自动乳腺全容积成像在乳腺导管原位癌诊断中的应用价值

目的探讨自动乳腺全容积成像(ABVS)在乳腺导管原位癌(DCIS)诊断中的应用价值。方法回顾性分析2010年12月至2012年12月杭州市第一人民医院收治的经手术病理证实的67例乳腺DCIS患者的钼靶X线、常规超声及ABVS表现。钼靶X线、常规超声及ABVS表现,钼靶X线、常规超声及ABVS的乳腺DCIS检出率比较采用非参数Cochran′s Q test比较,进一步组间两两比较采用Mc Nemar test。结果钼靶X线、常规超声及ABVS表现为肿块(伴或不伴微钙化)的乳腺DCIS分别为13例(19%)、22例(33%)、25例(37%),常规超声、ABVS表现为肿块(伴或不伴微钙化)的乳腺DCIS均多于钼靶X线,且差异均有统计学意义(χ2=7.11、10.08,P均<0.05),而常规超声与ABVS表现为肿块(伴或不伴微钙化)的乳腺DCIS差异均无统计学意义。钼靶X线、常规超声及ABVS表现为单纯或伴发微钙化的乳腺DCIS分别为42例(63%)、30例(45%)、39例(58%),钼靶X线、ABVS表现为单纯或伴发微钙化的乳腺DCIS均多于常规超声,且差异均有统计学意义(χ2=8.64、5.82,P均<0.05),而钼靶X线与ABVS表现为单纯或伴发微钙化的乳腺DCIS差异均无统计学意义。钼靶X线、常规超声及ABVS的乳腺DCIS检出率分别为84%、70%及91%,钼靶X线、ABVS的乳腺DCIS检出率均高于常规超声,且差异均有统计学意义(χ2=4.92、9.39,P均<0.05),但ABVS与钼靶X线的乳腺DCIS检出率差异无统计学意义。结论 ABVS能提高超声对乳腺DCIS的检出率,与钼靶X线诊断效能相仿。     

Neonatal Systemic AAV Induces Tolerance to CNS Gene Therapy in MPS I Dogs and Nonhuman Primates

The potential host immune response to a nonself protein poses a fundamental challenge for gene therapies targeting recessive diseases. We demonstrate in both dogs and nonhuman primates that liver-directed gene transfer using an adeno-associated virus (AAV) vector in neonates induces a persistent state of immunological tolerance to the transgene product, substantially improving the efficacy of subsequent vector administration targeting the central nervous system (CNS). We applied this approach to a canine model of mucopolysaccharidosis type I (MPS I), a progressive neuropathic lysosomal storage disease caused by deficient activity of the enzyme α-l-iduronidase (IDUA). MPS I dogs treated systemically in the first week of life with a vector expressing canine IDUA did not develop antibodies against the enzyme and exhibited robust expression in the CNS upon intrathecal AAV delivery at 1 month of age, resulting in complete correction of brain storage lesions. Newborn rhesus monkeys treated systemically with AAV vector expressing human IDUA developed tolerance to the transgene, resulting in high cerebrospinal fluid (CSF) IDUA expression and no antibody induction after subsequent CNS gene therapy. These findings suggest that inducing tolerance to the transgene product during a critical period in immunological development can improve the efficacy and safety of gene therapy.     

The mobilization of stem cells promote the recovery of the ischemia brain injury after cardiopulmonary resuscitation北大核心CSCD

