重复异位妊娠的临床处理策略

为了探讨重复异位妊娠适宜的临床治疗方案,对2006年1月至2006年12月我科收治的251例异位妊娠中42例重复异位妊娠患者的资料进行回顾性分析,资料显示:重复异位妊娠的发病率为16.7%(42/251),平均发病年龄30.7岁,42例患者中异位妊娠部位与上次发生在同侧输卵管12例,对侧输卵管30例,两次异位妊娠发生间隔的时间最短为2个月,最长为9年,平均3.2年。其中10例为第3次异位妊娠。此次患病手术治疗25例,包括切除输卵管13例,保守性手术12例。因盆腔炎症和保守性手术是重复异位妊娠的危险因素,预防和彻底治疗盆腔炎症是降低重复异位妊娠发生的重要手段,采取保守性治疗或保守性手术时应慎重考虑其对患者将来生育和心理的影响。     

重复异位妊娠的临床处理策略

为了探讨重复异位妊娠适宜的临床治疗方案,对2006年1月至2006年12月我科收治的251例异位妊娠中42例重复异位妊娠患者的资料进行回顾性分析,资料显示:重复异位妊娠的发病率为16.7%(42/251),平均发病年龄30.7岁,42例患者中异位妊娠部位与上次发生在同侧输卵管12例,对侧输卵管30例,两次异位妊娠发生间隔的时间最短为2个月,最长为9年,平均3.2年.其中10例为第3次异位妊娠.此次患病手术治疗25例,包括切除输卵管13例,保守性手术12例.因盆腔炎症和保守性手术是重复异位妊娠的危险因素,预防和彻底治疗盆腔炎症是降低重复异位妊娠发生的重要手段,采取保守性治疗或保守性手术时应慎重考虑其对患者将来生育和心理的影响.     

强脉冲光子脱毛并发症的防治

为了探讨强脉冲光的脱毛疗效与并发症之间的关系,应用SpaTouchTM 强脉冲光脱毛仪去除体表多余毛发,一般需要3次～5次治疗,每次治疗间隔1个月～2个月,记录每例疗效及并发症发生的情况。结果显示,332例中434个部位接受治疗,患者均能耐受,无需麻醉,治疗后可正常工作及生活。有26个部位出现并发症,总发生率5.99%。10例治疗后出现红斑,15例出现水疱,1例出现色素沉着。末次治疗6个月后随访,422个部位治疗后毛发基本完全脱落,部分患者有少数细软毳毛再生,总有效率为97.24%。因此,强脉冲光脱毛效果可靠、操作简单、快捷、并发症少,是一种理想的脱毛方法。并发症发生原因主要是治疗时光斑能量过大,治疗前应进行测试,选择个体化光斑能量以减少并发症的发生。     

汉字识别中的部位部件效应

汉字整体呈现时对某部位上部件的识别成绩可能优于或劣于另一部位上部件,这种现象称为汉字部位部件效应,简称部位部件效应。目前有四种作业方式可以观察到这一效应：整字呈现时识别指定部位部件;整字呈现时搜索指定部位部件;速示方式下抽取汉字构件(笔画的部分、笔画和笔画组合等);微观发生方式下抽取汉字构件。部位部件搜索时,右部件比左部件容易…;在速示方式下,往往抽取左右结构字的右下角的笔画,     

系统论在胰腺外科中的意义

胰腺作为一个消化器官,不过是人体中很小的部分,但由于胰腺在人体内发挥的重要作用以及在人体中的重要解剖毗邻关系,胰腺外科为广大普外科医生关注的焦点,成为普外科研究的热点问题。将系统论的整体性、联系性、有序性、综合性、动态性、最优化等原则运用到胰腺外科临床及科研工作中去,能更好地改进胰腺手术技巧和手术方式,能更好地提高胰腺疾病的诊治水平。     

肥胖致心肌脂毒性的机制的研究进展

肥胖是体内脂质过度沉积的一种状态,其不仅可引起糖脂代谢紊乱、胰岛素抵抗,从而继发糖尿病、高血压、冠心病等疾病,而且当脂质水平超过脂肪细胞的储存容量及出现胰岛素抵抗时,血液中游离脂肪酸含量会随之升高,进而可引起脂质在心脏的异位沉积.沉积于心肌细胞的脂质可进一步通过神经酰胺、内质网应激等机制影响心肌细胞的结构和功能,最终导致心力衰竭的发生.但肥胖所致心肌脂毒性具体机制不明,本文就肥胖所致心肌脂毒性可能机制做一综述.     

体外授精—胚胎移植后异位妊娠相关因素研究进展

近年来,随着体外授精一胚胎移植(IVF-ET)技术的蓬勃开展,IVF-ET后异位妊娠(EP)的发病率也随之升高.IVF-ET后EP发生的相关危险因素包括输卵管因素、子宫内膜异位症、授精方式、胚胎移植技术及控制性超排卵等,其中最主要的危险因素是由输卵管因素引起的输卵管功能紊乱.对具有以上危险因素的患者,在行IVF-ET治疗前,应尽量减少危险因素的影响,以提高临床妊娠率,并减少异位妊娠的发生率.本文就近年来对IVF-ET后EP发生的相关危险因素的研究作一综述.     

