内科胸腔镜下胸膜活检术常用于胸膜疾病的诊断和肿瘤的分期，内镜下新型成像技术的应用使胸膜病变更易于观察。传统的内科胸腔镜下胸膜活检应用可弯曲钳夹检，获取标本小，组织结构挤压变形严重，耗时长，且部分组织获取困难。近年来，部分学者使用新的活检方式在内科胸腔镜下对胸膜病变进行活检，获得优质的病理标本。本文主要从冷冻、海博刀、IT刀及SB刀在内科胸腔镜下胸膜活检术中的应用进行综述，使临床医师了解并应用胸膜活检的新方法。

目的 建立RP-HPLC法同时测定用于干预刀豆蛋白A(ConA)诱导的小鼠急性免疫性肝损伤的山茱萸萜类制剂(液体制剂)中莫诺苷、马钱苷、山茱萸新苷、齐墩果酸及熊果酸5种活性成分,为山茱萸萜类成分及其相关制剂的质量控制提供方法.方法 采用RP-HPLC法,Zorbax SB-C18柱(150 mm×4.6 mm,5μm)色谱柱;以乙腈-添加2 mmol/Lγ-环糊精的0.1％磷酸水溶液为流动相,梯度洗脱;体积流量1.0 mL/min;柱温30℃;检测波长240、360、210 nm;进样量3μL.结果 莫诺苷、马钱苷、山茱萸新苷、齐墩果酸及熊果酸的线性范围分别为10.42～333.33、23.44～750.00、9.11～291.67、10.42～333.33、13.02～416.67mg/L;供试样品中莫诺苷、马钱苷、山茱萸新苷、齐墩果酸及熊果酸的平均回收率为95.60％～98.02％,RSD为1.47％～1.89％;重复性试验RSD为1.46％～1.71％;稳定性试验RSD为1.29％～1.76％;6批山茱萸萜类制剂中含有莫诺苷、马钱苷、山茱萸新苷、齐墩果酸及熊果酸的平均质量浓度分别为669.6～680.2、850.1～869.5、94.1～96.4、164.3～166.1、85.6～87.6 mg/L.结论 该方法简便、灵敏度高、重复性好、回收率高,可用于检测山茱萸萜类制剂中莫诺苷、马钱苷、山茱萸新苷、齐墩果酸及熊果酸.

背景:经口内镜下肌切开术(POEM)目前已被广泛用于治疗贲门失弛缓症(AC)且效果显著.然而,POEM手术操作难度大,术后并发症发生率高.目的:探讨Flush刀和SB刀在POEM治疗AC中的有效性和安全性.方法:选取2013年4月-2017年4月武汉大学人民医院确诊为AC且接受POEM治疗的111例患者,将其分为Flush刀组、SB刀组和Dual刀组.比较三组手术相关指标、并发症和术后随访等方面的差异.结果:111例AC患者均顺利完成了POEM,三组平均手术时间、平均止血次数和平均更换设备的次数相比差异有统计学意义(P均＜0.05),进一步两两比较显示,Flush刀组和SB刀组上述手术相关指标均明显低于Dual刀组(P均＜0.05).三组术后并发症发生率相比差异有统计学意义(P=0.005),进一步两两比较显示,SB刀组显著低于Dual刀组(P=0.011),而Flush刀组与Dual刀组无明显差异(P=0.056).三组手术治疗成功率无明显差异(P＞0.05).结论:Flush刀和SB刀能有效缩短POEM治疗AC的手术时间,且其成功率与常规Dual刀相似.

研究嗜虫书虱触角的超微结构及其在交配行为中的作用,对于其生物学和行为学具有重要的意义.本研究利用Quanta 250型扫描电镜对嗜虫书虱触角超微结构进行研究,在LeiCAEZ4HD型解剖镜下用WPI500374型显微剪刀分别剪去雌、雄虫触角及触角不同部位后,利用Smartzoom 5型超景深显微镜观察其交配行为.研究结果表明,嗜虫书虱雌、雄虫触角形态类似,均属于线状触角,由柄节、梗节和鞭节组成,鞭节分13个亚节,成虫触角感受器主要有微毛形感受器、刺形感受器(SC1、SC2)、锥形感受器(SB1、SB2)和B(o)hm氏鬃毛4类感受器6种形态,绝大部分触角感受器分布在雌雄触角的背面、腹面和外侧面,两性间触角感器的类型和分布无明显差异,但数量差异明显(雌、雄虫感受器的数量分别约为8280和7240).嗜虫书虱触角在交配行为中起到重要的作用,其中雌虫触角的梗节在交配过程中起主要作用,其次是柄节,再次是鞭节;雄虫触角的鞭节部位起着主要的作用,其次是柄节和梗节.结合其交配行为并参考其他昆虫触角感受器的研究结果,推测雌虫触角柄节和梗节上分布的B(o)hm氏鬃毛和雄虫触角鞭节上分布的微毛形感受器在两性识别中起着主要作用,雌、雄虫触角上分布的两种刺形感受器(SC1、SC2)和两种锥形感受器(SB1、SB2)在交配过程中有机械感受的作用.本研究结果为嗜虫书虱的行为生物学、化学生态学和电生理学的研究提供参考.