Objective: To explore the therapeutic potential and mechanism of stem cells mobilized by granulocyte colony-stimulating factor (G-CSF) and AMD3100 to repair global cerebral ischemia injuries in a rat model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). Methods: Cardiac arrest was induced by asphyxia. Fifty-six SD rats were randomly assigned into four groups: G-CSF group, G-CSF + AMD3100 group, CPR control group and sham operated group. The animals were sacrificed at 3d and 6d after CPR respectively. The neurological status and morphological changes of damaged cerebrum, the apoptosis of nerve cells and vascular endothelial growth factor (VEGF) expressed in brain tissue and capillary density in hippocampus and temporal lobe cortex were measured and analyzed by means of neurological deficit score (NDS), adhesive tape removal test (TRT), ELISA, MRI and immunofluorescence. Results: NDS in G-CSF + AMD3100 group (61. 4 ± 10. 7) was significantly higher than that in CPR control group (49. 9 ± 10. 4) at 3 d after CPR (P <0. 05). And less time consumption for TRT found in G-CSF + AMD3100 group (85. 5 ±28. 9) s rather than was in CPR control group (148. 1 ± 23.8) s and G-CSF group (118.5±30.4) s (P < 0. 05). The severity of cerebral injury assessed by MRI was significantly milder at both 3 d and 6 d in the two stem cell mobilization groups. The apoptosis rate of nerve cells in G-CSF + AMD3100 group (0.23 ±0.06) was significantly lower than that in G-CSF group (0. 34 ± 0. 08) at 3 d after CPR, and that in both stem cell mobilization groups was lower than that in CPR control group (0.44 ± 0. 09) (P < 0. 05). At 3 d and 6 d after CPR, the levels of VEGF in brain tissue were (106. 2 ± 23. 3) pg/mL and (79. 9 ± 18. 4) pg/mL in G-CSF + AMD3100 group, and were (50. 6 ± 13. 7) pg/mL and (73. 9 ± 16. 6) pg/mL in G-CSF group, which were both significantly higher than that in CPR control group (23. 1 ± 10. 2) pg/mL and (36. 2 ± 12. 8) pg/mL (P < 0. 05). At 3 d after CPR, the cerebral capillary density (351. 8 ±67. 9) branches in every high power field (A/HPF) was significantly higher in G-CSF+ AMD3100 group than that (301. 4 ±77. 3) A/HPF in G-CSF group and (250.4 ±48.0) A/HPF in CPR control group (P < 0. 05). The cerebral capillary density in G-CSF group elevated to (348. 4 ±76. 7) A/HPF at 6 d after CPR which was significantly higher than that at 3 d (P <0. 05), and there was no difference between that at 3 d and 6 d in G-CSF + AMD3100 group. Conclusions: The mobilization stem cells improve the impaired neurological function. The increased expression of VEGF in brain tissue, the neo-vascularization promoted by the mobilized stem cells and the inhibition of nerve cell apoptosis may be associated with the protective effects of the stem cell mobilization.     

脂氧素抑制内毒素诱导大鼠原代肺成纤维细胞环氧合酶-2及前列腺素E2的表达

目的 探讨脂氧素对大鼠原代肺成纤维细胞环氧合酶-2及前列腺素E2表达的影响.方法 分离、纯化、鉴定得到大鼠肺成纤维细胞,用脂多糖(lipopolysaccharide,LPS)干预建立成纤维细胞体外急性炎症模型,并利用细胞增殖/毒性检测试剂MTT摸索出成纤维细胞急性炎症模型的最适LPS质量浓度和药物干预时间.分别应用不同浓度(0、100、200、400 nmol/mL)的脂氧素作用于经过LPS诱导的体外培养原代肺成纤维细胞.采用酶联免疫法(ELISA)检测细胞上清液前列腺素E2(PGE2)水平,同时应用Western blot检测原代肺成纤维细胞环氧合酶(COX-2)蛋白的表达.结果 用1 μg/mL LPS干预体外培养的原代肺成纤维细胞6h能建立较为合理的急性炎症模型.脂氧素能抑制LPS诱导的原代肺成纤维细胞环氧合酶(COX-2)蛋白的表达.对照组、LPS组、LPS组与LPS+脂氧素组测PGE2质量浓度分别为55.84 pg/mL、411.73 pg/mL、307.07 pg/mL,LPS组与LPS+脂氧素组间比较差异有统计学意义(P＜0.01).结论 脂氧素能抑制LPS诱导的原代肺成纤维细胞环氧合酶-2及前列腺素E2的表达,并呈剂量依赖性.     