异位妊娠临床诊疗中的策略与决策

通过异位妊娠的发病率,诊断及治疗中的注意事项,治疗方法的选择的分析,探讨异位妊娠的临床诊断及治疗的策略与决策。为了提高异位妊娠的诊断率、减少误诊率,需要建立合理的临床思维方法和科学的处理程序,为异位妊娠的临床诊断及治疗,提供科学的临床决策方法。     

胰十二指肠切除术后C级胰瘘防治

随着现代医学的发展以及手术技术的进步,胰十二指肠切除手术(PD)的围手术期死亡率不断下降,大部分胰腺中心甚至已经达到小于2%,但术后并发症,比如胰瘘、术后出血、腹腔感染、胃排空障碍等居高不下。其中术后出血和腹腔感染会导致病情危重,有时需要紧急处理,否则危及生命;术后胰瘘是最常见并发症。胰腺术后胰瘘(POPF)发生率3%~45%,可能导致术后出血和腹腔感染,也是导致术后死亡的主要原因。如何防治胰瘘,尤其是防治C级胰瘘,是所有胰腺外科医生共同面临的难题。本文结合临床实践与文献,对胰瘘发生危险因素,以及预防和治疗胰瘘进行探讨。     

关于银屑病动物模型的哲学思考

１银屑病动物模型银屑病是一种慢性炎症性增生性皮肤病。其临床特点［１］是不同部位皮肤反复发生红斑、丘疹、斑丘疹,具同形反应、Ａｕｓｐｉｔｚ征、薄膜现象。人们试图建立一个理想的动物模型,可以模拟银屑病的特征,以便揭示银屑病的病因、发病机理、预防治疗机理...     

妇科恶性肿瘤患者保留女性正常生理功能的思考

妇科医生需重视对妇科恶性肿瘤患者进行保留女性正常生理功能的治疗。对少女、育龄期妇女及早期患者治疗恶性肿瘤的同时,应尽量保留其正常的生理功能。需对患者进行全面评估,严格掌握实施保留生育功能手术的适应证;为预防放化疗对卵巢功能的损害,可以采取卵巢移位、卵巢组织冷冻移植,也可通过辅助生殖技术进行未成熟卵泡培养、卵子冷冻、卵母细胞冷冻及胚胎冷冻等。     

卵巢良性肿瘤诊断与治疗的思考

卵巢肿瘤位于盆腔深处早期没有症状,为临床诊治造成一定困难。如何在早期鉴别诊断卵巢肿瘤的良恶性?对卵巢肿瘤的处理原则有无规律可循?对治疗卵巢肿瘤引起的急腹症有无新的进展?在微创手术中如何保护正常卵巢组织?如何监测评价卵巢功能?本文将重点进行探讨。     

Soft tissue anatomy of the tongue and floor of the mouth: An ultrasound demonstration

Ultrasound technology has not been used extensively in the study of normal and abnormal oral physiology and speech. Features such as soft tissue detail, real-time motion display, and subject safety make ultrasound ideal for imaging the tongue and the floor of the mouth. This study demonstrates visualization of the muscles of the tongue and floor of the mouth for a normal subject using ultrasound imaging. By employing submandibular transducer placement of real-time sector scanners, tongue anatomy and motion were continuously visualized in sagittal or coronal planes. In addition to the entire tongue surface, much of the intrinsic anatomy was identified including: the genioglossus, geniohyoid, mylohyoid, and digastric muscles; fascial boundaries such as the median fibrous septum, floor intermuscular septum, and paramedian septums; and the hyoid bone. A tongue excised from a human cadaver was scanned using ultrasound and dissected to confirm the anatomy seen in the live tongue. Tongue surface shape and configuration of the intrinsic tissue structures were observed and compared for the phonemes /k/, /u/, and /i/. Anatomical landmarks in the resting and speaking tongue are discussed as well as applications in the fields of speech science and speech pathology.     

Effects of obesity and set point on taste responsiveness and ingestion in humans.

Two experiments investigated the relationships among degree of obesity, nearness to set point for adipose tissue mass, and responsiveness to taste. In Experiment 1, subjects rated milkshakes varying in sweetness intensity. Overweight and normal weight subjects did not have significantly different detection thresholds or preference ratings. However, overweight subjects worked longer than normals to obtain their most preferred substance. Experiment 2 varied the ease of tasting the milkshake. Preference and food intake of moderately overweight subjects were significantly more influenced by tastes that they found positive and negative than was the preference of normal weight or obese subjects. The ease of ingesting the taste substance also significantly influenced preference and food intake of the moderately obese only. Nearness to set point, operationally defined as weight stability for 2 years, had no significant effects.     