Objective To evaluate the short?term efficacy and cosmetic effect of dual?port laparoscopic distal gastrectomy (DPLDG) for gastric cancer. Methods Thirty consecutive patients underwent DPLDG at the Department of General Surgery,Nanfang Hospital from November 2016 to August 2018. Inclusion criteria:(1)age of 18 to 75 years;(2)primary gastric adenocarcinoma confirmed pathologically by endoscopic biopsy;(3)tumor located at middle?low stomach and planned for distal gastrectomy;(4)cT1b?2N0?1M0 at preoperative staging;(5)tumor diameter ≤3 cm;(6)US Eastern Cancer Cooperative Group(ECOG)score 0 to 1 points;(7)American Society of Anesthesiologists grade I to II;(8) perioperative management based on enhanced recovery after surgery (ERAS) principle. Exclusion criteria:previous upper abdominal surgery(except laparoscopic cholecystectomy),history of other malignant disease,and body mass index ≥30 kg/m2. A self?developed single?incision,multiport, laparoscopic surgery Trocar(Surgaid Medical,Xiamen,China,comprising 3 channels for observation, main surgeon and assistant surgeon)was placed through a 3?4 cm incision under or at the left side of the umbilicus. An additional 5 mm Trocar was inserted under the rib margin of the right clavicle to serve as the secondary operating hole and the position of the drainage tube. The liver was suspended to expose the surgical field clearly. Surgical procedure was as follows:conventional laparoscopic instruments were used. After entering the omental sac,dissection was performed along the transverse colon to the spleen flexure. Left gastroepiploic vessels were identified and then ligated at the root. No.4sb lymph nodes were dissected. The No.4d lymph nodes were dissected along the greater curvature of the stomach. Then the dissection was continued rightward to the hepatic flexure to separate mesogastrium and mesocolon. The right gastroepiploic artery was ligated at the root to allow the removal of No. 6 lymph nodes. The duodenal bulb was transacted by liner stapler,the right gastric artery was ligated at the root and the No. 5 lymph nodes were removed. Peritoneal trunk,common hepatic artery,splenic artery and left gastric artery and vein in posterior pancreatic space at upper pancreas were separated,then left gastric vessels were ligated,and No.9,No.8a,No.11p and No.7 lymph nodes were dissected. The left side wall of portal vein was exposed and No. 12a lymph nodes were removed. No. 1 and No. 3 lymph nodes were dissected along the lesser curvature. The stomach corpus was transacted by liner stapler at 4?5 cm proximal end of the tumor. Roux?en?Y anastomosis or Billroth II anastomosis was performed in the cavity. A drainage tube was placed near the gastrojejunal anastomosis through the right upper abdomen secondary operating hole. Postoperative short?term efficacy(operation time,blood loss,5?port conversion rate,open conversion rate,number of retrieved lymph nodes,time to postoperative first flatus,time to first soft diet intake, time to removal of drainage tube, postoperative hospital stay, postoperative analgesics use, and postoperative 30?day complication rate)and cosmetic scale(questionnaire:degree of satisfaction with scar,description of scar,grade of scar;total score ranged from the lowest 3 to the highest 24;the higher the better) were evaluated in all 30 patients. Results No serious complication and death were observed intraoperatively. The mean operative time was(197.8±46.9)minutes. The median blood loss was 30 ml(quartile 31.25 ml). The mean number of retrieved lymph node was 38.7±14.1. Five?port conversion rate was 3.3%(1/30),and no open conversion occurred. Mean time to postoperative first flatus,time to first soft diet intake,time to removal of drainage tube and postoperative hospital stay were(45.3±18.9) hours,(87.6±35.6)hours,(101.8±58.0)hours and(6.1±2.1)days,respectively. Twenty?four(80%) of patients had no additional analgesics use. The postoperative complication rate within 30 days was 16.7%(5/30). Postoperative overall cosmetic score was 22.1±1.3,and cosmetic score of 96.7%(29/30) of patients was 18 to 24. Conclusion DPLDG is safe and feasible with advantages of faster postoperative recovery,reducing pain and better cosmetic outcomes.