脊柱骨母细胞瘤的临床研究进展

脊柱是骨母细胞瘤最常见的发病部位,主要侵及脊柱的附件结构,单发椎体少见。在组织学上该肿瘤并无恶性表现,但临床上常表现出很明显的侵袭性,甚至有恶变的可能。大多数患者存在疼痛症状,肿瘤侵犯压迫脊髓时会产生不同程度的神经损害。手术治疗是脊柱骨母细胞瘤最重要的治疗措施,肿瘤一经发现均应尽快手术切除,手术术式的选择应根据Enneking system分期,切除不彻底容易复发。目前放化疗在脊柱骨母细胞瘤的应用还存在争议,不建议作为骨母细胞瘤的常规治疗手段。     

亚油酸乙酯抑制钛颗粒诱导的炎症反应及其作用机制

BACKGROUND: Ethyl linoleate has been proved to attenuate the inflammatory-cytokines release induced by lipopolysaccharide, but whether it can inhibit titanium-induced osteolysis and the underlying mechanism remain unclear. OBJECTIVE: To observe the effect of ethyl linoleate on the expression of inflammatory-related factors induced by titanium particles and explore its mechanism. METHODS: Forty-eight Kunming mice were randomly divided into blank control, titanium, dimethylsulfoxide (DMSO) and experimental groups. The back air pouch Inflammatory models were established in the mice of the titanium, DMSO and experimental groups, in which the 200 µL menstruum of DMSO (0.5%) and 200 µL ethyl linoleate (0.5%) were respectively administered into the pouch of the mice at 12 hours. Mice in the blank control group received no intervention. Fourteen days later, the inflammatory cell infiltration in the skin was examined through hematoxylin-eosin staining; the expression levels of inhibitor κB-α, nuclear factor-κB, inducible nitric oxide synthase, cyclooxygenase-2, tumor necrosis factor-α and interleukin-6 as well as ERK, p-ERK, JNK, p-JNK, p38 and p-p38 in MAPK signaling pathways were evaluated by western blot assay. RESULTS AND CONCLUSION: In the titanium group and DMSO group, there were numerous inflammatory cells and vacuole-like necrotic tissues in the hair follicle lacuna of dermis and loose connective tissues of hypodermis. The experiment group showed significant reduction in inflammatory cell infiltration and vacuole-like necrosis. Compared with the blank control group, the expression levels of inducible nitric oxide synthase, cyclooxygenase-2, nuclear factor-κB, tumor necrosis factor-α, interleukin-6, ERK, JNK and p38 in the DMSO and titanium groups were significantly increased, while inhibitor κB-α significantly decreased (P < 0.05). Compared with the DMSO and titanium groups, there were significantly down-regulated levels of inducible nitric oxide synthase, cyclooxygenase-2, nuclear factor-κB, tumor necrosis factor-α, interleukin-6, ERK, JNK and p38, and up-regulated inhibitor κB-α level in the experimental group (P < 0.05). In conclusion, ethyl linoleate can remarkably suppress the expressions of titanium-induced inflammatory factors associated with the inhibition of nuclear factor-κB and MAPK signaling pathway activation.     

