VEGF和NOS在口腔鳞癌组织中的表达

目的:研究口腔鳞癌组织血管内皮生长因子(VEGF)、诱导型一氧化氮合酶(iNOS)、内皮型一氧化氮合酶(eNOS)的表达与癌细胞增殖的相关性。方法：应用免疫组化方法检测64例口腔鳞癌手术切除标本VEGF、iNOS、eNOS和增殖细胞核抗原(PCNA)的分布及表达。结果：①39例(60.94％)口腔鳞癌组织表达VEGF，42例(65.63％)表达iNOS；45例(70.31％)表达eNOS；②VEGF与iNOS的表达具有明显相关性，VEGF与eNOS的表达无明显相关性；③表达VEGF的口腔鳞癌PCNA标记指数(PLI)明显高于不表达VEGF的口腔鳞癌；表达iNOS的口腔鳞癌PLI明显高于不表达iNOS的口腔鳞癌。表达eNOS的口腔鳞癌PLI与不表达eNOS的口腔鳞癌无显著性差异(P＞0.05)。结论：①VEGF与iNOS的表达具有明显相关性，说明iNOS在VEGF的生成和发挥作用过程中起重要作用；②PLI随着VEGF和iNOS表达的增加而增加；提示二者对口腔鳞癌细胞增殖具有促进作用。     

穴位注射联合黄芪汤治疗便秘型肠易激综合征45例

目的观察穴位注射联合黄芪汤治疗肺脾气虚证便秘型肠易激综合征的临床疗效。方法将89例患者随机分为2组,治疗组给予黄芪汤加减水煎口服,并联合参麦注射液穴位注射治疗,对照组给予枸椽酸莫沙必利分散片口服治疗。4周后观察总体疗效及各种临床症状的变化。结果治疗组总有效率P5.56%,对照组总有效率72.73%,2组比较差异有统计学意义（P〈0.05）;2组患者治疗前后症状总积分差异有统计学意义（P〈0.05）,治疗组在排便困难、排便不尽感、疲倦乏力及神疲懒言四个症状方面的改善与对照组比较差异有统计学意义（P〈0.05）;在Bristol粪便评分、腹痛和腹胀三个方面与治疗前比较有统计学差异（P〈0.05）。结论两种治疗方法均能明显改善便秘型肠易激综合征肺脾气虚证患者的临床症状,治疗组的疗效优于对照组,黄芪汤联合穴位注射治疗肺脾气虚证便秘型肠易激综合征值得临床推广应用。     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

外伤性硬膜窦血栓一例

患者 女,54岁.因头外伤3 d伴头痛恶心入院.3 d前患者乘坐汽车,因道路颠簸,头顶碰在车顶上,当时受力局部头痛,2 d前出现持续性全头胀痛.入院查体:无明显阳性体征.患者既往体健,近来未服用任何药物,月经不规律,尚未绝经.凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血酶时间各项值均正常.头CT提示:窦汇、右侧横窦、部分矢状窦、直窦血栓形成.入院诊断:硬膜窦血栓.     

永久起搏器植入常见并发症及防治措施

目的 回顾性分析710例永久起搏器植入术并发症的发生率及原因,以提高起搏器植入技术的安全性和有效性.方法 连续选择2005年1月至2010年6月在我院行永久起搏器植入术的患者710例,随访0.5 ～6年,观察并发症的发生率及原因.结果 起搏器植入常见的并发症分别是囊袋内积血及血肿（n=10,1.41％）、电极导线移位（n=8,1.25％）、起搏阈值升高（n=6,0.93％）及囊袋侵蚀（n=2,0.28％）.出血的发生与年龄偏大有关;电极导线的脱位主要是电极导线固定不良所致;囊袋侵蚀与患者体型偏瘦、囊袋制作偏小,或与原起搏器形状不相称引起皮肤受压缺血有关.结论 随着技术熟练及采取相应措施,可以减少并发症发生.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

