肾上腺髓质脂肪瘤23例诊治体会

目的 探讨肾上腺髓质脂肪瘤的诊断和治疗方法.方法 回顾性分析肾上腺髓质脂肪瘤23例患者的资料,对其临床特征、诊断和治疗方法以及预后进行总结.结果 23例患者术前影像学检查均明确诊断,17例开放手术,6例腹腔镜手术.23例患者均痊愈.患者术后病理检查均证实为肾上腺髓质脂肪瘤,随访时间1个月-8年,未见肿瘤复发,9例腰背酸胀患者术后症状消失,6例高血压患者术后3个月内血压恢复正常,3例头昏患者术后症状消失.结论 部分肾上腺髓质脂肪瘤伴有内分泌功能,影像学检查是肾上腺髓质脂肪瘤术前诊断的主要手段,开放或腹腔镜下切除肿瘤为主要治疗方法.     

原发性纵隔肿瘤的诊断和外科治疗

目的 探讨原发性纵隔肿瘤的临床特点及外科治疗的方法和效果.方法 回顾性分析2004年7月至2009年6月经病理检查确诊的原发性纵隔肿瘤住院患者31例患者的临床资料.结果 31例中前纵隔肿瘤18例,后纵隔肿瘤9例,中纵隔肿瘤4例;肿瘤直径＞10 cm者12例,最大直径达14.5 cm.病理检查良性肿瘤25例,恶性肿瘤6例;肿瘤全切除26例,姑息性切除5例.出院随访3个月～5年,良性肿瘤术后未见复发.1例患者术后肺部转移给予放化疗,未行二次手术,2例年轻胸腺癌患者分别于术后4、7个月死于肿瘤复发.结论 原发纵隔肿瘤的诊断主要依赖胸部X线和CT检查,手术为首选治疗方法.选择合适的手术入路是手术成功的关键.     

肾上腺偶发瘤43例临床分析

目的 提高肾上腺偶发瘤的诊断和治疗水平。方法回顾性分析1985年至2003年5月收治的肾上腺偶发瘤43例。结果所有患者均行手术治疗,术后病理诊断：肾上腺皮质腺瘤12例,肾上腺囊肿10例,肾上腺节细胞神经瘤7例,肾上腺皮质癌4例,肾上腺转移癌3例,肾上腺髓性脂肪瘤3例,肾上腺嗜铬细胞瘤4例。结论对于肾上腺偶发瘤,均应常规行内分泌检查,CT对确诊肾上腺占位病变有较高价值。对于确诊为恶性肿瘤、功能性肿瘤及直径大于3．5cm的肿瘤,应积极采取手术治疗,应警惕偶发性嗜铬细胞瘤的潜在危险性,对非功能性、直径小于3．5cm的肿瘤可行CT随诊。     

皮质醇增多症临床回顾分析

目的探讨皮质醇增多症的临床表现、诊断和治疗方法。方法回顾性分析郑州大学第一附属医院2006年9月～2011年12月收治的81例皮质醇增多症患者的临床资料。结果术后2周血压恢复正常50例,3个月后所有患者血压、血钾、血糖均恢复正常,6～9个月后库欣综合征症状完全消失,术后病理诊断肾上腺腺瘤40例,肾上腺皮质癌2例,肾上腺皮质大结节样增生1例,肾上腺皮质束状带增生22例,肾上腺皮髓质增生16例。结论临床表现、生化检查和影像学检查三者结合可提高皮质醇增多症的确诊率,绝大多数患者可以得到确诊,针对病因治疗效果较好。     

肾上腺嗜铬细胞瘤32例临床分析

目的探讨腹腔镜手术治疗肾上腺嗜铬细胞瘤的安全性及临床价值。方法对32例肾上腺嗜铬细胞瘤患者采用腹腔镜经后腹腔途径手术治疗。结果本组32例肿瘤均完整切除,术后经病理检查确诊为肾上腺嗜铬细胞瘤。手术时间45—200min,平均100min。术中出血量30～400ml,平均125ml,无需要输血者。术后住院3—10d,平均5d。切除肿瘤平均直径35（20～60）min。引流管术后1—2d拔除,术后并发血肿2例。随访3个月～2年,患者血压均恢复正常,肿瘤局部无复发。结论腹腔镜手术治疗肾上腺嗜铬细胞瘤不增加手术的危险性,而且创伤小,患者恢复快,可作为治疗肾上腺外嗜铬细胞瘤的方法之一。     

