金属钛夹治疗急性非静脉曲张性上消化道出血

目的评价金属钛夹对急性非静脉曲张上消化道山血（ANVUGIB）的疗效及安全性。方法在电子胃镜下对52例ANVUGIB施行金属钛夹止血治疗，观察止血效果及有无并发症。结果所有ANVUGIB病例经胃镜下金属钛夹治疗后立刻止血。仅有2例术后再次出血，再次给予钛夹钳夹后成功止血。所有病例术后恢复良好，无穿孔等并发症。结论金属钛夹治疗AN-VUGIB疗效显著，安全可靠。     

肠淋巴再灌注对肠系膜上动脉闭塞性休克多器官损伤的影响

目的：观察肠淋巴再灌注（MLR）对肠系膜上动脉闭塞性（SMAO）休克大鼠血压、存活率以及器官功能的影响。方法:Wistar雄性大鼠均分为4组：sham组，仅麻醉与手术；MLR组，夹闭肠系膜淋巴管（ML）1 h，再灌注2 h；SMAO组，夹闭肠系膜上动脉（SMA）1 h，再灌注2 h；MLR+SMAO：夹闭ML和SMA1 h，再灌注2 h。观察3 h期间平均动脉血压（MAP）变化后，观察肺、肝、肾、心肌功能和形态学变化。记录24 h存活率。结果:①sham、MLR、SMAO组大鼠24 h存活率（分别为100%、83.3%、66.7%）显著高于MLR+SMAO组（0%）。②夹闭SMA或ML前10 min，组间MAP无差异；SMAO组MAP在夹闭后多个时点显著高于MLR+SMAO和sham组；再灌注后，MLR和sham组MAP无明显变化，SMAO和MLR+SMAO组MAP迅速下降，后逐渐回升，SMAO组多个时点低于MLR和sham组，MLR+SMAO组在所有时点均低于MLR、sham和SMAO组。③MLR+SMAO组天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、尿素氮（BUN）、肌酐（Cre）、乳酸脱氢酶-1（LDH-1）、肌酸激酶同工酶（CK-MB）均显著高于sham组、MLR组、SMAO组，且SMAO组的这些指标显著高于sham组、MLR组。形态学观察显示sham组与MLR组的肺、肝、心、肾结构基本正常，SMAO组各脏器有一定的组织学损伤，而MLR+SMAO组则可见炎症、出血、核浓缩、破碎等严重病变。结论:MLR可加剧SMAO休克多个器官损伤，肠淋巴途径在SMAO休克的发病学中具有重要作用。     

内镜下金属钛夹联合立止血治疗上消化道出血的临床分析

目的探讨内镜下金属钛夹联合粘膜下注射和喷洒立止血治疗上消化道出血的临床效果。方法收集160例24 h内急诊内镜检查的非食管胃底静脉曲张破裂的上消化道出血病人,随机分为两组,每组各80例。内镜下单纯采用金属钛夹治疗者为对照组,内镜下金属钛夹联合粘膜下注射和喷洒立止血治疗者为治疗组。结果与内镜下单纯采用金属钛夹的治疗方法相比,内镜下采用金属钛夹联合粘膜下注射和喷洒立止血治疗非食管胃底静脉破裂的上消化道出血病例效果显著,两组的立即止血率、第二次止血率和止血成功率比较有统计学差异（P〈0.05）;而两组的止血无效率和外科手术率比较无统计学差异（P〉0.05）。结论内镜下联合使用金属钛夹及粘膜下注射和喷洒立止血是治疗非食管胃底静脉曲张破裂引起的上消化道出血的一种有效措施,其安全可靠、并发症少、操作简易、止血效果确切,值得临床推广与运用。     

