基于器官功能保全的局部进展期直肠癌诊治新策略

局部进展期直肠癌（locally advanced rectal cancer, LARC）的治疗进入肿瘤学效果和功能并重的时代，传统“三明治”治疗模式的利弊凸显，通过高分辨率核磁共振成像，可以将LARC按照局部复发风险进一步分成不同危险度组别，从而施行个体化治疗模式，是保障疗效和功能的最优化策略。部分危险度稍低的LARC可以通过直接进行高质量手术、单纯术前化疗来避免术前放疗带来的功能损害。而对于根治性手术可能带来较大功能损害的LARC，通过结合各种不同的术前治疗策略，乃至全程新辅助治疗（TNT）策略，强化肿瘤退缩，甚至获得肿瘤完全缓解来改变原有的手术方式，从不可保肛的根治性腹会阴联合切除术变为可保肛的低位/极低位前切除术、括约肌间切除术等根治性手术，或从全直肠系膜切除术变为经肛局部切除术，乃至最后不需要手术的“观察＆等待”，从而最大限度保全患者的器官功能。     

滞流区摩擦系数试验装置的改进

改进了滞流区摩擦系数的试验装置，试验数据用中文版Ｅｘｃｅｌ５．０处理，表图俱全，速度快。经验关联式与理论公式相当吻合。     

The effect of surfactants on hydrate particle agglomeration in liquid hydrocarbon continuous systems: a molecular dynamics simulation study

Anti-agglomerants (AAs), both natural and commercial, are currently being considered for gas hydrate risk management of petroleum pipelines in offshore operations. However, the molecular mechanisms of the interaction between the AAs and gas hydrate surfaces and the prevention of hydrate agglomeration remain critical and complex questions that need to be addressed to advance this technology. Here, we use molecular dynamics (MD) simulations to investigate the effect of model surfactant molecules (polynuclear aromatic carboxylic acids) on the agglomeration behaviour of gas hydrate particles and disruption of the capillary liquid bridge between hydrate particles. The results show that the anti-agglomeration pathway can be divided into two processes: the spontaneous adsorption effect of surfactant molecules onto the hydrate surface and the weakening effect of the intensity of the liquid bridge between attracted hydrate particles. The MD simulation results also indicate that the anti-agglomeration effectiveness of surfactants is determined by the intrinsic nature of their molecular functional groups. Additionally, we find that surfactant molecules can affect hydrate growth, which decreases hydrate particle size and correspondingly lower the risk of hydrate agglomeration. This study provides molecular-level insights into the anti-agglomeration mechanism of surfactant molecules, which can aid in the ultimate application of natural or commercial AAs with optimal anti-agglomeration properties.

Schematic of anti-agglomeration effect of surfactants promoting gas hydrate particle dispersion.     

Inhibition of shear-induced platelet aggregation in rat by tetramethylpyrazine and salvianolic acid B

Tetramethylpyrazine (TMP) and salvianolic acid B (SAB) are effective ingredients of Rhizoma Ligustici chuanxiong Hort. and Radix Salviae miltiorrhizae Bge., accordingly. The inhibitive effects of TMP, SAB and their combination on shear-induced platelet aggregation (SIPA) were investigated in the present study. SD rats were used as blood donors to collect anticoagulated blood, the concentration of platelet-rich-plasma (PRP) was adjusted to 5 x 10(5) microl. HAAKE rheometer RS 600 with sensor C60/0.5 degrees was used as shear generator. Different doses of TMP and SAB and their combinations were added to the PRP. After constant shear of 15 Pa at 37 degrees C for 360 seconds, PRP was transferred to a platelet aggregometer and SIPA was determined by turbidity. SIPA was inhibited by TMP and SAB in a dose-dependent manner. SIPA was decreased from 48.6 +/- 4.6% of the control to 12.5 +/- 2.1% in the presence of TMP (1.46 mM) and SAB (10 microM) (P < 0.0001). In conclusion, TMP and SAB have additive effects on inhibiting platelet aggregation induced by high shear stress.     

颈椎间盘突出程度与颈椎X线片相关指标测量值的相关性研究

目的探讨单节段脊髓型颈椎病患者颈椎X线片相关指标与椎间盘突出导致的颈脊髓压迫严重程度的相关性。方法回顾性分析2012年8月—2014年3月安徽医科大学第一附属医院脊柱外科诊治的60例单节段脊髓型颈椎病患者的临床资料,均为男性,年龄42~65岁,平均(54.8依9.3)岁。在颈椎MRI矢状位成像上按照颈脊髓受压的比例( E值)分为Ⅰ组、Ⅱ组及Ⅲ组。在颈椎MRI横断面成像上测量并计算颈髓横切面积( S1)与有效椎管横切面积( S0)的比值,以此判断椎间盘突出程度;在不同体位颈椎X线摄片上测量责任椎间隙的活动度值(B值)、椎间隙前缘高度( D值)、颈椎C2~7 Cobb角及椎间孔面积( M值)等相关指标。采用直线相关回归分析颈椎间盘突出程度与各观测指标之间的相关性。结果3组间S1/S0值、E值、B值、D值、C2~7 Cobb角和M值差异均有统计学意义(F值分别为44.187、112.789、7.232、3.778、3.232、15.813,P值均<0.05)。随着S1/S0值的增加,E值、B值、D值、C2~7 Cobb角和M值均逐渐减小,提示责任椎间隙E值、B值、D值、C2~7 Cobb角、M 值与 S1/S0值均呈负相关性( R 值分别为-0.821、-0.581、-0.378、-0.419、-0.576,P值均<0.05)。经多元线性回归分析,B 值、D 值、M 值是 S1/S0的3个独立影响因素, S1/S0值的预测方程为^Y=118.955-1.348X1-2.850X2-0.541X3(复相关系数R=0.742,决定系数R2=0.550,F=22.841,P<0.01),回归模型有统计学意义。结论不同体位颈椎X线摄片的相关指标B值、D值、M值是影响脊髓型颈椎病椎间盘退变突出程度的独立因素,对评估单节段脊髓型颈椎间盘突出的严重程度有一定的诊断价值;采用D值、B值及M值为3个自变量指标,可对椎间盘突出进行预测。     