肾上腺出血12例诊治分析

目的：探讨肾上腺出血的临床表现、诊断与治疗。方法：回顾性分析2002～2009年的经影像学和手术病理检查证实的12例肾上腺出血患者的临床资料。结果：12例肾上腺出血患者临床表现很不典型。3例出现肾上腺危象,余肾上腺功能均正常。B超检查10例,均见不均质肿块。12例行CT检查,10例急性出血见高密度肿块,2例慢性出血密度较低,增强CT扫描均无强化。MRI检查5例,显示肾上腺区不均匀肿物,T1加权为高或等信号,T2加权为低信号。3例开放手术治疗,2例予以介入治疗后手术。除1例脓毒血症患者死亡外,余11例均获随访,共随访5～72个月,恢复良好,除2例转移性肿瘤引起的肾上腺出血行双侧肾上腺切除后靠口服糖皮质激素外,其余均无肾上腺皮质功能不全表现。结论：肾上腺出血术前诊断困难,CT、MRI对诊断价值较大。对单侧肾上腺出血〉5cm时应采取介入或手术治疗;对双侧肾上腺出血,则立即予以激素替代治疗的同时准备介入或手术止血;对于肿瘤出血,做好充分的术前准备后择期手术生存率明显高于急诊手术。     

宫颈神经内分泌癌临床与病理分析

目的探讨宫颈小细胞神经内分泌癌的临床病理特征、诊断、治疗及预后。方法回顾性分析2006年4月至2011年10月在河南省肿瘤医院收治的6例神经内分泌癌患者的临床病理资料、治疗方式及预后。结果6例患者平均年龄42．5岁,ⅠB期2例,ⅡA期4例,临床症状主要为阴道出血,均无全身内分泌症状。全部患者均经病理检查,其中5例经免疫组化确诊,2例有淋巴结转移。6例患者中1例确诊后放弃治疗,4个月后死亡,余5例均接受综合治疗,2例患者已死亡,生存期分别为23个月,21个月,3例患者仍在治疗随访中。结论SC—NCC恶性度高,易早期转移,预后差,死亡率高。其诊断主要依靠病理组织形态学和免疫组化。目前尚没有规范有效的治疗方案,现大多采用手术、化疗和放疗联合综合治疗。     

肾上腺转移性肿瘤的MSCT诊断

目的探讨多层螺旋CT(MSCT)诊断肾上腺转移性肿瘤的临床应用价值。方法回顾性分析32例经手术病理、超声、核磁共振相印证的转移性肾上腺肿瘤的CT资料。结果转移性肾上腺肿瘤单侧多见,少数累及双侧,呈类圆形或不规则形,边界较清楚,大小悬殊,肿块<3cm者内多为密度均匀,>3cm者密度不均匀,可见中心坏死;小的增强后强化均匀,而大的强化不均匀,其增强与原发肿瘤强化表现类似。结论 CT可根据肿瘤大小、有无包膜和增强情况等征象来诊断和鉴别肾上腺转移瘤。     

乳头状肾细胞癌的临床病理研究

目的 探讨乳头状肾细胞癌的临床病理特征,提高对乳头状肾细胞癌的诊断及治疗水平.方法 回顾总结了25例乳头状肾细胞癌患者的诊断、治疗及随访情况.结果 25例乳头状肾细胞癌占同期肾癌的13.5%,平均发病年龄52.3岁.肿瘤最大径2～15cm,均以乳头或乳头管状结构为主,乳头轴心可见泡沫细胞.均有细胞角蛋白CK7表达.病理分型Ⅰ型肿瘤15例,Ⅱ型肿瘤10例.病理分级高分化14例、中分化7例,低分化4例.随访6～60个月,2倒分别于术后8、15个月死于转移,其余均生存.结论 乳头状肾细胞癌具有特殊的临床病理特征,其分型和分级、分期有关,其确诊有赖于典型病理检查,治疗仍以手术为主.     

