前列腺增生症术后排尿困难的原因探讨及预防

为了探讨前列腺增生症术后排尿困难的原因及预防方法,对前列腺切除术后27例仍有排尿困难的临床资料进行了分析。结果显示:尿道狭窄14例,尿道内口闭锁2例,膀胱逼尿肌功能紊乱2例,腺体残留3例,后唇瓣膜2例,输尿管间嵴肥厚1例,后尿道狭窄合并结石1例,膀胱颈水肿,前列腺癌1例。由此可见,尿道狭窄是术后排尿困难的主要原因,小前列腺增生或前列腺增生伴炎症宜采用TURP+膀胱颈内切开治疗以减少尿道狭窄。     

梯度离心法在肿瘤药敏试验中的应用及临床相关性研究

目的　研究梯度离心法在肿瘤药敏试验中的应用及肿瘤药敏试验与临床个体化化疗的相关性。方法　取 4 6例肿瘤患者新鲜癌细胞 ,梯度离心后用MTT法检测癌细胞对 8种常用抗癌药的敏感性 ;根据药敏结果对患者进行化疗 ,无敏感药物者按经验方案化疗 ,观察实验与临床疗效的相关性。结果　改良法癌细胞获得百分率为 94 6 5± 2 8 4 7,与传统方法比较差异有显著性 (P <0 0 1) ;药敏试验阳性者 2 5例 ,阴性者2 1例。实验提示敏感药物化疗者的有效率为 76 % (19/ 2 5 ) ;耐药者按经验方案化疗 ,有效率为 2 8 6 % (6 /2 1)。P <0 0 1,差异有显著性 ;实验与临床符合率达 73 9% (34/ 4 6 )。结论　梯度离心MTT法体外癌细胞药敏试验能更好的指导临床个体化治疗 ,具有预见癌症患者临床个体化化疗疗效的重要价值。     

Clinical relevance of post-transplant pharmacodynamic analysis of cyclosporine in renal transplantation

Although therapeutic drug monitoring based on blood concentration has been widely implemented in transplant recipients treated with immunosuppressive agents, clinical adverse events such as rejection, infection or drug-induced toxicity caused by inappropriate dosage cannot be completely controlled. Development of an effective assay for optimized immunosuppression would be desirable, which can potentially lead to personalized medicine in renal transplantation. Cyclosporine (CSA) pharmacodynamic analysis using carboxyfluorescein diacetate succinimidyl ester (CFSE)-based T cell proliferation assay was examined in 66 kidney transplant recipients before and after transplantation. Two parameters, the 50% inhibitory concentration (IC₅₀) and the percentage of T-cell proliferation values at the lower plateau (bottom), were compared with clinical events. A significant relation in CSA pharmacodynamic parameters was observed between pre- and post-transplantation. Analysis of the association between clinical outcomes and pharmacodynamic parameters in post-transplant samples demonstrated the following findings: (i) cytomegalovirus (CMV)/varicella zoster virus (VZV) reactivation and CSA-induced nephrotoxicity were significantly associated with high sensitivity to CSA (low bottom or low IC₅₀), (ii) acute T cell-mediated rejection (ATMR) was significantly related to low sensitivity to CSA (high bottom), and (iii) de novo human leukocyte antigen (HLA) antibody production was associated with lower bottom and IC₅₀ values, although the elucidation of those mechanisms is still in progress. It was suggested that CSA pharmacodynamics applied at post-transplantation would be useful for optimizing immunosuppressive therapy.     

