调节、集合与视觉保持测试相关性研究

目的探讨调节集合与视觉保持测试的相关性。方法292名8～12岁学龄儿童进行单眼调节程度、集合近点检查及本顿视觉保持测试,并应用SAS软件进行K-W秩和检验及Logistic多因素分析。结果左、右眼调节程度、集合近点分别与视觉保持测试结果比较,差异无统计学意义；视觉保持测试Logistic多因素分析结果表明左右眼调节程度异常及集合近点异常均为视觉保持测试结果的危险因素,其危险值分别为1．30,1．30,1．35。结论调节、集合异常患者,在进行视觉保持测试时因在融合功能范围能动用一定的储备,尚能代偿,但当认知任务较重时,超过代偿极限,测试结果异常的机率就增加。     

小儿难治性肾病的治疗进展

难治性肾病是一组病因复杂、病理特征各异的肾病综合征，即国外统称的复发性肾病(relapsing nephritic syndrome，RNS)，约占小儿原发性肾病的10％。按国际小儿肾脏病协作中心(ISKDC)标准，凡具备以下任何一项即为RNS。①ISKDC标准疗法初治8周内有效，复发无效；②标准疗法4～8周内无反应者(耐药)；     

含铂类联合化疗方案治疗老年晚期非小细胞肺癌的临床研究

目的观察含铂类联合化疗方案治疗老年晚期非小细胞肺癌(NSCLC)患者的临床疗效及不良反应。方法对住院治疗的38例老年晚期非小细胞肺癌患者采用卡铂(CBP)加健择(GEM)和卡铂加去甲长春花碱(NVB)组成二药联合化疗方案(GP,NP)进行化疗,二组病例年龄、性别、病理、病期及Wamofaky评分等具有可比性,按WHO疗效及毒副反应评价标准,完成2个周期以上治疗的患者进行临床疗效及不良反应评估。结果可评价患者为38例,NP组有效率38.9%,中位生存期8.0月,1年生存率33.3%;GP组有效率40%,中位生存期8.2月,1年生存率35%。二组间疗效无显著性差异(P>0.05)。主要毒副反应为骨髓抑制和消化道反应,均能耐受。结论CBP与GEM、NVB分别组成二药联合方案治疗老年晚期非小细胞肺癌患者的临床疗效较好,不良反应较轻,患者的耐受性好。     

含铂类联合化疗方案治疗老年晚期非小细胞肺癌的临床研究

目的观察含铂类联合化疗方案治疗老年晚期非小细胞肺癌(NSCLC)患者的临床疗效及不良反应.方法对住院治疗的38例老年晚期非小细胞肺癌患者采用卡铂(CBP)加健择(GEM)和卡铂加去甲长春花碱(NVB)组成二药联合化疗方案(GP,NP)进行化疗,二组病例年龄、性别、病理、病期及Wamofaky评分等具有可比性,按WHO疗效及毒副反应评价标准,完成2个周期以上治疗的患者进行临床疗效及不良反应评估.结果可评价患者为38例,NP组有效率38.9%,中位生存期8.0月,1年生存率33.3%;GP组有效率40%,中位生存期8.2月,1年生存率35%.二组间疗效无显著性差异(P＞0.05).主要毒副反应为骨髓抑制和消化道反应,均能耐受.结论 CBP与GEM、NVB分别组成二药联合方案治疗老年晚期非小细胞肺癌患者的临床疗效较好,不良反应较轻,患者的耐受性好.     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

乙型肝炎病毒X基因对大鼠肾小球系膜细胞增殖和肿瘤坏死因子α表达的影响

目的 探讨乙型肝炎病毒(HBV)X基因表达的蛋白HBx对体外培养的大鼠肾小球系膜细胞(GMC)表达肿瘤坏死因子α(TNF-α)及细胞增殖的影响.方法 扩增HBV X基因,与pCI-neo载体连接,构建pCI-neo-X真核表达载体.采用脂质体法将其转染大鼠GMC,用Western blot法检测HBx的表达;以半定量RT-PCR测定体外培养大鼠GMC TNF-α mRNA的表达;采用ELISA法测定培养上清液中TNF-α的含量;MTT法测定细胞增殖.结果 HBx在转染pCI-neo-X的GMC中表达, 转染后36、48 h HBx表达明显.转染pCI-neo-X组GMC TNF-α mRNA的表达明显高于未转染和空载体转染组.细胞转染pCI-neo-X后培养36、48 h,上清液中TNF-α浓度分别为(185.3±70.7)、(140.3 ±42.1) pg/ml,而未转染组分别为(41.7±10.3)、(43.7±10.6)pg/ml,空载体转染组分别为(44.l±10.1)、(33.3±8.6)pg/ml,均明显低于转染pCI-neo-X组(均P<0.05).转染pCI-neo-X后可诱导GMC出现增生反应,且在转染后36、48 h最明显,与未转染和空载体转染组差异均有显著性意义(P<0.05).结论 HBx可诱导大鼠GMC增生,并在基因和蛋白水平上调GMC TNF-α表达. HBx对GMC的增殖作用可能与其诱导TNF-α的高表达有关.     