肾上腺淋巴瘤的临床诊断和治疗探讨

目的：探讨肾上腺淋巴瘤的临床诊断和治疗方法。方法：回顾性分析9例肾上腺淋巴瘤患者,术前行CT及MRI检查,术后经病理证实皆为B细胞型非霍奇金氏淋巴瘤,分析其病变特征、浸润范围、软组织肿块的范围以及影像诊断特点和治疗方法等,为日后临床诊疗提供依据。结果：9例肾上腺淋巴瘤有16个病灶,其中双侧7例,单侧2例。肿瘤直径为3～9cm。CT为混杂密度软组织肿块,增强扫描肿瘤内见不均匀条状或间隔样强化影,瘤体大部密度均低于肝或脾。MRI T1WI为与肝组织等信号或低信号影像,T2WI为较脂肪组织略低的高信号,偶尔可有混杂信号。增强扫描病变区可见间隔样强化和斑片样强化,9例患者均为手术治疗,其中3例术后化疗。结论：影像学对肾上腺淋巴瘤诊断具有一定价值。     

Lipids and lipidomics in brain injury and diseases

Lipidomics is systems-level analysis and characterization of lipids and their interacting moieties. The amount of information in the genomic and proteomic fields is greater than that in the lipidomics field, because of the complex nature of lipids and the limitations of tools for analysis. The main innovation during recent years that has spurred advances in lipid analysis has been the development of new mass spectroscopic techniques, particularly the "soft ionization" techniques electrospray ionization and matrix-assisted laser desorption/ionization. Lipid metabolism may be of particular importance for the central nervous system, as it has a high concentration of lipids. The crucial role of lipids in cell signaling and tissue physiology is demonstrated by the many neurological disorders, including bipolar disorders and schizophrenia, and neurodegenerative diseases such as Alzheimer's, Parkinson's, and Niemann-Pick diseases, that involve deregulated lipid metabolism. Altered lipid metabolism is also believed to contribute to cerebral ischemic (stroke) injury. Lipidomics will provide a molecular signature to a certain pathway or a disease condition. Lipidomic analyses (characterizing complex mixtures of lipids and identifying previously unknown changes in lipid metabolism) together with RNA silencing, using small interfering RNA (siRNA), may provide powerful tools to elucidate the specific roles of lipid intermediates in cell signaling and open new opportunities for drug development.     

Catecholamines and self-stimulation: Reward and performance effects dissociated

Drug-induced changes in the specifically rewarding effect of brain stimulation can be shown by shifts in the location of the sharp rise in the function (reward summation function, RSF) which relates running speed in an alley to the number of pulses received as a reward. This method was used to characterize the depressions of self-stimulation induced by the dopamine antagonist pimozide (0.2–0.9 mg/kg) and clonidine, a drug which acts on presynaptic α-adrenoceptors to inhibit noradrenaline release. Pimozide shifted RSFs in the direction indicating a reduced rewarding effect of brain stimulation but did not proportionately depress the maximum running speed. The larger doses of pimozide led to extinction of alley running. Clonidine (0.03 and 0.15 mg/kg) similarly reduced the rewarding potency of brain stimulation but also depressed running speed. Piperoxane antagonized clonidine's effect on the RSF location but added to the depression of running speed, thus confirming that drug effects on reward are dissociable from performance effects with the RSF method. In the light of these and other recent findings it is suggested that dopaminergic mechanisms are directly involved in the putative reward system and noradrenaline may be indirectly involved in self-stimulation via an effect on cerebral metabolism.     

Monoclonal antibodies and toxins--a perspective on function and isotype

Antibody therapy remains the only effective treatment for toxin-mediated diseases. The development of hybridoma technology has allowed the isolation of monoclonal antibodies (mAbs) with high specificity and defined properties, and numerous mAbs have been purified and characterized for their protective efficacy against different toxins. This review summarizes the mAb studies for 6 toxins--Shiga toxin, pertussis toxin, anthrax toxin, ricin toxin, botulinum toxin, and Staphylococcal enterotoxin B (SEB)--and analyzes the prevalence of mAb functions and their isotypes. Here we show that most toxin-binding mAbs resulted from immunization are non-protective and that mAbs with potential therapeutic use are preferably characterized. Various common practices and caveats of protection studies are discussed, with the goal of providing insights for the design of future research on antibody-toxin interactions.     