非共面容积旋转调强技术在左侧乳腺癌保乳术后全乳加锁骨区放疗中的剂量学研究

目的:分析非共面容积旋转调强（nVMAT）技术与容积旋转调强（VMAT）技术在左侧乳腺癌保乳术后全乳加锁骨区放疗中的剂量学差异。方法:选取10例临床上接受VMAT的左侧乳腺癌保乳术后患者，采用nVMAT技术重新计划，比较靶区剂量学参数，危及器官心脏、全肺、对侧乳腺的Dmean，脊髓、冠状动脉Dmax，心脏V20、V30，左肺V5、V20以及气管V30、V40。结果:nVMAT计划在临床靶区（P-CTV）均匀性、心脏Dmean、全肺Dmean、对侧乳腺Dmean、冠状动脉Dmax方面优于VMAT计划，差异具有统计学意义（P<0.05）；靶区（P-CTV、P-GTV）适形度及心脏V30，左肺V20，气管V30、V40方面略优，但无统计学差异（P>0.05）；机器跳数明显增加（P<0.05）；脊髓Dmax略有增加，但差异不显著（P>0.05）。结论:nVMAT技术可使靶区剂量更均匀，并改善危及器官的剂量，其中心脏Dmean及冠状动脉Dmax显著降低。     

铱源驻留步长对宫颈癌三维近距离治疗计划的影响

目的:研究宫颈癌近距离治疗计划设计中,铱源驻留步长选择对计划评估及剂量稳定性的影响。方法:选取在安徽省肿瘤医院接受治疗的15例宫颈癌患者,均接受Fletcher型施源器植入的铱源高剂量率CT引导下近距离治疗。按照驻留步长大小分别为每位患者制定4组计划（Plan_1 mm、Plan_3 mm、Plan_5 mm和Plan_7 mm）,对比治疗时长,靶区D100、D90和V100和危及器官D2 cc、SF系数等参数。模拟计算施源器发生脚向3 mm移位时剂量分布,分析施源器移位对不同驻留步长近距离治疗计划剂量学的参数影响。结果:不同驻留步长治疗计划的高危靶区（HRCTV）剂量学参数差异不明显（P>0.05）,而Plan_1 mm、Plan_3 mm的中危靶区（IRCTV）的D100、D90、V100和治疗时长均大于Plan_5 mm,且差异有统计学意义（P<0.05）;Plan_5 mm计划中危及器官SF参数的平均值和中位值最小;Plan_5 mm在施源器移位后HRCTV和IRCTV的D90平均降幅最小,分别为2.88%和0.91%。结论:宫颈癌近距离治疗计划的制定应选择合适的铱源驻留步长,使得治疗计划不仅满足剂量评估要求,还具有一定的剂量传递稳定性。     

心肌超声造影心动图对高强度聚焦超声左心室心肌消融心肌坏死范围的评价

目的探讨心肌超声造影心动图评价高强度聚焦超声（HIFU）左心室心肌消融心肌坏死范围的可行性。方法新西兰兔9只,兔龄8～12个月,体质量（3.0±0.2）kg（2.8～3.5 kg）。HIFU治疗频率1.5 MHz,强度9.64 kW/cm2,脉冲照射方式,Ton=0.2 s、0.3 s,Toff=1.0 s、1.5 s,重复次数20次,靶区范围3 mm×2 mm。照射后行左心室心肌超声造影心动图,然后取下心脏,做2mm心肌切片,用2,3,5-三苯基氯化四氮唑（TTC）染色。测量造影剂充盈缺损面积及与之相对应心肌切片TTC染色心肌坏死面积,并计算其占整个心肌的面积百分比。结果造影剂充盈缺损面积百分比（13.7%±6.7%）与TTC染色心肌坏死面积百分比（15.5%±4.9%）间差异无统计学意义（P〉0.05）;两者间呈显著相关（r=0.94,P〈0.05）。结论心肌超声造影心动图可用于评价HIFU左心室心肌消融心肌坏死范围。     

