伤椎单侧椎弓根置钉联合对侧椎弓根椎体内植骨治疗胸腰段脊柱骨折

本文通过探讨经伤椎椎弓根单侧置钉后路钉棒系统内固定联合对侧椎弓根椎体内植骨在胸腰段脊柱骨折中的疗效,得出结论:胸腰段脊柱骨折经单侧伤椎椎弓根椎体植骨联合伤椎对侧椎弓根置钉内固定后,可恢复伤椎椎体高度,重建脊柱的稳定性,防止术后远期椎体高度和矫正Cobb角的再丢失以及内固定的松动、断裂.     

骨髓呈再生障碍性贫血样表现的低增生性白血病

目的 探讨低增生性白血病与再生障碍性贫血的鉴别诊断要点,以减少误诊.方法 回顾性分析我院收治的1例低增生性白血病的临床资料.结果 本例因反复牙龈出血2年,皮肤淤斑1个月入院.首次行骨髓穿刺(骨穿)及活检提示再生障碍性贫血可能,再次行骨穿及活检提示急性单核细胞白血病可能,后经流式细胞仪检测与多次多部位骨穿及活检确诊为低增生性白血病,予预激方案化疗两疗程,患者骨髓象未缓解,放弃治疗自动出院.结论 临床上低增生性白血病与再生障碍性贫血表现相似,易混淆.对可疑患者行外周血涂片同时,需结合多次多部位骨穿及活检的多项检查结果进行综合判断,以避免误诊.     

Suppression of EphB4 improves the inhibitory effect of mTOR shRNA on the biological behaviors of ovarian cancer cells by down-regulating Akt phosphorylation

The aim of the present study was to examine the effects of suppression of EphB4 and/or mTOR on the biological behaviors of ovarian cancer cells, and the potential regulatory pathways. An-tisense EphB4 vectors and shRNA vectors targeting mammalian target of rapamycin (mTOR) were constructed and transfected into A2780 and SKOV3 cells (two ovarian cancer cell lines). The effects of the antisense EphB4 vectors and the shRNA vectors on the proliferation, apoptosis and invasion of ovarian cancer cells were measured, and the expression of EphB4, mTOR and Akt detected. The results showed that transfection with mTOR shRNA could inhibit growth, induce apoptosis, and reduce invasive ability of ovarian cancer cells, which was accompanied by downregulation of EphB4, mTOR and Akt. The inhibitory effects on cell growth caused by mTOR shRNA alone were weaker than those by antisense pEGFP-C1-EphB4. In the antisense pEGFP-C1-EphB4-transfected cells, it was found that EphB4 knockdown could decrease the mTOR expression and slightly reduce the Akt phosphorylation. Significant suppressive effects on cell growth were observed in cells co-transfected with antisense pEGFP-C1-EphB4 and mTOR shRNA. In co-transfection group, the expression levels of EphB4, mTOR and Akt were distinctly lower than those in other groups. It was concluded that suppression of EphB4 may inhibit the growth of ovarian cancer cells by downregulation of the PI3K/Akt/mTOR pathway, and reverse Akt phosphorylation induced by mTOR shRNA. Inhibition of EphB4 and mTOR combined may cooperatively suppress the biological behaviors of ovarian cancer cells.     

Hyper-CVAD方案治疗成年人T淋巴母细胞淋巴瘤的临床分析

 【摘要】　目的　提高对Hyper-CVAD方案治疗成年人T淋巴母细胞淋巴瘤（TLL）的认识。方法　总结7例采用Hyper-CVAD方案治疗的成年TLL患者的转归。结果　7例患者中,1例因未完成首次化疗并未行相关后续治疗最后死亡;1例自体干细胞移植前骨髓获得完全缓解,移植后骨髓复发;3例一直获得完全缓解;2例患者复发后由于配型和经济原因,未实施异基因骨髓移植,使用ICE方案及重复原方案,疗效均不佳,自动放弃继续治疗。结论　成年人TLL应早期发现、早期治疗,并重视一些特异性的辅助检查,明确治疗的选择与淋巴瘤分期无关及腰椎穿刺鞘内注射的重要性,化疗周期应规律,确保足程化疗次数,纵隔占位者可在接受4个周期Hyper-CVAD化疗后对纵隔肿块直径＞5 cm的患者进行放疗,最后选择合适的移植方式进行移植。     

慢性NK细胞淋巴增殖性疾病一例并文献复习

目的 深入认识慢性NK细胞淋巴增殖性疾病（CLPDNK）的临床特点、诊断、鉴别诊断及治疗.方法 观察1例确诊的CLPDNK,并进行文献复习.结果 该例患者为中老年男性,呈惰性临床经过,临床表现主要为心脏损害及贫血,根据血象及流式细胞术免疫分型结果及病程可明确诊断,治疗主要以糖皮质激素为主,患者对激素治疗效果好.结论 CLPDNK是罕见的NK细胞疾病,以外周血成熟NK细胞慢性扩增为特点.外周血和骨髓可见到大颗粒淋巴细胞,免疫表型提示：sCD3-CD56＋/-CD16＋,且无TCR重排,临床呈惰性病程,预后较好,但有转变为侵袭性NK细胞白血病的可能.     

急诊救治濒死及危重创伤伤员127例

目的：探讨早期抢救濒死危重创伤伤员的意义及措施．方法：回顾性分析总结１９７９年１月～１９９６年１０月共１２７例濒死危重创伤伤员的急诊救治资料．结果：多发伤占８１．１％，平均存活概率（ＴＲＩＳＳ）为０．４０８７±０．９２６１．１９例死于术中或术毕（１５．０％），６例死于脓毒症（４．７％），１２例死于多器官功能衰竭（９．４％）．急诊抢救成活率达７０．９％．结论：早期采取不间断的、彻底的综合复苏措施，包括实施确定性抢救手术、及时恢复脏器有效血流灌注和改善组织微循环状态是临床抢救濒死危重伤员生命、预防创伤后继发性损伤的基础．     

内毒素血症中降钙素基因相关肽的变化及其对血流动力学的影响

观察了内毒素血症时血浆降钙素基因相关肽（ＣＧＲＰ）的变化及其与血流动力学改变的关系。结果表明，用辣椒素抑制ＣＧＲＰ再注射内毒素时，血浆ＣＧＲＰ的释放量仅为内毒素血症对照组的３９．１％，同时动物的平均动脉压（ＭＡＰ）、中心静脉压（ＣＶＰ）和总末梢阻力（ＴＰＲ）的降低幅度明显减少（分别为８７．５０±６．５７，３．８７±０．８８，３．０４±０．２７ｋＰａ）。当再次注射ＣＧＲＰ时，随着血浆ＣＧＲＰ含量的增加，ＭＡＰ、ＣＶＰ和ＴＰＲ又明显降低（分别６３．７５±５．１８，０．６０±１．５３，２．２８±０．２８ｋＰａ）。３组动物的血浆ＣＧＲＰ变化差值与ＭＡＰ的变化差值呈显著的负相关（分别为ｒ＝－０．８３９０，ｒ＝－０．８３６８，ｒ＝－０．９５６４；Ｐ＜０．０５，０．０５，０．０１），但与ＣＯ的变化差值无相关（分别ｒ＝０．３７５１，ｒ＝－０．２５７８，ｒ＝０．２２５８；Ｐ＞０．０５）。提示内毒素血症ＣＧＲＰ直接参与对血流动力学改变的作用，但并不直接影响心肌功能的改变。