托法替布与益赛普分别联合甲氨蝶呤治疗难治性类风湿关节炎的疗效及安全性分析

目的 探究托法替布与肿瘤坏死因子（TNF）-α受体拮抗剂益赛普分别联合甲氨蝶呤治疗难治性类风湿关节炎（RRA）疗效及安全性。方法 采用随机数字表法将60例RRA患者分为A组、B组和C组,每组20例。A组采用枸橼酸托法替布（5 mg）联合甲氨蝶呤（10 mg）治疗,B组单用益赛普（25 mg）治疗,C组采用益赛普（25 ...     

Preparation,characterization and evaluation of multi-component-loaded liposomes containing Tat-TOS,phospholipase D inhibitor and doxorubicin

In the present study, we aimed to co-load the α-TOS conjugate Tat-TOS with the phospholipase D inhibitor FIPI and the antitumor drug doxorubicin (DOX) in a liposome delivery system for antitumor metastasis. Firstly, Tat-TOS was synthesized by solid-phase synthesis, and its structure was confirmed. The ability of free and liposomal Tat-TOS to induce apoptosis in vitro was evaluated by flow cytometry. Biodistribution of Tat-TOS-loaded liposomes was investigated by a molecular imaging system. Multi-component-loaded liposomes modified with Tat-TOS containing FIPI and DOX was prepared by thin film dispersion method in combination with pH gradient method and post-insertion method. Physicochemical properties were determined, and the in vitro uptake ability of the formulations was evaluated. The results showed that the prepared liposomes were characterized by a uniform particle size distribution and small particle size. The encapsulation efficiency of FIPI and DOX exceeded 85%. Both free and liposomal Tat-TOS significantly improved the activity of inducing apoptosis of tumor cells. The liposomes modified with Tat-TOS were apparently accumulated in normal lung tissue and tumor metastasized lung. Multi-component-loaded liposomes exhibited the strongest cell uptake capacity, suggesting a stronger anti-metastatic effect and anti-tumor activity in vivo.     

Identification of 24-O-β-d-Glycosides and 7-Deoxy-Analogues of Okadaic Acid and Dinophysistoxin-1 and -2 in Extracts from Dinophysis Blooms,Dinophysis and Prorocentrum Cultures,and Shellfish in Europe,North America and Australasia

Two high-mass polar compounds were observed in aqueous side-fractions from the purification of okadaic acid (1) and dinophysistoxin-2 (2) from Dinophysis blooms in Spain and Norway. These were isolated and shown to be 24-O-β-d-glucosides of 1 and 2 (4 and 5, respectively) by nuclear magnetic resonance (NMR) spectroscopy, mass spectrometry, and enzymatic hydrolysis. These, together with standards of 1, 2, dinophysistoxin-1 (3), and a synthetic specimen of 7-deoxy-1 (7), combined with an understanding of their mass spectrometric fragmentation patterns, were then used to identify 1–5, the 24-O-β-d-glucoside of dinophysistoxin-1 (6), 7, 7-deoxy-2 (8), and 7-deoxy-3 (9) in a range of extracts from Dinophysis blooms, Dinophysis cultures, and contaminated shellfish from Spain, Norway, Ireland, Canada, and New Zealand. A range of Prorocentrum lima cultures was also examined by liquid chromatography–high resolution tandem mass spectrometry (LC–HRMS/MS) and was found to contain 1, 3, 7, and 9. However, although 4–6 were not detected in these cultures, low levels of putative glycosides with the same exact masses as 4 and 6 were present. The potential implications of these findings for the toxicology, metabolism, and biosynthesis of the okadaic acid group of marine biotoxins are briefly discussed.     

红霉素和阿奇霉素诱导斑马鱼肝毒性及作用机制研究

目的 利用模式生物斑马鱼模型探索红霉素和阿奇霉素导致肝毒性及作用机制,并比较红霉素和阿奇霉素诱导肝毒性的差异。方法 选用肝脏转基因斑马鱼Tg(fapb10: dsRed)作为实验动物,将发育正常的3dpf斑马鱼幼鱼暴露于不同浓度的红霉素和阿奇霉素溶液中72h后,统计各组斑马鱼死亡率,计算红霉素和阿奇霉素对斑马鱼的LD50;荧光显微镜下活体观察斑马鱼幼鱼给药后肝脏形态的变化;采用整体油红O染色观察肝脏脂肪含量变化;利用qRT-PCR检测肝脏病理标志基因和凋亡相关基因在转录水平的变化。结果 红霉素和阿奇霉素对斑马鱼的LD50分别为3.82mmol/L和3.10mmol/L;活体观察显示红霉素和阿奇霉素均能导致幼鱼肝脏形态和荧光强度变化;整体油红O染色显示红霉素和阿奇霉素均能导致肝细胞脂肪堆积,并呈剂量依赖性;qRT-PCR结果显示红霉素和阿奇霉素均能影响脂肪肝、肝纤维化和细胞凋亡相关基因的表达。结论 红霉素和阿奇霉素均能诱导斑马鱼肝毒性,作用机制可能与两者诱导肝细胞变性或凋亡有关,但两者影响的相关基因通路可能有所不同。     