乳腺导管内增生性病变中ER、Ki-67和cyclin D1的表达

目的 探讨ER、Ki-67和cyclin D1在乳腺导管内增生性病变中的表达及意义。方法 采用免疫组化和免疫荧光双标记法对56例乳腺导管内增生性病变进行ER、 Ki-67和cyclin D1染色标记。结果 正常乳腺组织中仅有散在的少数上皮细胞呈ER阳性表达。在普通型导管增生（usual ductal hyperplasia，UDH）中ER表达比正常乳腺组织增加，但ER阳性细胞呈不连续分布，阳性细胞间有较多的阴性细胞。非典型性导管增生（atypical ductal hyperplasia，ADH）和低级别原位导管癌（ductal carcinoma in situ，DCIS）中ER表达比UDH明显增加（P〈0．05），ER阳性细胞呈连续的片状分布，阳性细胞间较少或没有ER阴性细胞。ADH和低级别DCIS中ER表达较高级DCIS显著（P〈0．01）。DCIS中Ki-67和cyclin D1表达高于UDH（P〈0．05），并与UDH、ADH和DCIS的组织学分组呈正相关（r=0．352，P〈0．05和r=0．390，P〈0．05）。正常乳腺组织中上皮细胞内无ER和Ki-67同时表达。在UDH中有极少数上皮细胞ER和Ki-67同时表达，而在ADH和DCIS中ER和 Ki-67同时表达的细胞明显增加。结论 从正常乳腺组织到UDH、ADH、低级DCIS的恶性转化过程中伴有ER表达的逐渐增高。ER过度表达及ER和Ki-67在上皮细胞内同时表达可能是某些乳腺癌发生过程中的早期事件。     

成都地区中老年人高脂血症患者血清HDL亚类组成的研究

目的：探讨中老年人高脂血症患者血清HDL亚类组成和相对百分含量的变化及其与血脂水平的关系。方法： 采用双向电泳-免疫印迹检测法按年龄分层分析了172例中老年人高脂血症患者及115例正常中老年对照血清HDL亚类组成及相对百分含量。结果: 中老年人高脂血症患者血清中小颗粒的preβ1-HDL、HDL3b、HDL3a含量显著高于对照组（P＜0.01或P＜0.05），而大颗粒的HDL2b含量显著低于对照组（P＜0.01）；正常健康中老年人发现随着年龄的增长，preβ1-HDL有逐渐升高的趋势，HDL2b有降低的趋势，中老年高脂血症患者及正常对照，各年龄组中均可见男性preβ1-HDL含量显著高于女性（P＜0.05），HDL2b含量显著低于女性（P＜0.05）。此外，相关分析发现中老年人高脂血症组小颗粒的preβ1-HDL含量与患者血清TG、TC、apoB100、apoCⅡ、apoCⅢ、apoE水平及TG/HDL-C比值呈显著正相关（r=0.432；r=0.243；r=0.341；r=0.259；r=0.335；r=0.308及r=0.453，P＜0.05或P＜0.01），与HDL-C水平呈显著负相关（r=－0.167，P＜0.05）；与此相反，大颗粒的HDL2b水平与TG、TC、apoCⅡ、apoCⅢ、apoE水平及TG/HDC比值呈显著负相关（r=－0.296；r=－0.156；r=－0.182；r=－0.216；r=－0.203及r=－0.313，P＜0.05或P＜0.01），而与HDL-C水平呈显著正相关（r=0.124，P＜0.05）。结论: 中老年人高脂血症患者血清HDL亚类颗粒呈变小趋势，且男性HDL颗粒较女性小，中老年高脂血症患者胆固醇逆向转运过程可能减弱。     