重症患儿粪弹性蛋白酶-1的变化及其临床意义

目的 通过测定重症患儿粪弹性蛋白酶-1 (FE-1),探讨FE-1与胰酶、脓毒症及疾病严重程度之间的关系.方法 分析2013年7月至2014年3月湖南省儿童医院PICU收治的402例重症患儿,入住PICU 24 h内留取成形大便标本,根据FE-1质量分数分组:＞200μg/g为胰腺外分泌功能正常组(A组,n =300),(100～200)μg/g为轻中度胰腺外分泌功能不全组(B组,n =52),＜100 μg/g为重度胰腺外分泌功能不全组(C组,n=50).分析各组与胰酶变化、脓毒症及其严重程度,及其与休克、器官功能障碍个数、PCIS评分、SOFA评分、APACHEⅡ评分之间的关系.计数资料采用x2检验.计量资料非正态分布或方差不齐,以中位数和四分位数[M(P25,P75)]表示,行非参数检验,有统计学意义时行多个样本两两比较的秩和检验.相关性采用Spearman相关分析.结果 (1)A、B两组间血脂肪酶升高差异有统计学意义(P＜0.O1).(2)非脓毒症患儿288例,脓毒症114例,两组FE-1水平差异具有统计学意义(P＜0.05).脓毒症患儿分为一般脓毒症组、严重脓毒症组、脓毒性休克组,与非脓毒症组四组间FE-1差异具有统计学意义(P＜0.01). (3)A、B、C三组患儿在脓毒症与非脓毒症所占比例分别为65.79％vs.78.13％,15.79％ vs.11.80％,18.42％ vs.10.07％,B、C组在脓毒症中所占比例高于非脓毒症且逐渐升高.(4) FE-1质量分数的总体趋势随脓毒症严重程度而降低,非脓毒症组与一般脓毒症组,严重脓毒症组与脓毒性休克组两两比较差异无统计学意义(P＞0.05),其余组两两比较差异均具有统计学意义(P＜0.01).(5)三组间休克、器官功能障碍个数、MODS≥3个、PCIS评分、SOFA评分、APS评分比较差异均有统计学意义(P＜0.05).随着FE-1质量分数降低,器官功能障碍个数、SOFA评分、APS评分呈升高趋势(rst=-0.194,P=0.000;rs2=-0.348,P=0.000;rs3=-0.176,P=0.000),PCIS评分呈下降趋势(rs4=0.185,P=0.000).结论 胰腺外分泌功能受损与脓毒症存在相关性,这种胰腺功能障碍在轻症脓毒症患者可能并不显著,但随脓毒症严重程度加重或病情严重程度加重其发生率逐渐升高.     

腹膜透析结合血液透析治疗终末期肾脏病3例长期疗效并文献复习

目的探讨腹膜透析结合血液透析(Combined therapy with Peritoneal Dialysis and Hemodialysis,PHD)治疗终末期肾病(End stage renal disease ESRD)患者的长期临床疗效。方法对3例长期行PHD治疗的患者临床资料进行分析并复习相关文献。结果 3例患者经过PHD治疗后临床症状改善。例1周尿素清除指数[Kt/(V?W)]1.46增至1.90,周肌酐清除率(Weekly creatinine clearance WCC)36.52增至60.72L/1.73m2,血浆白蛋白、血红蛋白升高,左室肥厚(Left ventricle hypertrophy LVH)改善。例2[Kt/(V?W)]1.43增至1.81,WCC 35.34增至55.79 L/1.73m2,血浆白蛋白、血红蛋白升高。例3[Kt/(V?W)]1.55增至1.82,WCC 46.0增至56.53 L/1.73m2,血浆白蛋白、血红蛋白升高,LVH改善。结论 PHD能有效改善ESRD患者临床症状,提高透析充分性,可作为补充的肾脏替代治疗模式在临床应用。     

新型外转子低速直驱永磁游标电机的损耗

对一种新型自增速永磁游标电机的损耗情况进行了分析,重点分析了永磁体和铝壳中的损耗。在电磁损耗计算中采用二维时步有限元法,阐明了采用二维有限元法计算永磁体中涡流损耗的原理和注意事项,并通过三维有限元法检验了二维有限元计算永磁体涡流损耗的误差。分析了铝壳损耗的主要影响因素以及减小方法。空载计算损耗与实测损耗基本一致,验证了损耗计算方法的正确性。最后研究了不同负载情况下损耗的变化情况,以及温度对损耗的影响。     

复合溶菌酶杀菌纱布湿敷治疗化疗性静脉炎疗效观察

目的探讨复合溶菌酶杀菌纱布湿敷治疗化疗性静脉炎的效果。方法将120例化疗性静脉炎患者按随机数字表法随机分为试验组和对照组,每组各60例,试验组患者采用复合溶菌酶杀菌纱布湿敷患处,对照组患者采用50%硫酸镁湿敷患处。治疗1周后观察效果。结果试验组患者治疗总有效率明显高于对照组,化疗性静脉炎治愈时间明显短于对照组,两组比较,均P0.01,差异具有统计学意义。结论复合溶菌酶杀菌纱布湿敷治疗化疗性静脉炎明显优于50%硫酸镁湿敷,值得临床推广应用。