体外转染小鼠白细胞介素12基因抑制膀胱癌EJ细胞的实验研究

目的将含有小鼠白细胞介素12（mIL-12）全长基因的质粒转染到膀胱癌EJ细胞中,观察脾细胞对转染mIL-12膀胱癌细胞的杀伤作用。方法用脂质体转染法将含有mIL-12全长基因质粒转染到EJ细胞中,ELISA法检测IL-12表达水平。在脾细胞作用0～2 d时ELISA法连续检测上清干扰素γ（INF-γ）水平变化。转染后40 h加入制备好的小鼠脾细胞悬液约1×10^6作用24 h后,MTT法检测对膀胱癌细胞的抑制率。结果转染后40、60 h检测到IL-12的高表达（375±15） pg／ml和（400±50）pg／ml,较未转染组9～15 pg／ml明显增高;在EJ细胞表面可以检测到IL-12的表达,而对照组则无;加入脾细胞悬液1 d后,脾细胞加转染后的EJ细胞组的抑制率为58．7％（P〈 0．025）,而脾细胞加未转染EJ细胞组、单纯EJ细胞组以及转染的EJ细胞组差异无统计学意义（P〉 0．05）。脾细胞加入转染后EJ细胞上清24 h的。INF-γ为（155±21）pg／ml,与未转染组（65±8）pg／ml比较差异有统计学意义（P〈0．05）。结论体外转染mIL-12基因到膀胱癌EJ细胞中能够表达IL-12,在小鼠脾细胞存在的条件下,通过一系列的免疫调节作用,诱导T细胞、NK细胞等产生INF-γ等细胞因子从而杀伤膀胱癌细胞。     

粘着斑激酶在PDGF-BB诱导MHCC-97H细胞黏附侵袭中的作用

目的观察不同浓度血小板衍生生长因子（PDGF-BB）诱导MHCC-97H细胞中粘着斑激酶（focal adhesion kinase，FAK）mRNA的动态变化及FAK在细胞黏附、侵袭的作用。方法不同浓度（1，2．5，5，10，25ng／m1）PDGF-BB诱导MHCC-97H人肝癌细胞，Real-time PCR方法检测FAK及MMP-2的mRNA动态变化，黏附实验、侵袭实验分别检测诱导后MHCC-97H细胞的黏附、侵袭能力的变化。结果诱导后MHCC-97H细胞FAKmRNA水平上调，在10ng／ml浓度时达到最高，为对照组的112．6倍；MMP-2mRNA水平上调并与FAKmRNA水平上调呈一致性，在10ng／ml浓度时达到最高，为对照组的56．9倍。诱导后各组黏附率分别为（66±1．84）%、（69±1．41）％、（69±2．42）％、（71±1．37）%和（66±3．28）%，与对照组的（54±2．08）％比较均有统计学意义（P〈0．001）；诱导后5ng／ml和10ng／ml组侵袭细胞数分别为（26．63±4．5）、（28．75±4．2）个，与对照组（21．5±4．0）个比较有显著性差异（P〈0．05，P〈0．001）。诱导后黏附率与侵袭细胞数变化在10ng／ml浓度时都达到高峰。结论PDGF-BB上调MHCC-97H细胞中FAK表达，上调FAK促进MHCC-97H细胞的黏附和侵袭能力。     