凝血酶敏感蛋白-1在2型糖尿病心肌病大鼠心肌中的表达及意义

目的： 探讨凝血酶敏感蛋白-1（TSP-1）在2型糖尿病心肌病（DCM）发病中的作用。方法： 采用高脂高热量饮食诱导出胰岛素抵抗，加小剂量链脲佐菌素注射建立DCM动物模型，12周后采用Masson染色、免疫组织化学染色、实时定量逆转录－聚合酶链反应、Western blotting技术，检测左室心肌胶原含量、TSP-1 mRNA和蛋白质表达水平的变化。结果： DCM大鼠左室心肌组织胶原含量明显高于对照组（11.01±3.05 vs 16.92±3.18，P<0.01），TSP-1 mRNA和蛋白表达水平均明显高于对照组（0.0089±0.0034 vs 0.0141±0.0037，P<0.05；96.38±16.80 vs 129.98±16.96，P<0.05）；TSP-1 mRNA水平与血糖、心肌组织胶原含量、LVEDP均呈正相关（r=0.762，P<0.01；r=0.717，P<0.05；r=0.658，P<0.05）；与LVSP、-dp/dtmax均呈负相关（r=-0.605，P<0.05；r=-0.694，P<0.05）；TSP-1蛋白质表达水平与血糖、心肌组织胶原含量、LVEDP均呈正相关（r=0.735，P<0.01；r=0.750，P<0.01；r=0.716，P<0.05）；与LVSP、-dp/dtmax均呈负相关（r=-0.633，P<0.05；r=-0.669，P<0.05）。结论： 心肌组织TSP-1高表达在DCM心肌间质纤维化的发生中起着重要的作用。     

孕激素诱导耐药的子宫内膜癌细胞生物学特性的比对分析

目的 探讨孕激素诱导耐药子宫内膜癌细胞的生物学特征，为治疗耐药子宫内膜癌提供实验依据。方法 以子宫内膜癌Ishikawa细胞（IS）为母代，建立孕激素耐药细胞（PR）；通过CCK8、流式细胞术对比PR细胞与IS细胞的表型特征；通过RT-PCR、Western blotting、PCR+毛细管电泳、RNA测序技术进行PR细胞、富含AT的结合域1A(ARID1A)敲除细胞（ARID1A KO）和MUTL同源物1(MLH1)敲除细胞（MLH1 KO）的B型孕激素受体（PRB）表达量、ARID1A表达量、微卫星不稳定（MSI）、基因转录组的检测对比。结果 与IS细胞相比，PR细胞凋亡率增高（P=0.026,P<0.05）、G0/G1期细胞比例增高（P=0.041,P<0.05）及S期细胞比例降低（P=0.018,P<0.05），差异有统计学意义，PR细胞增殖率差异无统计学意义（P=0.07）；与IS细胞相比，PR细胞的ARID1A m RNA和蛋白表达量差异无统计学意义（分别为P=0.79和P=0.64）,PR细胞无MSI,ARID1A KO和MLH1 KO细胞中PRB的mR...     

Level of interest in video clips modulates event-related potentials to auditory probes.

This study examined whether a participant's level of interest in visual materials could be assessed by event-related potentials to auditory probe stimuli. Twelve young adults performed an auditory target detection task while viewing either interesting or less interesting (neutral) silent video clips. The auditory probe stimuli consisted of target (2000 Hz, p=0.15), standard (1800 Hz, p=0.70), and nontarget deviant (500 Hz, p=0.15) tones. Button press responses to target tones were required. Both target and deviant tones elicited a large P3 wave, the amplitude of which was smaller while participants were viewing interesting video clips than neutral video clips or simple still images (control condition). The amplitude reduction of the P3 to deviant tones was more prominent than that of the P3 to target tones. The difference between the neutral and control conditions was significant only for the deviant P3. The three-tone probe task using perceptually deviant, nontarget stimuli may be a useful objective method to assess how strongly a visual material attracts the viewer's attention.     