耐多药结核病诊断方法研究进展

耐多药结核病的防治对于结核病的防控具有重要意义,已成为结核病防治的难点和热点问题。早期对结核病患者进行耐多药检测能够提高耐多药结核病患者的治疗成功率。耐多药结核病的诊断方法包括传统的培养方法及新型分子生物学诊断方法。作者对耐多药结核病的诊断方法进行综述,以期为耐多药结核病防治提供科学依据。     

Distinct effect of cyclophosphamide and cyclosporine on pure red cell aplasia associated with T-cell large granular lymphocyte leukemia

Large granular lymphocyte (LGL) leukemia is characterized by a clonal proliferation of large-sized lymphocytes with prominent large azurophilic cytoplasmic granules. Although most cases of T-LGL leukemia are indolent and asymptomatic during the course of the disease, some present with pure red cell aplasia (PRCA) and require therapy. We here reported a case of T-LGL leukemia complicated by PRCA in which anemia was resistant to cyclosporine and had been controlled for several years by cyclophosphamide; however, progressive anemia developed despite the administration of cyclophosphamide, but was ameliorated by the re-administration of cyclosporine. The present case demonstrated the 3 different phases of T-LGL proliferation associated with anemia (1st, T-LGL leukemia; 2nd, polyclonal T-LGL expansion; 3rd, myelodysplastic syndrome). We also showed that cyclophosphamide was effective when PRCA was caused by increased numbers of LGL, whereas cyclosporine was administered when hypoplastic myelodysplastic syndrome was suspected as the main cause of anemia. Repetitive bone marrow examinations should be performed throughout the course of T-LGL in order to monitor combined myelodysplastic syndrome.     

Apoptosis pathway of liver cells in chronic hepatitis

AIM: To study the pathway of apoptosis in chronic liver disease and the role of mitochondria in programmed cell death.METHODS: Liver biopsy specimens from 72 cases of chronic hepatitis and 29 cases of post hepatitis cirrhosis were studied. The pro-apoptotic protein Fas, FasL, Bax and the anti-apoptotic protein Bcl-2, Bcl-xL, Bcl-2α were studied immunohistochemically by SP method. Specimens from 15 cases of chronic hepatitis and post hepatitis cirrhosis were examined for their ultramicrostructures with special attention to their mitochondrial changes. Specimens from 3 normal adults (demised in traffic accidents) were used as control.RESULTS: The expression of proapoptotic proteins (Fas, FasL, Bax) in hepatocytes was significantly higher in the chronic hepatitis group than in the cirrhosis group (P&lt;0.001). In the study of ultramicrostructure 364 hepatocytes were examined, from 12 cases of chronic hepatitis (including 10 mild cases, 1 moderate case and 1 severe case). Out of 364 hepatocytes 40 (11.0%) hepatocytes were found with various kinds of destruction in their mitochondria. Rupture of the outer membrane of mitochondria and the leakage of matrix from the intermembrane space were definitely demonstrated. The ultramicrostructural changes of mitochondria in the chronic hepatitis group were statistically higher than that in normal adults control group(X^2=4.32, P&lt;0.05). CONCLUSION: The result of the study was in support of the current view that the apoptotic process in chronic hepatitis patients were largely along the intrinsic pathway (mitochondrial pathway), given that the intrinsic and extrinsic pathways could interlinked (converged) at some point on their progression, also it is impossible at present to exclude the possibility that the two pathways could be chosen by hepatocytes in parallel simultaneously.     

骨桥蛋白通过内质网应激诱导C2C12肌细胞胰岛素抵抗

目的:探讨骨桥蛋白(osteopontin,OPN)对C2C12肌细胞胰岛素抵抗的影响及其可能的机制。方法:低血清培养辅以胰岛素处理诱导C2C12成肌细胞分化为C2C12肌细胞,蛋白免疫印迹检测蛋白质的表达,离心法分离细胞膜,葡萄糖摄取试剂盒定量葡萄糖摄取。结果:(1)骨桥蛋白以剂量依赖和时间依赖方式抑制胰岛素刺激的蛋白激酶B(Akt)的磷酸化,并抑制胰岛素所致的葡萄糖转运体4(Glut4)膜位移和葡萄糖的摄取;而特异性的抗OPN受体CD44抗体预处理可逆转上述变化。(2)OPN可诱导C2C12肌细胞的内质网应激,并促进c-Jun氨基端激酶(JNK)的磷酸化。(3)内质网应激抑制剂4-苯基丁酸(4-PBA)可降低OPN所增加的JNK磷酸化,恢复胰岛素刺激所致的Glut4的膜位移以及葡萄糖摄取。结论:骨桥蛋白通过诱导C2C12肌细胞内质网应激导致胰岛素抵抗。本研究为揭示骨桥蛋白在胰岛素抵抗和糖尿病中的作用提供了新的实验依据和理论解释。     

