Histamine and tryptase modulate asthmatic airway smooth muscle GM-CSF and RANTES release.

Degranulating mast cells are increased in the airway smooth muscle (ASM) of asthmatics, where they may influence ASM function. The aim of the present study was to determine whether histamine and tryptase modulate ASM cell granulocyte-macrophage colony-stimulating factor (GM-CSF) and RANTES (regulated on activation, normal T-cell expressed and secreted) release and also to examine which receptors are involved in this release. Confluent, quiescent ASM cells from asthmatic and nonasthmatic donors were treated with histamine (1 microM-100 microM) with and without histamine receptor antagonist pre-treatment, or the protease-activated receptor (PAR)-2 agonists tryptase (0.5-5 nM) and SLIGKV (100 and 400 microM). The cells were then stimulated with interleukin (IL)-1beta and/or tumour necrosis factor (TNF)-alpha (10 ng.mL(-1)) or left unstimulated for 24 h. Release of GM-CSF and RANTES was determined by ELISA and prostaglandin (PG)E(2) measured by enzyme immunoassay. Neither histamine nor tryptase induced ASM GM-CSF or RANTES secretion. However, histamine increased IL-1beta-induced GM-CSF release and markedly reduced TNF-alpha-induced RANTES release by both asthmatic and nonasthmatic cells to a similar extent, but did not modulate PGE(2) release. All changes involved activation of the histamine H1 receptor as they were partially or fully blocked by chlorpheniramine, but not ranitidine. Tryptase, via its proteolytic activity, also potentiated GM-CSF, but not RANTES, release from asthmatic and nonasthmatic ASM cells induced by both cytokines. PAR-2 involvement in the tryptase potentiation was unlikely because SLIGKV had no effect. In conclusion, mast cells, through histamine and tryptase, may locally modulate airway smooth muscle-induced inflammation in asthma.     

选择性子宫动脉栓塞治疗症状性子宫肌瘤

目的:评价选择性子宫动脉栓塞 (U AE)治疗症状性子宫肌瘤 (SUF)的临床疗效。方法:12例 SUF患者行双侧子宫肌瘤供血动脉的栓塞治疗 ,栓塞剂为聚乙烯醇微球颗粒 (PVA)。结果:栓塞成功率 10 0 % ,无严重并发症发生。随访 3～ 2 4个月 ,B超示术后 6个月肌瘤平均缩小 4 5 % ,1例肌瘤消失 ,均伴有月经量的明显减少。 结论 :U AE是治疗 SU F的安全方法 ,近期疗效肯定。     

磁共振胆胰管造影在梗阻性黄疸诊断和治疗中的作用

目的：探讨磁共振胆胰管造影(MRCP)对梗阻性黄疸患梗阻定位和定性的诊断价值及对治疗的指导意义。方法：对48例梗阻性黄疸的患进行MRCP检查，34例(70．8％)行手术治疗，14例(29．2％)行非手术治疗。结果：48例患中45例(93．8％)可通过MRCP明确诊断，并经手术或临床证实；2例(4．1％)硬化性胆管炎需结合其他临床资料做出诊断；1例(2．1％)胆总管结石误诊为胆管癌。结论：MRCP对胆道疾患诊断具有无创性、高灵敏度、高准确率等优点，能为梗阻性黄疸患临床治疗提供有效依据。     

Internal Hernias: Clinical Findings,Management, and Outcomes in 49 Nonbariatric Cases

Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality. Poster presentation at Digestive Disease Week, May 22, 2006, Los Angeles, California, USA.     