Adsorption of peroxidase on titanium surfaces: A pilot study

The present study demonstrates the in vitro and in vivo adsorption of peroxidase onto titanium surfaces. Titanium foils (mean +/- SEM: 365 +/- 2 mm(2), n = 114) were incubated during 30 min with lactoperoxidase (4 mg in 5 mL 100 mM phosphate buffer pH 7). After 15 washings by H(2)O, titanium foils were incubated with o-phenylenediamine (6 mg/mL) and H(2)O(2) (7 mM) during 30 min. The reaction was then stopped by the addition of HCI 1M and the absorbance of the liquid phase was read on a spectrophotometer at 492 nm. In vitro adsorbed lactoperoxidase onto titanium surfaces was 0.70 +/- 0.05 ng/mm(2) (mean +/- SEM, n = 30). X-ray photoelectron spectroscopy confirmed the incorporation of protein nitrogen onto titanium surfaces: the nitrogen atomic percentage increased from 0.9 +/- 0.3 to 12.7 +/- 0.2% (n = 3) and from 3.7 +/- 0.1 to 14.4 +/- 0. 4% (n = 5) when titanium foils were incubated in the lactoperoxidase solution during 30 min and 24 h respectively. In vivo, oral peroxidases adsorbed on titanium healing abutments from 0.01 to 0.58 ng/mm(2) (n = 19) after 2 weeks in the oral environment.     

Extravasal occlusion of large vessels with titanic clips: efficiency,indications, and contraindications

The mechanism of extravasal occlusion of blood vessels with titanic clips "Atrauclip" and "Ligaclip extra" was studied in order to reveal indications and contraindications to their use. Occlusion with the clips of both types was ineffective in vessels with a diameter of >7.0 mm. Arteritis or the presence of an intravascular occlusion facility in the vessel were also the contraindications for clip occlusion. In overcases the procedure of occlusion with titanic clips was efficient and atraumatic.     

Statistical analysis of fiber area in human skeletal muscle.

Previous research has indicated that 50 fiber measurements per individual for type I and II fibers would be sufficient to characterize the fiber areas. This study replicated the work of McCall et al. (1998) using the three major fiber types (I, IIA, and IIB) and sampling larger populations of fibers. Random blocks of fibers were also examined to investigate how well they correlated with the overall mean average fiber area. Using random blocks of 50 fibers provided an accurate reflection of the type IIB fibers (r = 0.96-0.98) but not for the type I (r = 0.85-0.94) or IIA fibers (r = 0.80-0.91). Type I fibers were consistently reflected by a random block of 150 fibers (r = 0.95-0.98) while type IIA fibers required random blocks of 200 fibers (r = 0.94-0.98), which appeared to provide an accurate reflection of the cross-sectional area. These results indicate that for a needle biopsy different numbers of fibers are needed depending on the fiber type to accurately characterize the mean fiber population.     

MRI to assess chemoprevention in transgenic adenocarcinoma of mouse prostate (TRAMP)

Background

The application of advanced 3T MRI imaging techniques to study recovery after subarachnoid hemorrhage (SAH) is complicated by the presence of image artifacts produced by implanted aneurysm clips. To characterize the effect of these artifacts on image quality, we sought to: 1) quantify extent of image artifact in SAH patients with implanted aneurysm clips across a range of MR sequences typically used in studies of volumetry, blood oxygen level dependent signal change (BOLD-fMRI), and diffusion-weighted imaging (DW-MRI) and 2) to explore the ability to reconstruct white matter pathways in these patients.

Methods

T1- and T2-weighted structural, BOLD-fMRI, and DW-MRI scans were acquired at 3T in two patients with titanium alloy clips in ACOM and left ACA respectively. Intensity-based planimetric contouring was performed on aligned image volumes to define each artifact. Artifact volumes were quantified by artifact/clip length and artifact/brain volume ratios and analyzed by two-way (scan-by-rater) ANOVAs. Tractography pathways were reconstructed from DW-MRI at varying distances from the artifacts using deterministic methods.

Results

Artifact volume varied by MR sequence for length (p = 0.007) and volume (p < 0.001) ratios: it was smallest for structural images, larger for DW-MRI acquisitions, and largest on fMRI images. Inter-rater reliability was high (r = 0.9626, p < 0.0001), and reconstruction of white matter connectivity characteristics increased with distance from the artifact border. In both patients, reconstructed white matter pathways of the uncinate fasciculus and inferior fronto-occipital fasciculus were clearly visible within 2 mm of the artifact border.