自动功能成像技术在慢性肾功能衰竭患者心脏早期受累诊断中的应用价值

目的研究自动功能成像(AFI)技术在慢性肾功能衰竭(CRF)患者心脏早期受累诊断中的应用价值。方法采用前瞻性研究方法,选取2018年1月至2019年12月海南省中医院超声科收治的CRF患者200例作为观察组,并选取同期正常体检者100例作为对照组。比较两组患者的常规超声指标[左室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、左室舒张末期质量(EDMass)、收缩末期质量(ESMass)、左室相对室壁厚度(RWT)、左室质量指数(LVMI)、左室射血分数(LVEF)]、AFI指标[径向峰值应变(GPSR)、面积峰值应变(GPSA)、左室整体的纵向峰值应变(GLPS)],比较不同肾功能分级患者AFI指标、肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、甲状旁腺激素(PTH)]水平,采用Pearson分析AFI指标与肾功能指标的相关性。结果观察组患者的LVEF低于对照组,EDVI、ESVI、EDMass、ESMass、LVMI、RWI高于对照组,差异具有统计学意义(P 0. 05);观察组患者的GPSR、GPSA绝对值、GLPS绝对值均低于对照组,差异具有统计学意义(P 0. 05);肾储备能力下降期、氮质血症期、肾衰竭期和尿毒症期患者随着肾功能分级递进,GPSR、GPSA绝对值、GLPS绝对值依次降低,组间比较差异具有统计学意义(P 0. 05);肾储备能力下降期、氮质血症期、肾衰竭期和尿毒症期患者随着肾功能分级递进,Scr、BUN、PTH依次升高,组间比较差异具有统计学意义(P 0. 05); GPSR、GPSA绝对值、GLPS绝对值均与Scr(r=-0. 473、-0. 594、-0. 596)、BUN(r=-0. 547、-0. 465、-0. 540)、PTH(r=-0. 414、-0. 367、-0. 422)呈负相关(P 0. 05)。结论 AFI技术检测CRF患者GPSR、GPSA、GLPS,可无创、定量评估患者心脏早期受累情况,为医师决策、干预提供参考,且GPSR、GPSA、GLPS与肾功能具有显著相关性,临床应重视CRF患者肾功能与心功能的同时干预,以改善患者预后。     

超声引导下射频消融术与微创切除术治疗小肝癌的远期预后比较

目的 比较超声引导下射频消融术与微创切除术治疗小肝癌的疗效。方法 选取2015年3月—2018年4月海南省中医院接受治疗的80例小肝癌患者，根据自愿原则分为消融组和切除组，每组40例。消融组接受超声引导下射频消融术治疗，切除组接受微创切除术。比较两组肝功能［谷丙转氨酶（ALT）、总胆红素（TBIL）、谷草转氨酶（AST）］、肿瘤标志物［癌胚抗原（CEA）、磷脂酰肌醇蛋白聚糖3（GPC3）、甲胎蛋白（AFP）］、循环肿瘤细胞（CTC）和肝细胞生长因子（HGF）、并发症、术后复发率及生存率。结果 两组患者术前ALT、AST、TBIL水平比较，差异无统计学意义（P >0.05）。消融组术后ALT、AST、TBIL水平低于切除组（P <0.05）。两组患者手术前与手术后CEA、GPC3、AFP水平比较，差异无统计学意义（P >0.05）。两组患者术前HGF、CTC水平比较，差异无统计学意义（P >0.05）。消融组术后HGF、CTC水平低于切除组（P <0.05）。消融组术后并发症发生率低于切除组（P <0.05）。两组患者术后3年总生存率、术后3年复发率比较，差异无统计学意义（P <0.05）。结论 与微创切除术比较，超声引导下射频消融治疗小肝癌在减少肝功能损伤、术后并发症方面具有一定优势，且可在一定程度上降低HGF和CTC水平，两者具有相似的远期预后效果。     

超声检测颈动脉正常的患者右锁骨下动脉亚临床动脉粥样硬化的分析

目的观察超声检测颈动脉正常的患者右锁骨下动脉亚临床动脉粥样硬化的结果。方法采用超声检测检查门诊、体检行颈动脉超声检查结果无异常的286例参与者右锁骨下动脉是否有粥样斑块形成。结果根据弗雷明汉风险评分,43.7%的参与者为低风险,40.2%参与者为中等风险,16.1%的参与者为高风险。共有84例参与者(29.4%)在右锁骨下动脉发现动脉粥样硬化斑块,其中年龄在55岁及以上的参与者右锁骨下动脉粥样硬化患病率明显高于55岁以下的参与者(χ~2=11.570,P=0.001),女性参与者右锁骨下动脉粥样硬化患病率明显高于男性(χ~2=44.002,P0.001)。而不同心血管疾病风险的参与者右锁骨下动脉粥样硬化患病率比较,差异无统计学意义(P0.05)。结论在颈动脉超声检查正常的参与者中,女性及大于55岁以上的人为右锁骨下动脉亚临床动脉粥样硬化的高发人群。