胶原复合梯度TCP修复关节软骨的形态学观察

目的采用新型双向三维可降解生物活性材料胶原复合梯度TCP（collagen complexTCP，Col／TCP）对兔关节软骨缺损进行修复，并对再生软骨进行组织形态学观察。方法取30只成年大白兔，体重2．0～2．5kg，雌雄不限，于双侧股骨外侧髁制作关节软骨缺损模型。于右侧植入Col／TCP修复缺损，作为实验组，左侧不予处理作为对照组。术后4、6、8、12和24周分别处死6只动物，取股骨外侧髁关节面行大体、组织学、透射电镜及Ⅱ型胶原免疫组织化学染色观察。采用Wakitanifa法软骨组织形态学评分评价修复组织质量。结果大体观察：实验组术后4周，缺损区由白色组织完全充填，表面较光滑，有光泽；12周，修复关节软骨组织与周围正常软骨基本一致，且与关节下骨结合紧密；24周，再生软骨未见明显退变。对照组观察期内均未见软骨组织形成，缺损由纤维组织填充，修复组织表面粗糙，与正常组织界线清楚。实验组术后4、6、8、12和24周组织学评分分别为（7．60±0．98）、（5．69±0．58）、（4．46±0．85）、（4．35±0．12）、（4．41±0．58）分，对照组分别为（10．25±1．05）、（9．04±0．96）、（8．96±0．88）、（8．88±0．68）、（8．66±0．54）分；Ⅱ型胶原含量实验组分别为0．28％±0．01％、0．59％±0．03％、0．68％±0．02％、0．89％±0．02％和0．90％±0．01％，对照组为0．08％±0．02％、0、09％±0．04％、0．11％±0．03％、0．25％±0．03％和0．29％±0．01％；两组各指标比较差异均有统计学意义（P〈0．05）。透射电镜观察实验组可见典型软骨细胞，而对照组为粗大胶原纤维，细胞少见。结论双向三维可降解生物活性材料Col／TCP在动物体内可诱导关节软骨缺损后的软骨修复。     

自体骨髓细胞经门静脉移植治疗肝硬化与肝功能不全的临床研究

目的观察自体骨髓细胞经门静脉移植对肝硬化和肝功能不全的治疗效果。方法2005年2月至2006年6月在我科接受手术治疗的40例肝硬化门静脉高压症患者（脾切除、断流术或内镜食道曲张静脉套扎术）,被随机分为治疗组和对照组,每组20例。两组患者于术中埋置“门静脉导管-皮下药盒”,术后3-4周,治疗组经移植通道输注自体骨髓细胞,而对照组只输注生理盐水。在第1次输注后每隔1个月再重复进行输注,共输注3次。第3次输注后1个月进行疗效评价。结果（1）两组恢复均顺利,未发现与移植操作有关的不良反应或并发症。（2）丙氨酸转氨酶、总胆红素、白蛋白和凝血酶原时间：治疗组分别由（60±52）μmol／L、（26±15）μmol／L、（33±5）μmol／L和（18±2）s变为（26±15）μmol／L、（14±8）μmol／L、（41±3）μmol／L和（12±2）s（P〈0．01）;对照组分别由（47±37）μmol／L、（22±23）μmol／L、（35±4）μmol／L和（18±4）s变为（65±51）μmol／L、（19±42）μmol／L、（35±4）μmol／L和（18±4）s（P〉0．05）;治疗组优于对照组（P〈0．01）。（3）血清透明质酸和前胶原Ⅲ肽：治疗组分别由（188±160）ng／ml和（13±18）ng／ml变为（104±80）ng／ml和（8±9） ng／ml（P〈0．05）;对照组分别由（79±193）ng／ml和（10±16）ng／ml变为（136±187）ng／ml和（9±17）ng／ml（P〉0．05）;治疗组亦优于对照组（P〈0．01）。结论自体骨髓细胞经门静脉移植可改善肝功能和肝纤维化血清学指标。     

益生菌对大肠癌术后肠屏障功能及全身炎症反应的影响

目的研究益生菌对大肠癌术后患者肠屏障功能及炎症反应的影响。方法60例择期大肠癌手术患者分为益生菌组和对照组，每组各30例。分别于术后第3～7d给予等氮量、等热卡营养支持。从术后第1d起，益生菌组口服优菌多2g／d，共7d。于术后每天观察2组患者体温及心率情况；术前，术后第1、5、8d分别进行白细胞计数；术前，术后第1、8d检测全血细菌DNA、血浆D-乳酸水平及尿乳果糖／甘露醇（L／M）比值；观察2组患者全身炎症反应综合征（SIRS）和感染并发症发生情况。结果益生菌组术后发热持续时间、术后5d平均心率及白细胞计数恢复正常时间均明显短于或低于对照组（P〈0．01）。术后第1d2组患者外周血细菌DNA检测阳性率差异无统计学意义；第8d对照组仍有7例（23．3％）PCR检测呈阳性，而益生菌组为1例（3．3％），2组间差异有统计学意义（P〈0．05）。对照组血浆D-乳酸水平由术后第1d的（6．63±1．29）ng／ml下降至第8d的（0．95土0．83）ng／ml，而益生菌组则由（6．90±1．41）ng／ml下降至（0．56±0．18）ng／ml，第8d时2组间差异有统计学意义（P〈0．05）。对照组L／M比值由术后第1d的0．053±0．019升高至第8d的0．063±0．016，益生菌组则由0．047±0．012降至0．031±0．008，第8d时2组间差异有统计学意义（P〈0．01）。术后SIRS发生率及感染并发症的发生率2组间差异无统计学意义（P〉0．05）。结论益生菌能降低大肠癌患者术后肠道通透性，减少细菌易位，有利于大肠癌患者术后早期炎症反应的恢复。     

