比例分别为31.2±8.9 ml/min和35.8±5.8%,术后3月GFR及占总GFR的比例分别为34.7±8.6 ml/min和38.4±5.3%,术后1年GFR及占总GFR的比例分别为41.1±9.7 ml/min和43.2±6.2%。血清肌酐及血清胱抑素术前术后对比因为受对侧肾功能的影响不能反映对分肾功能的影响。结论：LNSS术式对于直径小于4cm的肾早期肿瘤是切实可行的。     

糖原磷酸化酶BB在心脏直视手术后心肌损伤中的判定价值

目的:探讨糖原磷酸化酶BB对心脏直视手术后心肌损伤的判定价值.方法:108例行心脏瓣膜置换手术患者,分别于围术期多个时点取桡动脉血,测定血清糖原磷酸化酶BB、心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CKMB)的水平,并检测心肌细胞凋亡程度.结果:血清糖原磷酸化酶BB于体外循环主动脉开放后最早达峰值,其峰值与cT...     

小型猪体外循环下心脏手术的麻醉

目的研究医学手术实验用小型猪体外循环下心脏手术的麻醉管理及麻醉效果。方法实验用小型猪34例,分为CPB下停跳组手术组（停跳组,18例）及CPB下并行手术组（并行组,16例）,行自体心包片三尖瓣置换术。记录实验中麻醉药物及血管活性药用量,基础麻醉、麻醉维持及麻醉苏醒时间,术后3天、一周存活状况等,并评价基础麻醉及全麻效果。结果 34例均在全麻下顺利完成手术,各期血流动力学平稳,仅停跳组一例术后3天内死亡,存活率97.1%,麻醉效果良好。结论合理的麻醉药物与血管活性药物的联合应用,仔细的临床观察与正确而迅速的处理是小型猪体外循环下心脏手术麻醉的关键。     

系列硬质胆囊镜的研发

中国医生提出的硬镜微创保胆取石（息肉）新概念,对于治疗胆囊结石和胆囊息肉取得较好的临床效果。目前国内外没有专门针对胆囊病手术所设计的内镜设备。专门为胆囊病手术的发展而研发的系列硬质胆囊镜及其配套附件,已经获得多项国家专利授权,并成功在国家认定的药物临床试验机构中应用手术120多例。     

Implantation of Radiotelemetry Transmitters Yielding Data on ECG, Heart Rate, Core Body Temperature and Activity in Free-moving Laboratory Mice

The laboratory mouse is the animal species of choice for most biomedical research, in both the academic sphere and the pharmaceutical industry. Mice are a manageable size and relatively easy to house. These factors, together with the availability of a wealth of spontaneous and experimentally induced mutants, make laboratory mice ideally suited to a wide variety of research areas.In cardiovascular, pharmacological and toxicological research, accurate measurement of parameters relating to the circulatory system of laboratory animals is often required. Determination of heart rate, heart rate variability, and duration of PQ and QT intervals are based on electrocardiogram (ECG) recordings. However, obtaining reliable ECG curves as well as physiological data such as core body temperature in mice can be difficult using conventional measurement techniques, which require connecting sensors and lead wires to a restrained, tethered, or even anaesthetized animal. Data obtained in this fashion must be interpreted with caution, as it is well known that restraining and anesthesia can have a major artifactual influence on physiological parameters^{1, 2}.Radiotelemetry enables data to be collected from conscious and untethered animals. Measurements can be conducted even in freely moving animals, and without requiring the investigator to be in the proximity of the animal. Thus, known sources of artifacts are avoided, and accurate and reliable measurements are assured. This methodology also reduces interanimal variability, thus reducing the number of animals used, rendering this technology the most humane method of monitoring physiological parameters in laboratory animals^{3, 4}. Constant advancements in data acquisition technology and implant miniaturization mean that it is now possible to record physiological parameters and locomotor activity continuously and in realtime over longer periods such as hours, days or even weeks^{3, 5}.Here, we describe a surgical technique for implantation of a commercially available telemetry transmitter used for continuous measurements of core body temperature, locomotor activity and biopotential (i.e. onelead ECG), from which heart rate, heart rate variability, and PQ and QT intervals can be established in freeroaming, untethered mice. We also present pre-operative procedures and protocols for post-operative intensive care and pain treatment that improve recovery, well-being and survival rates in implanted mice^{5, 6}.     

急性胰腺炎患者腹腔镜胆囊切除术的时机研究

目的：探讨急性胰腺炎胆囊切除术的有效性及时机。方法：分别对患有急性胰腺炎而进行腹腔镜胆囊切除的38例患者的临床信息进行了研究。结果：首先对38例病人进行了3-15天非手术的保守治疗,当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,进行胆囊切除。手术时间为30分钟到90分钟（平均时间60分钟）,手术中无转化和严重并发症症状发生。对这38例病人随访6到56周后无复发现象发生。结论：当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,急性胰腺炎胆囊切除术是有效且可行的。在中国患有急性胰腺炎的患者中,进行腹腔镜胆囊切除的占50％～70％。胆结石治疗取决于患者胰腺炎的严重性,及患者是否患有梗阻性黄疸。对于非梗阻性胰腺炎的患者,早期是否要进行明确的手术治疗尚无定论。我院患有急性胰腺炎的38例患者进行腹腔镜胆囊切除术（2004年2月到2009年4月之间）后取得了满意的效果。详情如下。     

胃转流术后远端肠黏膜形态及生长因子表达的变化

目的：探讨胃转流术后远端肠管黏膜的适应性变化及生长因子的表达情况。方法：将8周龄的Wistar大鼠随机分为对照组、假手术组和胃转流术组,术后8周取吻合口远端肠管行常规病理切片检查,测量肠黏膜厚度和绒毛高度,采用免疫荧光法检测肠粘膜中表皮生长因子（EGF）和胰岛素样生长因子-1（IGF—1）的表达。结果：胃转流术组黏膜厚度（672±39与500±31um,P〈0．01）和绒毛高度（445±19与342±15um,P〈0．01）均显著高于假手术组（P〈0．01）,而对照组和假手术组间均无显著差异。与假手术组比较,胃转流术组肠粘膜中EGF和IGF-1的表达显著升高（P〈0．01）,而对照组和假手术组间无显著差异。结论：胃转流术后远端肠管粘膜发生适应性增生,同时伴随着EGF和IGF—1表达水平的升高。     

周六手术在医院运行管理中的价值和意义

目的 通过开展周六手术,缩短病人平均术前等待日及平均住院日。在保证医疗质量的前提下,达到提高效率,增加产能的目的。方法 在多部门协作的基础上,开展周六手术,改变原有人力配置方式和手术流程,以配合周六手术的进行。结果 手术流程再造后,与之前同期相比术前等待日缩短25.00%, 月平均手术台次增加12.35%, 病人平均住院日降低9.22%。结论 开展周六手术,能缩短患者平均住院日和术前等待日,为患者节约宝贵的时间和金钱,在一定程度上解决了患者看病难、看病贵的问题,提高了医院的工作效率。