【摘要】 目的 探讨医院产前超声检查中应用知情同意书的价值。 方法 对2002年1月-2010年1月经产前超声常规筛查并分娩出生缺陷儿（均为基层医院常规超声筛查难以显示或无法诊断的先天性异常）的产妇，按实行知情同意前后分为两组：实施前的有21例（A组），实施后的有19例（B组），比较两组出生缺陷儿产妇对产后结果的反映情况。 结果 B组产妇对产前超声筛查理解13例，可以理解4例，难以理解2例；A组理解3例，可以理解5例，难以理解13例，两组理解程度差异有统计学意义（Z=-3.741，P=0.000）。 结论 知情同意书是产前超声检查过程中孕妇对医方理解及对孕妇负责的必要手段。 【Abstract】 Objective To explore the value of informed consent in prenatal ultrasonographic examination. Methods Between January 2002 and January 2010, the puerperants who underwent routine screening by prenatal ultrasonography in our hospital and delivered the birth of babies with defects (conventional ultrasound screening in basic-level hospitals hard to display or unable to diagnosis of congenital anomaly) were selected. The patients were divided into two groups according to whether had informed consent. The responses after the parturition (having babies with defects) of the puerperants between the two groups were compared. Results The puerperants in informed consent group had more objective understanding of prenatal ultrasonographic examination, and better acceptance level of the results of ultrasonography. Conclusion Informed consent of prenatal ultrasonography process is necessary.
Objective To summarize the research progress on diagnostic criteria of lymph node metastasis in medullary thyroid carcinoma (MTC), and the indication and scope of lateral cervical lymph node dissection (LCLND). Method By searching PubMed and CNKI databases, the related guidelines and literature about the diagnosis and treatment of lateral cervical lymph node metastasis in MTC in recent years were obtained and reviewed. Results The metastatic rate of lateral cervical lymph nodes in MTC patients was high. The indication of LCLND was both consensus and controversy. The LCLND of MTC was also controversial, and the focus of controversy mainly focused on the survival rate, recurrence rate, distant metastasis and postoperative complications of patients receiving prophylactic LCLND. Different imaging methods had their own advantages and disadvantages in diagnosing lymph node metastasis of MTC. Nuclear medicine was effective but expensive. Fine needle puncture was also an effective method for the diagnosis of lymph node metastasis of MTC. At present, calcitonin level, tumor size and lymph node metastasis were still important indicators for evaluating MTC for prophylactic LCLND, but the application of related indications had not been unified. Many scholars recommended comprehensive consideration of various indicators to evaluate whether MTC carried out preventive LCLND. Conclusions The LCLND of MTC needs to be further explored and standardized on the basis of the existing consensus. The focus of prophylactic LCLND should be to improve the survival rate of patients while reducing complications as much as possible.
目的 探讨直肠癌前切除术吻合口漏的原因及对策。方法 对符合行直肠前切除术的73例直肠癌患者行全直肠系膜切除术,用双吻合器技术（double-stapling technique,DST）吻合结直肠。2004年1月以后收治的病例特别注意了会阴助推、 远侧直肠密闭试验、吻合器穿刺头穿刺点的选择、吻合口漏气试验和经肛门至结肠及经腹壁至吻合口旁放置引流管的技术细节。结果 全组2例(2.74%)发生吻合口漏，均为2004年1月以前的病例，1例经横结肠造瘘治愈，另1例经引流管冲洗治疗治愈； 2004年1月以后的65例无吻合口漏发生。结论 注意直肠癌前切除术中的一些技术细节， 可在一定程度上降低全直肠系膜切除条件下DST吻合的吻合口漏发生率。
ObjectiveTo investigate the anti-apoptotic ability of synovium-derived mesenchymal stem cells (SMSCs) by comparing the apoptosis induced by tumor necrosis factor α (TNF-α) between SMSCs and bone marrow mesenchymal stem cells (BMSCs). MethodSMSCs and BMSCs were isolated with tissue adhering and density gradient centrifugation respectively, and cells at passages 3-5 were used in further experiments. After immunophenotype identification and differentiation induction, cells were divided into 4 groups. In the experimental groups, apoptosis of SMSCs and BMSCs were induced by 20 ng/mL TNF-α and 10 μg/mL cycloheximide, and cells were cultured in normal culture medium in the control groups. Cellular morphology were observed by inverted phase contrast microscope. After apoptosis induction for 24 hours, cell viability was determined by cell counting kit 8 assay and apoptotic index was detected by flow cytometer. Moreover, the level of Cleaved Caspase-8, 3 were determined by Western blot. ResultsBoth SMSCs and BMSCs accorded with the definition criteria of MSCs according to results of immunophenotype identification and differentiation induction. After apoptosis induction, cells became shrinking