自闭症谱系障碍个体的疼痛敏感性异常：来自元分析的证据

本研究采用元分析方法, 以疼痛阈限、疼痛诱发生理反应和疼痛评分为结果变量, 考察了自闭症谱系障碍个体(Autism Spectrum Disorder, ASD)的疼痛敏感性异常, 以期为ASD的诊断和干预提供参考。元分析共纳入16项研究(总样本量N = 822)。对于疼痛阈限, ASD组和对照组无显著差异, 但受到疼痛模态等变量的调节作用, 如ASD组的压力疼痛阈限显著低于对照组。对于疼痛诱发生理反应, ASD组对现实医疗疼痛的生理反应强于对照组。然而, ASD组和对照组在疼痛评分上无显著差异。将来研究应结合多模态疼痛刺激和多维度疼痛评估, 系统考察ASD个体的疼痛敏感性及其与临床核心症状之间的联系。     

Definition and classification of cancer: Monothetic or polythetic?

Since the microbiological revolution, most infectious diseases have been defined and classified according to an etiologic criterion, i.e. the identification of single, external “necessary” causes (for example, Mycobacterium for tuberculosis). This is not the case with cancer. Not only external “necessary” causes of cancer have not been identified, but also the morphological classification cannot be based on univocal criteria. Although “neoplasia” and “anaplasia” appear to be universal attributes of cancer, these events are only quantitative. Neoplastic growth can be fast or slow (development may take weeks or years), and tissue pathologies are difficult to detect from normal tissue in some cancers but are obvious in others. Common special properties of anaplasia appear to be concealed in the wide range of morphologies. In the absence of a coherent morphological definition, and of external necessary causes (such as bacteria for infectious diseases), a mechanistic definition could be adopted. However, unless molecular biology discovers specific mechanistic steps in carcinogenesis, which indicate the existence of “necessary” events in carcinogenesis, we cannot adopt a univocal (monothetic) definition of cancer. The alternative is to use a polythetic definition, according to Wittgenstein's model of a “long rope twisted together out of many shorter fibres.”     

Hormonal state affects recovery from frontal cortex lesions in adult female rats

Pseudopregnant and normal cycling female Sprague-Dawley rats were trained on a delayed-spatial alternation task. After acquisition training, the subjects received frontal cortex lesions and were subsequently tested for retention. The pseudopregnant animals with lesions were less impaired than their normal cycling counterparts. Learning and retention testing were not affected by hormonal status in the noninjured controls. Histological examination showed that the normal cycling rats with frontal cortex lesions possessed enlarged ventricles, indicating the presence of edema in this surgical group. However, brain tissue of pseudopregnant subjects given the same lesion and sham operates of both hormonal states did not display this characteristic of edema. We speculate that the behavioral and anatomical impairment observed in the normal cycling females with brain injury is due to higher levels of vasopressin, a potent vasoconstrictor synchronized with brain injury in our manipulation.     

临床肿瘤免疫的研究近况

免疫系统具有特异性破坏肿瘤而不损伤正常组织的能力,并且可以产生长久记忆从而阻止肿瘤复发。过去30年的肿瘤免疫研究充分证明肿瘤可以被免疫系统识别,并且机体免疫监视可以阻止肿瘤的发展或长期控制。目前的临床试验提示免疫治疗可能成为肿瘤治疗非常重要的一部分,试验中发现免疫相关的毒性、疗效评价标准以及观察终点与传统的细胞毒药物及靶向治疗均存在很大的差别。为了充分发挥免疫治疗的疗效,研究者需要更深入地了解肿瘤与宿主免疫反应之间动力学关系以及肿瘤的免疫逃逸机制,识别、评价及处理免疫相关反应。     

Diffusion-tensor imaging of cognitive performance

MR methods have for some years been used to assess cognitive performance. Recently, studies have shown that diffusion-tensor imaging (DTI), which provides noninvasive maps of microscopic structural information of oriented tissue in vivo, is finding utility in studies of cognition in the normal and abnormal aging population. These studies suggest that water proton nonrandom, anisotropic diffusion measured by DTI is highly sensitive to otherwise subtle disease processes not easily seen with conventional MRI tissue contrast mechanisms and raises new issues of the role of MR in assessing cognitive potential.     

Promise and Ontological Ambiguity in the In vitro Meat Imagescape: From Laboratory Myotubes to the Cultured Burger

In vitro meat (IVM), also known as cultured meat, involves growing cells into muscle tissue to be eaten as food. The technology had its most high-profile moment in 2013 when a cultured burger was cooked and tasted in a press conference. Images of the burger featured in the international media and were circulated across the Internet. These images—literally marks on a two-dimensional surface—do important work in establishing what IVM is and what it can do. A combination of visual semiotics and narrative analysis shows that images of IVM afford readings of their story that are co-created by the viewer. Before the cultured burger, during 2011, images of IVM fell into four distinct categories: cell images, tissue images, flowcharts, and meat in a dish images. The narrative infrastructure of each image type affords different interpretations of what IVM can accomplish and what it is. The 2013 cultured burger images both draw upon and depart from these image types in an attempt to present IVM as a normal food stuff, and as ‘matter in place’ when placed on the plate. The analysis of individual images and the collection of images about a certain object or subject—known as the imagescape—is a productive approach to understanding the ontology and promise of IVM and is applicable to other areas of social life.