血浆长链非编码RNA HOTTIP与ROR联合高尔基体蛋白73对甲胎蛋白阴性肝癌的诊断与预后评估价值

目的探讨长链非编码RNA(long non-coding RNAs,lncRNAs)HOTTIP与ROR联合高尔基体蛋白73(Golgi protein 73,GP73)在甲胎蛋白(alpha-fetoprotein,AFP)阴性肝癌(AFP-negative hepatocellular carcinoma,AFP-NHCC)中的临床价值。方法 AFP-NHCC患者100例为AFP-NHCC组,肝脏良性疾病患者100例为肝脏良性疾病组,体检健康者110例为健康对照组。采用实时荧光定量PCR法检测3组血浆lncRNA HOTTIP、ROR,采用ELISA法检测3组血浆GP73,并进行组间比较;分析血浆lncRNA HOTTIP、ROR、GP73与AFP-NHCC临床特征的关系;绘制ROC曲线,分析血浆lncRNA HOTTIP、ROR与GP73对AFP-NHCC的诊断价值;多元logistic回归分析AFP-NHCC的危险因素。结果 AFP-NHCC组患者血浆lncRNA HOTTIP[12.8±0.6(-log)]、ROR表达[3.9±0.2(-log)]及GP73水平[(93.4±8.5)μg/L]高于肝脏良性疾病组[5.8±0.3(-log)、2.6±0.2(-log)、(30.8±3.7)μg/L]和健康对照组[5.7±0.2(-log)、2.5±0.2(-log)、(27.2±1.6)μg/L](P0.05);血浆lncRNA HOTTIP、ROR和GP73表达水平与AFP-NHCC患者的淋巴结转移(HOTTIP:r=0.567,P=0.002;ROR:r=0.552,P=0.006;GP73:r=0.535,P=0.011)及TNM分级(HOTTIP:r=0.559,P=0.001;ROR:r=0.539,P=0.007;GP73:r=0.538,P=0.017)呈线性关联;ROC曲线分析显示,血浆GP73、lncRNA HOTTIP、ROR诊断AFP-NHCC的灵敏度/特异度分别为80.4%/76.9%、86.1%/74.5%和69.3%/63.2%,而联合三者诊断AFP-NHCC的特异度为92.9%;logistic回归多因素分析显示,在校正年龄、性别、吸烟史、饮酒史等因素影响后,血浆高GP73、lncRNA HOTTIP和ROR水平仍是AFP-NHCC发病的独立危险因素(OR=3.51,95%CI:1.53～5.72,P0.001;OR=1.12,95%CI:1.03～1.34 P=0.032;OR=2.77,95%CI:1.47～5.08,P0.001)。结论血浆lncRNA HOTTIP、ROR和GP73在AFP-NHCC的诊断以及评估AFP-NHCC患者发生肿瘤远处转移中有重要临床意义。     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

目的心房-食管瘘是环肺静脉消融的少见并发症，但是伴有极高的病死率。最安全有效的预防心房．食管瘘发生的方法应当是避免消融食管左心房段。我们观察了采用食管造影检测食管和左心房的毗邻关系以及采用食管温度监测下消融左心房毗邻食管段对肺静脉隔离的作用。方法64例阵发性心房颤动（房颤）患者行环肺静脉消融术。行左心房和食管联合造影。在心房注射造影剂的同时，经食管吞人造影剂，观察食管走形和左心房后壁的关系。根据食管心房后壁段和肺静脉前庭的关系将食管走形分为Ⅰ型、Ⅱ型和Ⅲ型。经鼻送入食管温度计于食管左心房后壁相应部位。无食管走形重叠侧肺静脉，常规消融。分三步消融食管走形重叠侧肺静脉。并采用食管温度控制法消融，食管温度达到39℃即中断消融，待恢复正常后再行消融，直至达到肺静脉隔离。结果64例患者中Ⅰ型48例，Ⅱ型11例，Ⅲ型5例。在完成三步消融后，所有患者均完成肺静脉隔离。所有患者中仅有18．8％患者需在邻近食管左心房后壁处消融。结论多数阵发性房颤患者食管和心房后壁仅在一个肺静脉开口相邻，且多数患者可通过不消融食管相邻心房后壁而达到完全肺静脉隔离，可以大大减少消融时食管的损伤。     

静脉注射伊布利特与胺碘酮转复消融术后复发房性心动过速的对比研究

目的观察和比较伊布利特和胺碘酮转复心房颤动（房颤）射频消融术后早期复发房性心动过速（房速）的疗效和安全性。方法连续46例接受房颤射频消融后复发房速的患者，男性32例，女性14例，平均年龄（56±12）岁，分别静脉应用伊布利特（ibutilide，1．0mg／次，1～2次，10min内静脉推注）和胺碘酮（150me,／次，1～2次，10min内静脉推注）。观察转复率和转复时间，记录不良反应。结果4h内伊布利特组和胺碘酮组转复率分别为86．4％和41．7％（P=0．0023）；24h时内转复率分别为90．9％和62．5％（P=0．0376）。伊布利特组对持续时间〈24h的房速转复率为100％，胺碘酮组转复率为66．7％（P=0．0421）。伊布利特组平均转复时间为（13±8）min，胺碘酮组转复时间为（364-25）min（P〈0．01）。两组均未发生致命性不良反应，不良反应发生率差异无统计学意义。结论伊布利特和胺碘酮均能终止射频消融术后复发房速，伊布利特更快速、安全、有效。