and partially floated and cellular morphologies became worse than those in the control groups. After apoptosis induction for 24 hours, cell viabilities of SMSCs and BMSCs in the control groups were both 100%, and no apoptotic cells were observed. However, cell viabilities of SMSCs and BMSCs in the experimental groups were 60.13%±8.63% and 46.55%±10.54% respectively, which were both significantly lower than those in the control groups (P<0.05) , and cell viability in the SMSCs experimental group was significantly higher than that in the BMSCs experimental group (t=3.152, P=0.006) . The apoptotic index was 36.54%±8.63% in the SMSCs experimental group and was 53.77%±11.52% in the BMSCs experimental group, both were significantly higher than the control groups (1.12%±0.24% and 1.35%±0.31%) (P<0.05) . What's more, it was significantly lower in SMSCs experimental group than that in BMSCs experimental group (t=3.785, P=0.001) . Moreover, no expression of Cleaved Caspase-8, 3 was detected in the control groups. But the levels of Cleaved Caspase-8, 3 were significantly enhanced in the experimental groups and they were lower in SMSCs than in BMSCs (t=13.870, P=0.000; t=7.309, P=0.000) . ConclusionsTNF-α induced apoptosis is lower in SMSCs than in BMSCs, which means that SMSCs may have stronger anti-apoptosis ability than BMSCs.
Objective To investigate the synergistic interaction between the deltoid muscle and the rotator cuff muscle group in patients with rotator cuff tears (RCT), as well as the impact of the critical shoulder angle (CSA) on deltoid muscle strength. Methods A retrospective analysis was conducted on clinical data from 42 RCT patients who met the selection criteria and were treated between March 2022 and March 2023. There were 13 males and 29 females, with an age range of 42-77 years (mean, 60.5 years). Preoperative visual analogue scale (VAS) score was 6.0±1.6. CSA measurements were obtained from standard anteroposterior X-ray films before operation, and patients were divided into two groups based on CSA measurements: CSA>35° group (group A) and CSA≤35° group (group B). Handheld dynamometry was used to measure the muscle strength of various muscle group in the shoulder (including the supraspinatus, infraspinatus, subscapularis, and anterior, middle, and posterior bundles of the deltoid). The muscle strength of the unaffected side was compared to the affected side, and muscle imbalance indices were calculated. Muscle imbalance indices between male and female patients, dominant and non-dominant sides, and groups A and B were compared. Pearson correlation analysis was used to examine the relationship between muscle imbalance indices and CSA as well as VAS scores. Results Muscle strength in all muscle groups on the affected side was significantly lower than on the unaffected side (P<0.05). The muscle imbalance indices for the supraspinatus, subscapularis, infraspinatus, and anterior, middle, and posterior bundles of the deltoid were 14.8%±24.4%, 5.9%±9.7%, 7.2% (0, 9.1%), 17.2% (5.9%, 26.9%), 8.3%±21.3%, and 10.2% (2.8%, 15.4%), respectively. The muscle imbalance indices of the anterior bundle of the deltoid, supraspinatus, and infraspinatus were significantly lower in male patients compared to female patients (P<0.05); however, there was no significant difference in muscle imbalance indices among other muscle groups between male and female patients or between the dominant and non-dominant sides (P>0.05). There was a positive correlation between the muscle imbalance indices of infraspinatus and VAS score (P<0.05), and a positive correlation between CSA and the muscle imbalance indices of middle bundle of deltoid (P<0.05). There was no correlation between the muscle imbalance indices of other muscle groups and VAS score or CSA (P>0.05). Preoperative CSA ranged from 17.6° to 39.4°, with a mean of 31.1°. There were 9 cases in group A and 33 cases in group B. The muscle imbalance indices of the anterior bundle of the deltoid was significantly lower in group A compared to group B (P<0.05), while there was no significant difference in muscle imbalance indices among other muscle groups between group A and group B (P>0.05). ConclusionPatients with RCT have a phenomenon of deltoid muscle strength reduction, which is more pronounced in the population with a larger CSA.