Xpert HIV-1病毒载量检测系统用于HIV-1病毒载量检测的临床价值

目的探讨Xpert HIV-1病毒载量(Xpert HIV-1 VL)检测用于HIV-1病毒载量检测的临床价值。方法采用Xpert HIV-1 VL和Abbott m2000 Real Time检测系统(Abbott m2000)同时检测191份血浆样本的HIV-1病毒载量。采用符合率、卡方检验和Kappa值等统计分析两种检测方法定性检测结果的一致性,采用相关性、回归分析和Bland-Altman模型等统计分析两种检测方法定量检测结果的一致性。结果两种检测方法的阳性符合率、阴性符合率和总符合率均为100%,两种方法检测结果一致性分析的Kappa值为1.00(P<0.001);两种方法检测结果的相关系数为0.9576,回归分析表现出较高的相关性(R2=0.9170),Bland-Altman模型分析显示两种方法检测有95.3%(164/172)的样本在95%一致性界限内。结论Xpert HIV-1 VL用于检测HIV-1 RNA具有很高的灵敏度、准确性和稳定性,且操作简单、方便、安全,适合临床用于对HIV-1患者血浆样本中HIV-1 RNA的检测。     

Angiotensin 1-9 and 1-7 release in human heart: role of cathepsin A

Human heart tissue enzymes cleave angiotensin (Ang) I to release Ang 1-9, Ang II, or Ang 1-7. In atrial homogenate preparations, cathepsin A (deamidase) is responsible for 65% of the liberated Ang 1-9. Ang 1-7 was released (88% to 100%) by a metallopeptidase, as established with peptidase inhibitors. Ang II was liberated to about equal degrees by ACE and chymase-type enzymes. Cathepsin A's presence in heart tissue was also proven because it deamidated enkephalinamide substrate by immunoprecipitation of cathepsin A with antiserum to human recombinant enzyme and by immunohistochemistry. In immunohistochemistry, cathepsin A was detected in myocytes of atrial tissue. The products of Ang I cleavage, Ang 1-9 and Ang 1-7, potentiated the effect of an ACE-resistant bradykinin analog and enhanced kinin effect on the B(2) receptor in Chinese hamster ovary cells transfected to express human ACE and B(2) (CHO/AB), and in human pulmonary arterial endothelial cells. Ang 1-9 and 1-7 augmented arachidonic acid and nitric oxide (NO) release by kinin. Direct assay of NO liberation by bradykinin from endothelial cells was potentiated at 10 nmol/L concentration, 2.4-fold (Ang 1-9) and 2.1-fold (Ang 1-7); in higher concentrations, Ang 1-9 was significantly more active than Ang 1-7. Both peptides had traces of activity in the absence of bradykinin. Ang 1-9 and Ang 1-7 potentiated bradykinin action on the B(2) receptor by raising arachidonic acid and NO release at much lower concentrations than their 50% inhibition concentrations (IC(50)s) with ACE. They probably induce conformational changes in the ACE/B(2) receptor complex via interaction with ACE.     

肺表面活性物质对酸奶误吸鼠呼吸衰竭的作用

目的：探讨肺表面活性物质（PSD）对酸奶误吸鼠呼吸衰竭的作用。方法：33只Wistar大鼠在人工呼吸下经气道注入酸牛奶。当动脉血氧分压（PaO2）降至13.3kPa以下时，将动物随机分成三组。Ⅰ组（n=11）为对照组，气道内未注入任何物质，Ⅱ组（n=11)在附加0.49kPa呼气末正压（PEEP）30min后经气道注入PS（200mg/kg)；Ⅲ组（n=11）在附加PEEP的同时经气道注入等量PS。测定并记录动脉血气值、潮气量等。结果：注入酸奶后所有动物的PaO2均明显下降。自分组后Ⅰ组的PaO2未见改善；Ⅱ组的PaO2在PS注入后逐渐升高，（与Ⅰ组比较，P＜0．05）；Ⅲ组的PaO2在PS注入后显著升高，（与Ⅰ、Ⅱ组比较，P＜0．05）。动脉血二氧化碳分压（PaCO2）、潮气量等在Ⅰ组未见明显变化，而Ⅱ组及Ⅲ组均有明显改善，尤以Ⅲ组更显著。结论：气道内注入酸奶能导致呼吸衰竭，单纯应用附加PEEP的人工呼吸不能明显改善此种严重的低氧血症；PS补充疗法能明显改善肺功能，且以PS早期治疗效果更明显。     

颅骨嗜酸性细胞肉芽肿伴巨大缺损1例

患者男，25岁。主因右颞顶枕部颅骨进行性凹陷3年人院。查体：右颞顶枕部有一约10cm×10cm凹陷，边界尚清，无皮下硬结，无红肿及压痛，局部颅骨缺损下陷约0．8cm。外周血嗜酸性粒细胞8％，血沉50mm／h。头颅X线片：右侧颞顶枕骨部位显示大片低密度骨质破坏缺损区，直径约10cm×10cm，无硬化边缘，无骨膜反应，病灶边缘清楚锐利，呈穿凿状（图1）。