前列腺癌和前列腺增生中α辅肌动蛋白-1 的表达及其临床意义

摘要： 目的 探讨α辅肌动蛋白-1 （α-actinin-1, ACTN1） 在前列腺癌 （PCa） 和前列腺增生 （BPH） 中的表达及临床意义。方法 收集 2007 年 1 月—2014 年 10 月我校附属医院收治的 PCa 和 BPH 患者资料, 按一定的入组标准筛选, 采用免疫组织化学法检测 30 例 PCa 组织和 30 例 BPH 组织中 ACTN1 的表达情况, 采用蛋白免疫印迹（Western blot）方法检测其中的 18 例 PCa 组织和 20 例 BPH 组织中 ACTN1 的相对表达量。结果 免疫组织化学结果显示, ACTN1 在 PCa 和 BPH 两组中的阳性表达率分别为 76.7%和 20.0%, 差异有统计学意义 （P < 0.01）; Western blot 结果显示, ACTN1 在 PCa 组中的相对表达量（0.591±0.182）明显高于 BPH 组（0.037±0.052）, 差异有统计学意义（P < 0.05）; 免疫组织化学结果中, ACTN1 在 PCa 中的表达在不同年龄、 血清前列腺特异抗原 （PSA） 水平、 是否有骨转移、是否有淋巴结转移患者之间差异无统计学意义 （P > 0.05）, 而在不同 Gleason 分级、 T 分期患者之间差异有统计学意义（P < 0.05）。结论 ACTN1 在 PCa 组织中的表达明显高于 BPH 组织, 且在 PCa 组织中的表达与 Gleason 分级、 T 分期之间可能存在关联。     

红树林内生真菌来源dicerandrol A及其对肝癌HepG2细胞的增殖抑制作用和机制的初步研究

摘要：目的 研究红树林植物大红树内生真菌Phomopsis asparagi DHS-48发酵提取物中的化学成分及其对肝癌HepG2细胞 的抑制作用,并初步探讨其作用机制。方法 通过反复硅胶柱色谱、Sephadex LH-20柱色谱等方法进行分离纯化,根据理化性 质、波谱数据并结合参考文献鉴定化合物DD-38的结构;用不同浓度DD-38处理HepG2细胞,采用MTT比色法检测其对HepG2 细胞增殖的抑制作用;平板克隆形成实验检测HepG2细胞克隆形成能力;细胞划痕实验观察HepG2细胞细胞的体外迁移能力; Annexin V/PI双染流式细胞术检测细胞凋亡;Western blot检测β-catenin的表达水平。结果 通过1H NMR、13C NMR及MS等波谱 学方法,结合相关文献数据,鉴定化合物结构为：dicerandrol A(DD-38);MTT实验显示,DD-38对HepG2细胞的增殖具有明显 抑制作用,存在时间和剂量依赖性(P<0.05,P<0.01);根据细胞增殖率得出24 h时HepG2细胞的IC50为(4.8273±0.2216) μmol/L; 平板克隆形成实验显示,DD-38明显降低了HepG2细胞的克隆形成能力,具有剂量依赖性(P<0.01);细胞划痕实验表明DD-38可 以显著降低HepG2细胞的迁移能力(P<0.01),加药24 h后,细胞迁移率从77.09%±2.16%降低到12.14%±5.32%;流式细胞术检 测实验显示,DD-38可促进HepG2细胞凋亡,凋亡率存在剂量依赖性;Western blot实验显示,DD-38可抑制β-catenin蛋白在细胞 质和细胞核中的表达(P<0.05和P<0.01)。结论 DD-38可抑制HepG2细胞的增殖、迁移和克隆形成,促进细胞凋亡,其机制可能 与抑制Wnt/β-catenin信号通路活化有关。