3.0 T MR弥散加权成像对鉴别胰腺癌与慢性肿块型胰腺炎的价值

目的探讨在3．0T磁共振（MR）平台上应用弥散加权成像（diffusion—weighted imaging，DWI）鉴别诊断胰腺癌与慢性肿块型胰腺炎的价值。方法纳入经手术病理和临床随访证实的胰腺癌患者13例、慢性肿块型胰腺炎患者7例和健康志愿者14例，在行上腹部常规MR扫描后进行胰腺DWI检查。采用自旋回波回波平面成像技术和空间敏感性编码技术，分别取弥散梯度b值=400、600、800和1000s／mm^2获得相应的DWI图像，测量感兴趣区（ROI）的ADC值，并进行统计学分析。结果①健康志愿者胰腺DWI呈中等信号。②胰腺癌患者癌组织在DWI上呈均匀高信号，边界较清楚；各b值（400、600、800和1000s／mm^2）下，测得ADC值分别为（1．63±0．235）、（1．42±0．126）、（1．36±0．170）及（1．26±0．178）×10^-3mm^2／s，明显低于癌周胰腺组织[（2．11±0．444）、（1．83±0．230）、（1．81±0．426）及（1．60±0．230）×10^-3mm^2／s]及健康志愿者胰腺的ADC值[（1．85±0．350）、（1．69±0．290）、（1．67±0．268）及（1．42±0．221）×10^-3mm^2／s]，P〈0．05。③慢性肿块型胰腺炎在DWI上呈不均匀稍高信号，边界不清；各b值下测得ADC值分别为（1．69±0．150）、（1．56±0．119）、（1．59±0．172）及（1．35±0．080）×10^-3mm^2／s，均高于胰腺癌组织的ADC值，但仅当b值-800s／mm^2时，与胰腺癌组织间差异有统计学意义（P〈0．05）。结论DWI可以清楚显示胰腺肿瘤病灶及范围，结合ADC的测量值能够为鉴别胰腺癌与慢性肿块型胰腺炎提供一定的信息。     

等离子体双极汽化电切术治疗Ⅳ度良性前列腺增生

目的 探讨等离子体双极汽化电切术治疗Ⅳ度前列腺增生症的疗效和安全性。方法 在充分的术前准备后，采用经尿道等离子双极汽化前列腺切除术，患者年龄73—89岁，平均77．8岁；前列腺重量77-112．4g（97．6±24．1）g。术后随访3—12个月。结果 22例平均手术时间（133±37）min（107—165min），切除前列腺组织重量平均（82±29）g（62—93g），无一例需输血，无经尿道电切综合征（TURS）的发生，最大尿流率（Qmax）由术前0—7ml／s恢复到术后的（19．5±2．5）ml／s；国际前列腺症状评分（IPSS）由术前（27．5±2．4）下降至术后（6．7±2．2）：生活质量评分（QOL）由术前的（5．1±0．4）下降至（1．8±0．4）。结论 等离子体双极电切除术的术中、术后出血量少，可以避免TURP综合征的发生，疗效确切，在Ⅳ度前列腺增生症的治疗手段中，是安全、有效的手术方式。     

贲门癌患者血浆纤维蛋白原含量及其临床意义

目的观察贲门癌患者血浆Fibrinogen（FIB）水平与肿瘤临床分期、浸润程度和转移的关系，探讨其对于贲门癌患者的辅助诊断及判断预后的临床意义。方法结合临床资料，回顾分析使用美国贝克曼库尔特ACL8000型全自动凝血系列分析仪检测的我科收治的780例贲门癌患者的血浆中FIB含量。结果I～Ⅳ期FIB（g／L）含量分别为（3．13±0．73）、（4．08±0．71）、（4．87±0．83）、（5．59±0．74）。T1～T4FIB（g／L）含量分别为（3．16±0．69）、（3．59±0．74）、（4．52±0．75）、（5．47±0．68）。NOMFIB（g／L）含量分别为（3．21±0．60）、（4．17±0．43）、（5．06±0．72）、（5．59±0．74）差异均有统计学意义（P〈0．05）。结论贲门癌患者存在FIB异常，且与临床分期成正相关。     