Effects of Tanshinone ⅡA on Transforming Growth Factor β1-Smads Signal Pathway in Renal Interstitial Fibroblasts of Rats

The effects of tanshinone ⅡA (TSN) on transforming growth factor β1 (TGFβ1) signal transduction in renal interstitial fibroblasts of rats were studied in order to investigate its mechanism in prevention of renal interstitial fibrosis. Rat renal fibroblasts of the line NRK/49F were cultured in vitro, stimulated with 5 ng/mL TGFβ1 and pretreated with 10-6, 10-5, 10-4 mol/L TSN respectively. The mRNA levels of fibronectin (FN) were examined by RT-PCR. The protein expression of FN and Smads was detected by Western blot. TGFβ1 induced the expression of FN mRNA and Smads in a time-dependent manner in a certain range. Compared with pre-stimulation, the FN mRNA and protein levels were increased by 1.1 times and 1.5 times respectively (P<0.01, P<0.01), and the protein expression of phosphorylated Smad2/3 (p-Smad2/3) increased by 7 times at the end of TGFβ1 stimulation (P<0.01). TSN pretreatment may down-regulate the FN and p-Smad2/3 expression in a dose-dependent manner. 10-6 mol/L TSN pretreatment had no effect on the FN and p-Smad2/3 expression (both P>0.05). After pretreatment with 10-5 and 10-4 mol/L TSN, the FN mRNA levels were decreased by 28.1% and 43.8% respectively (P<0.05, P<0.01), the FN protein levels were decreased by 40% and 44% respectively (P<0.05, P<0.05), and the p-Smad2/3 protein expression were decreased by 40% and 65% respectively (P<0.05, P<0.01). The inhibitory effect of TSN on renal interstitial fibrosis may be related to its blocking effect on TGFβ1-Smads signal pathway in renal intersti- tial fibroblasts.     

含米托蒽醌联合方案治疗晚期乳腺癌近期观察

本文介绍了我院内二病房1991.8—1992。10应用含米托蒽醌的联合方案—A方案和含ADM的联合方案—B方案(对照组)治疗晚期,局部复发和转移性乳腺癌共20例,均为女性,平均年龄49岁;其中A方案治疗10例,有效率为40％(30％CR+10％PR),有效期为2—13个月;而B方案(对照组)治疗10例,有效率为50％(10％CR+40％PR),有效期为2—14个月。两组有效率P>0.05,无显著性差别。 A方案—MUM方案(Me—CCNU 100mg(0)d_1;米托蒽醌10—12mg/M~2,用5％葡萄糖100ml稀释,静点d_1;复方喃复啶200mg3次/天     

腹腔镜胆囊切除术300例报告

１９９２年９月至１９９３年８月，我院共实施腹腔镜胆囊切除术３００例，其中男１０４例，女１９６例，年龄１２～７６岁。行全麻１７６例，持续硬膜外麻醉１２４例（４１％）；中转开腹１６例（５．３％），无一例胆管损伤和死亡，治愈率达１００％。术后共发生并发症１２例（４％），其中出血２例，经开腹止血愈；漏胆５例，经开腹引流１例，穿刺引流４例治愈。作者认为预防并发症的关键在于手术操作熟练和认清局部解剖关系。在遇粘连严重致局部解剖不清时应果断中转开腹。     

颅内髓外造血组织瘤样增生1例及文献复习

目的探讨髓外造血组织瘤样增生的临床表现、诊断及治疗方法. 方法髓外造血组织瘤样增生1例,经开颅手术切除,经病理学检查得以确诊. 结果随访至今近一年,患者未见复发,生活如常.结论颅内髓外造血组织瘤样增生是一种罕见的特殊的良性增生性病变,CT、MRI等可定位诊断,其定性诊断依赖于病理学检查.治疗学上除按原发病治疗外,大的颅内病变需手术切除.