结肠癌COX-2mRNA表达与微血管密度关系的临床意义

目的通过观察结肠癌组织COX-2mRNA及CD34的表达，结合结肠癌组织中微血管密度（microvessel density，MVD）所见，探讨COX-2与肿瘤血管形成及病理特征的关系，为结肠癌生物治疗提供理论基础。方法 选择62例结肠癌、22例结肠腺瘤和22例正常结肠黏膜标本，采用原位分子杂交法检测COX-2mRNA并用MaxVisionTM快捷免疫组化法检测CD34表达，光镜下记数MVD。结果结肠癌、结肠腺瘤组织COX-2mRNA的阳性率明显高于正常黏膜，且有统计学意义（74．19％：36．36％，P=0．001；72．73％：36．36％，P=0．015）；结肠癌组平均MVD值高于腺瘤组和正常组，三组比较，有统计学意义（F=19．628，P=0．000）。在62例结肠癌组织中，高分化组COX-2mRNA阳性率高于低分化组（X^2=4．215、P=0．040）；进展期癌组的MVD高于早期癌组（t=3．079，P：0．003）；淋巴结有转移组MVD高于无转移组（t=3．180，P=0．002）；有血管侵犯组高于无血管侵犯组（t=2．093，P=0．041）；COX-2mRNA阳性组MVD高于阴性组，COX-2mRNA高表达组MVD高于低表达组，但差异均无统计学意义（P〉0．05）。结论MVD记数可作为判断肿瘤预后的有效评价指标，COX-2与肿瘤细胞的增殖和凋亡密切相关，与肿瘤血管生成无直接相关性。     

环状RNA在胃癌发生发展中的作用

人们在细胞中发现一种与线性RNA不同的缺少5′帽和3′polyA尾的共价闭合结构,由于其环形特性,具有更高稳定性和保守性,这种RNA被称为环状RNA(circRNA)。它在转录和转录后水平起调节作用,并影响肿瘤的发生发展。本文着重介绍与胃癌密切相关的circRNAs,对这类circRNAs的特异性表达和生物学功能进行总结,讨论其作为胃癌诊断和判断预后的生物学标志物,挖掘潜在的临床应用价值。     

尿毒症患者血浆脑钠肽水平变化及与心功能的关系研究

目的观察尿毒症患者血浆脑钠肽水平变化,探讨其与心功能的关系。方法收集徐州医学院附属连云港医院肾内科2012年6月—2013年12月收治的新发尿毒症患者72例,根据纽约心脏病协会(NYHA)心功能分级分为Ⅱ级组27例,Ⅲ级组25例,Ⅳ级组20例,比较3组患者血浆脑钠肽水平、射血分数、血肌酐水平。所有患者进行透析治疗,比较透析前、透析3次后次日、透析4周后次日血浆脑钠肽水平、射血分数、血肌酐水平。结果 3组患者血肌酐水平比较,差异无统计学意义(P0.05);Ⅲ级组、Ⅳ级组患者血浆脑钠肽水平高于Ⅱ级组、射血分数低于Ⅱ级组,Ⅳ级组患者血浆脑钠肽水平高于Ⅲ级组、射血分数低于Ⅲ级组(P0.05)。所有患者透析3次后次日、透析4周后次日血浆脑钠肽水平、血肌酐水平低于透析前,射血分数高于透析前,透析4周后次日血浆脑钠肽水平低于透析3次后次日,射血分数高于透析3次后次日(P0.05)。结论尿毒症患者心功能越差,血浆脑钠肽水平越高,透析治疗可明显改善尿毒症患者心功能,降低血浆脑钠肽水平。