应用腹直肌前鞘-腹外斜肌腱膜瓣修复先天性膀胱外翻

目的总结先天性膀胱外翻的修复,探讨腹直肌前鞘—腹外斜肌腱膜瓣及肌蒂阔筋膜张肌肌皮瓣在修复膀胱外翻中的应用。方法应用腹直肌前鞘—腹外斜肌腱膜形成的前鞘—腱膜瓣加局部皮瓣或同侧肌蒂阔筋膜张肌肌皮瓣修复先天性膀胱外翻及腹壁缺损,局部皮瓣修复尿道上裂,肌皮瓣的应用面积最大为10cm×8cm。结果临床应用12例,膀胱外翻及腹壁的修复均达到了良好效果,膀胱括约肌功能基本恢复,二次尿道紧缩后12例均能控制排尿。肌蒂阔筋膜张肌肌皮瓣部分坏死2例,游离植皮后痊愈。结论选择性地应用腹直肌前鞘及腹外斜肌腱膜形成前鞘—腱膜瓣加强腹壁,局部皮瓣转移或应用同侧肌蒂阔筋膜张肌肌皮瓣转移修复腹壁缺损能有效地修复先天性膀胱外翻,恢复膀胱颈部括约肌的连续性及尿道紧缩,能达到自主控制排尿的目的。     

包裹外毒素Ⅲ的VEGF-脂质体靶向杀伤肿瘤血管内皮细胞的实验研究

目的 利用包裹绿脓杆菌外毒素单元Ⅲ的VEGF(血管内皮生长因子)-脂质体于体外靶向杀伤肿瘤血管内皮细胞。方法 通过结合实验。验证VEGF连接脂质体对肿瘤血管内皮细胞具有特异结合能力。利用体外细胞毒实验(MTT)方法，检测外毒素单元Ⅲ及靶向脂质体包裹的单元Ⅲ对肿瘤血管内皮细胞的杀伤作用。结果 连有VEGF的脂质体可与表达血管内皮生长因子受体(VEGFR)的肿瘤血管内皮细胞特异性结合。结合率可达非特异性脂质体的2倍。在去除外毒素单元Ⅰ和Ⅱ后，单元Ⅲ的细胞毒作用消失。但包裹单元Ⅲ的VEGF-脂质体可特异性杀伤肿瘤血管内皮细胞。结论 VEGF-脂质体可特异性地识别肿瘤血管内皮细胞。并作为良好载体将绿脓杆菌外毒素单元Ⅲ带入细胞，实现其杀伤作用，可望成为一种有效的抗肿瘤物质。     

电视纵隔镜和CT对非小细胞肺癌术前分期的诊断性试验的评价

目的 评价电视纵隔镜和CT对非小细胞肺癌术前分期的价值。方法 2002年9月至2003年8月28例肺癌患者术前均行CT检查，颈部纵隔镜检查术23例，胸骨旁纵隔镜检查术5例。肺癌同侧纵隔淋巴结转移N2行新辅助化疗后再手术；对测纵隔淋巴结转移N3行放化疗；阴性者剖胸探查。结果 术前怀疑或已确诊的肺癌共28例中，纵隔镜诊断纵隔淋巴结转移(阳性)20例(鳞癌11例，腺癌9例)，未见纵隔淋巴结转移8例；阳性中同侧纵隔淋巴结转移N2(16例)行新辅助化疗，后再手术；对侧纵隔淋巴结转移M(4例)行放化疗；阴性者剖胸探查，术后病理证实肺腺癌3例、肺鳞癌1例(纵隔淋巴结未见转移与纵隔镜检查结果相符)，肺炎性假瘤2例，肺结核瘤2例。28例肺癌纵隔淋巴结经CT和纵隔镜检查，分别与纵隔淋巴结清扫术后病理对照，CT(诊断标准按淋巴结≥1．0cm为阳性)诊断纵隔淋巴结转移12例，其中7例证实为转移癌，5例为淋巴结炎性反应，CT诊断纵隔淋巴结阴性16例，其中病理证实4例均为转移癌，12例为淋巴结炎性反应；纵隔镜诊断纵隔淋巴结转移20例，术后病理证实20例均为转移癌；诊断8例为淋巴结炎性反应，术后病理证实其中1例纵隔淋巴结转移。CT灵敏度63．6％，特异度70．6％，阳性预测值58．3％，阴性预测值75％；电视纵隔镜灵敏度95．2％．特异度100％，阳性预测值100％，阴性预测值87．5％。结论 电视纵隔镜对非小细胞肺癌术前分期的灵敏度、特异度、阳性预测值和阴性预测值都大大高于CT，对非小细胞肺癌的综合治疗方案的制定非常重要。