Conclusions

Advanced 3T MR can successfully image brain tissue around implanted titanium aneurysm clips at different spatial ranges depending on sequence type. White matter pathways near clip artifacts can be reconstructed and visualized. These findings provide a reference for designing functional and structural neuroimaging studies of recovery in aSAH patients after clip placement.     

Prediction of cancer potency using a battery of mutation and toxicity data

Correlations between the carcinogenic potencies of 146 known mouse carcinogens and potency estimates determined from (i) Ames test results, (ii) a battery of mutation test results, and (iii) a battery of mutation and toxicity data are presented. The lowest correlation was found using Salmonella mutagenic potency (r = 0.37). The highest correlations were found using the battery of mutation and toxicity data to predict the potency of lung carcinogens (r = 0.94) and liver carcinogens (r = 0.91). The results suggest that short-term batteries which include tests for both mutagenicity and toxicity will be able to predict carcinogenic potency better than current batteries relying solely on mutagenicity tests.     

Initial cytotoxicity of novel titanium alloys

We assessed the biological response to several novel titanium alloys that have promising physical properties for biomedical applications. Four commercial titanium alloys [Super-TIX(R) 800, Super-TIX(R) 51AF, TIMETAL(R) 21SRx, and Ti-6Al-4V (ASTM grade 5)] and three experimental titanium alloys [Ti-13Cr-3Cu, Ti-1.5Si and Ti-1.5Si-5Cu] were tested. Specimens (n = 6; 5.0 x 5.0 x 3.0 mm(3)) were cast in a centrifugal casting machine using a MgO-based investment and polished to 600 grit, removing 250 mum from each surface. Commercially pure titanium (CP Ti: ASTM grade 2) and Teflon (polytetrafluoroethylene) were used as positive controls. The specimens were cleaned and disinfected, and then each cleaned specimen was placed in direct contact with Balb/c 3T3 fibroblasts for 72 h. The cytotoxicity [succinic dehydrogenase (SDH) activity] of the extracts was assessed using the MTT method. Cytotoxicity of the metals tested was not statistically different compared to the CP Ti and Teflon controls (p > 0.05). These novel titanium alloys pose cytotoxic risks no greater than many other commonly used alloys, including commercially pure titanium. The promising short-term biocompatibility of these Ti alloys is probably due to their excellent corrosion resistance under static conditions, even in biological environments.     

Improved neo-endothelialization of small diameter ePTFE grafts with titanium coating

BACKGROUND: Patency of small synthetic bypass grafts is inferior compared to autologous grafts for revascularization procedures. Titanium coating of foreign surfaces has shown to decrease thrombogenicity, enhance biocompatibility and promote adhesion of endothelial cells. The aim of this study was to test the effect of titanium coating of small diameter ePTFE grafts on short term patency, neo-endothelialization and neointimal proliferation. METHODS: Bilateral carotid graft interposition was performed in 5 pigs with uncoated (n=5) and titanium-coated (n=5) ePTFE grafts (internal diameter=4 mm, length=5 cm), thus each pig served as its own control. At the end of the study (30 +/- 3 days), patency and stenosis severity was assessed by carotid angiography. Animals were sacrificed and grafts were excised for histology and scanning electron microscopy. Morphometry of histologic sections was carried out to determine neointimal proliferation and percentage of neo-endothelial coverage. RESULTS: Patency rate was 80% for uncoated and titanium-coated grafts. Quantitative angiography did not show any significant difference in lumen size between two groups. Morphometry revealed a significantly higher cellular coverage with CD31 positive endothelial cells for titanium-coated (84 +/- 19%) than uncoated grafts (48 +/- 26%, p<0.001). There was a non significant trend (p=0.112) towards increased neointimal proliferation in titanium-coated (94 +/- 61 micron2/micron) compared to uncoated grafts (60 +/- 57 micron2/micron). CONCLUSIONS: Patency rate in uncoated and titanium-coated ePTFE grafts is similar at one month. However, titanium coated grafts show a significant improvement in neo-endothelialization compared to uncoated grafts.