病理性瘢痕中脂质过氧化产物和铜锌超氧化物歧化酶的变化

目的了解病理性瘢痕（增生性瘢痕与瘢痕疙瘩）中脂质过氧化产物和铜锌超氧化物歧化酶（copper，zinc-superoxide dismutase，CuZn-SOD）的变化。方法取2005年5月-2005年8月收治患者自愿捐献的标本。瘢痕疙瘩组10例，年龄16～35岁，平均病程2．2年；增生性瘢痕组10例，年龄17～32岁，平均病程8个月；正常皮肤组8例，年龄16～34岁。应用化学比色法测定3组标本中CuZn．SOD活力和丙二醛（malonaldehyde，MDA）含量，采用免疫组织化学方法观察CuZn-SOD蛋白在病理性瘢痕中的表达，并对其进行评分。结果正常皮肤组、增生性瘢痕组及瘢痕疙瘩组MDA含量分别为（0．8213±0．0864）、（1．1390±0．1067）、（1．1900±0．0748）nmol／mg prot；CuZn-SOD活力分别为（20．60±5．56）、（31．65±2．21）、（34．36±5．01）U／mg prot。增生性瘢痕组和瘢痕疙瘩组MDA含量与CuZn-SOD活力同正常皮肤组比较，差异均有统计学意义（P〈0．05）；增生性瘢痕组及瘢痕疙瘩组间比较，差异无统计学意义（P〉0．05）。免疫组织化学染色观察：3组表皮角质形成细胞和真皮成纤维细胞均有CuZn．SOD蛋白阳性表达。正常皮肤组、增生性瘢痕组及瘢痕疙瘩组在表皮角质形成细胞中免疫组织化学评分分别为（2．20±0．45）、（4．14±0．90）、（4．43±0．79）分；在真皮成纤维细胞中评分分别为（1．60±0．89）、（4．00±0．82）、（4．43±0．53）分。增生性瘢痕组和瘢痕疙瘩组CuZn-SOD蛋白表达与正常皮肤组比较，差异有统计学意义（P〈0．05）；增生性瘢痕组及瘢痕疙瘩组间比较，差异无统计学意义（P〉0．05）。结论病理性瘢痕中脂质过氧化产物MDA含量增加，CuZn-SOD活力升高、表达增强。     

全反式维甲酸和三氧化二砷协同诱导胰腺癌细胞凋亡

目的研究与三氧化二砷（As2O2）具有协同效应治疗胰腺癌的药物。方法以胰腺癌细胞系SWl990为研究对象，观察5-氟尿嘧啶（5-Fu）、健择（Gemcitabine）和全反式维甲酸（AT—RA）与As2O3共同作用对细胞的影响。通过台盼蓝拒染法检测细胞生长和细胞活力，流式细胞仪检测AnnexinV或PI阳性细胞的含量，评价以上药物对细胞增殖和凋亡的作用。结果5-Fu和Gemcitabine与As2O3无协同效应。单独应用As2O3或ATRA均抑制SWl990细胞生长，不诱导细胞凋亡。其中，对照组活细胞密度为（8．5±0．3）×10^5个／ml，As2O3组为（4．4±0．1）×10^5个／ml，ATRA组为（6．7±0．2）×10^5个／ml。但是，As203和ATRA共同处理SWl990细胞后，细胞生长明显抑制，并诱导细胞凋亡。对照组活细胞密度为（8．5±0．3）×10^5个／ml，As2O3＋ATRA组为（3．3±0．1）×10^5个／ml；对照组细胞活力为（92，0±1．2）％，As2O3组为（90．0±1．3）％，ATRA组为（93．0±1．4）％，As2O3＋ATRA组为（65．0±2．1）％；对照组Annexin V和PI阳性细胞的含量为（6．0±1．2）％，As2O3组为（11．0±3．3）％，ATRA组为（5．0±1．4）％，As2O3＋ATRA组为（37．0±5．3）％。结论As2O3和ATRA可协同诱导胰腺癌细胞凋亡，两者联合应用可能作为胰腺癌辅助治疗的另一选择。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.